Landon_Fulkerson_COI_-_819474568_-_Arizona_Game_and_Fish_.pdf

PDF 126 KB Posted

Attached to
AZ|CTR078893
Contract number
CTR078893
Issued by
Arizona

About this file

This document is a Certificate of Liability Insurance issued by Next First Insurance Agency, Inc. on behalf of Landon Fulkerson DBA Down Range Archery Arizona, with State National Insurance Company, Inc. as the primary insurer. The certificate is for the Arizona Game and Fish Department, located in Phoenix, Arizona, and covers the period from 10/01/2025 to 10/01/2026.

The insurance policy provides commercial general liability coverage with limits of $1,000,000 per occurrence and $2,000,000 aggregate, including professional liability coverage with a $2,000,000 aggregate limit. The policy includes additional insured status for the Arizona Game and Fish Department and its associated entities. The coverage encompasses general liability, with provisions for abuse and molestation coverage, subject to the policy's terms and conditions. The certificate serves as proof of insurance for the business relationship between Down Range Archery Arizona and the Arizona Game and Fish Department.

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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

E-MAIL

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

10/01/2025

Next First Insurance Agency, Inc.

PO Box 60787 Palo Alto, CA 94306

Landon Fulkerson Landon Fulkerson DBA Down Range Archery Arizona 1245 E Ames Ave Kingman, AZ 86409

(855) 222-5919 support@nextinsurance.com

819474568

X

X

X

1,000,000.00

100,000.00

15,000.00

2,000,000.00

2,000,000.00

Arizona Game and Fish Department 5000 W Carefree Hwy Phoenix, AZ 85086

1,000,000.00

10/01/2025 10/01/2026 Each Occurrence:

Aggregate:

$1,000,000.00 $2,000,000.00NXTC3RW7TW-01-GLProfessional Liability

State National Insurance Company, Inc. 12831

The Certificate Holder is Arizona Game and Fish Department. State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are an Additional Insured on the General Liability policy per the Additional Insured Automatic Status Endorsement. All Certificate Holder privileges apply only if required by written agreement between the Certificate Holder and the insured, and are subject to policy terms and conditions. The policy includes abuse and molestation coverage subject to policy terms and conditions. The policy includes abuse and molestation coverage subject to policy terms and conditions.

A X NXTC3RW7TW-01-GL 10/01/2025 10/01/2026

A

ACORD 0025 2016-03 -- Certificate of Insurance

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