CTR063267_Certificate_of_Insurance.pdf
PDF 17 KB Posted
- Attached to
- Master Agreement AZ|CTR063267
- Contract number
- CTR063267
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance dated August 18, 2023, for Follett Content Solutions, LLC, located in McHenry, IL. The insurance is provided by multiple carriers including StarNet Insurance Company, Berkley National Insurance Company, and Lexington Insurance Company. The certificate is issued to the State of Arizona, specifically for the State of Arizona located at 100 North 15th Avenue in Phoenix, with USI Insurance Services, LLC acting as the insurance producer.
The insurance coverage includes Commercial General Liability with a $1,000,000 each occurrence limit, Automobile Liability also with a $1,000,000 limit, and an Umbrella Liability policy with $20,000,000 coverage. Additionally, there is Workers Compensation insurance and a Cyber/Tech E&O policy with a $5,000,000 per occurrence/aggregate limit. The policies are effective from August 31, 2022, to August 31, 2023, with a special endorsement providing Additional Insured status to the State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees, but only when there is a written contract requiring such status.
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Text version
INSR ADDL SUBR
LTR INSR WVD
DATE (MM/DD/YYYY)
PRODUCER CONTACT
NAME:
FAXPHONE
(A/C, No):(A/C, No, Ext):
ADDRESS:
INSURER A :
INSURED INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
POLICY NUMBER
POLICY EFF POLICY EXP
TYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)
COMMERCIAL GENERAL LIABILITY
AUTOMOBILE LIABILITY
UMBRELLA LIAB
EXCESS LIAB
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
INSURER(S) AFFORDING COVERAGE NAIC #
Y / N
N / A (Mandatory in NH)
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
EACH OCCURRENCE $
DAMAGE TO RENTED
$PREMISES (Ea occurrence)CLAIMS-MADE OCCUR
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG $
PRO-
OTHER:
LOCJECT
COMBINED SINGLE LIMIT
$(Ea accident)
BODILY INJURY (Per person) $ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS
AUTOS ONLY
HIRED PROPERTY DAMAGE $
AUTOS ONLY (Per accident)
OCCUR EACH OCCURRENCE $
CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below
POLICY
NON-OWNED
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
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.
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.
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 any rights to the certificate holder in lieu of such endorsement(s).
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
CERTIFICATE HOLDER CANCELLATION
© 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03)
ACORDTM CERTIFICATE OF LIABILITY INSURANCE
StarNet Insurance Company
Berkley National Insurance Company
Lexington Insurance Company
8/18/2023
USI Insurance Services, LLC 8000 Norman Center Drive Suite 400 Bloomington, MN 55437
612 509-1001 610-537-1954 BloomingtonCertRequest@usi.com
Follett Content Solutions, LLC 1340 Ridgeview Drive Mc Henry, IL 60050
40045 38911 19437
A X X
X
TCP702112910 08/31/2022 08/31/2023 1,000,000
1,000,000 15,000 1,000,000 2,000,000 2,000,000
A X
X X
TCP702112910 08/31/2022 08/31/2023 1,000,000
A X X TCP702112910 08/31/2022 08/31/2023 20,000,000
20,000,000
B
N
TWC702113010 08/31/2022 08/31/2023 X
1,000,000
1,000,000 1,000,000
C Cyber / Tech E&O 015538110 09/09/2022 09/09/2023 $5,000,000 per occ/agg
This Certificate is issued for operations usual to the insured.
The General Liability, Automobile Liability and Umbrella Liability policies include an automatic Additional Insured endorsement that provides Additional Insured status to State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees, only when there is a written contract that requires such status, and only with regard to work performed by or on behalf of the (See Attached Descriptions)
State of Arizona 100 North 15th Avenue, Suite 305 Phoenix, AZ 85007
#S41194453/M37362305
FSSCONClient#: 1928474
JOBZZ
#S41194453/M37362305
SAGITTA 25.3 (2016/03)
DESCRIPTIONS (Continued from Page 1) named insured. The General Liability, Automobile Liability and Umbrella Liability policies contains a special endorsement with Primary and Noncontributory wording, when required by written contract. The General Liability and Workers Compensation policies provide a Blanket Waiver of Subrogation when required by written contract, except as prohibited by law.
#S41194453/M37362305
Job 1: State of Arizona
File details come from the government source that posted it. Updated .