LexisNexis_COI_01.01.2021.pdf

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Id e n ti fi e r

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77777 77707 07070 00735 25677 11545 60007 77415 01317 35474 07573 77234 71265 40071 66237 71203 61100 70336 22212 07350 00752 63773 02476 01107 47237 22071 33544 07123 73374 31661 10071 32327 35316 21000 77756 16335 17655 40777 77770 70007 07007

C e rt if ic a te

N o

CERTIFICATE OF LIABILITY INSURANCE

DATE(MM/DD/YYYY)

12/31/2019

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.

PRODUCER

Aon Risk Services Northeast, Inc.

Boston MA Office 53 State Street Suite 2201 Boston MA 02109 USA

PHONE

(A/C. No. Ext):

E-MAIL

ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC #

(866) 283-7122

INSURED 16535Zurich American Ins CoINSURER A:

22667ACE American Insurance CompanyINSURER B:

AA1780059Zurich Insurance PlcINSURER C:

INSURER D:

INSURER E:

INSURER F:

FAX

(A/C. No.):

(800) 363-0105

CONTACT

NAME:

LexisNexis 125 Park Ave 24th Floor New York NY 10017 USA

COVERAGES CERTIFICATE NUMBER: 570079933933 REVISION NUMBER:

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. Limits shown are as requested

POLICY EXP

(MM/DD/YYYY)

POLICY EFF

(MM/DD/YYYY)

SUBR

WVD

INSR

LTR

ADDL

INSD POLICY NUMBER TYPE OF INSURANCE LIMITS

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

POLICY LOC

EACH OCCURRENCE

DAMAGE TO RENTED

PREMISES (Ea occurrence)

MED EXP (Any one person)

PERSONAL & ADV INJURY

GENERAL AGGREGATE

PRODUCTS - COMP/OP AGG

X

X

X

GEN'L AGGREGATE LIMIT APPLIES PER:

$10,000,000

$1,000,000

$5,000

$10,000,000

$10,000,000

$10,000,000

$5,000,000Host Liquor Liab

B 01/01/2020 01/01/2021OGLG46663160

PRO-

JECT

OTHER:

AUTOMOBILE LIABILITY

ANY AUTO

OWNED

AUTOS ONLY

SCHEDULED

AUTOS

HIRED AUTOS

ONLY

NON-OWNED

AUTOS ONLY

BODILY INJURY ( Per person)

PROPERTY DAMAGE

(Per accident)

X

X

BODILY INJURY (Per accident)

$5,000,000A 01/01/2020 01/01/2021

Collision Ded $1,000

COMBINED SINGLE LIMIT

(Ea accident)

8376848 21

Comp Ded $1,000X

EXCESS LIAB

X OCCUR

CLAIMS-MADE AGGREGATE

EACH OCCURRENCE

DED

$45,000,000

$45,000,000

01/01/2020UMBRELLA LIABC 12/31/2020GBCGP2001519

RETENTION

X

E.L. DISEASE-EA EMPLOYEE

E.L. DISEASE-POLICY LIMIT

E.L. EACH ACCIDENT $1,000,000

X OTH-

ER

PER STATUTEA 01/01/2020 01/01/2021

$1,000,000

Y / N

(Mandatory in NH)

ANY PROPRIETOR / PARTNER / EXECUTIVE

OFFICER/MEMBER EXCLUDED? N / AN

WORKERS COMPENSATION AND

EMPLOYERS' LIABILITY

If yes, describe under DESCRIPTION OF OPERATIONS below

$1,000,000

837684521

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

Arizona Department of Administration is included as Additional Insured in accordance with the policy provisions of the General Liability policy.

CANCELLATIONCERTIFICATE HOLDER

AUTHORIZED REPRESENTATIVEArizona Department of Administration State Procurement Office Suite 201, 100 North 15thAvenue Phoenix AZ 85007 USA

ACORD 25 (2016/03)

©1988-2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE

EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE

POLICY PROVISIONS.

ADDITIONAL REMARKS SCHEDULE

AGENCY CUSTOMER ID:

LOC #:

ADDITIONAL REMARKS

EFFECTIVE DATE:

CARRIER NAIC CODE

NAMED INSUREDAGENCY

See Certificate Number:

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance

570000055869

Aon Risk Services Northeast, Inc.

570079933933

570079933933

See Certificate Number:

POLICY NUMBER

Companies Affording coverage

COMPANYLINE OF BUSINESS DESCRIPTION POLICY NUMBER NAICPOLICY

EFFECTIVE

DATE

(MM/DD/YYYY)

POLICY

EXPIRATION

DATE

(MM/DD/YYYY)

PRIMARY

(Y/N)

FLAG

PERCENTAGE

OF

RISK

Page _ of _

LexisNexis

837684521Workers Compensation Zurich American Ins Co 16535

8376848 21Business Auto Coverage Zurich American Ins Co 16535 100

GBCGP2001519Excess Liability Coverage

Zurich Insurance Plc AA1780059 100

OGLG46663160General Liability Coverage

ACE American Insurance Company 22667 100

Y

Y

Y

Y

1/1/2020 1/1/2021

1/1/2020

1/1/2020

1/1/2020 1/1/2021

12/31/2020

1/1/2021

The Subscribing insurers' obligations under contra cts of insurance to which they subscribe are severa l and not joint and are limited solely to the extent of their individual su bscriptions. The subscribing insurers are not respo nsible for the subscription of any co-subscribing insurer who for any reason do es not satisfy all or part of its obligations.

ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD