ASRS_ACORD_Form_20250624-162719_6.25.25.pdf
PDF 65 KB Posted
- Attached to
- Master Agreement AZ|CTR067438
- Contract number
- CTR067438
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance issued by Brown & Brown Metro, LLC for Barrack Rodos & Bacine, with coverage provided by Massachusetts Bay Insurance Company, The Hanover Insurance Company, and ACE American Insurance Company. The certificate is for the Arizona State Retirement System, located in Phoenix, Arizona, and covers various insurance policies from May 31, 2025 to May 31, 2026.
The certificate includes multiple coverage types: Commercial General Liability with a $1,000,000 per occurrence limit, Automobile Liability with a $1,000,000 combined single limit, Umbrella/Excess Liability with a $5,000,000 each occurrence limit, Workers' Compensation, and Cyber Liability/Technology E&O with $1,000,000 per claim and aggregate limits. The State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are included as additional insureds on the General Liability and Auto Liability policies, with a waiver of subrogation applied where legally permissible.
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Text version
06/24/2025
Brown & Brown Metro, LLC 10 Lake Center Drive Suite 310 Marlton NJ 08053
Kathy Teall CISR
(856) 552-6330 (856) 840-8484
Kathy.Teall@bbrown.com
Barrack Rodos & Bacine 2001 Market Street
Philadelphia PA 19103
Massachusetts Bay Insurance Company 22306 The Hanover Insurance Company 22292 ACE American Insurance Company 22667
25-26 Master Cert
A Y Y ODYA92860209 05/31/2025 05/31/2026
1,000,000 1,000,000 10,000 1,000,000 2,000,000 2,000,000
A Y Y ODYA92860209 05/31/2025 05/31/2026
1,000,000
A
ODYA92860209 05/31/2025 05/31/2026
5,000,000 5,000,000
B Y WHY-A928593-09 05/31/2025 05/31/2026
1,000,000 1,000,000 1,000,000
C Cyber Liability Technology E&O F1829154A001 05/29/2025 05/29/2026
Per Claim $1,000,000 Aggregate $1,000,000
State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees is/are included as additional insured on the captioned General Liability & Auto Liability policy if required by written contract per the attached policy forms. A waiver of subrogation applies to general liability and auto liability policies the limit the law will allow and the carrier will provide.
Arizona State Retirement System 3300 N Central Ave, Suite 1400
Phoenix AZ 85012
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
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