CTR054967_Certificate_of_Insurance.pdf

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

INSR ADDL SUBR

LTR INSD WVD

PRODUCER CONTACT

NAME:

FAXPHONE

(A/C, No):(A/C, No, Ext):

E-MAIL

ADDRESS:

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)

AUTOMOBILE LIABILITY

UMBRELLA LIAB

EXCESS LIAB

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

AUTHORIZED REPRESENTATIVE

EACH OCCURRENCE $

DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence)

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT

OTHER: $

COMBINED SINGLE LIMIT

$(Ea accident)

ANY AUTO BODILY INJURY (Per person) $

OWNED SCHEDULED

BODILY INJURY (Per accident) $AUTOS ONLY AUTOS

HIRED NON-OWNED PROPERTY DAMAGE

$AUTOS ONLY AUTOS ONLY (Per accident)

OCCUR EACH OCCURRENCE

CLAIMS-MADE AGGREGATE $

DED RETENTION $

PER OTH-

STATUTE ER

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE $

If yes, describe under

E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below

INSURER(S) AFFORDING COVERAGE NAIC #

COMMERCIAL GENERAL LIABILITY

Y / N N / A

(Mandatory in NH)

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

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.

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 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).

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

CERTIFICATE HOLDER CANCELLATION

© 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03)

CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)

The ACORD name and logo are registered marks of ACORD

5/25/2021

(520) 365-3909

19100

Headquarters West, Ltd.

P.O. Box 37018 Tucson, AZ 85740

15792

A 1,000,000

X X ACP7251857279 6/18/2020 6/18/2021 300,000

5,000

1,000,000 2,000,000 2,000,000

1,000,000A

X X ACP7251857279 6/18/2020 6/18/2021

1,000,000A

X X ACP7251857279 6/18/2020 6/18/2021 1,000,000

B Professional Liab MPL110120720 7/17/2020 Per Claim/Aggregate 2,000,000 B Claims Made 7/17/90 MPL110120720 7/17/2020 7/17/2021 Retention 10,000

Contract # CTR054967 - Real Estate Appraisal and Valuation Services, Statewide State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees as additional insureds with respect to liability arising out of the activities performed by or on behalf of the Contractor. A Waiver of Subrogation is granted in favor of the additional insureds on a primary and non-contributory basis., Arizona Department of Transportation 1739 W. Jackson Street Suite A Phoenix, AZ 85007

HEADWES-01 JOANADEMATTIA

NFP Property & Casualty Services, Inc.

6992 East Broadway Boulevard Tucson, AZ 85710

Joana De Mattia joana.demattia@nfp.com

AMCO Insurance Company Underwriters at Lloyds London (IL)

7/17/2021

X X

X

X X

X X

DocuSign Envelope ID: C9C23117-E14C-49B5-8617-DA987CADF6E2

ACCEPTED

ADOT Risk Management

BUSINESSOWNERS

PB 04 48 11 14

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED DESIGNATED PERSON OR

ORGANIZATION

This endorsement modifies insurance provided under the following:

PREMIER BUSINESSOWNERS LIABILITY COVERAGE FORM

Section III. LIMITS OF INSURANCE ANDA. The following is added to Section II. WHO IS AN

DEDUCTIBLE:INSURED:

If coverage provided to the additional insured is

Any person or organization shown in the required by a contract or agreement, the most we Schedule of this endorsement is also an insured, will pay on behalf of the additional insured is the but only with respect to liability amount of insurance:

1. Required by the contract or agreement; or

2. Available under the applicable Limits Ofor omissions or the acts or omissions of those

Insurance shown in the Declarations; whicheveracting on your behalf in the performance of your is less.ongoing operations or in connection with your

This endorsement shall not increase thepremises owned by or rented to you.

applicable Limits Of Insurance shown in theHowever:

Declarations.1. The insurance afforded to such additional insured only applies to the extent permitted C. This insurance, including any duty we have to by law; and defend "suits", does not apply to:

2. If coverage provided to the additional 1. "Bodily injury" or "property damage" that insured is required by a contract or arises out of, in whole or in part, or is a agreement, the insurance afforded to such result of, in whole or in part, the active additional insured will not be broader than negligence of the additional insured shown that which you are required by the contract in the Schedule of this endorsement.

or agreement to provide for such additional

2. "Personal and advertising injury" that arisesinsured.

out of any independent "personal and

B. With respect to the insurance afforded to these advertising injury" offense committed by the additional insureds, the following is added to additional insured shown in the Schedule of this endorsement.

