2023-01-01 CTR059432 PG GAUWP.pdf
PDF 84 KB Posted
- Attached to
- Master Agreement AZ|CTR070398
- Contract number
- CTR070398
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance for Eastern Research Group Inc and PG Environmental LLC, located in Lexington, Massachusetts. The certificate involves multiple insurers, including Underwriters at Lloyds and Federal Insurance Company, and names the State of Arizona, specifically the Arizona Department of Environmental Quality, as the certificate holder. The insurance policies are effective from January 1, 2022, to January 1, 2023, and are associated with contract number CTR059432.
The insurance coverage includes Commercial General Liability, Automobile Liability, Umbrella Liability, Workers' Compensation, Errors & Omissions, and Pollution Liability policies. The policies provide various coverage limits, with the Commercial General Liability offering $1,000,000 per occurrence and $2,000,000 aggregate, and the Umbrella Liability providing $10,000,000 each occurrence and aggregate. The State of Arizona is listed as an additional insured on the general liability and auto policies, with a waiver of subrogation. The Errors & Omissions and Pollution Liability policies have a combined limit of $5,000,000 per claim and in aggregate.
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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
5/24/2022
Eastern Insurance Group LLC 233 West Central St Natick MA 01760
Susan Haslam 508-620-3483 508-651-4783 shaslam@easterninsurance.com
Underwriters at Lloyds EASTRES-02 Federal Insurance Company 20281
Eastern Research Group Inc PG Environmental LLC 110 Hartwell Avenue Lexington MA 02421
573949590
B X 1,000,000 X 1,000,000
10,000
1,000,000
2,000,000 X
Y 36032885 1/1/2022 1/1/2023
B 1,000,000
X 99494564 1/1/2022 1/1/2023
B X X 10,000,00078180750 1/1/2022 1/1/2023
10,000,000 X 10,000
B X71754105 1/1/2022 1/1/2023
1,000,000
1,000,000
1,000,000 A A
Errors & Omissions Pollution Liability Combined Limit
B0621PNEKA000122
B0621PNEKA000222
1/1/2022 1/1/2022
1/1/2023 1/1/2023
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# CTR059432. 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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