COI-Exp2024-12-31-CAuUmPolPro_ACT.pdf
PDF 219 KB Posted
- Attached to
- Master Agreement AZ|CTR065778
- Contract number
- CTR065778
- Issued by
- Arizona
About this file
This is a Certificate of Liability Insurance for ACT Environmental Inc, issued by Homeland Insurance Company of New York through Crest Insurance Group, LLC. The certificate covers a contract (CTR065778) for Asbestos, Lead and Mold Consultant Services with the State of Arizona, Arizona Board of Regents, and the University of Arizona. The certificate holder is the Arizona Department of Environmental Quality, located in Phoenix, Arizona.
The insurance policy provides commercial general liability, automobile liability, umbrella liability, and professional liability coverage with policy limits ranging from $1,000,000 to $2,000,000. The policy is effective from 12/31/2023 to 12/31/2024, with a policy number of 793-00-73-90-0004. The coverage includes additional insured provisions for the state and university, is primary and non-contributory, and includes a waiver of subrogation. The policy specifically covers consulting services related to asbestos, lead, and mold, with a professional liability deductible of $2,500.
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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
7/16/2024
Crest Insurance Group, LLC 5285 E. Williams Circle Suite 4500 Tucson AZ 85711
Danel McCartin 520-881-5760 520-325-3757 dmccartin@crestins.com
Homeland Insurance Company of New York 34452
ACTENVI-02
ACT Environmental Inc 7592 N. La Cholla Blvd Tucson AZ 85741
1248519375
A X 1,000,000
100,000
5,000
1,000,000
2,000,000 X
Y Y 793-00-73-90-0004 12/31/2023 12/31/2024
2,000,000
A 1,000,000
X X
793-00-73-90-0004 12/31/2023 12/31/2024
A X X 2,000,000793-00-73-90-0004 12/31/2023 12/31/2024
A Professional Liability Claims Made Contractors Pollution Liabi
793-00-73-90-0004 12/31/2023 12/31/2024 Ea Claim Aggregate Deductible
$1,000,000 $2,000,000 $2,500
Certificate holder and others when required in a written contract or agreement are Additional Insured (General Liability) including Products Completed.
Coverage is Primary & Non-Contributory (General Liability). Waiver of Subrogation (General Liability) applies. Umbrella Liability is Follow-Form. This form is subject to all policy forms, terms, endorsements, conditions definitions & exclusions.
Re: Contract No. CTR065778.
Asbestos, Lead and Mold Consultant Services, The State of Arizona, Arizona Board of Regents, the University of Arizona, and its officers, officials, agents, and employees shall be named as additional insureds with respect to liability arising out of the activities performed by or on behalf of ACT Environmental, Inc.
Arizona Department of Environmental Quality 1110 W Washington Street Phoenix AZ 85007
793-00-73-90-0004
File details come from the government source that posted it. Updated .