COI_-_AZGFD.pdf
PDF 80 KB Posted
- Attached to
- Master Agreement AZ|CTR062508
- Contract number
- CTR062508
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for Oxbow Ecological Engineering, LLC, located in Flagstaff, Arizona. The certificate is issued by Stuckey Insurance and involves multiple insurers, including The Travelers Indemnity Company of Connecticut and XL Specialty Insurance. The certificate holder is the State of Arizona Game and Fish Department, with the insurance covering a contract numbered CTR062508.
The insurance policy provides comprehensive coverage including Commercial General Liability, Automobile Liability, and Workers' Compensation, with policy periods from 10/10/2024 to 10/10/2025. The General Liability coverage includes $1,000,000 per occurrence, $2,000,000 aggregate limits, and $5,000 medical expenses. Professional Liability is also included with $2,000,000 per claim and aggregate limits, with a retroactive date of 10/10/2013. The State of Arizona and its departments are named as additional insureds on a primary and non-contributory basis, with a waiver of subrogation applied to the General and Auto Liability policies.
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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
2/3/2025
Stuckey Insurance 2850 E Camelback Rd Suite 325 Phoenix AZ 85016
Teresa Alvarado 602-264-5533 teresa.alvarado@stuckeyinsurance.com
The Travelers Indemnity Company of Connecticut 25682 OXBOECO-01 XL Specialty Ins 37885
Oxbow Ecological Engineering, LLC 3491 S. Gillenwater Dr.
Flagstaff AZ 86005
779493276
A X 1,000,000 X 1,000,000
5,000
1,000,000
2,000,000 X
Y Y 6803H320192 10/10/2024 10/10/2025
2,000,000
A 1,000,000
X X
Y Y 6803H320192 10/10/2024 10/10/2025
A X
N
Y UB6J79069A 10/10/2024 10/10/2025
1,000,000
1,000,000
1,000,000 B Professional Liability DPS5003165 10/10/2022 10/10/2025 Per Claim
Aggregate 2,000,000 2,000,000
Professional Insurance - Claims Made - Retro Date 10/10/13 RE: Contract #CTR062508 State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are named as additional insureds as respects to General and auto Liability. General Liability is on a primary and non-contributory basis. Waiver of subrogation applies as indicated.
The State of Arizona Game and Fish Department 5000 W Carefree Highway Phoenix AZ 85086
USA
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