BNY_Mellon_COIs_for_CGL-Auto-UL_and_WC_to_4-1-2022.pdf

H o ld er

I d en ti fi e r

77777 77707

07070 00777

61616 04557

11107 66525

32602 75551

07762 11575

07341 32071

67375 61562

33100 74070

50222 67113

20743 72225

67176 66007

04367 64335

76622 07304

10760 33375

20076 25712

60016 01100

76727 24203

57720 00777

77770 70007

07007

77777 77707

07070 00735

25677 11545

60007 23001

51613 35130

07224 40113

56370 33070

33273 30243

35110 74377

62317 46315

50742 27736

13433 10007

12223 73530

63010 07133

22724 31730

10070 22227

35307 20010

77756 16335

17655 40777

77770 70007

07007 C er ti fi ca te N o

CERTIFICATE OF LIABILITY INSURANCE

DATE(MM/DD/YYYY)

08/31/2021

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.

PRODUCER

Aon Risk Services Northeast, Inc.

Morristown NJ Office 44 Whippany Road, Suite 220 Morristown NJ 07960 USA

PHONE

(A/C. No. Ext):

E-MAIL

ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC #

(866) 283-7122

INSURED 19399AIU Insurance CompanyINSURER A:

INSURER B:

INSURER C:

INSURER D:

INSURER E:

INSURER F:

FAX

(A/C. No.): 800-363-0105

CONTACT

NAME:

The Bank of New York Mellon Corporation And all of its subsidiaries including but not limited to BNY Mellon, NA 240 Greenwich Street- 6W New York NY 10286 USA

COVERAGES CERTIFICATE NUMBER: 570089008731 REVISION NUMBER:

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. Limits shown are as requested

POLICY EXP

(MM/DD/YYYY)

POLICY EFF

(MM/DD/YYYY)

SUBR

WVD

INSR

LTR

ADDL

INSD POLICY NUMBER TYPE OF INSURANCE LIMITS

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

POLICY LOC

EACH OCCURRENCE

DAMAGE TO RENTED

PREMISES (Ea occurrence)

MED EXP (Any one person)

PERSONAL & ADV INJURY

GENERAL AGGREGATE

PRODUCTS - COMP/OP AGG

GEN'L AGGREGATE LIMIT APPLIES PER:

PRO-

JECT

OTHER:

AUTOMOBILE LIABILITY

ANY AUTO

OWNED

AUTOS ONLY

SCHEDULED

AUTOS

HIRED AUTOS

ONLY

NON-OWNED

AUTOS ONLY

BODILY INJURY ( Per person)

PROPERTY DAMAGE

(Per accident)

BODILY INJURY (Per accident)

COMBINED SINGLE LIMIT

(Ea accident)

EXCESS LIAB

OCCUR

CLAIMS-MADE AGGREGATE

EACH OCCURRENCE

DED

UMBRELLA LIAB

RETENTION

E.L. DISEASE-EA EMPLOYEE

E.L. DISEASE-POLICY LIMIT

E.L. EACH ACCIDENT $1,000,000

X OTH-

ER

PER STATUTEA 04/01/2021 04/01/2022

AOS

$1,000,000

Y / N

(Mandatory in NH)

ANY PROPRIETOR / PARTNER / EXECUTIVE

OFFICER/MEMBER EXCLUDED? N / AN

WORKERS COMPENSATION AND

EMPLOYERS' LIABILITY

If yes, describe under DESCRIPTION OF OPERATIONS below

$1,000,000

WC016393103

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

Evidence of coverage

CANCELLATIONCERTIFICATE HOLDER

AUTHORIZED REPRESENTATIVEArizona State Retirement System ASRS Procurement 3300 N Central Ave Phoenix AZ 85012 USA

ACORD 25 (2016/03)

©1988-2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE

EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE

POLICY PROVISIONS.

Workers Compensation Coverage

AGENCY CUSTOMER ID:

ADDITIONAL REMARKS SCHEDULE

LOC #:

ADDITIONAL REMARKS

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance

EFFECTIVE DATE:

CARRIER NAIC CODE

POLICY NUMBER

NAMED INSUREDAGENCY

See Certificate Number:

See Certificate Number:

Aon Risk Services Northeast, Inc.

570000073397

570089008731

570089008731

Page _ of _

The Bank of New York Mellon Corporation

WC016393100 - CA

Insurer: AIU Insurance Company NAIC# 19399 Term Dates: 04/01/2021- 04/01/2022

WC016393101 - FL

Insurer: AIU Insurance Company NAIC# 19399 Term Dates: 04/01/2021 - 04/01/2022

WC016393102- MA OH WA WI

Insurer: New Hampshire Ins Co. NAIC# 23841 Term Dates: 04/01/2021- 04/01/2022

ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD