10.04.25_COI_GL_Cyber_02.04.26_COI_AL_05.29.26_COI_WC.pdf

PDF 6 MB Posted

Attached to
Master Agreement AZ|CTR077138
Contract number
CTR077138
Issued by
Arizona

About this file

This document is a Certificate of Liability Insurance issued by Cook Insurance, Inc. for Cam Montrose, LLC, a legal services company located in Mesa, Arizona. The certificate lists multiple insurers including Auto-Owners Insurance Co, Liberty Mutual, and Old Republic Residual Market Services. The primary certificate holder is the Arizona State Procurement Office, specifically the Arizona Department of Administration, located in Phoenix, Arizona.

The insurance certificate covers Cam Montrose, LLC for a contract (CTR077138) involving Legal Processing, Notary and Related Services. The policy provides multiple layers of coverage, including Commercial General Liability with a $1,000,000 per occurrence limit, Automobile Liability, Workers Compensation, and Cyber Liability. The policies are effective between October 4, 2024 and October 4, 2025, with various coverage limits including $2,000,000 in general aggregate, $1,000,000 in automobile liability, and a $1,000,000 annual aggregate for cyber liability with a $10,000 deductible per occurrence. The contract appears to be a statewide service agreement for legal and notary-related services with the state of Arizona.

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Text version

07/11/2025

Cook Insurance, Inc.

11512 E. Apache Trail

Apache Junction AZ 85120-

(480)986-4400

Auto-Owners Insurance Co

Liberty Mutual

Old Republic Residual Market Services

Cam Montrose, LLC

7119 E. Main St

Suite B

Mesa AZ 85207-

Fast Track Legal clservices@cookinsure.com

(480)986-1199

X

X

X

X BKS66835881B 10/04/2024 10/04/2025 1,000,000

300,000

15,000

1,000,000

2,000,000

2,000,000

X

X

X X

X 5371836100A 02/04/2025 02/04/2026 1,000,000X

X WCAZ000154101C 05/29/2025 05/29/2026 X

1,000,000

1,000,000

1,000,000

Cyber Liability BKS66835881B 10/04/2024 10/04/2025 Annual Aggregate $1,000,000

Ded per Occ $10,000

RE: Contract # - CTR077138 Project Description: Legal Processing, Notary and Related Services.

Additional Insured status subject to the attached forms

AI 025509

State Procurement Office

1802 W. Jackson #100

Phoenix AZ 85007-

Arizona Department of Administration

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

INSR ADDL SUBR

LTR INSD WVD

DATE (MM/DD/YYYY)

PRODUCER CONTACT

NAME:

FAXPHONE

(A/C, No):(A/C, No, Ext):

E-MAIL

ADDRESS:

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

POLICY NUMBER

POLICY EFF POLICY EXP

TYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)

AUTOMOBILE LIABILITY

UMBRELLA LIAB

EXCESS LIAB

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

AUTHORIZED REPRESENTATIVE

EACH OCCURRENCE $

DAMAGE TO RENTED

CLAIMS-MADE OCCUR $PREMISES (Ea occurrence)

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

PRO-

POLICY LOC PRODUCTS - COMP/OP AGG $JECT

OTHER: $

COMBINED SINGLE LIMIT $

(Ea accident)

ANY AUTO BODILY INJURY (Per person) $

OWNED SCHEDULED BODILY INJURY (Per accident) $

AUTOS ONLY AUTOS

HIRED NON-OWNED PROPERTY DAMAGE $

AUTOS ONLY AUTOS ONLY (Per accident)

OCCUR EACH OCCURRENCE $

CLAIMS-MADE AGGREGATE $

DED RETENTION $ $

PER OTH-

STATUTE ER

E.L. EACH ACCIDENT $

E.L. DISEASE - EA EMPLOYEE $

If yes, describe under

E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below

INSURER(S) AFFORDING COVERAGE NAIC #

COMMERCIAL GENERAL LIABILITY

Y / N

N / A

(Mandatory in NH)

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED

REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.

If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

CERTIFICATE HOLDER CANCELLATION

© 1988-2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03)

CERTIFICATE OF LIABILITY INSURANCE

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