ACCEPTED CTR075472 GL,AL,WC,PROF LIAB 07.2524-07.25.25.pdf
PDF 763 KB Posted
- Attached to
- Master Agreement AZ|CTR075472
- Contract number
- CTR075472
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for Tierra Right of Way Services, Ltd, issued by Risk Strategies Company on behalf of multiple insurance carriers including Sompo America Insurance Company, Endurance Assurance Corporation, Sompo America Fire & Marine Insurance, SiriusPoint Specialty Insurance, and Travelers Excess & Surplus Lines. The certificate covers insurance policies for the State of Arizona, its departments, agencies, boards, commissions, universities, and employees, with a contract number of CTR075472, effective from 7/25/2024 to 7/25/2025.
The insurance coverage includes commercial general liability with $1,000,000 per occurrence and $2,000,000 aggregate limits, automobile liability, umbrella liability with $10,000,000 limits, workers' compensation, professional liability (E&O), and cyber liability. Each policy includes additional insured provisions for the State of Arizona, with waiver of subrogation rights. The policies cover ongoing operations, completed operations, and various potential liability scenarios across multiple business activities. The certificate demonstrates comprehensive insurance protection for Tierra Right of Way Services' contractual obligations with the State of Arizona, ensuring financial safeguards for potential incidents or claims.
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CERTIFICATE HOLDER
© 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05)
AUTHORIZED REPRESENTATIVE
CANCELLATION
DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE
LOCJECT
PRO-POLICY
GEN'L AGGREGATE LIMIT APPLIES PER:
OCCURCLAIMS-MADE
COMMERCIAL GENERAL LIABILITY
GENERAL LIABILITY
PREMISES (Ea occurrence) $
DAMAGE TO RENTED
EACH OCCURRENCE $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
$RETENTIONDED
CLAIMS-MADE
OCCUR
AGGREGATE $
EACH OCCURRENCE $UMBRELLA LIAB
EXCESS LIAB
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
INSR
LTR TYPE OF INSURANCE POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY) LIMITS
WC STATU-
TORY LIMITS
OTH-
ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
ANY PROPRIETOR/PARTNER/EXECUTIVE
If yes, describe under DESCRIPTION OF OPERATIONS below
(Mandatory in NH)
OFFICER/MEMBER EXCLUDED?
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
HIRED AUTOS
NON-OWNED
AUTOS AUTOS
AUTOS
COMBINED SINGLE LIMIT
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE $
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.
INSR
ADDL
WVD
SUBR
N / A
(Ea accident)
(Per accident)
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.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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).
The ACORD name and logo are registered marks of ACORD
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
INSURED
PHONE
(A/C, No, Ext):
PRODUCER
ADDRESS:
FAX
(A/C, No):
CONTACT
NAME:
NAIC #
INSURER A :
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
INSURER(S) AFFORDING COVERAGE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Risk Strategies Company 750 Third Avenue, Suite 1500 New York, NY 10017
Robin Strauss 212-669-5400 212-669-5417 rstrauss@risk-strategies.com
SOMPO AMERICA INSURANCE COMPANY 11126
ENDURANCE ASSURANCE CORPORATION 11551
Tierra Right of Way Services, Ltd 1575 E. River Road Suite 201 Tuscon, AZ 85718
SOMPO AMERICA FIRE & MARINE INSURANCE 38997
SIRIUSPOINT SPECIALTY INSURANCE 16820
TRAVELERS EXCESS & SURPLUS LINES 29696
1327642570
A
X 1,000,000
1,000,000 X
X 1,000,000
Prim.Non-Cont. 2,000,000
2,000,000
Cross Liability
MGF30041677801 7/25/2024 7/25/2025
X
X
Y Y
15,000
A 1,000,000 X X X X X
MAF30041675201 7/25/2024YY 7/25/2025
B X X 10,000,000
X 10,000,000
10,000
MUF30041685901 7/25/2024 7/25/2025Y Y
C Y JWCS1086I0 7/25/2024 7/25/2025
1,000,000
1,000,000
1,000,000 D E
E&O/Professional - Claims Made Cyber Liability
1/22/2025
X
PROVAE-0000110-00
CYB-108072029-00
7/25/2024 7/25/2024
7/25/2025 7/25/2025
Each Claim/Agg. Limit Each Claim/Agg. Limit
$5MM/$5MM
$5MM/$5MM
Contract Number: CTR075472
State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are included as additional insureds as required by written contract subject to the policy terms, conditions and exclusions. Waiver of Subrogation applies in favor of the additional insureds as required by written contract subject to the policy terms, conditions and exclusions.
