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:

E-MAIL

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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