COI_thru_8-1-25.pdf
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- Attached to
- Master Agreement AZ|CTR054549
- Contract number
- CTR054549
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance for Blue World Construction Inc., issued by Conover Beyer Associates, with coverage from Valley Forge Ins Co, The Continental Ins Co of NJ, and Crum & Forster Specialty Insurance Co. The certificate is specifically related to a contract (CTR054549) with Arizona State Parks and Trails, located in Phoenix, AZ, and covers the period from 8/1/2024 to 8/1/2025.
The contract pertains to Pump Maintenance, Repair and Purchase, with the State of Arizona and its departments, agencies, boards, commissions, universities, officers, and employees included as additional insured parties. The insurance coverage includes commercial general liability with a $1,000,000 per occurrence limit, automobile liability with a $1,000,000 combined single limit, umbrella liability with a $5,000,000 each occurrence limit, workers' compensation, contractors pollution liability with a $5,000,000 limit, and errors & omissions liability with a $5,000,000 wrongful act limit. The policy includes a $10,000 deductible and provides primary and non-contributory coverage with a waiver of subrogation in favor of the certificate holder.
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Text version
8/2/2024
Conover Beyer Associates 2600 Highway 35
Manasquan NJ 08736
Lynda Hawk (732)223-9700 (732)223-6044 lyhawk@conoverbeyer.com
Blue World Construction Inc 26 Columbia Turnpike Suite 104 Florham Park NJ 07932
Valley Forge Ins Co 20508 The Continental Ins Co of NJ 42625 Crum & Forster Specialty Insurance Co 44520
CL248269354
A
X
X
X X
X 7092650224 8/1/2024 8/1/2025
1,000,000
100,000
15,000
1,000,000
2,000,000
2,000,000
B X
X X X 7092650207 8/1/2024 8/1/2025
1,000,000
Uninsured motorist combined single limit 1,000,000
B
X X
X 10,000
7092650210 8/1/2024 8/1/2025
5,000,000
5,000,000
B N
7092713340 8/1/2024 8/1/2025
X
1,000,000
1,000,000
1,000,000
A RENTED/LEASED EQUIPMENT 7092650224 8/1/2024 8/1/2025 ANY ONE ITEM $ 200,000
RE: Contract No. CTR054549 - Pump Maintenance, Repair and Purchase
The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are included as additional insured with respects to General Liability and Auto Liability for work performed by the named insured per written contract. Waiver of subrogation to apply in favor of certificate holder and additional insured as per written contract. Coverage is primary & non-contributory.
Arizona State Parks and Trails Procurement Services Attn: Charles Stevens 1110 W Washington Street Suite 100 Phoenix, AZ 85007 Warren Beyer/LYNDAH
The ACORD name and logo are registered marks of ACORD
CERTIFICATE HOLDER
© 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01)
AUTHORIZED REPRESENTATIVE
CANCELLATION
DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE
LOCJECT
PRO-
POLICY
GEN'L AGGREGATE LIMIT APPLIES PER:
OCCURCLAIMS-MADE
COMMERCIAL GENERAL LIABILITY
PREMISES (Ea occurrence) $
DAMAGE TO RENTED
EACH OCCURRENCE $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
$RETENTIONDED
CLAIMS-MADE
OCCUR
AGGREGATE $
EACH OCCURRENCE $UMBRELLA LIAB
EXCESS LIAB
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
INSR
LTR TYPE OF INSURANCE POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY) LIMITS
PER
STATUTE
OTH-
ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
ANY PROPRIETOR/PARTNER/EXECUTIVE
If yes, describe under DESCRIPTION OF OPERATIONS below
(Mandatory in NH)
OFFICER/MEMBER EXCLUDED?
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
HIRED AUTOS
NON-OWNED
AUTOS AUTOS
AUTOS
COMBINED SINGLE LIMIT
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE $
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.
INSD
ADDL
WVD
SUBR
N / A
(Ea accident)
(Per accident)
OTHER:
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.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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).
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
INSURED
PHONE
(A/C, No, Ext):
PRODUCER
ADDRESS:
FAX
(A/C, No):
CONTACT
NAME:
NAIC #
INSURER A :
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
INSURER(S) AFFORDING COVERAGE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
INS025 (201401)
C CONTRACTORS POLLUTION LIABILITY EACH OCCURRENCE LIMIT
5,000,000 10,000 DOLLARS
C ERRORS & OMISSIONS LIABILITY WRONGFUL ACT LIMIT
5,000,000 10,000 DOLLARS
ADDITIONAL COVERAGES
Ref # Description Edition DateForm No.Coverage Code
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref # Description Coverage Code Form No. Edition Date
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref # Description Coverage Code Form No. Edition Date
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref # Description Coverage Code Form No. Edition Date
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref # Description Coverage Code Form No. Edition Date
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref # Description Coverage Code Form No. Edition Date
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref # Description Coverage Code Form No. Edition Date
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref # Description Coverage Code Form No. Edition Date
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref # Description Coverage Code Form No. Edition Date
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref # Description Coverage Code Form No. Edition Date
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref # Description Coverage Code Form No. Edition Date
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Copyright 2001, AMS Services, Inc.OFADTLCV
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