NTT_Data_COI_-_Expires_7-1-2024.pdf

CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)

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.

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).

PRODUCER CONTACT

NAME:

PHONE

(A/C, No, Ext):

FAX

(A/C, No):

E-MAIL

ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC #

INSURED

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: XXXXXXX

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.

INSR

LTR TYPE OF INSURANCE

ADDL

INSD

SUBR

WVD POLICY NUMBER

POLICY EFF

(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY) LIMITS

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY PRO-

JECT LOC

OTHER:

EACH OCCURRENCE

DAMAGE TO RENTED

PREMISES (Ea occurrence)

MED EXP (Any one person)

PERSONAL & ADV INJURY

GENERAL AGGREGATE

PRODUCTS - COMP/OP AGG

AUTOMOBILE LIABILITY

ANY AUTO

OWNED

AUTOS ONLY

HIRED

AUTOS ONLY

SCHEDULED

AUTOS

NON-OWNED

AUTOS ONLY

COMBINED SINGLE LIMIT

(Ea accident)

BODILY INJURY (Per person)

BODILY INJURY (Per accident)

PROPERTY DAMAGE

(Per accident)

UMBRELLA LIAB OCCUR

EXCESS LIAB CLAIMS-MADE

DED RETENTION $

EACH OCCURRENCE

AGGREGATE

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY Y / N

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH)

If yes, describe under DESCRIPTION OF OPERATIONS below

N / A

PER

STATUTE

OTH-

ER

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE

E.L. DISEASE - POLICY LIMIT

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

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE

ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved

The ACORD name and logo are registered marks of ACORD

LOCKTON COMPANIES

2100 ROSS AVENUE, SUITE 1400

DALLAS TX 75201

214-969-6700

NTT DATA State Health Consulting, LLC.

(fka Cognosante Consultants, LLC.)

Attn: Letisa McKenzie 7950 Legacy Drive, 11th Floor Plano TX 75024

7/1/2024

1539876

X

X X

1,000,000

XXXXXXX

XXXXXXX

XXXXXXX

XXXXXXX

X X 25,000,000 25,000,000

XXXXXXX

X X

1,000,000 1,000,000 15,000 1,000,000 2,000,000 2,000,000

PROF. E&O/CYBER $10M PER CLAIM

N

X 1,000,000 1,000,000 1,000,000

The Charter Oak Fire Insurance Company 25615

The Phoenix Insurance Company 25623

The Standard Fire Insurance Company 19070 The Travelers Indemnity Company of America 25666

Travelers Property Casualty Company of America 25674

Endurance American Specialty Insurance Co. 41718

B HOCAP-1J668701-COF-23 7/1/2023 7/1/2024

A HN-660-6N030306-PHX -- 23 7/1/2023 7/1/2024

F NRO30020463601 7/1/2023 7/1/2024

C CUP-1J668829-23-I3 7/1/2023 7/1/2024

D UB-5N963631-23-I3-K (AOS) 7/1/2023 7/1/2024

E UB-5N963182-23-I3-R (Retro) 7/1/2023 7/1/2024

See Attachments

State of Arizona 801 E Jefferson Street Phoenix AZ 85034

17987690

17987690

3/25/2024

THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER, APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERM(S) REFERENCED.

*Privacy and Network Security Liability included - $10M each claim limit, $10M aggregate limit, $2.5M retention* Certificate holder includes: State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees. Umbrella is follow form.

Y Y

Y N

Y N

Y

N N

COMMERCIAL GENERAL LIABILITY

Policy Number: HN-660-6N030306-PHX -- 23

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

BLANKET ADDITIONAL INSURED – AUTOMATIC STATUS

IF REQUIRED BY WRITTEN CONTRACT (CONTRACTORS)

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

The following is added to SECTION II – WHO IS AN INSURED:

(a) The Additional Insured – Owners, Les-sees or Contractors – Scheduled Person

07 04 or CG 20 10 04 13, the Additional

a. You agree in a written contract or agreement to

Insured – Owners, Lessees or Contrac-include as an additional insured on this Coverage tors – Completed Operations endorse- Part; and ment CG 20 37 07 04 or CG 20 37 04 13,

b. Has not been added as an additional insured for or both of such endorsements with either the same project by attachment of an endorse- of those edition dates; or ment under this Coverage Part which includes

