2023-08-01_COI.pdf
PDF 29 KB Posted
- Attached to
- Master Agreement AZ|CTR060939
- Contract number
- CTR060939
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued on 4/17/2023 by AssuredPartners of Arizona, LLC for Sonotronics Inc, with Travelers Indemnity as the primary insurer. The certificate is associated with Contract #AGFD12-015032 and involves the State of Arizona and the Arizona Game & Fish Department. The insurance provides coverage for Sonotronics Inc, with the Arizona Game and Fish Department listed as an additional insured party.
The insurance policy includes commercial general liability coverage with policy limits of $1,000,000 per occurrence, $2,000,000 general aggregate, and $2,000,000 for products-completed operations. The policy is effective from 8/1/2022 to 8/1/2023 for general liability and from 1/1/2023 to 1/1/2024 for workers' compensation. Additional coverages include a waiver of subrogation, domestic terrorism, earthquake and catastrophic coverage, and other supplemental provisions. The certificate specifies that the insurance is subject to all policy terms, conditions, definitions, and exclusions, with a contract number linking it to the specific agreement between Sonotronics Inc and the Arizona Game & Fish Department.
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Text version
4/17/2023
AssuredPartners of Arizona, LLC 4544 E Camp Lowell Dr Ste 110
Tucson AZ 85712-1282
Frani Schmidt (520)571-7737 (520)571-9115
Frani.Schmidt@AssuredPartners.com
Sonotronics Inc 3169 S Chrysler Ave
Tucson AZ 85713
Travelers Indemnity 25658
22-23 GL 23-24 WC
A
X
X
X
X 6803H150727 8/1/2022 8/1/2023
1,000,000
300,000
5,000
1,000,000
2,000,000
2,000,000
A UB8R0524992142G 1/1/2023 1/1/2024
1,000,000
1,000,000
1,000,000
Contract #AGFD12-015032
The State of Arizona and the Arizona Game & Fish Dept are Additional Insureds as regards general libility, if required by contract, waiver of subrogation applies - per form CG D4 17 01 12 subject to all policy terms, conditions, definitions and exclusions.
Arizona Game and Fish Dept 5000 W Carefree Highway Phoenix, AZ 85085 jscherbing@azgfd.gove
Frani Schmidt/FRANI
The ACORD name and logo are registered marks of ACORD
CERTIFICATE HOLDER
© 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01)
AUTHORIZED REPRESENTATIVE
CANCELLATION
DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE
LOCJECT
PRO-
POLICY
GEN'L AGGREGATE LIMIT APPLIES PER:
OCCURCLAIMS-MADE
COMMERCIAL GENERAL LIABILITY
PREMISES (Ea occurrence) $
DAMAGE TO RENTED
EACH OCCURRENCE $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
$RETENTIONDED
CLAIMS-MADE
OCCUR
AGGREGATE $
EACH OCCURRENCE $UMBRELLA LIAB
EXCESS LIAB
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
INSR
LTR TYPE OF INSURANCE POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY) LIMITS
PER
STATUTE
OTH-
ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
ANY PROPRIETOR/PARTNER/EXECUTIVE
If yes, describe under DESCRIPTION OF OPERATIONS below
(Mandatory in NH)
OFFICER/MEMBER EXCLUDED?
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
HIRED AUTOS
NON-OWNED
AUTOS AUTOS
AUTOS
COMBINED SINGLE LIMIT
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE $
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.
INSD
ADDL
WVD
SUBR
N / A
(Ea accident)
(Per accident)
OTHER:
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.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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).
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
INSURED
PHONE
(A/C, No, Ext):
PRODUCER
ADDRESS:
FAX
(A/C, No):
CONTACT
NAME:
NAIC #
INSURER A :
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
INSURER(S) AFFORDING COVERAGE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
INS025 (201401)
Waiver of Subrogation WVSUB
$250.00
Domestic Terrorism, Earthquake & Catastrophic DTEC
$19.00
Expense constant EXCNT
$160.00
Increased employer's liability INEL
$2.00
Extended Broad Form EXBRD
$24.00
ADDITIONAL COVERAGES
Ref # Description Edition DateForm No.Coverage Code
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref # Description Coverage Code Form No. Edition Date
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref # Description Coverage Code Form No. Edition Date
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref # Description Coverage Code Form No. Edition Date
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref # Description Coverage Code Form No. Edition Date
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref # Description Coverage Code Form No. Edition Date
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref # Description Coverage Code Form No. Edition Date
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref # Description Coverage Code Form No. Edition Date
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref # Description Coverage Code Form No. Edition Date
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref # Description Coverage Code Form No. Edition Date
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref # Description Coverage Code Form No. Edition Date
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Copyright 2001, AMS Services, Inc.OFADTLCV
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