2023-02-09_COI.pdf
PDF 21 KB Posted
- Attached to
- Master Agreement AZ|CTR060942
- Contract number
- CTR060942
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by Christensen Group on February 8, 2022, for Advanced Telemetry Systems, Inc. located in Isanti, Minnesota. The certificate lists multiple insurers, including Great Northern Insurance, Federal Insurance Company, Travelers Casualty & Surety Company, and Ace American Insurance Company. The certificate holder is the Arizona Game and Fish Department, representing the State of Arizona, its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees.
The insurance coverage includes Commercial General Liability, Automobile Liability, Umbrella/Excess Liability, Workers' Compensation, and Professional Liability. The policies are effective from February 9, 2022, to February 9, 2023, with various coverage limits. For example, the Commercial General Liability has a $1,000,000 each occurrence limit and a $2,000,000 general aggregate limit. The Professional Liability coverage has an aggregate limit of $1,000,000 with a $25,000 deductible. The certificate includes provisions for additional insured status and a waiver of subrogation in favor of the Arizona Game and Fish Department when required by written contract.
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Text version
02/08/2022
Christensen Group 9855 West 78th Street, Ste 100
Eden Prairie MN 55344
Ginny Mosier
(952) 653-1000 (952) 653-1100 gmosier@christensengroup.com
ADVANCED TELEMETRY SYSTEMS, INC.
470 - 1st Avenue NW
Isanti MN 55040
Great Northern Ins. 20303 Federal Ins. Co. 20281 Travelers Casualty & Surety Co 19038 Ace American Insurance Co.
22-23 Liability
A 99470928 02/09/2022 02/09/2023
1,000,000 1,000,000 10,000 1,000,000 2,000,000 1,000,000
B 73583122 02/09/2022 02/09/2023
1,000,000
B
79888132 02/09/2022 02/09/2023 5,000,000 5,000,000
C N UB3K07238A 02/09/2022 02/09/2023
500,000 500,000 500,000
D Professional Liability
95881932 02/09/2022 02/09/2023 Aggregate 1,000,000 Deductible 25,000
Arizona Game and Fish Department, the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees is included as an Additional Insured under the General Liability when required by written contract. A Waiver of Subrogation in favor of the Arizona Game and Fish Department, the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees applies to the General Liability when required by written contract.
Arizona Game and Fish Department 5000 West Carefree Hwy
Phoenix AZ 85086
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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