2026.02.01 COI.pdf
PDF 37 KB Posted
- Attached to
- Master Agreement AZ|CTR072978
- Contract number
- CTR072978
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance issued on 01/31/2025 by GCG Risk Management Consultants LLC for School Health Corporation, with coverage for multiple insurance policies through Old Republic Insurance Company, Cincinnati Insurance Company, Vantage Risk Specialty Insurance Company, and Accredited Specialty Insurance Company. The certificate is specifically related to a contract with the Arizona Department of Health Services, referencing Contract #CTR040422 for Welch Allyn Spot Vision Screeners.
The insurance certificate provides comprehensive coverage including Commercial General Liability (with a $2,000,000 each occurrence limit), Automobile Liability (with a $1,000,000 combined single limit), Umbrella/Excess Liability (with a $5,000,000 each occurrence and aggregate limit), Workers' Compensation, and Cyber and Privacy Liability (with a $2,000,000 aggregate limit). The policies are effective from 02/01/2025 to 02/01/2026, and include provisions for additional insured status for the State of Arizona and its various departments, agencies, and employees, along with a waiver of subrogation endorsement.
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Text version
01/31/2025
GCG Risk Management Consultants LLC 410 North Michigan Ave.
12th Floor Chicago IL 60611
COIREQUEST@aleragroup.com
School Health Corporation Attention: Julissa J. Meloun 5600 Apollo Drive Rolling Meadows IL 60008
Old Republic Insurance Company 24147 Cincinnati Insurance Company 10677 Vantage Risk Specialty Insurance Company 16275 Accredited Specialty Insurance Company 16835
25-26 SH: GL AU UM WC
CY
A Y MWZY311657 02/01/2025 02/01/2026
2,000,000 500,000 5,000 2,000,000 4,000,000 4,000,000
B Y EBA0643416 02/01/2025 02/01/2026
1,000,000
C
P03XC0000052020 02/01/2025 02/01/2026
5,000,000 5,000,000
A N MWC311656 02/01/2025 02/01/2026
1,000,000 1,000,000 1,000,000
D Cyber and Privacy Liability
CYB-107946215-00 02/01/2025 02/01/2026 Aggregate Limit $2,000,000
RE: Contract #CTR040422 Welch Allyn Spot Vision Screeners.
Policy shall be endorsed, as required by this written agreement, to include the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees as additional insureds with respect to liability arising out of the activities performed by, or on behalf of, the Contractor involving automobiles owned, hired and/or non-owned by the Contractor. b. Policy shall contain a waiver of subrogation endorsement as required by this written agreement in favor of the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees for losses arising from work performed by or on behalf of the Contractor.
Arizona Department of Health Services 150 N 18th Ave
Phoenix AZ 85007
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
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