COI_2025-01-01_GL_AL_WC.pdf
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- Attached to
- Master Agreement AZ|CTR078230
- Contract number
- CTR078230
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by Liberty Mutual Fire Insurance Company and LM Insurance Corporation for VCA, Inc., located in Los Angeles, California. The certificate is dated January 3, 2024, and is specifically related to a contract with the Arizona Department of Corrections, Rehabilitation and Reentry, with the contract number CTR059206 for services at 4021 Southside Animal Hospital in Phoenix, Arizona.
The insurance coverage includes Commercial General Liability with a $2,000,000 per occurrence limit and a $4,000,000 aggregate limit, Automobile Liability with a $1,000,000 combined single limit, Workers' Compensation with statutory coverage, and Professional Liability (E&O) with a $2,000,000 per incident and aggregate limit. The policy period runs from January 1, 2024, to January 1, 2025. The State of Arizona and its departments are listed as additional insureds, with a waiver of subrogation granted in favor of the certificate holder. The insurance provides primary and non-contributory coverage for the specified contract and location.
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H o ld e r
Id e n ti fi e r
77777 77707 07070 00777 63616 06555 33307 63535 67602 64454 07763 11474 06241 33071 66374 60562 33110 74060 45772 76556 20717 27331 33432 22107 23701 06660 33746 07504 01357 62745 70077 24075 51005 67520 77727 25202 57731 10777 77770 70007 07007
66666 66606 06060 00626 06466 20444 62006 22022 42620 40002 06202 02626 22422 22062 00024 26224 00220 62220 04242 04200 00622 20240 40240 02006 22200 40420 60020 06200 00424 22600 02062 22004 26022 06000 66646 06224 06644 40666 66660 60006 06006
C e rt if ic a te
N o
CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
01/03/2024
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.
New York NY Office One Liberty Plaza 165 Broadway, Suite 3201 New York NY 10006 USA
PHONE
(A/C. No. Ext):
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
(866) 283-7122
INSURED 23035Liberty Mutual Fire Ins CoINSURER A:
33600LM Insurance CorporationINSURER B:
INSURER C:
INSURER D:
INSURER E:
INSURER F:
FAX
(A/C. No.):
(800) 363-0105
CONTACT
NAME:
VCA, Inc.
12401 W Olympic Blvd.
Los Angeles CA 90064 USA
COVERAGES CERTIFICATE NUMBER: 570103464215 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
X
X
X
GEN'L AGGREGATE LIMIT APPLIES PER:
$2,000,000
$1,000,000
Excluded
$2,000,000
$4,000,000
$4,000,000
A 01/01/2024 01/01/2025
SIR applies per policy terms & conditions
EB2631504078684
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)
X
BODILY INJURY (Per accident)
$1,000,000A 01/01/2024 01/01/2025 COMBINED SINGLE LIMIT
(Ea accident)
AS2-C31-504078-044
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 STATUTEB 01/01/2024 01/01/2025
Work Comp AOS
WC5631504078634B 01/01/2024 01/01/2025
$1,000,000
Y / N
(Mandatory in NH)
ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICER/MEMBER EXCLUDED? N / AN
Work Comp WI
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
If yes, describe under DESCRIPTION OF OPERATIONS below
$1,000,000
WA563D504078624
Each Vet IncidentEB2631504078684 01/01/2024 01/01/2025 SIR applies per policy terms & conditions $2,000,000Aggregate
E&O - Miscellaneous Professional-Excess
A $2,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: 4021 Southside Animal Hospital, 6045 S. Central Ave., Phoenix, Arizona 85042; Contract #CTR059206. State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees are included as Additional Insured in accordance with the policy provisions of the General Liability and Automobile Liability policies.
General Liability policy evidenced herein is Primary and Non-Contributory to other insurance available to Additional Insured, but only in accordance with the policy's provisions. A Waiver of Subrogation is granted in favor of Certificate Holder in accordance with the policy provisions of the General Liability, Automobile Liability and Workers' Compensation policies.