All terms and conditions of this policy apply unless modified by this endorsement.

SCHEDULE

Name Of Person Or Organization:

THE STATE OF ARIZONA AND ITS DEPARTMENTS, AGENCIES

SEE BLANK ENDORSEMENT PB2500

100 N 15TH AVE STE 402

PHOENIX AZ 850072636

PB 04 48 11 14 Page 1 of 1Includes copyrighted material of Insurance Services Office, Inc., with its permission.

ACP BPO 7251857279 INSURED COPY 46 14026

DocuSign Envelope ID: C9C23117-E14C-49B5-8617-DA987CADF6E2

ARIZONA DEPARTMENT OF TRANSPORTATION, PROCUREMENT

SEE BLANK ENDORSEMENT PB2500

1739 W JACKSON STREET, MD 100P

PHOENIX AZ 350073276

ACP BPO 7251857279 INSURED COPY 46 14036

EFFECTIVE DATE: 12:01 AM Standard Time, BUSINESSOWNERS (at your principal place of business) PB 25 00 (01-01)

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

OFM007 COMPLETE NAMES & ADDRESSES OF ADDITIONAL INSUREDS

RE: (PB0497)

ARIZONA DEPARTMENT OF TRANSPORTATION, PROCUREMENT GROUP, THE STATE OF ARIZONA,

AND ITS DEPARTMENTS, AGENCIES, BOARDS, COMMISSIONS, UNIVERSITIES, OFFICERS,

OFFICIALS, AGENTS, AND EMPLOYEES.

1739 W JACKSON STREET, MD 100P

PHOENIX, AZ 850073276

All terms and conditions of this policy apply unless modified by this endorsement.

PB 25 00 (01-01)

ACP BPO 7251857279 INSURED COPY 46 14047

SEE BLANK FORM PB2500

1739 WEST JACKSON ST STE A MD 100P

PHOENIX, AZ 85007-3276

ACP BPO 7251857279 INSURED COPY 46 14051

EFFECTIVE DATE: 12:01 AM Standard Time, BUSINESSOWNERS (at your principal place of business) PB 25 00 (01-01)

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

OFM008 COMPLETE NAMES & ADDRESSES OF ADDITIONAL INSUREDS

RE: (PB2997)

ARIZONA DEPARTMENT OF TRANSPORTATION, PROCUREMENT GROUP, THE STATE OF ARIZONA,

AND ITS DEPARTMENTS, AGENCIES, BOARDS, COMMISSIONS, UNIVERSITIES, OFFICERS,

OFFICIALS, AGENTS, AND EMPLOYEES.

1739 W JACKSON STREET, MD 100P

PHOENIX, AZ 850073276

All terms and conditions of this policy apply unless modified by this endorsement.

PB 25 00 (01-01)

ACP BPO 7251857279 INSURED COPY 46 14048

BUSINESSOWNERS

PB 60 72 07 11

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

AMENDMENT TO OTHER INSURANCE CLAUSE FOR

ADDITIONAL INSUREDS – PRIMARY AND NON-

CONTRIBUTORY WHEN REQUIRED IN A WRITTEN

AGREEMENT OR CONTRACT WITH YOU

This endorsement modifies insurance provided under the following:

PREMIER BUSINESSOWNERS COMMON POLICY CONDITIONS

Only with respect to any additional insured, in the COMMON POLICY CONDITIONS, form PB 00 09, under condition H. , paragraph 2.a. is replaced by the following:OTHER INSURANCE

H. OTHER INSURANCE

2. Under any liability coverage provided by this policy,

a. If for injury or loss we cover, there is other valid and collectible insurance available to any additional insured under another policy, our obligations are limited as follows:

(1) Issued by another insurer, or if there is self insurance or similar risk retention that applies to a loss covered by this policy, then this insurance provided by us shall be excess over such other insurance, unless you have agreed in a written contract or written agreement signed prior to the loss that this insurance shall be primary:

(a) Then this insurance is primary. If other insurance is also primary, we will share with all that other insurance as described in d. below; and

(b) The coverage afforded by this insurance is non-contributory with the additional insured’s own insurance.

