5-Attachment 6 - Supplement Insurance_1 of 2.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

09/20/2022

Marsh USA, Inc.

1166 Avenue of the Americas New York, NY 10036 Attn: Norwalk.certrequest@marsh.com Fax: 212-948-0929

CN102809999-IM-GAWU-21-22

ACE American Insurance Company Indemnity Insurance Company of North America N/A ACE Fire Underwriters Ins. Co. 20702

N/A 43575 22667

IRON MOUNTAIN INCORPORATED

ONE FEDERAL STREET

BOSTON, MA 02110

NYC-011482956-00 0

X X

X

HDO G7248048A 11/01/2021 11/01/2022

1,000,000 25,000

1,000,000 1,000,000

A

X

ISA H2554268A 11/01/2021 11/01/2022 1,000,000

D A B

N SCF C68917141 (WI)

WLR C68917104 (AZ,CA,MA)

WLR C68917062 (AOS)

11/01/2021 11/01/2021 11/01/2021

11/01/2022 11/01/2022 11/01/2022

1,000,000 1,000,000 1,000,000

A

EMP. LIABILITY

EXCESS WC & WCU C68917189 (OH & WA) 11/01/2021 11/01/2022

SIR

Each Accident/Emp for Disease

500,000

1,000,000

RE: AZ State Dept of Administration- *Sample* for Solicitation Purposes State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are additional insured with respects to General Liability and Auto Liability, but only to the extent of Iron Mountain’s liabilities agreed to under the written agreement or contract with certificate holder, and only as it relates to services and limits required by written agreement or contract. Waiver of subrogation is included on the Auto Liability and Worker's Compensation but only as relates to services and limits required by written contract or agreement. Notice of cancelIation will be provided in accordance with policy provisions.

1,000,000 2,000,000

X

A

Arizona Department of Administration of Marsh USA Inc.

State Procurement Office 100 N 15th Avenue Phoenix, AZ 85007

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:

Marsh USA, Inc.

2 2

IRON MOUNTAIN INCORPORATED

ONE FEDERAL STREET

BOSTON,MA 02110

25 Certificate of Liability Insurance

CN102809999

New York

Willis places the above Umbrella/Excess coverage for Iron Mountain Incorporated and Marsh only provides evidence as a courtesy.