ACCEPTED ANY_ALL GL,AL,WC,INSTALL FLOATER 11.30.24-11.30.25.pdf
PDF 5 MB Posted
- Attached to
- Master Agreement AZ|CTR064363
- Contract number
- CTR064363
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for CS Construction, Inc., located in Phoenix, Arizona, issued by Reseco Insurance Advisors, LLC. The certificate involves multiple insurance carriers, including Travelers Property Casualty Company of America, The Phoenix Insurance Company, CopperPoint Western Insurance Company, Hanover Insurance Company, and Greenwich Insurance Company. The insurance is specifically applicable to work performed for the Arizona Department of Transportation (ADOT), with coverage effective from 11/30/2024 to 11/30/2025.
The insurance package provides comprehensive coverage across multiple domains, including Commercial General Liability (with a $1,000,000 per occurrence limit), Automobile Liability, Umbrella Liability (with a $10,000,000 limit), Workers' Compensation, Professional Liability, Pollution Liability, and Cyber Liability. Additional specialized coverages include a Builders Risk/Installation Floater with a $2,000,000 limit and Technology Errors & Omissions with a $5,000,000 limit. The policy includes blanket additional insured provisions for governmental entities, waiver of subrogation, and coverage for work performed on behalf of the State of Arizona, with specific exclusions for certain officers and comprehensive protection across various operational risks.
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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
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
1/8/2025
Reseco Insurance Advisors, LLC 7901 N. 16th Street, Suite 100 Phoenix AZ 85020
602-753-4250 602-419-2242 certificates@resecoadvisors.com
Travelers Property Casualty Co of Amer 25674 5830 The Phoenix Insurance Company 25623
CS Construction, Inc.
22023 North 20th Avenue Phoenix AZ 85027
CopperPoint Western Insurance Company 13209 Hanover Insurance Company 22292 Greenwich Insurance Company 22322
1416493504
B X 1,000,000 X 300,000
X $5,000 PD Ded 10,000
1,000,000
2,000,000 X
Y Y DT-CO-3X116500-PHX-24 11/30/2024 11/30/2025
2,000,000
A 1,000,000
X
X X X HA Phys Dam
Y Y 810-3X080492-23-26-G 11/30/2024 11/30/2025
Comp/Coll Deductibles 1,000/$1,000 A X 10,000,000
X
CUP-7S273365-27-NF 11/30/2024 11/30/2025
10,000,000 X 10,000
C X
Y
Y 1019352 11/30/2024 11/30/2025
1,000,000
1,000,000
1,000,000 D E
Professional Liability Pollution Liability Cyber Liability
LH4-J199858-03
PEC003929812
11/30/2024 11/30/2024
11/30/2025 11/30/2025
Aggregate Limit Each Occurrence Occurrence/Aggregate
5,000,000 5,000,000
3MM/3MM
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holders and those parties, required by written contract, are included as Additional Insured with respects to the General Liability, Automobile Liability and Excess/Umbrella Liability on a primary and non-contributory basis, subject to all provisions and limitations of the policy. Waiver of Subrogation in favor of Certificate Holder and those parties required, by written contract, applies to the General Liability, Automobile Liability and Employers Liability/Workers Compensation, subject to all provisions and limitations of the policy.
This certificate applies for any and all work performed for or on behalf of the State of Arizona/Arizona Department of Transportation Excluded officers Zachary Teegarden and Ross Genebacher Builders Risk/Installation Floater: Limit: $2,000,000 Carrier/NAIC #: Travelers Casualty Insurance Company of America / 19046 See Attached...
ADOT
1655 W. Jackson Street - MD 100P Phoenix AZ 85007
Cindy Lewis Highlight
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:
1 1
Reseco Insurance Advisors, LLC CS Construction, Inc.
