2026.03.31_COI.pdf
PDF 127 KB Posted
- Attached to
- AZ|CTR076102
- Contract number
- CTR076102
- Issued by
- Arizona
About this file
Summary
This is a Certificate of Liability Insurance issued by Aon Risk Services Central, Inc. on October 14, 2025, for American Medical Response, Inc., headquartered in Lewisville, Texas. The certificate holder is the Arizona Department of Health Services located in Phoenix. The certificate covers multiple ambulance service entities operating throughout Arizona under various contract numbers with the state, including Rural/Metro Corporation divisions in Pima, Pinal, and Yuma counties; River Medical, Inc. dba Life Line Ambulance in Lake Havasu City; Southwest Ambulance entities in Safford and Tucson; ABC Ambulance LLC in Phoenix; American Medical Response of Cochise County LLC in Sierra Vista; and Professional Medical Transport, Inc. with multiple locations across the state.
The insurance policies are effective March 31, 2025, through March 31, 2026, and provide comprehensive coverage across multiple lines including Commercial General Liability with limits of $2,750,000 per occurrence and $5,000,000 aggregate; Automobile Liability with $10,000,000 combined single limits; Umbrella Liability of $10,000,000; Workers' Compensation with $1,000,000 per occurrence; and Professional Liability/Excess coverage of $15,000,000 per occurrence with $10,000,000 self-insured retention. Coverage is provided through ACE American Insurance Company, ACE Fire Underwriters Insurance Co., Indemnity Insurance Co of North America, Underwriters at Lloyds, and ACE Property & Casualty Insurance Co. The Arizona Department of Health Services and its related entities are included as additional insureds with primary and non-contributory coverage, and a waiver of subrogation applies to all covered losses arising from work performed under the contracts.
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Text version
H o ld e r Id e n ti fi e r
77777
77707 07070
00777 61616
04557 11107
67535 23602
64450 07763
11474 06241
33071 66374
60562 33110
70424 45732
76552 20753
67371 33432
22107 23701
06620 33742
07504 51713
27301 30076
25064 50015
77420 76727
24203 57720
00777 77770
70007 07007
77777
77707 07070
00735 25677
11545 60007
26211 17410
30640 07770
55003 13711
65077 24511
42036 21330
70223 37342
03601 00702
77322 17527
11107 06233
23560 33550
07422 23630
60331 54075
27326 74217
75400 77756
16335 17655
40777 77770
70007 07007
C e rt if ic a te N o
CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
10/14/2025
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.
PRODUCER
Aon Risk Services Central, Inc.
Philadelphia PA Office 100 North 18th Street 16th Floor Philadelphia PA 19103 USA
PHONE
(A/C. No. Ext):
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
(866) 283-7122
INSURED 22667ACE American Insurance CompanyINSURER A:
20702ACE Fire Underwriters Insurance Co.INSURER B:
43575Indemnity Insurance Co of North AmericaINSURER C:
32727Underwriters at LloydsINSURER D:
20699ACE Property & Casualty Insurance Co.INSURER E:
INSURER F:
FAX
(A/C. No.): (800) 363-0105
CONTACT
NAME:
American Medical Response, Inc.
4400 TX State Hwy 121 Suite 700 Lewisville TX 75056 USA
COVERAGES CERTIFICATE NUMBER: 570116187212 REVISION NUMBER:
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.
Limits shown are as requested
POLICY EXP
(MM/DD/YYYY)
POLICY EFF
(MM/DD/YYYY)
SUBR
WVD
INSR
LTR
ADDL
INSD POLICY NUMBER TYPE OF INSURANCE LIMITS
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
POLICY LOC
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
X
X
X
GEN'L AGGREGATE LIMIT APPLIES PER:
$2,750,000
$1,000,000
$10,000
$2,750,000
$5,000,000
$2,750,000
$250,000SIR
A 03/31/2025 03/31/2026Y Y
SIR applies per policy terms & conditions
XSLG48960455
PRO-
JECT
OTHER:
AUTOMOBILE LIABILITY
ANY AUTO
OWNED
AUTOS ONLY
SCHEDULED
AUTOS
HIRED AUTOS
ONLY
NON-OWNED
AUTOS ONLY
BODILY INJURY ( Per person)
PROPERTY DAMAGE
(Per accident)
X
BODILY INJURY (Per accident)
$10,000,000A 03/31/2025 03/31/2026Y Y COMBINED SINGLE LIMIT
(Ea accident)
ISA H10817614
EXCESS LIAB
X OCCUR
CLAIMS-MADE AGGREGATE
EACH OCCURRENCE
DED
$10,000,000
