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
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 .