2025-07-01 GHD CTR074222.pdf
PDF 358 KB Posted
- Attached to
- Master Agreement AZ|CTR074222
- Contract number
- CTR074222
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for GHD Inc., located in Phoenix, Arizona, with coverage provided by multiple insurers including Allied World Assurance Company, Zurich American Insurance Company, and Beazley Insurance Company. The certificate is issued for a Technical Assistance Contract (CTR074222) with the Arizona Department of Environmental Quality, with Willis Towers Watson Northeast, Inc. serving as the insurance producer.
The insurance package includes Commercial General Liability, Automobile Liability, Workers Compensation, and Professional Liability coverage with policy periods from December 1, 2024 to December 1, 2025 and July 1, 2024 to July 1, 2025. Key coverage limits include $1,000,000 for general liability, $2,000,000 aggregate, $2,000,000 for professional liability, and $1,000,000 for workers compensation. The policy includes additional insured provisions for the State of Arizona and its departments, and contains waivers of subrogation and primary/non-contributory insurance clauses as required by the contract. The specific project referenced is GHD Project no. 11206985, which appears to be a technical assistance contract with the Arizona Department of Environmental Quality.
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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
Willis Towers Watson Northeast, Inc.
c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA
GHD Inc.
3200 E Camelback Rd Suite 210 Phoenix, AZ 85018
GHD Project no.: 11206985, ADEQ Technical Assistance Contract CTR074222.
State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are included as Additional Insureds as respects to General Liability and Auto Liability, where required by contract or agreement.
Arizona Department of Environmental Quality 1110 W. Washington Street Phoenix, AZ 85007
12/03/2024
1-877-945-7378 1-888-467-2378 certificates@wtwco.com
Allied World Assurance Company US Inc 19489
Zurich American Insurance Company
Beazley Insurance Company Inc
16535
37540
W36460619
A
1,000,000
1,000,000
50,000
1,000,000
2,000,000
2,000,000
0310-4497 12/01/2024 12/01/2025
B
2,000,000
07/01/202507/01/2024
Coll Ded: $500 Hired Physical Damage
Comp Ded: $250
BAP 3757423-09
100,000.00
WC 0380936-09
B 1,000,000
No 07/01/2024 07/01/2025 1,000,000
1,000,000
C Professional Liability Each Claim:V29594240601 12/01/2024 12/01/2025
Aggregate:
372585926854920SR ID: BATCH:
$2,000,000
$2,000,000
WTW Certificate Center
ACORD 101 (2008/01)
The ACORD name and logo are registered marks of ACORD
© 2008 ACORD CORPORATION. All rights reserved.
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: FORM TITLE:
ADDITIONAL REMARKS
ADDITIONAL REMARKS SCHEDULE Page of
AGENCY CUSTOMER ID:
LOC #:
AGENCY
CARRIER NAIC CODE
POLICY NUMBER
NAMED INSURED
EFFECTIVE DATE:
GHD Inc.
3200 E Camelback Rd Suite 210 Phoenix, AZ 85018
General Liability and Auto Liability policy shall be Primary and Non-contributory with any other insurance in force for or which may be purchased by Additional Insureds, where required by contract or agreement.
Waiver of Subrogation applies in favor of Additional Insureds with respects to General Liability and Auto Liability, where required by contract or agreement.
Waiver of Subrogation applies in favor of Additional Insureds with respects to Workers Compensation, where required by written contract, agreement or permit where permissible by law or statute.
2 2
Willis Towers Watson Northeast, Inc.
See Page 1
See Page 1 See Page 1 See Page 1
25 Certificate of Liability Insurance
W36460619CERT:3725859BATCH:26854920SR ID:
POLICY NUMBER: 0310-4497 COMMERCIAL GENERAL LIABILITY
CG 20 10 10 01
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 10 10 01 © ISO Properties, Inc., 2000 Page 1 of 1
ADDITIONAL INSURED – OWNERS, LESSEES OR
CONTRACTORS – SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
Where required by written contract
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.)
A. Section II – Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations per-formed for that insured.
B. With respect to the insurance afforded to these additional insureds, the following exclusion is added:
2. Exclusions This insurance does not apply to "bodily inju-ry" or "property damage" occurring after:
(1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the addi-tional insured(s) at the site of the cov-ered operations has been completed;
or
(2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another con-tractor or subcontractor engaged in performing operations for a principal as a part of the same project.
