CTR071169_2025-01-05_COI.pdf

PDF 63 KB Posted

Attached to
Master Agreement AZ|CTR071169
Contract number
CTR071169
Issued by
Arizona

About this file

This document is an ACORD Certificate of Liability Insurance issued by J A Knapp Agency for Diamondback Shooting Sports Inc, Diamondback Police Supply Co Inc, and Diamondback Training Center LLC. The certificate is for the Arizona Department of Administration's State Procurement Office, located in Phoenix, AZ. The insurers are Berkshire Hathaway Specialty Insurance Company and Employers Preferred Insurance Company.

The insurance certificate covers commercial general liability and umbrella liability policies with effective dates from 01/05/2024 to 01/05/2025. The general liability policy has limits of $1,000,000 per occurrence, $2,000,000 aggregate, and $1,000,000 for personal and advertising injury. The umbrella liability policy provides an additional $2,000,000 per occurrence and aggregate. A workers' compensation policy is also included with statutory limits. The certificate specifies that the State of Arizona, its departments, agencies, boards, commissions, universities, and its officers, officials, agents, and employees shall be named as additional insureds with respect to liability arising from the contractor's activities.

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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

E-MAIL

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

Phoenix AZ 85007

100 N. 15th Ave Suite 402

State Procurement Office

Arizona Department of Administration

The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents and employees shall be named as additional insureds with respect to liability arising out of the activities performed by or on behalf of the Contractor.

1,000,000

1,000,000

1,000,000

07/20/202407/20/2023EIG 4584203 03YB

2,000,000

2,000,000

01/05/202501/05/202447-CHU-000256-01

10,000✘

A

2,000,000

2,000,000

1,000,000

10,000

100,000

1,000,000

01/05/202501/05/202447-CHP-001741-01Y

A

EMPLOYERS PREFERRED INS CO

Berkshire Hathaway Specialty Insurance Company

85710AZTucson

7030 E. Broadway Blvd

Diamondback Training Center LLC

Diamondback Shooting Sports Inc & Diamondback Police Supply Co Inc katie@jaknapp.com

7409130815

Katie Griggs

43074OHSunbury

PO BOX 286

J A Knapp Agency

1/8/2024

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