AZ_Dept_of_Admin_COI_2023_Mathematica.pdf

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

INSR ADDL SUBR

LTR INSD WVD

PRODUCER CONTACT

NAME:

FAXPHONE

(A/C, No):(A/C, No, Ext):

E-MAIL

ADDRESS:

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)

AUTOMOBILE LIABILITY

UMBRELLA LIAB

EXCESS LIAB

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

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

AUTHORIZED REPRESENTATIVE

EACH OCCURRENCE $

DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence)

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT

OTHER: $

COMBINED SINGLE LIMIT

$(Ea accident)

ANY AUTO BODILY INJURY (Per person) $

OWNED SCHEDULED

BODILY INJURY (Per accident) $AUTOS ONLY AUTOS

HIRED NON-OWNED PROPERTY DAMAGE

$AUTOS ONLY AUTOS ONLY (Per accident)

OCCUR EACH OCCURRENCE

CLAIMS-MADE AGGREGATE $

DED RETENTION $

PER OTH-

STATUTE ER

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE $

If yes, describe under

E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below

INSURER(S) AFFORDING COVERAGE NAIC #

COMMERCIAL GENERAL LIABILITY

Y / N N / A

(Mandatory in NH)

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

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.

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.

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).

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

CERTIFICATE HOLDER CANCELLATION

© 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03)

CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)

The ACORD name and logo are registered marks of ACORD

1/6/2023

License # 8041621

(609) 586-7474 (609) 586-3991

19682

Mathematica Group Holding, Inc.,; Mathematica, Inc. And Mathematica Global Inc.

P.O. Box 2393 Princeton, NJ 08543-2393

29424 29424 22667

A 1,000,000

X X 13UUNTG9914 1/1/2023 1/1/2024 300,000

10,000

1,000,000 2,000,000 2,000,000

1,000,000B

X X 13UENTG9950 1/1/2023 1/1/2024

25,000,000C

13RHUTG9517 1/1/2023 1/1/2024 25,000,000

10,000 B

13WBIB9256 1/1/2023 1/1/2024 500,000

N 500,000

500,000 D Professional/Cyber G71090310 1/1/2023 Per Claim/Aggregate 5,000,000 A Blanket BPP 13UUNTG9914 1/1/2023 1/1/2024 Limit 19,735,900

Professional/Cyber Liability, Hartford (Navigators Specialty Insurance Co) Policy #NY22PTLZ0A01EIC, effective 1/1/2023-24: $5,000,000 Shared Limits for Professional/Technology Liability, Network Security & Data Privacy Liability, Digital Media Liability, Regulatory Liability, Incident Response Fund, Cyber Extortion, Crisis Management and Public Relations Expense, and Cyber Crime coverages, with $250,000 Retention.

EXCESS Professional/Cyber Liability, ACE American Insurance Company (Chubb) policy #G71090310, effective 1/1/23-24, $5,000,000 excess limit over Primary $5,000,000 limit.

SEE ATTACHED ACORD 101

Arizona Department of Administration State Procurement Office 100 N. 15th Avenue, Suite 402 Phoenix, AZ 85007

MATHINC-01 ASAYRE

Rue Insurance 3812 Quakerbridge Road Hamilton, NJ 08619 clmail@RUEINSURANCE.com

Hartford Fire Insurance Company Hartford Insurance Co.

Hartford Casualty Insurance Company ACE American Insurance Company

X

1/1/2024

X X

X

X

X

X

X

FORM NUMBER:

EFFECTIVE DATE:

The ACORD name and logo are registered marks of ACORD

ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE

FORM TITLE:

Page of

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

ACORD 101 (2008/01)

AGENCY CUSTOMER ID:

LOC #:

AGENCY NAMED INSURED

POLICY NUMBER

CARRIER NAIC CODE

© 2008 ACORD CORPORATION. All rights reserved.

Rue Insurance

MATHINC-01

SEE PAGE 1

SEE PAGE 1

ACORD 25 Certificate of Liability Insurance

License # 8041621

SEE P 1

Mathematica Group Holding, Inc.,; Mathematica, Inc. And Mathematica Global Inc.

P.O. Box 2393 Princeton, NJ 08543-2393

SEE PAGE 1

ASAYRE

Description of Operations/Locations/Vehicles:

RE: RFP BPM001998 - Data Management Services. The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees are included as Additional Insureds under the General Liability and Automobile Liability policies shown above on a primary and noncontributory basis as respects work performed by the Named Insured if required by written contract. Waiver of Subrogation applies in favor of the Additional Insureds under the General Liability and Automobile Liability policies shown above if required by written contract. 30 days notice of cancellation to Certificate Holder applies, except 10 days for non payment of premium. Sexual abuse and molestation is not excluded under the General Liability policy.