Kutak_Rock_COI_for_CGL-Auto-UL-WC_to_9-20-2022.pdf
PDF 95 KB Posted
- Attached to
- Master Agreement AZ|CTR061730
- Contract number
- CTR061730
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance dated 8/19/2022 for Kutak Rock LLP, with insurance coverage provided by multiple insurers including Travelers Property Casualty of America, The Phoenix Insurance Co, Charter Oak Fire Insurance Co, and Travelers Indemnity Co. The certificate names the Arizona State Retirement System as the certificate holder, with coverage extending to the State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees.
The insurance certificate covers multiple types of liability, including commercial general liability, automobile liability, umbrella liability, and workers' compensation. Coverage limits vary by policy type, with commercial general liability set at $1,000,000 per occurrence and $5,000,000 aggregate, automobile liability at $1,000,000 combined single limit, umbrella liability at $10,000,000 each occurrence and aggregate, and workers' compensation at $1,000,000 per statute. The policies are effective from 9/20/2021 to 9/20/2022, with additional insured provisions and waivers of subrogation in favor of the State of Arizona where required by written contract.
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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
8/19/2022
FNIC
P.O. Box 45279 Omaha NE 68145
Patt Pierce 402-861-7029 patt.pierce@fnicgroup.com
Travelers Property Casualty of America 25674 The Phoenix Insurance Co 25623
Kutak Rock LLP 1650 Farnam St Omaha NE 68102-2186
Charter Oak Fire Insurance Co. 25615 Travelers Indemnity Co. 25658
796126848
B X 1,000,000 X 750,000
5,000
1,000,000
5,000,000
6309257N149PHX21 9/20/2021 9/20/2022
2,000,000
C 1,000,000
X
BA5N8576862143G 9/20/2021 9/20/2022
A X 10,000,000CUP8J567763 9/20/2021 9/20/2022
10,000,000 X 0
D XUB5J681290 9/20/2021 9/20/2022
1,000,000
1,000,000
1,000,000
State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees are additional insureds for General Liability where required by written contract.
Primary & noncontributory status is governed by the terms & conditions of the insurance policies of all parties to the contract.
Waiver of subrogation applies in favor of same for General Liability and Workers Compensation where required by written contract.
Arizona State Retirement System 3300 North Central Ave Phoenix AZ 85012
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