ACCEPTED_CTR061598_GL_AL_WC_03.31.25-03.31.26.pdf

PDF 2 MB Posted

Attached to
Master Agreement AZ|CTR061598
Contract number
CTR061598
Issued by
Arizona

About this file

The documents are a set of insurance policies and endorsements for Interwest Safety Supply LLC, a limited liability company based in Provo, Utah. The policies include a Commercial General Liability Insurance policy from Travelers Indemnity Company, a Business Auto Extension Endorsement, and a Workers Compensation and Employers Liability Insurance policy from WCF National Insurance Company. These policies provide coverage for multiple states including Arizona, Alabama, Colorado, New Mexico, Nevada, and Utah, with the Arizona Department of Transportation listed as a key certificate holder for the Commercial General Liability policy.

The policies cover Impact Crash Barrier Attenuators and Cable Barrier Systems, with a contract number CTR066796. The Commercial General Liability policy has a policy period from 3/31/2025 to 3/31/2026, with coverage limits including $1,000,000 per occurrence, $2,000,000 general aggregate, and $1,000,000 for personal and advertising injury. The Workers Compensation policy has a similar period and provides coverage with $1,000,000 limits for bodily injury by accident, disease policy limit, and per employee. The total estimated annual cost for the Workers Compensation policy is $11,991.00, with a minimum premium of $1,832.00 for New Mexico. The policies include various endorsements such as additional insured provisions, waiver of subrogation, and blanket additional insured coverage.

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Other files

File Type Posted
ACCEPTED_ANY_ALL_GL_AL_WC_02.04.24-02.04.25.pdf PDF
CTR061598_Contract_Amendment_Summary_Two__2_.pdf PDF
CTR061598_Contract_Documents.pdf PDF
Q2 2025 Usage Report.xlsx XLSX spreadsheet
2022 Q3 USAGE REPORT.xlsx XLSX spreadsheet
2022 Q4 Usage Report.xlsx XLSX spreadsheet
CTR061598_Contract_Amendment_Summary_Three__3_.pdf PDF
CTR061598__Contract_Amendment_Summary_One.pdf PDF

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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

E-MAIL

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

5/15/2025

Arthur J. Gallagher Risk Management Services, LLC 6967 South River Gate Dr.

Suite 200 Salt Lake City UT 84047

Aubrie Kemp 801-924-1400 801-924-1441 certrequests@ajg.com

WCF National Insurance Company 40517 INTESAF-01 WCF Mutual Insurance Company 10033

Interwest Safety Supply, LLC Interwest Safety Supply Holdings, LLC PO Box 31 Provo UT 84606

Travelers Indemnity Co of America 25666 Travelers Property Casualty Co of America 25674 St Paul Protective Insurance Company 19224

1957975489

C X 1,000,000 X 300,000

5,000

1,000,000

2,000,000 X

Y Y P-630-A6537147-TIA-25 3/31/2025 3/31/2026

2,000,000

EBL AGG 2,000,000

E 1,000,000

X

X X

Y Y BA-A643619A-25-43-G 3/31/2025 3/31/2026

D X X 6,000,000CUP-A6541996-25-43 3/31/2025 3/31/2026

6,000,000 X 10,000 Retention $10,000

B A

XY 3408993

3409035

3/31/2025 3/31/2025

3/31/2026 3/31/2026

1,000,000

1,000,000

1,000,000

Verification of insurance subject to the terms and conditions of the policy RE: CTR066796 Impact Crash Barrier Attenuators and Cable Barriers Systems The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are shown as Additional Insureds with respect to General Liability and Auto Liability. Coverage is primary and non-contributory as long as no other insurance applies. Waiver of Subrogation is in favor additional insured with regards to General Liability, Auto Liability and Workers Compensation.

ARIZONA DEPARTMENT OF TRANSPORTATION

1655 W. Jackson Street, MD 100P Phoenix, AZ 85007

USA

Cindy Lewis Accepted

POLICY :NUMBER

COMMERCIAL GENERAL LIABILITY

ISSUE DATE: 05 -15 -25

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED DESIGNATED PERSON OR

ORGANIZATION

This endorsement i ies insurance pro ided under t folmod f v he lowing:

COMMERC GENERAL L ITY VERA AIAL IABIL CO GE P RT

SCHEDULE

Name of Add onal nsured n(s) gan on(s):iti I Perso or Or izati

Sectio II Who Is An Insn ured is a to includ as an addit insured the person(s) or organizat n(s)mended e ional io shown in the Schedule, but on with respect to l abi ity for "bodi y , " orly i l ly injur ", "property damage" "personal injury "ad ising in " caused, in whole or in par by your acts or o issions ts m tingvert jury t, m or the ac or o issions of those ac on your behalf:

A. In the per mance f ions; orfor o your ongoing operat

B. In connect on with your pre ises owned by or rented toi m you.

CG D4 11 04 08 © 2008 The Travelers Companies, Inc. Page 1 of 1 Includes the copyrighted material of Insurance Services Office, Inc. with its permission.

