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):
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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