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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