NTT_Data_State_Health_Consulting_-_COI.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, LLC DBA Lockton Insurance Brokers, LLC in CA CA license #0F15767 2100 Ross Ave., Ste. 1400 Dallas TX 75201

(214) 720-5563

NTT DATA State Health Consulting, LLC.

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

7/1/2026

1462760

X

X X

1,000,000

XXXXXXX

XXXXXXX

XXXXXXX

XXXXXXX

XXXXXXX

XXXXXXX

X X

X $0 Deductible

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

N

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

The Phoenix Insurance Company 25623 The Travelers Indemnity Company of America 25666 Travelers Property Casualty Company of America 25674

B HHCAP-1J668701-TIA-25 7/1/2025 7/1/2026

A HN660-6N030306-PHX-25 7/1/2025 7/1/2026

C UB-0Y81711A-25-I3-K (AOS) 7/1/2025 7/1/2026

B UB-0Y810039-25-I3-R(Retro) 7/1/2025 7/1/2026

NOT APPLICABLE

See Attachments

Arizona Department of Administration State Procurement Office 1802 W. Jackson, #100 Phoenix AZ 85007

22297615

22297615

8/18/2025

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

Re: Contract Number: CTR078118. Certificate Holder Is Amended To Include: The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees.

X

Y Y

Y Y

Y

COMMERCIAL GENERAL LIABILITY

Policy Number: HN660-6N030306-PHX-25

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 : 22297615 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 : 22297615

Policy No. HN660-6N030306-PHX-25

Attachment Code : D561376 Certificate ID : 22297615

COMMERCIAL AUTO

Policy No. HHCAP-1J668701-TIA-25

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 : 22297615

POLICY

NUMBER:HN660-6N030306-PHX-25

M. BLANKET WAIVER OF SUBROGATION

The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of

SECTION IV – COMMERCIAL GENERAL

LIABILITY CONDITIONS:

If the insured has agreed in a contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of:

a. "Bodily injury" or "property damage" that occurs;

or

b. "Personal and advertising injury" caused by an offense that is committed;

subsequent to the execution of the contract or agreement.

Page 4 of 5 © 2017 The Travelers Indemnity Company. All rights reserved. CG D4 17 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission.

Attachment Code : D562177 Certificate ID : 22297615

Policy No. HHCAP-1J668701-TIA-25

(2) In or on your covered "auto".

This coverage applies only in the event of a total theft of your covered "auto".

No deductibles apply to this Personal Property coverage.

K. AIRBAGS

The following is added to Paragraph B.3., Exclu-sions, of SECTION III — PHYSICAL DAMAGE

COVERAGE:

Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered "auto" you own that in-flate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A.1.c., but only:

a. If that "auto" is a covered "auto" for Compre-hensive Coverage under this policy;

b. The airbags are not covered under any war-ranty; and

c. The airbags were not intentionally inflated.

We will pay up to a maximum of $1,000 for any one "loss".

L. NOTICE AND KNOWLEDGE OF ACCIDENT OR

LOSS

The following is added to Paragraph A.2.a., of

SECTION IV — BUSINESS AUTO CONDITIONS:

Your duty to give us or our authorized representa-tive prompt notice of the "accident" or "loss" ap-plies only when the "accident" or "loss" is known to:

(a) You (if you are an individual);

(b) A partner (if you are a partnership);

(c) A member (if you are a limited liability com-pany);

(d) An executive officer, director or insurance manager (if you are a corporation or other or-ganization); or

(e) Any "employee" authorized by you to give no-tice of the "accident" or "loss".

M. BLANKET WAIVER OF SUBROGATION

The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — BUSINESS AUTO CONDI-

TIONS:

5. Transfer Of Rights Of Recovery Against Others To Us

We waive any right of recovery we may have against any person or organization to the ex-tent required of you by a written contract signed and executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by

CA T3 53 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission.

You agree to maintain all required or compulsory insurance in any such country up to the minimum limits required by local law. Your failure to comply with compulsory insurance requirements will not invalidate the coverage afforded by this policy, but we will only be liable to the same extent we would have been liable had you complied with the compulsory in-surance requirements.

(d) It is understood that we are not an admit-ted or authorized insurer outside the United States of America, its territories and possessions, Puerto Rico and Can-ada. We assume no responsibility for the furnishing of certificates of insurance, or for compliance in any way with the laws of other countries relating to insurance.

G. WAIVER OF DEDUCTIBLE — GLASS

The following is added to Paragraph D., Deducti-ble, of SECTION III — PHYSICAL DAMAGE

COVERAGE:

No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced.

H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF

USE — INCREASED LIMIT

The following replaces the last sentence of Para-graph A.4.b., Loss Of Use Expenses, of SEC-

TION III — PHYSICAL DAMAGE COVERAGE:

However, the most we will pay for any expenses for loss of use is $65 per day, to a maximum of $750 for any one "accident".

I. PHYSICAL DAMAGE — TRANSPORTATION

EXPENSES — INCREASED LIMIT

The following replaces the first sentence in Para-graph A.4.a., Transportation Expenses, of

SECTION III — PHYSICAL DAMAGE COVER-

AGE:

We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in-curred by you because of the total theft of a cov-ered "auto" of the private passenger type.

J. PERSONAL PROPERTY

The following is added to Paragraph A.4., Cover-age Extensions, of SECTION III — PHYSICAL

DAMAGE COVERAGE:

Personal Property

We will pay up to $400 for "loss" to wearing ap-parel and other personal property which is:

(1) Owned by an "insured"; and

Attachment Code : D569902 Certificate ID : 22297615 such contract. The waiver applies only to the person or organization designated in such contract.

N. UNINTENTIONAL ERRORS OR OMISSIONS

The following is added to Paragraph B.2., Con-cealment, Misrepresentation, Or Fraud, of

The unintentional omission of, or unintentional error in, any information given by you shall not prejudice your rights under this insurance. How-ever this provision does not affect our right to col-lect additional premium or exercise our right of cancellation or non-renewal.

SECTION IV — BUSINESS AUTO CONDITIONS:

Page 4 of 4 @ 2015 The Travelers Indemnity Company. All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc. with its permission.

Attachment Code : D569902 Certificate ID : 22297615

AOS UB-0Y81711A-25-I3-K

WORKERS COMPENSATION

AND

EMPLOYERS LIABILITY POLICY

ENDORSEMENT WC 00 03 13 (00)-

POLICY NUMBER:

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.)

This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule.

SCHEDULE

DESIGNATED PERSON:

DESIGNATED ORGANIZATION:

ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED

BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS

WAIVER.

DATE OF ISSUE: 7-1-24 ST ASSIGN:

Attachment Code : D561974 Certificate ID : 22297615

WORKERS COMPENSATION

AND

EMPLOYERS LIABILITY POLICY

ENDORSEMENT WC 00 03 13 (00)-

POLICY NUMBER:

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.)

This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule.

SCHEDULE

DESIGNATED PERSON:

DESIGNATED ORGANIZATION:

ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED

BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS

WAIVER.

Retro UB-0Y810039-25-I3-R

07-01-2024DATE OF ISSUE: ST ASSIGN:

Attachment Code : D561975 Certificate ID : 22297615