COI_thru_10.1.24.pdf
PDF 207 KB Posted
- Attached to
- Master Agreement AZ|CTR062095
- Contract number
- CTR062095
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for The GEO Group Inc. and all its subsidiaries, including Cornell Companies Inc., with Willis Towers Watson Southeast, Inc. as the insurance producer. The certificate is issued for multiple insurance policies covering various jurisdictions, with the primary certificate holder being the Arizona Department of Corrections. The insurance policies involve multiple insurers, including National Union Fire Insurance Company of Pittsburgh, ACE Property & Casualty Insurance Company, AIU Insurance Company, Ironshore Specialty Insurance Company, and Berkley National Insurance Company.
The insurance coverage includes comprehensive liability protection across multiple domains: Commercial General Liability with Civil Rights coverage, Automobile Liability, Umbrella and Excess Liability, Workers Compensation, Pollution Liability, and Medical Malpractice. The policies cover specific correctional facilities in Arizona, including Phoenix West State Prison, Arizona State Prison - Florence West, Central Arizona Correctional Facility, and Kingman Correctional Facility. The policies are effective from 10/01/2023 to 10/01/2024, with various coverage limits ranging from $2,000,000 to $25,000,000. Additional insured status and waiver of subrogation are provided for the State of Arizona and Arizona Department of Corrections as required by written contracts.
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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
Willis Towers Watson Southeast, Inc.
c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA
The GEO Group Inc and All Subsidiaries including Cornell Companies Inc.
4955 Technology Way Boca Raton, FL 33431
General Liability: Contractual Liability is provided per form CG0001 - Commercial General Liability. Coverage includes Severability of interest and Cross Suits. Sexual Molestation - Physical Abuse is not excluded under the General Liability policy. Blanket Additional Insured is included to Certificate Holder as respects General Liability if required by written contract. Insurance is Primary and Non Contributory. Blanket Waiver of Subrogation is provided as respects General Liability as required by written contract.
SEE ATTACHED
Arizona Department of Corrections Contracts Administration Attn: Denel Pickering 1601 West Jefferson, M/C 55303 Phoenix, AZ 85007-3002
10/02/2023
1-877-945-7378 1-888-467-2378 certificates@willis.com
National Union Fire Insurance Company of P 19445
ACE Property & Casualty Insurance Company
AIU Insurance Company
20699
19399
Ironshore Specialty Insurance Company 25445
Berkley National Insurance Company 38911
W30493873
A
5,000,000
5,000,000
0Civil Rights
5,000,000
25,000,000
5,000,000
Y Y 1729003 10/01/2023 10/01/2024
A
5,000,000
10/01/202410/01/2023
Deductible
Y Y 4594443
1,000,000
B 10,000,000
XOOG72597631 002 10/01/2023 10/01/2024 10,000,000
049154398 C Y
2,000,000 No 10/01/2023 10/01/2024
2,000,000
2,000,000
D Pollution Liability Each IncidentISPILLSCV0Y3001 10/01/2023 10/01/2026
Policy Aggregate
Retention
315091224740543SR ID: BATCH:
$100,000
$10,000,000
$10,000,000
Willis Towers Watson Certificate Center
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:
The GEO Group Inc and All Subsidiaries including Cornell Companies Inc.
4955 Technology Way Boca Raton, FL 33431
Blanket Additional Insured is included to Certificate Holder as respect Automobile Liability if required by written contract. Blanket Waiver of Subrogation is provided as respects Automobile Liability as required by written contract.
Blanket Waiver of Subrogation is provided as respects Workers Compensation as required by written contract, as permitted by law.
State of Arizona and Arizona Department of Corrections are named as Additional Insureds not applicable to worker compensation per contracts.� Phoenix West State Prison, Contract #010039DC; Arizona State Prison - Florence West, Contract #020049DC; Central Arizona Correctional Facility, Contract #040176DC; Kingman Correctional Facility, Contract #AD9-010-A3-001.� Waiver of Subrogation is applicable in favor of the State of Arizona and its departments with respect to General Liability, Auto Liability, and Workers Compensation where required by written contract.
INSURER AFFORDING COVERAGE: National Union Fire Insurance Company of Pittsburgh NAIC#: 19445
POLICY NUMBER: 6547191 EFF DATE: 10/01/2023 EXP DATE: 10/01/2024
ADDITIONAL INSURED: Y
SUBROGATION WAIVED: Y
TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:
Medical Malpractice Limit 5,000,000 ������������������� Agg 25,000,000
ADDITIONAL REMARKS:
Certificate Holder is included as an Additional Insured as respects to Medical Malpractice. Waiver of Subrogation applies in favor of Certificate Holder with respects to Medical Malpractice.
