2023-12-23_COI.pdf

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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

E-MAIL

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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