CGS_FLITS_Attachment_07_Attachment_-_Supplement_Insurance_.pdf
PDF 34 KB Posted
- Solicitation number
- BPM005633
- Issued by
- Arizona
About this file
This is a Certificate of Liability Insurance issued on October 20, 2023, for Cayuse Holdings, LLC and Cayuse Government Services, LLC in support of a contract with the Arizona Department of Administration - State Procurement Office. The certificate confirms that the insured entities maintain comprehensive insurance coverage effective January 1, 2023, through January 1, 2024, across multiple policy types and insurers. Coverage includes Commercial General Liability with limits of $1,000,000 per occurrence and $2,000,000 general aggregate; Automobile Liability with $1,000,000 single limits; Umbrella Liability of $10,000,000; Excess Liability of $10,000,000; and Workers' Compensation with $1,000,000 limits per accident. Additional coverage includes Abusive Conduct Liability ($1,000,000 per incident/aggregate) and Professional Liability ($3,000,000 limit of liability).
The insurance policies are underwritten by Old Republic Union Insurance Company, Pennsylvania Manufacturers Indemnity Company, Old Republic Insurance Company, Certain Underwriters at Lloyds, and Zurich American Insurance Company. The certificate holder, Arizona Department of Administration - State Procurement Office, is named as an additional insured when required by written contract, with coverage designated as primary and non-contributory. The producer of record is The Mahoney Group - Mesa, located at 1835 South Extension Road, Mesa, Arizona. All policies include provisions for notice of cancellation prior to expiration, and the certificate is issued for informational purposes only, with coverage subject to all terms, exclusions, and conditions of the underlying policies.
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Text version
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
INSR ADDL SUBR
LTR INSD WVD
PRODUCER CONTACT
NAME:
FAXPHONE
(A/C, No):(A/C, No, Ext):
ADDRESS:
INSURER A :
INSURED INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)
AUTOMOBILE LIABILITY
UMBRELLA LIAB
EXCESS LIAB
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
EACH OCCURRENCE $
DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence)
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT
OTHER: $
COMBINED SINGLE LIMIT
$(Ea accident)
ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED
BODILY INJURY (Per accident) $AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE
$AUTOS ONLY AUTOS ONLY (Per accident)
OCCUR EACH OCCURRENCE
CLAIMS-MADE AGGREGATE $
DED RETENTION $
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below
INSURER(S) AFFORDING COVERAGE NAIC #
COMMERCIAL GENERAL LIABILITY
Y / N N / A
(Mandatory in NH)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
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.
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 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).
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
CERTIFICATE HOLDER CANCELLATION
© 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03)
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
The ACORD name and logo are registered marks of ACORD
10/20/2023
(480) 730-4920 (480) 730-4929
31143
Cayuse Holdings, LLC Cayuse Government Services, LLC 72632 Coyote Rd Pendleton, OR 97801
41424 24147 16535
A 1,000,000
SNGL00036401 1/1/2023 1/1/2024 300,000
1,000,000 2,000,000 2,000,000
1,000,000B 1522311131499 1/1/2023 1/1/2024
10,000,000C
SNXS00021403 1/1/2023 1/1/2024
10,000,000 D
WC1352409 1/1/2023 1/1/2024 1,000,000
1,000,000 1,000,000
A Abusive Conduct Liab SNGL00036401 1/1/2023 Each Incident/Agg 1,000,000 E Professional Liabili W3107F220101 1/1/2023 1/1/2024 Limit of Liability 3,000,000
Certificate holder is additional insured when required by written contract. Coverage is primary and non-contributory.
Arizona Department of Administration - State Procurement Office 100 N 15th Avenue Phoenix, AZ 85007
CAYUTEC-01 NROQUE
The Mahoney Group - Mesa 1835 South Extension Road Mesa, AZ 85210
Old Republic Union Ins Co Pennsylvania Manufacturers Indemnity Company Old Republic Insurance Company Zurich American Insurance Company Certain Underwriters at Lloyds
X
1/1/2024
X X
X X X
X X
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