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

E-MAIL

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

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