2024-11-01_COI.pdf

H o ld e r Id e n ti fi e r

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70007 07007

C e rt if ic a te N o

CERTIFICATE OF LIABILITY INSURANCE

DATE(MM/DD/YYYY)

06/12/2024

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.

PRODUCER

Aon Risk Services Northeast, Inc.

New York NY Office One Liberty Plaza 165 Broadway, Suite 3201 New York NY 10006 USA

PHONE

(A/C. No. Ext):

E-MAIL

ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC #

(866) 283-7122

INSURED 10172Westchester Surplus Lines Ins CoINSURER A:

22667ACE American Insurance CompanyINSURER B:

20702ACE Fire Underwriters Insurance Co.INSURER C:

43575Indemnity Insurance Co of North AmericaINSURER D:

INSURER E:

INSURER F:

FAX

(A/C. No.): (800) 363-0105

CONTACT

NAME:

Laboratory Corporation of America Holdings & Subsidiaries 531 S Spring Street 2nd Floor Burlington NC 27215 USA

COVERAGES CERTIFICATE NUMBER: 570106323227 REVISION NUMBER:

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, Limits shown are as requested

POLICY EXP

(MM/DD/YYYY)

POLICY EFF

(MM/DD/YYYY)

SUBR

WVD

INSR

LTR

ADDL

INSD POLICY NUMBER TYPE OF INSURANCE LIMITS

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

POLICY LOC

EACH OCCURRENCE

DAMAGE TO RENTED

PREMISES (Ea occurrence)

MED EXP (Any one person)

PERSONAL & ADV INJURY

GENERAL AGGREGATE

PRODUCTS - COMP/OP AGG

X

X

X

GEN'L AGGREGATE LIMIT APPLIES PER:

$1,000,000

$1,000,000

$1,000,000

$2,000,000

$1,000,000

B 11/01/2023 11/01/2024Y Y HDOG48900355

PRO-

JECT

OTHER:

AUTOMOBILE LIABILITY

ANY AUTO

OWNED

AUTOS ONLY

SCHEDULED

AUTOS

HIRED AUTOS

ONLY

NON-OWNED

AUTOS ONLY

BODILY INJURY ( Per person)

PROPERTY DAMAGE

(Per accident)

X

BODILY INJURY (Per accident)

$2,000,000B 11/01/2023 11/01/2024Y Y COMBINED SINGLE LIMIT

(Ea accident)

ISA H10819854

EXCESS LIAB

X OCCUR

CLAIMS-MADE AGGREGATE

EACH OCCURRENCE

DED

$3,000,000

$3,000,000

06/30/2023UMBRELLA LIABA 11/01/2024G27524485010

RETENTION

X

E.L. DISEASE-EA EMPLOYEE

E.L. DISEASE-POLICY LIMIT

E.L. EACH ACCIDENT $1,000,000

X OTH-

ER

PER STATUTED 11/01/2023 11/01/2024

WLRC55522881 AZB 11/01/2023 11/01/2024

SCFC55522923 WIC 11/01/2023 11/01/2024

$1,000,000

Y / N

(Mandatory in NH)

ANY PROPRIETOR / PARTNER /

EXECUTIVE OFFICER/MEMBER N / A

Y

N

WORKERS COMPENSATION AND

EMPLOYERS' LIABILITY

If yes, describe under DESCRIPTION OF OPERATIONS below

$1,000,000

WLRC55522972 AOS

Each IncidentHDCG48900409 11/01/2023 11/01/2024 Claims Made $3,000,000Aggregate

E&O - Professional Liability - Primary

B $1,000,000

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

Policy No. G27524485009 includes Professional Liability coverage on a claims Made basis. Professional Liability SIR applies as follows: $5,000,000 for Genetics and $3,000,000 for all other. The General Liability policy evidenced herein had been endorsed to include Limited Abuse and Molestation Coverage as regards all Arizona locations with a limit of $1M Each occurrence and $2M Aggregate. RE: Contract No. CTR055522. State of Arizona, Arizona Department of Economic security and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are included as Additional Insured in accordance with the policy provisions of the General Liability and Automobile Liability policies. General Liability policy evidenced herein are Primary and Non-Contributory to other insurance available to Additional Insured, but only in accordance

CANCELLATIONCERTIFICATE HOLDER

AUTHORIZED REPRESENTATIVEArizona Dept. of Economic Security c/o myCOI 1075 Broad Ripple Ave., Suite 313 Indianapolis IN 46220 USA

ACORD 25 (2016/03)

©1988-2015 ACORD CORPORATION. All rights reserved

The ACORD name and logo are registered marks of ACO

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION

DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

with the policy's provisions. Automobile Liability policy evidenced herein is Primary to other insurance available to Additional Insured, but only in accordance with the policy's provisions. A Waiver of subrogation is granted in favor of State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees in accordance with the policy provisions of the General Liability, Automobile Liability and Workers' compensation policies. Umbrella Liability includes professional liability coverage.

FORM TITLE:FORM NUMBER:

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

ADDITIONAL REMARKS

EFFECTIVE DATE:

CARRIER NAIC CODE

POLICY NUMBER

Aon Risk Services Northeast, Inc.

NAMED INSUREDAGENCY

LOC #:

570000008881 AGENCY CUSTOMER ID:

© 2008 ACORD CORPORATION. All rights reserved.

See Certificate Number:

See Certificate Number:

The ACORD name and logo are registered marks of ACORD

570106323227

570106323227

ACORD 25 Certificate of Liability Insurance Additional Description of Operations / Locations / Vehicles:

ACORD 101 (2008/01)

ADDITIONAL REMARKS SCHEDULE Page _ of _

Laboratory Corporation of America