2024-12-31 Consor GAWPP.pdf
PDF 2 MB Posted
- Attached to
- Master Agreement AZ|CTR074219
- Contract number
- CTR074219
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by multiple insurance carriers, including Continental Casualty Company and National Fire Insurance Company, for Consor North America, Inc. The certificate covers insurance policies for Consor, with the Arizona Department of Environmental Quality (ADEQ) listed as the certificate holder. The insurance policies are effective from December 31, 2023, to December 31, 2024, and include coverage for commercial general liability, automobile liability, umbrella liability, and workers' compensation.
The insurance relates to a specific project (W241258AZ) for the ADEQ, solicitation number BPM006379, involving Capacity Development and Technical Assistance to Small Public Drinking Water Systems, with contract number CTR074219. The policies provide various coverage limits, including $2,000,000 for general aggregate and each occurrence, $1,000,000 for personal and advertising injury, and $2,000,000 for workers' compensation. The State of Arizona, its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are included as additional insured where required by written contract, with a waiver of subrogation applicable under certain conditions.
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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
12/31/2023
X
C
26620
2,000,000
WC 7 36441749 (CA)
20443
EBZ634816/01/2023 (Ded:$500,000)
A
2,000,000
12/31/2024 X
National Fire Insurance Company
Prof & Environmental Liability
CN144764051--GAUWP-23-24
1,000,000
N/A
12/31/2024
SEA-004054735-04
12/31/2023
X
2,000,000
11/12/2024
2,000,000
12/31/2024
1,000,000
Aggregate
1,000,000 1,000,000
A
12/31/2024
12/31/2023
12/31/2023
20478
BUA 7036360766
Per Claim
15,000
WC 7 36465081 (AOS)
1,000,000
The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are included as additional insured where required by written contract with respect to general and auto liability. Waiver of subrogation is applicable where required by written contract and subject to policy terms and conditions.
Re: Consor project W241258AZ ADEQ Solicitation No. BPM006379 Capacity Development/Technical Assistance to Small Public Drinking Water Systems. Contract # CTR074219.
Axis Surplus Insurance Company 6505 Waterford District Drive, Suite 470
Consor North America, Inc
Miami, FL 33126
1,000,000
Continental Casualty Company
X
1225 17TH STREET, SUITE 1300
MARSH USA LLC.
DENVER, CO 80202-5534
7036360752
N/A
N
1110 W. Washington Street
Phoenix, AZ 85007
Arizona Department of Environmental
Quality(ADEQ)
12/31/2023
C
2,000,000
X
D
12/31/2024
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