Arizona_Department_of_Administration_6306313_Allied_Universal_Topco__LLC__1_.pdf
PDF 2 MB Posted
- Attached to
- Master Agreement AZ|CTR068383
- Contract number
- CTR068383
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for Allied Universal Topco, LLC, issued by multiple insurance carriers including Indian Harbor Insurance Company, Greenwich Insurance Company, XL Insurance America, XL Specialty Insurance Company, and Indemnity Insurance Company of North America. The certificate is issued for the State of Arizona, specifically the Arizona Department of Administration's State Procurement Office, and covers the period from 01/01/2025 to 01/01/2026.
The insurance coverage includes Commercial General Liability with a $30,000,000 aggregate limit, Automobile Liability with a $5,000,000 combined single limit, Umbrella/Excess Liability with a $10,000,000 limit, and Workers' Compensation with standard statutory limits. The policy includes additional insured provisions for the State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees. The coverage is primary and non-contributory where required by written contract, with a self-insured retention (SIR) of $1,750,000. The policy also includes waivers of subrogation and contractual liability provisions, ensuring comprehensive protection for Allied Universal Topco, LLC and its contractual obligations.
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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)
© 1988-2016 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
E 01/01/2025
01/01/2026
X
C
43575
55,000,000
XL Specialty Insurance Company
RWR300120409 (WI)
SIR $1,750,000
36940
RES943799405
10,000,000
A
D
2,000,000
01/01/2026 X
XL Insurance America
Professional Liability
01/01/2025
CN118025105-ALL-STAND-25-26
1,000,000
22322
Marsh | U.S. Operations
01/01/2026
CLE-006306313-45
01/01/2025
X
55,000,000
12/24/2024
X
X
01/01/2026
2,000,000
01/01/2026
30,000,000
X
Aggregate
X
1,000,000 1,000,000
B
Philadelphia.Certs@marsh.com
01/01/2026
01/01/2025
01/01/2025
Auto Liability, and Workers' Comp
24554
RAD943781808
Claim
01/01/2025
RWD300120309 (AOS)
RWE943548209 (CA, OH)
XSM G72500027 005
SIR: $1,750,000
30,000,000 where required by written contract. Liability coverage shall be primary and non-contributory where required by written contract. Waiver of subrogation is applicable where required by written contract.
RE: BPM004732.
The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are included as additional insured (except workers’ compensation and crime)
Indemnity Insurance Company of North America (See Attached for Additional Named Insureds)
Allied Universal Topco, LLC
Conshohocken, PA 19428 161 Washington Street, Suite 600
30,000,000
Indian Harbor Insurance Company
X
30 South 17th Street
MARSH USA LLC
Attn: Philadelphia.certs@marsh.com / Fax: (212) 948-0360 Philadelphia, PA 19103
RES943799405
Greenwich Insurance Company
N
100 N 15th Ave., Suite 402
Phoenix, AZ 85007
Arizona Department of Administration
State Procurement Office
01/01/2025
C
37885
5,000,000
866-966-4664
CONTRACTUAL LIABILITY
X
Excess of General Liability, A
10,000,000
01/01/2026
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 LLC�
Policy No.: CPO13303734 �
SIR: $1,000,000�
Employers Liability Disease-Each Employee: $1,000,000 �
Limit:� Effective Dates: 1/1/2025 - 1/1/2026�
Employers Liability Disease-Policy Limit: $1,000,000 � Employers Liability Each Accident: $1,000,000 �
Excess Workers' Compensation�
Policy No.: RWE943548209�
Employee Theft or Dishonesty: $2,000,000�
Insurer: National Union Fire Insurance Co. �
Effective Dates: 01/01/2024 - 01/01/2026�
Contractors Pollution Liability�
Insurer: Commerce and Industry Insurance Company�
Philadelphia
Certificate of Liability Insurance
Clients' Property: $2,000,000�
Effective Dates: 08/15/2024 - 08/15/2025�
The General Liability and Professional Liability policies evidenced above share in the limits shown. The limits do not apply separately to the individual coverages�
Limit: $5,000,000 �
Crime �
Deductible: $750,000�
Insurer: XL Specialty Insurance Company �
Limit:�
Policy No.: 01-468-22-46�
(See Attached for Additional Named Insureds)� Allied Universal Topco, LLC�
161 Washington Street, Suite 600�
CN118025105
Conshohocken, PA 19428
Deductible: $250,000�
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