The State of Arizona/ADOT 206 S. 17th Avenue Phoenix, AZ 85007
Cindy Lewis Accepted
CG 20 26 12 19 Page 1 of 1 © Insurance Services Office, Inc., 2018
POLICY NUMBER: MGF30041677801 COMMERCIAL GENERAL LIABILITY
CG 20 26 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED – DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s):
ANY PERSON OR ORGANIZATION THAT YOU ARE OBLIGATED PURSUANT TO A WRITTEN CONTRACT
OR AGREEMENT EXECUTED PRIOR TO A LOSS TO PROVIDE SUCH INSURANCE AS IS AFFORDED BY
THIS POLICY.
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.
CG 20 37 12 19 Page 1 of 1 © Insurance Services Office, Inc., 2018
CG 20 37 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED – OWNERS, LESSEES OR
CONTRACTORS – COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations
ANY LOCATION WHERE YOU ARE OBLIGATED
PURSUANT TO A WRITTEN CONTRACT OR
AGREEMENT EXECUTED PRIOR TO A LOSS TO
PROVIDE SUCH INSURANCE AS AFFORDED BY
THIS POLICY FOR "YOUR WORK" AT THE
LOCATION.
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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard".
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.
ANY PERSON OR ORGANIZATION WHERE YOU
ARE OBLIGATED PURSUANT TO A WRITTEN
CONTRACT OR AGREEMENT EXECUTED PRIOR
TO A LOSS TO PROVIDE SUCH INSURANCE AS IS
AFFORDED BY THE POLICY
CG 24 04 12 19 Page 1 of 1 © Insurance Services Office, Inc., 2018
CG 24 04 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
ELECTRONIC DATA LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES
POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS
SCHEDULE
Name Of Person(s) Or Organization(s):
ANY PERSON OR ORGANIZATION WHERE YOU ARE OBLIGATED TO WAIVE RIGHTS OF RECOVERY
PURSUANT TO A WRITTEN CONTRACT OR AGREEMENT EXECUTED PRIOR TO LOSS.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions:
We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
SGL 02 168 (0619)
PRIMARY AND NON-CONTRIBUTORY - OTHER INSURANCE CONDITION
Under Section IV - Commercial General Liability Conditions , the following is added to the Other Insurance Condition and supersedes any provision to the contrary:
Primary and Noncontributory Insurance
This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy, provided that:
(1) The additional insured is a Named Insured under such other insurance; and
(2) You have agreed in writing in a contract, agreement or permit that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured.
POLICY NUMBER: MGF30041677801
Includes copyrighted material of Insurance Services Office, Inc. with its permission.
SCA 01 002 (0718) Page 1 of 4
This Endorsement Changes the Policy. Please Read It Carefully.
COMMERCIAL AUTOMOBILE ENHANCEMENT
This endorsement modifies coverage provided under the following:
BUSINESS AUTO COVERAGE FORM
1. BROADENED INSURED COVERAGE
Under Section II - COVERED AUTOS LIABILITY COVERAGE , the following changes are made:
A. BROAD NAMED INSURED
The following is added to A. Coverage , paragraph 1. Who Is An Insured :
d. Any legally incorporated entity of which you own more than 50% of the voting stock on the effective date of this coverage part is an insured.
B. ADDITIONAL INSUREDS - BY CONTRACT, AGREEMENT OR PERMIT
The following is added to A. Coverage , paragraph 1. Who Is An Insured :
e. Any person or organization, not otherwise identified as an “insured” in this coverage or by endorsement to this coverage, that you are required by written contract, written agreement or written permit to name as an “insured”. However, such person or organization is an “insured” only:
(1) With respect to the operation, maintenance or use of a covered “auto”; and
(2) For “bodily injury” or “property damage” caused by an “accident” which takes place after:
(a) You executed the written contract or written agreement; or
(b) The permit has been issued to you.
