Revised_Certificate_Kiesler_Police_Supply__Inc._8-1-21_to_8-1-22.pdf
PDF 5 MB Posted
- Attached to
- Master Agreement AZ|CTR057648
- Contract number
- CTR057648
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by Arthur J. Gallagher Risk Management Services, Inc. for Kiesler Police Supply, Inc., with insurance coverage provided by multiple carriers including Granite State Insurance Company, Ohio Security Insurance Company, American Select Insurance Company, and National Union Fire Insurance Company of Pittsburgh. The certificate names the Arizona Game and Fish Department as the certificate holder, located in Phoenix, Arizona.
The insurance covers a contract (BPM003844) for Rifles/Firearms for Hunter Education, with policies active from August 1, 2021 to August 1, 2022. The coverage includes Commercial General Liability with a $1,000,000 per occurrence limit and $2,000,000 aggregate limit, Automobile Liability, Umbrella Liability with a $5,000,000 limit, and Workers Compensation insurance. The Arizona Game and Fish Department is listed as an additional insured on the General Liability and Automobile Liability policies on a primary and non-contributory basis, with a waiver of subrogation as required by the 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
10/11/2021
Arthur J. Gallagher Risk Management Services, Inc 1601 Alliant Ave Louisville KY 40299
502-415-7000 502-415-7001
Granite State Insurance Company 23809 KIESPOL-02 Ohio Security Insurance Company 24082
Kiesler Police Supply, Inc.
2802 Sable Mill Rd Jeffersonville IN 47130
American Select Insurance Company 19992 National Union Fire Insurance Company of Pittsburg 19445
1520006579
A X 1,000,000 X 100,000
10,000
1,000,000
2,000,000
Y Y 02LX0808368492 8/1/2021 8/1/2022
2,000,000
C 1,000,000
X
X X
Y Y TRA4037244 8/1/2021 8/1/2022
D X X 5,000,000Y 29UD0808368502 8/1/2021Y 8/1/2022
5,000,000 X 10,000
B XY XWS61048486 4/1/2021 4/1/2022
1.000,000
1.000,000
1.000,000
RE: BPM003844 Rifles/Firearms for Hunter Education
ARIZONA GAME AND FISH DEPARTMENT is additional insureds on the General Liability (CG 2015 04 13) on a primary and non-contributory basis (CG 20 01 04 13 and Automobile Liability Policies as required by written contract (CA 7078 10 13). Waiver of subrogation is as added in favor of the additional insureds on General Liability (CG 24 04 05 09), Auto Liability and Workers Compensation policies when required by written contract. Umbrella Liability follows form.
ARIZONA GAME AND FISH DEPARTMENT
5000 West Carefree Highway Phoenix AZ 85086
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