(b) Either or both of the following: the Addi-such person or organization in the endorsement's tional Insured – Owners, Lessees or Con-schedule;

tractors – Scheduled Person Or Organi-is an insured, but: zation endorsement CG 20 10, or the Ad-

a. Only with respect to liability for "bodily injury" or ditional Insured – Owners, Lessees or "property damage" that occurs, or for "personal Contractors – Completed Operations en-injury" caused by an offense that is committed, dorsement CG 20 37, without an edition subsequent to the signing of that contract or date of such endorsement specified;

agreement and while that part of the contract or the person or organization is an additional in-agreement is in effect; and sured only if the injury or damage is caused,

b. Only as described in Paragraph (1), (2) or (3) be- in whole or in part, by acts or omissions of low, whichever applies: you or your subcontractor in the performance of "your work" to which the written contract or(1) If the written contract or agreement specifical-agreement applies; orly requires you to provide additional insured coverage to that person or organization by (3) If neither Paragraph (1) nor (2) above applies:

the use of: (a) The person or organization is an addi-

(a) The Additional Insured – Owners, Les- tional insured only if, and to the extent sees or Contractors – (Form B) endorse- that, the injury or damage is caused by ment CG 20 10 11 85; or acts or omissions of you or your subcon-tractor in the performance of "your work"(b) Either or both of the following: the Addi-to which the written contract or agree-tional Insured – Owners, Lessees or Con-ment applies; andtractors – Scheduled Person Or Organi-zation endorsement CG 20 10 10 01, or (b) Such person or organization does not the Additional Insured – Owners, Lessees qualify as an additional insured with re-or Contractors – Completed Operations spect to the independent acts or omis-endorsement CG 20 37 10 01; sions of such person or organization.

the person or organization is an additional in- The insurance provided to such additional insured is sured only if the injury or damage arises out subject to the following provisions:

of "your work" to which the written contract or a. If the Limits of Insurance of this Coverage Part agreement applies; shown in the Declarations exceed the minimum

(2) If the written contract or agreement specifical- limits required by the written contract or agree-ly requires you to provide additional insured ment, the insurance provided to the additional in-coverage to that person or organization by sured will be limited to such minimum required the use of: limits. For the purposes of determining whether

CG D6 04 02 19 © 2017 The Travelers IndemnityCompany. All rights reserved. Page 1 of 2

Attachment Code : D561308 Certificate ID : 17987690

COMMERCIAL GENERAL LIABILITY

this limitation , the minimum limits required in a claim. To the extent possible, such by the written contract or agreement will be con- notice should include:

sidered to include the minimum limits of any Um- (a) How, when and where the "occurrence" brella or Excess liability coverage required for theor offense took place;

additional insured by that written contract or

(b) The names and addresses of any injured agreement. This provision will not increase the persons and witnesses; and limits of insurance described in Section III – Limits Of Insurance.(c) The nature and location of any injury or damage arising out of the "occurrence" or

b. The insurance provided to such additional insured offense.

does not apply to:

(2) If a claim is made or "suit" is brought against

(1) Any "bodily injury", "property damage" or the additional insured:

"personal injury" arising out of the providing, or failure to provide, any professional archi- (a) Immediately record the of the tectural, engineering or surveying services, claim or "suit" and the date received; and including: (b) Notify us as soon as practicable and see to it that we receive written notice of the(a) The preparing, approving, or failing to claim or "suit" as soon asprepare or approve, maps, shop draw-ings, opinions, reports, surveys, field or- (3) Immediately send us copies of all legal pa-ders or change orders, or the preparing, pers received in connection with the claim or approving, or failing to prepare or ap- "suit", cooperate with us in the investigation prove, drawings and specifications; and of the claim or defense against

(b) Supervisory, inspection, architectural orthe "suit", and otherwise comply with all policy engineering activities. conditions.

