CTR057184.M21-0058_Certificate_of_Insurance_Contractor_Network_Support.pdf

PDF 39 KB Posted

Attached to
Master Agreement AZ|CTR057184
Contract number
CTR057184
Issued by
Arizona

About this file

This document is an ACORD Certificate of Liability Insurance dated September 9, 2021, issued by SilverLeaf Insurance Group, LLC for The Cable Guy LLC, located in Scottsdale, Arizona. The insurance is provided by CNA Insurance Company and covers multiple liability policies for the insured. The certificate lists the State of Arizona Department of Emergency and Military Affairs as the certificate holder, with the agency located in Phoenix, Arizona.

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/Excess Liability with a $5,000,000 aggregate limit, Workers' Compensation, Technology E&O, and Rented/Leased Equipment coverage. The policies are effective from March 15, 2021, to March 15, 2022. The certificate specifies that the State of Arizona Department of Emergency and Military Affairs is an additional insured as required by written contract, with coverage being primary and non-contributory and including a 30-day cancellation notice provision.

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Text version

09/09/2021

SilverLeaf Insurance Group, LLC 20865 N 90th Pl, Ste 120 Scottsdale, AZ 85255 License #: 1086733

Diann Coons

(480)585-9725 (480)717-4780

Diann@silverleafinsure.com

00002559-2035479 36

The Cable Guy LLC 7741 E Gray Rd Ste 8 Scottsdale, AZ 85260

CNA Insurance Company 20443

A Y 6021007955 03/15/2021 03/15/2022X X

X

1,000,000 1,000,000

10,000 1,000,000 2,000,000 2,000,000

CNA Insurance Company 20443

A Y 6081297830 03/15/2021 03/15/2022

X

X X X Hired Physical Dmg

1,000,000

CNA Insurance Company 20443

A Y 6021008006 03/15/2021 03/15/2022XX

X 10,000

5,000,000 5,000,000

CNA Insurance Company 20443

A Y WC 621007972 03/15/2021 03/15/2022

N

X 1,000,000 1,000,000 1,000,000

CNA Insurance Company 20443

A 6020999533 03/15/2021 03/15/2022Technology E&O $1,000,000

CNA Insurance Company 20443

A 6021007955 03/15/2021 03/15/2022Rented/Leased Equip $250,000

The State of Arizona Department of Emergency and Military Affairs is an additional insured as required by written contract.

Coverage is primary and non-contributory. 30 days notice of cancellation applies.

State of Arizona Department of Emergency and Military Affairs 5636 East McDowell Road, Building, #M5800 Phoenix, AZ 85008-3495

(DMC)

Printed by DMC on September 09, 2021 at 09:58AM

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

INSR ADDL SUBR

LTR INSD WVD

DATE (MM/DD/YYYY)

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 EXP

TYPE 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 RENTED

CLAIMS-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 AGG $JECT

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 LIMIT $DESCRIPTION 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.

The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03)

CERTIFICATE OF LIABILITY INSURANCE

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