State_of_AZ_-_COI-22-23_Anixter_Inc__1_.pdf

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

INSR ADDL SUBR

LTR INSD WVD

PRODUCER CONTACT

NAME:

FAXPHONE

(A/C, No):(A/C, No, Ext):

E-MAIL

ADDRESS:

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)

AUTOMOBILE LIABILITY

UMBRELLA LIAB

EXCESS LIAB

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

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

AUTHORIZED REPRESENTATIVE

EACH OCCURRENCE $

DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence)

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT

OTHER: $

COMBINED SINGLE LIMIT

$(Ea accident)

ANY AUTO BODILY INJURY (Per person) $

OWNED SCHEDULED

BODILY INJURY (Per accident) $AUTOS ONLY AUTOS

HIRED NON-OWNED PROPERTY DAMAGE

$AUTOS ONLY AUTOS ONLY (Per accident)

OCCUR EACH OCCURRENCE

CLAIMS-MADE AGGREGATE $

DED RETENTION $

PER OTH-

STATUTE ER

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE $

If yes, describe under

E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below

INSURER(S) AFFORDING COVERAGE NAIC #

COMMERCIAL GENERAL LIABILITY

Y / N N / A

(Mandatory in NH)

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

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.

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).

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

CERTIFICATE HOLDER CANCELLATION

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

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

The ACORD name and logo are registered marks of ACORD

10/10/2022

License # 60236

(412) 992-2801

23035

Anixter Inc. a Subsidiary of WESCO Distribution Inc.

225 W. Station Square, Suite 700 Pittsburgh, PA 15219

42404 33600 12489

A 1,000,000

X X TB2-631-510095-032 6/4/2022 6/4/2023 300,000

Contractual Liab 10,000

1,000,000 4,000,000 4,000,000

X DED: $500,000

2,000,000A

X X AS2631510095-042 6/4/2022 6/4/2023

Auto Truck Fleet DED: $500,000 5,000,000B

X X TH7-631-510095-062 6/4/2022 6/4/2023 5,000,000

10,000

C

X WA563D510095-012 6/4/2022 6/4/2023 1,000,000

N 1,000,000 1,000,000

A Auto Private Pass X X AS2631510095-092 6/4/2022 DED: $100,000 2,000,000 D Professional Liab 7GA7PL0000978-01 6/4/2022 6/4/2023 DED: $100,000 5,000,000

WESCO International Inc., WESCO Distribution, Inc. and any other organization, other than a partnership or joint venture, over which WESCO maintains ownership or majority interest on the effective date of the above referenced policies are included as Named Insureds.

RE: Solicitation BPM004541 If awarded the contract, the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees will be named additional insureds with respect to liability arising out of the activities performed by or on behalf of the contractor. Coverage shall be primary and non-contributory. A waiver of subrogation will be provided in favor of e State of Arizona, and its departments, agencies, boards, commissions, universities, SEE ATTACHED ACORD 101

Arizona Department of Administration State Procurement Office 100 N 15th Avenue, Suite 201 Phoenix, AZ 85007

WESCINT-01 CEISENREICH

HUB International Three Rivers 210 Sixth Avenue 30th Floor Pittsburgh, PA 15222

Patty Jordan

Patty.Jordan@hubinternational.com

Liberty Mutual Fire Insurance Company Liberty Insurance Corporation LM Insurance Corporation Bridgeway Insurance Company

X

6/4/2023

X X

X

X

X

X X

X

X

X

X

FORM NUMBER:

EFFECTIVE DATE:

The ACORD name and logo are registered marks of ACORD

ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE

FORM TITLE:

Page of

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

ACORD 101 (2008/01)

AGENCY CUSTOMER ID:

LOC #:

AGENCY NAMED INSURED

POLICY NUMBER

CARRIER NAIC CODE

© 2008 ACORD CORPORATION. All rights reserved.

HUB International Three Rivers

WESCINT-01

SEE PAGE 1

SEE PAGE 1

ACORD 25 Certificate of Liability Insurance

License # 60236

SEE P 1

Anixter Inc. a Subsidiary of WESCO Distribution Inc.

225 W. Station Square, Suite 700 Pittsburgh, PA 15219

SEE PAGE 1

CEISENREICH

Description of Operations/Locations/Vehicles:

officers, officials, agents, and employees as required by contract. 30 day notice of cancellation will be provided in accordance with the insurance policy provisions.