1._Inspire_Youth_Homes_CERTIFICATE_OF_LIABILITY_INSURANCE_2024-2025_Redacted.pdf

PDF 571 KB Posted

Attached to
Master Agreement AZ|CTR071431
Contract number
CTR071431
Issued by
Arizona

About this file

The document is a Certificate of Liability Insurance issued by Breinholt Insurance Group, LLC for Inspire Youth Homes, LLC, with coverage provided by Social Service Contractors Indemnity Pool and PIE Casualty Insurance Company. The certificate is for the State of Arizona, specifically the Department of Child Safety, Office of Procurement & Contracts, located in Phoenix, Arizona. The insurance policy covers multiple lines of liability, including commercial general liability, automobile liability, workers' compensation, and professional liability, with policy effective dates from 4/1/2024 to 4/1/2025.

The insurance provides comprehensive coverage with $1,000,000 limits per occurrence across various categories, including commercial general liability, automobile liability, and workers' compensation. An additional remarks schedule notes that the certificate holder (State of Arizona) is an additional insured as required by written contract, and sexual abuse and molestation coverage is included. The policy includes endorsements for waiver of transfer rights of recovery and additional insured status, specifically protecting the State of Arizona, its departments, agencies, boards, commissions, universities, and employees for losses arising from work performed by or on behalf of the contractor.

View the file

Other files

File Type Posted
Exhibit V - Blood Sugar Log.pdf PDF
Exhibit VII Clothing Allowance Ledger.pdf PDF
Exhibit CS0-1015A.pdf PDF
Exhibit VI Fees Log.pdf PDF
Contract_Extension.pdf PDF
Exhibit XXII ADJC Residential Services Invoice.docx DOCX document
Insurance_25-26_SSCIP_Pkg_Renewal_Policy_Redacted.pdf PDF
PROOF_OF_INSURANCE_-_Inspire_Youth_Homes_-_COI_Redacted.pdf PDF
Exhibit XIV Provider Census Report.xlsm XLSM spreadsheet
Congregate_Care_Services_SOW_Amendment_2.pdf PDF
Congregate_Care_Services_Amendment_4.pdf PDF
Congregate_Care_Services_SOW_Amendment_1.pdf PDF
Exhibit X Returned Allowances Form.xlsx XLSX spreadsheet
Exhibit XVI Facility Modification Request.pdf PDF
Exhibit IX Clothing and Property Inventory.pdf PDF
HITECH_Business_Associate_Agreement-signed.pdf PDF
Congregate_Care_Services_Amendment.pdf PDF
Exhibit XVII Quarterly Report.xlsm XLSM spreadsheet
Offer_and_Acceptance_Redacted.pdf PDF
Exhibit XV Discharge Summary.pdf PDF
Exhibit XX ADJC-5002 ADJC Service Providers Protocol ADJC.doc DOC document
Exhibit IV - Medication Error Report.pdf PDF
2-Attachment_3-D_Boycott_of_Israel_Disclosure_Redacted.pdf PDF
Exhibit VIII Personal Allowance Ledger.pdf PDF
Directions_to_Procurement_File.docx DOCX document
Congregate_Care_Services_SOW_Amendment_3.pdf PDF
Congregate_Care_Services_SOW_2024.pdf PDF
Exhibit XIX ADJC Census Report.doc DOC document
Exhibit III - Medication Log.pdf PDF
Exhibit I - DCS 06-01 Limited English Proficiency.pdf PDF
2-Attachment_3-E_Forced_Labor_of_Ethnic_Uyghurs_Ban_Redacted.pdf PDF
Exhibit XII Bed Hold.pdf PDF
Exhibit II - Personalized Service Plan.pdf PDF
Exhibit XI One on One Supervision.pdf PDF
Exhibit XVIII ADJC Monthly Attendance Report.doc DOC document
Show all 35

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

��
�� �������

������ �(�0� 1 2###2#' 34' �55�� � 6� �1#7%#'%&#&7

�/�� ���������
����5��� ���(���� ,�

/� 5����)��*1

��!!�����8 ������8 8��9�8��� �������� ���!

