2024 COI GL WC Self Insured.pdf
PDF 163 KB Posted
- Attached to
- Master Agreement AZ|CTR056041
- Contract number
- CTR056041
- Issued by
- Arizona
About this file
This document is a Certificate of Insurance issued by Mayo Clinic Arizona on September 5, 2023, addressed to the Arizona Department of Health Services' Office of Procurement. The certificate pertains to a solicitation with RFGA Number BPM000334 and provides details about Mayo Clinic Arizona's insurance coverage. The document involves Mayo Clinic Arizona, Mayo Insurance Company Limited, the State of Arizona, and the Arizona Industrial Commission.
The certificate confirms Mayo Clinic Arizona's general liability coverage through Mayo Insurance Company Limited, with a policy limit of $5,000,000 per occurrence. The coverage includes a waiver of subrogation and lists the State of Arizona and its departments as additional insureds. Additionally, Mayo Clinic Arizona has workers' compensation and employer's liability coverage through a self-insured authority certified by the Industrial Commission of Arizona, which also includes a waiver of subrogation for the State of Arizona and its associated entities.
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Text version
September 5, 2023
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
CERTIFICATE OF INSURANCE
File details come from the government source that posted it. Updated .