CTR077300 Kearl GL COI 12.8.25.pdf
PDF 48 KB Posted
- Attached to
- Master Agreement AZ|CTR077300
- Contract number
- CTR077300
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by Hartford Underwriters Insurance Company for Kearl LLC, located in Gilbert, Arizona. The certificate is prepared by Specialty Program Group LLC and is specifically for the State of Arizona's Department of Economic Security, with a contract identification number CTR077300. The certificate holder is listed as the State of Arizona and Department of Economic Security, with the insurance coverage valid from 12/08/2024 to 12/08/2025.
The insurance policy provides Commercial General Liability coverage with limits of $1,000,000 per occurrence, $2,000,000 general aggregate, and $2,000,000 for products-completed operations. Additionally, an Employment Practices Liability Insurance is included with $25,000 each claim limit and $25,000 annual aggregate limit. The policy includes provisions making the State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees additional insureds. The coverage is primary and noncontributory, with a waiver of subrogation in favor of the certificate holder. The specific division name associated with the contract is ADES (Arizona Department of Economic Security).
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Text version
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
06/12/2025 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 be endorsed. If SUBROGATIONIS 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).
PRODUCER
SPECIALTY PROGRAM GROUP LLC
83556447
203 N LASALLE STREET STE 2000
CHICAGO IL 60601
CONTACT NAME:
PHONE
(A/C, No, Ext):
(800) 688-1984 FAX
(A/C, No):
E-MAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC#
INSURER A : Hartford Underwriters Insurance Company 30104
INSURED
KEARL LLC
394 E Julian Dr Gilbert, AZ 85295
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
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.
INSR
LTR
TYPE OF INSURANCE ADDL
INSR
SUBR
WVD
POLICY NUMBER POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/Y YYY)
LIMITS
A
COMMERCIAL GENERAL LIABILITY
X X 83 SBA BC1HJE 12/08/2024 12/08/2025
EACH OCCURRENCE $1,000,000
CLAIMS-MADE X OCCUR DAMAGE TO RENTED
PREMISES (Ea occurrence) $1,000,000
X General Liability MED EXP (Any one person) $10,000
PERSONAL & ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
X POLICY PRO-
JECT
LOC PRODUCTS - COMP/OP AGG $2,000,000
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
(Ea accident)
ANY AUTO BODILY INJURY (Per person)
ALL OWNED
AUTOS
SCHEDULED
AUTOS BODILY INJURY (Per accident)
HIRED
AUTOS
NON-OWNED
AUTOS
PROPERTY DAMAGE
(Per accident)
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS-
MADE
EACH OCCURRENCE
AGGREGATE
DED RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY
PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below
N/ A
PER
STATUTE
OTH-
ER
Y/N E.L. EACH ACCIDENT
E.L. DISEASE -EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
A Employment Practices Liability Insurance
83 SBA BC1HJE 12/08/2024 12/08/2025 Each Claim Limit Annual Aggregate Limit
$25,000 $25,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Those usual to the Insured's Operations. Division Name: ADES. Contract ID: CTR077300. Please see Additional Remarks Schedule Acord 101 Form Attached
CERTIFICATE HOLDER CANCELLATION
The State of Arizona and Dept of Economic Security c/o myCOI 8710 BASH ST PO Box 501970
INDIANAPOLIS IN 46256-6005
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
ACORD 101 (2014/01) © 2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID:
LOC# :
ADDITIONAL REMARKS SCHEDULE Page 2 of 2
AGENCY
SPECIALTY PROGRAM GROUP LLC
NAMED INSURED
KEARL LLC
3906 E VEST AVE
GILBERT AZ 85295-0035
POLICY NUMBER
SEE ACORD 25
CARRIER
SEE ACORD 25
NAIC CODE
EFFECTIVE DATE: SEE ACORD 25
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM
FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are an additional insured per the Additional Insured Owners, Lessees or Contractors - Ongoing Operation - Scheduled Person or Organization, form SL3024 and Additional Insured - Owners, Lessees or Contractors - Completed Operations, form SL3036, attached to this policy. Waiver of Subrogation applies in favor of the Certificate Holder per Waiver of Subrogation Form SL3003, attached to this policy. Coverage is primary and noncontributory per the Business Liability Coverage Form SL 00 00, attached to this policy.
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