ACORD_Form_20250210-130139.pdf
PDF 21 KB Posted
- Attached to
- Master Agreement AZ|CTR067410
- Contract number
- CTR067410
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance dated 02/10/2025, issued by The Lesser Agency for Pineapple Contracts Inc, with the State of Arizona listed as the certificate holder. The insurance is provided by Ohio Security Insurance Company and Ohio Casualty Insurance Company, covering multiple lines of insurance including commercial general liability, automobile liability, umbrella liability, and workers' compensation.
The insurance policies are effective from 12/01/2024 to 12/01/2025, with various coverage limits including $1,000,000 for general liability, $1,000,000 for automobile liability, $10,000,000 for umbrella liability, and $1,000,000 for workers' compensation. The certificate includes an additional insured clause that applies to the State of Arizona, its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees, with coverage on a primary and non-contributory basis and a waiver of subrogation.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| BPM005423_Solicitation_Requirements.pdf | ||
| BPM005423_Award_Letter_Pineapple.pdf | ||
| CTR067410_Price_Sheet_-_Per_A3.xlsx | XLSX spreadsheet | |
| BPM005423_Pricing.xlsx | XLSX spreadsheet | |
| BPM005423_Solicitation_Attachment_-_Offer_and_Acceptance_Executed.pdf | ||
| CTR067410_Contract_Amendment_No._3.pdf | ||
| Pineapple_Contracts_COI_24.pdf | ||
| _Pineapple_Contracts_INC__CTR067410_Contract_Amendment__1.docx | DOCX document | |
| CTR067410_Contract_Amendment_No._2.pdf | ||
| Pineapple_Contracts_Inc_COI.pdf |
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Text version
02/10/2025
The Lesser Agency 302 W Campbell St
Arlington Heights IL 60005
Todd Budnik
(847) 675-3111 (847) 675-3105 tbudnik@lesseragency.com
Pineapple Contracts Inc 7105 19 Mile Rd Bldg. #10 Sterling Heights MI 48314
Ohio Security Ins Co 24082 Ohio Casualty Ins Co 24074
CL24112611184
A BKS58399485 12/01/2024 12/01/2025
1,000,000 300,000 15,000 1,000,000 2,000,000 2,000,000
Stopgap 1,000,000
A BAS58399485 12/01/2024 12/01/2025
1,000,000
Bus Auto Enhncmt Endt
B 10,000
USO58399485 12/01/2024 12/01/2025
10,000,000 10,000,000
A Y XWS58399485 12/01/2024 12/01/2025
1,000,000 1,000,000 1,000,000
Per written contract the additional insured clause applies under the general liability and auto liability on a primary and non-contributory basis waiver of subrogation in included in favor of The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees as additional insureds with respect to liability arising out of the activities performed by or on behalf of the contractor.
Form Edition # CG8810
State of Arizona 100 N 15th Ave
Phoenix AZ 85007
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
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