2024-3-1_COI.pdf

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

INSR ADDL SUBR

LTR INSD WVD

PRODUCER CONTACT

NAME:

FAXPHONE

(A/C, No):(A/C, No, Ext):

E-MAIL

ADDRESS:

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

POLICY NUMBER

POLICY EFF POLICY EXP

TYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)

AUTOMOBILE LIABILITY

UMBRELLA LIAB

EXCESS LIAB

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

AUTHORIZED REPRESENTATIVE

EACH OCCURRENCE $

DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence)

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT

OTHER: $

COMBINED SINGLE LIMIT

$(Ea accident)

ANY AUTO BODILY INJURY (Per person) $

OWNED SCHEDULED

BODILY INJURY (Per accident) $AUTOS ONLY AUTOS

HIRED NON-OWNED PROPERTY DAMAGE

$AUTOS ONLY AUTOS ONLY (Per accident)

OCCUR EACH OCCURRENCE

CLAIMS-MADE AGGREGATE $

DED RETENTION $

PER OTH-

STATUTE ER

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE $

If yes, describe under

E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below

INSURER(S) AFFORDING COVERAGE NAIC #

COMMERCIAL GENERAL LIABILITY

Y / N

N / A (Mandatory in NH)

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

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.

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.

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).

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

CERTIFICATE HOLDER CANCELLATION

© 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03)

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

The ACORD name and logo are registered marks of ACORD

7/20/2023

24319

WestCare Arizona I, Inc.

PO Box 94738 Las Vegas, NV 89193-4738

44768 20044

A 1,000,000

X X 5088087804 7/1/2023 7/1/2024 1,000,000

20,000

1,000,000

3,000,000

3,000,000

ABUSE AGGREGATE 2,000,000

1,000,000B

X X 5091019304 7/1/2023 7/1/2024

3,000,000A

X X 5090022304 7/1/2023 7/1/2024

10,000 C

X WEWC418372 3/1/2023 3/1/2024 1,000,000

1,000,000

1,000,000

A Professional Liabili 5088087804 7/1/2023 Aggregate 3,000,000

A Professional Liabili 5088087804 7/1/2023 7/1/2024 Occurrence 1,000,000

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Contract #CTR066209 - Domestic Violence -Statewide The State of Arizona and the Dept. of Economic Security, Officials, Agents and Employees are included as additional insureds for general liability & auto liability arising out of the activities performed by the Named Insured where required by written contract. Waiver of subrogation is in favor of The State of Arizona and the Dept. of Economic Security, Officials, Agents and Employees where required by written contract.

Workers compensation waiver in favor of The State of Arizona and the Dept. of Economic Security, Officials, Agents and Employees where required by written contract.

Umbrella extends over General, Professional, and Automobile Liability.

30 Days notice of cancellation; except 10 days for nonpayment.

State of Arizona, Dept of Economic Security Procurement Office- bernadettehill@azdes.gov 1789 W. Jefferson, Mail Drop 1541 Phoenix, AZ 85007

WESTFOU-01 SE72DWILLIAMS

AssuredPartners, Lake Mary 300 Colonial Center Parkway, Suite 270 Lake Mary, FL 32746

Deidre Williams deedee.williams@assuredpartners.com

Allied World Surplus Lines Insurance Company

Vantapro Specialty Insurance Company Berkshire Hathaway Homestate

X

7/1/2024

X X

X

X X

X

FORM NUMBER:

EFFECTIVE DATE:

The ACORD name and logo are registered marks of ACORD

ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE

FORM TITLE:

Page of

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

ACORD 101 (2008/01)

AGENCY CUSTOMER ID:

LOC #:

AGENCY NAMED INSURED

POLICY NUMBER

CARRIER NAIC CODE

© 2008 ACORD CORPORATION. All rights reserved.

AssuredPartners, Lake Mary

WESTFOU-01

SEE PAGE 1

SEE PAGE 1

ACORD 25 Certificate of Liability Insurance

SEE P 1

WestCare Arizona I, Inc.

