CTR060204_Certificate_of_Insurance.pdf
PDF 143 KB Posted
- Attached to
- Master Agreement AZ|CTR060204
- Contract number
- CTR060204
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for 22nd Century Technologies Inc, issued by Technology Insurance Associates on May 3, 2022. The certificate lists multiple insurance policies covering the company, with the State of Arizona named as the certificate holder, specifically the State Procurement Office located in Phoenix. The insurance coverage involves multiple insurers, including Atlantic Specialty Insurance Company, United Wisconsin Insurance Company, Hartford Insurance, and Chubb-Federal Insurance Company.
The insurance certificate covers multiple types of liability and insurance products, including Commercial General Liability, Automobile Liability, Umbrella/Excess Liability, Workers' Compensation, Professional Liability/E&O, Third Party Fidelity Crime Bond, Cyber Liability, and Employment Practices Liability. Coverage periods are primarily from February 7, 2022 to February 7, 2023, with some variations. Key coverage limits include $1,000,000 for general liability, $12,000,000 in aggregate umbrella coverage, and specific limits for professional liability and other specialized insurance types. The policy provides additional insured status for the State of Arizona and its departments, agencies, boards, commissions, and universities, but only when there is a written 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
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 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
AUTOSAUTOS
NON-OWNED
HIRED AUTOS
SCHEDULEDALL OWNED
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 (2014/01)
© 1988-2014 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
Deductible
Bus. Pers. Prop.
N
CGL/Auto Deductible $2500
Contractual Liability
151392
05/03/2022
CERT NO:151392 Benjamin Levenson 05/03/2022
Benjamin Levenson
(888) 242-4675 (732) 862-1177
Ben@insureyourcompany.com
Atlantic Specialty Insurance Company 27154 A+
United Wisconsin Insurance Company
02/07/2022 02/07/2023711016584-0003
02/07/2022 02/07/2023
02/07/2022 02/07/2023
06/01/2022 06/01/2023
Hartford Insurance
Chubb -Federal Insurance Company
29157 A
19682 A+
20281 A++
A
A
A
State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees named as additional insured only if there is a written contract.
B
1,000,000
300,000
10,000
1,000,000
2,000,000
2,000,000
1,555,000
1,000,000
50,000
1,000
12,000,000
12,000,000
1,000,000
1,000,000
10,000
1,000,000
WC515-00750-022-SZ
711016584-0003
711016584-0003
Professional Liability/E&O 3rd Party Fidelity Crime Bond Cyber Liability EPL-Employment Practices Liab.
A C A D
760010565-0003
13TP0322385
760010565-0003 8262-5617
02/07/2022 02/07/2023
11/18/202211/18/2021 02/07/2022 02/07/2023
02/07/202302/07/2022
Technology Insurance Associates InsureYourCompany.com Gordons Corner Road 1H Manalapan NJ 07726
22nd Century Technologies Inc 8251 Greensboro Drive Suite 900 McLean VA 22102
State of Arizona State Procurement Office 100 North 15th Ave, Suite 305 Phoenix AZ 85007
$10,000,000 Each Occur / $10,000,000 Aggregate $5,000,000 Each Occur / $5,000,000 Aggregate $5,000,000 Each Occur / $5,000,000 Aggregate $1,000,000 Each Occur / $1,000,000 Aggregate if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on have ADDITIONAL INSURED provisions or be endorsed.
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
OWNED
AUTOS ONLY
HIRED
AUTOS ONLY ONLY
(2016/03)
File details come from the government source that posted it. Updated .