2023_Jun_24_COI_O_E_Liability.pdf

PDF 93 KB Posted

Attached to
Master Agreement AZ|CTR072825
Contract number
CTR072825
Issued by
Arizona

About this file

This Certificate of Liability Insurance, issued on September 15, 2022, certifies coverage for Fair Health Inc., located at 530 Fifth Avenue, New York, NY 10036. The certificate was issued by Erich Courant & Company, a licensed producer (License# BR525310), with Victoria Ackerson as the authorized representative. The certificate holder is the State of Arizona Industrial Commission of Arizona, located at 800 W. Washington Street, Phoenix, AZ 85007. The insurer providing coverage is Endurance American Specialty (NAIC# 41718).

The certificate documents Errors and Omissions (E&O) Liability coverage under policy number PRO10004045209, effective from June 24, 2022, through June 24, 2023. The policy provides aggregate coverage of $5,000,000 with a retention (deductible) of $100,000. This certificate supersedes any previously issued certificates and serves as documentation that the specified insurance policies are in force for the policy period indicated. The certificate confers no rights upon the certificate holder and does not amend or alter coverage afforded by the underlying policies, which remain subject to all terms, exclusions, and conditions therein.

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Text version

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

9/15/2022

Erich Courant & Company 25 East Spring Valley Ave Suite 270 Maywood NJ 07607

Victoria Ackerson 201-464-4856 201-226-1201

Victoria@erichcourant.com

License#: BR525310 Endurance American Specialty 41718

FAIRHEA-01

Fair Health Inc.

530 Fifth Avenue New York NY 10036

1775771576

A E&O Liability PRO10004045209 6/24/2022 6/24/2023 E&O Liability Aggregate Retention

5,000,000 5,000,000 100,000

The insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. This form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder.

State of Arizona Industrial Commission of Arizona 800 W. Washington Street Phoenix AZ 85007 United States

THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE

File details come from the government source that posted it. Updated .