2221-12-15_COI_GL_WC_Cyber.pdf

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

INSURER(S) AFFORDING COVERAGE

INSURER F :

INSURER E :

INSURER D :

INSURER C :

INSURER B :

INSURER A :

NAIC #

NAME:

CONTACT

(A/C, No):

FAX

E-MAIL

ADDRESS:

PRODUCER

(A/C, No, Ext):

PHONE

INSURED

REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES

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.

OTHER:

(Per accident)

(Ea accident)

N / A

SUBR

WVD

ADDL

INSD

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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

$PROPERTY DAMAGE

BODILY INJURY (Per accident)

BODILY INJURY (Per person)

COMBINED SINGLE LIMIT

AUTOS ONLY

AUTOSAUTOS ONLY

NON-OWNED

SCHEDULEDOWNED

ANY AUTO

AUTOMOBILE LIABILITY

Y / N

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH)

DESCRIPTION OF OPERATIONS below If yes, describe under

ANY PROPRIETOR/PARTNER/EXECUTIVE

E.L. DISEASE - POLICY LIMIT

E.L. DISEASE - EA EMPLOYEE

E.L. EACH ACCIDENT

ER

OTH-

STATUTE

PER

LIMITS(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY)

POLICY EFF

POLICY NUMBERTYPE OF INSURANCELTR

INSR

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

EXCESS LIAB

UMBRELLA LIAB $EACH OCCURRENCE

$AGGREGATE

OCCUR

CLAIMS-MADE

DED RETENTION $

$PRODUCTS - COMP/OP AGG

$GENERAL AGGREGATE

$PERSONAL & ADV INJURY

$MED EXP (Any one person)

$EACH OCCURRENCE

DAMAGE TO RENTED

$PREMISES (Ea occurrence)

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY

PRO-

JECT LOC

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

CANCELLATION

AUTHORIZED REPRESENTATIVE

ACORD 25 (2016/03)

© 1988-2016 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

1,000,000

05/01/2022

HH-GLSA-8741P758

Manashi Mukherjee

ATL-005262959-06

1,000,000

UB-7R024282-21-51-R (AZ,MA,WI)

X

N/A of Marsh USA Inc.

ATLANTA, GA 30326

N

X05/01/2021

The Travelers Indemnity Company

12/15/2020Cyber

C

2,000,000

1,000,000

25666 N/A

1,000,000

D

X agents, and employees under the general liability, workers’ compensation, and network security (cyber)/privacy liability insurance.

06/09/2021

05/01/2021

2,000,000

Re: Arizona Department of Economic Security Contract Number CTR055585. Income and employment verification services.

The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees is/are included as additional insured where required by written contract with

X

05/01/2021

1789 W. Jefferson, Mail Drop 3101

Phoenix, AZ 85007

State of Arizona

Syndicate 2623-623 at Lloyds respect to general liability. Waiver of subrogation is applicable where required by written contract in favor of the State of Arizona, its departments, agencies, boards, commissions, universities, officers, officials, C

Travelers Indemnity Co Of America

CN101920890-TALX.-GAWUP-20-

LIMIT:

10,000

05/01/2022 E

2,000,000

N/A

1,000,000

1,000,000

12/15/2021

UB-7R071781-21-51-K (AOS)

TWO ALLIANCE CENTER

*MARSH USA, INC.

3560 LENOX ROAD, SUITE 2400

Attn: Atlanta.CertRequest@marsh.com / Fax: 212-948-4321

11432 LACKLAND ROAD

TALX CORPORATION

ST LOUIS, MO 63146

W20485200901

Attn: Department of Economic Security, Kathi Barone, Contracts Manager

05/01/2022

25658

N/A

ACORD 101 (2008/01)

The ACORD name and logo are registered marks of ACORD

© 2008 ACORD CORPORATION. All rights reserved.

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: FORM TITLE:

ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE Page of

AGENCY CUSTOMER ID:

LOC #:

AGENCY

CARRIER NAIC CODE

POLICY NUMBER

NAMED INSURED

EFFECTIVE DATE:

where required by written contract with respect to vicarious liability of the insured arising out of the activities performed by or on behalf of the Contractor.�

Atlanta

The general liability, workers’ compensation, and network security (cyber)/privacy liability policies are primary and non-contributory over any existing insurance and limited to liability arising out of the operations of security (cyber)/privacy liability coverage, the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are included as additional insureds the named insured subject to policy terms and conditions to any insurance carried by the Department, its agents, officials, employees or the State of Arizona as provided by A.R.S. § 41-621 (E). For the network

Certificate of Liability Insurance

CN101920890

*MARSH USA, INC.�

11432 LACKLAND ROAD�

TALX CORPORATION�

ST LOUIS, MO 63146