INSURER AFFORDING COVERAGE: AIU Insurance Company NAIC#: 19399
POLICY NUMBER: 049154399 EFF DATE: 10/01/2023 EXP DATE: 10/01/2024
SUBROGATION WAIVED: Y
TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:
Workers Compensation - CA Each Accident $2,000,000 Per Statute Disease Each Empl $2,000,000 ����������� Disease Pol Limit $2,000,000
2 3
Willis Towers Watson Southeast, Inc.
See Page 1
See Page 1 See Page 1 See Page 1
25 Certificate of Liability Insurance
W30493873CERT:3150912BATCH:24740543SR ID:
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:
The GEO Group Inc and All Subsidiaries including Cornell Companies Inc.
4955 Technology Way Boca Raton, FL 33431
INSURER AFFORDING COVERAGE: AIU Insurance Company NAIC#: 19399
POLICY NUMBER: 049154397 EFF DATE: 10/01/2023 EXP DATE: 10/01/2024
SUBROGATION WAIVED: Y
TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:
Workers Compensation - WI Each Accident $2,000,000 Per Statute Disease Each Empl $2,000,000 ����������� Disease Pol Limit $2,000,000
INSURER AFFORDING COVERAGE: National Union Fire Insurance Company of Pittsburgh NAIC#: 19445
POLICY NUMBER: 4594444 EFF DATE: 10/01/2023 EXP DATE: 10/01/2024
ADDITIONAL INSURED: Y
SUBROGATION WAIVED: Y
TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:
Automobile Liability - MA Only Combined Single Limit $5,000,000 Any Auto including Hired & Non-Owned
INSURER AFFORDING COVERAGE: National Union Fire Insurance Company of Pittsburgh NAIC#: 19445
POLICY NUMBER: 25060203 EFF DATE: 10/01/2023 EXP DATE: 10/01/2024
TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:
Excess Liability Limit $10M x $10M
INSURER AFFORDING COVERAGE: Berkley National Insurance Company NAIC#: 38911
POLICY NUMBER: CEX09602890-05 EFF DATE: 10/01/2023 EXP DATE: 10/01/2024
TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:
Excess Liability Limit $5M x $20M
3 3
Willis Towers Watson Southeast, Inc.
See Page 1
See Page 1 See Page 1 See Page 1
25 Certificate of Liability Insurance
W30493873CERT:3150912BATCH:24740543SR ID:
10.0.2.20120224.1.869952
| DATE (MM/DD/YYYY): 10/02/2023 |
| PRODUCER: Willis Towers Watson Southeast, Inc. |
c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA
| FAX (A/C, No):: 1-877-945-7378 |
| FAX (A/C, No):: 1-888-467-2378 |
| FAX (A/C, No):: certificates@willis.com |
| NAIC #_INSURER A :: National Union Fire Insurance Company of P |
| NAIC #_INSURER A :: 19445 |
| INSURED: The GEO Group Inc and All Subsidiaries |
including Cornell Companies Inc.
4955 Technology Way Boca Raton, FL 33431
| NAIC #_INSURER B :: ACE Property & Casualty Insurance Company |
| NAIC #_INSURER C :: AIU Insurance Company |
| NAIC #_INSURER B :: 20699 |
| NAIC #_INSURER C :: 19399 |
| NAIC #_INSURER D :: Ironshore Specialty Insurance Company |
| NAIC #_INSURER D :: 25445 |
| NAIC #_INSURER E :: Berkley National Insurance Company |
| NAIC #_INSURER E :: 38911 |
| NAIC #_INSURER F :: |
| NAIC #_INSURER F :: |
| CERT_NUMBER: W30493873 |
| GL INSR LETTER: A |
| CGL_checkbox: Yes |
| Clams_Made_checkbox: 0 |
| Occur_checkbox: Yes |
| OTHER 1 checkbox: Yes |
| OTHER 1 checkbox: Off |
| undefined: 5,000,000 |
| undefined: 5,000,000 |
| undefined: 0 |
| GL_OTHER_1_TYPE_OF_INS: Civil Rights |
| GL_OTHER_2_TYPE_OF_INS: |
| undefined: 5,000,000 |
| undefined: 25,000,000 |
| undefined: 5,000,000 |
| Gen_Agg_Policy_checkbox: Yes |
| Gen_Agg_Project_checkbox: 0 |
| Gen_Agg_Location_checkbox: 0 |
| INSR ADDL_Row_1: Y |
| WVD SUBR_Row_1: Y |
