CTR062312 2026.04.01 COI.pdf
PDF 383 KB Posted
- Attached to
- Master Agreement AZ|CTR062312
- Contract number
- CTR062312
- Issued by
- Arizona
About this file
This document is a comprehensive insurance certificate and associated endorsements for Arizona Machinery Group, Inc. (DBA: Stotz Equipment), issued by multiple insurance carriers including National Union Fire Insurance Company of Pittsburgh, Great American Insurance Company, and New Hampshire Insurance Company. The primary certificate holder is the Arizona Department of Transportation (ADOT), with coverage effective from 4/1/2025 to 4/1/2026. The insurance package includes commercial general liability, automobile liability, umbrella liability, and workers' compensation coverage.
The insurance policy provides additional insured status for the State of Arizona, its departments, agencies, boards, commissions, universities, and its officers, officials, agents, and employees. The policy is associated with a specific rental agreement (CRA-5297) for Parcel #7-09767. Key policy features include primary and non-contributory coverage, waiver of subrogation, and 30-day notice of cancellation for non-renewal and 10-day notice for non-payment of premiums. The policy limits are substantial, with a general aggregate of $4,000,000, automobile liability of $2,000,000, and an umbrella/excess liability of $13,000,000. The policy also includes provisions for completed operations and covers various operational risks associated with the insured's business activities.
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Other files
| File | Type | Posted |
|---|---|---|
| CTR062312_Contract_Amendment_Summary_Four__4_.pdf | ||
| CTR062312_Contract_Amendment_Summary_One__1_.pdf | ||
| CTR062312__Contract_Amendment_Summary_Five__5_.pdf | ||
| CTR062312__Contract_Amendment_Summary_Two__2_.pdf | ||
| 2025.04.01 COI.pdf | ||
| 2023-04-01 COI.pdf | ||
| 2024.04.01 COI.pdf | ||
| CTR062312_Contract_Documents.pdf | ||
| CTR062312_Price_Sheet__2_.xlsx | XLSX spreadsheet | |
| CTR062312_Price_Sheet__3_.xlsx | XLSX spreadsheet | |
| CTR062312_Pricing.xlsx | XLSX spreadsheet | |
| CTR062312__Contract_Amendment_Summary_Three__3_.pdf |
Show all 12
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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 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
4/2/2025
Edgewood Partners Insurance Center 1390 Willow Pass Rd, Ste 800 Concord CA 94520
Diana Novicio
Diana.novicio@epicbrokers.com
License#: CA Lic#0B29370 National Union Fire Ins Co of Pittsburg 19445 ARIZMAC Great American Insurance Company 16691
Arizona Machinery Group, Inc. DBA: Stotz Equipment 11111 W. McDowell Road Avondale, AZ 85392
New Hampshire Insurance Company 23841
799124946
A X 2,000,000 X 500,000
25,000
2,000,000
4,000,000 X
Y Y GL5268219 4/1/2025 4/1/2026
4,000,000
A 2,000,000
X
X CompDed:$250 X CollDed:$500
Y Y CA4489712 4/1/2025 4/1/2026
GRGKPRS Lmt/Ded $1M/ $1,000
B X X 13,000,000TUUF30965700 4/1/2025 4/1/2026
13,000,000 X 0
A C
Y WC067961225
WC067961226
4/1/2025 4/1/2025
4/1/2026 4/1/2026
2,000,000
2,000,000
2,000,000 A Hired-Auto PD CA4489712 4/1/2025 4/1/2026 Limit
Comp/Coll Ded $100,000 $250/$500
Re: Parcel #: 7-09767. Rental Agreement #: CRA-5297 Additional Insured: The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents and employees.
Insurance is primary and non-contributory. Waiver of Subrogation applies in favor of the additional insureds. Umbrella/Excess Liability follow form basis.
30-Days Notice of Cancellation for Non-Renewal and 10-Days Notice of Cancellation for Non-Payment of Premiums per policy provisions.
Forms apply where required by written contract.
Arizona Department of Transportation (ADOT) 205 S. 17th Avenue MD612E, Room 370 Phoenix, AR 85007
Cindy Lewis Accepted
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s):
COMMERCIAL GENERAL LIABILITY
CG 20 26 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
POLICY NUMBER: 526-82-19
ANY PERSON OR ORGANIZATION FOR WHOM YOU WORK UNDER A WRITTEN CONTRACT THAT
REQUIRED YOU TO OBTAIN THIS AGREEMENT FROM US.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf:
1. In the performance of your ongoing operations; or
2. In connection with your premises owned by or rented to you.
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable limits of insurance;
whichever is less.
This endorsement shall not increase the applicable limits of insurance.
