2024-05-27_CGL_AL_WC_COI.pdf

ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

03/20/2024 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).

PRODUCER CONTACT

NAME: American Family Insurance - Business Insurance

American Family Insurance - Business Insurance

PHONE

(A/C, No, Ext): 480-968-6858

FAX

(A/C, No):

PO Box 5316 E-MAIL

ADDRESS: jmccarty@amfam.com Binghamton, NY 13902

INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A : Midvale Indemnity Company 27138

INSURED INSURER B :

INSURER C :

INSURER D :

SRT OF AZ, LLC dba/ SOUTHWEST RANCH SUPPLY CO

6328 W BROWN ST

GLENDALE AZ 85302 INSURER E :

INSURER F :

COVERAGES CERTIFICATE NUMBER: 1268118010087096 REVISION NUMBER:

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.

INSR

LTR TYPE OF INSURANCE

ADDL

INSR

SUBR

WVD POLICY NUMBER

POLICY EFF

(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY) LIMITS

COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000

A CLAIMS-MADE X OCCUR Y Y BPP1052443 05/27/2023 05/27/2024

DAMAGE TO RENTED

PREMISES (Ea occurrence) $100,000

MED EXP (Any one person) $5,000

PERSONAL & ADV INJURY

$2,000,000

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000

X POLICY

PRO-

JECT

LOC

PRODUCTS - COMP/OP AGG $4,000,000

OTHER:

AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT

(Ea accident)

ANY AUTO BODILY INJURY (Per person)

OWNED

AUTOS ONLY

SCHEDULED

AUTOS

BODILY INJURY

(Per accident)

X HIRED

AUTOS ONLY

X NON-OWNED

AUTOS ONLY

PROPERTY DAMAGE

(Per accident)

UMBRELLA LIAB OCCUR EACH OCCURRENCE

EXCESS LIAB CLAIMS-MADE AGGREGATE

DED RETENTION $

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY Y/N

PER

STATUTE

OTH-

ER

ANY PROPRIETOR/PARTNER/EXECU

-TIVE OFFICER/MEMBER EXCLUDED? N/A E.L. EACH ACCIDENT

(Mandatory in NH) E.L. DISEASE - EA

EMPLOYEE

If yes, describe under

DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT

PROFESSIONAL LIABILITY OCCURRENCE

AGGREGATE

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

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED

BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

Arizona Game and Fish Department 5000 West Carefree Highway Phoenix, Arizona 85086

AUTHORIZED REPRESENTATIVE

© 1988-2015 ACORD CORPORATION. All rights reserved.

R2WC348223 05/27/2023 05/27/2024C

$1,000,000

$1,000,000

$1,000,000

Y

X

Berkshire Hathaway Guard Progressive/United Financial Casualty Co 11770

42390

855-892-1565

B Y 965759332 02/01/2024 02/01/2025

$1,000,000

$250,000

Y

The policy shall be endorsed, as required by this written agreement, to include the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials and agents as additional insureds with respect to liability arising out of the activities performed by or on behalf of the Contractor.

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