COI_GL_AL_WC_Cyber_1.1.26.pdf

PDF 52 KB Posted

Attached to
Master Agreement AZ|CTR078557
Contract number
CTR078557
Issued by
Arizona

About this file

This document is a Certificate of Liability Insurance issued by Aon Risk Services Northeast, Inc. for Baker Tilly US, LLP and Baker Tilly Advisory Group, LP, with multiple insurers including National Fire Insurance Company of Hartford and American Casualty Company of Reading PA. The certificate is for the State of Arizona, covering its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees as additional insureds.

The insurance policy provides comprehensive coverage including Commercial General Liability ($1,000,000 per occurrence), Automobile Liability ($1,000,000), Workers Compensation (per statute), and Cyber Liability ($2,000,000 with a $500,000 network and privacy deductible). The policy is effective from 01/01/2025 to 01/01/2026, with a reference to contract CTR071217. The certificate includes provisions for additional insured status, waiver of subrogation, and notice of cancellation, specifically protecting the State of Arizona's interests across various operational and liability domains.

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Text version

B ri a n H e m m e rl e

H o ld e r

Id e n ti fi e r

77777 77707 07070 00777 63616 06555 33307 73725 77703 65557 07662 00774 16353 00072 66144 61543 11130 70626 67532 56772 00736 00555 30076 53007 70241 11726 50130 07304 05131 26303 10077 64217 37027 45500 77727 25202 57731 10777 77770 70007 07007

66666 66606 06060 00626 06466 20444 62006 02000 42622 40200 06022 20404 20622 22062 00024 04226 02000 62202 24040 06220 20622 20040 60042 02006 22200 42422 40022 06000 22624 02422 22060 02224 24022 26200 66646 06224 06644 40666 66660 60006 06006

C e rt if ic a te

N o

CERTIFICATE OF LIABILITY INSURANCE

DATE(MM/DD/YYYY)

06/06/2025

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):

E-MAIL

ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC #

(312) 381-1000

INSURED 20478National Fire Ins. Co. of HartfordINSURER A:

20427American Casualty Co. of Reading PAINSURER B:

20494Transportation Insurance Co.INSURER C:

AA1120156Lloyd's Syndicate No. 1686INSURER D:

INSURER E:

INSURER F:

FAX

(A/C. No.):

(312) 381-7007

CONTACT

NAME:

Baker Tilly US, LLP & Baker Tilly Advisory Group, LP P.O. Box 7398 4807 Innovate Lane Madison WI 53707-7398 USA

COVERAGES CERTIFICATE NUMBER: 570113081398 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

$2,000,000

A 01/01/2025 01/01/2026

General Liability C6016751638

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)

$1,000,000A 01/01/2025 01/01/2026

Auto

COMBINED SINGLE LIMIT

(Ea accident)

BUA 6016751641

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 01/01/2025 01/01/2026

WC623746823B 01/01/2025 01/01/2026

WC643413436C 01/01/2025 01/01/2026

$1,000,000

Y / N

(Mandatory in NH)

ANY PROPRIETOR / PARTNER / EXECUTIVE

OFFICER/MEMBER EXCLUDED? N / AN

Workers Compensation

WORKERS COMPENSATION AND

EMPLOYERS' LIABILITY

If yes, describe under DESCRIPTION OF OPERATIONS below

$1,000,000

WC616751624

LimitPSACZ2500011 06/01/2025 06/01/2026 Network&Privacy $500,000Deductible

Cyber LiabilityD $2,000,000

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

RE: CTR071217

State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are added as Additional Insured as respects the General Liability and Automobile Liability as required per written contract.

added as Additional Insured as respects the General Liability and Automobile Liability as required per written contract.

Umbrella is a follow form. Notice of cancellation will be provided in accordance with the policy provisions, except 10 days for non-payment. A waiver of subrogation in favor of Additional Insured as respect the General Liability, Auto Liability and Workers Compensation pursuant to a written contract.

CANCELLATIONCERTIFICATE HOLDER

AUTHORIZED REPRESENTATIVEState of Arizona 1802 W. Jackson Street Suite 100 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.

File details come from the government source that posted it. Updated .