Silhouette_Farm___Forestry__LLC_Arizona_Game_and_Fish_Department__1_.pdf
PDF 1 MB Posted
- Attached to
- Master Agreement AZ|CTR074705
- Contract number
- CTR074705
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for Silhouette Farm & Forestry, LLC, issued by k.p.d. Insurance LLC, with multiple insurance carriers including The Cincinnati Specialty Underwriters Insurance Company, Continental Divide Insurance Company, Gotham Insurance Company, SAIF Corporation, National Fire & Marine Insurance Company, and Great American Insurance Company. The primary certificate holder is the Arizona Game and Fish Department, located in Phoenix, Arizona. The insurance covers various liability types including commercial general liability, automobile liability, workers' compensation, excess liability, contractor professional liability, and contractor pollution liability.
The insurance policies are effective from November 30, 2024, to November 30, 2025, with multiple coverage limits. The commercial general liability policy has a $1,000,000 per occurrence limit and a $2,000,000 aggregate limit. Automobile liability is set at $1,000,000, and workers' compensation follows statutory requirements. The policy includes additional insured provisions for the Arizona Game and Fish Department, with coverage extending to the ownership, maintenance, and use of covered vehicles. The contract references Contract #CTR074705, and the insurance is primary and non-contributory, with waivers of subrogation in place for the certificate holder.
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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
10/21/2025 k.p.d. Insurance LLC 1111 Gateway Loop Springfield OR 97477
541-741-0550 541-741-1674
License#: PC-1210733 The Cincinnati Specialty Underwriters Insurance Co 13037 SILHFAR01A Continental Divide Insurance Company 35939
Silhouette Farm & Forestry, LLC PO Box 4058 Medford OR 97501-0147
Gotham Insurance Company 25569 SAIF Corporation 36196 National Fire & Marine Insurance Company 20079 Great American Insurance Company 16691
333065107
A X 1,000,000 X 100,000
X LOGGERS BFPD EXCLUDED
X WA STOP GAP 1,000,000
2,000,000 X
Y Y CSU 0220067 11/30/2024 11/30/2025
2,000,000
B 1,000,000
X X X
Y Y 05APM04070002 11/30/2024 11/30/2025
A C
X 1,000,000 X
CSU 0220102
EX202400004242
11/30/2024 11/30/2024
11/30/2025 11/30/2025
1,000,000
2ND LAYER 4,000,000
D X
Y
100038000 12/1/2024 12/1/2025 X 1,000,000
1,000,000
1,000,000 E F F
EXCESS AUTOMOBILE LIABILITY
CONTRACTOR PROFESSIONAL LIABILITY
CONTRACTOR POLLUTION LIABILITY
72XAS010780
PCEE90891202
PCEE90891202
11/30/2024 11/30/2024 11/30/2024
11/30/2025 11/30/2025 11/30/2025
$4,000,000 LIMIT
$3,000,000 OCC/AGG
$3,000,000 OCC/AGG
$10,000 RETENTION
$10,000 RETENTION
*Additional Insured wording does not apply to the Workers Comp/Employers Liability Coverage* **Excess/Umbrella Liability extends over the Workers Comp/Employers Liability Coverage**
RE: Contract #CTR074705.
Certificate Holder and all other parties required by the contract are included as Additional Insured including Completed Operations on the General Liability Policy, if required by written contract or agreement, subject to the policy terms and conditions. Certificate Holder and all other parties required by the contract are included as Additional Insured on the Automobile Liability Policy, if required by written contract or agreement, subject to the policy terms and conditions.
This Insurance is Primary & Non-Contributory on the General Liability Policy, if required by written contract or agreement, subject to the policy terms and See Attached...
Arizona Game and Fish Department 5000 W Carefree Hwy Phoenix AZ 85086-5000
THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE
ACORD 101 (2008/01)
The ACORD name and logo are registered marks of ACORD
© 2008 ACORD CORPORATION. All rights reserved.
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: FORM TITLE:
ADDITIONAL REMARKS
ADDITIONAL REMARKS SCHEDULE Page of
AGENCY CUSTOMER ID:
LOC #:
AGENCY
CARRIER NAIC CODE
POLICY NUMBER
NAMED INSURED
EFFECTIVE DATE:
SILHFAR01A
1 1 k.p.d. Insurance LLC Silhouette Farm & Forestry, LLC PO Box 4058 Medford OR 97501-0147
25 CERTIFICATE OF LIABILITY INSURANCE
conditions. A Waiver of Subrogation is provided in favor of Certificate Holder and all other parties required by the contract on the General Liability and Automobile Liability Policies, if required by written contract or agreement, subject to the policy terms and conditions.
Certificate Holder Includes: The State of Arizona and its Departments, Agencies, Boards, Commissions, Universities, Officers, Officials, Agents and Employees.
Includes copyrighted material of Insurance CSGA 4087 12 12 Services Office, Inc., with its permission. Page 1 of 1
COMMERCIAL GENERAL LIABILITY
CSGA 4087 12 12
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US - PER CONTRACT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
The following is added to Paragraph 8. Transfer of Rights of Recovery Against Others to Us of SECTION
IV - CONDITIONS:
If you have agreed, in a written contract or agreement, to provide a waiver of any right of recovery against a person or organization, we will waive any right of recovery we may have against that person or organization because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard".
This waiver applies only to that person or organization for which you have agreed to in a written contract to provide said waiver.
Includes�copyrighted�material of�ISO CSGA 437�12 13 Properties,�Inc.,�with�its�permission. Page 1�of�2
COMMERCIAL�GENERAL�LIABILITY
CSGA 437�12�13
THIS�ENDORSEMENT�CHANGES�THE POLICY.�PLEASE�READ�IT�CAREFULLY.
