2022-01-01_COI.pdf

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Attached to
Master Agreement AZ|CTR056208
Contract number
CTR056208
Issued by
Arizona

About this file

This document is an ACORD Certificate of Liability Insurance dated 04/13/2021 for Troutlodge Inc, located in Sumner, Washington. The certificate involves multiple insurers, including Zurich American Insurance Company and Starr Indemnity & Liability Company, with Marsh USA, Inc. serving as the producer. The primary certificate holder is the Arizona Game and Fish Department, located in Phoenix, Arizona, with the State of Arizona and its associated departments, agencies, boards, commissions, universities, officers, officials, agents, and employees included as additional insured parties.

The insurance coverage includes Commercial General Liability, Automobile Liability, and Workers' Compensation policies effective from 01/01/2021 to 01/01/2022. The Commercial General Liability policy has a $1,000,000 each occurrence limit and a $2,000,000 general aggregate limit. The Automobile Liability policy covers any auto with a $1,000,000 combined single limit. The Workers' Compensation policy provides $1,000,000 for each accident, each employee, and as a policy limit. The certificate demonstrates comprehensive insurance coverage for Troutlodge Inc's operations, with the State of Arizona named as an additional insured entity.

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Text version

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

E-MAIL

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)

© 1988-2016 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

1,000,000

2593750V0001

Manashi Mukherjee

CLE-006550683-02

1,000,000

X

38318 of Marsh USA Inc.

Attn: ROW.CertRequest@marsh.com

N

X01/01/2021

01/01/20221000198440211

B

2,000,000

1,000,000

Starr Indemnity & Liability Company

1,000,000

X

X

04/13/2021

01/01/2021

State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are included as additional insured, (except Workers’ Compensation), where required by written contract.

X

Phoenix, AZ 85086

Arizona Game and Fish Department

A

4367164674-HT-GAW-21-22

5,000

01/01/2022

1,000,000

2,000,000

16535

100,000

1,000,000

100 0003499

9830 Colonnade Blvd, Suite 400

Marsh USA, Inc.

San Antonio, TX 78230

12000 McCutcheon Rd

Troutlodge Inc

Sumner, WA 98391

01/01/2021

5000 West Carefree Highway

B

01/01/2022

Zurich American Insurance Company

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