ACCEPTED_CTR069748_GL_AL_07.18.24-05.01.25.pdf
PDF 1 MB Posted
- Attached to
- Master Agreement AZ|CTR069748
- Contract number
- CTR069748
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for Geveko Markings Inc., issued by HDI Global Insurance Company and Ohio Security Insurance Company, with Marsh USA, LLC as the producer. The primary certificate holder is the State of Arizona/ADOT (Arizona Department of Transportation), located in Phoenix, AZ. The insurance policies provide coverage for commercial general liability, automobile liability, and workers' compensation for work performed under Contract No. CTR069748.
The insurance policies provide coverage with limits of $1,000,000 for commercial general liability and automobile liability, with effective dates ranging from 05/01/2024 to 07/18/2025. The policies include additional insured provisions for the State of Arizona/ADOT, with the insurance being primary and non-contributory. The coverage applies to any work performed for or on behalf of the State of Arizona/ADOT, with a waiver of subrogation where required by written contract. The insured entity, Geveko Markings Inc., is located in Gainesville, GA, and the policies include endorsements for additional insured status, waiver of transfer of rights of recovery, and primary and noncontributory insurance conditions.
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Text version
X
3,000,000
41343
A
08/16/2025 X
Technology Insurance Company, Inc
1,000,000
24082
Marsh | U.S. Operations
HOU-004088897-17
08/16/2024
X
1,000,000
12/13/2024 conditions.
1,000,000
1,000,000
1,000,000
B
ROW.CertRequest@Marsh.com
05/01/2025
07/18/2024
42376
BAS 66848660
5,000
TWC4469250
100,000
The State of Arizona/ADOT is included as additional insured (except Workers' Compensation) where required by written contract. This insurance is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured subject to policy terms and conditions. Waiver of subrogation is applicable where required by written contract and subject to policy terms and
RE: Award of Contract No. CTR069748. Insurance applies to any and all work performed for or on behalf of the State of Arizona/ADOT.
1883 New Harvest Road Geveko Markings Inc.
Gainesville, GA 30507
1,000,000
HDI Global Insurance Company
X
9830 Colonnade Blvd, Suite 410
MARSH USA, LLC.
San Antonio, TX 78230
GLD5826802
Ohio Security Insurance Company
N
Phoenix, AZ 85007
The State of Arizona/ADOT 206 S. 17th Ave
05/01/2024
C
1,000,000
866-966-4664
X
07/18/2025
Cindy Lewis GL-AL Only
CG 20 26 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2
POLICY NUMBER: GLD5826802 COMMERCIAL GENERAL LIABILITY
CG 20 26 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED – DESIGNATED
PERSON OR ORGANIZATION
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s):
AS REQUIRED BY WRITTEN CONTRACT
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf:
1. In the performance of your ongoing operations;
or
2. In connection with your premises owned by or rented to you.
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable limits of insurance;
whichever is less.
This endorsement shall not increase the applicable limits of insurance.
This endorsement modifies insurance provided under the following:
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