COI__2024.04.08_GL-AL-UL_-Pollition_L.pdf
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- Attached to
- Master Agreement AZ|CTR055334
- Contract number
- CTR055334
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by AssuredPartners of Arizona, LLC on March 16, 2023, for M D Merrett, with Employers Mutual Insurance Co as the primary insurer. The certificate is related to a contract (CTR055334) with the Arizona Game and Fish Department, located in Phoenix, Arizona. The insurance covers Wildlife Waters Construction & Redevelopment/Wildlife Habitat Construction activities.
The insurance policy provides comprehensive coverage including Commercial General Liability with a $1,000,000 per occurrence limit, a $2,000,000 general aggregate limit, and a $5,000 medical expense limit. Additional coverage includes Automobile Liability with a $1,000,000 combined single limit, Umbrella/Excess Liability with $5,000,000 per occurrence and aggregate limits, and Pollution Liability with a $1,000,000 limit. The policy is effective from April 8, 2023, to April 8, 2024, and includes the State of Arizona, its departments, agencies, and employees as additional insureds on a primary and non-contributory basis.
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Text version
03/16/2023
AssuredPartners of Arizona, LLC 4544 E Camp Lowell Dr Ste 110
Tucson AZ 85712-1282
Donna Strusienski
(480) 483-3311 (520) 571-9115
Donna.Strusienski@AssuredPartners.com
M D Merrett P.O. Box 3804
Carefree AZ 85377
Employers Mutual Insurance Co
23/24GL,AL,XS,POL
A Y Y 5X10324 04/08/2023 04/08/2024
1,000,000 300,000 5,000 1,000,000 2,000,000 2,000,000
A Y Y 5X10324 04/08/2023 04/08/2024
1,000,000
A 10,000
5X10324 04/08/2023 04/08/2024 5,000,000 5,000,000
A Pollution Liability
5X10324 04/08/2023 04/08/2024 $1,000,000
RE: Wildlife Waters Construction & Redevelopment/Wildlife Habitat Construction The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents and employees as Additional Insureds on the General Liability policy shown above on a Primary & Non-Contributory basis and including a Waiver of Subrogation in their favor, if required by written contract for operations being performed for them by the named insured and subject to policy terms, forms and conditions. CG7393.1 (10-13) & CG2404 (05-09).
RE: Contract No. CTR055334
Arizona Game and Fish Department Purchasing Office 5000 West Carefree Highway
Phoenix AZ 85086
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
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