Policy Term: December 1, 2024 - December 1, 2025
CG 20 37 10 01
CG 20 37 10 01 © ISO Properties, Inc., 2000 Page 1 of 1
ADDITIONAL INSURED – OWNERS, LESSEES OR
CONTRACTORS – COMPLETED OPERATIONS
Name of Person or Organization:
Location And Description of Completed Operations:
Additional Premium:
N/A
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.)
Section II – Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" at the location designated and described in the schedule of this endorsement performed for that insured and included in the "products-completed operations haz-ard".
CG 24 04 05 09
CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
Name Of Person Or Organization:
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Conditions:
We waive any right of recovery we may have against the person or organization shown in the Schedule above 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 the person or organization shown in the Schedule above.
Coverage Extension Endorsement
Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. Add’l. Prem Return Prem.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Business Auto Coverage Form Motor Carrier Coverage Form
A. Amended Who Is An Insured
1. The following is added to the Who Is An Insured Provision in Section II – Covered Autos Liability Coverage:
The following are also "insureds":
a. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow for acts performed within the scope of employment by you. Any “employee” of yours is also an “insured” while operating an “auto” hired or rented under a contract or agreement in an “employee’s” name, with your permission, while performing duties related to the conduct of your business.
b. Anyone volunteering services to you is an "insured" while using a covered "auto" you don’t own, hire or borrow to transport your clients or other persons in activities necessary to your business.
c. Anyone else who furnishes an "auto" referenced in Paragraphs A.1.a. and A.1.b. in this endorsement.
d. Where and to the extent permitted by law, any person(s) or organization(s) where required by written contract or written agreement with you executed prior to any "accident", including those person(s) or organization(s) directing your work pursuant to such written contract or written agreement with you, provided the "accident" arises out of operations governed by such contract or agreement and only up to the limits required in the written contract or written agreement, or the Limits of Insurance shown in the Declarations, whichever is less.
2. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance – Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form:
Coverage for any person(s) or organization(s), where required by written contract or written agreement with you executed prior to any "accident", will apply on a primary and non-contributory basis and any insurance maintained by the additional "insured" will apply on an excess basis. However, in no event will this coverage extend beyond the terms and conditions of the Coverage Form.
All other terms, conditions, provisions and exclusions of this policy remain the same.
U-CA-424-F CW (04/14)
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
BAP 3757423-09 07/01/2024 07/01/2025 07/01/2024
U-CA-424-G NY (09/17)
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
M. Temporary Substitute Autos – Physical Damage
1. The following is added to Section I – Covered Autos:
Temporary Substitute Autos – Physical Damage
If Physical Damage Coverage is provided by this Coverage Form on your owned covered "autos", the following types of vehicles are also covered "autos" for Physical Damage Coverage:
Any "auto" you do not own when used with the permission of its owner as a temporary substitute for a covered "auto" you do own but is out of service because of its:
1. Breakdown;
2. Repair;
3. Servicing;
4. "Loss"; or
5. Destruction.
2. The following is added to the Paragraph A. Coverage Provision of the Physical Damage Coverage Section:
Temporary Substitute Autos – Physical Damage
We will pay the owner for "loss" to the temporary substitute "auto" unless the "loss" results from fraudulent acts or omissions on your part. If we make any payment to the owner, we will obtain the owner's rights against any other party.
The deductible for the temporary substitute "auto" will be the same as the deductible for the covered "auto" it replaces.
N. Amended Duties In The Event Of Accident, Claim, Suit Or Loss
Paragraph a. of the Duties In The Event Of Accident, Claim, Suit Or Loss Condition is replaced by the following:
a. In the event of "accident", claim, "suit" or "loss", you must give us or our authorized representative prompt notice of the "accident", claim, "suit" or "loss". However, these duties only apply when the "accident", claim, "suit" or "loss" is known to you (if you are an individual), a partner (if you are a partnership), a member (if you are a limited liability company) or an executive officer or insurance manager (if you are a corporation). The failure of any agent, servant or employee of the "insured" to notify us of any "accident", claim, "suit" or "loss" shall not invalidate the insurance afforded by this policy.
