AZ_Fish___Game_Secured.pdf

ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

07 2 5 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 CONTACT

NAME: American Family Insurance - Business Insurance

American Family Insurance - Business Insurance

PHONE

(A/C, No, Ext):

FAX

(A/C, No):

PO Box 5316 E-MAIL

ADDRESS:

Binghamton, NY 13902

INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A : Midvale Indemnity Company 27138

INSURED INSURER B :

INSURER C :

INSURER D :

SRT OF AZ

6328 W BROWN ST

GLENDALE AZ 85302 INSURER E :

INSURER F :

COVERAGES CERTIFICATE NUMBER: 1268118010087096 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

COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000

A CLAIMS-MADE X OCCUR Y BPP1052443 05/27/20 5 05/27/20 6

DAMAGE TO RENTED

PREMISES (Ea occurrence) $100,000

MED EXP (Any one person) $5,000

PERSONAL & ADV INJURY

$2,000,000

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000

X POLICY

PRO-

JECT

LOC

PRODUCTS - COMP/OP AGG $4,000,000

OTHER:

AUTOMOBILE LIABILITY

COMBINED SINGLE LIMIT

(Ea accident)

ANY AUTO BODILY INJURY (Per person)

OWNED

AUTOS ONLY

SCHEDULED

AUTOS

BODILY INJURY

(Per accident)

HIRED

AUTOS ONLY

NON-OWNED

AUTOS ONLY

PROPERTY DAMAGE

(Per accident)

UMBRELLA LIAB OCCUR EACH OCCURRENCE

EXCESS LIAB CLAIMS-MADE AGGREGATE

DED RETENTION $

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY Y/N

PER

STATUTE

OTH-

ER

ANY PROPRIETOR/PARTNER/EXECU

-TIVE OFFICER/MEMBER EXCLUDED? E.L. EACH ACCIDENT

(Mandatory in NH) E.L. DISEASE - EA

EMPLOYEE

If yes, describe under

DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT

PROFESSIONAL LIABILITY OCCURRENCE

AGGREGATE

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

CERTIFICATE HOLDER 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

© 1988-2015 ACORD CORPORATION. All rights reserved.

POLICY NUMBER: BPP1052443 BUSINESSOWNERS

BP 04 48 07 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

BP 04 48 07 13 © Insurance Services Office, Inc., 2012 Page 1 of 1

ADDITIONAL INSURED – DESIGNATED PERSON

OR ORGANIZATION

This endorsement modifies insurance provided under the following:

BUSINESSOWNERS COVERAGE FORM

SCHEDULE

Name Of Additional Insured Person(s) Or Organization(s):

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

Section II – Liability is amended as follows:

A. The following is added to Paragraph C. Who Is An

Insured:

3. Any person(s) or organization(s) shown in the

Schedule is also an additional insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf in the performance of your ongoing operations or in connection with your premises owned by or rented to you.

However:

a. The insurance afforded to such additional insured only applies to the extent permitted by law; and

b. 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 is added to Paragraph D. Liability And Medical Expenses 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 shown in the Declarations;

whichever is less.

This endorsement shall not increase the applicable Limits Of Insurance shown in the Declarations.

POLICY NUMBER: BPP1052443 SD0001 0110

SUPPLEMENTAL FORM DECLARATION FOR BP0448 0713

ADDITIONAL INSURED – DESIGNATED PERSON

OR ORGANIZATION

SD0001 0110 Midvale Indemnity Company Page 1 of 1

SCHEDULE

Name Of Additional Insured Person(s) Or Organization(s):

ARCADIA PARK PLACE, LLC @ 4840 E INDIAN SCHOOL RD, PHOENIX AZ

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

Name Of Additional Insured Person(s) Or Organization(s):

ARIZONA CATTLE GROWERS' ASSOCIATION

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

Name Of Additional Insured Person(s) Or Organization(s):

ARIZONA GAME AND FISH DEPARTMENT

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

Name Of Additional Insured Person(s) Or Organization(s):

HSB AGUA FRIA, LLC & WESTWOOD FINANCIAL

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

Name Of Additional Insured Person(s) Or Organization(s):

WFC AVONDALE FIESTA, LLC & WESTWOOD FINANCIAL, LLC

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

POLICY NUMBER: BPP1052443 COMMERCIAL GENERAL LIABILITY

CG 24 04 05 09

CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

SCHEDULE

Name Of Person Or Organization: A waiver of subrogation endorsement, when required by this written agree-ment, in favor of the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, for losses arising from work performed by or on behalf of the Contractor.

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 we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above.