CTR057656_Certificate_of_Insurance.pdf
PDF 172 KB Posted
- Attached to
- Master Agreement AZ|CTR057656
- Contract number
- CTR057656
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance for Proquest LLC, issued by Willis Towers Watson Insurance Services West, Inc. The certificate involves multiple insurers, including Federal Insurance Company and Great Northern Insurance Company, and is specifically designed to provide coverage for the State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees. The certificate holder is the State of Arizona State Procurement Office located in Phoenix, Arizona.
The insurance coverage includes Commercial General Liability, Automobile Liability, Umbrella Liability, and Workers' Compensation, with policy periods from 12/01/2022 to 12/01/2023. Key coverage limits include $1,000,000 for Commercial General Liability and Automobile Liability, $10,000,000 for Umbrella Liability, and $1,000,000 for Workers' Compensation. The policy provides additional insured status to the State of Arizona and includes provisions for primary and non-contributory coverage, as well as a waiver of subrogation for general liability, auto liability, and workers' compensation 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
Willis Towers Watson Insurance Services West, Inc.
c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA
Proquest LLC 3133 W Frye Road Suite 401 Chandler, AZ 85226
THE STATE OF ARIZONA AND ITS DEPARTMENTS, AGENCIES, BOARDS, COMMISSIONS, UNIVERSITIES, OFFICERS, OFFICIALS, AGENTS, AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSURED WITH REGARD TO GENERAL LIABILITY AND AUTO LIABILITY WHERE REQUIRED BY
WRITTEN CONTRACT.
PRIMARY AND NON-CONTRIBUTORY IS PROVIDED WITH REGARD TO GENERAL LIABILITY WHERE REQUIRED BY WRITTEN CONTRACT.
STATE OF ARIZONA
STATE PROCUREMENT OFFICE
100 NORTH 15TH AVENUE, SUITE 201
PHOENIX, AZ 85007
11/30/2022
1-877-945-7378 1-888-467-2378 certificates@willis.com
Federal Insurance Company 20281
Great Northern Insurance Company 20303
W26786386
A
1,000,000
1,000,000
10,000
1,000,000
2,000,000
1,000,000
Y Y 3604-45-27 12/01/2022 12/01/2023
B
1,000,000
12/01/202312/01/2022Y Y 7359-54-50
A 10,000,000
7818-26-80 12/01/2022 12/01/2023 10,000,000
(23) 7176-34-98 A Y
1,000,000 No 12/01/2022 12/01/2023
1,000,000
1,000,000
275823423375785SR ID: BATCH:
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:
Proquest LLC 3133 W Frye Road Suite 401 Chandler, AZ 85226
AUTO LIABILITY SHALL BE PRIMARY AND NON-CONTRIBUTORY WITH ANY OTHER INSURANCE IN FORCE FOR OR WHICH MAY BE PURCHASED
BY ADDITIONAL INSURED.
WAIVER OF SUBROGATION APPLIES WITH REGARD TO GENERAL LIABILITY, AUTO LIABILITY AND WORKERS COMPENSATION WHERE REQUIRED
BY WRITTEN CONTRACT AND AS PERMITTED BY LAW.
2 2
Willis Towers Watson Insurance Services West, Inc.
