2023-07-01_COI.pdf

PDF 23 KB Posted

Attached to
Master Agreement AZ|CTR065988
Contract number
CTR065988
Issued by
Arizona

About this file

This document is an ACORD Certificate of Liability Insurance issued on 06/14/2022 for the National Archery in the Schools Program, Inc., located in Waldo, Wisconsin. The certificate involves multiple insurance providers, including Central Mutual Insurance Company, West American Insurance Company, and Travelers C & S Company of America. The certificate holder is The State of Arizona and The Arizona Game and Fish Department, located in Phoenix, Arizona.

The insurance coverage includes commercial general liability, automobile liability, umbrella/excess liability, and directors & officers non-profit employment practices liability. The policy periods are from 07/01/2022 to 07/01/2023 for most coverages, with the directors & officers policy running from 01/01/2022 to 01/01/2025. Key coverage limits include $1,000,000 for general liability, $5,000,000 for umbrella liability, and $2,000,000 for directors & officers liability. The certificate provides additional insured status and a waiver of subrogation for The State of Arizona, its departments, agencies, boards, commissions, universities, and employees, with coverage primary and contingent upon a written contract being in place.

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Text version

06/14/2022

The Craft Agency Inc.

2533 Spring Arbor Rd P O Box 1187 Jackson MI 49204

Karen Cyrocki

(517) 787-0077 (517) 787-9356 kmc@craftagency.com

National Archery in the Schools Program, Inc.

W4285 Lake Drive

Waldo WI 53093

Central Mutual Insurance Company 20230 West American Insurance Company Travelers C & S Company of America

22-23 Master

A Y CLP8651342 07/01/2022 07/01/2023

1,000,000 300,000 5,000 1,000,000 2,000,000 2,000,000

A CLP8651342 07/01/2022 07/01/2023

1,000,000

A CXS8651865 07/01/2022 07/01/2023

5,000,000 5,000,000

B XWW(20)60371329 07/01/2022 07/01/2023

500,000 500,000 500,000

C Directors & Officers Non-Profit Employment Practices Liability 105542249 01/01/2022 01/01/2025 Per claim $2,000,000

Additional Insured and a waiver of subrogation is in place for: The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees for losses arising from work performed by or on behalf of the insured. Coverage up to the full limits provided coverage is primary. A written contract must be in place - contractual liability applies, as respects to operations of the insured.

The State of Arizona and The Arizona Game and Fish Department 5000 W. Carefree Highway

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

E-MAIL

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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