2022-04-01_GL_AL_U_WC_PL_SAM.pdf

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

7/22/2021

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

Lindsey Brundage 602-385-0535 602-956-2258 lbrundage@lovitt-touche.com

AMCO Insurance Company 19100 CENTE-9 Nationwide Mutual Insurance Company 23787

The Centers for Habilitation The Centers for Habilitation Enterprises, LLC dba ASDD 215 W. Lodge Drive Tempe AZ 85283

CopperPoint General Insurance Company 13043

1148276845

A X 1,000,000 X 1,000,000

20,000

1,000,000

3,000,000 X

Y Y ACP3029178513 4/1/2021 4/1/2022

3,000,000

B 1,000,000

X

Y Y ACPBA3029178513 4/1/2021 4/1/2022

A X X 5,000,000ACPCAA3029178513 4/1/2021 4/1/2022

5,000,000 X 0

C XY 1015685 4/1/2021 4/1/2022

1,000,000

1,000,000

1,000,000 A

Professional Liability Sexual Abuse & Molestation

ACP3029178513 4/1/2021 4/1/2022 Per Occurrence $1,000,000 $1,000,000

Per Aggregate $3,000,000 $3,000,000

The above-indicated Additional Insured and Waiver of Subrogation are provided with respects to General Liability when required in a written and executed contract.

The above-indicated Additional Insured is provided with respects to Automobile Liability when required in a written and executed contract.

Umbrella Liability, $5,000,000 is excess of General Liability, Automobile Liability, Employers Liability, Professional Liability and Sexual Abuse & Molestation.

Contract #CTR056121 See Attached...

The State of Arizona Department of Economic Security 1789 W. Jefferson, MS 1541 Phoenix AZ 85007

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:

CENTE-9

1 1

Lovitt & Touché A Marsh and McLennan Agency, LLC The Centers for Habilitation The Centers for Habilitation Enterprises, LLC dba ASDD 215 W. Lodge Drive Tempe AZ 85283

25 CERTIFICATE OF LIABILITY INSURANCE

Sexual Abuse and Molestation Coverage is included as evidenced on certificate.

Professional Liability coverage is written on a Claims Made basis, 2/14/2005 Retroactive Date.

Umbrella Liability is in addition to Professional Liability limits stated on certificate. Total insured Professional Liability limits $6,000,000 per occurrence and $8,000,000 per aggregate.

General Liability:

The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees are additional insureds with respect to liability arising out of the activities performed by, or on behalf of Vendor.

Policy contains a waiver of subrogation, as required by this written agreement, in favor of The State of Arizona, and its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees for losses arising from work performed by or on behalf of Vendor.

Business Automobile Liability:

The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees are additional insureds with respect to liability arising out of the activities performed by, or on behalf of, Vendor involving automobiles owned, hired and/or non-owned by Vendor.

Policy contains a waiver of subrogation as required by this written agreement in favor of 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 Vendor.

Workers' Compensation and Employers' Liability:

Policy contains a waiver of subrogation as required by this written agreement in favor of 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 Vendor.