Meketa_COI_for_CGL-WC-Auto-UL-EO_to_5-14-2024.pdf
PDF 151 KB Posted
- Attached to
- Master Agreement AZ|CTR057206
- Contract number
- CTR057206
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by Willis Towers Watson Northeast, Inc. for Meketa Investment Group, Inc., located in Westwood, MA. The certificate involves multiple insurance carriers including Great Northern Insurance Company, Federal Insurance Company, Everest National Insurance Company, Endurance American Insurance Company, and involves the State of Arizona and the Arizona State Retirement System as the certificate holder. The insurance policies are effective from 05/14/2023 to 05/14/2024.
The insurance coverage includes Commercial General Liability, Automobile Liability, Umbrella/Excess Liability, Workers' Compensation, and Errors and Omissions insurance. The policies provide various coverage limits, with the Commercial General Liability offering $1,000,000 per occurrence and $2,000,000 general aggregate. The Umbrella Liability provides $10,000,000 in coverage, and the Errors and Omissions policy has a per claim limit of $10,000,000 with a $500,000 retention. The certificate includes additional insured provisions for the certificate holder, with the General Liability policy being primary and non-contributory, and includes a waiver of subrogation in favor of 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
Willis Towers Watson Northeast, Inc.
c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA
Meketa Investment Group, Inc.
80 University Avenue Westwood, MA 02090
SEE ATTACHED
State of Arizona Arizona State Retirement System c/o Insurance Tracking Services, Inc.
P.O. Box 20270 Long Beach, CA 90801
05/23/2023
1-877-945-7378 1-888-467-2378 certificates@willis.com
Great Northern Insurance Company 20303
Federal Insurance Company
Everest National Insurance Company
20281
10120
Endurance American Insurance Company 10641
W29020729
A
1,000,000
1,000,000
10,000
1,000,000
2,000,000
Included
Y Y 3602-56-60 05/14/2023 05/14/2024
B
1,000,000
05/14/202405/14/2023Y 7362-24-02
B 10,000,000
7989-22-39 05/14/2023 05/14/2024 10,000,000
7175-00-12 B 1,000,000
No 05/14/2023 05/14/2024 1,000,000
1,000,000
C Errors and Omissions Per Claim LimitIMIP000309-231 05/14/2023 05/14/2024
Retention/Claim
298587424174529SR ID: BATCH:
$500,000
$10,000,000
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:
Meketa Investment Group, Inc.
80 University Avenue Westwood, MA 02090
Certificate Holder is included as an Additional Insureds respects to General Liability and Auto Liability.
General Liability policy 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 Certificate Holder with respects to General Liability.
INSURER AFFORDING COVERAGE: Endurance American Insurance Company NAIC#: 10641
POLICY NUMBER: FIX10007795106 EFF DATE: 05/14/2023 EXP DATE: 05/14/2024
TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:
1st Excess E&O Each Claim $5,000,000
INSURER AFFORDING COVERAGE: Endurance American Insurance Company NAIC#: 10641
POLICY NUMBER: FIX10007795106 EFF DATE: 05/14/2023 EXP DATE: 05/14/2024
TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:
2nd Excess E&O Each Claim $5,000,000
2 2
Willis Towers Watson Northeast, Inc.
See Page 1
See Page 1 See Page 1 See Page 1
25 Certificate of Liability Insurance
W29020729CERT:2985874BATCH:24174529SR ID:
10.0.2.20120224.1.869952
| DATE (MM/DD/YYYY): 05/23/2023 |
| PRODUCER: Willis Towers Watson Northeast, Inc. |
c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA
| FAX (A/C, No):: 1-877-945-7378 |
| FAX (A/C, No):: 1-888-467-2378 |
| FAX (A/C, No):: certificates@willis.com |
| NAIC #_INSURER A :: Great Northern Insurance Company |
| NAIC #_INSURER A :: 20303 |
| INSURED: Meketa Investment Group, Inc. |
