Nationwide_COI_for_CGL-Auto-UL-WC-Excess_to_1-1-2025.pdf

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

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)

© 1988-2015 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

12/20/2023

Arthur J. Gallagher Risk Management Services, LLC 201 E 4th Street, Suite 625 Cincinnati OH 45202

Bryan Felix

CertRequests@ajg.com

Arch Insurance Company 11150 NATIMUT-02 Arch Indemnity Insurance Company 30830

Nationwide Retirement Solutions, Inc.

One Nationwide Plaza Columbus, OH 43215

INACTIVE Nationwide Mutual Insurance Company 23787 American Guarantee and Liability Ins Co 26247

875247203

A X 5,000,000 X 1,000,000

10,000

5,000,000

5,000,000 X

11GPP4972913 1/1/2024 1/1/2025

5,000,000

Deductible 5,000,000 A A

5,000,000

X

X X

11CAB4973013

11CAB4973113

1/1/2024 1/1/2024

1/1/2025 1/1/2025

Deductible 5,000,000 C X X 5,000,0001-18911-00-24 1/1/2024 1/1/2025

5,000,000

A B A

X11WCI4973213 (AOS)

14WCI1000513

11WCX4973413

1/1/2024 1/1/2024 1/1/2024

1/1/2025 1/1/2025 1/1/2025 1,000,000

1,000,000

1,000,000 D Excess Liability ZAU 9300394-23 1/1/2024 1/1/2025 Ea Occurance

Aggregate 15,000,000 15,000,000

The Excess Liability coverage, Policy #1-18911-00-24, Retention Alternatives Ltd, Hamilton, Bermuda placement was made by Nationwide Mutual Insurance Company. Arthur J. Gallagher Risk Management Services, LLC has only acted in the role of a consultant to the client with respect to this placement, which is indicated here for your convenience. This excess liability coverage applies only to auto liability

RE: ARIZONA STATE RETIREMENT SYSTEM (ASRS)/ AS400-NRSA-0024/SOUTH-SW PROOF OF COVERAGE NATONWIDE RETIREMENT SOLUTIONS, INC.

ARIZONA STATE RETIREMENT SYSTEM

3300 NORTH CENTRAL AVENUE, SUITE 1400

PHOENIX AZ 85012