StateofArizona_HealthLab_W27905417__1_.pdf
PDF 137 KB Posted
- Attached to
- Master Agreement AZ|CTR057480
- Contract number
- CTR057480
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance for Matheson Tri-Gas, Inc., issued by Willis Towers Watson Northeast, Inc. on 01/12/2023. The certificate involves multiple insurance policies covering the company, with the primary certificate holder being the State of Arizona/Health Lab, Materials & Facilities Management, located in Phoenix, Arizona. The insurers include Tokio Marine Specialty Insurance Company and ACE American Insurance Company.
The insurance policies provide comprehensive coverage across multiple areas, including commercial general liability, automobile liability, umbrella/excess liability, and workers' compensation. The policies are effective from 12/01/2022 to 12/01/2023 (commercial general liability and excess liability) and 10/01/2022 to 10/01/2023 (automobile and workers' compensation). Coverage limits vary by policy type, with general liability set at $1,000,000 per occurrence, a $10,000,000 aggregate, and a $2,000,000 self-insured retention. Automobile liability and workers' compensation policies have similar comprehensive coverage limits designed to protect the insured across various operational scenarios.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| CTR057480_Pricing_-_Per_A6.xlsx | XLSX spreadsheet | |
| CTR057480_Contract_Amendment_Summary_2.docx | DOCX document | |
| CTR057480_Contract_Amendment_No._6__2_.pdf | ||
| CTR057480_Contract_Amendment_4.docx.pdf | ||
| FM_301_Procurement_File_Checklist.docx | DOCX document | |
| CTR057480_Pricing_Amendment_1.xlsx | XLSX spreadsheet | |
| CTR057480_Contract_Amendment_5.docx.pdf | ||
| CTR057480_Contract_Amendment_Summary_3.docx | DOCX document | |
| ADOAStateProcurementOffice_StateofArizona_W36358679__1_.pdf | ||
| MathesonTri-GasInc_-_Client_Pack_-_3401232.PDF |
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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
Matheson Tri-Gas, Inc.
3 Mountainview Road, 3rd Floor Warren, NJ 07059
State of Arizona/Health Lab Materials & Facilities Management/Brenda Accounting 1740 W. Adams Phoenix, AZ 85007
01/12/2023
1-877-945-7378 1-888-467-2378 certificates@willis.com
Tokio Marine Specialty Insurance Company 23850
ACE American Insurance Company 22667
W27905417
A
1,000,000
500,000
10,000
1,000,000
10,000,000
5,000,000
GLS 4300661 00 12/01/2022 12/01/2023
SIR 2,000,000
B
1,000,000
10/01/202310/01/2022ISA H10702550
A 10,000,000
10,000
CU 4300607-02 12/01/2022 12/01/2023 10,000,000
WLR C70306487
B 1,000,000
No 10/01/2022 10/01/2023 1,000,000
1,000,000
280796123609209SR ID: BATCH:
Willis Towers Watson Certificate Center
10.0.2.20120224.1.869952
| DATE (MM/DD/YYYY): 01/12/2023 |
| 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 :: Tokio Marine Specialty Insurance Company |
| NAIC #_INSURER A :: 23850 |
