2022.01.01 COI GL WC Self Insured.pdf
PDF 276 KB Posted
- Attached to
- Master Agreement AZ|CTR056041
- Contract number
- CTR056041
- Issued by
- Arizona
About this file
The document is a Certificate of Insurance (COI) issued by Mayo Clinic Arizona on July 6, 2021, for the Arizona Department of Health Services' Office of Procurement. The certificate covers Mayo Clinic Arizona's General Liability and Worker's Compensation insurance for a contract with the reference number RFGA Number: BPM000334. The insurance is provided through Mayo Insurance Company Limited for General Liability and a self-insured authority certified by the Industrial Commission of Arizona for Worker's Compensation.
The COI details general liability coverage with limits of $5,000,000 per occurrence, with the State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees listed as additional insureds. Both the General Liability and Worker's Compensation policies include a waiver of subrogation in favor of the State of Arizona. The insurance policy runs from January 1st to January 1st each year and is renewed annually with the same policy number under a self-insured program, which explains the lack of a specific expiration date on the certificate.
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Text version
July 6, 2021
CERTIFICATE OF INSURANCE
Certificate Holder Arizona Department of Health Services Office of Procurement 150 North 18th Avenue, Suite 260 Phoenix, AZ 85007
RE: Mayo Clinic Arizona (RFGA Number: BPM000334)
General Liability Coverage Worker’ Compensation Coverage
To Whom It May Concern:
Mayo Clinic Arizona is covered for its General Liability exposure through a policy issued by Mayo Insurance Company Limited, under policy No. 272-1-05011. Coverage is on an occurrence basis with limits $5,000,000 per occurrence. The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are listed as additional insureds with respect to liability arising out of the activities performed by or on behalf of Mayo Clinic Arizona.
The policy contains a waiver of subrogation in favor of the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees for losses arising from work performed by or on behalf of Mayo Clinic Arizona.
Mayo Clinic Arizona is provided with workers’ compensation and employer’s liability coverage through a self-insured authority certified by the Industrial Commission of Arizona. The policy includes a waiver of subrogation against the State of Arizona, its department, agencies, boards, commissions, universities and its officers, officials, agents, and employees for losses arising from work performed by or on behalf of Mayo Clinic Arizona.
Sincerely, Dawn M. Schieffer Director, Risk Management
7/13/2021 State of Arizona Mail - RE: [EXTERNAL] Re: BPM000338 - New Investigator Award https://mail.google.com/mail/u/0?ik=e7bc09bd8e&view=pt&search=all&permthid=thread-a%3Ar-8914419334585727067%7Cmsg-f%3A170483737790… 1/4
Delilah Gonzalez <delilah.gonzalez@azdhs.gov>
RE: [EXTERNAL] Re: BPM000338 - New Investigator Award
1 message
Schieffer, Dawn M. <Schieffer.dawn@mayo.edu> Fri, Jul 9, 2021 at 12:40 PM To: "Meek, Eric A." <Meek.Eric@mayo.edu>, Delilah Gonzalez <delilah.gonzalez@azdhs.gov> Cc: "De Filippis, Elena Anna O. (Eleanna), M.D., Ph.D." <DeFilippis.Elena@mayo.edu>
The letter COI provides the certificate holder and worker’s compensation information. The reason for no expiration is because they are both a self-insured program. The general liability policy runs from January 1st to January 1st and is renewed each year with the same policy number since it is a self-insured program.
I hope that helps.
Thanks.
Dawn Schieffer Director – Risk Management/Treasury Services | Centerplace 8-20H
Phone: (507)266-5325
Asst.: (507)266-7031 Email:
Schieffer.dawn@mayo.edu
Mayo Clinic| 200 First Street S.W.
Rochester, MN 55905
From: Meek, Eric A. <Meek.Eric@mayo.edu>
Sent: Friday, July 09, 2021 2:36 PM
To: 'Delilah Gonzalez' <delilah.gonzalez@azdhs.gov>; Schieffer, Dawn M. <Schieffer.Dawn@mayo.edu>
Cc: De Filippis, Elena Anna O. (Eleanna), M.D., Ph.D. <DeFilippis.Elena@mayo.edu>
Subject: FW: [EXTERNAL] Re: BPM000338 - New Investigator Award
Hi Delilah, Thank you for the feedback. I received the Mayo COI from the same individual that provided/signed the other document you provided. I have included her to help provide what you need.
Hi Dawn, I am not sure I totally understand what is needed, but are you able to update the document(s) and/or provide Delilah with the information or document she needs?
Let me know if there is anything additional needed from me at this time. Thank you.
Eric mailto:Schieffer.dawn@mayo.edu https://www.google.com/maps/search/200+First+Street+S.W.+%0D%0A+%7C+%0D%0A+Rochester,+MN+55905?entry=gmail&source=g https://www.google.com/maps/search/200+First+Street+S.W.+%0D%0A+%7C+%0D%0A+Rochester,+MN+55905?entry=gmail&source=g https://www.google.com/maps/search/200+First+Street+S.W.+%0D%0A+%7C+%0D%0A+Rochester,+MN+55905?entry=gmail&source=g mailto:Meek.Eric@mayo.edu mailto:delilah.gonzalez@azdhs.gov mailto:Schieffer.Dawn@mayo.edu mailto:DeFilippis.Elena@mayo.edu
GONZDEL
Highlight
| 2022.01.01 COI GL WC Self Insured |
| CERTIFICATE OF INSURANCE |
State of Arizona Mail - RE_ [EXTERNAL] Re_ BPM000338 - New Investigator Award
File details come from the government source that posted it. Updated .