ACCEPTED ANY_ALL GL,AL,WC 07.01.23-07.01.24.pdf
PDF 4 MB Posted
- Attached to
- Master Agreement AZ|CTR069473
- Contract number
- CTR069473
- Issued by
- Arizona
About this file
This document is a comprehensive insurance certificate and series of endorsements issued by Zurich American Insurance Company and Travelers Property Casualty Company of America for Inland Kenworth (US), Inc., located in Tolleston, Arizona. The primary certificate of liability insurance is dated January 18, 2024, with coverage effective from July 1, 2023, to July 1, 2024. The certificate holder is the State of Arizona/ADOT (Arizona Department of Transportation), located in Phoenix, Arizona.
The insurance coverage includes Commercial General Liability, Automobile Liability, Umbrella Liability, and Workers' Compensation policies. Key coverage limits include $2,000,000 for each occurrence under the General Liability policy, $2,000,000 for Automobile Liability, $10,000,000 for Umbrella Liability, and $1,000,000 for Workers' Compensation. The policies are specifically verified for any and all work performed for or on behalf of the State of Arizona/ADOT, with the state being named as an Additional Insured. The coverage is primary and non-contributory, with a waiver of subrogation in favor of the Additional Insured across General Liability, Auto Liability, and Workers' Compensation policies. Multiple endorsements provide additional details about coverage conditions, definitions, and specific insurance provisions.
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Other files
| File | Type | Posted |
|---|---|---|
| ACCEPTED ANY_ALL GL,AL,WC 07.01.25-07.01.26.pdf | ||
| CTR069473_Pricing.xls | XLS spreadsheet | |
| CTR069473_Contract_Amendment_Summary_No_1.pdf | ||
| CTR069473_Contract_Amendment_2.pdf | ||
| CTR069473_Contract_Documents.pdf | ||
| Certificate_ADOT_10.30.24.pdf |
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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)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
1/18/2024
Arthur J. Gallagher Risk Management Services, LLC 6967 South River Gate Dr.
Suite 200 Salt Lake City UT 84047
Carolyn Maldonado 801-924-1400 801-294-1441 certrequests@ajg.com
Zurich American Insurance Company 16535 INLAKEN-01 Travelers Property Casualty Co of America 25674
Inland Kenworth (US), Inc, dba Inland Kenworth 8314 W. Roosevelt St.
Tolleston , AZ 85353
1117557256
A X 2,000,000 X 1,000,000
10,000
2,000,000
4,000,000 X
Y Y GLO038117008 7/1/2023 7/1/2024
4,000,000
A 2,000,000
X
Y Y GP038116908 7/1/2023 7/1/2024
B X X 10,000,000CUP2S41349423NF 7/1/2023 7/1/2024
10,000,000 X 10,000
A XY WC038116808 7/1/2023 7/1/2024
1,000,000
1,000,000
1,000,000 A Garage and Dealers GP038116908 7/1/2023 7/1/2024 Occurrence Limit
Aggregate Limit $2,000,000 $2,000,000
Verification of insurance subject to the terms and conditions of the policy RE: Any and all work performed for or on behalf of the State of Arizona/ADOT.
The State of Arizona/ADOT is Additional Insured with respect to General Liability and Auto Liability policy. Coverage is primary and non-contributory as long as no other insurance applies. Waiver of Subrogation applies in favor of Additional Insured with respect to General Liability, Auto Liability and Workers Compensation policies.
The State of Arizona/ADOT 206 S. 17th Ave Phoenix, AZ 85007
B6370 Accepted
GLO038117008 7/1/2023 7/1/20237/1/2024
GLO038117008
7/1/2023
GP038116908
GP038116908
7/1/2023
WC038116808 7/1/2023
7/1/2023GLO038117008
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