CTR059003_Certificate_of_Insurance.pdf
PDF 1 MB Posted
- Attached to
- Master Agreement AZ|CTR059003
- Contract number
- CTR059003
- Issued by
- Arizona
About this file
This is a Certificate of Liability Insurance issued on 03/09/2023 by House-Chilson & Associates for Koehler Enterprises Inc., with Secura Insurance as the primary insurer. The certificate covers insurance policies for Koehler Enterprises Inc. in the state of Arizona, with the Arizona Department of Transportation (ADOT) listed as the certificate holder. The policies include Commercial General Liability, Automobile Liability, Umbrella Liability, and Workers' Compensation, with coverage periods from 03/01/2023 to 03/01/2024.
The insurance policies provide various coverage limits, including $1,000,000 for general liability, automobile liability, and umbrella liability, with additional aggregate and specific limits. The policies include provisions for additional insured status for the State of Arizona, ADOT, and its departments, agencies, boards, commissions, universities, officers, and employees. A waiver of subrogation is applied to General Liability, Auto, Workers' Compensation, and Umbrella coverage. The certificate covers all commercial jobs completed during the policy period, with Titan Landscaping listed as an additional named insured.
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Text version
03/09/2023
House-Chilson & Associates 400 White Spar Road
Prescott AZ 86303
Deann Harguess
(928) 445-4600 deann@housechilson.com
KOEHLER ENTERPRISES INC
PO BOX 12348
Prescott AZ 86304
Secura Insurance 22543
CL233989673
A Y TC3219046 03/01/2023 03/01/2024
1,000,000 500,000 5,000 1,000,000 2,000,000 2,000,000
A Y A3219047 03/01/2023 03/01/2024
1,000,000
A 10,000
CU3269552 03/01/2023 03/01/2024
1,000,000 1,000,000
A Y WC3219048 03/01/2023 03/01/2024
1,000,000 1,000,000 1,000,000
The State of Arizona, ADOT and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are defined as an additional insureds in respects to general liability and auto when required by written contract per forms #CG 20 33 07 04, CAE0131. Waiver of Subrogation applies to General Liability, Auto, Workers Compenstion & Umbrella per forms CG2404, CAE0131, WC0003 & CU24030900
The State of Arizona, ADOT, Arizona Department of Transportation 1324 N 22nd Ave MD 128A Phoenix AZ 85009
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
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
B6370 Accepted
Titan Landscaping Doing Business As
Additional Named Insureds
Other Named Insureds
OFAPPINF (02/2007) COPYRIGHT 2007, AMS SERVICES INC
File details come from the government source that posted it. Updated .