| INSURED: Matheson Tri-Gas, Inc. |
3 Mountainview Road, 3rd Floor Warren, NJ 07059
| NAIC #_INSURER B :: ACE American Insurance Company |
| NAIC #_INSURER C :: |
| NAIC #_INSURER B :: 22667 |
| NAIC #_INSURER C :: |
| NAIC #_INSURER D :: |
| NAIC #_INSURER D :: |
| NAIC #_INSURER E :: |
| NAIC #_INSURER E :: |
| NAIC #_INSURER F :: |
| NAIC #_INSURER F :: |
| CERT_NUMBER: W27905417 |
| 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: 500,000 |
| undefined: 10,000 |
| GL_OTHER_1_TYPE_OF_INS: |
| GL_OTHER_2_TYPE_OF_INS: |
| undefined: 1,000,000 |
| undefined: 10,000,000 |
| undefined: 5,000,000 |
| Gen_Agg_Policy_checkbox: Yes |
| Gen_Agg_Project_checkbox: 0 |
| Gen_Agg_Location_checkbox: 0 |
| INSR ADDL_Row_1: |
| WVD SUBR_Row_1: |
| POLICY NUMBER_Row_1: GLS 4300661 00 |
| POLICY EFF (MM/DD/YYYY)_Row_1: 12/01/2022 |
| POLICY EXP (MM/DD/YYYY)_Row_1: 12/01/2023 |
| OTHER_LIMIT_DESC: SIR |
| undefined: 2,000,000 |
| ANY_AUTO_checkbox: Yes |
| AL INSR LETTER: B |
| undefined: 1,000,000 |
| NON-OWNED_AUTOS_checkbox: 0 |
| SCHEDULED_AUTOS_checkbox: 0 |
| ALL_OWNED_AUTOS_checkbox: 0 |
| HIRED_AUTO_checkbox: 0 |
| POLICY EXP (MM/DD/YYYY)_Row_1: 10/01/2023 |
| undefined: |
| POLICY EFF (MM/DD/YYYY)_Row_1: 10/01/2022 |
| 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: |
| WVD SUBR_Row_2: |
| POLICY NUMBER_Row_2: ISA H10702550 |
| undefined: |
| UMB_LIAB: Yes |
| UMB_EX_OCC: Yes |
| UMB INSR LETTER: A |
| undefined: 10,000,000 |
| EX_LIAB_checkbox: 0 |
| CLAIMS_MADE_checkbox: 0 |
| RET_checkbox: Yes |
| DED_checkbox: Off |
| DED_RET_AMOUNT: 10,000 |
| INSR ADDL_Row_3: |
| WVD SUBR_Row_3: |
| POLICY NUMBER_Row_3: CU 4300607-02 |
| POLICY EFF (MM/DD/YYYY)_Row_3: 12/01/2022 |
| POLICY EXP (MM/DD/YYYY)_Row_3: 12/01/2023 |
| undefined: 10,000,000 |
| AGGREGATE_Row_1: |
| undefined: |
| POLICY NUMBER_N / A: WLR C70306487 |
| 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: 10/01/2022 |
| POLICY EXP (MM/DD/YYYY)_Row_3: 10/01/2023 |
| undefined: 1,000,000 |
| undefined: 1,000,000 |
| OTHER 1 INSR LETTER: |
| OTHER_1_TYPE_OF_INS: |
| OTHER_2_TYPE_OF_INS: |
| N / A_Row_1: |
| WVD SUBR_Row_5: |
| N / A_Row_1: |
| OTHER_1_LIMIT_OF_INS: |
| OTHER 2 INSR LETTER: |
| POLICY NUMBER_Row_5: |
| POLICY NUMBER_Row_5: |
| POLICY EFF (MM/DD/YYYY)_Row_5: |
| POLICY EFF (MM/DD/YYYY)_Row_5: |
| POLICY EXP (MM/DD/YYYY)_Row_5: |
| POLICY EXP (MM/DD/YYYY)_Row_5: |
| OTHER_2_LIMIT_OF_INS: |
| 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): |
| INSURED: |
State of Arizona/Health Lab Materials & Facilities Management/Brenda Accounting 1740 W. Adams Phoenix, AZ 85007
| AUTHORIZED REPRESENTATIVE: |
| BATCH_NUMBER: 2807961 |
| SR_NUMBER: 23609209 |
| 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: |
| OTHER_1_LIMIT_OF_INS_AMT_1: |
| Contact_Name: Willis Towers Watson Certificate Center |
| DATE (MM/DD/YYYY): Page 1 of 1 |
File details come from the government source that posted it. Updated .