2022-01-01_COI.pdf
PDF 40 KB Posted
- 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
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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