2025-11-01_COI.pdf
PDF 476 KB Posted
- 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):
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
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