9:������ �:�� �������� ���!

�����8 ������� ������ �����������8 8��9�8��� �������� ���!

��;:�8 �9:�� 8��9�8��� �������� ���!

��$� �� ��%&�' �% �%��'()�*(�'+ *,� �*�*� �� �%()�'�- (*& .�/�%*$�'*&- ���'0(�&- 1��%.&- 0�$$(&&(�'&- 2'(3�%&(*(�& �'. �44 ���(0�%&- ���(0(�4&- ���'*&- �'. �$/4�5��& �� *,�&� �'*(*(�&- ��% 4�&&�& �%(&('� �%�$ 6�%7 /�%��%$�. 15 �% �' 1�,�4� �� *,� 0�'*%�0*�%

'. �/� �����!�� �! ������ �! ����#��� ��'.(*(�' ��0*(�' �# ���������� ������� ���8����� ����������� �� ������� 0� ��� �5 /� 5����)��*1

� ����*/
�5���
�� )� ��� /�

�0� � 0���(�� �5 ,�����

� )� ��=� 5���>(� �����*�� �����* �(
�5 ��(��*���* �,��
?��()�=? ���� (���� ���
��

5� � 4

�� �,��
���� /�<��?. �/�� )��
��,,���� ����

��/��(�� �0�

&. �/� �����!�� �! ������ �! ����#��� ������� ������ �� "� ��'.(*(�' ��0*(�' �# 8"������ �"�� ����������� �� ������� 0� ��� �5 /� 5����)��*1

� ����*/
�5���
�� )� ��� /�

�0� � 0���(�� �5 ,����� � )� ��=� 5� ��>( � � ����*�� 5� @0����� ��>( �A � @, �,� � ����*�A

B. �/� �����!�� �! ������ �! ����#��� ������� ������ �� "� ��'.(*(�' ��0*(�' �# ���!�������� ���8����� ����������� �� ������� 0� ��� �5 /� 5����)��*1

� ����*/
�5���
�� )� ��� /�

�0� � 0���(�� �5 ,�����

� )� ��=� 5�@����*��A��(�
��* 5�� � @)��*5(� ��

A

7. �/� �����!�� �! ������ �! ����#��� ��'.(*(�' ��0*(�' � - ��9"�� �� �������� �8"�� �� ����������� ����������� �� ������� 0� ��� �5 5����)��*1

� ����*/
�5���
�� )� ��� /�

�0� � 0���(�� �5 ,����� � )� ��=� 5� ��>( � � ����*�� �(� � @�0(��A

��� ��� �����
��������� (��/��*��.
��
�� �������

������ �(�0� 1 2###2#' 3�4 �55�� �1 #6%#'%&#&&

�/�� ���������
����5��� ���(���� ,�

/� 5����)��*1

������ ���7��� �8���9 ���:�������� ���;����9 ��7���8� :��!

��<��� �� ��9����� �;��� �� !���������� ��7���8� :��!

;������� ���� ��7���8� :��! =��

��*� �,,����
� �)���- ������- /��� �0��)��

��!!������ 8������ ���;����9 ��7���8� :��! =����(���* � ��(�

� �5 � �?���- �

�- �*������- 0����- �����������- ��� (��
���
���- ��� ��� �55����-

�55������- �*�� �- ��� ��,������ �5 ���- 5� ������ � ����* 5 �� )� @ ,� 5� ��� 0� � �� 0�/��5 �5

��
�.

�,��.)�+*�, .�/&*.�% +� #�)0'�+� +$*- �#$�%&'�1 *� ,�+ -$�2, �3�4�1 2*'' 3� -$�2, *, +$� ��#'�.�+*�,-�

��� A�/� �� �� ���( ��B �� ���/ �5 � �*� 5� �� �� 5� / �0�

����(�� �� �� ���(��
/� ,���� ��*���?�

/� ��/��(��- 0(

� ���0���

5���C(� �����*���(�
��* 5�� ��(�,��
���� ,�5���� 5�

���( �� ��� ��(��� 0� ��( ��

��� ��� �����
��������� (��/��*��.

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