Arizona_Department_of_Administration.pdf
PDF 13 KB Posted
- Attached to
- Master Agreement AZ|CTR073467
- Contract number
- CTR073467
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance for US Computers Inc., located in Placentia, California, with Sentry Insurance Company and Sentry Select Insurance Company as the insurers. The certificate is issued for the Arizona Department of Administration's State Procurement Office in Phoenix, Arizona, and provides comprehensive insurance coverage details for the company.
The insurance policy covers Businessowners Liability and Automobile Liability with policy periods from 04/15/2024 to 04/15/2025. The policy includes $1,000,000 in general liability coverage, with additional provisions for personal and advertising injury, general aggregate, and products-completed operations aggregate. The Workers' Compensation portion provides $1,000,000 coverage for each accident, disease per employee, and disease policy limit. The certificate notes that additional insured status applies per the terms and conditions of the policy when required in a written contract or agreement, indicating this is likely related to a specific state procurement contract or service arrangement.
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Text version
DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
CONTACTPRODUCER
NAME:
PHONE FAX
(A/C, No, Ext): (A/C, No):
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A :
INSURED INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
INSR
LTR TYPE OF INSURANCE ADDL
INSR
SUBR
WVD POLICY NUMBER POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY) LIMITS
AUTHORIZED REPRESENTATIVE
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY
PRO-
JECT LOC
OTHER:
AUTOMOBILE LIABILITY
ANY AUTO
OWNED
AUTOS ONLY
SCHEDULED
AUTOS
HIRED
AUTOS ONLY
NON-OWNED
AUTOS ONLY
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS-MADE
DED RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below
Y / N N / A
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE
(Per accident)
EACH OCCURRENCE
AGGREGATE
PER
STATUTE
OTH-
ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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.
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).
US Computers Inc 181 W Orangethorpe Ave Ste C Placentia, CA 92870-6931
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.
Refer to attached
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
09/04/2024
Sentry Customer Service
800-473-6879 800-514-7191 businessproducts_direct@sentry.com
Sentry Insurance Company 24988
Sentry Select Insurance Company 21180
4024123
B 2557758002 04/15/2024 04/15/2025
X
1,000,000
1,000,000
1,000,000
Y
Sentry Insurance 1800 North Point Drive Stevens Point, WI 54481
BUSINESSOWNERS LIABILITY
X
A
X
X
2557758001 04/15/2024 04/15/2025
1,000,000
300,000
10,000
1,000,000
3,000,000
3,000,000
A
X X
2557758001 04/15/2024 04/15/2025
1,000,000
Arizona Department of Administration State Procurement Office 1802 W Jackson St # 100 Phoenix, AZ 85007-3221
09/04/20242557758
Sentry Insurance Company 00001 0000000000 24248 0 N1 a1c14562-460d-436d-aec2-97d7742304d1a1c14562-460d-436d-aec2-97d7742304d1
AGENCY CUSTOMER ID:
LOC #:
ADDITIONAL REMARKS SCHEDULE Page of
AGENCY
POLICY NUMBER
CARRIER NAIC CODE
ADDITIONAL REMARKS
NAMED INSURED
EFFECTIVE DATE:
US Computers Inc
XXXXXX4132
2 2
Scott Deaver
2557758001
Sentry Insurance Company 24988 04/15/2024
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: FORM TITLE:ACORD 25 Certificate of Liability Insurance
Certificate Details
Additional Insured status applies per the terms and conditions of the policy when required in written contract or written agreement.
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD 09/04/20242557758
Sentry Insurance Company
ACORD25_03-16 Certificate Of Liability Insurance
File details come from the government source that posted it. Updated .