Arizona-Game-and-Fi_Western-Chemica_2024-25-GL_-AL__10-29-2024_1761176814_1.pdf
PDF 137 KB Posted
- Attached to
- Master Agreement AZ|CTR057413
- Contract number
- CTR057413
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by Arthur J. Gallagher Risk Management Services, LLC for Western Chemical Incorporated (dba Syndel USA and Aquatic Life Sciences, Inc.), located in Ferndale, Washington. The certificate lists multiple insurers, including AIG Specialty Insurance Company and Aspen Specialty Insurance Company, and is specifically designated for the State of Arizona, with Arizona Game and Fish as the certificate holder. The insurance covers the insured's operations and provides additional insured status to the State of Arizona and its various departments, agencies, boards, commissions, universities, officers, and employees.
The insurance policy provides comprehensive coverage with multiple types of insurance, including commercial general liability, automobile liability, umbrella liability, workers' compensation, and pollution legal liability. The policies are effective from 10/31/2024 to 10/31/2025, with significant coverage limits. Notable coverage includes a $1,000,000 each occurrence limit for commercial general liability, a $10,000,000 excess liability limit, and a $1,000,000 workers' compensation coverage with Washington State stop-gap provisions. The policy includes pollution liability and vendors liability, with aggregate limits of $2,000,000 and specific endorsements protecting the State of Arizona's interests in the insured's operations.
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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
10/29/2024
Arthur J. Gallagher Risk Management Services, LLC 777 108th Avenue NE, Suite 200 Bellevue WA 98004
Kelsey Spaniel 425-586-1011 425-451-3716 kelsey_spaniel@ajg.com
AIG Specialty Insurance Company 26883 WESTCHE-12 Aspen Specialty Insurance Company 10717
Western Chemical Incorporated dba: Syndel USA; Aquatic Life Sciences, Inc;
1441 W Smith Rd, Ferndale WA 98248
National Union Fire Insurance Co of LA 32298
1761176814
A X 1,000,000 X 1,000,000
X Pollution Liab. 25,000 X Vendors Liab. 1,000,000
2,000,000 X X
14260808-03 10/31/2024 10/31/2025
2,000,000
C 1,000,000
X 184-12-558 10/31/2024 10/31/2025
A X X 10,000,00014260809-03 10/31/2024 10/31/2025
10,000,000
A 14260808-03 10/31/2024 10/31/2025 X WA Stop Gap 1,000,000
1,000,000
1,000,000 A B
Pollution legal Liability Excess Liability
14260808-03
EX00XYF24
10/31/2024 10/31/2024
10/31/2025 10/31/2025
Each Loss limit Per Occurrence
1,000,000 10,000,000
The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are listed as additional insureds with respect to work performed by the named insured.
Arizona Game and Fish 5000 W Carefree Hwy, Phoenix AZ 85086
File details come from the government source that posted it. Updated .