| POLICY NUMBER_Row_1: 1729003 |
| POLICY EFF (MM/DD/YYYY)_Row_1: 10/01/2023 |
| POLICY EXP (MM/DD/YYYY)_Row_1: 10/01/2024 |
| OTHER_LIMIT_DESC: |
| undefined: |
| ANY_AUTO_checkbox: Yes |
| AL INSR LETTER: A |
| undefined: 5,000,000 |
| NON-OWNED_AUTOS_checkbox: Yes |
| SCHEDULED_AUTOS_checkbox: 0 |
| ALL_OWNED_AUTOS_checkbox: 0 |
| HIRED_AUTO_checkbox: Yes |
| POLICY EXP (MM/DD/YYYY)_Row_1: 10/01/2024 |
| undefined: |
| POLICY EFF (MM/DD/YYYY)_Row_1: 10/01/2023 |
| undefined: |
| undefined: |
| AL_OTHER_1_checkbox: 0 |
| AL_OTHER_1_DESC: |
| PROPERTY DAMAGE (Per accident)_Row_1: Deductible |
| AL_OTHER_2_checkbox: 0 |
| AL_OTHER_2_DESC: |
| INSR ADDL_Row_2: Y |
| WVD SUBR_Row_2: Y |
| POLICY NUMBER_Row_2: 4594443 |
| undefined: 1,000,000 |
| UMB_LIAB: Yes |
| UMB_EX_OCC: Yes |
| UMB INSR LETTER: B |
| undefined: 10,000,000 |
| EX_LIAB_checkbox: 0 |
| CLAIMS_MADE_checkbox: 0 |
| RET_checkbox: 0 |
| DED_checkbox: Off |
| DED_RET_AMOUNT: |
| INSR ADDL_Row_3: |
| WVD SUBR_Row_3: |
| POLICY NUMBER_Row_3: XOOG72597631 002 |
| POLICY EFF (MM/DD/YYYY)_Row_3: 10/01/2023 |
| POLICY EXP (MM/DD/YYYY)_Row_3: 10/01/2024 |
| undefined: 10,000,000 |
| AGGREGATE_Row_1: |
| undefined: |
| POLICY NUMBER_N / A: 049154398 |
| STATUTORY: Yes |
| OTHER: Off |
| WC_OTHER_DESC: |
| WC INSR LETTER: C |
| WVD SUBR_N / A: Y |
| undefined: 2,000,000 |
| Y / N: No |
| POLICY EFF (MM/DD/YYYY)_Row_3: 10/01/2023 |
| POLICY EXP (MM/DD/YYYY)_Row_3: 10/01/2024 |
| undefined: 2,000,000 |
| undefined: 2,000,000 |
| OTHER 1 INSR LETTER: D |
| OTHER_1_TYPE_OF_INS: Pollution Liability |
| OTHER_2_TYPE_OF_INS: |
| N / A_Row_1: |
| WVD SUBR_Row_5: |
| N / A_Row_1: |
| OTHER_1_LIMIT_OF_INS: Each Incident |
| OTHER 2 INSR LETTER: |
| POLICY NUMBER_Row_5: ISPILLSCV0Y3001 |
| POLICY NUMBER_Row_5: |
| POLICY EFF (MM/DD/YYYY)_Row_5: 10/01/2023 |
| POLICY EFF (MM/DD/YYYY)_Row_5: |
| POLICY EXP (MM/DD/YYYY)_Row_5: 10/01/2026 |
| POLICY EXP (MM/DD/YYYY)_Row_5: |
| OTHER_2_LIMIT_OF_INS: Policy Aggregate |
| WVD SUBR_Row_5: |
| OTHER 3 INSR LETTER: |
| WVD SUBR_Row_5: |
| POLICY NUMBER_Row_5: |
| POLICY EFF (MM/DD/YYYY)_Row_5: |
| OTHER_3_TYPE_OF_INS: |
| N / A_Row_1: |
| POLICY EXP (MM/DD/YYYY)_Row_5: |
| OTHER_3_LIMIT_OF_INS: Retention |
| DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required): General Liability: Contractual Liability is provided per form CG0001 - Commercial General Liability. Coverage |
includes Severability of interest and Cross Suits. Sexual Molestation - Physical Abuse is not excluded under the General Liability policy. Blanket Additional Insured is included to Certificate Holder as respects General Liability if required by written contract. Insurance is Primary and Non Contributory. Blanket Waiver of Subrogation is provided as respects General Liability as required by written contract.
SEE ATTACHED
INSURED:
Arizona Department of Corrections Contracts Administration Attn: Denel Pickering 1601 West Jefferson, M/C 55303 Phoenix, AZ 85007-3002
| AUTHORIZED REPRESENTATIVE: |
| BATCH_NUMBER: 3150912 |
| SR_NUMBER: 24740543 |
| SRID_label: SR ID: |
| Batch_label: BATCH: |
| GL_Agg_applies_per_Other_checkbox: 0 |
| GL_Agg_applies_per_Other: |
| OTHER_3_LIMIT_OF_INS_AMT3: $100,000 |
| OTHER_2_LIMIT_OF_INS_AMT_2: $10,000,000 |
| OTHER_1_LIMIT_OF_INS_AMT_1: $10,000,000 |
| Contact_Name: Willis Towers Watson Certificate Center |
| DATE (MM/DD/YYYY): Page 1 of 3 |
File details come from the government source that posted it. Updated .