CTR073339_COI.pdf

PDF 429 KB Posted

Attached to
Master Agreement AZ|CTR077739
Contract number
CTR077739
Issued by
Arizona

About this file

This document is a Certificate of Liability Insurance for Level 3 Audio Visual, LLC, issued by Holmes Murphy & Associates and covering multiple insurance providers including Great Northern Insurance Company, Chubb Indemnity Insurance Company, ACE American Insurance Company, and Federal Insurance Company. The certificate is specifically for the State of Arizona, with the State Procurement Office at 100 North 15 Avenue, Suite 402 in Phoenix listed as the certificate holder. The insurance policies provide coverage from September 1, 2024 to September 1, 2025, with various liability protections including commercial general liability, automobile liability, umbrella liability, workers' compensation, and specialized coverages like Tech E&O and Cyber Liability.

The insurance policies include comprehensive coverage limits, such as $1,000,000 for each occurrence under commercial general liability, $1,000,000 combined single limit for automobile liability, and $5,000,000 for umbrella liability. The State of Arizona and its departments, agencies, boards, commissions, universities, and employees are included as additional insureds when required by written contract. The policies also include a waiver of subrogation for General Liability, Auto Liability, and Workers' Compensation. Workers' Compensation specifically excludes certain officers/owners/partners, with Robert Peterson noted as an excluded party. The coverage territory is worldwide, though with specific limitations for bodily injury and property damage occurring outside the United States, Canada, and Puerto Rico.

View the file

Other files

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file

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

7/16/2025

Holmes Murphy & Associates 2727 Grand Prairie Parkway Waukee IA 50263

800-247-7756 612-349-2490 certificates@holmesmurphy.com

Great Northern Insurance Company 20303 LEVAUDPC Chubb Indemnity Insurance Company 12777

Level 3 Audio Visual, LLC 955 E Javelina Ave, Ste B106 & 118;

Mesa, AZ 85204

ACE American Insurance Company 22667 Federal Insurance Company 20281

1790630885

B X 1,000,000 X 1,000,000

X BI & PD Ded - 5,000

$10,000 1,000,000

2,000,000 X X

D01829518 9/1/2024 9/1/2025

2,000,000

A 1,000,000

X

X X

73636111 9/1/2024 9/1/2025

B X X 5,000,00056718619 9/1/2024 9/1/2025

5,000,000 X 10,000

D X

Y

71839454 9/1/2024 9/1/2025

1,000,000

1,000,000

1,000,000 C B

Tech E&O & Cyber Liability Installation Floater

D01828307 D01829518

9/1/2024 9/1/2024

9/1/2025 9/1/2025

Each Occ/Aggregate Each Occurrence

5,000,000 1,000,000

RE: State of Arizona Workers' Compensation excluded officers/owners/partners: Robert Peterson

The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees are included as Additional Insured with respect the General Liability and Auto Liability when required by written contract and per attached policy forms. Waiver of Subrogation apply as respects General Liability, Auto Liability and Workers Compensation when required by written contract and per attached policy forms. 30 day notice of cancellation

State of Arizona- State Procurement Office 100 North 15 Avenue, Suite 402 Phoenix AZ 85007

CB CG 04 0001 0320 Includes copyrighted material of Insurance Services Office, with its permission. Page 5 of 9

With respect to “bodily injury” only, the limitations described in Paragraph 3.a.(1) above do not apply to:

(i) You or to your directors, managers, members, “executive officers”, partners or supervisors as insureds;

(ii) Your “employees” as insureds, with respect to such damages caused by cardiopulmonary resuscitation or first aid services administered by such an “employee”; or

(iii) Your “employees” who are nurses, emergency medical technicians, or paramedics as insureds, with respect to such damages that are caused by providing or failing to provide professional healthcare services, but only if you are not engaged in the business or occupation of providing medical, paramedical, surgical, dental, x-ray or nursing services.

(2) "Property damage" to any property owned, occupied or used by you or by any of your directors, managers, members, “executive officers” or partners (whether or not an “employee”) or by any of your “employees”. This limitation does not apply to “property damage” to premises while rented to you or temporarily occupied by you with the permission of the owner.

L. Additional Insureds

Paragraph 3. under Section II – Who Is An Insured is amended by including the following:

Controlling Interest

Any person or organization that has financial control of you or owns, maintains or controls premises while you lease or occupy such premises, but only with respect to their liability arising out of:

(1) Their financial control of you; or

(2) Premises they own, maintain or control while you lease or occupy these premises.

However, no such person or organization is an insured with respect to structural alterations, new construction or demolition operations performed by or for that person or organization.

Lessors Of Leased Equipment

Any person or organization from whom you lease equipment, but only with respect to the maintenance or use by you of such equipment, and only if you are obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by this Coverage Part. However, no such person or organization is an insured with respect to an “occurrence” that takes place, or an offense that is committed, after the equipment lease ends.

