Arizona-Department-_3AM-Innovations_24-25-COI_11-12-2024_1624977450_1.pdf
PDF 99 KB Posted
- Attached to
- Master Agreement AZ|CTR065361
- Contract number
- CTR065361
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance for 3AM Innovations Inc., issued by The Baldwin Group Mid-Atlantic LLC on 11/12/2024. The certificate lists multiple insurers, including Hartford/Pool and Lloyd's of London, and is issued for the benefit of the Arizona Department of Administration's State Procurement Office located in Phoenix, Arizona.
The insurance certificate covers multiple types of insurance for 3AM Innovations, including Commercial General Liability with a $5,000,000 each occurrence limit, Automobile Liability, Workers' Compensation, and Technology E&O/Cyber insurance. The policies are effective from 11/12/2024 to 11/12/2025, with a $2,500 deductible on some coverages. The certificate includes provisions for additional insured status on a primary non-contributory basis for general liability, with a waiver of subrogation when required by written contract. The policy provides coverage for claims arising from the named insured's activities, with the Arizona Department of Administration listed as the certificate holder.
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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
11/12/2024
The Baldwin Group Mid-Atlantic LLC 20 S. King Street Leesburg VA 20175
Amanda Boothby
Amanda.Boothby@baldwin.com
License#: CA#0658748 Hartford / Pool 914 3AMINNO-01 Lloyd's of London 15642
3AM Innovations Inc.
241 Main Street Buffalo NY 14203
1624977450
B X 5,000,000 X 5,000,000
10,000
5,000,000
5,000,000 X
ESN0340140980 11/12/2024 11/12/2025
5,000,000
B 5,000,000
X X
ESN0340140980 11/12/2024 11/12/2025
Deductible 2,500
A X08WECAA7AH1 10/1/2024 10/1/2025
1,000,000
1,000,000
1,000,000 B TECH E&O / Cyber ESN0340140980 11/12/2024 11/12/2025 Each Claim/Incident
Shared Aggregate Deductible
5,000,000 5,000,000 10,000
Certificate Holder is additional insured on a primary non-contributory basis for general liability for a claim arising solely out of an act committed by the named insured as required by written contract executed prior to loss per policy form CFC Technology V 4.1 Waiver of subrogation applies to the general liability when required by written contract executed prior to loss per policy form CFC Technology V 4.1
Arizona Department of Administration State Procurement Office 100 North 15th Avenue Phoenix AZ 85007
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