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.
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Other files
| File | Type | Posted |
|---|---|---|
| CTR074643_Amdt_2.pdf | ||
| CTR074643_Contract_Amendment_No._1__1_.pdf |
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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
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 .