Managers Or Lessors Of Premises

Any person or organization from whom you lease premises, but only with respect to the ownership, maintenance or use of that particular part of such premises leased to you and only if you are obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by this Coverage Part. However, no such person or organization is an insured with respect to:

(1) An “occurrence” that takes place, or an offense that is committed, after you cease to be a tenant in such premises; or

(2) Any structural alteration, new construction or demolition operations performed by or on behalf of them.

Mortgagee, Assignee Or Receiver

A mortgagee, assignee or receiver of premises, but only with respect to such mortgagee, assignee or receiver’s liability for “bodily injury”, “property damage” or “personal and advertising injury” arising out of your ownership, maintenance or use of a premises by you. However, no such person or organization is an insured with respect to structural alterations, new construction or demolition operations performed by, on behalf of, or for such additional insured.

Other Persons Or Organizations Pursuant To A Contract Or Agreement

Any person or organization that you are obligated pursuant to a contract or agreement to provide with such insurance as is afforded by this policy are insureds.

CB CG 04 0001 0320 Includes copyrighted material of Insurance Services Office, with its permission. Page 6 of 9

However, the person or organization is an insured only:

(1) To the extent such contract or agreement requires the person or organization to be afforded status as an insured;

(2) For activities that did not occur, in whole or in part, before the execution of the contract or agreement; and

(3) With respect to damages, loss, cost or expense for injury or damage to which this insurance applies.

No person or organization is an insured:

(1) That is more specifically identified under any other provision of Section II – Who Is an Insured (regardless of any limitation applicable thereto).

(2) With respect to any assumption of liability (of another person or organization) by them in a contract or agreement. This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contract or agreement.

Trade Show Event Lessor

With respect to your participation in a trade show event as an exhibitor, presenter or displayer, any person or organization whom you are required to include as an additional insured, but only with respect to such person or organization’s liability for “bodily injury”, “property damage” or “personal and advertising injury” caused 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 at the trade show event premises during the trade show event.

However, no such person or organization is an insured with respect to “bodily injury” or “property damage” included within the “products-completed operations hazard”.

Vendors

Any person or organization who is a vendor of “your products”, but only with respect to liability for “bodily injury” or “property damage” resulting from the distribution or sale of “your product” in the regular course of their business.

However, no such person or organization is an insured with respect to any:

(1) Assumption of liability (of another person or organization) by them in a contract or agreement. This limitation does not apply to the liability for damages for “bodily injury” or ”property damage” that such person or organization would have in the absence of such contract or agreement;

(2) Representation or warranty unauthorized by you;

(3) Physical or chemical change in “your product” made intentionally by the vendor;

(4) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container;

(5) Failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of “your product”;

(6) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor’s premises in connection with the sale of “your product”; or

(7) Of “your products” which, after distribution or sale by you, have been labeled or relabeled or used as a container, ingredient or part of any other thing or substance by or for the vendor.

Further, no person or organization is an insured from whom you have acquired “your product”, or any ingredient, part or container entering into, accompanying or containing “your product”.

Limitations Applicable To Additional Insureds

With respect any person or organization that qualifies as an additional insured under paragraph L. above, the following limitations apply to such insured:

CB CG 04 0001 0320 Includes copyrighted material of Insurance Services Office, with its permission. Page 7 of 9

(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.

Limits Of Insurance Applicable to Additional Insureds

With respect any person or organization that qualifies as an additional insured under paragraph L. above, 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.

However, the above paragraph shall not increase the applicable limits of insurance.

M. Medical Expense Limit – $15,000

Paragraph 7. under Section III – Limits Of Insurance is amended by including the following:

The Medical Expense Limit is the greater of:

a. $15,000; or

b. The amount shown in the Declarations for the Medical Expense Limit.

N. Knowledge/Notice Of Occurrence

Paragraph 2. under Section IV – Commercial General Liability Conditions is amended to include the following:

f. Knowledge of an “occurrence” or offense by an agent or “employee” of the insured will not constitute knowledge by the insured, unless an “executive officer” (whether or not an “employee”) of any insured or an “executive officer’s” designee knows about such “occurrence” or offense.

g. Failure of an agent or “employee” of the insured, other than an “executive officer” (whether or not an “employee”) of any insured or an “executive officer’s” designee, to notify us of an “occurrence” or offense that such person knows about will not affect the insurance afforded to you.

h. If a claim or loss does not reasonably appear to involve this insurance, but it later develops into a claim or loss to which this insurance applies, the failure to report it to us will not violate this condition, provided the insured gives us immediate notice as soon as the insured is aware that this insurance may apply to such loss or claim.

O. Primary And Non-Contributory

Subparagraph 4.a. under Section IV – Commercial General Liability Conditions is amended to include the following:

However, if you are obligated to a written contract or agreement to provide a person or organization that is included in Section II – Who Is an Insured with primary insurance such as is afforded by this policy, then this insurance is primary and we will not seek contribution from insurance available to such person or organization.

