ACCEPTED_ANY_ALL_SIR_GL_11.25.24-11.25.25.pdf
PDF 172 KB Posted
- Attached to
- Master Agreement AZ|CTR066557
- Contract number
- CTR066557
- Issued by
- Arizona
About this file
This document is a Self-Insured Retention (SIR) Practices letter from the Arizona Department of Transportation (ADOT) addressed to SiteOne Landscape Supply, a business operating in Arizona. The document outlines the company's self-insurance arrangements for general liability, auto liability, and workers' compensation, which have been approved by the Motor Vehicle Division (MVD) and Arizona Industrial Commission, respectively.
The document details SiteOne Landscape Supply's self-insurance coverage up to $1.2 Million per occurrence, as specified in an agreement with ADOT for permitted and non-public use of Arizona's right-of-way. The company agrees to maintain adequate retained earnings to meet these self-insuring obligations and will provide annual reports upon request. ADOT is granted additional insured status for vehicle and general liability, with coverages limited to the ADOT Permit Insurance Matrix. The company also waives subrogation rights for claims arising from work performed within the ADOT right-of-way, assuming full responsibility for responding to losses as a standard insurance policy would.
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Text version
The State of Arizona Arizona Department of Transportation 1324 N. 22nd Avenue, MD 128A Phoenix, AZ 85009
RE: General Liability, Auto Liability, and Workers' Compensation Self-Insured Retention (SIR) Practices for _____________________________
__________________________________, hereinafter referred to as "The Company", is a business with operations in Arizona. Based on its financial condition, The Company utilizes an SIR mechanism as an equivalent to third-party provided insurance for portions of its aggregate general liability risk. Auto liability self-insurance has been approved by MVD via self-insurance application process and an official MVD issued self-insurance certificate is attached. Workers' compensation self-insurance coverage has been approved according to all applicable statutory requirements and can be verified through the Arizona Industrial Commission.
Under the SIR, The Company self-insures for these risks at the level and dollar amounts, up to $___Million, on a per occurrence basis, as specified under the Agreement between The Company and ADOT for permitted and non-public use of the State of Arizona's and/or ADOT's right-of-way.
The Company maintains adequate levels of retained earnings to meet these self-insuring obligations. Copies of the Annual Report are available and electronic copies will be provided upon request.
The Company agrees to waive its rights of recovery in subrogation as to ADOT, its officials and employees for all claims, damages, losses, liabilities, or expenses relating to, arising from, resulting from work performed by or on behalf of The Company within the ADOT right-of-way, to the extent proceeds received under such self-insurance cover any such claim or damage.
ADOT shall have additional insured status with respect to The Company's self-insured vehicle liability and general liability insurance to the scope and extent of ISO Form CG20101185; and with all stated coverages limited to the amounts specified in the ADOT Permit Insurance Matrix.
As part of the SIR, The Company assumes responsibility to respond to any such loss or risk, to the extent that standard insurer policies would respond to an insurable loss.
Sincerely, Digital Signature (required)
Name of Company Representative
Title of Company Representative
Date (MM/DD/YYYY)
Company Name
11/25/2024
SiteOne Landscape Supply
SiteOne Landscape Supply
1/2
Keith O. McGinty
Director
Keith O.
McGinty
Digitally signed by Keith O. McGinty Date: 2024.11.25 15:41:18 -05'00'
ACCEPTED
ADOT Risk Management
File details come from the government source that posted it. Updated .