1-28-23_COI_GL.pdf

PDF 1 MB Posted Sep 1, 2021

Attached to: Master Agreement AZ|CTR056869
Contract number: CTR056869
Issued by: Arizona

About this file

Written by GovTribe AI · Oct 8, 2025

This document is a Certificate of Liability Insurance issued by State Farm Fire and Casualty Company for SPORTSCOM INC DBA HMA PUBLIC RELATIONS, located in Scottsdale, Arizona. The certificate is dated 02/15/2022 and names the State of Arizona as the certificate holder, specifically covering the state's departments, agencies, boards, commissions, universities, and their respective officers, officials, agents, and employees.

The insurance certificate provides commercial general liability coverage with a policy period from 01/28/2022 to 01/28/2023. The policy includes a $1,000,000 limit per occurrence, $2,000,000 general aggregate, and $1,000,000 for personal and advertising injury. The coverage is designed to protect the insured and additional insureds with respect to liability arising from the activities performed by or on behalf of the supplier. The policy is claims-made and occurs, with additional protections for the State of Arizona through specific additional insured provisions outlined in the document.

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1001486 132849.13 04-22-2020

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

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)

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

1001486 132849.13 04-22-2020

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.

REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

OTHER:

(Per accident) (Ea accident) N / A

SUBR

WVD

ADDL

INSD

PROPERTY DAMAGE

BODILY INJURY (Per accident) BODILY INJURY (Per person)

COMBINED SINGLE LIMIT

AUTOS ONLY

AUTOS

AUTOS ONLY

NON-OWNED

SCHEDULED

OWNED

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

OTH-

STATUTE

PER

LIMITS

(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY)

POLICY EFF

POLICY NUMBER

TYPE OF INSURANCE

LTR

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)

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

C:\Users\GAHL\Desktop\Logos R\Red_SF_logo_vert_small_R_1.png State Farm Logo

PageNumbering:

The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM).: ACORD 0025 2016-03

Enter date: The date on which the form is completed. (MM/DD/YYYY) : 2022-02-15

Enter text: The full name of the producer / agency. : ANDRA JEFFRESS

Enter text: The mailing address line one of the producer / agency. : 1704 W BETHANY HOME RD

Enter text: The mailing address line two of the producer / agency. : PHOENIX, AZ 85015

Enter text: The mailing address city name of the producer / agency. :

Enter code: The mailing address state or province code of the producer / agency. :

Enter code: The mailing address postal code of the producer / agency. :

Enter text: The name of the individual at the producer's establishment that is the primary contact. : ANDRA JEFFRESS

Enter number: The producer's contact person's phone number. If applicable, include the area code and extension. : 602-249-1037

Enter number: The fax number of the producer / agency. : 602-249-1218

Enter text: The producer's contact person's e-mail address. : andra.jeffress.b7gb@statefarm.com

Enter text: The named insured(s) as it / they will appear on the policy declarations page. : SPORTSCOM INC DBA HMA PUBLIC RELATIONS

Enter text: The named insured's mailing address line one. : 5814 E KINGS AVE

Enter text: The named insured's mailing address line two. : SCOTTSDALE, AZ 85254

Enter text: The named insured's mailing address city name. :

Enter code: The named insured's mailing address state or province code. :

Enter code: The named insured's mailing address postal code. :

Enter code: The identification code assigned to the insurer by the National Association of Insurance Commissioners (NAIC). As used here, this is Insurer A.: 25143

Enter code: The identification code assigned to the insurer by the National Association of Insurance Commissioners (NAIC). As used here, this is Insurer B.:

Enter code: The identification code assigned to the insurer by the National Association of Insurance Commissioners (NAIC). As used here, this is Insurer C.:

Enter code: The identification code assigned to the insurer by the National Association of Insurance Commissioners (NAIC). As used here, this is Insurer D.:

Enter code: The identification code assigned to the insurer by the National Association of Insurance Commissioners (NAIC). As used here, this is Insurer E.:

Enter code: The identification code assigned to the insurer by the National Association of Insurance Commissioners (NAIC). As used here, this is Insurer F.:

Enter identifier: The producer assigned number for the certificate. :

Enter number: The producer assigned revision number for the certificate. :

Enter code: The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the general liability policy. : A

Check the box (if applicable): Indicates the claims made or occurrence option applies for the general liability policy. :

Check the box (if applicable): Indicates the "claims made" option applies on the general liability policy. : 1

Check the box (if applicable): Indicates the general liability policy, occurrence basis applies. : 1

