2024-6-30_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 EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)

AUTOMOBILE LIABILITY

UMBRELLA LIAB

EXCESS LIAB

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

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 LIMIT

Occurence$1,000,000 Occurence$1,000,000

DESCRIPTION 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

7/18/2023

(928) 774-3345 (928) 779-4561

18058

Northland Family Help Center 2532 N. 4th St, Suite 506 Flagstaff, AZ 86004

14216

A 1,000,000

X X PHPK2572857 6/30/2023 6/30/2024 100,000

10,000

1,000,000 3,000,000 3,000,000

1,000,000A

X X PHPK2572857 6/30/2023 6/30/2024

1,000,000A

PHUB870996 6/30/2023 6/30/2024 1,000,000

10,000 B

X 1012347 2/1/2023 2/1/2024 1,000,000 1,000,000 1,000,000

A Professional Liability Sexual Abuse & Molestation

PHPK2572857 6/30/2023 1,000,000

A PHPK2572857 6/30/2023 6/30/2024 1,000,000

The State of Arizona and its departments, agencies, boards, commissions, universities and its officers, officials, agents and employees shall be named as Additional Insured with respect to General Liability per form CG2026 (04/13) with respect to liability arising out of activities performed by or on behalf of the contractor and Commercial Automobile per form CA2048 (10/13) with respect to liability arising out of the activites performed by or on behalf of the contractor involving automobiles, owned, leased, hired or borrowed by the contractor. Policy shall contain a Waiver of Transfer of Rights of Recovery Against Others in favor of The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents and employees for losses arising from work performed by or on behalf of the Contractor per form CG2404 (05/09) as respects General Liability and form CA0444 (03/10) as respects Commercial Auto and Work Comp per Form WC00 0313. DES Contract number CTR066201 Domestic Violence Statewide

The State of Arizona Arizona Department of Economic Security 1789 W Jefferson St Mail Drop1541 Phoenix, AZ 85007

NORTFAM-03 BUNNYALDERETE

NFP Property & Casualty Services, Inc.

214 E Birch Avenue Flagstaff, AZ 86001

Bunny Alderete

Philadelphia Indemnity Insurance Company CopperPoint Insurance Company

X

6/30/2024

X X

X

X

X

X

X

Aggregate Aggregate

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13

(Ed. 4-84)

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.)

This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.

Schedule

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.

(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)

Endorsement Effective Policy No. Endorsement No.

Insured Premium

Insurance Company Countersigned by___________________________________________

WC 00 03 13

(Ed. 4-84)

1983 National Council on Compensation Insurance.

Northland Family Help Center

1012347

Bunny L Alderete Copper Point Mutual Insurance Company

The State of Arizona, it's departments, agencies, boards, commissions, universities, officers, officials, agents and employees for losses arising from work performed by or on behalf of the Contractor.

PI-CXL-002 (05/19)

Includes copyrighted material of Insurance Services Office, Inc., with permission.

COMMERCIAL UMBRELLA LIABILITY INSURANCE

POLICY DECLARATIONS

NAMED INSURED:

MAILING ADDRESS:

POLICY PERIOD: FROM 06/30/2023 TO 06/30/2024 AT 12:01 A.M. STANDARD

TIME AT YOUR MAILING ADDRESS SHOWN ABOVE

IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS

POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY.

LIMITS OF INSURANCE

EACH OCCURRENCE LIMIT

(LIABILITY COVERAGE) $

PERSONAL & ADVERTISING INJURY LIMIT $ Any one person or organization

PRODUCTS COMPLETED OPERATIONS AGGREGATE LIMIT $

GENERAL AGGREGATE LIMIT (LIABILITY COVERAGE) (except with respect to Auto Liability and Products Completed Operations) $

RETAINED LIMIT

RETAINED LIMIT: $

Philadelphia Indemnity Insurance Company

19841

(928)774-3345

Northland Family Help Center

NFP Property & Casualty Services, Inc PO Box 1000 420 N Humphreys Flagstaff, AZ 86002

2532 N 4th St Ste 506 Flagstaff, AZ 86004-3712

1,000,000

1,000,000

10,000

1,000,000

1,000,000

POLICY # PHUB870996

POLICY NUMBER: PHUB870996

PI-CXL-002 (05/19)

Includes copyrighted material of Insurance Services Office, Inc., with permission.

