ACCEPTED ANY_ALL GL,AL,WC 11.01.24-11.01.25.pdf
PDF 353 KB Posted
- Attached to
- Master Agreement AZ|CTR069671
- Contract number
- CTR069671
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for Nutrien Ag Solutions, Inc. (formerly Crop Production Services Inc.), located in Loveland, CO. The insurance coverage involves multiple insurers, including XL Insurance America Inc., Greenwich Insurance Company, ACE American Insurance Company, and Indemnity Insurance Company of North America. The certificate is issued for the Arizona Department of Transportation (ADOT) Motor Vehicle Division and covers general liability, automobile liability, and workers' compensation policies with various endorsements.
The insurance policies are effective from November 1, 2024, to November 1, 2025, with coverage limits of $1,000,000 for general and automobile liability. The policies include additional insured provisions for the State of Arizona, its departments, agencies, boards, commissions, universities, and their officers, officials, agents, and employees. The coverage extends to any work performed on or behalf of ADOT and the State of Arizona, with waivers of subrogation and primary insurance clauses. The policies also include endorsements for automatic additional insured status and provisions for transferring rights of recovery, ensuring comprehensive protection for the state and its entities.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| AZDOT_2024_WVM_CATALOG_1-16-24.xlsx | XLSX spreadsheet | |
| CTR069671_Post_Award_Meeting_Sign-In_Sheet.pdf | ||
| ACCEPTED SIR GL 01.30.25-01.30.26.pdf | ||
| CTR069671_Contract_Amendment_Summary_One__1_.pdf | ||
| CTR069671_Contract_Documents.pdf | ||
| Contract_Amendment_Two__2_.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)
© 1988-2016 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
C 11/01/2024 of Marsh USA LLC
X
D
20702
10,000,000
N/A
SCF C72629061 (WI)
24554
A
11/01/2025 X
ACE American Insurance Company
CN101921609-STND-GAWUM-24-
1,000,000
22322
HOU-003239141-27
11/01/2024
X
1,000,000
02/04/2025
X
11/01/2025
Certificate Holder with respect to the General Liability and Workers Compensation policies, where required by written contract. Auto Policy includes XIC 411
11/01/2025
1,000,000
Indemnity Insurance Company of North America
1,000,000 1,000,000
B
11/01/2025
11/01/2024
22667
RAD9438042
5,000
11/01/2024
WLR C72629103 (AOS)
WLR C72629024 (AZ)
100,000
The State of Arizona, its departments, agencies, boards, commission, universities and its officers, officials, agents, and employees are included as Additional
Insured with respect to the General Liability and Auto Liability policies where required by written contract. A Waiver of Subrogation is included in favor of
Re: Any and all work performed on or behalf of ADOT and the State of Arizona
ACE Fire Underwriters Insurance Company f/k/a Crop Production Services Inc.
Nutrien Ag Solutions, Inc.
Loveland, CO 80538
3005 Rocky Mountain Ave
XL Insurance America Inc
X
Attn: Canada.Certrequest@marsh.com
Marsh Canada Limited
Calgary, AB T2P 0B4
Livingston Place, Suite 1100, 222- 3rd Avenue SW
US00103263LI24A
Greenwich Insurance Company
N
1801 WEST JEFFERSON STREET
PHOENIX, AZ 85001
ARIZONA DEPARTMENT OF TRANSPORTATION
MOTOR VEHICLE DIVISION
11/01/2024
F
N/A
1013 Endorsement and CA04441013 Endorsement. Workers Compensation includes WC 00 03 13 Endorsement.
SIR: $2,000,000
43575
X
11/01/2025
Cindy Lewis Accepted
ACORD 101 (2008/01)
The ACORD name and logo are registered marks of ACORD
© 2008 ACORD CORPORATION. All rights reserved.
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: FORM TITLE:
ADDITIONAL REMARKS
ADDITIONAL REMARKS SCHEDULE Page of
AGENCY CUSTOMER ID:
LOC #:
AGENCY
CARRIER NAIC CODE
POLICY NUMBER
NAMED INSURED
EFFECTIVE DATE:
Marsh Canada Limited placement, which is indicated here for your convenience.��
E. Berkley Insurance Company / Starr Insurance & Reinsurance Limited ��
The policies listed here were made by Marsh USA Inc. Marsh Canada Limited has only acted in the role of a consultant to the client with respect to this��
Nutrien Solutions��
Nutrien LTD��
Insurance afforded by the Policy(ies) stated herein is subject to the limits, Deductibles, Self-Insured Retention(s), exclusions, terms, and conditions of such��
San Antonio
Certificate of Liability Insurance
Nutrien Ag Solutions��
Policies. ��
Insurance Carrier Participation Continued: ��
Nutrien Holding Company��
Other Named Insured:�� f/k/a Crop Production Services Inc. �� Nutrien Ag Solutions, Inc.��
3005 Rocky Mountain Ave��
CN101921609
Loveland,CO 80538��
Cindy Lewis Highlight
Cindy Lewis Highlight
Cindy Lewis Highlight
Cindy Lewis Highlight
Cindy Lewis Highlight
POLICY NUMBER: US00103263LI24A COMMERCIAL GENERAL LIABILITY
Effective Date: November 01, 2024 CG 20 26 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 26 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1
ADDITIONAL INSURED – DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s):
Any person or organization that you are required in a written contract or written agreement to include as an additional insured provided the “Bodily Injury” or “Property Damage” occurs subsequent to the execution of the written contract or written agreement.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf:
1. In the performance of your ongoing operations;
or
2. In connection with your premises owned by or rented to you.
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable limits of insurance;
whichever is less.
