APPROVED CTR062472 GL,AL,WC,PROFESSIONAL 01.01.22-01.01.23.pdf
PDF 1 MB Posted
- Attached to
- Master Agreement AZ|CTR062472
- Contract number
- CTR062472
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by multiple insurance companies (National Union Fire Insurance Company of Pittsburgh, Lexington Insurance Company, and AIU Insurance Company) for Parsons Transportation Group Inc., with The State of Arizona listed as the certificate holder. The insurance covers multiple policy types including Commercial General Liability, Auto Liability, Professional Liability, and Workers Compensation, effective from 01/01/2022 to 01/01/2023. The certificate is specifically related to Contract No. CTR062472 for TSMO (Transportation Systems Management and Operations) On-Call Consultants for the Arizona Department of Transportation (ADOT).
The contract appears to be an on-call consulting services agreement with a contract end date of 09/30/2023 and a professional liability retroactive date of 06/19/1986. The insurance policies provide various coverage limits, including $2,000,000 for each occurrence in the Commercial General Liability policy, $1,000,000 for Auto Liability, and $5,000,000 for Professional Liability. The policies include additional insured provisions for the State of Arizona, its departments, agencies, boards, commissions, universities, officers, agents, and employees. The insurance coverage is primary and will apply as required by written contract or agreement, with waivers of subrogation and transfer of rights of recovery included in the endorsements.
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Text version
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
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
$PREMISES (Ea occurrence)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY
PRO-
JECT LOC
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY X
10/07/2022
The State of Arizona
X
1-816-960-9000
B
B
B
B
2,000,000
5,000,000
5,000,000
01/01/23
X
2,000,000
CSL (EA ACCIDENT)
POLICY AGG
PER CLAIM
X
X
4,000,000
01/01/23
01/01/23
2,000,000
1,000,000
10,000
01/01/23
01/01/23 01/01/23
01/01/23
X
A
C
4,000,000
X
Phoenix, AZ 85009
Kansas City, MO 64112-1906
LIC #CA 0C19812
X
See attached endorsements and special clauses.
GL17587105
Contract End Date: 09/30/2023 Professional Liability Retroactive Date: 06/19/1986 officials, agents, and employees.
Additional Insureds: State of Arizona, and its departments, agencies, boards, commissions, universities, officers, RE: Contract No. CTR062472 - TSMO On-Call Consultants - ADOT CTR062472.
01/01/22
Lockton-HA2
X
A
100 M Street SE, Suite 1200
1,000,000
RiskManagement.Parsons@parsons.com
1324 N. 22nd Ave.
X
CA134-1447(NJ)
11665420
01/01/22
WC012-32-6657(CA)
X
WC013-75-1697(NY)
X
WC012-32-6660(WI)
WC012-32-6658(AOS)
N
A
LEXINGTON INS CO
1,000,000
2,000,000
AIU INS CO
NATIONAL UNION FIRE INS CO OF PITTS
X
X
01/01/22
01/01/22
USA
Parsons Transportation Group Inc.
AUTO LIABILITY
Lockton Companies, LLC-1 Kansas City
PROFESSIONAL LIABILITY
ARCHITECTS & ENGINEERS
X
444 W. 47th Street, Suite 900
01/01/22 01/01/22
CA134-1446(AOS)
01/01/22
01/01/22
19437
1,000,000
19399
X
19445
Washington, DC 20003-3515
01/01/23
66881283
66881283 a8812 Accepted
ENDORSEMENT
This endorsement, effective 12:01 A.M. 01/01/20 forms a part of
Policy No. CA!"#$!##% (AOS) issued to PARSONS CORPORATION by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
SCHEDULE
ADDITIONAL INSURED
Any person or organization for whom you are contractually bound to provide Additional Insured status but only to the extent of such person’s or organizations liability arising out of the use of a covered “auto”.
Section II - Liability Coverage, A. - Coverage, 1. - Who Is An Insured, is amended to add:
d. Any person or organization, shown in the schedule above, to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered
“auto”. However, the insurance provided will not exceed the lesser of:
1. The coverage and/or limits of this policy, or
2. The coverage and/or limits required by said contract or agreement.
87950 (09/14)
CA!"#$!##& ('()
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POLICY NUMBER: CA !"# ""$ !"#$% COMMERCIAL AUTO
CA 04 44 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.
