CTR055608_Certificate_of_Insurance__2_.pdf

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Attached to
Master Agreement AZ|CTR055608
Contract number
CTR055608
Issued by
Arizona

About this file

This document is an ACORD Certificate of Liability Insurance for Vista Recycling Inc., issued by Allreds Insurance Agency, covering multiple insurance policies for the State of Arizona, specifically the Department of Corrections Rehabilitation & Reentry, Procurement Services. The certificate involves multiple insurers including Nautilus Insurance Company, Key Risk Insurance Company, GuideOne National Ins Co, Star Stone Specialty Ins Co, and Incline Casualty Company, with the certificate dated 05/02/24 and referencing Contract #CTR055608.

The insurance coverage includes Commercial General Liability, Automobile Liability, Umbrella/Excess Liability, and Workers Compensation, with various policy periods spanning from 11/04/23 to 04/01/25. Key coverage limits include $1,000,000 for each occurrence in general liability, $1,000,000 combined single limit for automobile liability, $2,000,000 for umbrella/excess liability, and $1,000,000 for workers compensation. The policy is specifically endorsed to include the State of Arizona and its departments as additional insureds, with a waiver of transfer of rights and primary non-contributory coverage. The contract appears to provide comprehensive insurance protection for Vista Recycling Inc.'s operations related to the state contract.

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Text version

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

E-MAIL

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

Phoenix AZ 85034 Mail Code 55302 701 E Jefferson St Reentry, Procurement Services Dept of Corrections Rehabilitation & State of Arizona

This policy is endorsed, as required by this written agreement, to include the 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, with a waiver of transfer of rights, coverage is primary noncontributory. 30 Day notice of cancellation applies except for nonpayment of premium.

See attached forms that apply Contract #CTR055608

$2,000,000 $2,000,000

11/04/2411/04/23AXS7000202#2

Excess Liability 2 Million Excess over 2 Million ExcessD

1,000,000 1,000,000

1,000,00004/01/2504/01/24SWB10027600YYE

2,000,000 2,000,000

11/04/2411/04/23560002846-02C

1,000,000

11/04/2411/04/23BAP2036202-12YYB

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

5,000 100,000

1,000,000

11/04/2411/04/23GLP2036201-12YYA

11090Incline Casualty Company 44776Star Stone Specialty Ins Co 14167GuideOne National Ins Co 10885Key Risk Insurance Company 17370Nautilus Insurance Company

Safford, AZ 85546 114 West 8th St.

Vista Recycling Inc.

allredsins@vtc.net (928)428-1245(928)428-1244

Beau Allred

Safford, AZ 85546 201 W 5th St

ALLREDS INSURANCE AGENCY

05/02/24

File details come from the government source that posted it. Updated .