ADDITIONAL INSURED -�OWNERS, LESSEES OR
CONTRACTORS -�AUTOMATIC STATUS WHEN
REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU -
OPERATIONS�AND COMPLETED OPERATIONS
This�endorsement modifies�insurance�provided�under�the following:
COMMERCIALGENERAL�LIABILITY�COVERAGE�PART
A. SECTION II - WHO IS AN INSURED is amended to include as an additional insured any person or organization when�you�and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an�additional insured on your policy, but only with respect to "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by:
1. Your acts or omissions in the perform-ance of your ongoing operations for the additional insured;
2. The acts or omissions of those acting on your behalf in the performance of your ongoing operations for the additional in-sured;�or
3. "Your work" performed for the additional insured and included in the "products-completed�operations�hazard".
If not specified otherwise in the written con-tract or agreement, a person's or organiza-tion's status as�an�additional�insured�under�this endorsement ends one year after your opera-tions for that additional insured are completed.
The written contract or agreement must be currently in effect or become effective during the�term of this Coverage Part. The contract or agreement�must be�executed prior to�the "bod-ily injury", "property damage" or "personal and advertising injury" to which this endorsement pertains.
However:
1. The insurance afforded to such additional insured only applies to the extent permit-ted�by�law; and
2. If coverage provided to the additional in-sured is required by a contract or agree-ment, the insurance afforded to such ad-ditional insured will not be broader than that which you are required by the con-tract or agreement to provide for such ad-ditional�linsured.
B. With respect to the insurance afforded to these additional insureds, the following addi-tional exclusions�apply:
This�insurance�does�not apply�to:
1. "Bodily injury", "property damage" or "per-sonal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineer-ing�or�surveying services,�including:
a. The preparing, approving, or failing�to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or draw-ings and�specifications;�or
b. Supervisory, inspection, architectural or�engineering�activities.
2. "Bodily injury" or "property damage" aris-ing out of "your work" for which a consoli-dated (wrap-up) insurance program has been provided by the prime contrac-tor/project manager or owner of the con-struction�project in�which�you�are�involved.
3. "Bodily injury", "property damage" or "per-sonal and advertising injury" to any em-ployee of you or to any obligation of the additional insured to indemnity another because of damages arising out of such injury.
Includes�copyrighted�material of�ISO CSGA 437�12 13 Properties,�Inc.,�with�its�permission. Page 2�of�2
4. "Bodily injury", "property damage" or "per-sonal and advertising injury" for which the Named Insured is afforded no coverage under this�policy�of�insurance.
C. With respect to the insurance afforded to these additional insureds, SECTION III - LIM- ITS�OF�INSURANCE�is�amended�to�include:
The limits applicable to the additional insured are those specified in the written contract or agreement or in the Declarations of this Cov-erage Part, whichever is less. If no limits are specified in the written contract or agreement, the limits applicable to the additional insured are those specified in the Declarations of this Coverage Part. The limits of insurance are in-clusive of and not in addition to the limits of in-surance�shown�in�the�Declarations.
D. With respect to the insurance afforded to these additional insureds, SECTION IV -
COMMERCIAL GENERAL LIABILITY CON-
DITIONS, 4. Other Insurance is amended to include:
Any coverage provided herein will be excess over any other valid and collectible insurance available to the additional insured whether primary, excess, contingent or on any other basis unless you have agreed in a written con-tract or written agreement executed prior to any loss that this insurance will be primary.
This insurance will be noncontributory only if you have so agreed in a written contract or written agreement executed prior to any loss and this coverage is determined to be primary.
M-3745a (06/2009)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED ENDORSEMENT
In consideration of payment of the additional premium listed below, LIABILITY COVERAGE is extended to include the additional insured named herein, provided that:
1) such insurance applies only to the ownership, maintenance or use of a covered auto; and
2) such insurance applies only to acts or omissions by you, your agents or your “employees” while such covered auto is being used in your business; and
3) such insurance does not apply to the acts or omissions of the additional insured or any of the additional insured’s agents or "employees" other than you; and
4) such inclusion of additional insured shall not increase our limit of liability under this policy.
ADDITIONAL INSURED:
ARIZONA GAME AND FISH DEPARTMENT
ATTN: PURCHASING
5000 W CAREFREE HIGHWAY
PHOENIX, AZ 85086-5000
M-3745a (06/2009)
All other terms, conditions and agreements remain unchanged.
Additional Premium: $
Company Name Policy Number
Named Insured
Endorsement Effective
Countersigned by
(Authorized Representative)
(The Attaching Clause need be completed only when this endorsement is issued subsequent to preparation of the policy .)
Continental Divide Insurance Company
05 APM 040700
SILHOUETTE FARM AND FORESTRY LLC
Kathleen.Burt Typewriter
Kathleen.Burt_1 Typewriter 11/30/2024
SILHOUETTE FARM AND FORESTRY LLC
ARIZONA GAME AND FISH DEPARTMENT
ATTN: PURCHASING
SCHEDULE
(Authorized Representative)
Countersigned By:
Named Insured:
Endorsement Effective:
Name Of Person(s) Or Organization(s):
M-5144a (06/2007)
WAIVER OF TRANSFER OF RIGHTS OF
RECOVERY AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM
GARAGE COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi-fied by the endorsement.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.
POLICY NUMBER 05 APM 040700
5000 W CAREFREE HIGHWAY
PHOENIX, AZ 85086-5000
$Additional Premium
Includes copyrighted material of Insurance Services Office , Inc. with its permission.
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.)
The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply to the person (s) or organiza-tion(s) shown in the Schedule. We will retain the additional premium shown above, regardless of any early termi-nation of this endorsement or the policy.
M-5144a (06/2007)
Kathleen.Burt_2 Typewriter 11/30/2024
Kathleen.Burt_3 Typewriter
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