2025-05-30 COI GL AL WC PL.pdf
PDF 503 KB Posted
- Attached to
- Master Agreement AZ|CTR074466
- Contract number
- CTR074466
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by Ideal Insurance Agency for Field Data Services of Arizona Inc, with multiple insurance carriers including James River Insurance Company, Auto-Owners, Evanston Insurance Company, Travelers Property Casualty, and US Liability Insurance Company. The certificate is dated 2/4/2025 and names the Arizona Department of Transportation (ADOT) as the certificate holder, located in Phoenix, Arizona.
The insurance coverage includes Commercial General Liability with a $1,000,000 per occurrence limit and $2,000,000 aggregate limit, Automobile Liability, Umbrella Liability with a $4,000,000 limit, Workers' Compensation, and Professional Liability with a $2,000,000 aggregate and each occurrence limit. The policies are effective from various dates in 2024 to 2025, with coverage periods typically running one year. The document includes multiple endorsements that add ADOT as an additional insured, provide primary and non-contributory coverage, and include waivers of subrogation rights across different policy types.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| CTR074466_Contract_Amendment_1.pdf | ||
| 01 Post Award Documents.pdf | ||
| 2-Method of Approach.pdf | ||
| CTR074466_Contract_Documents.pdf | ||
| CTR074466_Pricing.pdf | ||
| 2-Experience and Quailifications of Firm.pdf |
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Text version
2/4/2025
Ideal Insurance Agency 14239 W Bell Rd Ste 205
Surprise AZ 85374
Sarah Mitchell (623)933-8263 (623)209-5363
Sarah@idealins.com
Field Data Services of Arizona Inc 31894 Whitetail Lane
Temecula AZ 92595
James River Ins Co Auto-Owners 18988 Evanston Ins Co Travelers Property Casualty US Liability Ins Co
CL252408693
A
X
X
X
X Y 00077715-7 6/3/2024 6/3/2025
1,000,000
50,000
1,000
1,000,000
2,000,000
2,000,000
Per Project Aggregate 2,000,000
B
X X 19
X X
55-352-396-00 6/13/2024 6/13/2025
1,000,000
WRRPA
C
X
X Y XOBW9700123 6/3/2024 6/3/2025
4,000,000
4,000,000
D UB-4Y680023-24-42-G 6/1/2024 6/1/2025
1,000,000
1,000,000
1,000,000
E X Y PL-SP1015584P 5/30/2024 5/30/2025
Additional Insured Arizona Department of Transportation is added to the policy.
Arizona Department of Transportation MD 100P, 1655 W Jackson St Phoenix, AZ 85007
Y
The ACORD name and logo are registered marks of ACORD
CERTIFICATE HOLDER
© 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01)
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
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 (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
INSR
LTR TYPE OF INSURANCE POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY) LIMITS
PER
STATUTE
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.
INSD
ADDL
WVD
SUBR
N / A
(Ea accident)
(Per accident)
OTHER:
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).
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.
INS025 (201401)
35378 25658 25895
12203
Professional Liability x
Aggregate Limit:
Each Occurrence: 2,000,000
2,000,000
Cindy Lewis Accepted
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
CG 20 26 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1
ADDITIONAL INSURED – DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s):
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf:
1. In the performance of your ongoing operations;
or
2. In connection with your premises owned by or rented to you.
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
Policy: 00077715-7
ENDORSEMENT WC 00 03 13 (00) -
POLICY NUMBER:
EMPLOYERS LIABILITY POLICY
AND
WORKERS COMPENSATION
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
ONE TOWER SQUARE
HARTFORD CT 06183
UB-4Y680023-24-42-G
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.)
This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule.
SCHEDULE
DESIGNATED ORGANIZATION:
DESIGNATED PERSON:
ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED
BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS
WAIVER.
DATE OF ISSUE: PAGEST ASSIGN: OF06-10-24 1 1
| COI Packet -- 2024-2025 -- Final |
| COI Packet -- 2024-2025 |
| FDS COI |
| CG 20 26 04 13 AI - Designated Person or Organization -- ADOT |
| IR110000 (22) -- primary |
| COI Packet -- 2024-2025 -- Final |
| Waver of Suborgnation -- General Liability |
| COI Packet -- 2024-2025 |
| AI and WOS |
| Worker Comp |
| Text_1: 00077715-7 |
| Text_2: |
| Text_3: |
| Text_4: State of Arizona / ADOT, |
MD 100P, 1655 W Jackson St Phoenix, AZ 85007
File details come from the government source that posted it. Updated .