ACCEPTED ANY_ALL WC 09.01.24-09.01.25.pdf

This document is an ACORD Certificate of Liability Insurance and a Workers Compensation and Employers Liability Insurance Policy Endorsement for Mertens Heavy Equipment Repair LLC, located in Kingman, Arizona. The insurance is issued by CopperPoint Indemnity Insurance Company and is specifically accepted by ADOT (Arizona Department of Transportation) Risk Management. The certificate is dated 3/14/2025 with a policy number WC1034985, effective from 9/1/2024 to 9/1/2025.

The workers compensation policy provides coverage with statutory limits of $1,000,000 for each accident, each employee disease, and policy disease limit. The policy includes a waiver of subrogation endorsement, which means the insurance company limits its right to recover payments from other parties when the insured performs work under a written contract. The total premium for this policy is $766.00. The certificate holder is ADOT, located at 1655 W. Jackson St. in Phoenix, Arizona, indicating this insurance likely supports a state or local government contract for equipment repair services.