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231055 characters
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
INSR
ADDL SUBR
LTR
INSD WVD
PRODUCER
CONTACT
NAME:
FAX
PHONE
(A/C, No):
(A/C, No, Ext):
E-MAIL
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.
ACORD 25 (2016/03)
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
$
$
$
$
$
The ACORD name and logo are registered marks of ACORD
7/10/2024
(703) 827-2277
(703) 827-2279
25615
Ardurra Group, Inc.
4921 Memorial Highway
Suite 300
Tampa, FL 33634
25623
25674
20079
A
1,000,000
630-5X487435
1/1/2024
1/1/2025
1,000,000
Contractual Liab.
15,000
1,000,000
2,000,000
2,000,000
1,000,000
B
810-5X558309
1/1/2024
1/1/2025
15,000,000
C
CUP-5X642114
1/1/2024
1/1/2025
15,000,000
10,000
C
UB-5X489557
1/1/2024
1/1/2025
1,000,000
N
1,000,000
1,000,000
D Professional Liab.
42-EPP-306878-06
1/1/2024
Per Claim/Aggregate
2,000,000
RE: GAZELLE MEADOWS PARK RENOVATIONS Project No. PR2107.451
The City of Chandler, AZ is included as additional insured with respect to General Liability, Automobile Liability, and Umbrella Liability when required by
written contract. General Liability includes Additional Insured coverage for Completed Operations as required by written contract. Separation of Insureds is
included in the General Liability policy. General Liability, Automobile Liability, and Umbrella Liability are primary and non-contributory over any existing
insurance and limited to liability arising out of the operations of the named insured and when required by written contract. General Liability, Automobile
Liability, Workers Compensation, and Umbrella Liability policies include a waiver of subrogation in favor of the additional insureds where permissible by state
SEE ATTACHED ACORD 101
City of Chandler, AZ
PO Box 4008
Mail Stop 407
Chandler, AZ 85244-4008
ARDURRA-01
EMORRIS
Ames & Gough
8300 Greensboro Drive
Suite 980
McLean, VA 22102
admin@amesgough.com
Charter Oak Fire Insurance Company A++ (XV)
Phoenix Insurance Company A++, XV
Travelers Property Casualty Company of America, A++, XV
National Fire & Marine Insurance Company
X
1/1/2025
X
X
X
X
X
X
X
X
X
FORM NUMBER:
EFFECTIVE DATE:
The ACORD name and logo are registered marks of ACORD
ADDITIONAL REMARKS
ADDITIONAL REMARKS SCHEDULE
FORM TITLE:
Page of
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
ACORD 101 (2008/01)
AGENCY CUSTOMER ID:
LOC #:
AGENCY
NAMED INSURED
POLICY NUMBER
CARRIER
NAIC CODE
© 2008 ACORD CORPORATION. All rights reserved.
Ames & Gough
ARDURRA-01
SEE PAGE 1
1
SEE PAGE 1
ACORD 25
Certificate of Liability Insurance
2
SEE P 1
Ardurra Group, Inc.
4921 Memorial Highway
Suite 300
Tampa, FL 33634
SEE PAGE 1
EMORRIS
1
Description of Operations/Locations/Vehicles:
law and when required by written contract. Umbrella Liability coverage sits excess over General Liability, Automobile Liability and
Employers’ Liability coverage. 30-day Notice of Cancellation will be issued for the General Liability, Automobile Liability, Umbrella
Liability, Workers Compensation and Professional Liability policies in accordance with policy terms and conditions.
Any Person Or Organization For Which The Insured Has Agreed by Written Contract
Executed Prior to Loss To Furnish This Waiver
UB-5X489557
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Policy # P-630-5X487435
Policy Number: 810-5X558309
COMMERCIAL AUTO
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED – PRIMARY AND
NON-CONTRIBUTORY WITH OTHER INSURANCE
© 2016 The Travelers Indemnity Company. All rights reserved.
Includes copyrighted material of Insurance Services Office, Inc. with its permission.
Page 1 of 1
CA T4 74 02 16
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
PROVISIONS
1.
The following is added to Paragraph A.1.c., Who
Is An Insured, of SECTION ll – COVERED
AUTOS LIABILITY COVERAGE:
This includes any person or organization who you
are
required
under
a
written contract
or
agreement between you and that person or
organization, that is signed by you before the
"bodily injury" or "property damage" occurs and
that is in effect during the policy period, to name
as an additional insured for Covered Autos
Liability Coverage, but only for damages to which
this insurance applies and only to the extent of
that person's or organization's liability for the
conduct of another "insured".
2.
The following is added to Paragraph B.5., Other
Insurance of SECTION IV – BUSINESS AUTO
CONDITIONS:
Regardless of the provisions of paragraph a. and
paragraph d. of this part 5. Other Insurance, this
insurance is primary to and non-contributory with
applicable other insurance under which an
additional insured person or organization is the
first named insured when the written contract or
agreement between you and that person or
organization, that is signed by you before the
"bodily injury" or "property damage" occurs and
that is in effect during the policy period, requires
this insurance to be primary and non-contributory.
Policy Number: 810-5X558309
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