BPM006010_Attach07_07-A_LetterInsurability_MatrixNEWorld_COMBINED.pdf

Request for Proposal

Solicitation No. BPM006010

ASRAC Assessment and Remediation of Hazardous Substances

Arizona Department of Environmental

Quality (ADEQ)

1110 W. Washington Street

Phoenix, AZ 85007

Solicitation Attachment – Letter of Insurability | Revision No. 2 | Revised 08-23

Attachment 7 – Letter of Insurability

The Offeror shall provide a Letter of Insurability from the Insurance Company as a proof that the Offeror currently possesses the required insurance as stated in Addendum A of the Special Terms and Conditions or the Offeror is able to obtain the required Minimum Scope and Limits of Insurance should a contract be awarded to them.

The Letter of Insurability (and any additional letters) should be clearly marked as:

Attachment - Supplement Insurance

NOTE: Awarded Contractors shall provide a Certificate of Insurance (e.g. ACORD forms) and associated policy endorsement(s) electronically prior to beginning Service(s) or performing any other work under the Contract. Contractors shall also provide updated Certificates of Insurance electronically, so the State has current Certificates of Insurance as required under the Contract.

OFFEROR RESPONSE:

See: BPM006010_Attach07-A_Sup1of1_Supplement.Insurance_MatrixNEWorld.pdf

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

E-MAIL

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

3/14/2024

Marsh & McLennan Agency LLC 250 Pehle Avenue, Suite 400 Saddle Brook NJ 07663

Lori Woods 201-845-6600

Lori.Woods@MarshMMA.com

Nautilus Insurance Company 17370 MATRINEW1 Allmerica Financial Benefit Insurance 41840

Matrix New World Engineering, Land Surveying and Landscape Architecture, P.C.

26 Columbia Tpke.

Florham Park NJ 07932

Great Divide Insurance Company 25224 Houston Casualty Company 42374

307040997

A X 2,000,000 X 300,000

X Contractual Liab 5,000 X Pollution Liab 2,000,000

2,000,000 X

Y Y ECP201734119 3/2/2024 3/2/2025

2,000,000

Pollution-Each Claim 2,000,000 B 1,000,000

X

X X

Y Y AWYJ42223301 3/2/2024 3/2/2025

A X 10,000,000 X

Y FFX201734219 3/2/2024Y 3/2/2025

10,000,000

C A

X

N

Y WCA201734321

WCA201734420

3/2/2024 3/2/2024

3/2/2025 3/2/2025

1,000,000

1,000,000

1,000,000 A D

Professional Liability Cyber Liability

ECP201734119

H23NGP22309700

3/2/2024 3/2/2024

3/2/2025 3/2/2025

2,000,000 5,000,000 per claim/agg

RE: Solicitation Number: BPM006010 ASRAC - Assessment and Remediation of Hazardous Substances

The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are named Additional Insured with regard to the General Liability and Pollution Liability for ongoing and completed operations, Auto Liability, and Excess Liability Policies of the Named Insured, but only with respect to and to the extent of the liabilities assumed by the Named Insured under written contract, agreement or permit. The General Liability, Pollution Liability, Auto Liability, and Excess Liability insurance is Primary; any other insurance maintained by the contractor & Owner is excess & non contributory, when required by written contract, agreement or permit, subject to the provisions and limitations of the policy.

See Attached...

Arizona Department of Environmental Quality (ADEQ) 1110 W. Washington Street Phoenix AZ 85007

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:

MATRINEW1

1 1

Marsh & McLennan Agency LLC Matrix New World Engineering, Land Surveying and Landscape Architecture, P.C.

26 Columbia Tpke.

Florham Park NJ 07932

25 CERTIFICATE OF LIABILITY INSURANCE

Waiver of Subrogation is issued in favor of the Additional Insureds with regard to the General Liability, Pollution Liability, Auto Liability, Excess Liability, and Workers' Compensation Policies of the Named Insured, but only with respect to and to the extent of the liabilities assumed by the Named Insured under written contract, agreement or permit.

Excess Liability is Follow Form over the General Liability, Pollution Liability, Auto Liability, Employers Liability, and Professional Liability Policies of the Named Insured.

Notice of Cancellation - 10 Days for Non-Pay, 30 Days for all other; subject to the terms and conditions of the policy.