PO Box 94738 Las Vegas, NV 89193-4738

SEE PAGE 1

SE72DWILLIAMS

Additional Coverages:

Coverage: Abuse & Molestation INSURER AFFORDING COVERAGE: Allied World Surplus Lines Insurance Company

POLICY NUMBER: 5088-0878-04 EFF DATE: 07/01/2023 EXP DATE: 07/01/2024

TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:

Abuse & Molestation Per Occurrence $1,000,000

Aggregate $3,000,000

Coverage: Cyber Liability INSURER AFFORDING COVERAGE: Houston Casualty Company

POLICY NUMBER: H21NGP210771-02 EFF DATE: 09/21/2022 EXP DATE: 09/21/2023

TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:

Network Security Liability Per Claim: $5,000,000

Aggregate: $5,000,000

Coverage: Executive Risk/Management Liability INSURER AFFORDING COVERAGE: Federal Insurance Company

POLICY NUMBER: 8250-4431 EFF DATE: 09/21/2022 EXP DATE: 09/21/2023

TYPE OF INSURANCE: LIMIT DESCRIPTION LIMIT AMOUNT: Retention:

Directors & Officers Liability Each Incident $6,000,000 $100,000 Employment Practices Liability Each Incident $6,000,000 $150,000 Fiduciary Liability Each Incident $2,000,000 $0 Maximum Aggregate: Aggregate $6,000,000

POLICY NUMBER:5091-0193-04 COMMERCIAL AUTO

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

NON-PROFIT AND SOCIAL SERVICES AUTO ENHANCEMENT ENDORSEMENT

This endorsement modifies insurance provided under the:

BUSINESS AUTO COVERAGE FORM

With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement.

1. TEMPORARY SUBSTITUTE AUTOS PHYSICAL DAMAGE

The following is added to Section I - Covered Autos:

D. Temporary Substitute Autos - Physical Damage

If Physical Damage Coverage is provided by this Coverage Form for an "auto" you own and that covered "auto" is out of service because of its:

1. Breakdown;

2. Repair;

3. Servicing;

4. "Loss"; or

5. Destruction, then solely in that event, Physical Damage Coverage is provided for an "auto" you do not own while it is being used with the permission of its owner as a temporary substitute "auto" for the out of service covered "auto". We will pay the owner for "loss" to the temporary substitute "auto". This insurance covers the interest of the owner unless the "loss" results from fraudulent acts or omissions on your part. If we make any payment to the owner, we will obtain the owner's rights against any other party.

2. EMPLOYEES OR VOLUNTEER WORKERS AS INSUREDS

The following is added to Paragraph A.1. Who Is An Insured of Section II - Covered Autos Liability Coverage:

d. Your "employee" or "volunteer worker" while using a covered "auto" you do not own, hire, or borrow, while performing duties related to the conduct of your business.

This insurance shall be excess over any other valid and collectible insurance.

3. BOARD MEMBERS

The following is added to Paragraph A.1. Who Is An Insured of Section II - Covered Autos Liability Coverage:

e. Your elected or appointed board members while using a covered "auto" you do not own, hire or borrow, while performing duties related to the conduct of your business. Anyone else who furnishes that "auto" is also an "insured".

This insurance shall be excess over any other valid and collectible insurance.

NPSS CA 00001 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 1 of 7

POLICY NUMBER:5088-0878-04 COMMERCIAL GENERAL LIABILITY

NON-PROFIT AND SOCIAL SERVICES GENERAL LIABILITY

ENHANCEMENT ENDORSEMENT

It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposures are provided under this policy. If such specific coverage applies, the terms, conditions, and limits of that coverage are the sole and exclusive coverage applicable under this policy.

Throughout this endorsement the words "you" and "your" refer to the "Named Insured" shown in the Declarations. The words "we", "us", and "our" refer to the "Company" providing this insurance.

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE FORM

The following is a summary of the Limits of Insurance and Additional Coverage provided by this endorsement. For complete details on specific coverages, consult the policy contract wording.

