Certificate_of_ins_2025-2026.pdf
PDF 126 KB Posted
- Attached to
- Master Agreement AZ|CTR068587
- Contract number
- CTR068587
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance issued by Leavitt Select Insurance Services, Inc. on 3/18/2025, covering Cove River Ranch LLC located in Venice, UT. The insurance policies are provided by Scottsdale Insurance Company, United Financial Casualty Company, and WCF Mutual Insurance Company. The certificate holder is the State of Arizona, including its departments, boards, commissions, universities, offices, officials, agents, and employees, specifically naming the Arizona Game and Fish Department.
The insurance certificate covers three main types of coverage: Commercial General Liability (Policy CPS8168937), Automobile Liability (Policy 06627184), and Workers Compensation (Policy 4007392). The policies are effective from 3/16/2025 to 3/16/2026 for general and auto liability, and from 9/24/2024 to 9/24/2025 for workers compensation. The general liability policy includes $1,000,000 per occurrence, $2,000,000 general aggregate, and $5,000 medical expenses. The auto liability provides a $1,000,000 combined single limit, and the workers compensation has $1,000,000 limits for each accident, disease per employee, and disease policy limit.
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Text version
3/18/2025
Leavitt Select Insurance Services, Inc.
2200 S. Main Street Suite 600 Salt Lake City UT 84115
Colleen Stanton (801)308-1500 (801)308-1427 colleen-stanton@leavitt.com
Cove River Ranch LLC 202 N West haven Rd
Venice UT 84701
Scottsdale Insurance Company 41297 United Financial Casualty Company 11770 WCF Mutual Insurance Company 10033
25/26
A
X
X
X
X Y CPS8168937 3/16/2025 3/16/2026
1,000,000
100,000
5,000
1,000,000
2,000,000
2,000,000
B X X Y 06627184 3/16/2025 3/16/2026
1,000,000
Uninsured motorist combined single limit 1,000,000
C 4007392 9/24/2024 9/24/2025
X
1,000,000
1,000,000
1,000,000
The State of Arizona, and its departments boards, commissions, universities, office officials, agents, and employees Arizona Game and Fish Dept.
5000 W Carefree Hwy Phoenix, AZ 85086 C Stanton-Exec/COSTAN
The ACORD name and logo are registered marks of ACORD
CERTIFICATE HOLDER
© 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01)
AUTHORIZED REPRESENTATIVE
CANCELLATION
DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE
LOCJECT
PRO-
POLICY
GEN'L AGGREGATE LIMIT APPLIES PER:
OCCURCLAIMS-MADE
COMMERCIAL GENERAL LIABILITY
PREMISES (Ea occurrence) $
DAMAGE TO RENTED
EACH OCCURRENCE $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
$RETENTIONDED
CLAIMS-MADE
OCCUR
AGGREGATE $
EACH OCCURRENCE $UMBRELLA LIAB
EXCESS LIAB
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
INSR
LTR TYPE OF INSURANCE POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY) LIMITS
PER
STATUTE
OTH-
ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
ANY PROPRIETOR/PARTNER/EXECUTIVE
If yes, describe under DESCRIPTION OF OPERATIONS below
(Mandatory in NH)
OFFICER/MEMBER EXCLUDED?
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
HIRED AUTOS
NON-OWNED
AUTOS AUTOS
AUTOS
COMBINED SINGLE LIMIT
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE $
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.
INSD
ADDL
WVD
SUBR
N / A
(Ea accident)
(Per accident)
OTHER:
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 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).
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
INSURED
PHONE
(A/C, No, Ext):
PRODUCER
ADDRESS:
FAX
(A/C, No):
CONTACT
NAME:
NAIC #
INSURER A :
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
INSURER(S) AFFORDING COVERAGE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
INS025 (201401)
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