COI_2025-07-25_GL_WC.pdf

PDF 97 KB Posted

Attached to
Master Agreement AZ|CTR074643
Contract number
CTR074643
Issued by
Arizona

About this file

This is an ACORD Certificate of Liability Insurance for Victory Supply LLC, located in Mount Pleasant, Tennessee, issued by Professional Insurance Plans in Lexington, Kentucky. The certificate covers insurance policies from Grange Mutual Casualty Company and Hartford Insurance Company, and is specifically associated with Contract No. CTR074643 for the State of Arizona. The additional insured on this certificate is the Arizona Department of Juvenile Corrections, located in Phoenix, Arizona.

The insurance coverage includes commercial general liability, automobile liability, and workers' compensation policies, with policy periods from 07/25/2024 to 07/25/2025. The general liability policy has a $2,000,000 each occurrence limit and a $4,000,000 general aggregate limit. The umbrella liability provides an additional $2,000,000 in coverage. The workers' compensation policy has $1,000,000 limits for each accident and disease coverage. The certificate includes a waiver of subrogation and additional insured provisions for the State of Arizona and its departments, subject to policy terms and conditions.

View the file

Other files

File Type Posted
CTR074643_Amdt_2.pdf PDF
CTR074643_Contract_Amendment_No._1__1_.pdf PDF

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file

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

01/22/2025

Professional Insurance Plans 1795 Alysheba Way Ste 4201

Lexington KY 40509

Tonya L Farmer

(859) 543-8955 (859) 559-0019 agent@professionalplans.com

Victory Supply LLC 7025 Industrial Park Rd

Mount Pleasant TN 38474

GRANGE MUTUAL CASUALTY COMPANY 14060

HARTFORD INSURANCE COMPANY 914

A Y BP 2763438 07/25/2024 07/25/2025

2,000,000 100,000 10,000

4,000,000 4,000,000

A CUP2789587 07/25/2024 07/25/2025

2,000,000 2,000,000

B Y Y 33WECAX8D08 07/25/2024 07/25/2025

1,000,000 1,000,000 1,000,000

Contract No. CTR074643 - State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are additional insureds on a primary & non-contributory basis regarding general liability and automobile liability policies. Waiver of subrogation in favor of additional insureds applies regarding general liability, automobile liability and workers compensation policies. All of the above applies where required by written contract, subject to policy terms & conditions.

Additional Insured:

Arizona Department of Juvenile Corrections 100 N 15th Ave Ste 103 Phoenix AZ 85007

File details come from the government source that posted it. Updated .