630A6537147-TIA-25

Arizona Department of Transportation 1655 W. Jackson Street, MD 100p Phoenix, AZ 85007

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

XTEND ENDORSEMENT FOR MANUFACTURERS AND

WHOLESALERS

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

GENERAL DESCRIPTION OF COVERAGE - This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered.

A. Who Is An Insured - Unnamed Subsidiaries

B. Who Is An Insured - Employees And Volunteer Workers - Bodily Injury To Co-Employees And Co-Volunteer Workers

C. Who Is An Insured - Newly Acquired Or Formed Limited Liability Companies

D. Blanket Additional Insured - Broad Form Vendors

E. Blanket Additional Insured - Controlling Interest

F. Blanket Additional Insured - Mortgagees, Assignees, Successors Or Receivers

G. Blanket Additional Insured - Governmental Entities - Permits Or Authorizations Relating To Premises

PROVISIONS

A. WHO IS AN INSURED UNNAMED

SUBSIDIARIES

The following is added to SECTION II - WHO IS

AN INSURED:

Any of your subsidiaries, other than a partnership or joint venture, that is not shown as a Named Insured in the Declarations is a Named Insured if:

a. You are the sole owner of, or maintain an ownership interest of more than 50% in, such subsidiary on the first day of the policy period;

and

b. Such subsidiary is not an insured under similar other insurance.

No such subsidiary is an insured for "bodily injury'' or "property damage" that occurred, or "personal and advertising injury" caused by an offense committed:

H. Blanket Additional Insured - Governmental Entities - Permits Or Authorizations Relating To Operations

I. Blanket Additional Insured - Grantors Of Franchises

J. Incidental Medical Malpractice

K. Medical Payments - Increased Limit

L. Blanket Waiver Of Subrogation

M. Contractual Liability - Railroads

a. Before you maintained an ownership interest of more than 50% in such subsidiary; or

b. After the date, if any, during the policy period that you no longer maintain an ownership interest of more than 50% in such subsidiary.

For purposes of Paragraph 1. of Section II -Who Is An Insured, each such subsidiary will be deemed to be designated in the Declarations as:

a. A limited liability company;

b. An organization other than a partnership, joint venture or limited liability company; or

c. A trust;

as indicated in its name or the documents that govern its structure.

CG D4 58 0219 © 2017 The Travelers Indemnity Company. All rights reserved. Page 1 of 5 Includes copyrighted material of Insurance Services Office, Inc. with its permission

B. WHO IS AN INSURED - EMPLOYEES AND

VOLUNTEER WORKERS - BODILY INJURY TO

CO-EMPLOYEES AND CO-VOLUNTEER

WORKERS

The following is added to Paragraph 2.a.(1) of

SECTION II - WHO IS AN INSURED:

Paragraphs (1)(a), (b) and (c) above do not apply to "bodily injury" to a co-"employee" while in the course of the co-"employee's" employment by you or performing duties related to the conduct of your business, or to "bodily injury'' to your other "volunteer workers" while performing duties related to the conduct of your business.

C. WHO IS AN INSURED - NEWLY ACQUIRED

OR FORMED LIMITED LIABILITY COMPANIES

The following replaces Paragraph 3. of SECTION

II - WHO IS AN INSURED:

3. Any organization you newly acquire or form, other than a partnership or joint venture, and of which you are the sole owner or in which you maintain an ownership interest of more than 50%, will qualify as a Named Insured if there is no other similar insurance available to that organization. However:

a. Coverage under this provision is afforded only:

(1) Until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier, if you do not report such organization in writing to us within 180 days after you acquire or form it; or

(2) Until the end of the policy period, when that date is later than 180 days after you acquire or form such organization, if you report such organization in writing to us within 180 days after you acquire or form it;

b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and

c. Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization.

For the purposes of Paragraph 1. of Section II

- Who Is An Insured, each such organization will be deemed to be designated in the Declarations as:

a. A limited liability company;

b. An organization, other than a partnership, joint venture or limited liability company;

or

c. A trust;

as indicated in its name or the documents that govern its structure.

