2.12.2023 GL UL.pdf
PDF 1 MB Posted
- Attached to
- Master Agreement AZ|CTR058724
- Contract number
- CTR058724
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued on 02/22/2023 by Strong Tower Insurance Group Inc, featuring insurance coverage for Specialized Delivery Services Inc. The insurance is provided by United Specialty Insurance Company and Ameritrust Insurance Corporation, with the Arizona Department of Health Services (ADHS) listed as the certificate holder. The policy covers commercial general liability and umbrella liability for the period of 02/12/2023 to 02/12/2024, specifically referencing contract ADHS17-142750.
The insurance certificate provides multiple coverage types, including commercial general liability with a $1,000,000 each occurrence limit, $2,000,000 general aggregate limit, and a $5,000 medical expense limit. An additional umbrella liability policy offers $1,000,000 in coverage. The document includes an automatic additional insured status for the State of Arizona, its departments, agencies, boards, commissions, universities, and its officers, officials, agents, and employees when required by a written contract. The policies include crime coverage and provisions for monies and securities, with specific endorsements addressing waiver of transfer of rights of recovery and additional insured status.
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Text version
02/22/2023
Strong Tower Insurance Group Inc 3325 E Baseline Rd
Gilbert AZ 85234-2633
Strong Tower Insurance Group Inc
(480) 926-9011 (877) 464-6442 agency@strongtowerig.com
Specialized Delivery Services Inc 3200 N Hayden Rd Ste 100
Scottsdale AZ 85251-6653
United Specialty Insurance Company 12537 Ameritrust Insurance Corporation 10665
23-24 GL & EXS
A
Crime
AIC-4009158 02/12/2023 02/12/2024
1,000,000 100,000 5,000 1,000,000 2,000,000 Included
Monies & Securities 5,000
B AIC4006921 02/12/2023 02/12/2024
1,000,000
Re: ADHS17-142750.
Automatic Additional Insured Status for The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents and employees when required by a written contract per attached endorsement.
Arizona Department of Health Services 1500 N 18th Ave Ste 500
Phoenix AZ 85007
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A :
NAIC #
NAME:
CONTACT
(A/C, No):
FAX
ADDRESS:
PRODUCER
(A/C, No, Ext):
PHONE
INSURED
REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
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).
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.
OTHER:
(Per accident)
(Ea accident)
N / A
SUBR
WVD
ADDL
INSD
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.
$PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person)
COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOSAUTOS ONLY
NON-OWNED
SCHEDULEDOWNED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
ER
OTH-
STATUTE
PER
LIMITS(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
POLICY EFF
POLICY NUMBERTYPE OF INSURANCELTR
INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB $EACH OCCURRENCE
$AGGREGATE
OCCUR
CLAIMS-MADE
DED RETENTION $
$PRODUCTS - COMP/OP AGG
$GENERAL AGGREGATE
$PERSONAL & ADV INJURY
$MED EXP (Any one person)
$EACH OCCURRENCE
DAMAGE TO RENTED
$PREMISES (Ea occurrence)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY
PRO-
JECT LOC
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
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