Arnold_Machinary_Company_-_General-Auto-Umbrella__Exp_10.01.26_.pdf
PDF 226 KB Posted
- Attached to
- Master Agreement AZ|CTR072394
- Contract number
- CTR072394
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by Sentry Select Insurance Company for Arnold Machinery Company, with the State of Arizona Department of Emergency & Military Affairs (DEMA) Procurement Office as the certificate holder. The insurance policy provides comprehensive coverage including Commercial General Liability, Automobile Liability, Umbrella Liability, Workers' Compensation, Errors & Omissions, Pollution Liability, and Cyber Liability insurance. The policy is effective from 10/01/2025 to 10/01/2026 and includes additional insured provisions for the State of Arizona, its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees.
The insurance policies offer substantial coverage limits, including $1,000,000 for Commercial General Liability per occurrence, $25,000,000 for Umbrella Liability each occurrence, $1,000,000 for Pollution Liability aggregate limit, and $100,000 for Cyber Liability. The policies include various endorsements that provide additional protections such as waiver of subrogation and designated insured coverage for the State of Arizona. The insurance is primary and non-contributory, meaning it will respond first in the event of a claim. The policies cover Arnold Machinery Company's operations, with specific provisions for liability arising from the company's ongoing operations and completed work.
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Text version
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).
PRODUCER
Sentry Insurance
1800 North Point Drive
Stevens Point, WI 54481
CONTACT
NAME: Sentry Customer Service
PHONE
(A/C, No, Ext): 800-473-6879
FAX
(A/C, No): 800-514-7191
ADDRESS: businessproducts_direct@sentry.com
INSURER(S) AFFORDING COVERAGE NAIC#
INSURER A : Sentry Select Insurance Company 21180
INSURED
Arnold Machinery Company PO Box 30020 Salt Lake City, UT 84130-0020
INSURER B : Sentry Insurance Company 24988
INSURER C :
INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: 1277141 REVISION NUMBER:
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.
INSR
LTR TYPE OF INSURANCE ADDL
INSR
SUBR
WVD POLICY NUMBER POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE X OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY PRO-
JECT LOC
OTHER:
X X 2568383004 10/01/2025 10/01/2026
EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
PREMISES (Ea occurrence) $ 500,000
MED EXP (Any one person) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 3,000,000
PRODUCTS - COMP/OP AGG $ 2,000,000
A
AUTOMOBILE LIABILITY
X ANY AUTO
OWNED
AUTOS ONLY
SCHEDULED
AUTOS
HIRED
AUTOS ONLY
NON-OWNED
AUTOS ONLY
X X 2568383005 10/01/2025 10/01/2026
COMBINED SINGLE LIMIT
(Ea accident) $ 1,000,000
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE
(Per accident) $
A
X UMBRELLA LIAB X OCCUR
X EXCESS LIAB CLAIMS-MADE
DED RETENTION $
2568383006 10/01/2025 10/01/2026
EACH OCCURRENCE $ 25,000,000
AGGREGATE $ 75,000,000
PRODUCTS - COMP/OP AGG $ 75,000,000
B
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
Y N / A 2568383010 10/01/2025 10/01/2026
X PER
STATUTE
OTH-
ER
E.L. EACH ACCIDENT $ 1,000,000
E.L. DISEASE - EA EMPLOYEE $ 1,000,000
E.L. DISEASE - POLICY LIMIT $ 1,000,000
A ERRORS & OMISSIONS 2568383008 10/01/2025 10/01/2026
Employee Benefits Occurrence Limit $ 500,000
Errors & Omissions Annual Aggregate Limit $ 1,000,000
Deductible $ 1,000
All Other Errors &
Omissions
Occurrence Limit $ 250,000
Annual Aggregate Limit $ 500,000
Deductible $ 10,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Refer to attached
DATE (MM/DD/YYYY)
09/15/2025CERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE HOLDER
State of Arizona Dept of Emergency & Military Affairs Dema Procurement Office Building #M5800 5645 E Mcdowell Rd Phoenix, AZ 85008-3423
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD2568383 Sentry Select Insurance Company
0027020044383518204285008342345 f4b4e9ea-2bbd-4f1b-a7c6-6c4bf1bc1e6a
09/15/2025
2568383 Sentry Select Insurance Company
0027020044383518204285008342345 f4b4e9ea-2bbd-4f1b-a7c6-6c4bf1bc1e6a
09/15/2025The ACORD name and logo are registered marks of ACORD
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
AGENCY CUSTOMER ID: XXXXXX2120
LOC #:
Page 2 of 2ADDITIONAL REMARKS SCHEDULE
AGENCY NAMED INSURED
Andrew Sevic Arnold Machinery Company
POLICY NUMBER
2568383004
CARRIER NAIC CODE
Sentry Select Insurance Company 21180 EFFECTIVE DATE: 10/01/2025
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: ACORD 25 Certificate of Liability InsuranceFORM TITLE:
General Liability
THE STATE OF ARIZONA, & ITS DEPARTMENTS, AGENCIES, BOARDS, COMMISIONS UNIVERSITIES, OFFICERS, OFFICALS, AGENTS, & EMPLOYEES ARE ADDITIONAL INSURED WITH RESPECT TO LIABILITY ARISING OUT OF THE ACTIVITIES PREFORMED BY OR ON BEHALF OF THE CONTACTOR. COVERAGE IS
PRIMARY & NON-CONTRIBUTORY.
