23-24_COI_CTR055619.pdf

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

E-MAIL

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

X

D

C

10/01/22

10/01/23

10/01/23

07/17/2023

1000067113221

Nick Brown

X

10/01/23

ATLANTIC SPECIALTY INS CO

PINNACOL ASSUR

ZURICH AMER INS CO

FIREMENS INS CO OF WASHINGTON DC

STARR SURPLUS LINES INS CO

1,000,000

1,000,000

100,000

Liability and Automobile Liability with respect to the above referenced.

commissions, universities, officers, officials, agents, and employees applies to Worker's Compensation, General

69296877

69296877 of Subrogation in favor of Arizona Game and Fish Department, State of Arizona, and its departments, agencies, boards, contributory basis with respect to the above referenced. As required by written contract or written agreement, a Waiver employees are included as Additional Insured under General Liability and Automobile Liability on a primary and non State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and Contract Number:CTR055619 As required by written contract or written agreement, Arizona Game and Fish Department, X

27154

41190

16535

X

21784

13604

2,000,000 smartinezurrutiaco

Pollution/Professional Liab.

Leased/Rented Equipment

Installation Floater

X

X

BI/PD Ded: $2,500

4226286

WC298299505

CPA328385021

Phoenix, AZ 85086-0000

10/01/23

X

Holmes Murphy & Associates - CO

10/01/22

10/01/22

10/01/22

1000067113221

8,000,000

10/01/22

1-844-484-7750

CPA328385021

7900359570000

7600 East Orchard Road, Suite 230 South

X

USA

Greenwood Village, CO 80111

1,000,00010/01/22

10/01/22

8,000,000

10/01/23

2,500Ded

1,000Ded

2,500Ded

NBrown@holmesmurphy.com

1,000,000

10/01/23

10/01/23

10/01/22

10/01/23

X

Arvada, CO 80004

A

1,000,000

Arizona Game and Fish Department;Purchasing Office

5,000

A

X

A

720-458-5770

B

E

14045 West 66th Avenue

$1Mil Occ/$2Mil Agg

$1,000,000 Limit

$1,000,000 Limit

2,000,000

N

X

Metals Treatment Technologies, LLC

1,000,000

5000 West Carefree Highway

B

1000337409221

SUPP (10/00)

SUPPLEMENT TO CERTIFICATE OF INSURANCE

DATE

NAME OF INSURED:

Metals Treatment Technologies, LLC

07/17/2023