CTR074822-_COI_GCAuWCProfPol-Exp_2025-9-27-_Partner_Eng.pdf
PDF 3 MB Posted
- Attached to
- Master Agreement AZ|CTR074822
- Contract number
- CTR074822
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for Partner Assessment Corporation dba Partner Engineering & Science, Inc., covering multiple insurance policies issued by Axis Surplus Insurance Company, Travelers Property Casualty Company of America, and Allied World Assurance Company. The insurance certificate is specifically related to a contract (CTR074822) for Brownfields Environmental Site Assessment Services with the State of Arizona, specifically the Arizona Department of Environmental Quality. The policies provide comprehensive coverage including Commercial General Liability, Automobile Liability, Umbrella Liability, Workers' Compensation, Professional Errors & Omissions, and Pollution Liability.
The insurance policies are effective from 9/27/2024 to 9/27/2025, with various coverage limits including $1,000,000 for Commercial General Liability, $1,000,000 for Automobile Liability, $5,000,000 for Umbrella Liability, and $2,000,000 for Professional E&O and Pollution Liability. The State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are named as additional insured parties. The policies include primary and non-contributory insurance provisions, waivers of subrogation, and cover all projects and locations. The insurance is specifically for environmental site assessment services, with policies designed to protect against potential liabilities arising from professional environmental consulting work.
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ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
INSR ADDL SUBR
LTR INSD WVD
PRODUCER CONTACT
NAME:
FAXPHONE
(A/C, No):(A/C, No, Ext):
ADDRESS:
INSURER A :
INSURED INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)
AUTOMOBILE LIABILITY
UMBRELLA LIAB
EXCESS LIAB
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
EACH OCCURRENCE $
DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence)
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT
OTHER: $
COMBINED SINGLE LIMIT
$(Ea accident)
ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED
BODILY INJURY (Per accident) $AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE
$AUTOS ONLY AUTOS ONLY (Per accident)
OCCUR EACH OCCURRENCE
CLAIMS-MADE AGGREGATE $
DED RETENTION $
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below
INSURER(S) AFFORDING COVERAGE NAIC #
COMMERCIAL GENERAL LIABILITY
Y / N N / A
(Mandatory in NH)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
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).
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
CERTIFICATE HOLDER CANCELLATION
© 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03)
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
The ACORD name and logo are registered marks of ACORD
12/17/2024
License # 0M63276
(951) 368-0700 (951) 368-0707
26620
Partner Assessment Corporation dba Partner Engineering & Science, Inc.
2154 Torrance Blvd., #200 Torrance, CA 90501
25674 19489
A 1,000,000
X X SP004650042024 9/27/2024 9/27/2025 300,000
$25,000 Deductible 25,000
1,000,000 2,000,000 2,000,000
1,000,000B
X X 8100X771722 9/27/2024 9/27/2025
5,000,000C 03098032 9/27/2024 9/27/2025 5,000,000
B
X UB0X817777 9/27/2024 9/27/2025 1,000,000
Y 1,000,000
1,000,000 A Professional E&O SP004650042024 9/27/2024 Each Claim/Aggregate 2,000,000 A Pollution Liability SP004650042024 9/27/2024 9/27/2025 Each Occ/Aggregate 2,000,000
Re: CTR074822, Brownfields Environmental Site Assessment Services
State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees named as additional insured in regards to General Liability and Auto Liability.
Waiver of Subrogation applies per attached forms to General Liability, Auto Liability and Workers' Compensation
Arizona Department of Environmental Quality Contracts and Procurement 1110 W. Washington Street Phoenix, AZ 85007
PARTASS-01 ASHUNN
Gallant Risk and Insurance Services, LLC 4160 Temescal Canyon Rd. Suite 214 Corona, CA 92883
Axis Surplus Insurance Company Travelers Property Casualty Company of America Allied World Assurance Company (U.S.) Inc
Follow Form X
9/27/2025
X X
X
X
X
X X
X X
X
Includes copyrighted material of Insurance Services Office, Inc with its permission
SPP 2001 04 (04 14) Page 1 of 1
Endorsement No. 20
Effective Date: 09/27/2024 @12:01 a.m. Standard Time at the address of the Named Insured Policy Number: SP004650-04-2024 Insured Name: Partner Assessment Corporation Issuing Company: AXIS Surplus Insurance Company Additional (Return) Premium: $0 If the Endorsement Effective Date is blank, then the effective date of this Endorsement is the Inception Date of the Policy.
PRIMARY AND NONCONTRIBUTORY OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following:
SPECIALTY PACKAGE POLICY
The following is added to SECTION VI, COMMON CONDITIONS, Paragraph 9, Other Insurance. It 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.
SPP 2404 09 (04 14) Page 1 of 1
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
SPECIALTY PACKAGE POLICY
SCHEDULE
Name Of Person Or Organization:
Where required by written contract in force prior to any claim
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The following is added to Paragraph 12.
