2026.02.01 COI.pdf

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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

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

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