2024-11-30_COI_Silhouette.pdf

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Attached to
Master Agreement AZ|CTR074705
Contract number
CTR074705
Issued by
Arizona

About this file

The document is a Certificate of Liability Insurance for Silhouette Farm & Forestry, LLC, issued by k.p.d. Insurance LLC. The certificate involves multiple insurance carriers including The Cincinnati Specialty Underwriter, Continental Divide Insurance Company, Gotham Insurance Company, National Fire & Marine Insurance Company, and Great American Insurance Company. The primary certificate holder is the Arizona Game and Fish Department, located in Phoenix, Arizona. The insurance covers various liability aspects for the insured, including commercial general liability, automobile liability, workers' compensation, excess liability, professional liability, and pollution liability.

The insurance policies provide comprehensive coverage with varying limits, including a $1,000,000 general aggregate, $1,000,000 per occurrence for commercial general liability, and additional layers of coverage such as a $4,000,000 excess automobile liability. The policies are effective from November 19, 2023, to November 30, 2024, with specific endorsements that include the State of Arizona and its departments as additional insureds. Notable provisions include waivers of subrogation, primary and non-contributory coverage, and extensions for products and completed operations. The policies cover all operations for Silhouette Farm & Forestry, LLC, with specific protections for the Arizona Game and Fish Department across multiple insurance types.

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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)

© 1988-2015 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

11/20/2024 k.p.d. Insurance LLC 1111 Gateway Loop Springfield OR 97477

541-741-0550 541-741-1674

License#: PC-1210733 THE CINCINNATI SPECIALTY UNDERWRITER 13037

SILHFAR01C CONTINENTAL DIVIDE INS CO 35939

Silhouette Farm & Forestry, LLC PO Box 4058 Medford OR 97501-0147

GOTHAM INS CO 25569

NATIONAL FIRE & MARINE INS CO 20079

GREAT AMER INS CO 16691

SAIF Corporation 36196

1537558979

A X 1,000,000 X 100,000

X LOGGERS BFPD EXCLUDED

X WA STOP GAP 1,000,000

2,000,000

Y Y CSU0220067 11/19/2023 11/30/2024

2,000,000

B 1,000,000

X X X

Y Y 05APM040700 11/30/2023 11/30/2024

A C

X 1,000,000 X

CSU0220102

EX202300004242

11/19/2023 11/19/2023

11/30/2024 11/30/2024

1,000,000

2ND LAYER 4,000,000

F X100038000 12/1/2024 12/1/2025 X

1,000,000

1,000,000

1,000,000 D E E

EXCESS AUTOMOBILE LIABILITY

PROFESSIONAL LIABILITY

POLLUTION LIABILITY

72XAS009527

PCEE90891201

PCEE90891201

11/30/2023 2/28/2024 2/28/2024

11/30/2024 11/30/2024 11/30/2024

$4,000,000 LIMIT

$3,000,000 LIMIT

$3,000,000 LIMIT

$5,000 RETENTION

$5,000 RETENTION

RE: All Operations The State of Arizona and its Departments, Agencies, Boards, Commissions, Universities, Officers, Officials, Agents and Employees are included as Additional Insureds, for General Liability, per forms CSGA4034_0612, which includes Primary and Non-Contributory coverage and CSGA437_1213, which includes Products/Completed Operations coverage; and for Automobile Liability, per form M-3745a_0609. Waiver of Subrogation applies to General Liability, per form CSGA4087_1212; and to Automobile Liability, per form M-5144a_0607.

Arizona Game and Fish Department Attn: Purchasing 5000 W Carefree Highway Phoenix AZ 85086-5000

THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE

Includes copyrighted material of Insurance CSGA 4087 12 12 Services Office, Inc., with its permission. Page 1 of 1

COMMERCIAL GENERAL LIABILITY

CSGA 4087 12 12

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US - PER CONTRACT

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

The following is added to Paragraph 8. Transfer of Rights of Recovery Against Others to Us of SECTION

IV - CONDITIONS:

If you have agreed, in a written contract or agreement, to provide a waiver of any right of recovery against a person or organization, we will waive any right of recovery we may have against that person or organization because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard".

This waiver applies only to that person or organization for which you have agreed to in a written contract to provide said waiver.

Includes�copyrighted�material of�ISO CSGA 437�12 13 Properties,�Inc.,�with�its�permission. Page 1�of�2

COMMERCIAL�GENERAL�LIABILITY

CSGA 437�12�13

THIS�ENDORSEMENT�CHANGES�THE POLICY.�PLEASE�READ�IT�CAREFULLY.

ADDITIONAL INSURED -�OWNERS, LESSEES OR

CONTRACTORS -�AUTOMATIC STATUS WHEN

REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU -

OPERATIONS�AND COMPLETED OPERATIONS

This�endorsement modifies�insurance�provided�under�the following:

COMMERCIALGENERAL�LIABILITY�COVERAGE�PART

A. SECTION II - WHO IS AN INSURED is amended to include as an additional insured any person or organization when�you�and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an�additional insured on your policy, but only with respect to "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by:

1. Your acts or omissions in the perform-ance of your ongoing operations for the additional insured;

2. The acts or omissions of those acting on your behalf in the performance of your ongoing operations for the additional in-sured;�or

3. "Your work" performed for the additional insured and included in the "products-completed�operations�hazard".

