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

1/31/2022

(520) 467-6063 (520) 571-9667

19100

Headquarters West, Ltd.

P.O. Box 37018 Tucson, AZ 85740

A1122J

A 1,000,000

X X ACPBPO7261857279 6/18/2021 6/18/2022 300,000

5,000

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

1,000,000A

ACPBPO7261857279 6/18/2021 6/18/2022

1,000,000A

ACPBPO7261857279 6/18/2021 6/18/2022 1,000,000

B E&O Claims Made MPL1101207.21 7/17/2021 Per Claim/Aggregate 2,000,000

Contract # CTR054967 - Real Estate Appraisal and Valuation Services, Statewide

VALUABLE PAPERS & RECORDS COVERAGE: $50,000 INCLUDED.

Additional Insured and Waiver of Subrogation per attached forms PB AI 07, PB 0497 07 07, PB 25 00 (01-01) RE: PBAI 07 Primary & Non-Contributory per attached form PB 6072 07 11

30 NOC per attached form PB 6297 0707

Arizona Department of Transportation 1739 W. Jackson Street Suite A Phoenix, AZ 85007

HEADWES-01 ELANENORMAN

NFP Property & Casualty Services, Inc.

6992 East Broadway Boulevard Tucson, AZ 85710

Elane Norman elane.norman@nfp.com

AMCO Insurance Company Lloyds of London

7/17/2022

X X

X

X X

X X

ACCEPTED

ADOT Risk Management

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