Certificate_of_Insurance__Kiesler_Police_Supply__CGL_AL_Umb_8-3-2022_to_8-3-23_WC_4-1-22_to_4-1-23.pdf
PDF 4 MB Posted
- Attached to
- Master Agreement AZ|CTR057648
- Contract number
- CTR057648
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by Arthur J. Gallagher Risk Management Services, Inc. for Kiesler Police Supply, Inc., with insurance coverage provided by multiple carriers including Liberty Mutual Holding Company, Berkshire Hathaway Specialty Insurance Company, and American Security Insurance Company. The certificate is specifically related to a contract with the Arizona Game and Fish Department, located in Phoenix, Arizona.
The contract appears to involve rifles and firearms for hunter education, with the insurance policy providing comprehensive coverage including commercial general liability, automobile liability, and workers' compensation. The policy periods are from August 1, 2022 to August 1, 2023, with total coverage limits including $1,000,000 for general liability, $1,000,000 for automobile liability, and $10,000,000 in umbrella liability. The Arizona Game and Fish Department is listed as an additional insured on the policy, with coverage extending to general liability and automobile liability as required by the written contract.
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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
8/3/2022
Arthur J. Gallagher Risk Management Services, Inc 1601 Alliant Ave Louisville KY 40299
502-415-7000 502-415-7001
Liberty Mutual Holding Company, Inc.
KIESPOL-02 Berkshire Hathaway Specialty Insurance Company 22276
Kiesler Police Supply, Inc.
2802 Sable Mill Rd Jeffersonville, IN 47130
American Security Insurance Company 42978
707114337
B X 1,000,000 X 100,000
10,000
1,000,000
2,000,000
Y Y Q23724 8/1/2022 8/1/2023
2,000,000
C 1,000,000
X
X X
Y Y TRA4037244 8/1/2022 8/1/2023
B X X 10,000,000Y Q-23729 8/1/2022Y 8/1/2023
10,000,000 X 10,000
A XY XWS61048486 4/1/2022 4/1/2023
1.000,000
1.000,000
1.000,000
RE: BPM003844 Rifles/Firearms for Hunter Education ARIZONA GAME AND FISH DEPARTMENT is additional insureds on the General Liability (CG 2015 04
13) on a primary and non-contributory basis (CG 20 01 04 13 and Automobile Liability Policies as required by written contract (CA 7078 10 13). Waiver of subrogation is as added in favor of the additional insureds on General Liability (CG 24 04 05 09), Auto Liability and Workers Compensation policies when required by written contract. Umbrella Liability follows form.
ARIZONA GAME AND FISH DEPARTMENT
5000 West Carefree Highway Phoenix AZ 85086
USA
02LX808368493
POLICY NUMBER: 02LX808368493 COMMERCIAL GENERAL LIABILITY
CG 2015 0413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - VENDORS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Oraanization(s) (Vendor) Your Products
All vendors of the Named Insured's All Products
Products
Information reauired to comolete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II - Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) (referred to throughout this endorsement as vendor) shown in the Schedule, but only with respect to "bodily injury" or "property damage" arising out of "your products" shown in the Schedule which are distributed or sold in the regular course of the vendor's business.
However:
1. The insurance afforded to such vendor only applies to the extent permitted by law; and
2. If coverage provided to the vendor is required by a contract or agreement, the insurance afforded to such vendor will not be broader than that which you are required by the contract or agreement to provide for such vendor.
B. With respect to the insurance afforded to these vendors, the following additional exclusions apply:
1. The insurance afforded the vendor does not apply to:
a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement;
b. Any express warranty unauthorized by you;
c. Any physical or chemical change in the product made intentionally by the vendor;
d. Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container;
CG 2015 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2
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