See Page 1
See Page 1 See Page 1 See Page 1
25 Certificate of Liability Insurance
W26786386CERT:2758234BATCH:23375785SR ID:
10.0.2.20120224.1.869952
| DATE (MM/DD/YYYY): 11/30/2022 |
| PRODUCER: Willis Towers Watson Insurance Services West, 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 :: Federal Insurance Company |
| NAIC #_INSURER A :: 20281 |
| INSURED: Proquest LLC |
3133 W Frye Road Suite 401 Chandler, AZ 85226
| NAIC #_INSURER B :: Great Northern Insurance Company |
| NAIC #_INSURER C :: |
| NAIC #_INSURER B :: 20303 |
| NAIC #_INSURER C :: |
| NAIC #_INSURER D :: |
| NAIC #_INSURER D :: |
| NAIC #_INSURER E :: |
| NAIC #_INSURER E :: |
| NAIC #_INSURER F :: |
| NAIC #_INSURER F :: |
| CERT_NUMBER: W26786386 |
| GL INSR LETTER: A |
| CGL_checkbox: Yes |
| Clams_Made_checkbox: 0 |
| Occur_checkbox: Yes |
| OTHER 1 checkbox: Off |
| OTHER 1 checkbox: Off |
| undefined: 1,000,000 |
| undefined: 1,000,000 |
| undefined: 10,000 |
| GL_OTHER_1_TYPE_OF_INS: |
| GL_OTHER_2_TYPE_OF_INS: |
| undefined: 1,000,000 |
| undefined: 2,000,000 |
| undefined: 1,000,000 |
| Gen_Agg_Policy_checkbox: 0 |
| Gen_Agg_Project_checkbox: 0 |
| Gen_Agg_Location_checkbox: 0 |
| INSR ADDL_Row_1: Y |
| WVD SUBR_Row_1: Y |
| POLICY NUMBER_Row_1: 3604-45-27 |
| POLICY EFF (MM/DD/YYYY)_Row_1: 12/01/2022 |
| POLICY EXP (MM/DD/YYYY)_Row_1: 12/01/2023 |
| OTHER_LIMIT_DESC: |
| undefined: |
| ANY_AUTO_checkbox: Yes |
| AL INSR LETTER: B |
| undefined: 1,000,000 |
| 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: 12/01/2023 |
| undefined: |
| POLICY EFF (MM/DD/YYYY)_Row_1: 12/01/2022 |
| undefined: |
| undefined: |
| AL_OTHER_1_checkbox: 0 |
| AL_OTHER_1_DESC: |
| PROPERTY DAMAGE (Per accident)_Row_1: |
| AL_OTHER_2_checkbox: 0 |
| AL_OTHER_2_DESC: |
| INSR ADDL_Row_2: Y |
| WVD SUBR_Row_2: Y |
| POLICY NUMBER_Row_2: 7359-54-50 |
| undefined: |
| UMB_LIAB: Yes |
| UMB_EX_OCC: Yes |
| UMB INSR LETTER: A |
| 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: 7818-26-80 |
| POLICY EFF (MM/DD/YYYY)_Row_3: 12/01/2022 |
| POLICY EXP (MM/DD/YYYY)_Row_3: 12/01/2023 |
| undefined: 10,000,000 |
| AGGREGATE_Row_1: |
| undefined: |
| POLICY NUMBER_N / A: (23) 7176-34-98 |
| STATUTORY: Yes |
| OTHER: Off |
| WC_OTHER_DESC: |
| WC INSR LETTER: A |
| WVD SUBR_N / A: Y |
| undefined: 1,000,000 |
| Y / N: No |
| POLICY EFF (MM/DD/YYYY)_Row_3: 12/01/2022 |
| POLICY EXP (MM/DD/YYYY)_Row_3: 12/01/2023 |
| undefined: 1,000,000 |
| undefined: 1,000,000 |
| OTHER 1 INSR LETTER: |
| OTHER_1_TYPE_OF_INS: |
| OTHER_2_TYPE_OF_INS: |
| N / A_Row_1: |
| WVD SUBR_Row_5: |
| N / A_Row_1: |
| OTHER_1_LIMIT_OF_INS: |
| OTHER 2 INSR LETTER: |
| POLICY NUMBER_Row_5: |
| POLICY NUMBER_Row_5: |
| POLICY EFF (MM/DD/YYYY)_Row_5: |
| POLICY EFF (MM/DD/YYYY)_Row_5: |
| POLICY EXP (MM/DD/YYYY)_Row_5: |
| POLICY EXP (MM/DD/YYYY)_Row_5: |
| OTHER_2_LIMIT_OF_INS: |
| 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: |
| DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, 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 INSURED WITH REGARD TO GENERAL LIABILITY AND AUTO LIABILITY WHERE REQUIRED BY
WRITTEN CONTRACT.
PRIMARY AND NON-CONTRIBUTORY IS PROVIDED WITH REGARD TO GENERAL LIABILITY WHERE REQUIRED BY WRITTEN CONTRACT.
INSURED:
STATE OF ARIZONA
STATE PROCUREMENT OFFICE
100 NORTH 15TH AVENUE, SUITE 201
PHOENIX, AZ 85007
| AUTHORIZED REPRESENTATIVE: |
| BATCH_NUMBER: 2758234 |
| SR_NUMBER: 23375785 |
| 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: |
| OTHER_2_LIMIT_OF_INS_AMT_2: |
| OTHER_1_LIMIT_OF_INS_AMT_1: |
| Contact_Name: Willis Towers Watson Certificate Center |
| DATE (MM/DD/YYYY): Page 1 of 2 |
File details come from the government source that posted it. Updated .