Include, as soon as practicable:
(1) How, when and where the "accident" or "loss" occurred, and if a claim is made or "suit" is brought, written notice of the claim or "suit" including, but not limited to, the date and details of such claim or "suit";
(2) The "insured’s" name and address; and
(3) To the extent possible, the names and addresses of any injured persons and witnesses.
If you report an "accident", claim, "suit" or "loss" to another insurer when you should have reported to us, your failure to report to us will not be seen as a violation of these amended duties provided you give us notice as soon as practicable after the fact of the delay becomes known to you.
O. Waiver of Transfer Of Rights Of Recovery Against Others To Us
The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition:
This Condition does not apply to the extent required of you by a written contract, executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by such contract. This waiver only applies to the person or organization designated in the contract.
BAP 3757423-09
Eff: 7/1/2024-7/1/2025
WC 00 03 13
(Ed. 4-84) 1983 National Council on Compensation Insurance.
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13
(Ed. 4-84)
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.
Policy #WC 0380936-09
GL 00021 00 (07/09)
PRIMARY AND NON-CONTRIBUTORY
Notwithstanding any other provision of this policy to the contrary, the insurance afforded to an additional insured under this policy will be primary to, and non-contributory with, any other insurance available to that person or organization in the event a contract or agreement you enter into requires you to furnish insurance to that person or organization of the type provided by this policy.
10.0.2.20120224.1.869952
| DATE (MM/DD/YYYY): 12/03/2024 |
| PRODUCER: Willis Towers Watson Northeast, Inc. |
c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA
| FAX (A/C, No):: 1-877-945-7378 |
| FAX (A/C, No):: 1-888-467-2378 |
| FAX (A/C, No):: certificates@wtwco.com |
| NAIC #_INSURER A :: Allied World Assurance Company US Inc |
| NAIC #_INSURER A :: 19489 |
| INSURED: GHD Inc. |
3200 E Camelback Rd Suite 210 Phoenix, AZ 85018
| NAIC #_INSURER B :: Zurich American Insurance Company |
| NAIC #_INSURER C :: Beazley Insurance Company Inc |
| NAIC #_INSURER B :: 16535 |
| NAIC #_INSURER C :: 37540 |
| NAIC #_INSURER D :: |
| NAIC #_INSURER D :: |
| NAIC #_INSURER E :: |
| NAIC #_INSURER E :: |
| NAIC #_INSURER F :: |
| NAIC #_INSURER F :: |
| CERT_NUMBER: W36460619 |
| GL INSR LETTER: A |
| CGL_checkbox: Yes |
| Clams_Made_checkbox: 0 |
| Occur_checkbox: Yes |
| OTHER 1 checkbox: Off |
| OTHER 1 checkbox: Off |
| undefined: 1,000,000 |
| undefined: 1,000,000 |
| undefined: 50,000 |
| GL_OTHER_1_TYPE_OF_INS: |
| GL_OTHER_2_TYPE_OF_INS: |
| undefined: 1,000,000 |
| undefined: 2,000,000 |
| undefined: 2,000,000 |
| Gen_Agg_Policy_checkbox: 0 |
| Gen_Agg_Project_checkbox: Yes |
| Gen_Agg_Location_checkbox: 0 |
| INSR ADDL_Row_1: |
| WVD SUBR_Row_1: |
| POLICY NUMBER_Row_1: 0310-4497 |
