2024-06-01 COI GL AL WC CPL.pdf
PDF 2 MB Posted
- Attached to
- Master Agreement AZ|CTR071402
- Contract number
- CTR071402
- Issued by
- Arizona
About this file
Document Summary
This is a Certificate of Liability Insurance dated April 30, 2024, issued for Native Environmental, LLC in connection with work performed for the State of Arizona and the Arizona Department of Transportation (ADOT) under Contract No. CTR071402. The insured, Native Environmental, LLC, located at 2435 E University Drive, Phoenix, Arizona, maintains comprehensive liability coverage through multiple insurers including Great Divide Insurance Company, Key Risk Insurance Company, Ironshore Specialty Insurance Company, and Nautilus Insurance Company, all rated A+ by AM Best. The certificate holder is The State of Arizona and ADOT, located at 206 S. 17th Avenue, Phoenix, Arizona 85007. The insurance broker is UCW Insurance Agency, Inc., with contact Melanie C. Tyson.
The insurance coverage includes Commercial General Liability with limits of $1,000,000 per occurrence and $2,000,000 general aggregate; Contractors Pollution Liability with $1,000,000 limits; Auto Liability with $1,000,000 combined single limits; Umbrella Liability with $4,000,000 per occurrence and aggregate; and Workers Compensation with statutory limits. All policies are effective June 1, 2023, and expire June 1, 2024. The State of Arizona and ADOT are added as additional insureds with respect to all work performed for or on behalf of ADOT. The insurance is primary and noncontributory, with a waiver of subrogation applied to Commercial General Liability, Contractors Pollution Liability, Auto Liability, and Workers Compensation in favor of the additional insureds. Excess Liability follows form. The certificate represents that coverage is provided for bodily injury, property damage, and personal and advertising injury liability directly caused by the insured's operations.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| CTR071402_Contract_Amendment_2.pdf | ||
| 1-Key Personnel Bio.pdf | ||
| 1-Method of Approach.pdf | ||
| CTR071402_Pricing_05-01-24.xlsx | XLSX spreadsheet | |
| 2025-06-01 COI GL AL WC CPL.pdf | ||
| 1-Firm Experience and Capacity.pdf | ||
| CTR071402_Contract_Documents.pdf | ||
| Contract_Amendment_Summary_1.pdf |
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Text version
CERTIFICATE HOLDER
© 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05)
AUTHORIZED REPRESENTATIVE
CANCELLATION
DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE
LOCJECT
PRO-
POLICY
GEN'L AGGREGATE LIMIT APPLIES PER:
OCCURCLAIMS-MADE
COMMERCIAL GENERAL LIABILITY
GENERAL LIABILITY
PREMISES (Ea occurrence) $
DAMAGE TO RENTED
EACH OCCURRENCE $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
$RETENTIONDED
CLAIMS-MADE
OCCUR
AGGREGATE $
EACH OCCURRENCE $UMBRELLA LIAB
EXCESS LIAB
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
INSR
LTR TYPE OF INSURANCE POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY) LIMITS
WC STATU-
TORY LIMITS
OTH-
ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
ANY PROPRIETOR/PARTNER/EXECUTIVE
If yes, describe under DESCRIPTION OF OPERATIONS below
(Mandatory in NH)
OFFICER/MEMBER EXCLUDED?
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
HIRED AUTOS
NON-OWNED
AUTOS AUTOS
AUTOS
COMBINED SINGLE LIMIT
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE $
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
ADDL
WVD
SUBR
N / A
(Ea accident)
(Per accident)
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 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).
The ACORD name and logo are registered marks of ACORD
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
INSURED
PHONE
(A/C, No, Ext):
PRODUCER
ADDRESS:
FAX
(A/C, No):
CONTACT
NAME:
NAIC #
INSURER A :
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
INSURER(S) AFFORDING COVERAGE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
1,000,000
750758719
750758719
2435 E University Dr
2435 E University Dr
The State of Arizona Arizona Department of Transportation (ADOT)
X
X mtyson@ucwinsurance.com mtyson@ucwinsurance.com
100,000
25445
25445
17370
17370
25224
25224
1,000,000
10885
10885
X
4,000,000
RE: Any and all work performed for or on behalf of the State of Arizona/ADOT Contract No. CTR071402
X
1-866-829-4368
1-866-829-4368
X
Commercial General Liability, Contractors Pollution Liability and Auto Liability.
The State of Arizona and Arizona Department of Transportation are added as additional insureds with respect to the those person(s) or organization(s) with which the Insured has so agreed in a written contract or written agreement.
The coverage provided the additional insured shall be primary and not contributing with any other insurance available to and Workers Compensation in favor of the additional insureds. Excess Liability Follows Form.
06/01/24
A waiver of subrogation is added to the Commercial General Liability, Contractors Pollution Liability, Auto Liability
USA
X
06/01/24
Native Environmental, LLC
Native Environmental, LLC
XSCUW0015197900
WCA1510776-24
06/01/23
X
(866) 829-4369
(866) 829-4369
1,000,000
06/01/24X
X mtyson
X
Melanie C. Tyson
Melanie C. Tyson
06/01/23
2,000,000
Professional Liability
X
Phoenix , AZ 85007
PO Box 31644
PO Box 31644
5,000 Contractors Pollution
Key Risk Ins Co (AM Best Rating: A+)
Key Risk Ins Co (AM Best Rating: A+)
Great Divide Ins Co (AM Best Rating: A+)
Great Divide Ins Co (AM Best Rating: A+)
Nautilus Ins Co (AM Best Rating: A+)
Nautilus Ins Co (AM Best Rating: A+)
2,000,000
Ironshore Specialty Ins Co (AM Best
Ironshore Specialty Ins Co (AM Best
1,000,000
06/01/23
BAP2014907-18
X
X
06/01/23
Phoenix, AZ 85034 USA
Phoenix, AZ 85034 USA
Y
Melanie Tyson
Melanie Tyson
D
C
(866) 829-4368
(866) 829-4368
A ECPO1511066-24
1,000,000B
04/30/2024
04/30/2024
X
X
4,000,000
1,000,000
LIC #124221
LIC #124221
206 S. 17th Ave
Mesa, AZ 85275-1644
Mesa, AZ 85275-1644
06/01/24
UCW Insurance Agency, Inc.
UCW Insurance Agency, Inc.
X
G0171 Accepted
File details come from the government source that posted it. Updated .