IBM_Certificate_of_Insurance_-_Expires_6-1-2024.pdf
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- Attached to
- Master Agreement AZ|CTR062780
- Contract number
- CTR062780
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance for AT&T Corp., issued by Marsh USA, LLC, with Old Republic Insurance Company as the primary insurer. The certificate covers insurance policies for AT&T Corp. and includes the State of Arizona as an additional insured, specifically covering the state's departments, agencies, boards, commissions, universities, officers, officials, agents, and employees. The insurance policies are effective from 06/01/2023 to 06/01/2024 and provide coverage across multiple states, with specific provisions for Ohio and Washington.
The insurance certificate provides comprehensive coverage including Commercial General Liability, Automobile Liability, and Workers' Compensation/Employers' Liability. Key coverage limits include $2,000,000 for each occurrence under General Liability, $1,000,000 for Automobile Liability, and $1,000,000 for Workers' Compensation. The policy includes additional details such as self-insured retentions, with specific terrorism excess coverage of $600,000,000 for Ohio and Washington, and $500,000,000 for non-terrorism risks. The certificate serves as proof of insurance for AT&T Corp.'s contractual obligations with the State of Arizona, ensuring protection for both the insured and the certificate holder.
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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
N
X
Y
10,000,000
24147
MWXS 313639 23 (OH,WA)
A
1,000,000
06/01/2024 X
Excess Workers' Compensation /
CN103150778-GAW-CRT-23-24
1,000,000
Marsh | U.S. Operations
06/01/2024
CHI-010530910-01
06/01/2023
X
2,000,000
01/30/2024
1,000,000Employers' Liability
N
2,000,000 ju7072
EL Disease-Policy Limit
1,000,000 1,000,000
A
Att.CertRequest@marsh.com
06/01/2024
06/01/2023
06/01/2023MWTB 313635 23
EL Each Accident / EL Disease
N/A
MWC 313638 23 (AOS)
See Second Page
1,000,000
State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees is/are included as Additional Insured under the General Liability and Automobile Liability policies but only with respect to the requirements of the contract between the Certificate Holder and the Insured.
One AT&T Plaza
AT&T Corp.
Room 1820
208 South Akard
Dallas, TX 75202
2,000,000
Old Republic Insurance Company
X
800 Market Street, Suite 1800
MARSH USA, LLC.
St. Louis, MO 63101
MWZY 313636 23
N
1802 West Jackson Street - Number 100
Phoenix, AZ 85007
State of Arizona
Attn: Michael Hillebrand
06/01/2023
A
1,000,000
866-966-4664
X
A
06/01/2024
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:
MARSH USA, LLC.�
OH & WA - $600,000,000 Terrorism
Excess Workers' Compensation -MWXS 313639 23 (OH-WA) �
Self Insured Retentions �
St. Louis
Certificate of Liability Insurance
Dallas, TX 75202
OH & WA - $500,000,000 (except Terrorism) �
One AT&T Plaza� AT&T Corp.�
208 South Akard�
CN103150778
Room 1820�
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