| POLICY EFF (MM/DD/YYYY)_Row_1: 12/01/2024 |
| POLICY EXP (MM/DD/YYYY)_Row_1: 12/01/2025 |
| OTHER_LIMIT_DESC: |
| undefined: |
| ANY_AUTO_checkbox: Yes |
| AL INSR LETTER: B |
| undefined: 2,000,000 |
| NON-OWNED_AUTOS_checkbox: Yes |
| SCHEDULED_AUTOS_checkbox: 0 |
| ALL_OWNED_AUTOS_checkbox: 0 |
| HIRED_AUTO_checkbox: Yes |
| POLICY EXP (MM/DD/YYYY)_Row_1: 07/01/2025 |
| undefined: |
| POLICY EFF (MM/DD/YYYY)_Row_1: 07/01/2024 |
| undefined: |
| undefined: |
| AL_OTHER_1_checkbox: Yes |
| AL_OTHER_1_DESC: Coll Ded: $500 |
| PROPERTY DAMAGE (Per accident)_Row_1: Hired Physical Damage |
| AL_OTHER_2_checkbox: Yes |
| AL_OTHER_2_DESC: Comp Ded: $250 |
| INSR ADDL_Row_2: |
| WVD SUBR_Row_2: |
| POLICY NUMBER_Row_2: BAP 3757423-09 |
| undefined: 100,000.00 |
| UMB_LIAB: Off |
| UMB_EX_OCC: Off |
| UMB INSR LETTER: |
| undefined: |
| EX_LIAB_checkbox: Off |
| CLAIMS_MADE_checkbox: Off |
| RET_checkbox: Off |
| DED_checkbox: Off |
| DED_RET_AMOUNT: |
| INSR ADDL_Row_3: |
| WVD SUBR_Row_3: |
| POLICY NUMBER_Row_3: |
| POLICY EFF (MM/DD/YYYY)_Row_3: |
| POLICY EXP (MM/DD/YYYY)_Row_3: |
| undefined: |
| AGGREGATE_Row_1: |
| undefined: |
| POLICY NUMBER_N / A: WC 0380936-09 |
| STATUTORY: Yes |
| OTHER: Off |
| WC_OTHER_DESC: |
| WC INSR LETTER: B |
| WVD SUBR_N / A: |
| undefined: 1,000,000 |
| Y / N: No |
| POLICY EFF (MM/DD/YYYY)_Row_3: 07/01/2024 |
| POLICY EXP (MM/DD/YYYY)_Row_3: 07/01/2025 |
| undefined: 1,000,000 |
| undefined: 1,000,000 |
| OTHER 1 INSR LETTER: C |
| OTHER_1_TYPE_OF_INS: Professional Liability |
| OTHER_2_TYPE_OF_INS: |
| N / A_Row_1: |
| WVD SUBR_Row_5: |
| N / A_Row_1: |
| OTHER_1_LIMIT_OF_INS: Each Claim: |
| OTHER 2 INSR LETTER: |
| POLICY NUMBER_Row_5: V29594240601 |
| POLICY NUMBER_Row_5: |
| POLICY EFF (MM/DD/YYYY)_Row_5: 12/01/2024 |
| POLICY EFF (MM/DD/YYYY)_Row_5: |
| POLICY EXP (MM/DD/YYYY)_Row_5: 12/01/2025 |
| POLICY EXP (MM/DD/YYYY)_Row_5: |
| OTHER_2_LIMIT_OF_INS: Aggregate: |
| WVD SUBR_Row_5: |
| OTHER 3 INSR LETTER: |
| WVD SUBR_Row_5: |
| POLICY NUMBER_Row_5: |
| POLICY EFF (MM/DD/YYYY)_Row_5: |
| OTHER_3_TYPE_OF_INS: |
| N / A_Row_1: |
| POLICY EXP (MM/DD/YYYY)_Row_5: |
| OTHER_3_LIMIT_OF_INS: |
| DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required): GHD Project no.: 11206985, ADEQ Technical Assistance Contract CTR074222. |
State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are included as Additional Insureds as respects to General Liability and Auto Liability, where required by contract or agreement.
INSURED:
Arizona Department of Environmental Quality 1110 W. Washington Street Phoenix, AZ 85007
| AUTHORIZED REPRESENTATIVE: |
| BATCH_NUMBER: 3725859 |
| SR_NUMBER: 26854920 |
| SRID_label: SR ID: |
| Batch_label: BATCH: |
| GL_Agg_applies_per_Other_checkbox: 0 |
| GL_Agg_applies_per_Other: |
| OTHER_3_LIMIT_OF_INS_AMT3: |
| OTHER_2_LIMIT_OF_INS_AMT_2: $2,000,000 |
| OTHER_1_LIMIT_OF_INS_AMT_1: $2,000,000 |
| Contact_Name: WTW Certificate Center |
| DATE (MM/DD/YYYY): Page 1 of 2 |
File details come from the government source that posted it. Updated .