PREMIUM

PREMIUM SUBTOTAL

STATE TAXES, FEES, SURCHARGES (if applicable)

PREMIUM TOTAL (including Taxes, Fees, Surcharges)

AUDIT PERIOD: NOT APPLICABLE ANNUALLY SEMI-ANNUALLY QUARTERLY MONTHLY

SEE ATTACHED SCHEDULE

ENDORSEMENTS ATTACHED TO THIS POLICY

DESCRIPTION OF BUSINESS

FORM OF BUSINESS:

BUSINESS DESCRIPTION:

NON PROFIT ORGANIZATION

X

Non-Profit Umbrella

$ 2,074.00

$ 2,074.00

Not Applicable

POLICY NUMBER: PHUB870996

PI-CXL-002 (05/19)

Includes copyrighted material of Insurance Services Office, Inc., with permission.

SCHEDULE OF UNDERLYING INSURANCE

Employers' Liability

Company:

Policy Number:

Policy Period:

Minimum Applicable Limits

Bodily injury by accident $ Each Accident

Bodily injury by disease $ Each Employee

Bodily injury by disease $ Policy Limit

Commercial General Liability Occurrence Claims-Made

Company:

Policy Number:

Policy Period:

Retroactive Date:

Minimum Applicable Limits:

General Aggregate $

Products-Completed Operations Aggregate $

Personal And Advertising Injury $

Each Occurrence $

Commercial Auto Liability

Company:

Policy Number: PHPK2572857

Policy Period: 6/30/2023

Minimum Applicable Limits Garage Aggregate Limit For Other Than Autos (if applicable)

Each Accident

Professional Liability Occurrence Claims-Made

Company:

Policy Number:

Policy Period:

Retroactive Date:

Minimum Applicable Limits

PHPK2572857

Philadelphia Indemnity Insurance Company

06/30/2023 06/30/2024 Not Applicable

X

1,000,000

1,000,000

3,000,000

3,000,000

Philadelphia Indemnity Insurance Company

Not Applicable

1,000,000

PHPK2572857

Philadelphia Indemnity Insurance Company

06/30/2023 06/30/2024 09/15/1987

Each Professional Incident 1,000,000

Aggregate 3,000,000

X

6/30/2024

Includes copyrighted material of Insurance Services Office, Inc., with permission.

Employee Benefits Liability Occurrence Claims-Made

Company:

Policy Number:

Policy Period:

Retroactive Date:

Abusive Conduct Liability Occurrence Claims-Made

Company:

Policy Number:

Policy Period:

Retroactive Date:

Minimum Applicable Limits

Directors & Officers Liability Occurrence Claims-Made

Company:

Policy Number:

Policy Period:

Retroactive Date:

Minimum Applicable Limits

Liquor Liability Occurrence Claims-Made

Company:

Policy Number:

Policy Period:

Retroactive Date:

Minimum Applicable Limits

X

Includes copyrighted material of Insurance Services Office, Inc., with permission.

Watercraft Liability Occurrence Claims-Made

Company:

Policy Number:

Policy Period:

Retroactive Date:

Minimum Applicable Limits

Other Coverages Not Included in Above Occurrence Claims-Made

Company:

Policy Number:

Policy Period:

Retroactive Date:

Minimum Applicable Limits

THESE DECLARATIONS, TOGETHER WITH THE COMMON POLICY CONDITIONS AND COVERAGE

FORM(S) AND ANY ENDORSEMENT(S), COMPLETE THE ABOVE NUMBERED POLICY.

Countersigned: By:

(Date) (Authorized Representative)

IN WITNESS WHEREOF, we have caused this policy to be executed and attested, and, if required by state law, this policy shall not be valid unless countersigned by our authorized representative.

Secretary