2023-10-01 COI.pdf
PDF 1 MB Posted
- Attached to
- Master Agreement AZ|CTR068900
- Contract number
- CTR068900
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by Robert Bell Insurance Brokers Inc. on September 30, 2022, for Effem Corporation (doing business as A to Z Equipment Rentals & Sales), located in Gilbert, Arizona. The insurance policies are underwritten by Axis Insurance Company and QBE Specialty Insurance Company, with the Arizona Department of Transportation listed as the certificate holder. The insurance coverage is valid from October 1, 2022, to October 1, 2023.
The certificate details multiple insurance coverages, including Commercial General Liability with limits of $1,000,000 per occurrence and $2,000,000 aggregate, Automobile Liability, Umbrella Liability with a $5,000,000 aggregate limit, and coverage for owned/rented/leased equipment with a special form and replacement cost deductible of $5,000. The policy includes additional insured status for the Arizona Department of Transportation, with a waiver of subrogation and primary and noncontributory language applied to General Liability and Auto Liability. The insurance provides comprehensive protection for A to Z Equipment Rentals & Sales' operations, covering potential risks associated with their business activities.
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Text version
9/30/2022
Robert Bell Insurance Brokers Inc.
605 East Alvarado Street
Suite 200
Fallbrook CA 92028
Mariellen High
(760)451-8556 (760)451-8613 mariellen@robertbellinsurance.com
Effem Corporation, DBA: A to Z Equipment Rentals & Sales
1313 E. Baseline Road
Gilbert AZ 85233
ARA - Axis Insurance Company 37273
QBE-QBE Specialty Insurance Company 11515
22-23 Master
A
X
X
X
X Y A1AZAZ002-034389-05 10/1/2022 10/1/2023
1,000,000
100,000
10,000
1,000,000
2,000,000
2,000,000
Employee Benefits 1,000,000
A X
X
X *HA Phys Dmg
X
X Y A1AZAZ002-034389-05 10/1/2022 10/1/2023
1,000,000
*ACV Less Comp/Coll Ded 100/1,000
A
B
X
X
A=A5AZAZ002-034391-01 10/1/2022 10/1/2023
B= MQSX0000715602 10/1/2022 10/1/2023
3,000,000
3,000,000 Each Occurrence/Aggregate
$5,000,000
A Owned/Rented/Lsd Equipment A1AZAZ002-034389-05 10/1/2022 10/1/2023 Limit-Actual Loss Sustained Unlimited
Special Form, Repl Cost Deductible $5,000
Certificate holder is additional insured for Ongoing Operations, Completed Operations. Waiver of Subrogation applies with Primary and Noncontributory language as it applies the the General Liability and the Auto Liabity per attached endorsments CG 20371219, CG20101219, CG24040509, CG20011219, CA 04 49 11 16, CA 04 43 11 20. ca 20 48 10 13
Arizona Department of Transportation 1739 W. Jackson St Suite A MD 100P Phoenix, AZ 85007
Michael Bell/HIGH
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)
a8812 Accepted
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