ACCEPTED ANY_ALL GL,WC 06.18.25-06.18.26.pdf
PDF 10 MB Posted
- 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
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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