ACCEPTED ANY_ALL GL,AL,WC 05.26.23-05.26.24.pdf
PDF 11 MB Posted
- Attached to
- Master Agreement AZ|CTR066172
- Contract number
- CTR066172
- Issued by
- Arizona
About this file
This document is a Business Liability Insurance Certificate issued by Brown & Brown of Florida, Inc. for Gridmatrix, Inc., with insurance coverage provided by Sentinel Insurance Company, Ltd. and Hartford Casualty Insurance Company. The policy is effective from 05/26/2023 to 05/26/2024 and covers multiple states including California, Arizona, Oregon, Colorado, and Idaho. The certificate holder is the Arizona Department of Transportation, located in Phoenix, AZ.
The insurance policy provides comprehensive business liability coverage with various limits, including $1,000,000 for each occurrence, $2,000,000 general aggregate, and $1,000,000 for personal and advertising injury. Additional coverages include automobile liability, umbrella liability, and workers' compensation. The policy includes a waiver of subrogation and lists the State of Arizona and its departments, agencies, boards, commissions, universities, officers, and employees as additional insureds. The policy covers potential bodily injury, property damage, and other liability risks associated with Gridmatrix, Inc.'s business operations, with a 10-day notice of cancellation provision.
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Text version
06/16/2023
Brown & Brown of Florida, Inc.
2290 Lucien Way, Suite 400
Maitland FL 32751
Shelley Clark
(321) 214-2304 (407) 660-2012
Shelley.clark@bbrown.com
Gridmatrix, Inc.
2443 Fillmore St. #380-6286
San Francisco CA 94115
Sentinel Insurance Company, Ltd. 11000 Hartford Casualty Insurance Company 29424
CL2361513472
A Y Y 21SBAVL5754 05/26/2023 05/26/2024
1,000,000 100,000 10,000 1,000,000 2,000,000 2,000,000
HNOA 1,000,000
A Y Y 21SBAVL5754 05/26/2023 05/26/2024
1,000,000
A 10,000
21SBAVL5754 05/26/2023 05/26/2024
5,000,000 5,000,000
B N 21WECAX5MP7 05/26/2023 05/26/2024
1,000,000 1,000,000 1,000,000
State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are listed as additional insureds with regards to General liability and Auto liability if required by written contract. A waiver of subrogation applies to all of the additional insureds with regards to general liability and Auto liability.
10 day notice of cancellation applies.
Arizona Department of Transportation 1655 W. Jackson St., MD 100P
Phoenix AZ 85007
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
a8812 Accepted
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