ACCEPTED CTR077154 WC 04.01.25-04.01.26.pdf

PDF 390 KB Posted

Attached to
Master Agreement AZ|CTR069471
Contract number
CTR069471
Issued by
Arizona

About this file

This document is a Certificate of Liability Insurance issued by Lovitt & Touché A Marsh and McLennan Agency, LLC, featuring insurance coverage for Don Sanderson Ford, Inc. The certificate involves multiple insurance providers, including CopperPoint Indemnity Insurance Company and The Continental Insurance Company, with the State of Arizona/ADOT (Arizona Department of Transportation) listed as the certificate holder. The insurance policies cover the period from 4/1/2025 to 4/1/2026, with an additional Workers Compensation endorsement effective from 1/1/2025 to 1/1/2026.

The insurance package includes a Workers' Compensation policy with limits of $1,000,000 per accident, disease, and policy limit, and an Umbrella/Excess Liability policy with coverage limits of $15,000,000. The document indicates an underlying Commercial Umbrella Policy from Federated Service Insurance Company with a contract number CTR077154. A specific endorsement includes a Waiver of Subrogation, which means the insurance company waives its right to recover payments from the Arizona Department of Transportation for injuries covered under the policy. The certificate is marked as "ACCEPTED - WC Only" by ADOT Risk Management, suggesting it meets specific requirements for workers' compensation insurance.

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Text version

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

6/5/2025

Lovitt & Touché A Marsh and McLennan Agency, LLC 8605 E. Raintree Drive, Suite 200 Scottsdale AZ 85260

Betsy Fillicelli 602-397-0263 602-385-7060

Betsy.Fillicelli@MarshMMA.com

CopperPoint Indemnity Insurance Company 13928 DONSAND-C3 The Continental Insurance Company 35289

Don Sanderson Ford, Inc.

P. O. Box 1407 Glendale AZ 85301

1723285784

B 15,000,000 X

7091758442 4/1/2025 4/1/2026

15,000,000

A X

N

Y WC1021511 1/1/2025 1/1/2026

1,000,000

1,000,000

1,000,000

Excess Liability follows form over the following underlying policy:

Federated Service Insurance Company - Commercial Umbrella Policy #1854885 - Effective 04-01-25 to 04-01-26.

Contract # CTR077154. Waiver of subrogation applies per form WC000313.

The State of Arizona/ADOT 206 S. 17th Ave Phoenix AZ 85007

THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE

Cindy Lewis WC Only

File details come from the government source that posted it. Updated .