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).
PRODUCER
Sentry Insurance
1800 North Point Drive
Stevens Point, WI 54481
CONTACT
NAME: Sentry Customer Service
PHONE
(A/C, No, Ext): 800-473-6879
FAX
(A/C, No): 800-514-7191
ADDRESS: businessproducts_direct@sentry.com
INSURER(S) AFFORDING COVERAGE NAIC#
INSURER A : Sentry Select Insurance Company 21180
INSURED
Arnold Machinery Company PO Box 30020 Salt Lake City, UT 84130-0020
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: 1277141 REVISION NUMBER:
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.
INSR
LTR TYPE OF INSURANCE ADDL
INSR
SUBR
WVD POLICY NUMBER POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
LIMITS
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JECT LOC
OTHER:
EACH OCCURRENCE $
DAMAGE TO RENTED
PREMISES (Ea occurrence) $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
AUTOMOBILE LIABILITY
ANY AUTO
OWNED
AUTOS ONLY
SCHEDULED
AUTOS
HIRED
AUTOS ONLY
NON-OWNED
AUTOS ONLY
COMBINED SINGLE LIMIT
(Ea accident) $
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE
(Per accident) $
UMBRELLA LIAB OCCUR
EXCESS LIAB CLAIMS-MADE
DED RETENTION $
EACH OCCURRENCE $
AGGREGATE $
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
PER
STATUTE
OTH-
ER
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
A
POLLUTION LIABILITY
X CLAIMS-MADE OCCUR N / A 2568383009 10/01/2025 10/01/2026
AGGREGATE LIMIT $ 1,000,000
POLLUTION INCIDENT LIMIT $ 1,000,000
CLEANUP COSTS COVERED
LOCATION LIMIT $ 100,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
DATE (MM/DD/YYYY)
09/15/2025CERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE HOLDER
State of Arizona Dept of Emergency & Military Affairs Dema Procurement Office Building #M5800 5645 E Mcdowell Rd Phoenix, AZ 85008-3423
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD2568383 Sentry Select Insurance Company
0027020044383518205585008342345 f2bb9d90-eeea-4bf1-b5f4-b4837faf0354
0027020044383518205585008342345 f2bb9d90-eeea-4bf1-b5f4-b4837faf0354
09/15/2025The ACORD name and logo are registered marks of ACORD
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
AGENCY CUSTOMER ID: XXXXXX2120
LOC #:
Page 2 of 2ADDITIONAL REMARKS SCHEDULE
AGENCY NAMED INSURED
Andrew Sevic Arnold Machinery Company
POLICY NUMBER
2568383009
CARRIER NAIC CODE
Sentry Select Insurance Company 21180 EFFECTIVE DATE: 10/01/2025
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: ACORD 25 Certificate of Liability InsuranceFORM TITLE:
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).
PRODUCER
Sentry Insurance
1800 North Point Drive
Stevens Point, WI 54481
CONTACT
NAME: Sentry Customer Service
PHONE
(A/C, No, Ext): 800-473-6879
FAX
(A/C, No): 800-514-7191
ADDRESS: businessproducts_direct@sentry.com
INSURER(S) AFFORDING COVERAGE NAIC#
INSURER A : Sentry Select Insurance Company 21180
INSURED
Arnold Machinery Company PO Box 30020 Salt Lake City, UT 84130-0020
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: 1277141 REVISION NUMBER:
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.