A) Medical Payment- Limit increased to $20,000 B) Supplementary Payments - Bail bonds increased to $3,000 / Loss of Earnings increased to

$1,000 each day C) Legal Liability Extension - For fire, lightning, explosion, smoke, and leaks from sprinklers limit increased to $1,000,000 D) Broadened definition of Who is an Insured E) Knowledge or Notice of Occurrence F) Broadened definition of Advertising Injury includes televised or videotaped publication G) Amended definition of Bodily Injury to include mental anguish H) Amended Unintentional Failure to Disclose Hazards I) Amended Liberalization Clause J) Property Damage - Removal of exclusion for "Property Damage" resulting from the use of reasonable force to protect persons or property K) Premises Sold or Abandoned by You L) Added Blanket Additional Insured - Funding sources M) Added Blanket Additional Insured - Managers or lessors of premises N) Additional Insured - By Contract, Agreement or Permit

0) General Aggregate Limit Per Location P) Blanket Special Events Coverage Q) Non-Owned Watercraft Coverage - Length is increased to 65 feet R Blanket Waiver of Subrogation S) Violation of Rights of Residents Coverage (Patient's Rights) T) Liquor Liability Exception to Exclusion

U) Employee Criminal Defense Costs Only Coverage - $25,000 limit of insurance - each "criminal proceeding"

A) MEDICAL PAYMENTS

If Medical Payments Coverage (Coverage C) is not otherwise excluded from this coverage part:

NPSS GL 00004 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 1 of 9

POLICY NUMBER:5088-0878-04 COMMERCIAL GENERAL LIABILITY

PHYSICAL ABUSE AND SEXUAL MOLESTATION ENDORSEMENT

(OCCURRENCE)

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

In consideration of an additional premium of $47,708, it is agreed the following changes are made to the Policy:

A. The insurance provided by this endorsement shall be subject to the limits shown below:

$1,000,000 Physical Abuse and Sexual Molestation

Occurrence Limit

$2,000,000 Physical Abuse and Sexual Molestation

Aggregate Limit

The above Physical Abuse and Sexual Molestation Occurrence Limit of Insurance is the most we will pay for any one claim arising out of "Physical Abuse and Sexual Molestation" during the policy period.

The Physical Abuse and Sexual Molestation Aggregate Limit is the most we will pay, regardless of the number of claim(s) or claimants in any one policy period for "Physical Abuse and Sexual Molestation".

No other limits stated in the Commercial General Liability Coverage Form, the Social Services Professional Liability Coverage Form, or any other Coverage Form attached to this policy applies to any coverage for "Physical Abuse and Sexual Molestation".

These limits are in addition to the Limits of Insurance shown on the Declarations.

Upon exhaustion of the Physical Abuse and Sexual Molestation Aggregate Limit stated in this

Endorsement we shall have no obligation to make any further payments to or on behalf of the insured for defense, indemnification or otherwise.

B. SECTION I - COVERAGES, COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE

LIABILITY and COVERAGE B - PERSONAL AND ADVERTISING INJURY LIABILITY is amended to include the following:

1. Insuring Agreement

a. We will pay those sums that the insured becomes legally obligated to pay as damages because of "bodily injury", "property damage", or "personal and advertising injury" arising out of "Physical Abuse and Sexual Molestation".

b. This insurance applies only if the "Physical Abuse and Sexual Molestation" is caused by an "occurrence" that takes place in the coverage territory place on or after the inception date of this policy, but before the end of the policy period, and within the coverage territory.

NPSS GL 00005 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 1 of 3

Insurance Company: Allied World Surplus Lines Insurance Company

SCHEDULE - NAMED INSURED(S)

Named Insured: Westcare Foundation, Inc.

Name of Agent: NSM Insurance Group

WestCare Arizona I, Inc.

WestCare Gulf coast-Florida, Inc.

WestCare Florida, Inc.

The Village South, Inc.

Guidance/Care Center, Inc.

WestCare Georgia, Inc.

WestCare Kentucky, Inc.

WestCare Illinois, Inc.

WestCare Nevada, Inc.

FitzHouse Enterprises Inc. f/k/a W WestCare estcare Works, Inc.

WestCare North Carolina, Inc.

WestCare Wisconsin.Inc.

The Family Alliance For Veterans of America, Inc.

WestCare Oregon, Inc.

