2023-11-02_COI.pdf

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

INSR ADDL SUBR

LTR INSD WVD

PRODUCER

CONTACT

NAME:

FAXPHONE

(A/C, No):(A/C, No, Ext):

E-MAIL

ADDRESS:

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

POLICY NUMBER

POLICY EFF POLICY EXP

TYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)

AUTOMOBILE LIABILITY

UMBRELLA LIAB

EXCESS LIAB

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

AUTHORIZED REPRESENTATIVE

EACH OCCURRENCE $

DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence)

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT

OTHER: $

COMBINED SINGLE LIMIT

$(Ea accident)

ANY AUTO BODILY INJURY (Per person) $

OWNED SCHEDULED

BODILY INJURY (Per accident) $AUTOS ONLY AUTOS

HIRED NON-OWNED PROPERTY DAMAGE

$AUTOS ONLY AUTOS ONLY (Per accident)

OCCUR EACH OCCURRENCE

CLAIMS-MADE AGGREGATE $

DED RETENTION $

PER OTH-

STATUTE ER

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE $

If yes, describe under

E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below

INSURER(S) AFFORDING COVERAGE NAIC #

COMMERCIAL GENERAL LIABILITY

Y / N

N / A (Mandatory in NH)

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

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.

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.

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).

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

CERTIFICATE HOLDER CANCELLATION

© 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03)

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

The ACORD name and logo are registered marks of ACORD

6/19/2023

(928) 445-1900 (928) 445-0134

14329

Stepping Stones Foundations Inc.

dba: Stepping Stones Agencies 2651 N Industrial Way, Suite A Prescott Valley, AZ 86314

31003

A 1,000,000

X X 60004695 11/2/2022 11/2/2023 1,000,000

10,000

1,000,000

2,000,000

2,000,000

Abuse & Molest 1,000,000

1,000,000A

X X 60004695 11/2/2022 11/2/2023

2,000,000A 60005535 11/2/2022 11/2/2023 2,000,000

B

X PWC9500587 11 1/1/2023 1/1/2024 1,000,000

1,000,000

1,000,000

A Professional Liab 60004695 11/2/2022 Occurrence 1,000,000

A Professional Liabili 60004695 11/2/2022 11/2/2023 Aggregate 2,000,000

RE: Contract # CTR066203 State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees additional insured and waiver of subrogation applies.

Sexual Abuse & Molestation coverage is included: $1,000,000/$2,000,000

Professional Liability limits are $1,000,000 Each Claim/Occurence/Offense/Wrongfull Act with $2,000,000 Aggregate. Professional Liability is included under the Excess Liability policy schedule & limits.

The State of Arizona Dept of Economic Security 1789 W Jefferson Street Mail Drop 6271 Phoenix, AZ 85007

STEPSTO-02 KHERTER

The Mahoney Group - Prescott 3636 Crossing Drive, Suite B Prescott, AZ 86305

Social Services Contractor

Tri-State Insurance Company of Minnesota

X

11/2/2023

X

X

X

X

X X

The State of Arizona, its departments, agencies, boards, commissions, and universities, and all officers, officials, agents, and employees of these entities, for losses arising from work performed by or on behalf of the Contractor

Social Service Contractors Indemnity Pool

EXCESS LIABILITY COVERAGE AGREEMENT DECLARATIONS_SSEDEC_01/21

SSEDEC (01-21) Includes wording © ISO Properties, Inc., used with permission Page 1 of 2

EXCESS LIABILITY COVERAGE AGREEMENT

DECLARATIONS

Policy # 6000553-5

Replaces Policy # 6000553-

4SSCE

THIS DECLARATIONS PAGE AND THE ATTACHED EXCESS LIABILITY COVERAGE AGREEMENT COMPLETE THIS COVERAGE PART.

Item 1. "NAMED INSURED":

Stepping Stones Foundations Inc. dba: Stepping Stones Agencies 2651 N Industrial Way Ste A Prescott Valley, AZ 86314

Item 2. CONTINOUS COVERAGE PERIOD:

12:01 A.M. Standard Time at Named Insured Mailing Address

Rating Period from: 11/02/2022 To: 11/02/2023

Item 3. LIMITS OF INSURANCE

Aggregate Limit of Liability

$ 2,000,000 $ 2,000,000

Item 4. EXCESS RETRO-ACTIVE DATE:

Professional (E & O): 11/02/2000

Employers Benefits Liability: 11/21/2014

Item 5. SCHEDULE OF "UNDERLYING INSURANCE COVERAGE":

Excess coverage applies only to coverage for which underlying Limits of Coverage are shown.

COMMERCIAL GENERAL LIABILITY LIMITS (OCCURRENCE)

Underlying Insurer: SSCIP Underlying Policy Number: 6000469 Policy Period: From: 11/02/2022 General Liability – Aggregate $ 2,000,000 General Liability – Each Occurrence $ 1,000,000