D. BLANKET ADDITIONAL INSURED - BROAD

FORM VENDORS

The following is added to SECTION II - WHO IS

AN INSURED:

Any person or organization that is a vendor and that you have agreed in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury" or "property damage" that:

a. Occurs subsequent to the signing of that contract or agreement; and

b. Arises out of "your products" that are distributed or sold in the regular course of such vendor's business.

The insurance provided to such vendor is subject to the following provisions:

a. The limits of insurance provided to such vendor will be the minimum limits that you agreed to provide in the written contract or agreement, or the limits shown in the Declarations, whichever are less.

b. The insurance provided to such vendor does not apply to:

(1) Any express warranty not authorized by you or any distribution or sale for a purpose not authorized by you;

(2) Any change in "your products" made by such vendor;

(3) Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container;

(4) Any failure to make such inspections, adjustments, tests or servicing as vendors agree to perform or normally undertake to perform in the regular course of business, in connection with the distribution or sale of "your products";

Page 2 of 5 © 2017 The Travelers Indemnity Company. All rights reserved. CG D4 58 0219

(5) Demonstration, installation, servicing or repair operations, except such operations performed at such vendor's premises in connection with the sale of "your products"; or

(6) "Your products" that, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or on behalf of such vendor.

Coverage under this provision does not apply to:

a. Any person or organization from whom you have acquired "your products", or any ingredient, part or container entering into, accompanying or containing such products;

or

b. Any vendor for which coverage as an additional insured specifically is scheduled by endorsement.

E. BLANKET ADDITIONAL INSURED

CONTROLLING INTEREST

1. The following is added to SECTION II -WHO

IS AN INSURED:

Any person or organization that has financial control of you is an insured with respect to liability for "bodily injury'', "property damage" or "personal and advertising injury" that arises out of:

a. Such financial control; or

b. Such person's or organization's ownership, maintenance or use of premises leased to or occupied by you.

The insurance provided to such person or organization does not apply to structural alterations, new construction or demolition operations performed by or on behalf of such person or organization .

2. The following is added to Paragraph 4. of

SECTION II - WHO IS AN INSURED:

This paragraph does not apply to any premises owner, manager or lessor that has financial control of you.

F. BLANKET ADDITIONAL INSURED

MORTGAGEES, ASSIGNEES, SUCCESSORS

OR RECEIVERS

The following is added to SECTION II - WHO IS

AN INSURED:

Any person or organization that is a mortgagee, assignee, successor or receiver and that you have agreed in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to its

COMMERCIAL GENERAL LIABILITY

liability as mortgagee, assignee, successor or receiver for "bodily injury", "property damage" or "personal and advertising injury" that:

a. Is "bodily injury'' or "property damage" that occurs, or is "personal and advertising injury" caused by an offense that is committed, subsequent to the signing of that contract or agreement; and

b. Arises out of the ownership, maintenance or use of the premises for which that mortgagee, assignee, successor or receiver is required under that contract or agreement to be included as an additional insured on this Coverage Part.

The insurance provided to such mortgagee, assignee, successor or receiver is subject to the following provisions:

a. The limits of insurance provided to such mortgagee, assignee, successor or receiver will be the minimum limits that you agreed to provide in the written contract or agreement, or the limits shown in the Declarations, whichever are less.

b. The insurance provided to such person or organization does not apply to:

(1) Any "bodily injury'' or "property damage" that occurs, or any "personal and advertising injury'' caused by an offense that is committed, after such contract or agreement is no longer in effect; or

(2) Any "bodily injury'', "property damage" or "personal and advertising injury" arising out of any structural alterations, new construction or demolition operations performed by or on behalf of such mortgagee, assignee, successor or receiver.

G. BLANKET ADDITIONAL INSURED

GOVERNMENTAL ENTITIES - PERMITS OR

AUTHORIZATIONS RELATING TO PREMISES

The following is added to SECTION II - WHO IS

AN INSURED:

Any governmental entity that has issued a permit or authorization with respect to premises owned or occupied by, or rented or loaned to, you and that you are required by any ordinance, law, building code or written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of the existence, ownership, use, maintenance, repair, construction, erection or removal of any of the following for which that governmental entity has

CG D4 58 0219 © 2017 The Travelers Indemnity Company. All rights reserved. Page 3 of 5 issued such permit or authorization: advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, elevators, street banners or decorations.

