ACCEPTED ANY_ALL GL,WC 06.18.25-06.18.26.pdf

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Attached to
Master Agreement AZ|CTR077358
Contract number
CTR077358
Issued by
Arizona

About this file

This document is a Certificate of Liability Insurance and Business Liability Coverage Form issued by The Hartford for Jess Recruiting LLC, located in Chandler, Arizona. The policy is specifically designed to provide insurance coverage for the company, with the State of Arizona/Arizona Department of Transportation (ADOT) listed as the certificate holder. The insurance policies include Commercial General Liability and Workers' Compensation coverage, with policy numbers 46 SBM BT6XBX and 46 WEC BT7RZG, respectively, effective from 06/18/2025 to 06/18/2026.

The insurance policy provides comprehensive coverage with several key provisions, including listing the Arizona Department of Transportation as an Additional Insured with a waiver of subrogation. The Commercial General Liability coverage includes a $1,000,000 each occurrence limit, $2,000,000 general aggregate limit, and $1,000,000 personal and advertising injury limit. The policy also includes medical expenses coverage with a $10,000 limit. The Workers' Compensation coverage provides $1,000,000 for each accident, each employee disease, and policy disease limit. A 30-day notice of cancellation applies, and the insurance is designated as primary and non-contributory. The policy covers various business liability risks and excludes specific types of potential claims and damages.

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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

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

6/30/2025

The Hulett Agency Inc.

185. S. Kimball Ave. #110

Southlake TX 76092

Jenny Sevy

(817) 592-5379 (817) 461-3254 jenny@hulettinsurance.com

Jess Recruiting LLC

1255 North Arizona Avenue #1142

Chandler AZ 85225

PROPERTY & CAS INS CO OF HARTFORD 34690

HARTFORD CAS INS CO 29424

A

Y Y 46 SBM BT6XBX 06/18/2025 06/18/2026

1,000,000

1,000,000

10,000

1,000,000

2,000,000

2,000,000

B Y Y 46 WEC BT7RZG 06/18/2025 06/18/2026

1,000,000

1,000,000

1,000,000

Arizona Department of Transportation is listed as Additional Insured. A waiver of subrogation applies in favor of Arizona Department of Transportation. Insurance is primary and non-contributory. A 30 day notice of cancellation applies

The State of Arizona/ADOT

206 S. 17th Ave

Phoenix AZ 85007

Cindy Lewis GL Only

Cindy Lewis WC Only

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