CTR078010_COI_2026-04-01.pdf
PDF 1 MB Posted
- Attached to
- Master Agreement AZ|CTR078010
- Contract number
- CTR078010
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for Sunland Asphalt & Construction, LLC, located in Phoenix, Arizona, covering their operations in Arizona, Colorado, New Mexico, Nevada, Texas, and Georgia. The certificate is issued by multiple insurers including Endurance American Insurance Co, Homesite Insurance Company of Florida, Travelers Excess and Surplus Lines Company, National Union Fire Insurance Co of Pittsburgh PA, and Travelers Property Casualty Co of America. The primary certificate holder is the State of Arizona/ADOT (Arizona Department of Transportation), with insurance policies effective from 4/1/2025 to 4/1/2026.
The contract appears to be for On-Call Milling & Asphalt Services, specifically Contract #CTR078010, with Sunland Asphalt providing comprehensive insurance coverage including Commercial General Liability ($2M per occurrence), Automobile Liability ($2M), Umbrella Liability ($15M), Workers' Compensation, Professional Liability, and Builders Risk Installation Floater. The policies include additional insured provisions for the State of Arizona/ADOT, with waiver of subrogation and primary/non-contributory status. The insurance covers various operational risks, with policy limits ranging from $1,500,000 for leased/rented equipment to $5,000,000 for cyber liability, ensuring broad protection for the contracted services.
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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
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
8/4/2025
Reseco Insurance Advisors, LLC 7901 N. 16th Street, Suite 100 Phoenix AZ 85020
602-753-4250 602-419-2242 certificates@resecoadvisors.com
Endurance American Insurance Co 10641 6934 Homesite Insurance Company of Florida 11156
Sunland Asphalt & Construction, LLC dba Sunland Asphalt 1625 E. Northern Avenue Phoenix AZ 85020
Travelers Excess and Surplus Lines Company 29696 National Union Fire Insurance Co of Pittsburgh PA 19445 Travelers Property Casualty Co of Amer 25674
1347431928
D X 2,000,000 X 500,000
25,000
2,000,000
4,000,000 X
Y Y GL9925617 4/1/2025 4/1/2026
4,000,000
D 2,000,000
X
X X
Y Y CA9775927 4/1/2025 4/1/2026
B C
X X 15,000,000Y CXP-016711-01
EX-2T42594A-24-NF
4/1/2025 4/1/2025
Y 4/1/2026 4/1/2026
15,000,000 X $10,000
D X
N
Y WC072113252 4/1/2025 4/1/2026
2,000,000
2,000,000
2,000,000 A E
Prof/Poll Liabilty Bldrs Risk Installation Floater Y
Y PNV10015397701
QT-630-3S841370-TIL-25
4/1/2025 8/1/2025
4/1/2026 8/1/2026
Aggregate/Each Claim Any One Jobsite
$5,000,000 $2,000,000
Certificate holder is hereby included as Additional Insured with respects to the General Liability, Automobile Liability and Umbrella Liability on a primary and non-contributory basis if required by written contract subject to all provisions and limitations of the policies. Waiver of Subrogation in favor of Certificate Holder applies to the General Liability, Automobile Liability and Employers Liability/Workers Compensation if required by written contract subject to all provisions and limitations of the policies. The above referenced Excess/Umbrella Liability policy is follow-form and provides additional limits of insurance for General Liability, Automobile Liability and Employers Liability/Workers Compensation.
The $100,000 is the limit for hired auto physical damage. Comprehensive Deductible $250/Collision Deductible $500.
See Attached...
The State of Arizona/ADOT 206 S. 17th Ave Phoenix AZ 85007
Cindy Lewis Accepted
ACORD 101 (2008/01)
The ACORD name and logo are registered marks of ACORD
© 2008 ACORD CORPORATION. All rights reserved.
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: FORM TITLE:
ADDITIONAL REMARKS
ADDITIONAL REMARKS SCHEDULE Page of
AGENCY CUSTOMER ID:
LOC #:
AGENCY
CARRIER NAIC CODE
POLICY NUMBER
NAMED INSURED
EFFECTIVE DATE:
1 1
Reseco Insurance Advisors, LLC Sunland Asphalt & Construction, LLC dba Sunland Asphalt 1625 E. Northern Avenue Phoenix AZ 85020
25 CERTIFICATE OF LIABILITY INSURANCE
Leased/Rented Equipment – Limit Per Item/Deductible: $1,500,000 / $5,000 Carrier/NAIC #: Travelers Property Casualty Co of America / 31194 Policy Number: QT-630-3S841370-TIL-24 Policy Term: 8/1/2025 – 8/1/2026
Cyber Liability – Each Occurrence/Aggregate Limit $5,000,000 Carrier/NAIC #: Houston Casualty Company / 42374 Policy Number: H25NGP25245000 Policy Term: 04/01/2025 - 04/01/2026 Cyber Liability includes Privacy, Network Security and Data Breach.
