STATEOFARIZONA_W41693438.pdf

PDF 54 KB Posted

Attached to
Master Agreement AZ|CTR079348
Contract number
CTR079348
Issued by
Arizona

About this file

This document is an ACORD Certificate of Liability Insurance for QTC Commercial Services, LLC, a subsidiary of Leidos Holdings, Inc., with coverage issued by Underwriters at Lloyd's London. The certificate is addressed to the State of Arizona, Arizona Department of Administration, Office of Special Events, located in Phoenix, AZ, and is associated with Contract Number CTR079348.

The insurance policy provides Professional Liability coverage, including Contractors Pollution Legal Liability and Cyber Liability, with policy limits of $25,000,000 per each claim and in the aggregate. The policy includes a $10M aggregate sublimit for Privacy Notification Costs. The coverage is effective from 10/26/2025 to 10/12/2026, with the insurance certificate issued on 11/06/2025. The policy is administered by Willis Towers Watson Southeast, Inc., based in Nashville, TN, and serves as a certification of insurance for the specified contract between QTC Commercial Services and the State of Arizona.

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File Type Posted
STATEOFARIZONA_W41693439.pdf PDF
CTR079348_Pricing.xlsx XLSX spreadsheet
STATEOFARIZONA_W41693437.pdf PDF
STATEOFARIZONA_W41693440.pdf PDF
CTR079348_Contract_Summary_Document.pdf 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

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 Southeast, Inc.

c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA

QTC Commercial Services, LLC a wholly owned subsidiary of Leidos Holdings, Inc.

1750 Presidents Street Reston, VA 20190

Note:

Professional Liability inclusive of a $10M Aggregate Sublimit for Privacy Notification Costs.

Contract Number: CTR079348

STATE OF ARIZONA,

ARIZONA DEPARTMENT OF ADMINISTRATION,

OFFICE OF SPECIAL EVENTS

100 N. 15111Avenue, Suite 202 Phoenix, AZ 85007

11/06/2025

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

Underwriters at Lloyd's London 15792

W41693438

A Professional Liability including

Contractors Pollution Legal Liab

Each ClaimB080130966P25 10/26/2025 10/12/2026

Aggregate and Cyber Liability

419643228827140SR ID: BATCH:

$25,000,000

$25,000,000

WTW Certificate Center

10.0.2.20120224.1.869952

DATE (MM/DD/YYYY): 11/06/2025
PRODUCER: Willis Towers Watson Southeast, 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 :: Underwriters at Lloyd's London
NAIC #_INSURER A :: 15792
INSURED: QTC Commercial Services, LLC

a wholly owned subsidiary of Leidos Holdings, Inc.

1750 Presidents Street Reston, VA 20190

NAIC #_INSURER B ::
NAIC #_INSURER C ::
NAIC #_INSURER B ::
NAIC #_INSURER C ::
NAIC #_INSURER D ::
NAIC #_INSURER D ::
NAIC #_INSURER E ::
NAIC #_INSURER E ::
NAIC #_INSURER F ::
NAIC #_INSURER F ::
CERT_NUMBER: W41693438
GL INSR LETTER:
CGL_checkbox: Off
Clams_Made_checkbox: Off
Occur_checkbox: Off
OTHER 1 checkbox: Off
OTHER 1 checkbox: Off
undefined:
undefined:
undefined:
GL_OTHER_1_TYPE_OF_INS:
GL_OTHER_2_TYPE_OF_INS:
undefined:
undefined:
undefined:
Gen_Agg_Policy_checkbox: Off
Gen_Agg_Project_checkbox: Off
Gen_Agg_Location_checkbox: Off
INSR ADDL_Row_1:
WVD SUBR_Row_1:
POLICY NUMBER_Row_1:
POLICY EFF (MM/DD/YYYY)_Row_1:
POLICY EXP (MM/DD/YYYY)_Row_1:
OTHER_LIMIT_DESC:
undefined:
ANY_AUTO_checkbox: Off
AL INSR LETTER:
undefined:
NON-OWNED_AUTOS_checkbox: Off
SCHEDULED_AUTOS_checkbox: Off
ALL_OWNED_AUTOS_checkbox: Off
HIRED_AUTO_checkbox: Off
POLICY EXP (MM/DD/YYYY)_Row_1:
undefined:
POLICY EFF (MM/DD/YYYY)_Row_1:
undefined:
undefined:
AL_OTHER_1_checkbox: Off
AL_OTHER_1_DESC:
PROPERTY DAMAGE (Per accident)_Row_1:
AL_OTHER_2_checkbox: Off
AL_OTHER_2_DESC:
INSR ADDL_Row_2:
WVD SUBR_Row_2:
POLICY NUMBER_Row_2:
undefined:
UMB_LIAB: Off
UMB_EX_OCC: Off
UMB INSR LETTER:
undefined:
EX_LIAB_checkbox: Off
CLAIMS_MADE_checkbox: Off
RET_checkbox: Off
DED_checkbox: Off
DED_RET_AMOUNT:
INSR ADDL_Row_3:
WVD SUBR_Row_3:
POLICY NUMBER_Row_3:
POLICY EFF (MM/DD/YYYY)_Row_3:
POLICY EXP (MM/DD/YYYY)_Row_3:
undefined:
AGGREGATE_Row_1:
undefined:
POLICY NUMBER_N / A:
STATUTORY: Off
OTHER: Off
WC_OTHER_DESC:
WC INSR LETTER:
WVD SUBR_N / A:
undefined:
Y / N:
POLICY EFF (MM/DD/YYYY)_Row_3:
POLICY EXP (MM/DD/YYYY)_Row_3:
undefined:
undefined:
OTHER 1 INSR LETTER: A
OTHER_1_TYPE_OF_INS: Professional Liability including
OTHER_2_TYPE_OF_INS: Contractors Pollution Legal Liab
N / A_Row_1:
WVD SUBR_Row_5:
N / A_Row_1:
OTHER_1_LIMIT_OF_INS: Each Claim
OTHER 2 INSR LETTER:
POLICY NUMBER_Row_5: B080130966P25
POLICY NUMBER_Row_5:
POLICY EFF (MM/DD/YYYY)_Row_5: 10/26/2025
POLICY EFF (MM/DD/YYYY)_Row_5:
POLICY EXP (MM/DD/YYYY)_Row_5: 10/12/2026
POLICY EXP (MM/DD/YYYY)_Row_5:
OTHER_2_LIMIT_OF_INS: Aggregate
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: and Cyber Liability
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): Note:

Professional Liability inclusive of a $10M Aggregate Sublimit for Privacy Notification Costs.

Contract Number: CTR079348

INSURED:

STATE OF ARIZONA,

ARIZONA DEPARTMENT OF ADMINISTRATION,

OFFICE OF SPECIAL EVENTS

100 N. 15111Avenue, Suite 202 Phoenix, AZ 85007

AUTHORIZED REPRESENTATIVE:
BATCH_NUMBER: 4196432
SR_NUMBER: 28827140
SRID_label: SR ID:
Batch_label: BATCH:
GL_Agg_applies_per_Other_checkbox: Off
GL_Agg_applies_per_Other:
OTHER_3_LIMIT_OF_INS_AMT3:
OTHER_2_LIMIT_OF_INS_AMT_2: $25,000,000
OTHER_1_LIMIT_OF_INS_AMT_1: $25,000,000
Contact_Name: WTW Certificate Center
DATE (MM/DD/YYYY): Page 1 of 1

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