2025-06-01_COI_Cutting_Edge.pdf
PDF 1 MB Posted
- Attached to
- Master Agreement AZ|CTR074699
- Contract number
- CTR074699
- Issued by
- Arizona
About this file
This is a Certificate of Liability Insurance issued on November 8, 2024, for Cutting Edge Forestry, Inc., a contractor based in Talent, Oregon. The certificate evidences insurance coverage required for Solicitation #BPM006328 involving tree thinning, tree removal, and woody vegetation removal work for the State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees. The certificate holder is the Arizona Game and Fish Department, Purchasing Division, located in Phoenix, Arizona. Six insurance carriers are involved: The Cincinnati Specialty Underwriters Insurance Co, Continental Divide Insurance Company, National Fire & Marine Insurance Company, Evanston Insurance Company, SAIF Corporation, and Zurich American Insurance Company. The insurance was arranged through k.p.d. Insurance LLC, a licensed producer in Springfield, Oregon.
The insurance coverage includes Commercial General Liability with limits of $1,000,000 per occurrence and $2,000,000 general aggregate, Automobile Liability at $1,000,000, Excess Automobile Liability at $1,000,000, Umbrella Liability at $1,000,000 per occurrence and $1,000,000 aggregate, Workers Compensation and Employers Liability with statutory limits and $500,000 per accident, and specialized Contractor's Pollution Liability, Transportation Liability, and Third Party Pollution Liability coverage, each with $3,000,000 limits and $2,500 deductibles. All policies include provisions for the State of Arizona as an Additional Insured with Primary and Non-Contributory coverage and Waiver of Subrogation endorsements. The coverage period for most policies runs from June 1, 2024, to June 1, 2025, with Workers Compensation coverage effective November 1, 2024, through November 1, 2025. Pesticide coverage is included in the Commercial General Liability policy.
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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)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
11/8/2024 k.p.d. Insurance LLC 1111 Gateway Loop Springfield OR 97477
541-741-0550 541-741-1674
License#: PC-1210733 The Cincinnati Specialty Underwriters Insurance Co 13037
CUTTEDG01A CONTINENTAL DIVIDE INS CO 35939
Cutting Edge Forestry, Inc.
PO Box 300 Talent OR 97540-0300
NATIONAL FIRE & MARINE INS CO 20079
Evanston Insurance Company 35378 SAIF Corporation 36196 Zurich American Insurance Company 16535
798062586
A X 1,000,000 X 100,000
X LOGGERS BFPD EXCLUDED
X STOP GAP 1,000,000
2,000,000 X
Y Y CSU 0189594 6/1/2024 6/1/2025
2,000,000
PESTICIDE COVERAGE INCLUDED
B C
1,000,000
X
05APM02607804
72XAS010267
6/1/2024 6/1/2024
6/1/2025 6/1/2025
EXCESS AUTO LIAB $1,000,000 LIMIT
A X 1,000,000
X
Y CSU0189596 6/1/2024Y 6/1/2025
1,000,000
EXCESS OVER GL & EMPLOYERS' LIAB
E F
XY 887888
1152904
11/1/2024 11/1/2024
11/1/2025 11/1/2025
X 500,000
500,000
500,000
D CONTRACTOR'S POLLUTION LIABILITY
TRANSPORTATION LIABILITY
THIRD PARTY POLLUTION LIABILITY
ECPENV05644 6/1/2024 6/1/2025 $3,000,000 LIMIT
$3,000,000 LIMIT
$3,000,000 LIMIT
$2,500 DEDUCTIBLE
$2,500 DEDUCTIBLE
$2,500 DEDUCTIBLE
*Additional Insured wording does not apply to the Workers Comp/Employers Liability Coverage* **Excess/Umbrella Liability extends over the Workers Comp/Employers Liability Coverage**
RE: Solicitation #BPM006328 - Tree Thinning, Tree Removal and Woody Vegetation Removal 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.
Waiver of Subrogation applies to Workers' Compensation.
Arizona Game and Fish Department Attn: Purchasing 5000 W Carefree Highway Phoenix AZ 85086-5000
THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE
Include op ghted aterial of ura CSGA 4087 12 12 Servic ice, I w th permis ion 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 endorseme mod ies ura pro ided un er the oll w ng
COMMERCIAL ENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERAT NS LIABILITY COVERAGE PART
The ollowing added to Paragrap 8. Transfer of Rights of Recovery Against Others o Us SECTION
IV CONDITIONS
u e greed in a written ntr or agreemen to provide waiver of gh of er ag ins per n or rganiz on w will wai ght of rec er we ma ha ag ins tha person or organ bec e of payment we m r inju or damage arising out yo r ongoing op ra o you w rk do e under ontrac with th erson rgani on nd included n he produ mpleted opera ons ha ard This waiver ap lies on to that ers n org nization fo w ic you ha gr ed to a written ontrac provide id waiver.
