ACCEPTED_CTR059067_GL__AL__WC__TECH_01.01.23_-_01.01.24.pdf
PDF 16 MB Posted
- Attached to
- Master Agreement AZ|CTR059067
- Contract number
- CTR059067
- Issued by
- Arizona
About this file
This document is a comprehensive insurance certificate and associated endorsements for Wunderlich-Malec Engineering Inc., Wunderlich-Malec Services, Inc., and Wunderlich-Malec Systems, Inc., headquartered in Eden Prairie, Minnesota. The insurance is issued through multiple carriers including Hartford Fire Insurance Company, The Charter Oak Fire Insurance Company, The Travelers Indemnity Company, and The Cincinnati Insurance Company, with coverage extending to the State of Arizona and specifically ADOT (Arizona Department of Transportation) for contract number CTR059067.
The insurance package provides extensive coverage including commercial general liability, automobile liability, workers' compensation, cyber liability, employee theft, and various endorsements covering additional insured status, blanket waivers of subrogation, and professional liability. The policies are effective from January 1, 2023 to January 1, 2024, with total general aggregate limits of $10,000,000 and various specific coverage limits for different risk categories. The policies include provisions for additional insureds, primary and non-contributory coverage, and specific protections for the State of Arizona across multiple operational contexts, with explicit references to liability arising from contract activities and work performed on behalf of the state.
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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
8/17/2023
Hub International Great Plains, LLC dba Horizon Agency, Inc.
6500 City West Parkway, Suite 100 Eden Prairie MN 55344
Kim Anderson 952-914-7145 952-956-3357 kim@horizonagency.com
Hartford Fire Insurance Compan 19682 WUNDENG-01 The Charter Oak Fire Insurance 25615
Wunderlich-Malec Engineering Inc, Wunderlich-Malec Services, Inc., Wunderlich-Malec Systems, Inc.
6101 Blue Circle Drive Eden Prairie MN 55344
The Travelers Indemnity Compan 25666 The Travelers Property Casualt 25674 Travelers Casualty and Surety 31194
1146190630
C X 1,000,000 X 300,000
5,000
1,000,000
2,000,000 X X
Y Y P630-1N669205-TIA-23 1/1/2023 1/1/2024
2,000,000
D 1,000,000
X
X X
Y Y BA1N6515642343G 1/1/2023 1/1/2024
D X X 20,000,000Y CUP-1N707158-23-43 1/1/2023Y 1/1/2024
20,000,000 X 10,000
B X
N
Y UB-1N673083-23-43-G 1/1/2023 1/1/2024
1,000,000
1,000,000
1,000,000 E A D
Crime Inland Marine Automobile
105877082
41MSRC0983
BA1N6515642343G
1/1/2023 1/1/2023 1/1/2023
1/1/2024 1/1/2024 1/1/2024
Employee Dishonesty Equipment Hired/Physical Damage
1,000,000 395,000 50,000
Blanket Additional Insured, Blanket Primary & Non-Contributory, Blanket Waiver of Subrogation applies to the general liability, Automobile Liability and Umbrella. Auto: Comprehensive Ded $1000 and Collision Ded $1,000. General Liability - No Deductible; Excess/Umbrella Follow Form; Blanket Waiver of Subrogation applies to the Workers Compensation: Monopolistic Stop Gap included for OH, WA, WY, ND: All coverages are per the forms and endorsements on the policies listed above. Should any of the above described policies be cancelled before the expiration date 60 days notice will be sent in accordance with the policy provisions. 10 Days notice of cancellation due to non-payment of premium in accordance with the policy provisions Regarding Contract number CTR059067, The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents and employees shall be named as additional insureds with respect to liability arising out of the activities performed by or on behalf of the contractor. Waiver of Subrogation applies against the State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents and employees See Attached...
ADOT Risk Management Insurance and Indemnification Unit 1324 N. 22nd Avenue Phoenix AZ 85009 e6906 Accepted
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
8/17/2023
Hub International Great Plains, LLC dba Horizon Agency, Inc.
6500 City West Parkway, Suite 100 Eden Prairie MN 55344
Kim Anderson 952-914-7145 952-956-3357 kim@horizonagency.com
License#: PC-749727 The Cincinnati Insurance Co 10677 WUNDENG-01 Travelers Casualty and Surety 31194
Wunderlich-Malec Engineering Inc, Wunderlich-Malec Services, Inc., Wunderlich-Malec Systems, Inc.
6101 Blue Circle Drive Eden Prairie MN 55344
1329087594
A A B
Cyber Liability Deductible Employee Theft
EMP 0419247
EMP 0419247
105877082
1/1/2023 1/1/2023 1/1/2023
1/1/2024 1/1/2024 1/1/2024
Annual Aggregate Deductible Limit
10,000,000 25,000 1,000,000
Employee Theft of Client Property is $2,000,000 Regarding Contract number CTR059067, The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents and employees shall be named as additional insureds with respect to liability arising out of the activities performed by or on behalf of the contractor. Waiver of Subrogation applies against the State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents and employees for losses arising from work performed by or on behalf of the Contractor and involving automobiles owned, leased, hired or borrowed by the contractor. General Liability insurance is primary. Forms CGD414, CGD415 and WC000313 apply.
ADOT Risk Management Insurance and Indemnification Unit 1324 N. 22nd Avenue Phoenix AZ 85009
ACORD 101 (2008/01)
The ACORD name and logo are registered marks of ACORD
© 2008 ACORD CORPORATION. All rights reserved.
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: FORM TITLE:
ADDITIONAL REMARKS
ADDITIONAL REMARKS SCHEDULE Page of
AGENCY CUSTOMER ID:
LOC #:
AGENCY
CARRIER NAIC CODE
POLICY NUMBER
NAMED INSURED
EFFECTIVE DATE:
WUNDENG-01
1 1
Hub International Great Plains, LLC dba Horizon Agency, Inc. Wunderlich-Malec Engineering Inc, Wunderlich-Malec Services, Inc., Wunderlich-Malec Systems, Inc.
6101 Blue Circle Drive Eden Prairie MN 55344
25 CERTIFICATE OF LIABILITY INSURANCE
for losses arising from work performed by or on behalf of the Contractor and involving automobiles owned, leased, hired or borrowed by the contractor. General Liability insurance is primary. Forms CGD414, CGD415 and WC000313 apply.
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