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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2023-07-01_COI.zip ZIP file
2025.07.01 COI GL AL UL WC.pdf PDF
CTR065358_Pricing.xlsx XLSX spreadsheet
CTR065358_Contract_Documents.pdf 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

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

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 .