Named Insured: !"#$%#&'$"($"!)*$%
Endorsement Effective Date: +,-+,-.+
SCHEDULE
Name(s) Of Person(s) Or Organization(s):
Any person or organization for whom the Named Insured is required to provide a waiver
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization.
90533 (3/06) Page 1 of 1
ENDORSEMENT
This endorsement, effective 12:01 A.M. 01/01/20 forms a part of policy No.!GL 175871"# issued to PARSONS CORPORATION by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT
PRIMARY COVERAGE FOR SPECIFIED PERSONS OR
ORGANIZATIONS NAMED AS ADDITIONAL INSUREDS �
ONGOING AND COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
The following paragraph is added to SECTION II � WHO IS AN INSURED and applies only to persons or organizations we have added to your policy as additional insureds by endorsement to comply with insurance requirements of written contracts relative to: a) the performance of your ongoing operations for the additional insured; or b) �your work� performed for the additional insured sans included in the �products-completed hazard� :
This insurance is primary over any similar insurance available to any person or organization we have added to this policy as an additional insured. However, this insurance is primary over any other similar insurance only if the additional insured is designated as a named insured in the Declarations of the similar insurance. We will not require contribution of limits from the other similar insurance if the insurance afforded by this endorsement is primary.
This insurance is excess over any other valid and collectible insurance, whether primary, excess, contingent or on any other basis, if it is not primary as defined in the paragraph above.
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
CG 20 10 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2
ADDITIONAL INSURED OWNERS, LESSEES OR
CONTRACTORS SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf;
in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above.
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:
This insurance does not apply to "bodily injury" or "property damage" occurring after:
1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or
2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project.
GL17587105
WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT.WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT.
Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13
C. With respect to the insurance afforded to these additional insureds, the following is added to Section III Limits Of Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
CG 20 37 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1
ADDITIONAL INSURED – OWNERS, LESSEES OR
CONTRACTORS – COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard".
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT.WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT.
CG 24 04 05 09
CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 �
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Person Or Organization:
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 we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above.
WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT.
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13
(Ed. 4-84)
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 anyone not named in the Schedule.
Schedule
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective Policy No. Endorsement No.
Insured: Premium $ Company: Countersigned By
WC 00 03 13
(Ed. 4-84)
Copyright 198:1 National Council on Compensation Insurance. AGENT COPY
01/01/22
The State of Arizona
USA
1324 N. 22nd Ave.
Phoenix, AZ 85009
AIU INS CO
WC012-32-6658(AOS)
Parsons Transportation Group Inc.
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA
This endorsement changes the policy to which it is attached effective on inception date of the policy unless a different date is indicated below.
(The following “attaching clause” need be completed only when this endorsement is issued subsequent to preparation of the policy.)
This endorsement, effective 12:01 AM forms a part of Policy No.
Issued to:
By:
Premium: INCL
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).
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule.
The additional premium for this endorsement shall be 5% of the California workers’ compensation premium otherwise due on such remuneration.
Schedule
Person or Organization
Job Description
WC 04 03 06 Countersigned by__________________________________________ (Ed. 4-84) Authorized Representative
Phoenix, AZ 85009
Parsons Transportation Group Inc.
WC012-32-6657(CA)
AIU INS CO
1324 N. 22nd Ave.
01/01/22
Where required by written contract or agreement.
The State of Arizona
SUPP (10/00)
SUPPLEMENT TO CERTIFICATE OF INSURANCE
DATE
NAME OF INSURED:
10/07/2022 notification to that effect.
cancellation, or reduction in coverage or limits, of any insurance within thirty (30) days of receipt of insurers'
The named insured, Parsons Corporation or its Insurance Broker shall notify the certificate holder of any
Cancellation Notice:
by the policy).
General Liability includes Contractual Liability (insurance is available only to the extent provided
Contractual Liability:
SPECIAL CLAUSES
Parsons Transportation Group Inc.
File details come from the government source that posted it. Updated .