COI_for_Arizona_Game_and_Fish_Department.pdf
PDF 22 KB Posted
- Attached to
- Master Agreement AZ|CTR071841
- Contract number
- CTR071841
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by Insurance Services Group LLC on 04/30/2024 for Atlas Trap Company, LLC, located in Benton, Kansas. The certificate is issued for the Arizona Game and Fish Department, with coverage provided by EMCASCO Insurance Company and Employers Mutual Casualty Company. The insurance policies are effective from 07/10/2023 to 07/10/2024.
The certificate outlines multiple insurance coverages including Commercial General Liability with a $1,000,000 each occurrence limit, Automobile Liability with a $1,000,000 combined single limit, Workers Compensation, and Commercial Cyber and Privacy Liability. The policies include specific sublimits such as $50,000 for Data Compromise Response Expense, $25,000 for Legal Review, and $50,000 for Named Malware. The insurance is primary and applies to the contractor's operations, with the Arizona Game and Fish Department listed as the certificate holder.
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Text version
04/30/2024
Insurance Services Group LLC 1720 N Webb Rd Suite 110 Wichita KS 67206
Stephanie McFaul
(316) 928-0044 certs@isgkansas.com
ATLAS TRAP COMPANY, LLC
14200 SW 50TH ST
BENTON KS 67017-9165
EMCASCO Insurance Company 21407 Employers Mutual Casualty Company 21415 EMC Insurance 21415
CL2443001698
A Y Y 6D46431 07/10/2023 07/10/2024
1,000,000
5,000 1,000,000 2,000,000 2,000,000
Damage to Premises Rented to You
300,000
B Y Y 6E46431 07/10/2023 07/10/2024
1,000,000
Uninsured motorist combined single limit
1,000,000
A Y Y 6H46431 07/10/2023 07/10/2024 1,000,000 1,000,000 1,000,000
C Commercial Cyber and Privacy Liability
6Q46431 07/10/2023 07/10/2024
DATA COMPROMISE -
RESPONSE EXPENSE
$50,000
LEGAL REVIEW
SUBLIMIT
$25,000
NAMED MALWARE
SUBLIMIT
$50,000
The Contractor's policies, as applicable, shall stipulate that the insurance afforded the Contractor shall be primary and that any insurance carried by the Department, its agents, officials, employees or the State of Arizona.
Arizona Game and Fish Department 5000 W. Carefree Highway
Phoenix AZ 85086
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
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