(2) Any "bodily injury" or "property damage" (4) Tender the defense and indemnity of any caused by " work" and included in the claim or "suit" to any provider of other insur- "products-completed operations hazard" un- ance which would cover such additional in-less the written contract or agreement specifi- sured for a loss we cover. However, this con-cally requires you to provide such coverage dition does not affect whether the insurance for that additional insured during the policy provided to such additional insured is primary period. to other insurance available to such additional

c. The additional insured must comply with the insured which covers that person or organiza-lowing duties: tion as a named insured as described in Par-agraph 4., Other Insurance, of Section IV –(1) Give us written notice as soon as practicable Commercial General Liability Conditions.of an "occurrence" or an offense which may fol-your or settlement practicable.

specifics applies result

Page 2 of 2 © 2017 The Travelers IndemnityCompany. All rights reserved. CG D6 04 02 19

Attachment Code : D561308 Certificate ID : 17987690

COMMERCIAL AUTO

Policy No. HOCAP-1J668701-COF-23

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

BLANKET ADDITIONAL INSURED PRIMARY AND

NON-CONTRIBUTORY WITH OTHER INSURANCE

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

PROVISIONS 2. The following is added to Paragraph B .5., Other

1. The following is added to Paragraph A.1.c., Who Is An Insured, of SECTION II

COVERED CONDITIONS:

AUTOS LIABILITY COVERAGE: Regardless of the provisions of paragraph a. and This includes any person or organization who you paragraph d. of this part 5. Other Insurance, this are required under a written contract or insurance is primary to and non-contributory with agreement between you and that person or applicable other insurance under which an organization, that is signed by you before the additional insured person or organization is the "bodily injury" or "property damage" occurs and first named insured when the written contract or that is in effect during the policy period, to name agreement between you and that person or as an additional insured for Covered Autos organization, that is signed by you before the Liability Coverage, but only for damages to which "bodily injury" or "property damage" occurs and this insurance applies and only to the extent of that is in effect during the policy period, requires that person's or organization's liability for the this insurance to be primary and non-contributory.

conduct of another "insured".

CA T 4 74 02 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission.

Insurance of SECTION IV BUSINESS AUTO

Attachment Code : D569898 Certificate ID : 17987690

POLICY NUMBER: HN-660-6N030306-PHX -- 23

ISSUE DATE: 7/1/2023

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

DESIGNATED PERSON OR ORGANIZATION – NOTICE OF

CANCELLATION OR NONRENEWAL PROVIDED BY US

This endorsement modifies insurance provided under the following:

ALL COVERAGE PARTS INCLUDED IN THIS POLICY

SCHEDULE

CANCELLATION: Number of Days Notice: 30

WHEN WE DO NOT RENEW (Nonrenewal):

Number of Days Notice: 30

PERSON OR ORGANIZATION

Any person or organization to whom you have agreed in a written contract that notice of cancellation of this policy will be given, but only if:

1. You send us a written request to provide such notice, including the name and address of such person or organization, after the first Named Insured receives notice from us of the cancellation of this policy; and

2. We receive such written request at least 14 days before the beginning of the applicable number of days shown in this endorsement.

ADDRESS:

The address for the person or organization included in such written request from you to us.

PROVISIONS B. If we do not renew this policy for any legally

A. If we cancel this policy for any legally permitted permitted reason other than nonpayment of premium, and a number of days is shown for When We Do Not Renew (Nonrenewal) in the Schedule above, we will mail notice of nonrenewal to the person or organization shown in such Schedule. We will mail such notice to the address shown in the Schedule above at least the number of days shown for When We Do Not Renew (Nonrenewal) in such Schedule before the effective date of nonrenewal.

reason other than nonpayment of premium, and a number of days is shown for Cancellation in the Schedule above, we will mail notice of cancellation to the person or organization shown in such Schedule. We will mail such notice to the address shown in the Schedule above at least the number of days shown for Cancellation in such Schedule before the effective date of cancellation

IL T4 00 05 19 ú 2019 The Travelers Indemnity Company. All rights reserved Page 1 of 1

Attachment Code : D561375 Certificate ID : 17987690