CTR055585_-_COI_and_Endorsements.pdf
PDF 2 MB Posted
- Attached to
- Master Agreement AZ|CTR055585
- Contract number
- CTR055585
- Issued by
- Arizona
About this file
This document is a comprehensive Certificate of Liability Insurance for Equifax Workforce Solutions, LLC, issued by multiple insurers including Zurich American Insurance Company, XL Specialty Insurance Company, and Syndicates at Lloyd's. The certificate covers various insurance types for Equifax, with the State of Arizona and its Department of Economic Security named as the primary certificate holder. The insurance policies are effective from 05/01/2024 to 05/01/2025, with coverage spanning Commercial General Liability, Automobile Liability, Workers Compensation, Professional Liability, Cyber, Crime, and other associated insurance types.
The contract appears to be related to income and verification services, specifically referencing Contract ID: CTR055585 between Equifax Workforce Solutions and the Arizona Department of Economic Security. The insurance provides coverage with various limits, including $1,000,000 for General Liability, $15,000,000 in Excess Liability, $2,000,000 for Workers Compensation, and additional coverages for Professional Liability, Cyber, and Crime. The policy includes additional insured provisions for the State of Arizona, its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees, with waiver of subrogation applicable where required by written contract.
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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
05/01/2024
X
A
2,000,000
WC 4257158-01 (AZ)
16535
W20485241301
C
A
15,000,000
05/01/2025 X
XL Specialty Insurance Company
Professional Liability/Cyber
CN101920890-TALX-GAWUP-24-25
1,000,000
37540
12/15/2025
ATL-005262959-29
05/01/2024
X
2,000,000
12/06/2024
Cyber and E&O coverages are also included subject to policy terms and conditions.
5,000,000
05/01/2025
Crime
1,000,000
LIMIT:12/15/2025
1,000,000 1,000,000
A
05/01/2025
12/15/2024
05/01/2024
37885
GLA 3906538-01
Cyber and E&O Limit
10,000
WC 4257158-01 (AOS)
ELU201156-24
1,000,000
The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees is/are included as additional insured where required by written contract with respect to General Liability, Auto Liability, Professional Liability. Waiver of subrogation is applicable where required by written contract in regards to General Liability, Auto Liability, and Workers Compensation.
Re: ADES. – Contract ID: CTR055585.
11432 LACKLAND ROAD
EQUIFAX WORKFORCE SOLUTIONS, LLC
ST LOUIS, MO 63146
1,000,000
Zurich American Insurance Company
X
TWO ALLIANCE CENTER
MARSH USA, LLC.
ATLANTA, GA 30326
3560 LENOX ROAD, SUITE 2400
Attn: Atlanta.CertRequest@marsh.com / Fax: 212-948-4321
GLA 3906538-01
Syndicates 2623/623 at Lloyd's
12/15/2024
N
C/O: myCOI, 1075 Broad Ripple Ave, Suite 313
Indianapolis, IN 46220
The State of Arizona and
Dept. of Economic Security, 05/01/2024
A
1,000,000
X
B
05/01/2025
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:
MARSH USA, LLC.�
Cyber: the limit shown is the occurrence and aggregate limit. �
Atlanta
Certificate of Liability Insurance25
11432 LACKLAND ROAD�
EQUIFAX WORKFORCE SOLUTIONS, LLC�
ST LOUIS, MO 63146
CN101920890
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