Check the box (if applicable): Indicates other coverage not found on the form exists for the general liability policy. :

Enter text: The description of other coverage (not the limit) on the general liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). :

Check the box (if applicable): Indicates other coverage not found on the form exists for the general liability policy. : 1

Check the box (if applicable): Indicates the general liability policy, general aggregate limit applies per policy. :

Check the box (if applicable): Indicates the general liability policy, general aggregate limit applies per project. :

Check the box (if applicable): Indicates the general liability policy, general aggregate limit applies per location. :

Check the box (if applicable): Indicates the general liability policy, general aggregate limit applies to option is other than those listed on the form. :

Enter text: The description of the other option to which the general liability policy, general aggregate limit applies. :

Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as an additional insured on the general liability policy. : Y

Enter Y for a “Yes” response. Input N for “No” response. Indicates if subrogation has been waived on the general liability policy. : Y

Enter limit: The general liability, each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as governed by the policy.: 1000000.00

Enter limit: The general liability, damage to rented premises each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as governed by the policy.: 300000.00

Enter limit: The general liability, medical expense each person limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as governed by the policy.: 5000.00

Enter limit: The general liability, personal and advertising injury limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as governed by the policy.: 1000000.00

Enter limit: The general liability, general aggregate limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as governed by the policy.: 2000000.00

Enter limit: The general liability, products and completed operations aggregate limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as governed by the policy.: 2000000.00

Enter limit: The general liability, other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). :

Enter code: The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the policy. :

Check the box (if applicable): Indicates the commercial vehicle policy covers any auto. As used here, complete this section only if you are certifying automobile liability. Check all appropriate boxes to correspond with the covered auto symbols found on the policy declarations page. If the certificate is being issued to the owner of a leased vehicle, DO NOT USE THIS FORM. Use ACORD 23, Vehicle or Equipment Certificate of Insurance.:

Check the box (if applicable): Indicates the commercial vehicle policy covers owned autos only. :

Check the box (if applicable): Indicates the vehicle policy covers hired autos only. :

Check the box (if applicable): Indicates the vehicle policy covers autos other than those listed. :

Enter text: The description of the other covered autos. :

Check the box (if applicable): Indicates the vehicle policy covers scheduled autos. :

Check the box (if applicable): Indicates the vehicle policy covers non-owned autos only. : 1

Check the box (if applicable): Indicates the vehicle policy covers autos other than those listed. :

Enter text: The description of the other covered autos. :

Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as an additional insured on the automobile liability policy. :

Enter Y for a “Yes” response. Input N for “No” response. Indicates if subrogation has been waived on the automobile policy. :

Enter identifier: The identifier assigned by the insurer to the automobile liability policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. :

Enter date: The effective date of the automobile liability policy. The date that the terms and conditions of the policy commence. :

Enter date: The date on which the terms and conditions of the automobile liability policy will expire. :

Enter limit: The vehicle combined single limit liability each accident amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as governed by the policy.:

Enter limit: The vehicle policy, bodily injury per person limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as governed by the policy.:

Enter limit: The vehicle policy, bodily injury per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). :

Enter limit: The vehicle policy, property damage per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as governed by the policy.:

Enter text: The description of the coverage. :

Enter limit: The limit amount of the other coverage. :

Enter code: The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the commercial excess or umbrella liability policy. :

Check the box (if applicable): Indicates the type of policy is umbrella. As used here, if evidencing an umbrella coverage, underlying policy number(s), term(s) and line(s) of business may be listed on an ACORD 101.:

Check the box (if applicable): Indicates the type of policy is excess. As used here, if evidencing an excess coverage, underlying policy number(s), term(s) and line(s) of business may be listed on an ACORD 101.:

Check the box (if applicable): Indicates "coverage trigger" is on an occurrence basis on an excess or umbrella liability policy. :

Check the box (if applicable): Indicates the "coverage trigger" is on a claims-made basis on an excess or umbrella liability policy. :

Check the box (if applicable): Indicates a deductible amount applies to the excess or umbrella liability policy. :

Check the box (if applicable): Indicates a retention amount applies to the excess or umbrella liability policy. :

Enter deductible: The excess or umbrella liability deductible or retention amount. :

Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as an additional insured on the umbrella/excess liability policy. Place a "Y" next to each coverage where an additional insured endorsement has been issued or for umbrella / excess where there is an additional insured on the underlying primary policy and this umbrella / excess is follow form. :

Enter Y for a “Yes” response. Input N for “No” response. Indicates if subrogation has been waived on the excess policy. For umbrella / excess, place a "Y" next to each coverage where subrogation has been waived on the underlying primary policy and this umbrella / excess is follow form. :