WestCare Texas, Inc.

WestCare Tennessee, Inc.

WestCare California, Inc.

Guara Bl, Inc.

WestCare Washington, Inc.

WestCare Endowment, Inc.

The Village South Institute of Human Resources, Inc.

The Village Foundation, Inc.

The Guidance Clinic of The Middle Keys, Inc.

The Care Center For Mental Health Inc.

WestCare Iowa, Inc.

WestCare Minnesota, Inc.

WestCare Pacific Islands, Inc.

WestCare Wyoming, Inc.

The Village - Virgin Islands Partner In Recovery, Inc.

The Village South, Inc. Profit Sharing Plan WestCare West Virginia, Inc.

WestCare Ohio, Inc.

WestCare Foundation, Inc. Retirement Plan WestCare Puerto Rico, Inc.

VP-IL 10007 00 (09/20)

Policy No.

Effective Date: 7/1/2023 12:01 a.m., Standard Time

Agent No.

5088-0878-04

VP-UM 00001 00 (04/18)

Endorsement No:

This Endorsement, effective: 7/1/2023

(at 12:01 A.M. standard time at the address of the Named Insured as shown in Item 1. B. of the Declarations) forms a part of Policy No: 5090-0223-04 Issued to: Westcare Foundation, Inc.

by: Allied World Surplus Lines Insurance Company

SCHEDULE OF UNDERLYING INSURANCE

SCHEDULE

Type of Coverage

Insurer Policy Number Policy Period

Limits of Insurance

Allied World Surplus Lines Insurance Company

$1,000,000 Each Occurrence Limit

5088-0878-04 $3,000,000 General Aggregate Limit 7/1/2023 - 7/1/2024 $3,000,000 Products-Completed Operations

Aggregate Limit

1. Commercial General Liability

Personal & Advertising Injury Limit

$1,000,000 Any One Person Or Organization

Defense costs:

Erode Do not erode

The Limits of Insurance listed in the policy above.

RETROACTIVE DATE: None

Vantapro Specialty Insurance Company

$1,000,000 Any One Accident Or Loss

5091-0193-04

2. Automobile Liability

7/1/2023 - 7/1/2024 Defense costs:

Erode Do not erode The Limits of Insurance listed in the policy above.

Allied World Surplus Lines Insurance Company

$1,000,000 Each Professional Incident Limit (Per “Claim”)

5088-0878-04 $3,000,000 Professional Liability Aggregate Limit

7/1/2023 - 7/1/2024 $ 25,000 Information Privacy Limit

3. Non-Profit and Social Services Professional Liability Coverage Form $ 5,000 Disciplinary Proceedings Limit

(Per “Proceeding”) Defense costs:

Erode Do not erode The Limits of Insurance listed in the policy above.

RETROACTIVE DATE: N/A

Allied World Surplus Lines Insurance Company

$1,000,000 Each Occurrence Limit

5088-0878-04 $2,000,000 Aggregate Limit

4. Abuse and Molestation

7/1/2023 - 7/1/2024

VP-UM 00001 00 (04/18)

Type of Coverage

Insurer Policy Number Policy Period

Limits of Insurance

Defense costs:

Erode Do not erode

The Limits of Insurance listed in the policy above.

RETROACTIVE DATE: N/A

Allied World Surplus Lines Insurance Company

$1,000,000 Each Employee Limit

5088-0878-04 $3,000,000 Aggregate Limit

5. Employee Benefits Liability

7/1/2023 - 7/1/2024 Defense costs:

Erode Do not erode The Limits of Insurance listed in the policy above.

RETROACTIVE DATE: 5/12/2007

Allied world Surplus Lines Insurance Company

$1,000,000 Each Accident

5088-0878-04 $1,000,000 Disease – Each Employee

6. Stop Gap Liability

7/1/2023 – 7/1/2024 $ Disease – Policy Limit Defense costs:

Erode Do not erode The Limits of Insurance listed in the policy above.

All other terms and conditions of this policy remain unchanged.

By:

Joseph Saraiva

Title: Chief Underwriting Officer

Date: 7/21/2023

1,000,000