COI_AZ_State_Contract_CTR062453_.pdf
PDF 3 MB Posted
- Attached to
- Master Agreement AZ|CTR062453
- Contract number
- CTR062453
- Issued by
- Arizona
About this file
This document is a comprehensive insurance policy package for Corporate Technology Solutions, LLC, issued by Amerisure Insurance Company, Amerisure Mutual Insurance Company, and Berkley Assurance Company. The policies include Commercial General Liability, Commercial Automobile Liability, Workers' Compensation, Professional Liability, and Commercial Liability Umbrella coverage, with the State of Arizona Department of Administration as the primary certificate holder. The insurance is effective from November 1, 2021 to November 1, 2022, and covers operations related to a Master Agreement #CTR062453 and Contract #BPM004541 for Communications Cabling Systems.
The insurance policies provide coverage with various limits, including $1,000,000 for each occurrence of general liability, $1,000,000 for automobile liability, $5,000,000 for umbrella liability, and $1,000,000 for workers' compensation. The policies include additional insured provisions for the State of Arizona, its departments, agencies, boards, commissions, universities, and their officers, officials, agents, and employees. The coverage is primary and non-contributory when required by written contract, with supporting endorsements that expand coverage for product recall, bodily injury, property damage, and other potential business risks. A $15,000 self-insured retention is noted for the professional liability coverage.
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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
10/3/2022
Lovitt & Touché A Marsh and McLennan Agency, LLC 1050 W Washington Street, Suite 233 Tempe AZ 85281
Sandy Coons 602-956-2250 602-956-2258 scoons@lovitt-touche.com
Amerisure Insurance Company 19488 CORPTEC-C1 Amerisure Mutual Insurance Company 23396
Corporate Technology Solutions, LLC
1971 E 5TH ST STE 111
Tempe AZ 85288
Berkley Assurance Company 39462
366509773
A X 1,000,000 X 1,000,000
10,000
1,000,000
2,000,000 X
Y Y CPP20899550801 11/1/2021 11/1/2022
2,000,000
Deductible PD 250 A 1,000,000
X
X X
Y Y CA20899540801 11/1/2021 11/1/2022
B X X 5,000,000Y CU20899560802 11/1/2021Y 11/1/2022
5,000,000 X 0
B X
N
Y WC20899570802 11/1/2021 11/1/2022
1,000,000
1,000,000
1,000,000 C Professional Liability
Retro Date: 02/02/2014 Y PCXB50174961121 11/1/2021 11/1/2022 Each Claim
Aggregate
SIR
$2,000,000 $2,000,000 $15,000
The above-indicated Additional Insured and Waiver of Subrogation (WOS) are provided with respects to General Liability, Automobile Liability, Workers’ Compensation (WOS only) when required in a written and executed contract. Such coverage afforded by these policies for the benefit of the additional insured(s) is primary and any other coverage maintained by such additional insured(s) shall be non-contributory when required in a written and executed contract.
Supporting endorsements attached include: CG7048 10/15, CG7049 04/17, CA7115 11/09, CA7165 10/07, CU2403 09/00, CU7467 11/07, WC000313 04/84.
RE: Master Agreement #CTR062453 - Contract# BPM004541 - Communications Cabling Systems The State of Arizona, its departments, agencies, boards, commissions, universities and it officers, officials, agents, and employees are additional insured if required by written contract.
Arizona Department of Administration State Procurement Office 100 N 15th Ave, #201 Phoenix AZ 85007
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTOR’S BLANKET ADDITIONAL INSURED ENDORSEMENT –
FORM A
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
Policy Number Agency Number Policy Effective Date
Policy Expiration Date Date Account Number
Named Insured Agency Issuing Company
1. a. SECTION II - WHO IS AN INSURED is amended to add as an additional insured any person or organization:
(1) Whom you are required to add as an additional insured on this policy under a written contract or written agreement relating to your business; or
(2) Who is named as an additional insured under this policy on a certificate of insurance.
b. The written contract, written agreement, or certificate of insurance must:
(1) Require additional insured status for a time period during the term of this policy; and
(2) Be executed prior to the "bodily injury", "property damage", or "personal and advertising injury" leading to a claim under this policy.
c. If, however:
(1) “Your work” began under a letter of intent or work order; and
(2) The letter of intent or work order led to a written contract or written agreement within 30 days of beginning such work; and
(3) Your customer’s customary contracts require persons or organizations to be named as additional insureds;
we will provide additional insured status as specified in this endorsement.
2. The insurance provided under this endorsement is limited as follows:
a. That person or organization is an additional insured only with respect to liability caused, in whole or in part, by:
(1) Premises you:
(a) Own;
(b) Rent;
(c) Lease; or
(d) Occupy;
(2) Ongoing operations performed by you or on your behalf. Ongoing operations does not apply to “bodily injury” or “property damage” occurring after:
Includes copyrighted material of Insurance Services Office, Inc.
CG 70 48 10 15 Pages 1 of 4
CPP20899550801 0705003 11/1/2021
11/1/2022 11/1/2021 20060088 Corporate Technology Solutions, LLC Lovitt & Touché a Marsh McLennan Agency Amerisure Insurance Company
(a) All work to be performed by you or on your behalf for the additional insured(s) at the site of the covered operations is complete, including related materials, parts or equipment (other than service, maintenance or repairs); or
(b) That portion of “your work” out of which the injury or damage arises is put to its intended use by any person or organization other than another contractor working for a principal as a part of the same project.
