2023-10-07_COI.pdf
PDF 79 KB Posted
- Attached to
- Master Agreement AZ|CTR060941
- Contract number
- CTR060941
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by AW Welt Ambrisco Insurance, Inc. on 6/6/2022 for Vectronic Aerospace Inc., located in Coralville, Iowa. The certificate involves two primary insurers: Cincinnati Specialty Underwriters and Accident Fund Insurance Company of America. The certificate is specifically designed to provide insurance coverage for the State of Arizona, with the state listed as the certificate holder at 100 N. 15th Avenue in Phoenix, Arizona.
The insurance coverage includes multiple policy types with specific limits: Commercial General Liability with a $1,000,000 per occurrence limit, Automobile Liability with $1,000,000 coverage for hired and non-owned autos, Umbrella/Excess Liability with $1,000,000 aggregate, and Workers' Compensation coverage with statutory limits of $1,000,000. The policies are effective from 10/07/2021 to 10/07/2023, with a 30-day cancellation notice provision. The certificate specifically notes that if required by written contract, the State of Arizona and its departments are included as a Primary/Non-Contributory Additional Insured on the General Liability policy, with a waiver of subrogation endorsed in favor of the state.
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Text version
6/6/2022
AW Welt Ambrisco Insurance, Inc.
24 Westside Drive
Iowa City IA 52246
Christina Chamberlin
(319) 887-3700 (319) 887-3701 cchamberlin@awwelt.com
Vectronic Aerospace Inc.
3292 Ridgeway Drive, Ste B-C
Coralville IA 52241
CSU - Cincinnati Specialty Underwrit 13037
Accident Fund Ins. Company of America 10166
Master 21-23
A Y Y CSU0140872 10/07/2021 10/07/2023
1,000,000
100,000
5,000
1,000,000
2,000,000
2,000,000
Employee Benefit Liab Cov
1,000,000
A CSU0140872 10/07/2021 10/07/2023
Hired & Non-Owned 1,000,000
A CSU0140880 10/07/2021 10/07/2023
1,000,000
1,000,000
B Y Y WCV6197917 10/11/2021 10/11/2023
1,000,000
1,000,000
1,000,000
If required by written contract, the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are included as a Primary/Non-Contributory Additional Insured on the General Liability.
A 3rd Party 30-Day Notice of Cancellation and Waiver of Subrogation has been endorsed in favor of the below listed Certificate Holder on the General Liability and Workers’ Compensation.
State of Arizona
100 N. 15th Avenue
Phoenix AZ 85007
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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