2022-01-01 PG Environmental GAUWP.pdf
PDF 98 KB Posted
- Attached to
- Master Agreement AZ|CTR070125
- Contract number
- CTR070125
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by Eastern Insurance Group LLC on 7/30/2021 for Eastern Research Group Inc and PG Environmental LLC. The certificate covers insurance policies for the State of Arizona, specifically the Arizona Department of Environmental Quality, with multiple insurers including Great Northern Insurance Company, Federal Insurance Company, and Underwriters at Lloyds.
The insurance coverage includes Commercial General Liability, Automobile Liability, Umbrella Liability, Workers Compensation, and Errors & Omissions/Pollution Liability policies. Key policy limits include $1,000,000 for general liability, $10,000,000 for umbrella liability, and $5,000,000 for errors & omissions per claim and aggregate. The policies are effective from 1/1/2021 to 1/1/2022, with the State of Arizona listed as an additional insured under the general liability and auto policies for contract numbers CTR054765 and CTR056472. The certificate also indicates a waiver of subrogation in favor of the State of Arizona across the general liability, auto, and workers compensation policies.
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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)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
7/30/2021
Eastern Insurance Group LLC 233 West Central St Natick MA 01760
Susan Haslam 508-620-3483 508-651-4783 shaslam@easterninsurance.com
GREAT NORTHERN INS CO 20303
EASTRES-02 FEDERAL INS CO 20281
Eastern Research Group Inc PG Environmental LLC 110 Hartwell Avenue Lexington MA 02421
FEDERAL INS CO 20281
FEDERAL INS CO 20281
Underwriters at Lloyds
731365033
A X 1,000,000 X 1,000,000
10,000
1,000,000
2,000,000 X X
Y Y 99492425 1/1/2021 1/1/2022
2,000,000
B 1,000,000
X Y Y 99494564 1/1/2021 1/1/2022
D X X 10,000,00078180750 1/1/2021 1/1/2022
10,000,000 X 10,000
C XY 71754105 1/1/2021 1/1/2022
1,000,000
1,000,000
1,000,000 E E
Errors & Omissions Pollution Liability Combined Limit
B0621PNEKA000121
B0621PNEKA000221
1/1/2021 1/1/2021
1/1/2022 1/1/2022
Per Claim Aggregate
5,000,000 5,000,000
The State of Arizona, its departments, agencies, boards, commissions, universities, and its officers, officials, agents, and employees are addtional insureds with respect to the general liability and auto policy per their contract with the insured for contract# CTR054765 and CTR056472. And they have a waiver of subrogation in their favor on those two policies and on the workers compensation policy.
Arizona Department of Environmental Quality 1110 W Washington St.
Phoenix AZ 85007
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