2025-07-15 Tata and Howard GAUW.pdf
PDF 3 MB Posted
- Attached to
- Master Agreement AZ|CTR074232
- Contract number
- CTR074232
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for Tata and Howard, Inc., issued by AAA Northeast Insurance Agency with Travelers Insurance Companies as the insurers. The certificate covers a contract (CTR074232) with the Arizona Department of Environment Quality for Capacity Development/Technical Assistance to Small Public Drinking Water Systems. The insurance policies provide coverage from July 15, 2024 to July 15, 2025, with the State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees listed as additional insureds.
The contract involves technical assistance services for small public drinking water systems, with multiple insurance coverages in place: Commercial General Liability ($1,000,000 per occurrence), Automobile Liability ($1,000,000), Umbrella Liability ($5,000,000), and Workers' Compensation ($1,000,000). The insurance policies include specific endorsements for architects, engineers, and surveyors, and provide additional coverage for incidents related to the contractor's operations. The certificate includes a 30-day cancellation provision and is specifically tied to the activities performed by Tata and Howard, Inc. involving owned, hired, and non-owned automobiles.
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Text version
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
INSR ADDL SUBR
LTR INSD WVD
PRODUCER CONTACT
NAME:
FAXPHONE
(A/C, No):(A/C, No, Ext):
ADDRESS:
INSURER A :
INSURED INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
POLICY NUMBER
POLICY EFF POLICY EXP
TYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)
AUTOMOBILE LIABILITY
UMBRELLA LIAB
EXCESS LIAB
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
EACH OCCURRENCE $
DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence)
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT
OTHER: $
COMBINED SINGLE LIMIT
$(Ea accident)
ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED
BODILY INJURY (Per accident) $AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE
$AUTOS ONLY AUTOS ONLY (Per accident)
OCCUR EACH OCCURRENCE
CLAIMS-MADE AGGREGATE $
DED RETENTION $
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below
INSURER(S) AFFORDING COVERAGE NAIC #
COMMERCIAL GENERAL LIABILITY
Y / N
N / A (Mandatory in NH)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
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.
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 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).
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
CERTIFICATE HOLDER CANCELLATION
© 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03)
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
The ACORD name and logo are registered marks of ACORD
11/4/2024
(413) 205-2423 (413) 205-2319
25666
Tata and Howard , Inc.
67 Forest Street Marlborough, MA 01752
A 1,000,000
X X 680-3J115327-24-47 7/15/2024 7/15/2025 1,000,000
5,000
1,000,000
2,000,000
2,000,000
1,000,000B
X X BA-9R32200A-24-47-G 7/15/2024 7/15/2025
5,000,000C
X X CUP-3555T177-24-47 7/15/2024 7/15/2025 5,000,000
10,000 A
X UB-7K27857A-24-47-G 7/15/2024 7/15/2025 1,000,000
1,000,000
1,000,000
Proof of Coverage Contract# CTR074232- Capacity Developement/Technical Assistance to Small Public Drinking Water Systems
State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees as additional insureds with respect to liability arising out of the activities performed by, or on behalf of, the Contractor involving automobiles owned, hired and/or non-owned by the Contractor.
30 day cancellation per written contract
Arizona Department of Enviroment Quality Contracts and Procurement 1110 W. Washington Street Phoenix, AZ 85007
TATAAND-01 NMORA
AAA Northeast Insurance Agency, Inc.
110 Royal Little Drive Providence, RI 02904
Nilsa Morales nmorales@aaanortheast.com
Travelers Indemnity Company of America Travelers Indemnity Co.
Travelers Property Casualty Company of America
X
X
X X
X
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