2022-03-01 COI.pdf

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Master Agreement AZ|CTR050592
Contract number
CTR050592
Issued by
Arizona

About this file

This document is a Certificate of Liability Insurance issued by Selective Insurance Company of America and Republic Indemnity Company of California, with Lovitt & Touché A Marsh and McLennan Agency, LLC serving as the insurance producer. The certificate is for Adelante Healthcare, Inc., located in Phoenix, Arizona, and names the Arizona Department of Health Services as the certificate holder. The policy covers the Health Start Program under Contract #CTR050592, with coverage effective from March 1, 2021 to March 1, 2022.

The insurance provides commercial general liability, automobile liability, umbrella liability, and workers' compensation coverage. Key coverage limits include $1,000,000 for each occurrence of bodily injury and property damage, $3,000,000 general aggregate, $1,000,000 for automobile liability, and $7,000,000 umbrella liability. The policy includes additional insured provisions for the State of Arizona, its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees. A notable feature is the waiver of subrogation in favor of the state and its entities for losses arising from work performed by or on behalf of the contractor.

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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

7/23/2021

Lovitt & Touché A Marsh and McLennan Agency, LLC 1050 W Washington Street, Suite 233 Tempe AZ 85281

Jasmine Loesch 602-792-2329 602-956-2258 jloesch@lovitt-touche.com

Selective Insurance Co of America 12572 ADELA-1 Republic Indemnity Company of Californi 43753

Adelante Healthcare, Inc.

3033 N. Central Ave, Ste 145, 140, 200 Phoenix AZ 85012

254020455

A X 1,000,000 X 500,000

15,000

1,000,000

3,000,000 X X X

Y Y S230452001 3/1/2021 3/1/2022

3,000,000

A 1,000,000

X

X X

Y Y S230452001 3/1/2021 3/1/2022

A X X 7,000,000S230452001 3/1/2021 3/1/2022

7,000,000 X 0

B X18285111 3/1/2021 3/1/2022

1,000,000

1,000,000

1,000,000 A Sexual Abuse/Molestation S230452001 3/1/2021 3/1/2022 Each Claim

Aggregate 1,000,000 3,000,000

With respects to General Liability and Auto Liability coverage:

The State of Arizona, and its departments, agencies, boards, commissions, universities, 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 Contractor.

Subrogation is waived in favor of the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees for losses arising from work performed by or on behalf of the Contractor.

RE: Contract #CTR050592 | HEALTH START PROGRAM

Arizona Department of Health Services 150 N. 18th Avenue, Suite 530 Phoenix AZ 85007

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