Includes pyrighted�material of�ISO CSGA 437�12 13 Properti ,�In .,�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�endorseme mod ies ura e�provided�under�the followin
COMMERCIALGENERAL�LIABILITY�COVERAGE�PART
A SECTION II WHO S AN INSURED is amended o include an additiona insured any person or rganization w en�you�and h per n organization ha greed in writing a trac agreeme th person ganization be dded an�addition in red on ur polic bu nly with res to odily injury", "property damage" "person nd advert ing njury" au ed, n w ole pa by:
1. ur or omi io in the erform-anc you ongoing opera fo the add tion insured;
2. The or mis ion th e ing n ur behal the performa e ur ongoing perations or the ad ion n-red
3. You w rk" performed or he ad ion insured nd included n he ro mpleted�operations�hazard peci d otherwis n the w tten n-trac or agreemen person's or organiza-tion's atu �an�additional�ins red�under�thi endors men nds one year er your pe a-tion or hat dditional in red re mplete The w itten ntr or agreemen mus be rrently in ef be ome effe ive uring the rm of this Coverage Par The ontrac or agreement�m be�e uted prio to e d-ily injury", ropert amage ers nal nd advertising injury" o which his endorseme pe tain
Howeve
1. The in ura e afforded h ad ion insured on pplies he ten erm ted�by�law and
2. erage rovided to he ddition n-red is required a ontrac or gree-men the in ran e orded h d-tion insured wil not e broader than tha w ich you re required by the n-trac agreemen provide fo d-ditional�li ured.
B. W respe he ran e af orded o the additiona insureds the ollowng ad tion lusio �apply:
This ran e�does�n ply�to
1. Bodily injury", "property amage or "pe na and ertising injury" arising the rendering or the ailure o rende any prof ion rchite tura nginee ing�or� rve ng ,�incl ing
a. The reparin pproving or ailing o prepare or approve, maps hop drawin pinion reports urveys orders hange orders or raw ing and peci tion ;�or b Supe ry, ins rchite tura or�engineering�a tivities
2. Bodily njury" or ropert damage" ar s-ing you work" or w ich ons dated (wra up) ura e rogram ha been provided the prime ontrac-tor/proje manager owne the n-ruc n�proj in�whi �you�are volved
3. Bodily injury", "property amage or "pe na and advertising injury" o ny m-plo e you or ny bligation the additiona insured to indemni another bec e of damag arising of injury.
Includes pyrighted�material of�ISO CSGA 437�12 13 Properti ,�In .,�with�its�permission Page 2�of�2
4. Bodily injury", "property amage or "pe na nd adver ing injury" or w ich the
Named In red is orded no overage under this�policy�o ura e.
C. W respe he ura e orded the additiona insureds SECTION III LIM- ITS�OF�INSURANCE �amended clude
The limits pplicable to the additiona insured are tho pec ied in the w tten ontrac or agreemen the De lara this Cov-erage Part whic eve no imit re ied in the w itten ontrac agreemen the limi applicab to the additiona insured are th e ied in the Declaration of Coverage Part. he limi of insuranc are n-cl ive and addition the limi of n-ran e�show �the�Dec rations
D. W respe he ura e af orded to the ddition ure SECTION IV
COMMERCIAL GENERAL LIABILITY CON-
DITIONS 4. O her nsurance is amended to include:
Any erage provided herein will e ove ny other alid and ollec ura e available the dditional in ured whethe primary, on gen or on ny other basis unl you have agreed n a written n-trac or w itten greement uted rio any lo th his in ran e wil e primar This ins ran w ll be no ontributo nly u ave o greed a written ntr or w tten greement uted rior any lo and this erage is determined o be pr mar
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 026078 - 04
10/28/2024 4:48 PM
CUTTING EDGE FORESTRY INC
CUTTING EDGE FORESTRY INC
10/28/2024 4:48 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 026078 - 04
5000 W CAREFREE HIGHWAY
PHOENIX, AZ 85086-5000
59$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)
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13
(Ed. 04-84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
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 anyone not named in the Schedule.
Schedule
ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE
PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND/OR
ORGANIZATION
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective Policy No. Endorsement No.
Insured Premium $
Insurance Company
Countersigned by______________________________Zurich American Insurance Company
11/01/2024 WC 1152904 - 06
Cutting Edge Forestry Inc
Copyright 1983 National Council on Compensation Insurance, Inc.WC124 (4-84)
WC 00 03 13
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