CTR061242__COI-CGL__Pollution__Professional_thru_10.1.22.PDF
PDF 222 KB Posted
- Attached to
- Master Agreement AZ|CTR061242
- Contract number
- CTR061242
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for The GEO Group Inc and its subsidiaries, including GEO Transport, Inc., located in Boca Raton, FL. The certificate involves multiple insurance providers, including National Union Fire Insurance Company, American Guarantee and Liability Insurance Company, AIU Insurance Company, Steadfast Insurance Company, Ironshore Specialty Insurance Company, and Berkley National Insurance Company. The certificate references the State of Arizona Department of Corrections, Rehabilitation & Reentry Procurement Services as a key stakeholder, with Willis Towers Watson Southeast, Inc. serving as the insurance producer.
The insurance coverage includes multiple policy types with significant liability limits: General Liability with $5 million coverage and civil rights provisions, Automobile Liability with $5 million limits for various states (VA, MA), Workers' Compensation coverage for multiple states (WI, NY, CA) with $2 million limits, Pollution Liability with a $10 million per incident and aggregate limit, Professional Liability with $3 million per loss and annual aggregate, and Excess Liability coverage with layered limits ranging from $5 million to $25 million. The policies are effective from 10/01/2021 to 10/01/2022, with provisions for additional insured status, blanket waiver of subrogation, and primary non-contributory insurance conditions.
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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 GEO Transport, 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
State of Arizona Department of Corrections, Rehabilitation & Reentry Procurement Services 1645 W Jefferson Street Phoenix, AZ 85007
07/18/2022
1-877-945-7378 1-888-467-2378 certificates@willis.com
National Union Fire Insurance Company of P 19445
American Guarantee and Liability Insurance
AIU Insurance Company
26247
19399
Steadfast Insurance Company 26387
Ironshore Specialty Insurance Company 25445
Berkley National Insurance Company 38911
W25444638
A
5,000,000
5,000,000
0Civil Rights
5,000,000
25,000,000
5,000,000
Y Y 1729003 10/01/2021 10/01/2022
A
5,000,000
10/01/202210/01/2021Y Y 4594443
B 15,000,000
IPR 3792274-07 10/01/2020 10/01/2022 15,000,000
065885756 C Y
2,000,000 No 10/01/2021 10/01/2022
2,000,000
2,000,000
D Professional Liability Per LossIPR 3792303-09 10/01/2021 10/01/2022
Annual Aggregate
259896822848674SR ID: BATCH:
$3,000,000
$3,000,000
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 GEO Transport, 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.
INSURER AFFORDING COVERAGE: AIU Insurance Company NAIC#: 19399
POLICY NUMBER: 065885755 EFF DATE: 10/01/2021 EXP DATE: 10/01/2022
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: AIU Insurance Company NAIC#: 19399
POLICY NUMBER: 065885758 EFF DATE: 10/01/2021 EXP DATE: 10/01/2022
SUBROGATION WAIVED: Y
TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:
Workers Compensation - NY Each Accident $2,000,000 Per Statute Disease Each Empl $2,000,000 ����������� Disease Pol Limit $2,000,000
INSURER AFFORDING COVERAGE: AIU Insurance Company NAIC#: 19399
POLICY NUMBER: 065885757 EFF DATE: 10/01/2021 EXP DATE: 10/01/2022
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 4
Willis Towers Watson Southeast, Inc.
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25 Certificate of Liability Insurance
W25444638CERT:2598968BATCH:22848674SR ID:
© 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 GEO Transport, Inc.
4955 Technology Way Boca Raton, FL 33431
INSURER AFFORDING COVERAGE: National Union Fire Insurance Company of Pittsburgh NAIC#: 19445
POLICY NUMBER: 4594445 EFF DATE: 10/01/2021 EXP DATE: 10/01/2022
ADDITIONAL INSURED: Y
SUBROGATION WAIVED: Y
TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:
Automobile Liability - VA Only Any Auto - CSL Limit: $5,000,000 Any Auto including Hired & Non-Owned
INSURER AFFORDING COVERAGE: National Union Fire Insurance Company of Pittsburgh NAIC#: 19445
POLICY NUMBER: 4594444 EFF DATE: 10/01/2021 EXP DATE: 10/01/2022
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: Ironshore Specialty Insurance Company NAIC#: 25445
POLICY NUMBER: 004443800 EFF DATE: 10/01/2020 EXP DATE: 10/01/2023
TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:
Pollution Liability Each Incident $10,000,000 ������������������� Policy Aggregate $10,000,000 ������������������� Retention $100,000
3 4
Willis Towers Watson Southeast, Inc.
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© 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 GEO Transport, Inc.
4955 Technology Way Boca Raton, FL 33431
INSURER AFFORDING COVERAGE: Berkley National Insurance Company NAIC#: 38911
POLICY NUMBER: CEX09602890-4 EFF DATE: 10/01/2021 EXP DATE: 10/01/2022
TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:
Excess Liability Limit $5M XS $15M
INSURER AFFORDING COVERAGE: Endurance Assurance Corporation NAIC#: 11551
POLICY NUMBER: EXC10005626207 EFF DATE: 10/01/2021 EXP DATE: 10/01/2022
TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:
Excess Liability Limit $5M x $20M
4 4
Willis Towers Watson Southeast, Inc.
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