CTR079416_COI_2026-09-01.pdf
PDF 2 MB Posted
- Attached to
- Master Agreement AZ|CTR079416
- Contract number
- CTR079416
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by North Risk Partners for Kurita America, Inc., with coverage effective from 09/01/2025 to 09/01/2026. The certificate names the Arizona Department of Corrections, Rehabilitation & Reentry as the certificate holder. The insurance policies are underwritten by Nautilus Ins Co Non-Admitted and Great Divide Insurance Company, covering various liability types including Commercial General Liability, Automobile Liability, Workers' Compensation, Excess Liability, and Contractors Pollution Liability.
The insurance provides coverage with various limits, including $1,000,000 for General Liability with a $25,000 deductible, $1,000,000 for Automobile Liability, $1,000,000 for Workers' Compensation, and $10,000,000 for Excess Liability. The policy includes additional insured provisions for the Arizona Department of Corrections, Rehabilitation & Reentry when required by written contract, with a waiver of subrogation applying to General Liability, Auto Liability, and Workers' Compensation policies. The coverage is specifically related to Contract CTR079416, with a Contractors Pollution Liability policy featuring a $1,000,000 General Aggregate and $10,000 per claim retention.
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Text version
11/07/2025
North Risk Partners P.O. Box 64016
St Paul MN 55164
Marilyn Roof
(763) 536-8006 marilyn.roof@northriskpartners.com
Kurita America, Inc.
6600 94th Ave. N.
Minneapolis, MN 55445
Nautilus Ins Co Non-Admitted 17370 Great Divide Insurance Company 25224
25/26
A $25k Ded.-Per Occurrence
GLP2012581-21 09/01/2025 09/01/2026
1,000,000 500,000 10,000 1,000,000 3,000,000 3,000,000
B
$25k Ded-Acc
BAP2012580-21 09/01/2025 09/01/2026
1,000,000
A
FFX2035635-14 09/01/2025 09/01/2026
10,000,000 10,000,000
B N WCA2012578-21 09/01/2025 09/01/2026
1,000,000 1,000,000 1,000,000
A Contractors Pollution Liability - Claims Made Form CPL2027018-17 09/01/2025 09/01/2026
General Aggregate $1,000,000 Each Pollution Condition $1,000,000 Per Claim Retention $10,000
Re: Contract CTR079416 Arizona Department of Corrections, Rehabilitation & Reentry is named as Additional Insured on the General Liability and Auto Liability policies when required by written contract per policy terms & conditions. Waiver of Subrogation applies to General Liability, Auto Liability and Worker's Compensation policies per policy terms & conditions.
Arizona Department of Corrections, Rehabilitation & Reentry Procurement Services 701 E. Jefferson Street Phoenix AZ 85034
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
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