CTR077825_COI_CGL_ALWCSAM_Exp10.1.26.pdf

PDF 2 MB Posted Aug 1, 2025

Attached to: Master Agreement AZ|CTR077825
Contract number: CTR077825
Issued by: Arizona

About this file

Written by GovTribe AI · Nov 26, 2025

This document is a comprehensive insurance certificate and related endorsements for the International Rescue Committee, Inc., involving multiple insurance policies issued by Philadelphia Indemnity Insurance Company, Continental Casualty Company, and National Fire Insurance Company. The primary certificate holder is the State of Arizona and its Department of Economic Security, with coverage extending to the state's departments, agencies, boards, commissions, universities, officers, officials, agents, and employees. The insurance policies include Commercial General Liability, Automobile Liability, Workers' Compensation, and Professional Liability coverage.

The insurance policies provide coverage from October 1, 2025 to October 1, 2026, with various liability limits including $1,000,000 for General Liability, $1,000,000 for Automobile Liability, $1,000,000 for Workers' Compensation, and $2,000,000 for Professional Liability (each occurrence and aggregate). The contract number is CTR077825, and the policies include additional insured provisions, waivers of subrogation, and primary and non-contributory coverage for the State of Arizona. The endorsements specifically protect the state and its entities from losses arising from work performed by or on behalf of the International Rescue Committee, with comprehensive coverage for potential liability, property damage, and other related risks.

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BPM006584_Exhibit_C_-_Arizona_s_Annual_Outcome_Goal_Plan.xls	XLS spreadsheet	Aug 1, 2025
BPM006584_Exhibit_B_-_RSS_Client_Services_Procedural_Manual.pdf	PDF	Aug 1, 2025
CTR077825_Attachment_14_Itemized_Service_Budget.pdf	PDF	Aug 1, 2025
CTR077825_Contract_Document.pdf	PDF	Aug 1, 2025
BPM006584_Exhibit_D_-_Contractor_s_Equipment_List.doc	DOC document	Aug 1, 2025
CTR077825_Attachment_12_BAA.pdf	PDF	Aug 1, 2025
CTR077825_Contract_Amendment_1.pdf	PDF	Aug 1, 2025
BPM006584_Exhibit_A_-_Arizona_State_Plan_for_Refugee_Resettlement.pdf	PDF	Aug 1, 2025
CTR077825_Contract_Summary.pdf	PDF	Aug 1, 2025

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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

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)

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

Willis Towers Watson Northeast, Inc.

c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA

International Rescue Committee, Inc.

122 East 42nd Street, 12th Floor New York, NY 10168

Contract number: CTR077825

SEE ATTACHED

The State of Arizona and Dept of Economic Security C/O: myCOI P.O. Box# 501970 8710 Bash Street Indianapolis, IN 46256

10/30/2025

1-877-945-7378 1-888-467-2378 certificates@willis.com

Philadelphia Indemnity Insurance Company 18058

Continental Casualty Company 20443

W41531340

1,000,000

100,000

5,000

1,000,000

3,000,000

Y Y PHPK2610041-010 10/01/2025 10/01/2026

1,000,000

10/01/202610/01/2025Y Y PHPK2610026-008

6020527252 B Y

1,000,000 No 10/01/2025 10/01/2026

1,000,000

A Abuse & Molestation Liability Each OccurrencePHPK2610041-010 10/01/2025 10/01/2026

Aggregate

418649628776112SR ID: BATCH:

$500,000

Willis Towers Watson Certificate Center

ACORD 101 (2008/01)

The ACORD name and logo are registered marks of ACORD

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:

International Rescue Committee, Inc.

122 East 42nd Street, 12th Floor New York, NY 10168

The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are included as an Additional Insured as respects to General Liability and Automobile Liability.

General Liability and Automobile Liability policies shall be Primary and Non-Contributory with any other insurance in force for or which may be purchased by Additional Insureds.

Waiver of Subrogation applies in favor of Additional Insureds with respects to General Liability, Automobile Liability and Worker's Compensation, as permitted by law.

Coverage for Contractual Liability is provided under the General Liability policy.

INSURER AFFORDING COVERAGE: Philadelphia Indemnity Insurance Company NAIC#: 18058

POLICY NUMBER: PHPK2610041-010 EFF DATE: 10/01/2025 EXP DATE: 10/01/2026

TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:

Professional Liability Each Occurrence $2,000,000 �� Aggregate $2,000,000

2 2

Willis Towers Watson Northeast, Inc.

See Page 1

See Page 1 See Page 1 See Page 1

25 Certificate of Liability Insurance

W41531340CERT:4186496BATCH:28776112SR ID:

COMMERCIAL GENERAL LIABILITY

CG 20 10 04 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2

ADDITIONAL INSURED – OWNERS, LESSEES OR

CONTRACTORS – SCHEDULED PERSON OR

ORGANIZATION

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE

Name Of Additional Insured Person(s) Location(s) Of Covered OperationsOr Organization(s)

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by:

1. Your acts or omissions; or

2. The acts or omissions of those acting on your behalf;

in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above.

However:

1. The insurance afforded to such additional insured only applies to the extent permitted by law; and

2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.

B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:

This insurance does not apply to "bodily injury" or "property damage" occurring after:

1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or

2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project.

out of the activities performed by or on behalf of the Contractor.

employees as additional insureds with respect to liability arising commissions, universities, officers, officials, agents, and

The State of Arizona, and its departments, agencies, boards, POLICY NUMBER: PHPK2188749

PHPK2610041

COMMERCIAL GENERAL LIABILITY

CG 24 04 05 09

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

SCHEDULE

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Conditions:

We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above.

POLICY NUMBER:

of the Contractor.

with respect to liability arising out of the activities performed by or on behalf universities,officers, officials, agents, and employees as additional insureds The State of Arizona, and its departments, agencies, boards, commissions, Name Of Person Or Organization:

PHPK2610041

COMMERCIAL AUTO

CA 20 48 02 99

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

DESIGNATED INSURED

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

GARAGE COVERAGE FORM

MOTOR CARRIER COVERAGE FORM

TRUCKERS COVERAGE FORM

With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi-fied by this endorsement.

This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi-sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.

This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.

Countersigned By:

Named Insured:

(Authorized Representative)

SCHEDULE

(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.)

Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form.

International Rescue Committee Inc.

1 1 and employees for losses arising from work performed by or on behalf of the Contractor.

State of Arizona, and its departments, agencies, boards,commissions, universities, officers, officials, agents, Name of Person(s) or Organization(s):

POLICY NUMBER:PHPK2610026

Endorsement Effective: 10/01/2024

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Workers Compensation And Employers Liability Insurance Policy Endorsement

*£!£;*RIGHr,),TO RECOVER FROM OTHERS ENDORSEMENTWAIVER •lain

We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.

This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.

Schedule

The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees for losses arising from work performed by or on behalf of the contractor.

i The premium charge for the endorsement is reflected in the Schedule of Operations.

All other terms and conditions of the policy remain unchanged.

This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. __a I I a

Policy No: WC 6020527252 Policy Effective Date: 10/01/2022 Policy Page: 221 of 372

Form No: WC 00 03 13 (04-1984)

Endorsement Effective Date:

Endorsement No: 8; Page: 1 of 1 Underwriting Company: National Fire Insurance Company of Hartford, 151 N Franklin St, Chicago. IL

60606

Endorsement Expiration Date: 10/01/2025

File details come from the government source that posted it. Updated Nov 26, 2025.

CTR077825_COI_CGL_AL__WC__SAM_Exp10.1.26.pdf

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CTR077825_COI_CGL_ALWCSAM_Exp10.1.26.pdf