COI_for_AZ_-_LNRS.pdf

H o ld e r

Id e n ti fi e r

77777 77707 07070 00777 61616 04557 11107 67535 23602 64450 07763 11474 06241 33071 66374 60562 33110 74060 45772 76556 20753 63731 37432 22107 67341 42224 77302 07500 51753 27741 30072 74135 44115 73120 76727 24203 57720 00777 77770 70007 07007

77777 77707 07070 00735 25677 11545 60007 66515 00316 24575 07473 76234 60275 40071 77336 60303 70100 71227 22303 17350 00743 73663 02576 00007 57236 33171 22445 07023 73265 20661 10070 33336 25306 31000 77756 16335 17655 40777 77770 70007 07007

C e rt if ic a te

N o

CERTIFICATE OF LIABILITY INSURANCE

DATE(MM/DD/YYYY)

12/19/2023

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.

Boston MA Office 53 State Street Suite 2201 Boston MA 02109 USA

PHONE

(A/C. No. Ext):

E-MAIL

ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC #

(866) 283-7122

INSURED 22667ACE American Insurance CompanyINSURER A:

AA1128623Lloyd's Syndicate No. 2623INSURER B:

16535Zurich American Ins CoINSURER C:

AA1780059Zurich Insurance PlcINSURER D:

INSURER E:

INSURER F:

FAX

(A/C. No.):

(800) 363-0105

CONTACT

NAME:

LexisNexis Risk Solutions FL Inc.

1000 Alderman Drive Alpharetta GA 30005 USA

COVERAGES CERTIFICATE NUMBER: 570103112723 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:

$1,000,000

$1,000,000

$5,000

$1,000,000

$2,000,000

$1,000,000

$5,000,000Host Liquor Liab

A 01/01/2024 01/01/2025OGLG46663160

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

X

BODILY INJURY (Per accident)

$1,000,000C 01/01/2024 01/01/2025

Collision Ded $1,000

COMBINED SINGLE LIMIT

(Ea accident)

BAP 8376848 25

Comp Ded $1,000X

EXCESS LIAB

X OCCUR

CLAIMS-MADE AGGREGATE

EACH OCCURRENCE

DED

$45,000,000

$45,000,000

01/01/2024UMBRELLA LIABD 01/01/2025GBCGP2401519

RETENTION

X

E.L. DISEASE-EA EMPLOYEE

E.L. DISEASE-POLICY LIMIT

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

X OTH-

ER

PER STATUTEC 01/01/2024 01/01/2025

$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

WC837684525

Per ClaimFSCEO2400015 01/01/2024 01/01/2025 SIR applies per policy terms & conditions $2,000,000Aggregate

E&O - Professional Liability

- Primary

B $2,000,000

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

The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees are included as Additional Insureds with respect to the General Liability and Automobile Liability policies arising out of the activities performed by or on behalf of the Contractor. A Waiver of Subrogation applies in favor of the Certificate Holder.

CANCELLATIONCERTIFICATE HOLDER

AUTHORIZED REPRESENTATIVEArizona Department of Administration State Procurement Office 100 N. 15th Ave., Suite 402 Phoenix AZ 85007 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:

570103112723

570103112723

Aon Risk Services Northeast, Inc.

570000055869

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 #

LexisNexis Risk Solutions FL Inc.

TYPE OF INSURANCE

POLICY NUMBER LIMITS

GENERAL LIABILITY

A OGLG46663160 01/01/2024 01/01/2025 Deductible $15,000

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 REMARKS SCHEDULE

AGENCY CUSTOMER ID:

LOC #:

ADDITIONAL REMARKS

EFFECTIVE DATE:

CARRIER NAIC CODE

NAMED INSUREDAGENCY

See Certificate Number:

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

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

570000055869

Aon Risk Services Northeast, Inc.

570103112723

570103112723

See Certificate Number:

POLICY NUMBER

Companies Affording coverage

COMPANYLINE OF BUSINESS DESCRIPTION POLICY NUMBER NAICPOLICY

EFFECTIVE

DATE

(MM/DD/YYYY)

POLICY

EXPIRATION

DATE

(MM/DD/YYYY)

PRIMARY

(Y/N)

FLAG

PERCENTAGE

OF

RISK

Page _ of _

LexisNexis Risk Solutions FL Inc.

BAP 8376848 25Business Auto Coverage Zurich American Ins Co 16535

FSCEO2400015E&O - Professional Liability - Primary

Lloyd's Syndicate No. 2623 AA1128

FSCEO2400015E&O - Professional Liability - Primary

Lloyd's Syndicate No. 623 AA1126

GBCGP2401519Excess Liability Coverage

Zurich Insurance Plc AA1780

OGLG46663160General Liability Coverage

ACE American Insurance Company 22667 100

WC837684525Workers Compensation Zurich American Ins Co 16535 100

Y

Y

N

Y

Y

Y

1/1/2024 1/1/2025

1/1/2024

1/1/2024

1/1/2024

1/1/2024

1/1/2024 1/1/2025

1/1/2025

1/1/2025

1/1/2025

1/1/2025

The Subscribing insurers' obligations under contra cts of insurance to which they subscribe are severa l and not joint and are limited solely to the extent of their individual su bscriptions. The subscribing insurers are not respo nsible for the subscription of any co-subscribing insurer who for any reason do es not satisfy all or part of its obligations.

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

The ACORD name and logo are registered marks of ACORD