Emailed_Package_BIP-7Y185287_08-14-2025_10-47.PDF
PDF 68 KB Posted
- Attached to
- Master Agreement AZ|CTR075309
- Contract number
- CTR075309
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for Cook Insurance, Inc., located in Apache Junction, Arizona, involving multiple insurance carriers including Travelers, AmTrust Insurance Company, and Liberty Mutual. The certificate is issued to the Arizona State Procurement Office and the Arizona Department of Administration, indicating a state-level insurance and contract compliance document.
The insurance coverage includes multiple policy types with various effective dates and coverage limits, such as a General Liability policy (BIP-7Y185287A) effective from 10/03/2024 to 10/03/2025 with $1,000,000 in coverage, an Umbrella policy (CUP-3X824657-24-42A) with $1,000,000 in coverage from 10/12/2024 to 10/12/2025, and an Inland Marine - Installation Floater (BMO69111375C) with a jobsite limit of $500,000 and a catastrophe limit of $1,000,000, effective from 05/08/2025 to 05/08/2026. The certificate includes provisions for additional insured status, waiver of subrogation, and a 30-day cancellation notice.
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Text version
08/14/2025
Cook Insurance, Inc.
11512 E. Apache Trail
Apache Junction AZ 85120-
(480)986-4400
Travelers
AmTrust Insurance Company
Liberty Mutual
Engineering and Recording Inc
1625 W University Dr
Suite 113
Tempe AZ 85281-
EAR Professional Audio Video clservices@cookinsure.com
(480)986-1199
X
X
X
X BIP-7Y185287A 10/03/2024 10/03/2025 1,000,000
300,000
5,000
1,000,000
2,000,000
2,000,000
X
X X CUP-3X824657-24-42A 10/12/2024 10/12/2025 1,000,000
1,000,000
KWC1396055B 06/01/2025 06/01/2026 X
1,000,000
1,000,000
1,000,000
Inland Marine - Installation Floater BMO69111375C 05/08/2025 05/08/2026 Jobsite Limit $500,000
Catastrophe Limit $1,000,000 ded $5,000
The certificate holder is an additional insured and a waiver of subrogation and primary/non-contributory wording applying, subject to the attached GL and auto policy forms and endorsements.
Attached is a 30-day cancel notice endorsement
AI 025509
State Procurement Office
1802 W. Jackson #100
Phoenix AZ 85007-
Arizona Department of Administration
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
INSR ADDL SUBR
LTR INSD WVD
DATE (MM/DD/YYYY)
PRODUCER CONTACT
NAME:
FAXPHONE
(A/C, No):(A/C, No, Ext):
ADDRESS:
INSURER A :
INSURED INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
POLICY NUMBER
POLICY EFF POLICY EXP
TYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)
AUTOMOBILE LIABILITY
UMBRELLA LIAB
EXCESS LIAB
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
EACH OCCURRENCE $
DAMAGE TO RENTED
CLAIMS-MADE OCCUR $PREMISES (Ea occurrence)
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
PRO-
POLICY LOC PRODUCTS - COMP/OP AGG $JECT
OTHER: $
COMBINED SINGLE LIMIT $
(Ea accident)
ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident)
OCCUR EACH OCCURRENCE $
CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below
INSURER(S) AFFORDING COVERAGE NAIC #
COMMERCIAL GENERAL LIABILITY
Y / N
N / A
(Mandatory in NH)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
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.
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 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).
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
CERTIFICATE HOLDER CANCELLATION
© 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03)
CERTIFICATE OF LIABILITY INSURANCE
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