ACORD_Form_20250506-104114.pdf
PDF 22 KB Posted
- Attached to
- Master Agreement AZ|CTR071841
- Contract number
- CTR071841
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for Atlas Trap Company, LLC, based in Benton, Kansas, issued by Insurance Services Group LLC in Wichita, Kansas. The certificate involves multiple insurers, including EMCASCO Insurance Company and EMC Insurance, and is specifically designated for the State of Arizona and the Arizona Game & Fish Department as the certificate holder.
The insurance coverage spans multiple areas including commercial general liability, automobile liability, workers' compensation, and commercial cyber and privacy liability. The policies are effective from 07/10/2024 to 07/10/2025, with various coverage limits. Notably, the general liability policy has a $1,000,000 each occurrence limit and a $2,000,000 general aggregate limit. The automobile liability provides a $1,000,000 combined single limit, and the cyber liability includes specific sublimits for data compromise response expenses, legal review, and named malware. The certificate includes a waiver of subrogation in favor of the certificate holder and considers the State of Arizona and Arizona Game & Fish Department as additional insureds via written contract.
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Text version
05/06/2025
Insurance Services Group LLC 1720 N Webb Rd Suite 110 Wichita KS 67206
Steven Jones
(316) 928-0044 steven@isgkansas.com
ATLAS TRAP COMPANY, LLC
14200 SW 50TH ST
BENTON KS 67017-9165
EMCASCO Insurance Company 21407 Employers Mutual Casualty Company 21415 EMC Insurance
CL255602842
A 6D46431 07/10/2024 07/10/2025
1,000,000 300,000 10,000 1,000,000 2,000,000 2,000,000
B 6E46431 07/10/2024 07/10/2025
1,000,000
Uninsured motorist combined single limit
1,000,000
A Y 6H46431 07/10/2024 07/10/2025 1,000,000 1,000,000 1,000,000
C Commercial Cyber and Privacy Liability
6Q46431 07/10/2024 07/10/2025
DATA COMPROMISE -
RESPONSE EXPENSE
$50,000
LEGAL REVIEW
SUBLIMIT
$25,000
NAMED MALWARE
SUBLIMIT
$50,000
Certificate Holder: State of Arizona and the Arizona Game & Fish Department are considered Additional Insureds via written contract. Waivor of Subrogation in favor of Certificate Holder.
Arizona Game and Fish Department 5000 W. Carefree Highway
Phoenix AZ 85086
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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