2024-07-01_COI.pdf
PDF 104 KB Posted
- Attached to
- Master Agreement AZ|CTR065358
- Contract number
- CTR065358
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for the American Lung Association, issued by Arthur J. Gallagher Risk Management Services, LLC on 7/31/2023. The certificate involves multiple insurance carriers, including Continental Insurance Company and Transportation Insurance Company, and is specifically related to a contract with the State of Arizona (CTR065358). The certificate holder is the Arizona Department of Health Services, located in Phoenix, Arizona.
The insurance coverage includes Commercial General Liability with a $1,000,000 per occurrence limit and a $2,000,000 general aggregate, Automobile Liability covering any auto with a $1,000,000 limit, Umbrella Liability with a $10,000,000 each occurrence and aggregate limit, and Workers' Compensation with a $1,000,000 policy limit. The policies are effective from 7/1/2023 to 7/1/2024, and include additional insured provisions for the State of Arizona, its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees. The insurance is primary, with a waiver of subrogation, and includes specific coverage for abuse or molestation.
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Other files
| File | Type | Posted |
|---|---|---|
| 2023-07-01_COI.zip | ZIP file | |
| 2025.07.01 COI GL AL UL WC.pdf | ||
| CTR065358_Pricing.xlsx | XLSX spreadsheet | |
| CTR065358_Contract_Documents.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
7/31/2023
Arthur J. Gallagher Risk Management Services, LLC 702 King Farm Boulevard, Suite 210 Rockville MD 20850
Julia Van De Wille 301-795-6600
Julia_VanDeWille@ajg.com
Continental Insurance Company 35289 AMERLUN-04 Transportation Insurance Company 20494
American Lung Association 55 W. Wacker Drive Suite 1150 Chicago IL 60601
1247515500
B X 1,000,000 X 1,000,000
5,000
1,000,000
2,000,000 X
Y Y 6078757486 7/1/2023 7/1/2024
2,000,000
Abuse or Molestation 1,000,000 B 1,000,000
X Y Y 6078757441 7/1/2023 7/1/2024
A X X 10,000,000Y 6078757455 7/1/2023Y 7/1/2024
10,000,000 X 10,000 Abuse or Molestation 1,000,000
B X
N
Y 6078757472 7/1/2023 7/1/2024
1,000,000
1,000,000
1,000,000
RE: CTR065358 State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees are included as Additional Insured as respects General Liability, Umbrella and Auto liability policies pursuant to and subject to the policy's terms, definitions, conditions and exclusions. The insurance provided in the General Liability policy is primary and any other insurance shall be excess only, and not contributing. Waiver of Subrogation applies to additional insured, as respects General Liability, Auto liability and Workers’ Compensation policies, pursuant to and subject to the policy's terms, definitions, conditions and exclusions
Arizona Department of Health Services 150 N 18th Ave., Suite 530 Phoenix AZ 85007
USA
File details come from the government source that posted it. Updated .