cert_SEA_Arizona_Department_of_Administration_4076773_1__1_.pdf
PDF 93 KB Posted
- Attached to
- Master Agreement AZ|CTR068890
- Contract number
- CTR068890
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance for Dell Technologies Inc., issued by Marsh Risk & Insurance Services. The certificate covers Dell Technologies and its subsidiaries, with the Arizona Department of Administration listed as the certificate holder. The insurance is provided by Zurich American Insurance Company and American Zurich Insurance Company, spanning multiple states including Massachusetts, Nebraska, Wisconsin, and Arizona.
The insurance coverage includes commercial general liability, automobile liability, and workers' compensation, with policy periods from 03/01/2024 to 03/01/2025. Key coverage limits include $5,000,000 for general liability and automobile liability, and $1,000,000 for workers' compensation per accident and per employee. The certificate references Contract No. CTR068890 and includes the State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees as additional insured parties. The policies provide primary and non-contributory coverage, with a waiver of subrogation where required by written contract and permitted by law.
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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
03/01/2024
X
A
N/A
10,000,000
WC699017600 (MA, NE, WI)
16535
A
03/01/2025 X
American Zurich Insurance Company
1,000,000
N/A
SEA-004076773-01
03/01/2024
X
10,000,000
02/17/2025
03/01/2025
5,000,000
1,000,000 1,000,000
A
03/01/2025
03/01/2024
40142
BAP699017700
10,000
WC699017500 (AOS)
X
5,000,000 by written contract. Any such coverage extended to the additional insured will apply as primary and non-contributory, to the extent of liability assumed under contract. Waiver of subrogation applies where required by written contract and permitted by law.
RE: Contract No.: CTR068890
The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are included as additional insured (except workers compensation) where required
N/A and all Subsidiaries
Dell Technologies Inc.
Round Rock, TX 78682 One Dell Way - RR1-50
5,000,000
Zurich American Insurance Company
X
FOUR EMBARCADERO CENTER, SUITE 1100
MARSH RISK & INSURANCE SERVICES
SAN FRANCISCO, CA 94111
CALIFORNIA LICENSE NO. 0437153
Attn: SanFrancisco.Certs@marsh.com / FAX 212-948-0398
GLO699017800
N/A
N
Phoenix, AZ 85007
Arizona Department of Administration
1802 W Jackson St #100
03/01/2024
C
5,000,000
X
X
03/01/2025
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