DBA_01-01-2022_Insurance.pdf

The ACORD name and logo are registered marks of ACORD

CERTIFICATE HOLDER

© 1988-2014 ACORD CORPORATION. All rights reserved.

ACORD 25 (2014/01)

AUTHORIZED REPRESENTATIVE

CANCELLATION

DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE

LOCJECT

PRO-POLICY

GEN'L AGGREGATE LIMIT APPLIES PER:

OCCURCLAIMS-MADE

COMMERCIAL GENERAL LIABILITY

PREMISES (Ea occurrence) $

DAMAGE TO RENTED

EACH OCCURRENCE $

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $

PRODUCTS - COMP/OP AGG $

$RETENTIONDED

CLAIMS-MADE

OCCUR

AGGREGATE $

EACH OCCURRENCE $UMBRELLA LIAB

EXCESS LIAB

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

INSR

LTR TYPE OF INSURANCE POLICY NUMBER

POLICY EFF

(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY) LIMITS

PER

STATUTE

OTH-

ER

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE

E.L. DISEASE - POLICY LIMIT

ANY PROPRIETOR/PARTNER/EXECUTIVE

If yes, describe under DESCRIPTION OF OPERATIONS below

(Mandatory in NH)

OFFICER/MEMBER EXCLUDED?

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY Y / N

AUTOMOBILE LIABILITY

ANY AUTO

ALL OWNED SCHEDULED

HIRED AUTOS

NON-OWNED

AUTOS AUTOS

AUTOS

COMBINED SINGLE LIMIT

BODILY INJURY (Per person)

BODILY INJURY (Per accident)

PROPERTY DAMAGE $

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.

INSD

ADDL

WVD

SUBR

N / A

(Ea accident)

(Per accident)

OTHER:

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 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:

INSURED

PHONE

(A/C, No, Ext):

PRODUCER

ADDRESS:

E-MAIL

FAX

(A/C, No):

CONTACT

NAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INSURER(S) AFFORDING COVERAGE

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

5/17/2021

Commercial West Insurance Agency 2152 South Vineyard, Suite 107 Mesa AZ 85210

Lori Spelde 480-961-5400 480-961-5401

Lori@trycwi.com

Phoenix Insurance Company 25623 DBACO-1 Travelers Property Casualty Co 25674

DBA Construction, Inc.

P.O. Box 63035 Phoenix AZ 85082-3035

Travelers Casualty & Surety 31194 Continental Casualty Co. 20443 Travelers Indemnity Company 25658

801526495

A X 1,000,000 X 300,000

5,000

1,000,000

2,000,000

X

Y Y DT-CO-9D586889-PHX-21 1/1/2021 1/1/2022

2,000,000

B 1,000,000 X

XX

Y Y 810-2L968980-21-26-G 1/1/2021 1/1/2022

B X X 10,000,000CUP-0K482811-21-26

10,000,000

1/1/2021 1/1/2022

C

N

Y UB-9J634648-21-26-G 1/1/2021 1/1/2022 X

1,000,000

1,000,000

1,000,000 D E

Leased & Rented Equip from others Scheduled Equipment RPL/Intersections, Chandler, AZ

6079982568

SPS-5R667114-IND

1/1/2021 5/6/2021

1/1/2022 5/6/2022

Limit/Deductible Limit/Deductible Limit

500,000/1,000 2,548,458/1,000 5MIL Occ/10MIL Agg

Work Comp applies to all states excluding monopolistic - ND, OH, WA, WY Contractor's Pollution Liability| Policy # G70963620 002| Westchester Surplus Lines Insurance Co.| Effective 12/18/20 to 12/18/21| Limit $5,000,000 Occurrence $5,000,000 Aggregate.

RE: BPM003283

The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees areadditional insureds as required by written contract per the attached forms. Coverage is primary & non-contributory. Waiver of subrogation applies.

Arizona Game & Fish Department Purchasing Office 5000 W. Carefree Hwy Phoenix AZ 85086

UB-9J634648-21-26-G