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.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| CTR062093Contract_Amendment_2.pdf | ||
| CTR062093_Pricing.xlsx | XLSX spreadsheet | |
| CTR072825_ContractExtension_Amd3.pdf | ||
| 2022_Dec_07_COI_GL__AL.pdf | ||
| CTR072825_Amd4_Adding_Dental.pdf | ||
| 2023_11_30_COI.pdf | ||
| Contract_Extension_2023.pdf |
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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
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 .