2024_03_01 COI.pdf
PDF 59 KB Posted
- Attached to
- Master Agreement AZ|CTR053476
- Contract number
- CTR053476
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance for Northern Arizona Healthcare doing business as Guardian Air Transport, located in Flagstaff, Arizona. The certificate involves multiple insurance providers, including Endurance American Specialty Insurance Company and National Union Fire Insurance Company of Pittsburgh, PA. The primary certificate holder is the Arizona Department of Health Services, with Marsh USA Inc. serving as the insurance agency. The policy covers the period from 03/01/2023 to 03/01/2024 and includes commercial general liability, automobile liability, and healthcare professional liability insurance.
The insurance provides coverage with various limits, including $10,000,000 for general liability and $1,000,000 for each medical incident. The policy includes additional insured provisions for the State of Arizona, its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees. The coverage applies to general liability and auto liability as required by written contract, with a waiver of subrogation. The policy is primary and non-contributory, limited to liability arising from the named insured's operations and subject to policy terms and conditions. The contract number referenced is CTR053480, and the insurance includes excess liability with specific coverage layers and self-insured retention provisions.
View the file
Other files
Show all 20
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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)
© 1988-2016 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
Included
HHL10015218202
LOS-002549191-17
X
19445
Flagstaff, AZ 86001
Aggregate Limit''XS of $1M/$1M XS $4M/$10M SIR''
Phoenix, AZ 85016
N
03/01/2024
03/01/2024
03/01/2023
CA1342223
Healthcare Professional Liab.
10,000,000
1,000,000
National Union Fire Ins. Co. of Pittsburgh, PA
X
A
X
General Liability and Auto Liability where required by written contract. Waiver of subrogation is applicable as respects General Liability and Auto Liability where required by written contract and subject to policy terms
X
03/02/2023
10,000,000
03/01/2023
2,000,000
Contract # CTR053480
Phoenix, AZ 85007
Arizona Department of Health Services
Arizona Department of Health Services State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are included as additional insured as respects and conditions. Notice of Cancellation provided per attached endorsements. --- Please see additional page. ---
A
CN102428952-AHPs-GAP-23-24
Each Medical Incident
1,000,000
Claims Made
Included
41718
Included
03/01/2024
2325 E. Camelback Road
Marsh USA Inc.
Suite 600
Guardian Air Transport, Northern Arizona Healthcare dba
1200 N Beaver Street
Flagstaff Medical Center
XS of $1M/$1M XS $1M/$10M SIR
HHL10015218202
03/01/2023
03/01/2023
150 N 18th Ave Suite 530
A
B
03/01/2024
Endurance American Specialty Insurance Company
ACORD 101 (2008/01)
The ACORD name and logo are registered marks of ACORD
© 2008 ACORD CORPORATION. All rights reserved.
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: FORM TITLE:
ADDITIONAL REMARKS
ADDITIONAL REMARKS SCHEDULE Page of
AGENCY CUSTOMER ID:
LOC #:
AGENCY
CARRIER NAIC CODE
POLICY NUMBER
NAMED INSURED
EFFECTIVE DATE:
Phoenix
This insurance is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured subject to policy terms and conditions.�
Certificate of Liability Insurance
CN102428952
Marsh USA Inc.� Guardian Air Transport,� Northern Arizona Healthcare dba�
1200 N Beaver Street� Flagstaff Medical Center�
Flagstaff, AZ 86001
File details come from the government source that posted it. Updated .