The insurance provided under item B. above applies on a primary basis if that is required by the written contract, written agreement or written permit. Coverage under this provision is limited to the minimum limits of liability stipulated in that written contract, written agreement or written permit or the amount of loss not to exceed the Limit of Liability shown in the Declarations, whichever is less.
C. EMPLOYEES AS INSUREDS
The following is added to A. Coverage , paragraph 1. Who Is An Insured :
f. Any “employee” of yours is an “insured” while using a covered “auto” you don’t own, hire or borrow in your business or your personal affairs.
D. FELLOW EMPLOYEE COVERAGE
B. Exclusions, paragraph 5. Fellow Employee is deleted and replaced with the following:
POLICY NUMBER: MAF30041675201 EFFECTIVE: 7/25/24 - 7/25/25
its permission.
SCA 01 002 (0718) Page 2 of 4
“Bodily injury” to:
a. Any fellow “employee” of the “insured” arising out of and in the course of the fellow “employee’s” employment or while performing duties related to the conduct of your business; or
b. The spouse, child, parent, brother or sister of that fellow “employee” as a consequence of Paragraph a. above.
However, we will cover “bodily injury” caused by your “employee” to his or her fellow “employee” if the “bodily injury” results from the use of a covered “auto”.
2. ADDITIONAL SUPPLEMENTARY PAYMENTS
Section II - COVERED AUTOS LIABILITY COVERAGE , A. Coverage , paragraph 2.a.
Coverage Extensions, Supplementary Payments, items (2) and (4) are deleted and replaced by the following:
(2) Up to $5000 for the cost of bail bonds (including bonds for related traffic law violations) required because of an “accident” we cover. We do not have to furnish these bonds.
(4) All reasonable expenses incurred by the “insured” at our request, including actual loss of earnings up to $500 a day because of time off from work.
3. KNOWLEDGE AND NOTICE OF OCCURRENCE
Section IV - BUSINESS AUTO CONDITIONS , A. Loss Conditions, paragraph 2.
Duties In The Event Of Accident, Claim, Suit Or Loss , item a. is deleted and replaced by the following and item d. is added:
a. In the event of an “accident”, claim, “suit” or “loss” you must give us or our authorized representative prompt notice of the “accident” or “loss” when the “accident”, claim, “suit” or “loss” is known to:
(1) You, if you are an individual;
(2) A partner, if you are a partnership or joint venture;
(3) An “executive officer” or director if you are an organization other than a partnership, joint venture or limited liability company;
(4) A member, if you are a limited liability company;
(5) A trustee if you are a trust; or
(6) An “employee” designated by you to give us such a notice.
This notice should include:
(1) How, when and where the “accident” or “loss” occurred;
(2) The “insured’s“ name and address; and
(3) To the extent possible, the names and addresses of any injured persons and witnesses.
d. Your rights afforded under this policy will not be prejudiced if you fail to give us notice of an “accident”, claim, “suit” or “loss”, solely due to your reasonable and documented belief that the “bodily injury” or “property damage” is not covered under this policy.
its permission.
SCA 01 002 (0718) Page 3 of 4
4. WAIVER OF SUBROGATION
The following is added to Section IV - BUSINESS AUTO CONDITIONS , A. Loss Conditions , paragraph 5. Transfer of Rights of Recovery Against Other To Us :
If the insured has waived those rights prior to the “accident” or “loss”, our rights are waived also.
5. UNINTENTIONAL ERRORS AND OMISSIONS
The following is added to Section IV - BUSINESS AUTO CONDITIONS , B. General Conditions, paragraph 2. Concealment, Misrepresentation Or Fraud :
We will not disclaim coverage under this Coverage Part if you fail to disclose all hazards existing as of the inception date of the policy, provided such failure is not intentional and you report the failure to us as soon as practicable after its discovery.
However, we reserve the right to charge additional premium for any such hazard.
6. BROADENED PHYSICAL DAMAGE COVERAGE
Under Section III - PHYSICAL DAMAGE COVERAGE, the following changes are made:
A. WAIVER OF DEDUCTIBLE - GLASS REPAIR
The following is added to D. Deductible:
No deductible for a covered “auto” will apply to glass damage if the glass is repaired rather than replaced.
