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Old Crescent Insurance Company / Indiana University
<br />Certificate of Insurance
<br />Insured
<br />The Trustees of Indiana University
<br />c/o INLOCC
<br />2805 E. 10th St, Rm 110
<br />Bloomington IN 47408
<br />01/30/2025 Certificate 8877
<br />This certificate is issued as matter of information, only, and conveys no rights upon the certificate holder. This certificate does not
<br />amend, extend or alter the coverage afforded by the policies below.
<br />Insurers Affording Coverage
<br />Should any of the below described policies be cancelled
<br />before the expiration date thereof the issuing company
<br />and/or The Trustees of Indiana University will endeavor
<br />to mail 30 days written notice to the certificate holder
<br />named below, but failure to do so shall impose no
<br />obligation or liability of any kind upon the company or
<br />the Trustees of Indiana University, their agents or
<br />representatives.
<br />Insurer A: Old Crescent Insurance Company Insurer F: XL Specialty Ins. Co.
<br />Insurer B: Travelers Insurer G: Columbia Casualty Co.
<br />Insurer C: Star Insurance Company Insurer H: Allied World Ass. Co
<br />Insurer D: StarNet Insurance Co. Insurer I: Westchester
<br />Insurer E: United Educators Insurer J: Liberty Mutual
<br />The policies of insurance listed below have been issued to the insured named above for the policy period indicated, notwithstanding any
<br />requirement, term or condition of any contract or other document with respect to which this certificate may be issued or may pertain, the
<br />insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. Aggregate
<br />limits shown may have been reduced by paid claims.
<br />Insr
<br />Ltr Type of Insurance Policy Number Policy Dates Limits
<br />A GENERAL LIABILITY
<br />Commercial General Liability – Occurrence
<br />including Contractual
<br />Excess of $100,000 retention
<br />Includes coverage for Professional Liability excluding
<br />Medical Malpractice
<br />GLEx-1v 02/01/2025 – 02/01/2026 Each Occurrence $5,000,000
<br />Fire Damage $5,000,000
<br />Personal & Adv Injury $5,000,000
<br />General Aggregate $5,000,000
<br />Products/Comp Ops $5,000,000
<br />Liquor Liability $5,000,000
<br />A VEHICLE LIABILITY
<br />All licensed vehicles owned, leased, rented by or for, or driven on
<br />behalf of Indiana University (Excess of $100,000 retention)
<br />AEx-1v 02/01/2025 – 02/01/2026 Combined Single Limit $5,000,000
<br />A CYBER LIABILITY CLEx-1d 02/01/2025 – 02/01/2026 Each Occurrence $2,000,000
<br />E
<br />H
<br />I
<br />J
<br />EXCESS LIABILITY Layer 1
<br />Layer 2
<br />Layer 3
<br />Layer 4
<br />G74-67K 02/01/2025 – 02/01/2026 Aggregate $30,000,000
<br />03127174 02/01/2025 – 02/01/2026 Aggregate $10,000,000
<br />G48651033 001 02/01/2025 – 02/01/2026 Aggregate $5,000,000
<br />1000703819-01 02/01/2025 – 02/01/2026 Aggregate $5,000,000
<br />C WORKERS COMPENSATION &
<br />EMPLOYERS LIABILITY
<br />(excess of $850,000/claim retention
<br />WCE-0953273-25 02/01/2025 – 02/01/2026 Each Occurrence Statutory +
<br />$1M
<br />Employers Liability $1,000,000
<br />A
<br />B
<br />PROPERTY (Incl Boiler, Flood, Earthquake)
<br />Sub-limits may apply. Excess of $100,000 retention.
<br />ARP-1v 02/01/2025 – 02/01/2026 Each Occurrence $5,000,000
<br />EXCESS PROPERTY KTK-CMB-5647P70-9-25 02/01/2025 – 02/01/2026 Each Occurrence $1 billion
<br />F
<br />D
<br />FINE ART (pro rata: 60% share)
<br />FINE ART (pro rata: 40% share)
<br />UMA0010548SP25A 02/01/2025 – 02/01/2026 Each Occurrence $360 million
<br />HBB-000528-FA03 02/01/2025 – 02/01/2026 Each Occurrence $240 million
<br />A MEDICAL MALPRACTICE
<br />(coverage subject to Indiana statutes)
<br />Includes $1 million out–of–state coverage. This includes
<br />participation in the Indiana Patient Compensation Fund with current
<br />statutory limits.
<br />HL-1v 02/01/2025 – 02/01/2026 Statutory $500,000
<br />G EXCESS MEDICAL MALPRACTICE
<br />(out–of–state, only)HMC 1064386826 02/01/2025 – 02/01/2026 Aggregate $2,000,000
<br />Description of operations/locations/vehicles/exclusions added by endorsement/Special Provisions:
<br />To provide proof of various insurance coverages for The Trustees of Indiana University and for the IU School of Medicine Subcontract Number (22X056Q) during the time period shown below.
<br />Leidos Biomed is listed as additional insured per form CG 20 26 04 13. Waiver of Subrogation in favor of the additional insured applies with respect to the General Liability policy where required by
<br />written contract.
<br />Certificate Holder:
<br />Leidos Biomedical Research, Inc.
<br />1050 Boyles Street, Box B
<br />FREDERICK MD 21702
<br />Authorized signature
<br />Approved by: Kutina L. England
<br />The signer of this document is authorized to represent the coverages of the Old Crescent Insurance Company. In addition,
<br />the signer is authorized to make representations of the other coverages outlined on this certificate of insurance based on
<br />policy information on file at the Indiana University Office of Insurance, Loss Control and Claims. Certificate of insurance
<br />for the other insurance companies indicated on this certificate may be obtained, if necessary.
<br />Effective dates: 02/01/2025 — 02/01/2026
<br />Docusign Envelope ID: 03F2E850-0D84-438B-ACE6-8AEC26A3D53D
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