CTR055522_Certificate_of_Insurance.pdf
PDF 1 MB Posted
- Attached to
- Master Agreement AZ|CTR055522
- Contract number
- CTR055522
- Issued by
- Arizona
About this file
This document is a comprehensive insurance policy package for Laboratory Corporation of America Holdings (LabCorp), issued by multiple insurance carriers including ACE American Insurance Company, Indemnity Insurance Company of North America, and Westchester Surplus Lines Insurance Company. The policy covers various liability aspects and is specifically tailored to provide insurance for LabCorp's operations in Arizona, with the State of Arizona, its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees named as additional insureds.
The insurance package includes Commercial General Liability, Business Auto Coverage, Workers' Compensation, and Employers' Liability policies, with coverage periods from 11/01/2020 to 11/01/2021. Key coverage details include commercial general liability with limits of $2,000,000 aggregate and $1,000,000 per occurrence, automobile liability with a $2,000,000 combined single limit, and workers' compensation coverage. The policies include specific endorsements such as additional insured provisions, waivers of subrogation, and limited abuse and molestation coverage. The insurance is primary for the State of Arizona and includes provisions for 30-day cancellation notices and comprehensive risk management protections across multiple insurance domains.
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CG 20 26 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1
POLICY NUMBER: HDO G71567382 Endorsement Number: 87
COMMERCIAL GENERAL LIABILITY
CG 20 26 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
LIMITED PRODUCT WITHDRAWAL EXPENSE ENDORSEMENTADDITIONAL INSURED – DESIGNATED PERSON OR ORGANIZATION
ADDITIONAL INSURED – DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s):
The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees shall be named as additional insureds with respect to liability arising out of the activities performed by or on behalf of the Contractor
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf:
1. In the performance of your ongoing operations;
or
2. In connection with your premises owned by or rented to you.
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable limits of insurance;
whichever is less.
This endorsement shall not increase the applicable limits of insurance.
LD-25238 (12/08) Page 1 of 3
ABUSE AND MOLESTATION EXCLUSION AND LIMITED COVERAGE ENDORSEMENT
ABUSE AND MOLESTATION EXCLUSION AND LIMITED COVERAGE ENDORSEMENT
Named Insured
Laboratory Corp of America Holdings Endorsement Number
Policy Symbol
HDO
Policy Number
G71567382 Policy Period
11/01/2020 to 11/01/2021 Effective Date of Endorsement
Issued By (Name of Insurance Company)
ACE American Insurance Company
Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY POLICY
THIS ENDORSEMENT PROVIDES CLAIMS MADE AND REPORTED COVERAGE
This Endorsement is written on a Claims Made and Reported basis and provides “Limited Abuse and Molestation Coverage” as set forth below that takes place subsequent to the Retroactive Date and before the end of the policy period, which are first made against you and reported to us during the policy period. No coverage exists for claims first made against you or reported to us after the end of the policy period.
I. Abuse and Molestation Exclusion
The following exclusion is added to Paragraph 2. Exclusions of SECTION I – COVERAGE A –Bodily Injury And Property Damage Liability and to Paragraph 2., Exclusions of SECTION I – Coverage B – Personal and Advertising Injury Liability:
This insurance does not apply to “bodily injury”, “property damage” or “personal and advertising injury” directly or indirectly from or arising out of “abuse or molestation”.
II. Limited Abuse and Molestation Coverage
SCHEDULE
Limits of Insurance:
Each Person Limit: $1,000,000 Each Occurrence Limit: $1,000,000 Aggregate Limit: $2,000,000
Deductible: $1,000,000 Locations: All Arizona locations of the Named Insured Entity: The Department of Economic Security in Arizona Retroactive Date: 6/1/2006
A. In consideration of an additional premium, we provide “Limited Abuse and Molestation Coverage” for the locations shown in the Schedule and only for the benefit of the entities shown in the Schedule, which is described as follows, and is subject to the terms, conditions and exclusions set out below:
Subject to the Limits of Insurance listed in the Schedule and to the Exclusions below, we will pay under this endorsement the “ultimate net loss” that the insured becomes legally obligated to pay as damages for “bodily injury”, “property damage” or “personal and advertising injury” arising out of “abuse or molestation”, only if a claim for damages is first made against any insured during the policy period, and the insured had no knowledge, or reasonably should not have been expected to know, of the “abuse or molestation” prior to the inception date of the policy.
No other obligation or liability to pay sums or perform acts or services is covered unless explicitly provided for under Paragraph B. Defense, Investigation, Settlement, Legal Expenses, and Interest on Judgments.
But the amount we will pay for the “ultimate net loss” because of damages is limited as described in the Limits of Insurance listed in the schedule.
LD-25238 (12/08) Page 2 of 3
B. Defense, Investigation, Settlement, Legal Expenses and Interest on Judgments
The insurance provided under this endorsement does not apply to defense, investigation, settlement or legal expenses, or to prejudgment interest arising out of any “occurrence” or offense. However, we shall have the right and opportunity to assume from the insured the defense and control of any claim or “suit”, including any appeal from a judgment, seeking payment of damages covered under this endorsement. In such event, we and the insured shall cooperate fully.