If not specified otherwise in the written con-tract or agreement, a person's or organiza-tion's status as�an�additional�insured�under�this endorsement ends one year after your opera-tions for that additional insured are completed.

The written contract or agreement must be currently in effect or become effective during the�term of this Coverage Part. The contract or agreement�must be�executed prior to�the "bod-ily injury", "property damage" or "personal and advertising injury" to which this endorsement pertains.

However:

1. The insurance afforded to such additional insured only applies to the extent permit-ted�by�law; and

2. If coverage provided to the additional in-sured is required by a contract or agree-ment, the insurance afforded to such ad-ditional insured will not be broader than that which you are required by the con-tract or agreement to provide for such ad-ditional�linsured.

B. With respect to the insurance afforded to these additional insureds, the following addi-tional exclusions�apply:

This�insurance�does�not apply�to:

1. "Bodily injury", "property damage" or "per-sonal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineer-ing�or�surveying services,�including:

a. The preparing, approving, or failing�to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or draw-ings and�specifications;�or

b. Supervisory, inspection, architectural or�engineering�activities.

2. "Bodily injury" or "property damage" aris-ing out of "your work" for which a consoli-dated (wrap-up) insurance program has been provided by the prime contrac-tor/project manager or owner of the con-struction�project in�which�you�are�involved.

3. "Bodily injury", "property damage" or "per-sonal and advertising injury" to any em-ployee of you or to any obligation of the additional insured to indemnity another because of damages arising out of such injury.

Includes�copyrighted�material of�ISO CSGA 437�12 13 Properties,�Inc.,�with�its�permission. Page 2�of�2

4. "Bodily injury", "property damage" or "per-sonal and advertising injury" for which the Named Insured is afforded no coverage under this�policy�of�insurance.

C. With respect to the insurance afforded to these additional insureds, SECTION III - LIM- ITS�OF�INSURANCE�is�amended�to�include:

The limits applicable to the additional insured are those specified in the written contract or agreement or in the Declarations of this Cov-erage Part, whichever is less. If no limits are specified in the written contract or agreement, the limits applicable to the additional insured are those specified in the Declarations of this Coverage Part. The limits of insurance are in-clusive of and not in addition to the limits of in-surance�shown�in�the�Declarations.

D. With respect to the insurance afforded to these additional insureds, SECTION IV -

COMMERCIAL GENERAL LIABILITY CON-

DITIONS, 4. Other Insurance is amended to include:

Any coverage provided herein will be excess over any other valid and collectible insurance available to the additional insured whether primary, excess, contingent or on any other basis unless you have agreed in a written con-tract or written agreement executed prior to any loss that this insurance will be primary.

This insurance will be noncontributory only if you have so agreed in a written contract or written agreement executed prior to any loss and this coverage is determined to be primary.

M-3745a (06/2009)

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED ENDORSEMENT

In consideration of payment of the additional premium listed below, LIABILITY COVERAGE is extended to include the additional insured named herein, provided that:

1) such insurance applies only to the ownership, maintenance or use of a covered auto; and

2) such insurance applies only to acts or omissions by you, your agents or your “employees” while such covered auto is being used in your business; and

3) such insurance does not apply to the acts or omissions of the additional insured or any of the additional insured’s agents or "employees" other than you; and

4) such inclusion of additional insured shall not increase our limit of liability under this policy.

ADDITIONAL INSURED:

ARIZONA GAME AND FISH DEPARTMENT

ATTN: PURCHASING

5000 W CAREFREE HIGHWAY

PHOENIX, AZ 85086-5000

M-3745a (06/2009)

All other terms, conditions and agreements remain unchanged.

Additional Premium: $

Company Name Policy Number

Named Insured

Endorsement Effective

Countersigned by

(Authorized Representative)

(The Attaching Clause need be completed only when this endorsement is issued subsequent to preparation of the policy .)

Continental Divide Insurance Company

05 APM 040700 - 01

10/25/2024 5:23 PM

SILHOUETTE FARM AND FORESTRY LLC

SILHOUETTE FARM AND FORESTRY LLC

10/25/2024 5:23 PM

ARIZONA GAME AND FISH DEPARTMENT

ATTN: PURCHASING

SCHEDULE

(Authorized Representative)

Countersigned By:

Named Insured:

Endorsement Effective:

Name Of Person(s) Or Organization(s):

M-5144a (06/2007)

WAIVER OF TRANSFER OF RIGHTS OF

RECOVERY AGAINST OTHERS TO US

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM

GARAGE COVERAGE FORM

MOTOR CARRIER COVERAGE FORM

TRUCKERS COVERAGE FORM

With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi-fied by the endorsement.

This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.

POLICY NUMBER 05 APM 040700 - 01

5000 W CAREFREE HIGHWAY

PHOENIX, AZ 85086-5000

10$Additional Premium

Includes copyrighted material of Insurance Services Office , Inc. with its permission.

(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.)

The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply to the person (s) or organiza-tion(s) shown in the Schedule. We will retain the additional premium shown above, regardless of any early termi-nation of this endorsement or the policy.

M-5144a (06/2007)

File details come from the government source that posted it. Updated .