B. ADDITIONAL TRANSPORTATION EXPENSES
A. Coverage, 4. Coverage Extensions, paragraph a. Transportation Expenses is deleted and replaced by the following:
We will pay up to $50 per day to a maximum of $1500 for temporary transportation expense incurred by you because of the total theft of a covered “auto” of the private passenger type. We will pay only for those covered “autos” for which you carry either Comprehensive or Specified Causes Of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy’s expiration, when the covered “auto” is returned to use or we pay for its “loss”.
C. ADDITIONAL LOSS OF USE EXPENSES
A. Coverage, 4. Coverage Extensions, paragraph b. Loss Of Use Expenses is deleted and replaced by the following:
For Hired Auto Physical Damage, we will pay expenses for which an “insured” becomes legally responsible to pay for loss of use of a vehicle rented or hired without a driver under a written rental contract or agreement. We will pay for loss of use expenses if caused by:
(1) Other than collision only if the Declarations indicates that Comprehensive Coverage is provided for any covered “auto”;
(2) Specified Causes of Loss only if the Declarations indicates that Specified Causes of Loss Coverage is provided for any covered “auto”; or
(3) Collision only if the Declarations indicates that Collision Coverage is provided for any covered “auto”.
its permission.
SCA 01 002 (0718) Page 4 of 4
However, the most we will pay for any expenses for loss of use is $65 per day, to a maximum of $1500.
D. COST TO RECOVER STOLEN AUTO
The following is added to A. Coverage, 4. Coverage Extensions.
We will pay reasonable and necessary expenses incurred by you to return a stolen, covered “auto” from the place where it is recovered to its usual garaging place. The most we will pay for such expenses is $1000. This Coverage Extension does not apply if your business is selling, servicing or repairing “autos”.
E. PERSONAL EFFECTS COVERAGE
The following is added to A. Coverage, 4. Coverage Extensions.
In the event of a total theft of a covered “auto”, we will pay for personal effects owned by an “insured” and in or on the covered “auto” at the time of “loss”. The most we will pay for such personal effects is $500 per “loss”. No deductibles apply to this Personal Effects Coverage.
F. AIRBAGS - ACCIDENTAL DISCHARGE COVERAGE
The following is added to B. Exclusions, paragraph 3.
This exclusion does not apply to the accidental or unintended discharge of an airbag.
The most we will pay for such “loss” is $1000. This coverage is excess over any other collectible insurance or warranty.
G. VEHICLE WRAP COVERAGE
The following is added to A. Coverage, 4. Coverage Extensions.
In the event of a total “loss” to a covered “auto” and in addition to the actual cash value of the covered “auto”, we will pay up to $1000 to repair or replace vehicle wraps displayed on the “auto” at the time of “loss”. The most we will pay under the Vehicle Wrap Coverage is $5000 for any one “loss”, regardless of the number of covered “autos” deemed a total “loss”. For the purpose of this coverage, vehicle wraps are full color, graphic images printed on vinyl film and attached to an “auto”.
7. ADDITIONAL DEFINITIONS
The following is added to Section V - DEFINITIONS :
“Executive Officer” means a person holding any of the officer positions created by your charter, constitution, by-laws or any similar governing document.
POLICY NUMBER: JWCS1086I0
1983 National Council on Compensation Insurance.
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13
(Ed. 4-84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.)
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule
PERSONS OR ORGANIZATIONS WITH WHOM THE INSURED HAS ENTERED
INTO A WRITTEN WAIVER AGREEMENT PRIOR TO THE DATE OF LOSS
THIS ENDORSEMENT DOES NOT APPLY TO KENTUCKY, NEW HAMPSHIRE
For policies or exposure in Missouri:
Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual.
Insured: CONTRACT LAND STAFF,LLC,TIERRA RIGHT OF WAY SERVICES,LTD
KEYSTONE CONSULTANTS,LLC, PARAGON PARTNERS CONSULTANTS,INC.
EPIC LAND SOLUTIONS,INC.
DATE OF ISSUE: 07-25-24
Insurance Company Sompo America Fire & Marine Insurance Company
WC 00 03 13
(Ed. 4-84)
File details come from the government source that posted it. Updated .