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

E-MAIL

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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