StateofArizona_W39050726.pdf

PDF 146 KB Posted

Attached to
Master Agreement AZ|CTR057206
Contract number
CTR057206
Issued by
Arizona

About this file

This document is a Certificate of Liability Insurance issued by Willis Towers Watson Northeast, Inc. for Meketa Investment Group, Inc., located in Westwood, MA. The certificate involves multiple insurance carriers including Great Northern Insurance Company, Federal Insurance Company, Everest National Insurance Company, US Specialty Insurance Company, and Endurance American Insurance Company. The certificate holder is the State of Arizona, specifically the Arizona State Retirement System, with coverage effective from 05/14/2025 to 05/14/2026.

The insurance coverage includes Commercial General Liability, Automobile Liability, Umbrella/Excess Liability, Workers' Compensation, and Errors and Omissions insurance. Key coverage limits include $1,000,000 for Commercial General Liability, $1,000,000 for Automobile Liability, $10,000,000 for Umbrella Liability, and $10,000,000 for Errors and Omissions with a $500,000 retention/claim. The policy provides additional insured status for the certificate holder with respect to General and Auto Liability, and includes a waiver of subrogation. The coverage is primary and non-contributory, with two excess E&O policies providing $5,000,000 each in additional coverage.

View the file

Other files

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file

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

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)

© 1988-2016 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

Meketa Investment Group, Inc.

80 University Avenue Westwood, MA 02090

SEE ATTACHED

State of Arizona Arizona State Retirement System c/o Insurance Tracking Services, Inc.

P.O. Box 20270 Long Beach, CA 90801

05/16/2025

1-877-945-7378 1-888-467-2378 certificates@wtwco.com

Great Northern Insurance Company 20303

Federal Insurance Company

Everest National Insurance Company

20281

10120

US Specialty Insurance Company 29599

Endurance American Insurance Company 10641

W39050726

A

1,000,000

1,000,000

50,000

1,000,000

2,000,000

Y Y 3602-56-60 05/14/2025 05/14/2026

B

1,000,000

05/14/202605/14/2025Y 7362-24-02

B 10,000,000

7989-22-39 05/14/2025 05/14/2026 10,000,000

7175-00-12 B 1,000,000

No 05/14/2025 05/14/2026 1,000,000

1,000,000

C Errors and Omissions Per Claim LimitIMIP000309-251 05/14/2025 05/14/2026

Retention/Claim

396777227784816SR ID: BATCH:

$500,000

$10,000,000

WTW Certificate Center

ACORD 101 (2008/01)

The ACORD name and logo are registered marks of ACORD

© 2008 ACORD CORPORATION. All rights reserved.

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: FORM TITLE:

ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE Page of

AGENCY CUSTOMER ID:

LOC #:

AGENCY

CARRIER NAIC CODE

POLICY NUMBER

NAMED INSURED

EFFECTIVE DATE:

Meketa Investment Group, Inc.

80 University Avenue Westwood, MA 02090

Certificate Holder is included as an Additional Insureds respects to General Liability and Auto Liability.

General Liability policy shall be Primary and Non-Contributory with any other insurance in force for or which may be purchased by Additional Insureds.

Waiver of Subrogation applies in favor of Certificate Holder with respects to General Liability.

INSURER AFFORDING COVERAGE: US Specialty Insurance Company NAIC#: 29599

POLICY NUMBER: XDG U725-621677 EFF DATE: 05/14/2025 EXP DATE: 05/14/2026

TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:

1st Excess E&O Each Claim $5,000,000 $5M x/s $10M

INSURER AFFORDING COVERAGE: Endurance American Insurance Company NAIC#: 10641

POLICY NUMBER: FIX10007795108 EFF DATE: 05/14/2025 EXP DATE: 05/14/2026

TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:

2nd Excess E&O Each Claim $5,000,000 $5M x/s $15M

2 2

Willis Towers Watson Northeast, Inc.

