2025-11-01_COI.pdf

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Attached to
Master Agreement AZ|CTR055522
Contract number
CTR055522
Issued by
Arizona

About this file

This document is a Certificate of Liability Insurance for Laboratory Corporation of America Holdings (Labcorp), issued by Aon Risk Services Northeast, Inc. The insurance policies are underwritten by multiple insurers including Indemnity Insurance Co of North America, ACE American Insurance Company, ACE Fire Underwriters Insurance Co., and Westchester Surplus Lines Insurance Co. The certificates specifically relate to insurance coverage for Labcorp's contract with the State of Arizona, specifically the Arizona Department of Economic Security (ADES), with a contract ID of CTR055522.

The insurance coverage includes Commercial General Liability, Automobile Liability, Umbrella Liability, Workers' Compensation, Employers' Liability, and Professional Liability (E&O) policies. The policy period runs from 11/01/2024 to 11/01/2025, with various coverage limits, including $1,000,000 for general liability, $2,000,000 for automobile liability, $3,000,000 for umbrella liability, and $1,000,000 for workers' compensation. The policies include additional insured provisions for the State of Arizona, its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees. The professional liability coverage has a claims-made basis with specific self-insured retention limits of $5,000,000 for Genetics and $3,000,000 for other services.

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

77777

77707 07070

00777 61616

04557 11107

67535 23602

64450 07763

11474 06241

33071 66374

60562 33110

74060 45772

76556 20753

67335 33032

26107 63341

02620 77302

07144 11757

63345 70076

25031 44015

77120 76727

24203 57720

00777 77770

70007 07007

77777

77707 07070

00735 25677

11545 60007

41713 26334

42211 07224

51660 16221

13073 20405

52472 31330

75362 23753

16741 10713

32363 53127

00007 02672

33064 37111

07427 23324

75375 44074

62237 60616

71100 77756

16335 17655

40777 77770

70007 07007

C e rt if ic a te N o

CERTIFICATE OF LIABILITY INSURANCE

DATE(MM/DD/YYYY)

12/11/2024

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 43575Indemnity Insurance Co of North AmericaINSURER A:

22667ACE American Insurance CompanyINSURER B:

20702ACE Fire Underwriters Insurance Co.INSURER C:

10172Westchester Surplus Lines Ins CoINSURER 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: 570109716658 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 11/01/2024 11/01/2025Y Y HDOG48956762

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 11/01/2024 11/01/2025Y Y COMBINED SINGLE LIMIT

(Ea accident)

ISA H10823055

EXCESS LIAB

X OCCUR

CLAIMS-MADE AGGREGATE

EACH OCCURRENCE

DED

$3,000,000

$3,000,000

11/01/2024UMBRELLA LIABD 11/01/2025G27524485011

RETENTION

X

E.L. DISEASE-EA EMPLOYEE

E.L. DISEASE-POLICY LIMIT

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

X OTH-

ER

PER STATUTEA 11/01/2024 11/01/2025

WLRC72630026 AZB 11/01/2024 11/01/2025

SCFC72630063 WIC 11/01/2024 11/01/2025

$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

WLRC72630105 AOS

Each IncidentHDCG48956816 11/01/2024 11/01/2025 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. G27524485010 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: Division Name: ADES. - Contract ID: 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, CANCELLATIONCERTIFICATE HOLDER

AUTHORIZED REPRESENTATIVEArizona Department 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 ACORD

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

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

but only in accordance 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

570109716658

570109716658

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

PUBLIC ENTITY ADDITIONAL INSURED ENDORSEMENT

ALL-22422 (05/07) Page 1 of 1

Named Insured Labcorp Holdings Inc. Endorsement Number

Policy Symbol

HDO

Policy Number

G48956762 Policy Period

11/01/2024 TO 11/01/2025

Effective Date of Endorsement

Issued By (Name of Insurance Company)

ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE FORM

EXCESS COMMERCIAL GENERAL LIABILITY POLICY

BUSINESS AUTO COVERAGE FORM

SCHEDULE

(name and address of additional insured)

The State of Arizona, its departments, agencies, boards, commissions, universities, and its officers, officials, agents and employees.