Enter identifier: The identifier assigned by the insurer to the excess liability policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. :

Enter date: The effective date of the excess liability policy. The date that the terms and conditions of the policy commence. :

Enter date: The date on which the terms and conditions of the excess liability policy will expire. :

Enter limit: The excess or umbrella liability each occurrence limit. As used here, the limit should be listed as a whole dollar amount, as governed by the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).:

Enter limit: The excess or umbrella liability aggregate limit should be listed as whole dollar amount, as governed by the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). :

Enter text: The description of other coverage (not the limit) on the excess or umbrella liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). :

Enter limit: The excess or umbrella liability other coverage limit should be listed as a whole dollar amount, as governed by the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). :

Enter code: The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the commercial workers compensation and employers liability policy. :

Enter Y for a “Yes” response. Input N for “No” response. Indicates whether the workers compensation and employers liability policy excludes any proprietor, partner, executive officer, or member. As used here, the DESCRIPTION OF OPERATIONS section is available, if needed, to provide details of any "Yes" response. In NH, if "Yes" response is indicated, it is mandatory to provide corresponding details in the DESCRIPTION OF OPERATIONS section.:

Enter Y for a “Yes” response. Input N for “No” response. Indicates if subrogation has been waived on the workers compensation policy. :

Enter identifier: The identifier assigned by the insurer to the workers' compensation and employers liability policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. :

Enter date: The effective date of the workers' compensation and employers liability policy. The date that the terms and conditions of the policy commence. .:

Enter date: The date on which the terms and conditions of the workers' compensation and employers liability policy will expire. :

Check the box (if applicable): Indicates that workers compensation coverage is per statute. :

Check the box (if applicable): Indicates that additional coverage above the workers compensation statutory limits applies (permitted in some states). :

Enter text: The description of other coverage (not the limit) on the workers compensation and employers liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the DESCRIPTION OF OPERATIONS section is available if more space is required.:

Enter limit: The workers compensation and employers liability policy, employers liability each accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). :

Enter limit: The workers compensation and employers liability policy, employers liability disease each employee limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as governed by the policy.:

Enter limit: The workers compensation and employers liability policy, employers liability disease policy limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). :

Enter code: The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the other policy. :

Enter text: The description of the other policy not listed on the form. :

Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as an additional insured on the other policy. :

Enter Y for a “Yes” response. Input N for “No” response. Indicates subrogation has been waived on the other policy. :

Enter identifier: The other policy number exactly as it appears on the policy, including prefix and suffix symbols. :

Enter date: The date on which the terms and conditions of the other policy commence. :

Enter date: The date on which the terms and conditions of the other policy expires. :

Enter code: The coverage code for the other policy. :

Enter limit: The other policy, coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as governed by the policy.:

Enter code: The coverage code for the other policy. :

Enter text: The Certificate Of Liability Insurance general remarks. The additional comments or special conditions that may exist upon the policy. ACORD 101, Additional Remarks Schedule, may be attached if more space is required. As used here, records information necessary to identify the operations, locations and vehicles for which the certificate was issued.: *** ADDITIONAL INSUREDS ***

The State of Arizona, its departments, agencies, boards, commissions, universities, and its officers, officials, agents and employees, will be named as additional insureds with respect to liability arising out of the activities performed by or on behalf of the Supplier Mail Code 5212 Tempe, AZ 85287-5212

Enter text: The certificate holder's full name. : The State of Arizona

Enter text: The certificate holder's mailing address line one. : Mail Code 5212

Enter text: The certificate holder's mailing address line two. : Tempe, AZ 85287-5212

Enter text: The certificate holder's mailing address city name. :

Enter code: The certificate holder's mailing address state or province code. :

Enter code: The certificate holder's mailing address postal code. :

Enter test: The insurer’s full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer’s group name or trade name. As used here, this is Insurer A. : State Farm Fire and Casualty Company

Enter identifier: The identifier assigned by the insurer to the general liability policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. : 93-J0-H245-0

Enter date: The effective date of the general liability policy. The date that the terms and conditions of the policy commence. : 2022-01-28

Enter date: The date on which the terms and conditions of the general liability policy will expire. : 2023-01-28

Enter date: The effective date of the automobile liability policy. The date that the terms and conditions of the policy commence. :

Enter date: The date on which the terms and conditions of the automobile liability policy will expire. :

Signature chooses:

File details come from the government source that posted it. Updated Oct 8, 2025.