See Page 1

See Page 1 See Page 1 See Page 1

25 Certificate of Liability Insurance

W39050726CERT:3967772BATCH:27784816SR ID:

10.0.2.20120224.1.869952

DATE (MM/DD/YYYY): 05/16/2025
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@wtwco.com
NAIC #_INSURER A :: Great Northern Insurance Company
NAIC #_INSURER A :: 20303
INSURED: Meketa Investment Group, Inc.

80 University Avenue Westwood, MA 02090

NAIC #_INSURER B :: Federal Insurance Company
NAIC #_INSURER C :: Everest National Insurance Company
NAIC #_INSURER B :: 20281
NAIC #_INSURER C :: 10120
NAIC #_INSURER D :: US Specialty Insurance Company
NAIC #_INSURER D :: 29599
NAIC #_INSURER E :: Endurance American Insurance Company
NAIC #_INSURER E :: 10641
NAIC #_INSURER F ::
NAIC #_INSURER F ::
CERT_NUMBER: W39050726
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: 1,000,000
undefined: 50,000
GL_OTHER_1_TYPE_OF_INS:
GL_OTHER_2_TYPE_OF_INS:
undefined: 1,000,000
undefined: 2,000,000
undefined:
Gen_Agg_Policy_checkbox: Yes
Gen_Agg_Project_checkbox: 0
Gen_Agg_Location_checkbox: 0
INSR ADDL_Row_1: Y
WVD SUBR_Row_1: Y
POLICY NUMBER_Row_1: 3602-56-60
POLICY EFF (MM/DD/YYYY)_Row_1: 05/14/2025
POLICY EXP (MM/DD/YYYY)_Row_1: 05/14/2026
OTHER_LIMIT_DESC:
undefined:
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: 05/14/2026
undefined:
POLICY EFF (MM/DD/YYYY)_Row_1: 05/14/2025
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: Y
WVD SUBR_Row_2:
POLICY NUMBER_Row_2: 7362-24-02
undefined:
UMB_LIAB: Yes
UMB_EX_OCC: Yes
UMB INSR LETTER: B
undefined: 10,000,000
EX_LIAB_checkbox: 0
CLAIMS_MADE_checkbox: 0
RET_checkbox: 0
DED_checkbox: Off
DED_RET_AMOUNT:
INSR ADDL_Row_3:
WVD SUBR_Row_3:
POLICY NUMBER_Row_3: 7989-22-39
POLICY EFF (MM/DD/YYYY)_Row_3: 05/14/2025
POLICY EXP (MM/DD/YYYY)_Row_3: 05/14/2026
undefined: 10,000,000
AGGREGATE_Row_1:
undefined:
POLICY NUMBER_N / A: 7175-00-12
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: 05/14/2025
POLICY EXP (MM/DD/YYYY)_Row_3: 05/14/2026
undefined: 1,000,000
undefined: 1,000,000
OTHER 1 INSR LETTER: C
OTHER_1_TYPE_OF_INS: Errors and Omissions
OTHER_2_TYPE_OF_INS:
N / A_Row_1:
WVD SUBR_Row_5:
N / A_Row_1:
OTHER_1_LIMIT_OF_INS: Per Claim Limit
OTHER 2 INSR LETTER:
POLICY NUMBER_Row_5: IMIP000309-251
POLICY NUMBER_Row_5:
POLICY EFF (MM/DD/YYYY)_Row_5: 05/14/2025
POLICY EFF (MM/DD/YYYY)_Row_5:
POLICY EXP (MM/DD/YYYY)_Row_5: 05/14/2026
POLICY EXP (MM/DD/YYYY)_Row_5:
OTHER_2_LIMIT_OF_INS: Retention/Claim
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):

SEE ATTACHED

INSURED:

State of Arizona Arizona State Retirement System c/o Insurance Tracking Services, Inc.

P.O. Box 20270 Long Beach, CA 90801

AUTHORIZED REPRESENTATIVE:
BATCH_NUMBER: 3967772
SR_NUMBER: 27784816
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: $500,000
OTHER_1_LIMIT_OF_INS_AMT_1: $10,000,000
Contact_Name: WTW Certificate Center
DATE (MM/DD/YYYY): Page 1 of 2

File details come from the government source that posted it. Updated .