2022_03_10_CL_AL_UL_PL_SAM_WC.pdf
PDF 894 KB Posted
- Attached to
- Master Agreement AZ|CTR058022
- Contract number
- CTR058022
- Issued by
- Arizona
About this file
The document is a Certificate of Liability Insurance issued by Philadelphia Indemnity Insurance Company through Pinnacle Insurance Consultants, covering Odyssey Services Corporation. The policy provides insurance for Odyssey Services Corporation and names the State of Arizona, its departments, agencies, boards, commissions, universities, and employees as additional insureds. The insurance policy covers the period from 01/29/2022 to 01/29/2023.
The insurance includes multiple coverage types with various liability limits: Commercial General Liability with a $2,000,000 general aggregate and $1,000,000 per occurrence, Professional Liability with $1,000,000 per incident and $2,000,000 aggregate, and Commercial Umbrella Liability with $1,000,000 each occurrence. The policy covers services including Career Exploration, Pre-Employment Transition Services, Tutoring Service, Supported Education Services for Vocational Rehabilitation Clients, and Small Business Consultation. The total premium for the policy is $3,240.00, and it is structured as a claims-made policy with a retroactive date of 07/13/2005 for professional liability coverage.
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Text version
POLICY CHANGE DOCUMENT
POLICY NO.:
CHANGE EFFECTIVE CHANGE # REVISION #
DESCRIPTION
PHPK2227220
102/03/2021
02/05/2021____________________ Issue Date
Amended:
Manuscript- Addl Insured Full Name-State of Arizona
Per attached Form
Philadelphia Indemnity Insurance Company
NAMED INSURED
25827 Pinnacle Insurance Consultants
Odyssey Services Corporation
MAILING ADDRESS 8947 E Quill St Mesa, AZ 85207-9724
POLICY PERIOD: FROM TO at 12:01 A.M. Standard Time at your mailing address shown above.
Path ID 14437737
0.00
NO CHANGE
COUNTERSIGNED BY
(Date) (Authorized Representative)
01/29/2021 01/29/2022
In consideration of the premium reflected, the policy is amended as indicated below:
Total Annual 0.00Additional/Return Premium $ Additional/Return Premium $
Total Prorate
NO CHANGE
Insurance Policy
PI-MANU-1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
All other terms and conditions of this Policy remain unchanged.
The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees for losses arising from work performed by or on behalf of the Contractor
Policy Number: PHPK2227220
Addl Insured Full Name-State of Arizona
| COI thru 012923.pdf |
| CGL-AL-PL-SAM-UL ACORD+ENDs EXP 1-29-22 |
| WC and Waiver EXP 3-10-22 - Odyssey Services WC coverage |
| CGL-AL - same policy number - Addnl Insured END EXP 1-29-22 |
| Insurance Policy |
| Policy Change Document |
| Manuscript Endorsement |
File details come from the government source that posted it. Updated .