ACCEPTED SIR 04.11.24-04.11.25.pdf
PDF 993 KB Posted
- Attached to
- Master Agreement AZ|CTR062306
- Contract number
- CTR062306
- Issued by
- Arizona
About this file
This document is a Self-Insured Retention (SIR) Practices letter from Alamo Group's Bush Hog division to the Arizona Department of Transportation (ADOT). The letter outlines Bush Hog's self-insurance practices for general liability, auto liability, and workers' compensation in Arizona. The document has been accepted by ADOT's Risk Management division on 4/11/2024 and details the company's approach to managing insurance risk without traditional third-party insurance.
The letter specifies that Bush Hog self-insures up to $1 Million on a per-occurrence basis for risks associated with permitted and non-public use of ADOT's right-of-way. The company maintains adequate retained earnings to meet these self-insuring obligations and has received prior approvals from the Motor Vehicle Division (MVD) for auto liability and the Arizona Industrial Commission for workers' compensation. Bush Hog agrees to waive subrogation rights and provide ADOT with additional insured status, with their self-insurance being primary and limited to the amounts specified in the ADOT Permit Insurance Matrix.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Date: ___________________________
The State of Arizona Arizona Department of Transportation 1324 N. 22nd Avenue, MD 128A Phoenix, AZ 85009
RE: General Liability, Auto Liability, and Workers' Compensation Self-Insured Retention (SIR) Practices for ___________________________________________
__________________________________, hereinafter referred to as "The Company", is a business with operations in Arizona. Based on its financial condition, The Company utilizes an SIR mechanism as an equivalent to third-party provided insurance for portions of its aggregate general liability risk. Auto liability self-insurance has been approved by MVD via self-insurance application process, and an official MVD issued self-insurance certificate is attached. Workers' compensation self-insurance coverage has been approved according to all applicable statutory requirements and can be verified through the Arizona Industrial Commission.
Under the SIR, The Company self-insures for these risks at the level and dollar amounts, up to $___ Million, on a per occurrence basis, as specified under the Agreement between The Company and ADOT for permitted and non-public use of the State of Arizona's and/or ADOT's right-of-way.
The Company maintains adequate levels of retained earnings or revenue to meet these self-insuring obligations. Copies of the Annual Report are available and electronic copies will be provided upon request.
The Company agrees to waive its rights of recovery in subrogation as to ADOT, its officials and employees for all claims, damages, losses, liabilities, or expenses relating to, arising from, or resulting from work performed by or on behalf of The Company within the ADOT right-of-way.
ADOT shall have additional insured status with respect to The Company's self-insured vehicle liability and general liability insurance to the scope and extent of ISO Form CG20101185; and with all stated coverages limited to the amounts specified in the ADOT Permit Insurance Matrix.
________________________'s self-insurance shall be primary and any insurance maintained by ADOT shall not contribute to, or be excess of, ________________________’s self-insurance.
As part of the SIR, The Company assumes responsibility to respond to any loss or risk relating to, arising from, or resulting from work performed by or on behalf of The Company within the ADOT right-of-way, to the extent that standard insurer policies would respond to an insurable loss.
Sincerely, Ian Eckert Chief Accounting Officer Alamo Group
Bush Hog jgugliotti Typewritten Text 4/11/2024 jgugliotti Typewritten Text Bush Hog jgugliotti Typewritten Text jgugliotti Typewritten Text Bush Hog jgugliotti Typewritten Text Bush Hog
F0950 Accepted
File details come from the government source that posted it. Updated .