Subrogation of Section VI – Common Conditions:
We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or Your Work done under a contract with that person or organization and included in the Products- Completed Operations Hazard. This waiver applies only to the person or organization shown in the Schedule above.
CG 20 01 04 13
Endorsement No. 23
Effective Date: 09/27/2024@12:01 a.m. Standard Time at the address of the Named Insured Policy Number: SP004650-04-2024 Insured Name: Partner Assessment Corporation Issuing Company: AXIS Surplus Insurance Company Additional (Return) Premium: $0 If the Endorsement Effective Date is blank, then the effective date of this Endorsement is the Inception Date of the Policy.
SPP 2404 09 (04 14) Page 1 of 1
CG 24 04 05 09
CG 20 10 04 13
SPP 2010 13 (02 14) Page 1 of 2
Endorsement No.
Effective Date: 09/27/2024@12:01 a.m. Standard Time at the address of the Named Insured Policy Number: SP004650-04-2024 Insured Name: Partner Assessment Corporation Issuing Company: AXIS Surplus Insurance Company Additional (Return) Premium: $0 If the Endorsement Effective Date is blank, then the effective date of this Endorsement is the Inception Date of the Policy.
ADDITIONAL INSURED – OWNERS, LESSEES OR
CONTRACTORS – SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
SPECIALTY PACKAGE POLICY
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section III – 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.
Where required by written contract in force prior to any claim.
All Projects/Locations
CG 20 10 04 13
SPP 2010 13 (02 14) Page 2 of 2
C. With respect to the insurance afforded to these additional insureds, the following is added to Section IV – 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 shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
CG 20 37 04 13
SPP 2037 13 (06 12) Page 1 of 1
Endorsement No.
Effective Date: 09/27/2024@12:01 a.m. Standard Time at the address of the Named Insured Policy Number: SP004650-04-2024 Insured Name: Partner Assessment Corporation Issuing Company: AXIS Surplus Insurance Company Additional (Return) Premium: $0 If the Endorsement Effective Date is blank, then the effective date of this Endorsement is the Inception Date of the Policy.
ADDITIONAL INSURED – OWNERS, LESSEES OR
CONTRACTORS – COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
SPECIALTY PACKAGE POLICY
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section III – 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 IV – 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 shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
Where required by contract in force prior to any claim. All Projects/Locations
COMM RCI L AUTOE A
T IS ENDORSEMENT CHANGES T E POLICY. PL ASE READ IT CAREFULLY.H H E
BLANKET ADDITIONAL INSURED PRIMARY AND
NON-CONTRIBUTORY WITH OTHER INSURANCE
Thi e dorseme t m d fie i surance prov ded under he f l o ing:s n n o i s n i t o l w
BUS NE S A TO OV RAGE F RMI S U C E O
2.PROVISIONS The fol o ing i added to Paragraphl w s B 5.. , O het r In u ances r of SE TION IV BUSIN SS AUTC E O1. The fo lowing is added to Paragraphl A.1.c. , Who COND T ONI I S:Is An Insu edr , of SE TION Il COV REDC E
AU OS LIAB LIT CO E AGET I Y V R : Re ardle s o the prov sions o pa ag aph a. a dg s f i f r r n Thi i cludes any pe son or organization who yos n r u pa ag aphr r d. of this part 5. O her Insurance,t this are requi ed under a writ en co tra t or t n c r i suran e i prim ry to and non-contri utory witn c s a b h ag ee ent betwee yo and that perso or m n u n r appl cable othe in urance under which ani r s organi a ion, that is signed by you be o e thez t f r addi ional insured person o o ganiza io is thet r r t n "bodi y inju y or "property dam ge o curs andl r " a " c fi st nam d insured when the writ en co tra t or e t n c r that i i e fe t during the poli y period, to nams n f c c e ag ee ent be ween you and that person or m t r a an addit onal i sured fo Cov red Autos i n r e s organi ation, that is signed by you be o e thez f r Lia il ty Cov rage, but only fo dam ges to whi hb i e r a c "bo ily inj ry or "property dam ge o curs andd u " a " c th s insuran e applie and only to the ex ent oi c s t f that i in e fe t duri g the pol cy period, requi es f c n i r s that person s or o ganiza io 's l abi i y fo the' r t n i l t r th s i surance to be prim ry an non-contri utory.i n a d b conduct o anothe "in ured".f r s
CA 4 74 2 16T 0 © 2016 The T avelers Indemnit Company. All righr y ts reserved. Pa e 1 of 1g Includes copyrighted material of nsurance Services OfI f ce, Inc. with its permis ion.i s
Policy Number: 8100X771722
LauraBramer_aviac71 Highlight
UB00X771722
9/27/2023 UB0X817777
Partner Assessment Corporation
Travelers Property Casualty Company of America
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