2023-12-23_COI.pdf
PDF 1 MB Posted
- Attached to
- Master Agreement AZ|CTR066557
- Contract number
- CTR066557
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for SiteOne Landscape Supply, Inc., issued by ACE American Insurance Company, covering a policy period from 12/23/2022 to 12/23/2023. The certificate involves the Arizona Department of Transportation (ADOT) as the certificate holder, with multiple insurance policies providing coverage including commercial general liability, automobile liability, and workers' compensation. The insurance policies include carriers such as ACE American Insurance Company, Indemnity Ins Co Of North America, and ACE Fire Underwriters Insurance Company.
The contract pertains to Irrigation System Supplies, Parts & Accessories for Arizona DOT, with a bid reference number BPM005370. The insurance coverage includes commercial general liability with limits of $2,000,000 each occurrence and $4,000,000 general aggregate, automobile liability with a $3,000,000 combined single limit, and workers' compensation coverage. The policies include additional insured endorsements for the State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees. The insurance provides primary and non-contributory coverage limited to liability arising from the named insured's operations, with waivers of subrogation where required by written contract.
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Text version
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)
© 1988-2016 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
2,000,000
12/23/2023
XSL G47301294
ATL-005619600-01
1,000,000
SCF C5066692A (WI)
X
X
43575
ATLANTA, GA 30326
N
X
SIR: $750,000
SIR: $350,000
12/23/2022
12/23/2023ISAH10693123
B
4,000,000
2,000,000
20702 Indemnity Ins Co Of North America
1,000,000
X terms and conditions with respect to General Liability and Auto Liability. Waiver of subrogation is applicable where required by written contract and subject to policy terms and conditions. General Liability and Auto
07/06/2023
12/23/2022
RE: Arizona DOT #BPM005370 Irrigation System Supplies, Parts & Accessories.
Phoenix, AZ 85007-3276
Arizona Department of Transportation
State of Arizona and its departments, agencies, boards, commissions, universities, officers, official, agents, and employees is/are included as Additional Insured as required by written contract subject to the policy
Liability are primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured and where required by written contract.
A
ACE Fire Underwriters Insurance Company
CN117936603--GAW-22-23
N/A
12/23/2023
3,000,000
C
4,000,000
22667
1,000,000
X
Bid
1,000,000
WLR C50680332 (AOS)
TWO ALLIANCE CENTER
MARSH USA, LLC.
3560 LENOX ROAD, SUITE 2400
Attn: Michelle.W.Robles@marsh.com
& its subsidiaries
SiteOne Landscape Supply, Inc.
Roswell, GA 30076 300 Colonial Center Parkway, Suite 600
1739 West Jackson St., MD 100P
A
12/23/2023
ACE American Insurance Company
ACCEPTED
ADOT Risk Management
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