Paragraphs (a) and (b) do not apply to other insurance to which the additional insured has been added as an additional insured to any other person or organization’s policy.; or

(2) Issued by us or any of our affiliate companies, that applies to a loss covered by this policy, then only the highest applicable Limit of Insurance shall apply to such loss. This condition does not apply to any policy issued by us that is designed to provide Excess or Umbrella liability insurance.

All terms and conditions of this policy apply unless modified by this endorsement.

PB 60 72 07 11 Page 1 of 1Includes copyrighted material of Insurance Services Office, Inc., with its permission.

ACP BPO 7251857279 INSURED COPY 46 14062

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

INSR ADDL SUBR

LTR INSD WVD

PRODUCER CONTACT

NAME:

FAXPHONE

(A/C, No):(A/C, No, Ext):

E-MAIL

ADDRESS:

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)

AUTOMOBILE LIABILITY

UMBRELLA LIAB

EXCESS LIAB

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

AUTHORIZED REPRESENTATIVE

EACH OCCURRENCE $

DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence)

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT

OTHER: $

COMBINED SINGLE LIMIT

$(Ea accident)

ANY AUTO BODILY INJURY (Per person) $

OWNED SCHEDULED

BODILY INJURY (Per accident) $AUTOS ONLY AUTOS

HIRED NON-OWNED PROPERTY DAMAGE

$AUTOS ONLY AUTOS ONLY (Per accident)

OCCUR EACH OCCURRENCE

CLAIMS-MADE AGGREGATE $

DED RETENTION $

PER OTH-

STATUTE ER

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE $

If yes, describe under

E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below

INSURER(S) AFFORDING COVERAGE NAIC #

COMMERCIAL GENERAL LIABILITY

Y / N N / A

(Mandatory in NH)

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

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.

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 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).

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

CERTIFICATE HOLDER CANCELLATION

© 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03)

CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)

The ACORD name and logo are registered marks of ACORD

5/14/2021

(520) 365-3909

19100

Headquarters West, Ltd.

P.O. Box 37018 Tucson, AZ 85740

15792

A 1,000,000

X X ACP7251857279 6/18/2020 6/18/2021 300,000

5,000

1,000,000 2,000,000 2,000,000

1,000,000A

X X ACP7251857279 6/18/2020 6/18/2021

1,000,000A

X X ACP7251857279 6/18/2020 6/18/2021 1,000,000

B Professional Liab MPL110120720 7/17/2020 Per Claim/Aggregate 2,000,000 B Claims Made 7/17/90 MPL110120720 7/17/2020 7/17/2021 Retention 10,000

Contract # CTR054967 - Real Estate Appraisal and Valuation Services, Statewide State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees as additional insureds with respect to liability arising out of the activities performed by or on behalf of the Contractor. A Waiver of Subrogation is granted in favor of the additional insureds, Arizona Department of Transportation 1739 W. Jackson Street Suite A Phoenix, AZ 85007

HEADWES-01 JOANADEMATTIA

NFP Property & Casualty Services, Inc.

6992 East Broadway Boulevard Tucson, AZ 85710

Joana De Mattia joana.demattia@nfp.com

AMCO Insurance Company Underwriters at Lloyds London (IL)

7/17/2021

X X

X

X X

X X

DocuSign Envelope ID: D699D389-B2C3-4180-B4FA-C4AA56C86C38

ACCEPTED

ACCEPTED – WC Only

Arizona Department of Transportation-Procurement

CTR054967