22533175_Dawson_Global__LLC.pdf
PDF 57 KB Posted
- Attached to
- Master Agreement AZ|CTR068575
- Contract number
- CTR068575
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for Dawson Global, LLC, issued by Lockton Companies, LLC, with multiple insurance providers including Crum & Forster Specialty Insurance Company, Starstone National Insurance Company, The Insurance Company of the State of Pennsylvania, and United States Fire Insurance Company. The certificate is issued for the State of Arizona Game and Fish Department, located in Phoenix, Arizona, and covers the period from 1/1/2025 to 1/1/2026.
The insurance coverage includes Commercial General Liability with a $5,000,000 aggregate limit, Automobile Liability with $1,000,000 per occurrence, and Workers' Compensation with statutory limits. Additionally, the policy provides Excess Liability coverage from three different insurers: Crum & Foster ($1,000,000), Colony Insurance ($5,000,000), and Hamilton Syndicate at Lloyds of London ($5,000,000). A Cyber Liability policy from Lexington Insurance Company offers $5,000,000 in coverage with a $150,000 retention. The certificate includes additional insured provisions for the State of Arizona and its departments, with a 30-day cancellation notice requirement.
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Text version
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
INSR ADDL SUBR
LTR INSD WVD
DATE (MM/DD/YYYY)
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 RENTED
CLAIMS-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 AGG $JECT
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 LIMIT $DESCRIPTION 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.
The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03)
CERTIFICATE OF LIABILITY INSURANCE
Lockton Companies, LLC
DBA Lockton Insurance Brokers, LLC in CA
CA license #0F15767
1185 Avenue of the Americas, Ste. 2010
New York NY 10036
(646) 572-7300
Dawson Global, LLC 900 Fort Street Mall Suite 1850 Honolulu, HI 96813
Crum & Forster Specialty Insurance Co 44520
United States Fire Insurance Company 21113
--- SEE ATTACHMENT ---
Starstone National Insurance Company 25496 The Insurance Company of the State of Pennsylvania 19429
X X
5,000,000 100,000 5,000 5,000,000 5,000,000 5,000,000
X
XXXXXXX
1,000,000 1,000,000 1,000,000
XXXXXXX
X
XXXXXXX
XXXXXXX
XXXXXXX
N
X
1,000,000 1,000,000 1,000,000
Defense Base Act Defense Base Act- Subcontactors
Limits: Statutory EL: 1M/1M/1M Limits: Statutory EL: 1M/1M/1M
E 1337576859 1/1/2025 1/1/2026
A EPK-150216 1/1/2025 1/1/2026
C 19600606 11/6/2024 11/6/2025 C 19600607 11/6/2024 11/6/2025
D See Attached 1/1/2025 1/1/2026
B T10230829(AOS) 12/31/2024 12/31/2025
B T10240830(FL) 12/31/2024 12/31/2025
11/6/2025
1564749
Y Y
Y Y
N N
Y
10/22/2025
N N
22533175
22533175 XXXXXXX
THE STATE OF ARIZONA
GAME AND FISH DEPARTMENT
5000 W. CAREFREE HIGHWAY
Phoenix, AZ 85086-5000
THE STATE OF ARIZONA, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are included as Additional Insureds on the General Liability and Automobile Liability as required by written contract. Waiver of Subrogation applies in favor of Additional Insured under the General Liability, Automobile Liability and Worker’s Compensation as required by written contract. 30-day notice of cancellation included.
X
See Attachment
Lockton Companies
(202) 414-2400 DawsonCertRequests@lockton.com
Dawson Global, LLC
1/01/2025 – 1/01/2026
Excess Liability
Coverage Issuing Company Policy Number Policy Term Limits
First Excess General Liability/Professional Liability/Pollution
Crum & Foster Specialty Insurance Company
EFX-127430 1/01/2025 –
1/01/2026
$1,000,000 each occ./ claim and aggregate
Second Excess GL/Professional/Pollution & Auto
Colony Insurance Company
EXO4278359 1/01/2025 –
1/01/2026
$5,000,000 each occurrence and aggregate
Third Excess GL/Professional/Pollution & Auto
Hamilton Syndicate 4000 at Lloyds of London
ENVXSS510384 1/01/2025 –
1/01/2026
$5,000,000 each occurrence and aggregate
Cyber Liability
Coverage Issuing Company Policy Number Policy Term Limits Retention
Cyber Lexington Insurance Company
02-823-58-63 1/01/2025 – 1/01/2026
$5,000,000 $150,000
Attachment Code: D675748 Master ID: 1564749, Certificate ID: 22533175
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