22023 North 20th Avenue Phoenix AZ 85027
25 CERTIFICATE OF LIABILITY INSURANCE
Policy Number: QT-630-4X620984-TIL-23 Policy Term: 11/30/2024-11/30/2025
Technology Errors & Omissions: Limit $5,000,000 Carrier/NAIC #: Greenwich Insurance Company / 22322 Policy Number: PEC003929811 Policy Term: 11/30/2024-11/30/2025
Cindy Lewis Highlight
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
XTEND ENDORSEMENT FOR CONTRACTORS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
GENERAL DESCRIPTION OF COVERAGE – This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered.
A. Who Is An Insured – Unnamed Subsidiaries C. Incidental Medical Malpractice
B. Blanket Additional Insured – Governmental D. Blanket Waiver Of Subrogation Entities – Permits Or Authorizations Relating To
E. Contractual Liability – Railroads Operations
F. Damage To Premises Rented To You
PROVISIONS a. An organization other than a partnership, joint venture or limited liability company; or
A. WHO IS AN INSURED – UNNAMED
b. A trust;SUBSIDIARIES
The following is added to SECTION II – WHO IS as indicated in its name or the documents that AN INSURED: govern its structure.
Any of your subsidiaries, other than a partnership, B. BLANKET ADDITIONAL INSURED – joint venture or limited liability company, that is GOVERNMENTAL ENTITIES – PERMITS OR not shown as a Named Insured in the AUTHORIZATIONS RELATING TO OPERATIONS Declarations is a Named Insured if:
The following is added to SECTION II – WHO IS
a. You are the sole owner of, or maintain an
AN INSURED:
ownership interest of more than 50% in, such
Any governmental entity that has issued a permitsubsidiary on the first day of the policy period;
or authorization with respect to operationsand performed by you or on your behalf and that you
b. Such subsidiary is not an insured under are required by any ordinance, law, building code similar other insurance.
or written contract or agreement to include as an
No such subsidiary is an insured for "bodily injury" additional insured on this Coverage Part is an or "property damage" that occurred, or "personal insured, but only with respect to liability for "bodily injury", "property damage" or "personal andand advertising injury" caused by an offense advertising injury" arising out of such operations.committed:
The insurance provided to such governmentala. Before you maintained an ownership interest entity does not apply to:of more than 50% in such subsidiary; or
a. Any "bodily injury", "property damage" orb. After the date, if any, during the policy period "personal and advertising injury" arising out ofthat you no longer maintain an ownership operations performed for the governmentalinterest of more than 50% in such subsidiary.
entity; or
For purposes of Paragraph 1. of Section II – Who
b. Any "bodily injury" or "property damage"Is An Insured, each such subsidiary will be included in the "products-completed deemed to be designated in the Declarations as:
operations hazard".
CG D3 16 02 19 ú 2017 The Travelers Indemnity Company. All rights reserved. Page 1 of 3 Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Policy Number: DT-CO-3X116500-PHX-23
C. INCIDENTAL MEDICAL MALPRACTICE pharmaceuticals committed by, or with the knowledge or consent of, the insured.1. The following replaces Paragraph b. of the definition of "occurrence" in the 5. The following is added to the DEFINITIONS DEFINITIONS Section: Section:
b. An act or omission committed in providing "Incidental medical services" means:
or failing to provide "incidental medical
a. Medical, surgical, dental, laboratory, x-ray services", first aid or "Good Samaritan or nursing service or treatment, advice orservices" to a person, unless you are in instruction, or the related furnishing ofthe business or occupation of providing food or beverages; orprofessional health care services.
b. The furnishing or dispensing of drugs or2. The following replaces the last paragraph of medical, dental, or surgical supplies orParagraph 2.a.(1) of SECTION II – WHO IS appliances.AN INSURED:
6. The following is added to Paragraph 4.b.,Unless you are in the business or occupation Excess Insurance, of SECTION IV –of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do COMMERCIAL GENERAL LIABILITY not apply to "bodily injury" arising out of CONDITIONS:
providing or failing to provide:
This insurance is excess over any valid and
(a) "Incidental medical services" by any of collectible other insurance, whether primary, your "employees" who is a nurse, nurse excess, contingent or on any other basis, that assistant, emergency medical technician is available to any of your "employees" for or paramedic; or "bodily injury" that arises out of providing or failing to provide "incidental medical services"(b) First aid or "Good Samaritan services" by to any person to the extent not subject toany of your "employees" or "volunteer workers", other than an employed or Paragraph 2.a.(1) of Section II – Who Is An volunteer doctor. Any such "employees" Insured.
