2022-02-12_COI_GL_AL_WC_PL_SAM.pdf

07/16/2021

Harnish Insurance Group 2045 S Vineyard Ste 143

Mesa AZ 85210

Bryan Harnish

(480) 839-9077 (866) 771-9077 certs@theharnishgroup.com

Pathway to Work, LLC 1445 E Guadalupe Rd Ste 101

Tempe AZ 85283

Secura Insurance Secura Ins 22543 Trumbull Insurance Company 27120

CL212802585

A Directors & Officers Liability

Y Y CP3280983 02/12/2021 02/12/2022

2,000,000 100,000 10,000 2,000,000 2,000,000 2,000,000

B Y Y A3294757 02/09/2021 02/09/2022

1,000,000

WVR SUBROGATION

SPECIFIC

C Y Y 59WECAB7Z2T 07/10/2021 07/10/2022

1,000,000 1,000,000 1,000,000

A Professional Liability Sexual Abuse & Molestation Liability Y Y CP3280983 02/12/2021 02/12/2022

Each Occurrence 2,000,000 Aggregate 2,000,000

Solicitation No: BPM003395 RE: Contract # CRT056097

The State of Arizona and the Department of Economic Security are named as additional insured with respect to liability arising out of the activities performed by or on behalf of the Qualified Vendor, per the provisions of the attached endorsement(s).

General Liability, Automobile Liability, and Workers Compensation Liability coverage contains a waiver of subrogation in favor of the State of Arizona, its

State of Arizona Department of Economic Security 1789 W Jefferson, Mail Drop 1541 Phoenix AZ 85007

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)

© 1988-2015 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

Pathway to Work, LLC

00005982

Harnish Insurance Group

25 Certificate of Liability Insurance departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees for losses arising from work performed by or on behalf of the the Qualified Vendor per the provisions of the attached endorsement(s).

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:

Manuscript Cov 1 @MN01

$250.00

Designtd Insrd 01 @DI01

Additional Prem to Equal Inc Limits AILMP

$114.00

Increased employer's liability INEL

$6.00

Expense constant EXCNT

$160.00

Waiver of Subrogation WVSUB

$250.00

ADDITIONAL COVERAGES

Ref # Description Edition DateForm No.Coverage Code

Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium

Ref # Description Coverage Code Form No. Edition Date

Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium

Ref # Description Coverage Code Form No. Edition Date

Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium

Ref # Description Coverage Code Form No. Edition Date

Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium

Ref # Description Coverage Code Form No. Edition Date

Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium

Ref # Description Coverage Code Form No. Edition Date

Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium

Ref # Description Coverage Code Form No. Edition Date

Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium

Ref # Description Coverage Code Form No. Edition Date

Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium

Ref # Description Coverage Code Form No. Edition Date

Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium

Ref # Description Coverage Code Form No. Edition Date

Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium

Ref # Description Coverage Code Form No. Edition Date

Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium

Copyright 2001, AMS Services, Inc.OFADTLCV

SGE 2001 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 3 1001 © 2010 SECURA Insurance Company

THIS ENDORSEMENT CHANGES YOUR POLICY. PLEASE READ IT CAREFULLY.

PROFESSIONAL LIABILITY SCHEDULE – HUMAN SERVICES

This Endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PROFESSIONAL LIABILITY COVERAGE FORM

With respect to coverage provided by this Endorsement, the provisions of the Coverage Part apply unless modified by the Endorsement.

SCHEDULE

COVERED PROFESSIONS

Specified Profession: Vocational Training Program

LIMITS OF INSURANCE

$ 2,000,000 EACH “WRONGFUL ACT”

$ 2,000,000 PROFESSIONAL LIABILITY AGGREGATE

$ DEDUCTIBLE (None if blank)

LIMITS ARE: In Addition To The General Liability Limits.

(If no entry appears above, information required to complete this Endorsement will be shown in the Schedule of the Declarations as applicable to this Endorsement.)

Additional Human Services Exclusions

The following are added to PROFESSIONAL LIABILITY COVERAGE EXCLUSIONS:

This insurance does not apply to liability:

a. Resulting from commitment of any person to a psychiatric or mental health institution.

b. Arising out of the operation of any hospital, sanatorium, “medical clinic”, pharmacy, or any other medical facility or laboratory.

c. Arising out of acts, errors or omissions in providing managerial or administrative services other than the providing of professional services to individuals in your capacity as a human services organization.

d. Arising out of:

(1) The actual or threatened physical or sexual abuse or molestation by anyone of any person while that person is in the care, custody or control of any insured regardless whether the abuse or molestation was specifically intended or resulted from negligent conduct;

(2) The negligent:

(a) Employment;

(b) Investigation;

(c) Supervision;

(d) Reporting to the proper authorities, or failure to so report; or

(e) Retention of a person for whom any insured is or ever was legally responsible and whose conduct would be excluded by (1) above; or

(3) The negligent failure to provide professional services in connection with or to neglect the therapeutic needs of a client, patient, or other person because of the conduct which would be excluded by paragraph (1) above.

