2025-06-01 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
This Certificate of Liability Insurance documents coverage 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 certificate was issued on May 31, 2024, by UCW Insurance Agency, Inc., and names The State of Arizona and ADOT as certificate holders and additional insureds. The policy period runs from June 1, 2024, to June 1, 2025. Four insurance carriers provide coverage: Great Divide Insurance Company, Key Risk Insurance Company, Ironshore Specialty Insurance Company, and Nautilus Insurance Company, all with A+ ratings from AM Best.
The insurance portfolio includes Commercial General Liability with limits of $2,000,000 general aggregate and $1,000,000 per occurrence; Contractors Pollution Liability with $5,000,000 aggregate; Auto Liability with $1,000,000 combined single limit; Umbrella Liability with $5,000,000 per occurrence and aggregate; Professional Liability with $1,000,000 limits; and Workers Compensation with statutory limits of $1,000,000 per employee and $1,000,000 disease limits. The State of Arizona and ADOT are added as additional insureds with respect to the work performed, with coverage provided on a primary and non-contributing basis. A waiver of subrogation is included for Commercial General Liability, Contractors Pollution Liability, Auto Liability, and Workers Compensation in favor of the additional insureds. Excess Liability follows form provisions. The certificate includes multiple endorsements establishing automatic additional insured status for ongoing and completed operations, primary and noncontributory insurance conditions, and waiver of subrogation requirements tied to written contract or agreement execution prior to loss.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 1-Key Personnel Bio.pdf | ||
| 1-Method of Approach.pdf | ||
| CTR071402_Pricing_05-01-24.xlsx | XLSX spreadsheet | |
| CTR071402_Contract_Amendment_2.pdf | ||
| 1-Firm Experience and Capacity.pdf | ||
| 2024-06-01 COI GL AL WC CPL.pdf | ||
| CTR071402_Contract_Documents.pdf | ||
| Contract_Amendment_Summary_1.pdf |
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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
1,000,000
750903532
750903532
2435 E University Dr
The State of Arizona Arizona Department of Transportation (ADOT)
X
X mtyson@ucwinsurance.com
100,000
25445
17370
1,000,000
25224
10885
X
5,000,000
RE: Any and all work performed for or on behalf of the State of Arizona/ADOT Contract No. CTR071402
X
1-866-829-4368
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.
A waiver of subrogation is added to the Commercial General Liability, Contractors Pollution Liability, Auto Liability
06/01/25
USA
X
06/01/25
Native Environmental, LLC
XSCUW0015197901
WCA1510776-25
06/01/24
866-829-4369
X
1,000,000
06/01/25X
X mtyson
X
06/01/24
2,000,000
Professional Liability
X
Phoenix , AZ 85007
PO Box 31644
5,000Contractors Pollution
Key Risk Ins Co (AM Best Rating: A+)
Great Divide Ins Co (AM Best Rating: A+)
Nautilus Ins Co (AM Best Rating: A+)
Ironshore Specialty Ins Co (AM Best
2,000,000
1,000,000
06/01/24
BAP2014907-19
X
X
06/01/24
Phoenix, AZ 85034 USA
Y
Melanie Tyson
D
866-829-4368
C
A ECPO1511066-25
1,000,000B
05/31/2024
X
X
5,000,000
LIC #124221
1,000,000
206 S. 17th Ave
Mesa, AZ 85275-1644 USA
06/01/25
UCW Insurance Agency, Inc.
X e6906 Accepted
SUPP (05/04)
SUPPLEMENT TO CERTIFICATE OF INSURANCE
DATE
NAME OF INSURED:
Additional Description of Operations/Remarks from Page 1:
Additional Information:
Native Environmental, LLC
05/31/2024
File details come from the government source that posted it. Updated .