ADDITIONAL INSURED

It is agreed that the entity shown in the Schedule, its Officers, Employees, and Agents are named as Additional Insureds with respect to the operations and activities of the Named Insured.

PRIMARY INSURANCE

Insurance provided by this policy shall be primary insurance and no other insurance or self insured retention carried or held by the Scheduled Entity shall be called upon to contribute to a loss covered by insurance for the named insured.

CANCELLATION CLAUSE

Thirty (30) days written notice shall be given to the Scheduled Entity in the event of cancellation and/or reduction in limits or coverage.

SEVERABILITY OF INTEREST

This insurance shall apply separately to each insured against whom claim is made or suit is brought except with respect to the limits of liability of the insuring company.

Except as stated above and not in conflict with this endorsement, nothing contained herein shall be held to waive, alter or extend any of the limits, agreements, or exclusions of the policy(ies) to which this endorsement applies.

All other terms and conditions of this policy remain the same.

Authorized Agent

DA-13115a (06/14) Page 1 of 1

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS

Named Insured Labcorp Holdings Inc. Endorsement Number

Policy Symbol

ISA

Policy Number

H10823055 Policy Period

11/01/2024 TO 11/01/2025

Effective Date of Endorsement

Issued By (Name of Insurance Company)

ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

This Endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

MOTOR CARRIERS COVERAGE FORM

AUTO DEALERS COVERAGE FORM

We waive any right of recovery we may have against the person or organization shown in the Schedule below because of payments we make for injury or damage arising out of the use of a covered auto. The waiver applies only to the person or organization shown in the SCHEDULE.

SCHEDULE

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 the Contractor

Authorized Representative

CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1

POLICY NUMBER: HDO G48956762 Endorsement Number: 128

COMMERCIAL GENERAL LIABILITY

CG 24 04 12 19

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US (WAIVER OF SUBROGATION)

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

ELECTRONIC DATA LIABILITY COVERAGE PART

LIQUOR LIABILITY COVERAGE PART

POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES

POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

RAILROAD PROTECTIVE LIABILITY COVERAGE PART

UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS

SCHEDULE

Name Of Person(s) Or Organization(s):The State of Arizona, and departments, agencies, boards, commissions, universities, officers, agents, and employees for losses arising from work performed by or on behalf of the Contractor

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV � Conditions:

We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above.

Workers' Compensation and Employers' Liability Policy

WC 00 03 13 (11/05) © Copyright 1983�2017 National Council on Compensation Insurance, Inc. All Rights Reserved.

Named Insured

LABCORP HOLDINGS INC.

531 S SPRING ST 2ND FLOOR

BURLINGTON NC 27215

Endorsement Number

Policy Number

Symbol: WLR Number: C72630026 Policy Period

11-01-2024 TO 11-01-2025

Effective Date of Endorsement 11-01-2024

Issued By (Name of Insurance Company)

ACE AMERICAN INSURANCE COMPANY

Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.

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 agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.

This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule.

Schedule

THE STATE OF ARIZONA, ITS DEPARTMENTS, AGENCIES, BOARDS, COMMISSIONS,

UNIVERSITIES, AND ITS OFFICERS, OFFICIALS, AGENTS AND EMPLOYEES.

For the states of CA, UT, TX, refer to state specific endorsements.

This endorsement is not applicable in KY, NH, and NJ.

The endorsement does not apply to policies in Missouri where the employer is in the construction group of code classifications. According to Section 287.150(6) of the Missouri statutes, a contractual provision purporting to waive subrogation rights against public policy and void where one party to the contract is an employer in the construction group of code classifications.

For Kansas, use of this endorsement is limited by the Kansas Fairness in Private Construction Contract Act(K.S.A..

16-1801 through 16-1807 and any amendments thereto) and the Kansas Fairness in Public Construction Contract Act(K.S.A 16-1901 through 16-1908 and any amendments thereto). According to the Acts a provision in a contract for private or public construction purporting to waive subrogation rights for losses or claims covered or paid by liability or workers compensation insurance shall be against public policy and shall be void and unenforceable except that, subject to the Acts, a contract may require waiver of subrogation for losses or claims paid by a consolidated or wrap-up insurance program.

Authorized Agent

CertDocumentContent (74).pdf
endoreee

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