or "volunteer workers" providing or failing
D. BLANKET WAIVER OF SUBROGATION
to provide first aid or "Good Samaritan
The following is added to Paragraph 8., Transferservices" during their work hours for you Of Rights Of Recovery Against Others To Us,will be deemed to be acting within the of SECTION IV – COMMERCIAL GENERALscope of their employment by you or performing duties related to the conduct LIABILITY CONDITIONS:
of your business. If the insured has agreed in a contract or
3. The following replaces the last sentence of agreement to waive that insured's right of
Paragraph 5. of SECTION III – LIMITS OF recovery against any person or organization, we INSURANCE: waive our right of recovery against such person or organization, but only for payments we makeFor the purposes of determining the because of:applicable Each Occurrence Limit, all related acts or omissions committed in providing or a. "Bodily injury" or "property damage" that failing to provide "incidental medical occurs; or services", first aid or "Good Samaritan
b. "Personal and advertising injury" caused byservices" to any one person will be deemed to an offense that is committed;be one "occurrence".
4. The following exclusion is added to subsequent to the execution of the contract or
Paragraph 2., Exclusions, of SECTION I – agreement.
COVERAGES – COVERAGE A – BODILY
E. CONTRACTUAL LIABILITY – RAILROADSINJURY AND PROPERTY DAMAGE
LIABILITY: 1. The following replaces Paragraph c. of the definition of "insured contract" in theSale Of Pharmaceuticals DEFINITIONS Section:
"Bodily injury" or "property damage" arising out of the violation of a penal statute or c. Any easement or license agreement;
ordinance relating to the sale of
Page 2 of 3 ú 2017 The Travelers Indemnity Company. All rights reserved. CG D3 16 02 19
2. Paragraph f.(1) of the definition of "insured a. Any premises while rented to you or contract" in the DEFINITIONS Section is temporarily occupied by you with permission deleted. of the owner; or
F. DAMAGE TO PREMISES RENTED TO YOU b. The contents of any premises while such premises is rented to you, if you rent suchThe following replaces the definition of "premises premises for a period of seven or fewerdamage" in the DEFINITIONS Section:
consecutive days.
"Premises damage" means "property damage" to:
CG D3 16 02 19 ú 2017 The Travelers Indemnity Company. All rights reserved. Page 3 of 3
Policy Number: DT-CO-3X116500-PHX-23
Policy No. DT-CO-3X116500-PHX-24
Policy Number: 810-3X080492-23-26-G
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13
(Ed. 4-84)
WC 00 03 13
(Ed. 4-84)
© 1983 National Council on Compensation Insurance.
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
11/30/2023Endorsement Effective 1019352Policy No. 22Endorsement No.
CS Construction IncInsured Premium $
Pacific Compensation Insurance CompanyInsurance Company Countersigned by
This document may have been uploaded to the CopperPoint Portal.
Blanket Waiver: Anyone for whom you have agreed to provide this Waiver subject to the terms of this endorsement
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us).
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule State Blanket/Schedule/State
AZ BLANKET
| 24-25 GL PNC CS Construction Inc. |
| COI GL AL WC IF-11-30-25 |
| azdot CG AI Scheduled 20 10 04 13 (004) |
| Untitled Extract Pages.pdf |
COI - CS Construction Inc. _ ADOT _ (002)
| COi_GL AL WC IF-11-30-25.pdf |
| 24-25 GL PNC CS Construction Inc. |
| COI GL AL WC IF-11-30-25 |
| azdot CG AI Scheduled 20 10 04 13 (004) |
| Untitled Extract Pages.pdf |
COI - CS Construction Inc. _ ADOT _ (002)
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