Arizona_Department_of_Administration.pdf
PDF 57 KB Posted
- Attached to
- Master Agreement AZ|CTR074456
- Contract number
- CTR074456
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by MARSH USA, LLC on behalf of Brinc Drones, Inc., located in Seattle, Washington. The certificate names the Arizona Department of Administration and State Procurement Office as the certificate holder, with coverage provided by multiple insurers including Granite State Insurance Co and National Union Fire Insurance Co of Pittsburgh, PA.
The insurance certificate provides commercial general liability, automobile liability, and umbrella liability coverage for Brinc Drones, Inc. The policies are effective from 12/21/2024 to 12/21/2025, with general liability coverage limits of $1,000,000 per occurrence and $2,000,000 aggregate. The State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are included as additional insureds. The policy includes a waiver of subrogation for General Liability as required by written contract and allowed by law.
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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)
© 1988-2016 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
B
1,000,000
02-LX-018953124-1
X
SEA-004061214-02
1,000,000
19445
1,000,000
N
12/21/2025
12/21/2025
02-CA-044251915-1
2,000,000
1,000,000
X
National Union Fire Ins. Co. of Pittsburgh, PA
X
X
12/10/2024
12/21/2024
State of Arizona, and its departments, agencies, boards,commissions, universities, officers, officials, agents, and employees are included as additional insureds with respect to liability arising out of the activities as required by written contract and allowed by law, and waiver of subrogation applies as respects General Liability as required by written contract and allowed by law.
X
1802 West Jackson Street # 100
Phoenix, AZ 85007
Arizona Department of Administration
A
CN140412127--GAX-24-25
5,000
1,000,000
29-UD-019920574-1
Excluded
23809
100,000
1301 5th Avenue, Suite 1900
MARSH USA, LLC.
Seattle, WA 98101
Attn: Robert Madel
Brinc Drones, Inc.
Seattle, WA 98103 3668 Albion Place N
12/21/2024
State Procurement Office
12/21/2024
A
12/21/2025
Granite State Insurance Co
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