2023-9-15_GL__AL__PL.PDF

06/22/2023

Mrs. DL Beaver Insurance Agency Inc.

914 Arizona Ave Parker, AZ 85344 License #: 1338710

Jessica Shontz

(928)669-2255 (928)669-8955 jessica@beaverins.com

00001064-2422688 8

Colorado River Regional Crisis Services 1301 Joshua Avenue Ste C Parker, AZ 85344

SSCIP/Southwest Risk

A Y Y 6000262 09/15/2022 09/15/2023X X

X Sexual Abuse/Molest X ation cov included

X

1,000,000 500,000 10,000

1,000,000 2,000,000 2,000,000

SSCIP/Southwest Risk

A Y Y 6000262 09/15/2022 09/15/2023

X

1,000,000

SSCIP/Southwest Risk

A Y Y 6000486 09/15/2022 09/15/2023

X

1,000,000 1,000,000

Carolina Casualty Insurance Company

B Y Y 1430493 09/15/2022 09/15/2023Directors & Officers Each Claim 1,000,000

SSCIP/Southwest Risk

A Y Y 6000262 09/15/2022 09/15/2023Professional Liab Agg/Occ 2MIL/2MIL

Policy shall contain a WAIVER OF SUBROGATION endorsement as required by this written agreement, in favor of the State of Arizona,and its departments, agencies, boards, commission, universities, officers, officials, agents, and employees for losses arising from work performed by or on behalf of the Contractor.

Contract number is CTR066194 The policy shall be endorsed, as required by this written agreement, to include the State of Arizona, and its departments, (continued on ACORD 101 Additional Remarks Schedule)

Arizona Department of Economic Security, Division of Community Assistance & Development 1789 W Jefferson, MD 4271 Phoenix, AZ 85007

(JRS)

Printed by JRS on 06/22/2023 at 02:31PM

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

INSR ADDL SUBR

LTR INSD WVD

DATE (MM/DD/YYYY)

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 RENTED

CLAIMS-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 AGG $JECT

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 LIMIT $DESCRIPTION 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.

The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03)

CERTIFICATE OF LIABILITY INSURANCE

Printed by JRS on June 22, 2023 at 02:31PM

00001064

Mrs. DL Beaver Insurance Agency Inc.

N/A

Multiple Carriers

Colorado River Regional Crisis Services

25 Certificate of Liability Insurance

(continued from Description of Operations) (continued on ACORD 101 Additional Remarks Schedule)

Additional Remarks:

agencies, boards, commissions, universities, officers, officials, agents, and employees as ADDITIONAL INSUREDS with respect to liability arising out of the activities performed by or on behalf of the Contractor.

The policy shall be endorsed, as required by this written agreement, to include the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees as additional insureds with respect to liability arising out of the activities performed by or on behalf of the Contractor involving automobiles owned, hired and/or non-owned by the Contractor.

AGENCY NAMED INSURED

POLICY NUMBER

CARRIER NAIC CODE

EFFECTIVE DATE:

AGENCY CUSTOMER ID:

LOC #:

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: FORM TITLE:

ADDITIONAL REMARKS

ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

Page ofADDITIONAL REMARKS SCHEDULE