CG 20 26 12 19 Page ofInsurance Services Office, Inc., 2018 1 1
POLICY NUMBER:
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations
COMMERCIAL GENERAL LIABILITY
CG 20 10 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
526-82-19
ANY PERSON OR ORGANIZATION WHOM YOU
BECOME OBLIGATED TO INCLUDE AS AN
ADDITIONAL INSURED AS A RESULT OF ANY
CONTRACT OR AGREEMENT YOU HAVE ENTERED
INTO.
PER THE CONTRACT OR AGREEMENT.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Insurance Services Office, Inc., 2018CG 20 10 12 19 Page of1 2
A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf;
in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above.
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:
This insurance does not apply to "bodily injury" or "property damage" occurring after:
1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or
2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project.
C. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable limits of insurance;
whichever is less.
This endorsement shall not increase the
Insurance Services Office, Inc., 2018 CG 20 10 12 19Page of2 2
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations
COMMERCIAL GENERAL LIABILITY
CG 20 37 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
POLICY NUMBER: 526-82-19
ANY PERSON OR ORGANIZATION WHOM YOU
BECOME OBLIGATED TO INCLUDE AS AN
ADDITIONAL INSURED AS A RESULT OF ANY
CONTRACT OR AGREEMENT YOU HAVE ENTERED
INTO.
PER THE CONTRACT OR AGREEMENT.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard".
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable limits of insurance;
whichever is less.
This endorsement shall not increase the
CG 20 37 12 19 Page ofInsurance Services Office, Inc., 2018 1 1
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
COMMERCIAL GENERAL LIABILITY
CG 24 04 12 19
This endorsement modifies insurance provided under the following:
SCHEDULE
Name Of Person(s) Or Organization(s):
COMMERCIAL GENERAL LIABILITY COVERAGE PART
ELECTRONIC DATA LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES
POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS
526-82-19
PURSUANT TO APPLICABLE WRITTEN CONTRACT OR AGREEMENT YOU ENTER INTO.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Conditions:
We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above.
The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Conditions:
We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above.
CG 24 04 12 19 Insurance Services Office, Inc., 2018 Page 1 of 1
PRIMARY AND NONCONTRIBUTORY -
COMMERCIAL GENERAL LIABILITY
CG 20 01 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 01 12 19 Insurance Services Office, Inc., 2018 Page 1 of 1
OTHER INSURANCE CONDITION
The following is added to the Other Insurance Condition and supersedes any provision to the contrary:
Primary And Noncontributory Insurance
This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that:
(1) The additional insured is a Named Insured under such other insurance; and
(2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured.
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
526-82-19
ENDORSEMENT
This endorsement, effective 12:01 A.M. 04/01/2025 forms a part of Policy No. 448-97-12 issued to ARIZONA MACHINERY GROUP, INC.
by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA.
ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
SCHEDULE
ADDITIONAL INSURED:
AUTHORIZED REPRESENTATIVE
I. SECTION II - COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. - Who Is Insured, is amended to add:
d. Any person or organization, shown in the schedule above, to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered "auto". However, the insurance provided will not exceed the lesser of:
(1) The coverage and/or limits of this policy, or
(2) The coverage and/or limits required by said contract or agreement.
ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE CONTRACTUALLY BOUND TO PROVIDE
ADDITIONAL INSURED STATUS BUT ONLY TO THE EXTENT OF SUCH PERSON'S OR
ORGANIZATIONS LIABILITY ARISING OUT OF THE USE OF A COVERED AUTO.
87950 (9/14) Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1
ENDORSEMENT
This endorsement, effective 12:01 A.M. 04/01/2025 forms a part of Policy No. 448-97-12 issued to ARIZONA MACHINERY GROUP, INC.
by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA.
BUSINESS AUTO COVERAGE FORM
AUTHORIZED REPRESENTATIVE
This endorsement modifies insurance provided under the following:
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US
(2)
(1)
The contract or agreement was entered into prior to any "accident" or "loss".
No waiver of the right of recovery will directly or indirectly apply to your employees or employees of the person or organization, and we reserve our rights or lien to be reimbursed from any recovery funds obtained by any injured employee.
Section IV - Business Auto Conditions, A. - Loss Conditions, 5. - Transfer of Rights of Recovery Against Others to Us, is amended to add:
The "accident" or "loss" is due to operations undertaken in accordance with the contract existing between you and such person or organization; and
However, we will waive any right of recover we have against any person or organization with whom you have entered into a contract or agreement because of payments we make under this Coverage Form arising out of an "accident" or "loss" if:
62897 (6/95) Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1
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WC 06796122504/01/2025
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