2023-03-01 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 Lovitt & Touché A Marsh and McLennan Agency, LLC for Adelante Healthcare, Inc., with multiple insurance carriers including Republic Indemnity Company of California, Selective Insurance Co of America, Great American Insurance Company, and others. The certificate is for a contract with the Arizona Department of Health Services, specifically for the Health Start Program, with a contract number of CTR050592. The policy period runs from 3/1/2022 to 3/1/2023 and provides coverage in Arizona.

The insurance provides comprehensive general liability, automobile liability, umbrella liability, and workers' compensation coverage. The general liability policy has a $1,000,000 per occurrence limit, a $3,000,000 general aggregate limit, and includes additional insured provisions when required by written contract. The automobile liability coverage has a $1,000,000 combined single limit, and the workers' compensation insurance provides $1,000,000 in coverage. The policy also includes sexual abuse/molestation coverage with $1,000,000 per claim and $3,000,000 aggregate limits. The insurance is primary and non-contributory, with a waiver of subrogation for general and automobile liability.

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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

3/3/2022

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

Marlene Carles 602-792-2307 602-385-7060 mcarles@lovitt-touche.com

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

Adelante Healthcare, Inc.

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

Great American Insurance Company 16691

1021412476

B X 1,000,000 X 500,000

15,000

1,000,000

3,000,000 X X

Y Y S2304520 3/1/2022 3/1/2023

3,000,000

B 1,000,000

X Y Y S2304520 3/1/2022 3/1/2023

B X X 7,000,000S2304520 3/1/2022 3/1/2023

7,000,000 X 0

A C

X18285111

WCE79829601

3/1/2022 3/1/2022

3/1/2023 3/1/2023

1,000,000

1,000,000

1,000,000 B Sexual Abuse/Molestation S2304520 3/1/2022 3/1/2023 Each Claim

Aggregate 1,000,000 3,000,000

Additional insured applies, when required by written contract, as respects to General Liability per form CG7300 01/19 and Automobile Liability per form CA7809 11/17. Insurance is Primary and Non-Contributory as respects to General Liability per form CG7300 01/19. Waiver of subrogation applies to General Liability per form CG7300 01/19 and Automobile Liability per form CA7809 11/17.

RE: Contract #CTR050592 | HEALTH START PROGRAM

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

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