This endorsement shall not increase the applicable limits of insurance.
POLICY NUMBER: US00103263LI24A COMMERCIAL GENERAL LIABILITY
Effective Date: November 01, 2024 CG 24 04 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
ELECTRONIC DATA LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES
POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS
SCHEDULE
Name Of Person(s) Or Organization(s):
Any person or organization that you are required in a written contract or written agreement to waive any right of recovery we may have against the person or organization, provided the “Bodily Injury” or “Property Damage” occurs subsequent to the execution of the written contract or written agreement.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Conditions:
We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above.
XIL 424 0605
©, 2005, XL America, Inc.
ENDORSEMENT #
This endorsement, effective 12:01 a.m., November 01, 2024, forms a part of Policy No. US00103263LI24A issued to Nutrien Ltd by XL Insurance America, Inc.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY INSURANCE CLAUSE ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS COVERAGE PART
It is agreed that to the extent that insurance is afforded to any Additional Insured under this policy, this insurance shall apply as primary and not contributing with any insurance carried by such Additional Insured, as required by written contract.
All other terms and conditions of this policy remain unchanged.
ENDORSEMENT #
This endorsement, effective 12:01 a.m., November 1, 2024, forms a part of
Policy No. RAD9438042-04 issued to Nutrien Ltd.
by Greenwich Insurance Company.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AUTOMATIC ADDITIONAL INSURED
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
AUTO DEALERS COVERAGE FORM
A. COVERED AUTOS LIABILITY COVERAGE, Who Is An Insured, is amended to include as an “insured” any person or organization you are required in a written contract to name as an additional insured, but only for “bodily injury” or "property damage" otherwise covered under this policy caused, in whole or in part, by the negligent acts or omissions of:
1. You, while using a covered “auto”; or
2. Any other person, except the additional insured or any employee or agent of the additional insured, operating a covered “auto” with your permission;
Provided that:
a. The written contract is in effect during the policy period of this policy;
b. The written contract was signed by you and executed prior to the “accident” causing “bodily injury” or “property damage” for which liability coverage is sought; and
c. Such person or organization is an “insured” solely to the extent required by the contract, but in no event if such person or organization is solely negligent.
B. The Limits of Insurance provided for the Additional Insured shall not be greater than those required by contract and, in no event shall the Limits of Insurance set forth in this policy be increased by the contract.
C. General Conditions, Other Insurance is amended as follows:
Any coverage provided hereunder shall be excess over any other valid and collectible insurance available to the additional insured whether such insurance is primary, excess, contingent or on any other basis unless the contract specifically requires that this policy be primary.
All terms, conditions, exclusions and limitations of this policy shall apply to the liability coverage provided to any additional insured, and in no event shall such coverage be enlarged or expanded by reason of the contract.
All other terms and conditions of this policy remain unchanged.
XIC 411 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 1 of 1 May not be copied without permission.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
POLICY NUMBER: RAD943804204 COMMERCIAL AUTO
CA 04 44 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.
SCHEDULE
Name(s) Of Person(s) Or Organization(s):
Any person or organization where required by written contract provided that such contract was executed prior to the date of loss.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization.
CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1
Named Insured: NUTRIEN LTD.
Endorsement Effective Date: November 1, 2024
| ADOT Self-Insured Retention Letter Template.pdf (p.1) |
| Untitled.pdf (p.2-13) |
| ARIZONA DEPARTMENT OF TRANSPORTATION.pdf (p.1-2) |
| Endorsement - 2024-2025 - Auto - CA04441013 Waiver of Sub.pdf (p.3) |
| Endorsement - 2024-2025 - Auto - CA04491116 PNC.pdf (p.4) |
| Endorsement - 2024-2025 - Auto - XIC 411 1013 AI Automatic.pdf (p.5) |
| AUTOMATIC ADDITIONAL INSURED |
| Business Auto Coverage Form |
| Endorsement - 2024-2025 - GL - ADDITIONAL INSURED - DESIGNATED.pdf (p.6) |
| CG 20 26 12 19 -blanket |
| Endorsement - 2024-2025 - GL - Primary Insurance.pdf (p.10) |
| Endorsement - 2024-2025 - GL - WAIVER OF SUBROGATION.pdf (p.11) |
| CG 24 04 12 19 -blanket |
Endorsement - 2024-2025 - WC - Waiver of Subrogation .pdf (p.12)
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