We shall pay interest only on that amount of any judgment we pay that accrues as post-judgment interest after entry of the judgment and before we have paid, offered to pay, or deposited in court that part of the judgment that is within the applicable limit of insurance shown in the Schedule.
C. Exclusions
The insurance for “Limited Abuse and Molestation Coverage” provided by this endorsement does not apply to:
1. Claims or damages for “abuse or molestation” that occurred before the Retroactive Date shown above or which occur after the end of the policy period;
2. Any insured who is alleged to have personally participated in committing any “abuse or molestation”;
3. Any insured who is alleged to have remained passive after having personal knowledge, or under circumstances in which the insured should reasonably have known, of any “abuse or molestation”;
4. Any “abuse or molestation” of a person if the first incident of “abuse or molestation” of that person by the same, or allegedly the same, individual or individuals occurred prior to the effective date of this endorsement.
D. Limits of Insurance and Deductible
The Limits shown in the Schedule of this endorsement and the rules below fix the most we will pay for the “Limited Abuse and Molestation Coverage” provided for herein, regardless of the number of:
1. Insureds;
2. Claims made or “suits” brought; or
3. Persons or organizations making claims or bringing “suits”.
The Each Person Limit is the most we will pay for all damages sustained resulting from “abuse or molestation” to any one person regardless of the number of incidents of “abuse or molestation”.
The Each Occurrence Limit is, subject to the Each Person Limit, the most we will pay for the sum of all “bodily injury”, “property damage” and “personal and advertising injury” arising out of any one “occurrence”.
The Aggregate Limit is, subject to the Each Person Limit and the Each Occurrence Limit, the most we will pay for all damages regardless of the number of a) insureds, b) claims made or "suits" brought, or c) persons or organizations making claims or bringing suits. The Aggregate Limit is included in, and is not in addition to, the General Aggregate Limit.
Coverage under this endorsement is subject to the Deductible amount shown in the Schedule above. We will pay up to the applicable limit for Each Person or Each Occurrence and you will reimburse us up to the Deductible amount.
E. Definitions
For the purposes of this endorsement only:
1. "Abuse or molestation" means:
a. The actual or threatened abuse or molestation by anyone of any person while in the care, custody or control of any insured, including but not limited to “physical abuse”, “sexual misconduct”, mental abuse, harassment, and any other type of abuse or molestation, or
LD-25238 (12/08) Page 3 of 3
b. The actual or alleged negligent:
i. Employment;
ii. Investigation;
iii. Supervision;
iv. Reporting to the proper authorities, or failure to so report; or
v. Retention of a person for whom any insured is or ever was legally responsible and whose conduct would be excluded by sub-paragraph a. above.
2. “Bodily injury” includes mental anguish resulting from “physical abuse” or “sexual misconduct” of the person injured.
3. “Physical abuse” means actual, alleged, or threatened physical mistreatment.
4. “Sexual misconduct” means any conduct, whether actual, alleged, or threatened, of a sexual nature.
5. “Ultimate net loss” means the total amount which the insured is legally obligated to pay as damages due to an “occurrence” or offense arising out of covered claims or “suits” either by an adjudication or a settlement to which we agree in writing and includes interest that accrues after entry of the judgment and deductions for recoveries and salvages which have been or will be paid. "Ultimate net loss” does not include any of the expenses incurred by the insured or us in connection with defending the claim or “suit”.
Authorized Agent
ALL-32688 (01/11) Page 1 of 2
NOTICE TO OTHERS ENDORSEMENT - SPECIFIC PARTIES
NOTICE TO OTHERS ENDORSEMENT - SPECIFIC PARTIES
Named Insured Laboratory Corp of America Holdings Endorsement Number
Policy Symbol
HDO
Policy Number
G71567382
Policy Period
11/01/2020 TO 11/01/2021
Effective Date of Endorsement
Issued By (Name of Insurance Company)
ACE American Insurance Company
Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
A. If we cancel the Policy prior to its expiration date by notice to you or the first Named Insured for any reason other than nonpayment of premium, we will endeavor, as set out below, to send written notice of cancellation, via such electronic or other form of notification as we determine, to the persons or organizations listed in the schedule set out below (the “Schedule”). You or your representative must provide us with both the physical and e-mail address of such persons or organizations, and we will utilize such e-mail address or physical address that you or your representative provided to us on such Schedule.
B. We will endeavor to send or deliver such notice to the e-mail address or physical address corresponding to each person or organization indicated in the Schedule at least 30 days prior to the cancellation date applicable to the Policy.
C. The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). Our failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule shall impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy.
D. We are not responsible for verifying any information provided to us in any Schedule, nor are we responsible for any incorrect information that you or your representative provide to us. If you or your representative does not provide us with the information necessary to complete the Schedule, we have no responsibility for taking any action under this endorsement. In addition, if neither you nor your representative provides us with e-mail and physical address information with respect to a particular person or organization, then we shall have no responsibility for taking action with regard to such person or entity under this endorsement.
E. We may arrange with your representative to send such notice in the event of any such cancellation.
F. You will cooperate with us in providing, or in causing your representative to provide, the e-mail address and physical address of the persons or organizations listed in the Schedule.
