AZDOPS_COI.pdf
PDF 229 KB Posted
- Attached to
- AZ|CTR078106
- Contract number
- CTR078106
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance for Tyrrell-Marxen Chevrolet, located in Flagstaff, Arizona. The certificate is issued by Brightline Dealer Advisors and involves two primary insurance carriers: Columbia Casualty Company (NAIC 31127) and The Continental Insurance Company (NAIC 35289). The certificate holder is the Arizona Department of Public Safety, and the named insured entities include Tyrrell-Marxen Chevrolet, Inc., Terry Marxen Chevrolet dba Flagstaff Chevrolet, Harris Automotive Inc. dba Winslow Ford, and Mr. Harris Properties LLC.
The insurance policy provides comprehensive coverage with various limits, including a $1,000,000 general aggregate limit, $1,000,000 for each occurrence, and $5,000 for medical expenses. The policy covers commercial general liability, automobile liability (any auto), and umbrella liability, with policy periods from 7/1/2025 to 7/1/2026. The additional remarks schedule details garagekeepers legal liability for three locations in Flagstaff and Winslow, Arizona, with comprehensive/collision coverage ranging from $120,000 to $1,200,000 and deductibles of $1,000 for collision and $1,000/$5,000 for comprehensive coverage.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| CTR078106_Pricing.pdf | ||
| CI_Auto_Parts_and_Repair.pdf | ||
| CTR078106_Contract_Documents.pdf | ||
| CTR078106_Award_Letter.pdf | ||
| CTR078106_O_A.pdf | ||
| CTR078106_Contract_Documents_-_Flagstaff_Chevrolet.docx | DOCX document | |
| SPO_Form_120_-_PDS_Gerrick_Provencio.pdf |
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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 be low If yes , describe under
ANY P ROPRIETOR/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
06/27/2025
Brightline Deale r Advisors
15301 Dallas Pkwy
Suite 400
Addison TX 75001
Mike Morte nsen
(855) 955-2718 (469) 533-3854 mmortensen@brightlinedeale r.com
Tyrre ll-Marxen Chevrole t
1118 West Hwy 66
Fla gstaff AZ 86001
Columbia Casualty Company 31127
The Continenta l Insurance Company 35289
A
Garage
AYA737206122 7/1/2025 7/1/2026
1,000,000
100,000
5,000
1,000,000
2,000,000
1,000,000
Garage 1,000,000
A AYA737206122 7/1/2025 7/1/2026
1,000,000
A
10,000
AYU737207092 7/1/2025 7/1/2026
5,000,000
10,000,000
Named Insured(s ) Include:
Tyrre ll-Marxen Chevrole t, Inc.
Terry Ma rxen Chevrole t dba Flagstaff Chevrole t Harris Automotive Inc. dba Winslow Ford Mr Harris Properties LLC
Covered Location(s ) Include:...(continued on Form 101)...
AZ Department of Public Safety
EFFECTIVE DATE:
NAMED INSURED
POLICY NUMBER
NAIC CODECARRIER
AGENCY
LOC #:
AGENCY CUSTOMER ID:
ofPageADDITIONAL REMARKS SCHEDULE
ADDITIONAL REMARKS
FORM TITLE:FORM NUMBER:
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACORD 101 (2008/01)
1 1
25 Certifica te of Liability Insurance
Loc 1: 1118 West Hwy 66, Fla gstaff, AZ 86001 Loc 2: 805 We st Hwy 66, Flagstaff, AZ 86001 Loc 3: 840 Mike 's Pike St, Wins low, AZ 86047
Garagekeepers Legal Liability Comp / Collis ion Loc 1: $1,200,000 Loc 2: $120,000 Loc 3: $720,000
GK Deductible :
Collis ion: $1,000 Comprehens ive : $1,000/$5,000
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