CANCELLATIONCERTIFICATE HOLDER
AUTHORIZED REPRESENTATIVEArizona Department of Corrections, Rehabilitation and Reentry 701 East Jefferson Street Phoenix AZ 85034 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.
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:
570103464215
570103464215
Aon Risk Services Northeast, Inc.
570000063611
ADDITIONAL POLICIES
If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits.
INSURER
INSURER
INSURER
INSURER
INSURER(S) AFFORDING COVERAGE
Page _ of _
NAIC #
VCA, Inc.
TYPE OF INSURANCE
POLICY NUMBER LIMITS
OTHER
A Excess Auto Liability Coverage
TL2-631-504078-724 01/01/2024 01/01/2025 Each Occurrence
$1,000,000 Excess Auto
ADDL
INSD
INSR
LTR
SUBR
WVD
POLICY
EFFECTIVE
DATE
(MM/DD/YYYY)
POLICY
EXPIRATION
DATE
(MM/DD/YYYY)
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ADDITIONAL NAMED INSURED:
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.
570000063611
570103464215
570103464215
Page _ of _
VCA, Inc.
Animal Healthcare of Kansas, P.A.
Animal Healthcare of North Carolina, P.C.
Animal Healthcare of Rhode Island, PC Animal Healthcare of Texas, P.C.
Antech Diagnostics, Inc.
Antech Molecular Innovations, LLC Biovet (USA) Inc.
Camp Bow Wow Franchising, Inc.
CBW Operating, Inc.
Companion Pet Services of Alabama, P.C.
Critter Health, LLC Edgebrook Animal Hospital, LP General Fluidics Corporation Manhattan Veterinary Group, P.C.
Pay It Forward II, PC Pet Services of District of Columbia, P.C.
Pet Services of Idaho, P.C.
Pet Services of Louisiana, A Professional Corporation Pet Services of Maine, P.C.
Pet Services of Michigan, P.C.
Pet Services of Minnesota, P.C.
Pet Services of Nebraska, P.C.
Pet Services of New Jersey, P.C.
Pet Services of Vermont, PC Pet Services of Washington, P.S.
Pet Services of West Virginia, Inc.
Sound Technologies, Inc.
Strategic Pharmaceutical Solutions, Inc.
The Bow Wow Buddies Foundation, Inc.
V2P2 LLC
VCA Advanced Veterinary Care Center, LLC VCA Animal Diagnostic Clinic, LLC VCA Animal Hospitals, Inc.
VCA Animal Hospitals-Texas, L.P.
VCA Asher Animal Hospital, LP VCA Charities VCA Companion Animal Hospital, L.P.
VCA Dudley Avenue Animal Hospital, LLC VCA Hyannis Animal Hospital, LP VCA Inc.
VCA International Limited Partner, LLC VCA Los Angeles Veterinary Specialists, LP VCA Maple Leaf, Inc.
VCA Metroplex Animal Hospital, LP VCA Mill Run Animal Hospital, LP VCA Old Trail Animal Hospital, LLC VCA Orange County Veterinary Specialists, LP VCA Real Property Acquisition Corporation VCA Saw Mill Animal Hospital, LP VCA South County Animal Hospital, LLC VCA Valley Oak Veterinary Center, LP VCA Westlake Village Animal Hospital, LP
ADDITIONAL NAMED INSURED:
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.
570000063611
570103464215
570103464215
Page _ of _
VCA, Inc.
Vet Success US Inc.
Veterinary Healthcare of New Hampshire, P.C.
Vetica Labs, Inc.
Vicar Operating, Inc.
VCA Wexford Animal Hospital, LLC
- BioTech Laboratories U.S.A. LLC (Workers' Compensation Only)
- Diamond Animal Health, Inc. (Workers' Compensation Only)
- Heska Corporation (Workers' Compensation Only)
- MBio Diagnostics, Inc. (Workers' Compensation Only)
- MBio Health LLC (Workers' Compensation Only)
Workers' Compensation Policies
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.
570000063611
570103464215
570103464215
Page _ of _
VCA, Inc.
