Certificate_of_Insurance_-_Spragues_Sports_LLC.pdf
PDF 93 KB Posted
- Attached to
- Master Agreement AZ|CTR057649
- Contract number
- CTR057649
- Issued by
- Arizona
About this file
This is an ACORD Certificate of Liability Insurance dated 9/28/2021 for Sprague's Sports, LLC, located in Yuma, Arizona. The certificate involves multiple insurers, including Nova Casualty Company, CopperPoint Mutual Insurance, and Auto Owners Insurance Company. The primary certificate holder is the Arizona Game & Fish Department, representing the State of Arizona, with additional insured status for the state's departments, agencies, boards, commissions, universities, officers, agents, and employees.
The insurance coverage includes Commercial General Liability, Automobile Liability, Umbrella Liability, Workers' Compensation, and Professional Liability policies. The policies are effective from 4/27/2021 to 4/27/2022, with various coverage limits, including a $1,000,000 per occurrence limit for general liability, a $1,000,000 combined single limit for automobile liability, and a $2,000,000 aggregate limit for umbrella liability. The certificate includes a waiver of subrogation as required by written contract or agreement, and provides coverage for Arizona Game & Fish Department and the State of Arizona as additional insureds.
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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
9/28/2021
A.T.P. and Associates, LLC 350 W 16th Street Ste 103 Yuma AZ 85364
928-783-0000 928-783-3731
Nova Casualty Company SPRAG-1 CopperPoint Mutual Ins. 14216
Sprague's Sports, LLC Richard Sprague 345 W. 32nd Street Yuma AZ 85365
Auto Owners Insurance Co. 18988
184997931
A X 1,000,000 X 100,000
5,000
1,000,000
2,000,000
Y Y BRO-ML-10001048-01 4/27/2021 4/27/2022
2,000,000
C 1,000,000
X 5283254900 5/14/2021 5/14/2022
A X X 2,000,000BRO-XS-10000131-01 4/27/2021 4/27/2022
X 10,000 B X
Y
Y 1020873 7/1/2021 7/1/2022
1,000,000
1,000,000
1,000,000 A Professional Liability\ BRO-ML-10001048-01 4/27/2021 4/27/2022 1,000,000
Arizona Game & Fish and the State of Arizona Its Departments, agencies, boards, commissions, universities, officers, agents & Employees are listed As Additional Insured as required by written contract or agreement. Waiver of subrogation applies per forms AGL01351118 & WC000313 as required by written contract or agreement.
Arizona Game & Fish Dept.
State of Arizona 5000 W. Carefree Highway Phoenix AZ 85086
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