2023-04-30_COI.pdf
PDF 372 KB Posted
- Attached to
- Master Agreement AZ|CTR060938
- Contract number
- CTR060938
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by Royal & Sun Alliance Insurance Company of Canada for Lotek Wireless Inc., with Arthur J. Gallagher Canada Limited serving as the brokerage/agency. The certificate names Arizona Game and Fish Department as the certificate holder, and additionally insures the State of Arizona, its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees.
The insurance policy provides comprehensive coverage including Commercial General Liability with a $10,000,000 general aggregate limit, Products and Completed Operations coverage with a $2,000,000 aggregate limit, and Automobile Liability for non-owned and hired automobiles. The policy is effective from April 30, 2022, to April 30, 2023, with various specific liability limits including $2,500 deductibles and $2,000,000 in coverage for areas such as tenants legal liability. The certificate specifically notes that the State of Arizona is an additional insured, but only for liability arising from operations carried out by or on behalf of the named insured, excluding automobile liability.
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Text version
AUTHORIZED REPRESENTATIVE
c 2016, Centre for Study of Insurance Operations. All rights reserved.
This certificate is issued as a matter of information only and confers no rights upon the certificate holder and imposes no liability on the insurer.
CERTIFICATE OF LIABILITY INSURANCE
TYPE OF INSURANCE
COMMERCIAL GENERAL LIABILITY
POSTAL
CODE
BROKER CLIENT ID:
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 requirements, terms or conditions 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 terms, exclusions and conditions of such policies.
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INSURANCE COMPANY
AND POLICY NUMBER
EFFECTIVE
DATE
EXPIRY
DATE
LIMITS OF LIABILITY
(Canadian dollars unless indicated otherwise)
NON-OWNED AUTOMOBILES
HIRED AUTOMOBILES
AUTOMOBILE LIABILITY
DESCRIBED AUTOMOBILES
ALL OWNED AUTOMOBILES
** ALL AUTOMOBILES LEASED IN EXCESS OF
30 DAYS WHERE THE INSURED IS REQUIRED
TO PROVIDE INSURANCE
EXCESS LIABILITY
UMBRELLA FORM
OTHER LIABILITY (SPECIFY)
BODILY INJURY AND PROPERTY
DAMAGE COMBINED
BODILY INJURY (PER PERSON)
BODILY INJURY (PER ACCIDENT)
PROPERTY DAMAGE
Should any of the above described policies be cancelled before the expiration date thereof, the issuing company will endeavor to mail ________ days written notice to the certificate holder named above, but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives.
AUTHORIZED REPRESENTATIVE
ISSUER
DATE
EACH OCCURRENCE
AGGREGATE
This certificate does not amend, extend or alter the coverage afforded by the policies below.
NON-OWNED AUTOMOBILES
POSTAL
CODE
POSTAL
CODE
1. CERTIFICATE HOLDER - NAME AND MAILING ADDRESS INSURED’S FULL NAME AND MAILING ADDRESS
DESCRIPTION OF OPERATIONS/LOCATIONS/AUTOMOBILES/SPECIAL ITEMS TO WHICH THIS CERTIFICATE APPLIES (but only with respect to the operations of the Named Insured)
COVERAGES
CANCELLATION
6. BROKERAGE/AGENCY FULL NAME AND MAILING ADDRESS
ADDITIONAL INSURED NAME AND MAILING ADDRESS
(Commercial General Liability- but only with respect to the operations of the Named Insured)
8. CERTIFICATE AUTHORIZATION
COMMERCIAL GENERAL LIABILITY
- GENERAL AGGREGATE
MEDICAL PAYMENTS
TENANTS LEGAL LIABILITY
PRODUCTS AND COMPLETED OPERATIONS
AGGREGATE
- EACH OCCURRENCE
DED.
AMOUNT OF
INSURANCECOVERAGE
BODILY INJURY AND PROPERTY DAMAGE
LIABILITY
YYYY/MM/DD YYYY/MM/DD
POSTAL
CODE
PERSONAL INJURY LIABILITY
PERSONAL AND ADVERTISING INJURY
LIABILITY
OR
POLLUTION LIABILITY EXTENSION
7.
CONTACT NUMBER(S)
TYPE
TYPE
NO.
NO.
TYPE
TYPE
NO.
NO.
EMAIL ADDRESS
SIGNATURE OF
CSIO - Certificate of Liability Insurance CA4301e 201609
HIRED AUTOMOBILES
CLAIMS MADE OR OCCURRENCE
PRODUCTS AND / OR COMPLETED OPERATIONS
EMPLOYER’S LIABILITY
CROSS LIABILITY
WAIVER OF SUBROGATION
2.
3.
4.
5.
LEASED AUTOMOBILES **
TENANTS LEGAL LIABILITY
POLLUTION LIABILITY EXTENSION
Arizona Game and Fish Dept. Lotek Wireless Inc.
Attn: Purchasing Kathy Edison
5000 W Carefree Hwy 115 Pony Drive
Phoenix AZ 85086 Newmarket ON L3Y 7B5
The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees, are listed as an additional insured to the Commercial General Liability Coverage Policy, but only with respect to liability arising out of operations carried out by or on behalf of the Named Insured, excluding any automobile liability.
$10,000,000X X $2,500 $2,000,000 n/a $2,000,000 X
X n/a $2,000.000 n/a $2,500
X $2,500 $2,000,000
Royal & Sun Alliance Insurance Company of Canada
COM028806875
2022/04/30 2023/04/30
X Royal & Sun Alliance Insurance Company of Canada
COM028806875
2022/04/30 2023/04/30 $2,000,000
X
Royal & Sun Alliance Insurance Company of Canada
COM028806875
2022/04/30 2023/04/30 $8,000,000
$8,000,000
Arthur J. Gallagher Canada Limited See Description of Operations/ Special Item if Applicable
145 Wellington Street, Suite 1200
Toronto ON M5J1H8
Arthur J. Gallagher Canada Limited
Julie Rogers
2022/06/07 thusa_thanes@ajg.com
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