80 University Avenue Westwood, MA 02090
| NAIC #_INSURER B :: Federal Insurance Company |
| NAIC #_INSURER C :: Everest National Insurance Company |
| NAIC #_INSURER B :: 20281 |
| NAIC #_INSURER C :: 10120 |
| NAIC #_INSURER D :: Endurance American Insurance Company |
| NAIC #_INSURER D :: 10641 |
| NAIC #_INSURER E :: |
| NAIC #_INSURER E :: |
| NAIC #_INSURER F :: |
| NAIC #_INSURER F :: |
| CERT_NUMBER: W29020729 |
| GL INSR LETTER: A |
| CGL_checkbox: Yes |
| Clams_Made_checkbox: 0 |
| Occur_checkbox: Yes |
| OTHER 1 checkbox: Off |
| OTHER 1 checkbox: Off |
| undefined: 1,000,000 |
| undefined: 1,000,000 |
| undefined: 10,000 |
| GL_OTHER_1_TYPE_OF_INS: |
| GL_OTHER_2_TYPE_OF_INS: |
| undefined: 1,000,000 |
| undefined: 2,000,000 |
| undefined: Included |
| Gen_Agg_Policy_checkbox: 0 |
| Gen_Agg_Project_checkbox: 0 |
| Gen_Agg_Location_checkbox: 0 |
| INSR ADDL_Row_1: Y |
| WVD SUBR_Row_1: Y |
| POLICY NUMBER_Row_1: 3602-56-60 |
| POLICY EFF (MM/DD/YYYY)_Row_1: 05/14/2023 |
| POLICY EXP (MM/DD/YYYY)_Row_1: 05/14/2024 |
| OTHER_LIMIT_DESC: |
| undefined: |
| ANY_AUTO_checkbox: 0 |
| AL INSR LETTER: B |
| undefined: 1,000,000 |
| NON-OWNED_AUTOS_checkbox: Yes |
| SCHEDULED_AUTOS_checkbox: Yes |
| ALL_OWNED_AUTOS_checkbox: 0 |
| HIRED_AUTO_checkbox: Yes |
| POLICY EXP (MM/DD/YYYY)_Row_1: 05/14/2024 |
| undefined: |
| POLICY EFF (MM/DD/YYYY)_Row_1: 05/14/2023 |
| undefined: |
| undefined: |
| AL_OTHER_1_checkbox: 0 |
| AL_OTHER_1_DESC: |
| PROPERTY DAMAGE (Per accident)_Row_1: |
| AL_OTHER_2_checkbox: 0 |
| AL_OTHER_2_DESC: |
| INSR ADDL_Row_2: Y |
| WVD SUBR_Row_2: |
| POLICY NUMBER_Row_2: 7362-24-02 |
| undefined: |
| UMB_LIAB: Yes |
| UMB_EX_OCC: Yes |
| UMB INSR LETTER: B |
| undefined: 10,000,000 |
| EX_LIAB_checkbox: 0 |
| CLAIMS_MADE_checkbox: 0 |
| RET_checkbox: 0 |
| DED_checkbox: Off |
| DED_RET_AMOUNT: |
| INSR ADDL_Row_3: |
| WVD SUBR_Row_3: |
| POLICY NUMBER_Row_3: 7989-22-39 |
| POLICY EFF (MM/DD/YYYY)_Row_3: 05/14/2023 |
| POLICY EXP (MM/DD/YYYY)_Row_3: 05/14/2024 |
| undefined: 10,000,000 |
| AGGREGATE_Row_1: |
| undefined: |
| POLICY NUMBER_N / A: 7175-00-12 |
| STATUTORY: Yes |
| OTHER: Off |
| WC_OTHER_DESC: |
| WC INSR LETTER: B |
| WVD SUBR_N / A: |
| undefined: 1,000,000 |
| Y / N: No |
| POLICY EFF (MM/DD/YYYY)_Row_3: 05/14/2023 |
| POLICY EXP (MM/DD/YYYY)_Row_3: 05/14/2024 |
| undefined: 1,000,000 |
| undefined: 1,000,000 |
| OTHER 1 INSR LETTER: C |
| OTHER_1_TYPE_OF_INS: Errors and Omissions |
| OTHER_2_TYPE_OF_INS: |
| N / A_Row_1: |
| WVD SUBR_Row_5: |
| N / A_Row_1: |
| OTHER_1_LIMIT_OF_INS: Per Claim Limit |
| OTHER 2 INSR LETTER: |
| POLICY NUMBER_Row_5: IMIP000309-231 |
| POLICY NUMBER_Row_5: |
| POLICY EFF (MM/DD/YYYY)_Row_5: 05/14/2023 |
| POLICY EFF (MM/DD/YYYY)_Row_5: |
| POLICY EXP (MM/DD/YYYY)_Row_5: 05/14/2024 |
| POLICY EXP (MM/DD/YYYY)_Row_5: |
| OTHER_2_LIMIT_OF_INS: Retention/Claim |
| WVD SUBR_Row_5: |
| OTHER 3 INSR LETTER: |
| WVD SUBR_Row_5: |
| POLICY NUMBER_Row_5: |
| POLICY EFF (MM/DD/YYYY)_Row_5: |
| OTHER_3_TYPE_OF_INS: |
| N / A_Row_1: |
| POLICY EXP (MM/DD/YYYY)_Row_5: |
| OTHER_3_LIMIT_OF_INS: |
| DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required): |
SEE ATTACHED
INSURED:
State of Arizona Arizona State Retirement System c/o Insurance Tracking Services, Inc.
P.O. Box 20270 Long Beach, CA 90801
| AUTHORIZED REPRESENTATIVE: |
| BATCH_NUMBER: 2985874 |
| SR_NUMBER: 24174529 |
| SRID_label: SR ID: |
| Batch_label: BATCH: |
| GL_Agg_applies_per_Other_checkbox: 0 |
| GL_Agg_applies_per_Other: |
| OTHER_3_LIMIT_OF_INS_AMT3: |
| OTHER_2_LIMIT_OF_INS_AMT_2: $500,000 |
| OTHER_1_LIMIT_OF_INS_AMT_1: $10,000,000 |
| Contact_Name: Willis Towers Watson Certificate Center |
| DATE (MM/DD/YYYY): Page 1 of 2 |
File details come from the government source that posted it. Updated .