(3) Completed operations coverage, but only if:
(a) The written contract, written agreement, or certificate of insurance requires completed operations coverage or “your work” coverage; and
(b) This coverage part provides coverage for “bodily injury” or “property damage” included within the “products-completed operations hazard”.
However, the insurance afforded to such additional insured only applies to the extent permitted by law.
b. If the written contract, written agreement, or certificate of insurance:
(1) Requires “arising out of” language; or
(2) Requires you to provide additional insured coverage to that person or organization by the use of either or both of the following:
(a) Additional Insured – Owners, Lessees or Contractors – Scheduled Person Or Organization endorsement CG 20 10 10 01; or
(b) Additional Insured – Owners, Lessees or Contractors – Completed Operations endorsement CG 20 37 10 01;
then the phrase “caused, in whole or in part, by” in paragraph 2.a. above is replaced by “arising out of”.
c. If the written contract, written agreement, or certificate of insurance requires you to provide additional insured coverage to that person or organization by the use of:
(1) Additional Insured – Owners, Lessees or Contractors – Scheduled Person Or Organization endorsement CG 20 10 07 04 or CG 20 10 04 13; or
(2) Additional Insured – Owners, Lessees or Contractors – Completed Operations endorsement CG 20 37 07 04 or CG 20 37 04 13; or
(3) Both those endorsements with either of those edition dates; or
(4) Either or both of the following:
(a) Additional Insured – Owners, Lessees or Contractors – Scheduled Person Or Organization endorsement CG 20 10 without an edition date specified; or
(b) Additional Insured – Owners, Lessees or Contractors – Completed Operations endorsement CG 20 37 without an edition date specified;
then paragraph 2.a. above applies.
d. Premises, as respects paragraph 2.a.(1) above, include common or public areas about such premises if so required in the written contract or written agreement.
e. Additional insured status provided under paragraphs 2.a.(1)(b) or 2.a.(1)(c) above does not extend beyond the end of a premises lease or rental agreement.
f. The limits of insurance that apply to the additional insured are the least of those specified in the:
(1) Written contract;
(2) Written agreement;
(3) Certificate of insurance; or
(4) Declarations of this policy.
The limits of insurance are inclusive of and not in addition to the limits of insurance shown in the Declarations.
Includes copyrighted material of Insurance Services Office, Inc.
Page 2 of 4 CG 70 48 10 15
g. The insurance provided to the additional insured does not apply to "bodily injury", "property damage", or "personal and advertising injury" arising out of an architect’s, engineer’s, or surveyor’s rendering of, or failure to render, any professional services, including but not limited to:
(1) The preparing, approving, or failing to prepare or approve:
(a) Maps;
(b) Drawings;
(c) Opinions;
(d) Reports;
(e) Surveys;
(f) Change orders;
(g) Design specifications; and
(2) Supervisory, inspection, or engineering services.
h. SECTION IV – COMMERCIAL GENERAL LIABILITY CONDITIONS, paragraph 4. Other Insurance is deleted and replaced with the following:
4. Other Insurance.
Coverage provided by this endorsement is excess over any other valid and collectible insurance available to the additional insured whether:
a. Primary;
b. Excess;
c. Contingent; or
d. On any other basis;
but if the written contract, written agreement, or certificate of insurance requires primary and non-contributory coverage, this insurance will be primary and non-contributory relative to other insurance available to the additional insured which covers that person or organization as a Named Insured, and we will not share with that other insurance.
i. If the written contract, written agreement, or certificate of insurance as outlined above requires additional insured status by use of CG 20 10 11 85, then the coverage provided under this CG 70 48 endorsement does not apply except for paragraph 2.h. Other Insurance. Additional insured status is limited to that provided by CG 20 10 11 85 shown below and paragraph 2.h. Other Insurance shown above.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person or Organization: Blanket Where Required by Written Contract, Agreement, or Certificate of Insurance that the terms of CG 20 10 11 85 apply
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you.
CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984
CG 70 48 10 15 Pages 3 of 4
j. The insurance provided by this endorsement does not apply to any premises or work for which the person or organization is specifically listed as an additional insured on another endorsement attached to this policy.
Page 4 of 4 CG 70 48 10 15
Policy Number:
On File
"Any person or organization required by written contract or certificate of insurance."
"This endorsement is not applicable in California, Kentucky, New Hampshire, New Jersey, Texas and Utah."
"this endorsement does not apply to policies in Missouri where the employer is in the construction group of code classifications. According to Section 287,150(6) of the Missouri Statues, a contractual provision purporting to waiver of subrogation right is against public policy and void where one party to the contract is an employer in the construction group of code classifications."
Corporate Technology Solutions, LLC
On File
COMMERCIAL LIABILITY UMBRELLA
CU 74 67 11 07
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED –
PRIMARY/NON-CONTRIBUTORY COVERAGE
This endorsement modifies insurance provided under the following:
COMMERCIAL LIABILITY UMBRELLA COVERAGE FORM
Under SECTION II – WHO IS AN INSURED, the following is added to paragraph 3:
If coverage provided to any additional insured is required by a written contract or agreement, we will provide coverage to the additional insured on a primary basis without contribution from any other valid and collectible insurance available to the additional insured.
The most we will pay under this insurance on a primary basis without contribution from any other valid and collectible insurance is the amount of insurance required by the written contract or agreement or the Each Occurrence Limit shown in the Commercial Liability Umbrella Declarations, whichever is less.
Under SECTION IV – CONDITIONS, paragraph 5. Other Insurance does not apply to coverage provided by this endorsement.
Includes copyrighted material of Insurance Services Office, Inc. with its permission.
Copyright Insurance Services Office, Inc. 1994
CU 74 67 11 07
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