SGE 2001 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 2 of 3

Additional Human Services Supplementary Payments

The SUPPLEMENTARY PAYMENTS - PROFESSIONAL LIABILITY COVERAGE applicable to PROFESSIONAL LIABILITY COVERAGE are amended to add:

1. Related Disciplinary Proceeding Defense Expense

We will reimburse you, but not others who may otherwise qualify as an insured hereunder, for your reasonable legal services charged by a lawyer we agree to and other expenses you may incur in the investigation and defense of “disciplinary proceeding(s)” brought against you arising out of a “wrongful act” that is otherwise covered by this policy. This supplementary payment is limited to $100,000 per “wrongful act”. The most we will pay in any one policy period is $100,000.

2. Standards Review Defense Expense

We will reimburse you, but not others who may otherwise qualify as an insured hereunder, for your reasonable legal services charged by a lawyer we agree to and other expenses you may incur arising out of any act or omission in the furnishing or failure to furnish services as a formal accreditation, standards review or similar board. This supplementary payment is limited to $100,000 per incident.

The most we will pay in any one policy period is $100,000.

3. Added Covered Professions

If you begin professional services other than Covered Professions stated above after the effective date of this policy, you may extend coverage to your new operation. If professional services other than a Covered Professions stated above were part of your operation on or prior to the effective date of this policy, coverage does not apply. Any added profession is subject to all the Exclusions and conditions of this policy.

Additional Human Services Who Is An Insured

Who Is An Insured applicable to PROFESSIONAL LIABILITY COVERAGE is amended to add:

1. Your medical directors, board members and administrators, but only while acting within the scope of and during the course of their duties as such. But such medical directors, board members and administrators are not insured and coverage does not apply to “damages” arising out of such individuals furnishing or failure to furnish professional services as a physician, psychiatrist, physician assistant, dentist, pharmacist, anesthesiologist, nurse anesthetist, nurse practitioner, nurse midwife, x-ray therapist, radiologist, chiropodist, chiropractor, optometrist, podiatrist in the treatment of a patient.

2. Students in training, but only for acts within the scope of their duties related to the conduct of your organization.

3. Any social workers, “lay counselor”, “professional counselor”, and/or case managers, but only for acts within the scope of their duties related to the conduct of your organization.

4. An independent contractor is an insured, but only with respect to professional services not excluded in PROFESSIONAL LIABILITY COVERAGE; 2. Exclusions; C. (2) of the PROFESSIONAL LIABILITY COVERAGE FORM, and performed for your Human Service organization.

Additional Human Services Conditions

SECTION IV – COMMERCIAL GENERAL LIABILITY CONDITIONS on the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is amended to add:

Governmental Immunity

If you are a public institution, you may be entitled to Governmental Immunity. This Coverage Form does not constitute a waiver of any charitable or governmental immunity to which you are entitled.

Additional Human Services Definitions

Definitions applicable to PROFESSIONAL LIABILITY COVERAGE are amended to add:

1. “Counseling” means the professional guidance of the individual by utilizing psychological methods especially in collecting case history data, using various techniques of personal interview and/or testing interests and aptitudes.

2. “Disciplinary proceedings” means any proceeding brought against you by a state regulatory or disciplinary official or agency to investigate charges alleging professional misconduct.

3. “Lay counselor” means your appointed person or your employee or your volunteer who:

a. Has been trained to counsel others; and

b. Is specifically authorized by you or your leaders to engage in “counseling” activities on behalf of your organization.

SGE 2001 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 3 of 3

4. “Medical clinic” means any medical facility open to the general public. A medical clinic does not include facilities operated solely for the treatment of your consumers or clients, for whom you provide professional services.

5. “Professional counselor” means your appointed person, your employee or your volunteer who:

a. Has been professional trained through obtaining education degrees to perform “counseling” activities; and

b. Is generally authorized by you or your leaders to engage in “counseling” activities on behalf of your organization.

All other terms and conditions of this policy not in conflict with the terms and conditions of this Endorsement shall continue to apply.

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