G. This endorsement does not apply in the event that you cancel the Policy.
SCHEDULE
Name of Certificate Holder E-Mail Address Physical Address
Arizona Dept. of Economic Security, Division of Child Support Enforcement
P.O. Box 40458 Phoenix, AZ 85081
CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1
POLICY NUMBER: HDO G71567382 Endorsement Number: 118
COMMERCIAL GENERAL LIABILITY
CG 24 04 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
ELECTRONIC DATA LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES
POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS
SCHEDULE
Name Of Person(s) Or Organization(s):The State of Arizona, and departments, agencies, boards, commissions, universities, officers, agents, and employees for losses arising from work performed by or on behalf of the Contractor
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Conditions:
We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above.
DA-9U74c (03/16) Page 1 of 1
ADDITIONAL INSURED – DESIGNATED PERSONS OR ORGANIZATIONS
ADDITIONAL INSURED –
DESIGNATED PERSONS OR ORGANIZATIONS
Named Insured Laboratory Corporation of America Holdings Endorsement Number
Policy Symbol
ISA
Policy Number
H2531167A
Policy Period
11/01/2020 TO 11/01/2021
Effective Date of Endorsement
Issued By (Name of Insurance Company)
ACE American Insurance Company
Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
AUTO DEALERS COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
EXCESS BUSINESS AUTO COVERAGE FORM
Additional Insured(s): The State of Arizona, and its departments agencies, boards, commissions universities, officers, officials, agents and employees shall be named as additional insureds with respect to liability arising out of the activities performed by, or on behalf of, the Contractor, involving automobiles owned, leased, hired or borrowed by the Contractor
A. For a covered “auto,” Who Is Insured is amended to include as an “insured,” the persons or organizations named in this endorsement. However, these persons or organizations are an “insured” only for “bodily injury” or “property damage” resulting from acts or omissions of:
1. You.
2. Any of your “employees” or agents.
3. Any person operating a covered “auto” with permission from you, any of your “employees” or agents.
B. The persons or organizations named in this endorsement are not liable for payment of your premium.
Authorized Representative
DA-13115a (06/14) Page 1 of 1
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS
Named Insured Laboratory Corporation of America Holdings Endorsement Number
Policy Symbol
ISA
Policy Number
H2531167A
Policy Period
11/01/2020 TO 11/01/2021
Effective Date of Endorsement
Issued By (Name of Insurance Company)
ACE American Insurance Company
Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This Endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIERS COVERAGE FORM
AUTO DEALERS COVERAGE FORM
We waive any right of recovery we may have against the person or organization shown in the Schedule below because of payments we make for injury or damage arising out of the use of a covered auto. The waiver applies only to the person or organization shown in the SCHEDULE.
SCHEDULE
The State of Arizona, and its departments agencies, boards, commissions universities, officers, officials, agents and employees for losses arising from work performed by or on behalf of the Contractor
Authorized Representative
ALL-22422 (05/07) Page 1 of 1
PUBLIC ENTITY ADDITIONAL INSURED ENDORSEMENT
PUBLIC ENTITY ADDITIONAL INSURED ENDORSEMENT
Named Insured Laboratory Corp of America Holdings Endorsement Number
Policy Symbol
HDO
Policy Number
G71567382
Policy Period
11/01/2020 TO 11/01/2021
Effective Date of Endorsement
Issued By (Name of Insurance Company)
ACE American Insurance Company
Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
EXCESS COMMERCIAL GENERAL LIABILITY POLICY
BUSINESS AUTO COVERAGE FORM
SCHEDULE
(name and address of additional insured)
The State of Arizona, its departments, agencies, boards, commissions, universities, and its officers, officials, agents and employees.
ADDITIONAL INSURED
It is agreed that the entity shown in the Schedule, its Officers, Employees, and Agents are named as Additional Insureds with respect to the operations and activities of the Named Insured.
PRIMARY INSURANCE
Insurance provided by this policy shall be primary insurance and no other insurance or self insured retention carried or held by the Scheduled Entity shall be called upon to contribute to a loss covered by insurance for the named insured.
CANCELLATION CLAUSE
Thirty (30) days written notice shall be given to the Scheduled Entity in the event of cancellation and/or reduction in limits or coverage.
SEVERABILITY OF INTEREST
This insurance shall apply separately to each insured against whom claim is made or suit is brought except with respect to the limits of liability of the insuring company.
Except as stated above and not in conflict with this endorsement, nothing contained herein shall be held to waive, alter or extend any of the limits, agreements, or exclusions of the policy(ies) to which this endorsement applies.
All other terms and conditions of this policy remain the same.
Authorized Agent
| Labcorp_State of AZ Certificate of Insurance and Endorsements |
| LabCorp_State of AZ_COI |
| AZ_AI_GL |
| AZ End-Sexual Abuse & Molestation |
| AZ_NOC_GL |
| AZ_WOS_GL |
| AZ_AI_Auto |
| AZ_WOS_Auto |
| AZ_WOS_WC |
| Public Entity_GL |
Labcorp WC
File details come from the government source that posted it. Updated .