2025-05-01 COI GL,AL,WC.pdf
PDF 1 MB Posted
- Attached to
- Master Agreement AZ|CTR061868
- Contract number
- CTR061868
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by Marsh USA LLC for Mayer Brown LLP, with insurance provided by Great Northern Insurance Company and Chubb National Insurance Company. The certificate covers liability for the State of Arizona/ADOT (Arizona Department of Transportation) across multiple states including California, District of Columbia, Illinois, North Carolina, New York, Texas, and Utah, with policy periods from May 1, 2024 to May 1, 2025.
The insurance provides comprehensive coverage including commercial general liability, automobile liability, and workers' compensation with various policy limits. The commercial general liability coverage includes $1,000,000 per occurrence, $2,000,000 general aggregate, and $10,000 medical expenses. Automobile liability is set at $1,000,000 for combined single limit, with hired auto coverage included. The policy is primary and non-contributory, applies to work performed for the State of Arizona/ADOT, and includes additional insured provisions where required by written contract. The certificate holder is the State of Arizona/ADOT, located at 206 S. 17th Ave, Phoenix, AZ 85007, with the insurance designed to cover liability arising from the organization's operations.
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Text version
X
2,000,000
(CA, DC, IL, NC, NY, TX, UT)
20303
A
05/01/2025 X
Chubb National Insurance Company
X
1,000,000
N/A
Marsh | U.S. Operations
CHI-010126026-21
05/01/2024
2,000,000
06/28/2024
212-948-0770
1,000,000
1,000,000
1,000,000
A
Chicago.CertRequest@marsh.com
05/01/2025
05/01/2024
10052
7353-26-10
10,000
7172-02-31
X
1,000,000 and subject to policy terms and conditions. This insurance is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured subject to policy terms and conditions.
RE: the insurance applies to any and all work performed for or on behalf of the State of Arizona/ADOT.
The Certificate Holder is/are included as additional insured where required by written contract with respect to general liability and auto liability. Waiver of subrogation is applicable where required by written contract
Attn: Jon Brooks Mayer Brown LLP
Chicago, IL 60604 71 S. Wacker Dr.
1,000,000
Great Northern Insurance Company
155 N. WACKER, SUITE 1200
MARSH USA LLC.
CHICAGO, IL 60661
3575-67-07
N/A
N
Phoenix, AZ 85007
The State of Arizona/ADOT 206 S. 17th Ave, 05/01/2024
HIRED $1,000 COMP/COLL DED
C
1,000,000
866-966-4664
X
X
05/01/2025
Cindy Lewis Accepted
CHUBB• Liability Insurance
Endorsement
Policy Period
Effective Date
Polley Number
Insured
Name of Company
Date Issued
MAY 1, 2024 TO MAY I, 2025
MAY I, 2024
3575-67--07 CHI
MA YER BROWN LLP
GREAT NORTHERN INSURANCE COMPANY
MAY 16,2024
This Endorsement applle.s to the following forms:
GENERAL LIABILITY
Who Is An Insured
Additional Insured Scheduled Person Or Organization
Llability tnsurancs
Form 80-02-2367 (Rev. 5-07)
Under Who Is An Insured, the following provision is added.
Persons or organizations shown in the Schedule are insureds; but they are insureds only if you are obligated pursuant to a contract or agrecroont to provide them with sucb insurance as is afforded by this policy.
However. the person or organization is an lnmNd only:
if and then only to the extent the person or organization is descnoed in the Schedule:
to the e�tent such CQntract or agreement requires the person or o{gan.i1.ation to be afforded status as an Insured;
for activities that did not occurt in whole or in part, before the execution of the contra.et or agreement; and with respect. to damages, loss, cost or expense for injury or damage to which this insurance applies.
No person or organization is an in.sured under this provision:
that is more specifically identified under any other provisioo of the Who Is An Insured section (regardless of any limitation applicable thereto).
with respect to any assumption of liability (of another perron or organi,.ation) by them in a contract or agreement. This limitation doe.< not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contract or agreement
Endorsement Po9" 1
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313
(Ed. 4-64)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agre.ement applies only to the extent that you perform work under a written contract that requires you to obtai•n this agreement from us.)
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule
My person or organization against whom you have agreed to waive your right of recovery in a written contract, provided such contract was executed prior to the date of loss.
For policies or exposure in Missouri:
My person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a \Naiver of subrogation. However, for purposes of work performed by the employer in Missouri, this v;aiver of subrogation does not apply to any construction group of class�ications as designated by the waiver of right to recover from others (subrogation) rule in our manual.
This endorsement changes the policy 10 ¼hich tis attached and is effecti,e on the date issued unless othervvise slated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective o 5 -o 1 -2 4 lnsoxecl MAYER BROWN LLP
Policy No. 71 720231 Endorsement No.
Premium$ Incl.
lnso.,-ance Company Chubb National Insurance Company
WC 000313
(Ed. 4-<14) o 1983 National council oncompenution tnsu.-ance.
Counterstgnecl By _____________ _
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