H BLANKET ADDITIONAL INSURED

GOVERNMENTAL ENTITIES - PERMITS OR

AUTHORIZATIONS RELATING TO OPER

ATIONS

The following is added to SECTION II - WHO IS

AN INSURED:

Any governmental entity that has issued a permit or authorization with respect to operations performed by you or on your behalf and that you are required by any ordinance, law, building code or written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of such operatic ns.

The insurance provided to such governmental entity does not apply to:

a. Any "bodily injury'', "property damage" or "personal and advertising injury" arising out of operations performed for the governmental entity; or

b. Any "bodily injury'' or "property damage" included in the "products-completed operations hazard".

I. BLANKET ADDITIONAL INSURED

GRANTORS OF FRANCHISES

The following is added to SECTION II - WHO IS

AN INSURED:

Any person or organization that grants a franchise to you is an insured, but only with respect to liability for "bodily injury'', "property damage" or "personal and advertising injury" arising out of your operations in the franchise granted by that person or organization .

If a written contract or agreement exists between you and such additional insured, the limits of insurance provided to such insured will be the minimum limits that you agreed to provide in the written contract or agreement, or the limits shown in the Declarations, whichever are less.

J. INCIDENT AL MEDICAL MALPRACTICE

1. The following replaces Paragraph b. of the definition of "occurrence" in the DEFINITIONS Section:

b. An act or omission committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to a person, unless you are in the business or occupation of providing professional health care services.

2. The following replaces the last paragraph of Paragraph 2.a.(1) of SECTION II - WHO IS

AN INSURED:

Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to "bodily injury" arising out of providing or failing to provide:

(a) "Incidental medical services" by any of your "employees" who is a nurse, nurse assistant, emergency medical technician, paramedic, athletic trainer, audiologist, dietician, nutritionist, occupational therapist or occupation al therapy assistant, physical therapist or speech language pathologist; or

(b) First aid or "Good Samaritan services" by any of your "employees" or "volunteer workers", other than an employed or volunteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first aid or "Good Samaritan services" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business.

3. The following replaces the last sentence of Paragraph 5. of SECTION Ill - LIMITS OF

INSURANCE:

For the purposes of determining the applicable Each Occurrence Limit, all related acts or omissions committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to any one person will be deemed to be one "occurrence".

4. The following exclusion is added to Paragraph 2., Exclusions, of SECTION I -

COVERAGES - COVERAGE A - BODILY

INJURY AND PROPERTY DAMAGE

LIABILITY:

Sale Of Pharmaceuticals

"Bodily injury'' or "property damage" arising out of the violation of a penal statute or ordinance relating to the sale of pharmaceuticals committed by, or with the knowledge or consent of, the insured.

Page 4 of 5 © 2017 The Travelers Indemnity Company. All rights reserved. CG D4 58 0219

5. The following is added to the DEFINITIONS Section:

"Incidental medical services" means:

a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; or

b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances.

6. The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV -

COMMERCIAL GENERAL LIABILITY

CONDITIONS:

This insurance is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to any of your "employees" for "bodily injury" that arises out of providing or failing to provide "incidental medical services" to any person to the extent not subject to Paragraph 2.a.(1) of Section II - Who Is An Insured.

K. MEDICAL PAYMENTS - INCREASED LIMIT

The following replaces Paragraph 7. of SECTION Ill - LIMITS OF INSURANCE:

7. Subject to Paragraph 5. above, the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury" sustained by any one person, and will be the higher of:

COMMERCIAL GENERAL LIABILITY

a. $10,000; or

b. The amount shown in the Declarations of this Coverage Part for Medical Expense Limit.

L. BLANKET WAIVER OF SUBROGATION

The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against others To Us, of SECTION IV - COMMERCIAL GENERAL

LIABILITY CONDITIONS:

If the insured has agreed in a contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of:

a. "Bodily injury" or "property damage" that occurs; or

b. "Personal and advertising injury" caused by an offense that is committed;

subsequent to the execution of the contract or agreement.

M. CONTRACTUAL LIABILITY - RAILROADS

1. The following replaces Paragraph c. of the definition of "insured contract" in the DEFINITIONS Section:

c. Any easement or I icense agreement;

2. Paragraph f.(1) of the definition of "insured contract" in the DEFINITIONS Section is deleted.

CG D4 58 0219 © 2017 The Travelers Indemnity Company. All rights reserved. Page 5 of 5 Includes copyrighted material of Insurance Services Office, Inc. with its permission

Cindy Lewis Highlight

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