2026-6-1_CTR077408.pdf
PDF 84 KB Posted
- Attached to
- Master Agreement AZ|CTR077408
- Contract number
- CTR077408
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance for Personify Health Holding Company, LLC (formerly HealthComp), issued by Marsh Risk & Insurance Services. The certificate involves multiple insurance carriers including XL Insurance America, Inc., Greenwich Insurance Company, Continental Casualty Company, and others, with the primary certificate holder being the State of Arizona for Contract #CTR052905, located at 1200 W Washington St in Phoenix, AZ.
The insurance coverage includes multiple policy types with varying limits, including Commercial General Liability (with a $1,000,000 per occurrence limit), Automobile Liability, Umbrella/Excess Liability (with a $10,000,000 aggregate), and Workers' Compensation. The policies have effective dates ranging from 06/01/2025 to 08/01/2026, with primary retentions of $500,000 for several policies. Additional coverage includes Cyber Insurance with limits up to $10,000,000, Professional Liability with a $5,000,000 limit and $100,000 deductible, and Crime Coverage with various sub-limits for different insuring clauses. The document references a specific contract (CTR052905) between Personify Health and the State of Arizona.
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| PH_Exceptions.xlsx | XLSX spreadsheet |
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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)
© 1988-2016 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
A
1,000,000
PGG7479295-01
X
LOS-002817880-04
1,000,000
10,000,000
X
22322
10,000,000
SIR: $500,000
Los Angeles, CA 90071
N
X07/01/2025
06/01/2026
08/01/2024
06/01/2026
PGA7479296-01
Cyber
A
2,000,000
1,000,000
X
20443 Greenwich Insurance Company
1,000,000
C
X
07/09/2025
06/01/2025
10,000,000
RE: Contract #CTR052905.
X
1200 W Washington St
Phoenix, AZ 85007
State of Arizona
10,000
A
Continental Casualty Company
CN101881059-COD 1-GAWCM-25-
Limit
10,000
07/01/2026
1,000,000
PUU7479297-01
2,000,000
24554
1,000,000
1,000,000
08/01/2025
PDW7479378-01
CA License #0437153
Marsh Risk & Insurance Services
X
633 W. Fifth Street, Suite 1200 fka.HealhComp
Personify Health Holding Company, LLC
Fresno, CA 93721 621 Santa Fe Ave.
794119814
06/01/2025
Contract #CTR052905
06/01/2025
B
06/01/2026
XL Insurance America, Inc.
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:
Limit: $5,000,000 part of $10,000,000 x $30,000,000�
Effective Date: 08/01/2024�
Policy Number: 01-449-15-80�
Primary Retention: $500,000�
Policy Number: 8264-0748�
Effective Date: 08/01/2024�
3rd Excess Cyber:�
Carrier: ALLIED WORLD SPECIALTY INSURANCE COMPANY �
Effective Date: 08/01/2024�
Retention: $100,000 �
Carrier: Chubb Custom Insurance Company�
Expiration Date: 08/01/2025�
Social Engineering Fraud: $250,000�
Limit: $10,000,000�
Los Angeles
Expiration Date: 08/01/2025� Effective Date: 08/01/2024� xs $10,000,000� Primary Retention: $500,000�
1st Excess Cyber:�
Carrier: Indian Harbor Insurance Company � Policy Number: MTE9047660 00�
Certificate of Liability Insurance
Primary Retention: $500,000�
CN101881059
Primary Retention: $500,000�
2nd Excess Cyber:�
Primary Retention: $500,000�
Carrier: Chubb/ ACE American Insurance Company �
Expiration Date: 08/01/2025�
Policy Number: EO5DAC3B81001�
Limit: $5,000,000 part of $10,000,000 x $20,000,000�
Limit: $5,000,000 part of $10,000,000 x $30,000,000�
Effective Date: 08/01/2024�
Policy Number: 0314-3675�
Expiration Date: 08/01/2025�
Claim and Computer Investigation Expense $250,000 �
Crime Coverage (part of Primary Management Liability) �
Limit: $5,000,000 part of $10,000,000 x $20,000,000�
Expiration Date: 02/01/2026��
Marsh Risk & Insurance Services�
Effective Date: 02/01/2025� fka.HealhComp� Personify Health Holding Company, LLC�
Fresno, CA 93721 621 Santa Fe Ave.�
Carrier: Liberty Surplus Insurance Corporation �
Carrier: AIG SPECIALTY INSURANCE COMPANY �
Expiration Date: 08/01/2025�
Limit: All Insuring Clauses (other than those listed below) �
Policy Number: G71410997 001�
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:
Los Angeles
Deductible: $100,000� Expiration Date: 06/01/2026�
Limit: $5,000,000
Policy Number: MPP 9047631 01� Professional Liability�
Effective Date: 06/01/2025� Carrier: Indian Harbor Insurance Company�
Certificate of Liability Insurance
CN101881059
Marsh Risk & Insurance Services� fka.HealhComp� Personify Health Holding Company, LLC�
Fresno, CA 93721 621 Santa Fe Ave.�
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