2023-12-22-COI_CGAWPol-_AZ_Env_Services_.pdf

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

INSR ADDL SUBR

LTR INSD WVD

PRODUCER CONTACT

NAME:

FAXPHONE

(A/C, No):(A/C, No, Ext):

E-MAIL

ADDRESS:

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

POLICY NUMBER

POLICY EFF POLICY EXP

TYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)

AUTOMOBILE LIABILITY

UMBRELLA LIAB

EXCESS LIAB

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

AUTHORIZED REPRESENTATIVE

EACH OCCURRENCE $

DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence)

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT

OTHER: $

COMBINED SINGLE LIMIT

$(Ea accident)

ANY AUTO BODILY INJURY (Per person) $

OWNED SCHEDULED

BODILY INJURY (Per accident) $AUTOS ONLY AUTOS

HIRED NON-OWNED PROPERTY DAMAGE

$AUTOS ONLY AUTOS ONLY (Per accident)

OCCUR EACH OCCURRENCE

CLAIMS-MADE AGGREGATE $

DED RETENTION $

PER OTH-

STATUTE ER

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE $

If yes, describe under

E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below

INSURER(S) AFFORDING COVERAGE NAIC #

COMMERCIAL GENERAL LIABILITY

Y / N

N / A (Mandatory in NH)

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

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.

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 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).

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

CERTIFICATE HOLDER CANCELLATION

© 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03)

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

The ACORD name and logo are registered marks of ACORD

ARIZO25 OP ID: SM

06/21/2023

Southwest Insurance Brokers, Southwest Insurance Brokers 14805 N 73rd St Scottsdale, AZ 85260 Southwest Insurance Brokers, 602-263-0777

Ameritrust Insurance Company The Hanover Insurance Group

Arizona Environmental Specialists LLC 201 E Southern #114 Tempe, AZ 85282

ProCentury Insurance Co

A X 2,000,000

X X X AIC4007591 12/22/2022 12/22/2023 100,000

5,000

2,000,000

2,000,000

X 2,000,000

1,000,000B

X X X AW4-D721004 12/22/2022 12/22/2023

X X

XC

X WC 0836644 12/22/2022 12/22/2023 1,000,000

Y 1,000,000

1,000,000

A AIC4007591 12/22/2022 12/22/2023 Ea Occ 2,000,000

A Prof Liab-Ret$2500 AIC4000950/RETRO 122208 12/22/2022 12/22/2023 Per Claim 2,000,000

Prj: - SolicitationNo BPM004287

State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees are continued next page:

ADEQ-02

Arziona Department of Environmental Quality 1110 W Washington Street Phoenix, AZ 85007

602-263-0777

22292

Contr Pollution

NOTEPAD

PAGE

INSURED'S NAME Date

OP ID: SM

hereby listed as Additional Insured on a Primary/non contributory basis including a Waiver of Subrogation and a Per Project Aggregate for the General Liability. The Commercial Auto extends a Blanket Additional Insured on a Primary/Non contributory basis including a Waiver of Subrogation. A Waiver of Subrogation is proivded under the Workers compensation policy.

All Forms apply per written contract.

FORMS: EAI2010b(06/22), EAI2037b(6/22), EAI1816b(06/22), EAI1935b(06/22), ENV2018B(06/22), ENV2006B(06/22), 461-0478(12/12) & 461-0155(9/97) and

WC000313(3/84).

ARIZO25

06/21/2023

Arizona Environmental

Arizona Environmental Specialists LLC

WC0836644

ProCentury Insurance Company

12/22/2022

Arizona En.pdf