Crime/Employee Dishonesty – Limit/Deductible: $1,000,000 / $10,000 Carrier/NAIC #: Hudson Insurance Company / 25054 Policy Number: SXS31210420 Policy Term: 1/13/2021 – 1/13/2027
Aviation Liability – Limit: $1,000,000 Carrier/NAIC #: American Alternative Ins Corp / 19720 Policy Number: 9044202 Policy Term: 04/01/2025 - 04/01/2026
Technology Errors & Omissions: Limit $5,000,000 Carrier/NAIC #: Endurance American Insurance Co / 10641 Policy Number: PNV10015397701 Policy Term: 04/01/2025 - 04/01/2026
Primary Excess Liability: Limit Per Occurrence/Aggregate: $5,000,000 Carrier/NAIC#: Homesite Insurance Company of Florida/11156 Policy Number: CXP 016711 02 Policy Term: 04/01/2025-04/01/2026
Second Layer Excess Liability Limit: Limit Per Occurrence/Aggregate: $10,000,000 Carrier/NAIC#: Travelers Excess and Surplus Lines Company/29696 Policy#: EX-2T42594A-24-NF Policy Term: 04/01/2025-04/01/2026
Third Layer Excess Liability Limit: Limit Per Occurrence/Aggregate: $15,000,000 Carrier/NAIC#: Westchester Fire Insurance/10030 Policy#: G7255100A005 Policy Term: 04/01/02025 - 04/01/2026
RE: ADOT On-Call Milling & Asphalt Services Contract # CTR078010 Additional Insured: Insurance applies to any and all work performed for or on behalf of the State of Arizona/ADOT
POLICY NUMBER: GL 992-56-17 COMMERCIAL GENERAL LIABILITY
CG 20 10 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or OrQanization(s) Location(s) Of Covered Operations
ANY PERSON OR ORGANIZATION WHOM YOU PER THE CONTRACT OR AGREEMENT.
BECOME OBLIGATED TO INCLUDE AS AN
ADDITIONAL INSURED AS A RESULT OF ANY
CONTRACT OR AGREEMENT YOU HAVE ENTERED
INTO.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 □
POLICY NUMBER: GL 992-56-17 COMMERCIAL GENERAL LIABILITY
CG 20 37 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations
Any person or organization whom you Per the contract or agreement.
become obligated to include as an additional insured as a result of any contract or agreement you have entered into.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II - 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 Ill - 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.
This endorsement shall not increase the applicable limits of insurance.
CG 20 37 12 19 0 Insurance Services Office, Inc., 2018 Page 1 of 1
COMMERCIAL GENERAL LIABILITY
CG 24 04 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
POLICY NUMBER: GL 992-56-17
EFFECTIVE: 4-1-2025
CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
ELECTRONIC DATA LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES
POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS
SCHEDULE
Name of Person(s) Or Organization(s):
any person or organization required per contract
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Conditions:
We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above.
GL
policy No issued to Sunland Asphalt & Construction Inc by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
SCHEDULE
ADDITIONAL INSURED:
ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE CONTRACTUALLY
BOUND TO PROVIDE ADDITIONAL INSURED STATUS BUT ONLY TO THE
EXTENT OF SUCH PERSON OR ORGANIZATIONS LIABILITY ARISING OUT OF
THE USE OF A COVERED AUTO.
I. SECTION II - COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. - Who Is Insured, is amended to add:
d. Any person or organization, shown in the schedule above, to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered "auto". However, the insurance provided will not exceed the lesser of:
(1) The coverage and/or limits of this policy, or
(2) The coverage and/or limits required by said contract or agreement.
AUTHORIZED REPRESENTATIVE
87950 (9/14)
CA9775927
ENDORSEMENT
This endorsement, effective 12:01 A.M. 04/01/2025 forms a part of
Sun land Aspha l t & Cons t ruc t ion , LLC
ENDORSEMENT
This endorsement, effective 12:01 A.M. 04/01/2025 forms a part of Policy No. 977-59-27 issued to SUNLAND ASPHALT & CONSTRUCTION by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA.
BUSINESS AUTO COVERAGE FORM
AUTHORIZED REPRESENTATIVE
This endorsement modifies insurance provided under the following:
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US
(2)
(1)
The contract or agreement was entered into prior to any " accident" or " loss" .
No waiver of the right of recovery will directly or indirectly apply to your employees or employees of the person or organization, and we reserve our rights or lien to be reimbursed from any recovery funds obtained by any injured employee.
Section IV - Business Auto Conditions, A. - Loss Conditions, 5. - Transfer of Rights of Recovery
Against Others to Us, is amended to add:
The " accident" or " loss" is due to operations undertaken in accordance with the contract existing between you and such person or organization; and
However, we will waive any right of recover we have against any person or organization with whom you have entered into a contract or agreement because of payments we make under this Coverage Form arising out of an " accident" or " loss" if:
62897 (6/95) Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1
Covered States:
AZ
CO
NM
NV
04/01/2025 WC 072113252
File details come from the government source that posted it. Updated .