CTR063142 Certificate of Insurance.pdf
PDF 4 MB Posted
- Attached to
- Master Agreement AZ|CTR063142
- Contract number
- CTR063142
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for AmeriGas Propane, L.P., issued by McGriff Insurance Services, Inc. and underwritten by multiple insurers including ACE Fire Underwriters Insurance Company, ACE American Insurance Company, and Indemnity Insurance Company of North America. The certificate is issued to the State of Arizona Department of Transportation, located in Phoenix, Arizona, and covers the period from 07/01/2022 to 07/01/2023.
The insurance policy provides comprehensive coverage including Commercial General Liability, Automobile Liability, and Workers' Compensation with various policy limits. The coverage includes additional insured provisions for the State of Arizona Department of Transportation, with waivers of subrogation and primary non-contributory insurance terms. The policy covers operations across multiple states including California, Wisconsin, and other unspecified locations, with aggregate liability limits ranging from $2,000,000 to $2,500,000 depending on the specific coverage type. The policy includes protections for bodily injury, property damage, and other potential liabilities associated with AmeriGas Propane's business operations.
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Text version
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).
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
CERTIFICATE HOLDER
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03)
AUTHORIZED REPRESENTATIVE
CANCELLATION
DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
OTHER:
LOCJECT
PRO-
POLICY
GEN'L AGGREGATE LIMIT APPLIES PER:
OCCURCLAIMS-MADE
COMMERCIAL GENERAL LIABILITY
PREMISES (Ea occurrence) $
DAMAGE TO RENTED
EACH OCCURRENCE $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
$RETENTIONDED
CLAIMS-MADE
OCCUR
AGGREGATE $
EACH OCCURRENCE $UMBRELLA LIAB
EXCESS LIAB
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
INSR
LTR TYPE OF INSURANCE POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY) LIMITS
PER
STATUTE
OTH-
ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
ANY PROPRIETOR/PARTNER/EXECUTIVE
If yes, describe under DESCRIPTION OF OPERATIONS below
(Mandatory in NH)
OFFICER/MEMBER EXCLUDED?
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
AUTOMOBILE LIABILITY
ANY AUTO
OWNED SCHEDULED
HIRED NON-OWNED
AUTOS ONLY AUTOS
AUTOS ONLY AUTOS ONLY
COMBINED SINGLE LIMIT
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE $
INSD
ADDL
WVD
SUBR
N / A
(Ea accident)
(Per accident)
The ACORD name and logo are registered marks of ACORD
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
INSURED
PHONE
(A/C, No, Ext):
PRODUCER
ADDRESS:
FAX
(A/C, No):
CONTACT
NAME:
NAIC #
INSURER A :
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
INSURER(S) AFFORDING COVERAGE
T2C47BVD
07/01/2023
The State of Arizona Department of Transportation 1324 N. 22nd Ave Phoenix, AZ 85009
2,500,000
2,000,000
800-476-2211
ACE Fire Underwriters Insurance Company
Indemnity Insurance Company of North America
2,500,000
22667
07/01/202307/01/2022
07/01/202307/01/2022
2,000,000
2,500,000
2,500,000
20702
B
ACE American Insurance Company
HDO G47297783
B
A B C
2,500,000
N
McGriff Insurance Services, Inc.
P.O. Box 10265 Birmingham, AL 35202
AmeriGas Propane, L.P.
P.O. Box 858 Valley Forge, PA 19482
11/21/2022
07/01/2022
SCF C50668010 (WI)
WLR C50667911 (Energy Services)
WLR C50667832 (CA)
WLR C50667741(AOS)
2,000,000
10,000
Certificate Holder is included as Additional Insured (excluding Workers' Compensation) and Waiver of Subrogation applies except where not permissible by law if required by written contract subject to policy terms, conditions and exclusions. Insurance is primary and non-contributory over any other collectible insurance if required by written contract subject to policy terms, conditions and exclusions.
2,500,000
ISA H10689107
43575
X
X
X
X
X
X X
X X
X e6906
ACCEPTED
| Amerigas COI |
| CTR063142 The State of Arizona Department of Transportation (1) |
| UGI Corporation Auto- Additional Insured- Person or Organization |
| UGI Corporation Auto- Waiver of Subrogation |
| UGI Corporation GL- Additional Insured- Owners, Lessees, or Contractors- Completed Operations |
| UGI Corporation GL- Primary Noncontributory |
| UGI Corporation GL- Waiver of Subrogation |
| UGI Corporation WC- Waiver of Subrogation (1) |
UGI Corporation GL- Additional Insured- Owners, Lessees, or Contractors- Ongoing Operations (2) (2)
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