ACCEPTED ANY_ALL WC 01.01.25-01.01.26.pdf

This document is a Certificate of Liability Insurance issued by USI Insurance Services LLC for Courtesy Chevrolet, located in Phoenix, Arizona. The certificate lists CopperPoint American Insurance Company as the primary insurer with NAIC number 13751. The certificate holder is the Arizona Department of Transportation, located at 1324 N. 22nd Ave MD 128A in Phoenix, Arizona.

The insurance policy includes Workers' Compensation coverage with policy number 1020186, effective from 01/01/2025 to 01/01/2026. The policy provides workers' compensation coverage with limits of $1,000,000 per accident, per employee disease, and policy limit. The description of operations indicates "Various Works and Projects" and notes that Proprietors/Partners/Executive Officers/Members William Grumwell and Scott Grumwell are excluded from the coverage. The total premium for this policy is $2,210.00. An additional endorsement is included that outlines a waiver of the insurance company's right to recover payments from other liable parties.