P. Unintentional Failure To Disclose Hazards

Paragraph 6. under Section IV – Commercial General Liability Conditions is amended to include the following:

Unintentional failure of an “employee” of the insured to disclose a hazard or other material information will not violate this condition, unless an “executive officer” (whether or not an “employee”) of any insured knows about such hazard or other material information.

Q. Waiver Of Subrogation Required By Contract

Paragraph 8. under Section IV – Commercial General Liability Conditions is deleted and replaced by the

CB CG 04 0001 0320 Includes copyrighted material of Insurance Services Office, with its permission. Page 8 of 9 following:

8. Waiver Of Subrogation Required By Contract

We will waive the rights of recovery we would otherwise have had against another person or organization, for loss to which this insurance applies, provided the insured has waived their rights of recovery against such person or organization in a contract or agreement that is executed before such loss.

To the extent that the insured’s rights to recover all or part of any payment made under this Coverage Part have not been waived, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring “suit” or transfer those rights to us and help us enforce them. This paragraph does not apply to Coverage C.

R. In Rem

The following is added to Section IV – Commercial General Liability Conditions:

Any “suit” brought as an action In Rem against any watercraft owned or operated by or for the insured shall in all respects be treated in the same manner as though such “suit” were brought against the insured.

CB CG 04 0001 0320 Includes copyrighted material of Insurance Services Office, with its permission. Page 9 of 9

S. Coverage Territory – Limited Worldwide

Paragraph 4. under Section V – Definitions is deleted and replaced by the following:

4. "Coverage territory" means all parts of the world.

However, “coverage territory” does not include any:

a. “Bodily injury” or “property damage” that takes place or any offense committed outside of the United States of America (including its possessions and territories), Canada and Puerto Rico, unless the insured’s responsibility to pay damages is determined by a “suit” on the merits that is brought in the United States of America (including its possessions and territories), Canada or Puerto Rico; or

b. Injury or damage in connection with any “suit” brought outside the United States of America (including its possessions and territories), Canada and Puerto Rico.

T. Insured Contract Amended – Railroad Limitations Removed

Paragraph 9. under Section V – Definitions is deleted and replaced by the following:

9. "Insured contract" means:

a. A lease of premises;

b. A sidetrack agreement;

c. An easement or license agreement;

d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality;

e. An elevator maintenance agreement; or

f. Any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for such municipality) in which you assume the tort liability of another person or organization to pay damages, to which this insurance applies, sustained by a third person or organization.

“Insured contract” does not include that part of any contract or agreement that indemnifies an architect, engineer or surveyor for damages arising out of:

(1) Preparing, approving, or failing to prepare or approve, maps, drawings, opinions, reports, surveys, field orders, change orders, designs or specifications; or

(2) Giving directions or instructions, or failing to give them.

All Other Terms And Conditions Remain Unchanged.

Authorized Representative

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.

(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)

Endorsement Effective 09-01-23 Policy No. 71839454 Endorsement No. 001 Insured LEVEL 3 AUDIO VISUAL LLC Premium $ Incl.

Insurance Company Federal Insurance Company

Countersigned By

WC 42 03 04 B

(Ed. 6-14) © Copyright 2014 National Council on Compensation Insurance, Inc. All Rights Reserved.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 42 03 04 B

(Ed. 6-14)

TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page.

We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us.

This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule.

The premium for this endorsement is shown in the Schedule.

Schedule

1. (☐) Specific Waiver Name of person or organization

(☒) Blanket Waiver Any person or organization against whom you have agreed to waive your right of recovery in a written contract, provided such contract was executed prior to the date of loss.

2. Operations:

3. Premium:

The premium charge for this endorsement shall be 2% percent of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described.

4. Advance Premium:

Insured Copy

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.

(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)

Endorsement Effective 09-01-23 Policy No. 71839454 Endorsement No. 001 Insured LEVEL 3 AUDIO VISUAL LLC Premium $ Incl.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13

(Ed. 4-84)

WC 00 03 13

(Ed. 4-84) 1983 National Council on Compensation Insurance.

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.)

This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.

Schedule

Any person or organization against whom you have agreed to waive your right of recovery in a written contract, provided such contract was executed prior to the date of loss.

For policies or exposure in Missouri:

Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual.

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.

(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)

Endorsement Effective 09-01-23 Policy No. 71839454 Endorsement No. 001 Insured LEVEL 3 AUDIO VISUAL LLC Premium $ Incl.

WC 90 03 75 (05/18)

CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page.

We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us.

You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule.

Schedule

1. (☐) Specific Waiver Name of person or organization

(☒) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver.

2. Operations:

3. Premium:

The premium charge for this endorsement shall be 1% percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described.

4. Minimum Premium:

Authorized Representative

File details come from the government source that posted it. Updated .