Effective January 1, 2024 - January 1, 2025 Underwriting Company - Liberty Insurance Corp.
NAMED INSURED POLICY NUMBER
Animal Healthcare of Kansas, P.A. WA5-63D-504078-674 Animal Healthcare of North Carolina, P.C. WA5-63D-504078-664 Animal Healthcare of Rhode Island, PC WA5-63D-504078-654 Animal Healthcare of Texas, P.C. WA5-63D-504078-644 Companion Pet Services of Alabama, P.C. WA5-63D-504078-614 Manhattan Veterinary Group, P.C. WA5-63D-504078-604 Pay It Forward II, PC WA5-63D-504078-594 Pet Services of District of Columbia, P.C. WA5-63D-504078-584 Pet Services of Idaho, P.C. WA5-63D-504078-574 Pet Services of Michigan, P.C. WA5-63D-504078-554 Pet Services of Minnesota, P.C. WA5-63D-504078-544 Pet Services of Nebraska, P.C. WA5-63D-504078-534 Pet Services of New Jersey, P.C. WA5-63D-504078-524 Pet Services of Washington, P.S. WA5-63D-504078-514 Pet Services of West Virginia, Inc. WA5-63D-504078-504 Veterinary Healthcare of New Hampshire, P.C. WA5-63D-504078-494
Pet Services of Vermont, P.C. WA5-63D-504078-484 Pet Services of Maine, P.C. WA5-63D-504078-474 Pet Services of Louisiana, A Professional Corporation WA5-63D-504078-564
Liberty Mutual Insurance
National Accounts - Casualty
157 Berkeley Street
Boston, MA 02116
(617) 357-9500
December 21, 2023
Insured Name: VCA, Inc.
Policy Numbers: WA5-63D-504078-474
WA5-63D-504078-484
WA5-63D-504078-494
WA5-63D-504078-504
WA5-63D-504078-514
WA5-63D-504078-524
WA5-63D-504078-534
WA5-63D-504078-544
WA5-63D-504078-554
WA5-63D-504078-564
WA5-63D-504078-574
WA5-63D-504078-584
WA5-63D-504078-594
WA5-63D-504078-604
WA5-63D-504078-614
WA5-63D-504078-624
WC5-631-504078-634
WA5-63D-504078-644
WA5-63D-504078-654
WA5-63D-504078-664
WA5-63D-504078-674
WA7-63D-504078-714
AS2-C31-504078-044
EB2-631-504078-684
KE1-631-504090-164
TL2-631-504078-724
LQ1-631-504090-174
To Whom It May Concern:
Please accept this letter as confirmation that this customer has placed their insurance with Liberty Mutual under the above policy numbers. Coverage is bound with the endorsements listed below.
I hope this will suffice for verification purposes. Please advise if any additional information is needed.
Sincerely, James Barnard Underwriting Consultant National Insurance Risk Management Liberty Mutual Insurance One Battery Park Plaza, 30th Floor New York, New York 10004
Liberty Mutual Insurance
National Accounts - Casualty
157 Berkeley Street
Boston, MA 02116
(617) 357-9500
Endorsements:
Workers Compensation:
Waiver Of Our Right to Recover From Others Endorsement WC 00 03 13 Notice of Cancellation to Third Parties WC 99 20 74
General Liability:
Waiver Of Transfer Of Rights Of Recovery Against Others To Us CG 24 04 05
Additional Insured – Vendors CG 20 15 04 13 Notice of Cancellation to Third Parties LIM 99 03 10 12 Additional Insured — Managers or Lessors of Premises CG 20 11 04 13 Blanket Additional Insured ‐ LN 20 01 06 05 Primary and Noncontributory ‐ Other Insurance Condition CG 20 01 04 13
Auto Liability:
Waiver of Transfer of Rights of Recovering Against Others to Us (Waiver of Subrogation) CA 04 44 03 10 Primary and Noncontributory – Other Insurance Condition CA 04 49 11 16 Notice of Cancellation to Third Parties LIM 99 02 08 11
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