INSR
LTR TYPE OF INSURANCE ADDL
INSR
SUBR
WVD POLICY NUMBER POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
LIMITS
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JECT LOC
OTHER:
EACH OCCURRENCE $
DAMAGE TO RENTED
PREMISES (Ea occurrence) $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
AUTOMOBILE LIABILITY
ANY AUTO
OWNED
AUTOS ONLY
SCHEDULED
AUTOS
HIRED
AUTOS ONLY
NON-OWNED
AUTOS ONLY
COMBINED SINGLE LIMIT
(Ea accident) $
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE
(Per accident) $
UMBRELLA LIAB OCCUR
EXCESS LIAB CLAIMS-MADE
DED RETENTION $
EACH OCCURRENCE $
AGGREGATE $
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
PER
STATUTE
OTH-
ER
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
A Cyber Liability and Data Breach Response N / A 2568383011 10/01/2025 10/01/2026 Policy Aggregate Limit of Liability $ 100,000
Retention $ 2,500
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
DATE (MM/DD/YYYY)
09/15/2025CERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE HOLDER
State of Arizona Dept of Emergency & Military Affairs Dema Procurement Office Building #M5800 5645 E Mcdowell Rd Phoenix, AZ 85008-3423
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD2568383 Sentry Select Insurance Company
0027020044383518198985008342345 b59499f2-5566-4022-b9a5-68a0a3caf978
0027020044383518198985008342345 b59499f2-5566-4022-b9a5-68a0a3caf978
09/15/2025The ACORD name and logo are registered marks of ACORD
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
AGENCY CUSTOMER ID: XXXXXX2120
LOC #:
Page 2 of 2ADDITIONAL REMARKS SCHEDULE
AGENCY NAMED INSURED
Andrew Sevic Arnold Machinery Company
POLICY NUMBER
2568383011
CARRIER NAIC CODE
Sentry Select Insurance Company 21180 EFFECTIVE DATE: 10/01/2025
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: ACORD 25 Certificate of Liability InsuranceFORM TITLE:
2568383005
Arnold Machinery Company
10/01/2025
State of Arizona Dept of Emergency & Military Affairs Dema Procurement Office Building #M5800
2568383 Sentry Select Insurance Company
09/15/2025
CA 04 44 10 13 Page 1 of 1 a9fc3609-b42f-4aa9-be39-aa7455029f4f
Named Insured:
Endorsement Effective Date:
Name(s) Of Person(s) Or Organization(s):
POLICY NUMBER: COMMERCIAL AUTO
CA 04 44 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.
SCHEDULE
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization.
© Insurance Services Office, Inc., 2011
09/15/2025
CA 20 48 10 13 Page 1 of 1 ab35cfb0-b046-4dec-9218-95bad6e55189
POLICY NUMBER:
Named Insured:
Endorsement Effective Date:
SCHEDULE
Name Of Person(s) Or Organization(s):
© Insurance Services Office, Inc., 2011
COMMERCIAL AUTO
CA 20 48 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED FOR
COVERED AUTOS LIABILITY COVERAGE
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement.
This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form.
Arnold Machinery Company
10/01/2025
State of Arizona Dept of Emergency & Military Affairs Dema Procurement Office Building #M5800
2568383005
POLICY NUMBER: 2568383004
Sentry Select Insurance Company
09/15/2025
CG 20 10 12 19 Page 1 of 2 e399779c-1bce-4f5f-a58a-f7f013f765b6
© Insurance Services Office, Inc., 2018
COMMERCIAL GENERAL LIABILITY
CG 20 10 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf;
in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above.
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:
This insurance does not apply to "bodily injury" or "property damage" occurring after:
1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or
2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project.
Name Of Additional Insured Person(s)
Or Organization(s) Location(s) Of Covered Operations
State of Arizona Dept of Emergency & Military Affairs Dema Procurement Office Building #M5800
All Locations Description:
State of Arizona Dept of Emergency & Military Affairs Dema Procurement Office Building #M5800
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
09/15/2025
CG 20 10 12 19Page 2 of 2 e399779c-1bce-4f5f-a58a-f7f013f765b6
C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable limits of insurance;
whichever is less.
This endorsement shall not increase the applicable limits of insurance.
© Insurance Services Office, Inc., 2018
POLICY NUMBER:
© Insurance Services Office, Inc., 2018
COMMERCIAL GENERAL LIABILITY
CG 24 04 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
ELECTRONIC DATA LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES
POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS
SCHEDULE
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions:
We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss.
This endorsement applies only to the person(s) or organization(s) shown in the Schedule above.
Name Of Person(s) Or Organization(s):
State of Arizona Dept of Emergency & Military Affairs Dema Procurement Office Building #M5800
2568383004
Page 1 of 1CG 24 04 12 19 09/15/20252568383
0ca6ea41-003d-4bc9-90dd-41bb01ec20e70ca6ea41-003d-4bc9-90dd-41bb01ec20e7
File details come from the government source that posted it. Updated .