$10,000,000
03/31/2025
Umb - Auto
UMBRELLA LIABE 03/31/2026XCQG72514816005
RETENTION
X
E.L. DISEASE-EA EMPLOYEE
E.L. DISEASE-POLICY LIMIT
E.L. EACH ACCIDENT $1,000,000
X OTH-
ER
PER STATUTEC 03/31/2025 03/31/2026
AOS
SCFC72631158B 03/31/2025 03/31/2026
$1,000,000
Y / N
(Mandatory in NH)
ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICER/MEMBER EXCLUDED? N / A
Y
N
WI
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
If yes, describe under DESCRIPTION OF OPERATIONS below
$1,000,000
WLRC72631110
Per Occ/AggCSHLC2501663 03/31/2025 03/31/2026 Ex Prof(Claim Made)/Ex GL $10,000,000SIR - Ex Prof
SIR - Ex GL $10,000,000
E&O - Professional Liability - Excess
D
SIR applies per policy terms & conditions
$15,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Additional Named Insureds: River Medical, Inc. dba Life Line Ambulance, 415 EL Camino Way Lake, Havasu City, AZ 85403 (Con 94), Rural/Metro Corporation (PIMA), 3759 N. Commerce Dr., Tucson, AZ 85705 (Con 55), Rural/Metro Corporation (Pinal) dba TRI-City Med dba Life Line Ambulance, 3759 N. Commerce Dr., Tucson, AZ 85705 (Con 87), Rural/Metro Corporation (Yuma) dba Rural/Metro Ambulance Service, 2029 S. Arizona Ave., Yuma, AZ 85364 (Con 65), Southwest Ambulance of Southeastern Arizona, Inc. dba Southwest Ambulance of Safford dba Life Line Ambulance, 3759 N. Commerce Dr., Tucson, AZ 85705 (Con 63), ABC Ambulance LLC, 3118 E. McDowell Rd., Phoenix, AZ 85008 (Con 139), American Medical Response of Cochise County LLC, 4266 Industry Drive, Ste.
3, Sierra Vista, AZ 85635 (Con 120). RE: CTR053477 Rural Metro Corp., R053486 Southwest Ambulance, CTR053478 PMT Ambulance
CANCELLATIONCERTIFICATE HOLDER
AUTHORIZED REPRESENTATIVEArizona Department of Health Services 150 N. 18th Ave., Suite 530 Phoenix AZ 85007 USA
ACORD 25 (2016/03)
©1988-2015 ACORD CORPORATION. All rights reserved
The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
AGENCY CUSTOMER ID:
ADDITIONAL REMARKS SCHEDULE
LOC #:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance
EFFECTIVE DATE:
CARRIER NAIC CODE
POLICY NUMBER
NAMED INSUREDAGENCY
See Certificate Number:
See Certificate Number:
570116187212
570116187212
Aon Risk Services Central, Inc.
570000073826
ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits.
INSURER
INSURER
INSURER
INSURER
INSURER(S) AFFORDING COVERAGE
Page _ of _
NAIC #
American Medical Response, Inc.
TYPE OF INSURANCE
POLICY NUMBER LIMITS
WORKERS COMPENSATION
A WCUC72631195 03/31/2025 03/31/2026
OH
N/A
ADDL
INSD
INSR
LTR
SUBR
WVD
POLICY
EFFECTIVE
DATE
(MM/DD/YYYY)
POLICY
EXPIRATION DATE
(MM/DD/YYYY)
SIR applies per policy terms & conditions
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Ground, CTR076102 America Medical Response of Maricopa and CTR073240 American Medical Response of Maricopa. State of Arizona Department, Department, its agents, officials, employees or the State of Arizona are included as Additional Insured in accordance with the policy provisions of the General Liability and Automobile Liability policies. General Liability policy evidenced herein is Primary and Non-Contributory to other insurance available to Additional Insured, but only in accordance with the policy's provisions. A Waiver of Subrogation is granted in favor of 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 in accordance with the policy provisions of the General Liability, Automobile Liability and Workers' Compensation policies.
FORM TITLE:FORM NUMBER:
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
ADDITIONAL REMARKS
EFFECTIVE DATE:
CARRIER NAIC CODE
POLICY NUMBER
Aon Risk Services Central, Inc.
NAMED INSUREDAGENCY
LOC #:
570000073826 AGENCY CUSTOMER ID:
© 2008 ACORD CORPORATION. All rights reserved.
See Certificate Number:
See Certificate Number:
The ACORD name and logo are registered marks of ACORD
570116187212
570116187212
ACORD 25 Certificate of Liability Insurance Additional Description of Operations / Locations / Vehicles:
ACORD 101 (2008/01)
ADDITIONAL REMARKS SCHEDULE Page _ of _
American Medical Response, Inc.
Additional Remarks
AGENCY CUSTOMER ID:
ADDITIONAL REMARKS SCHEDULE
LOC #:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance
EFFECTIVE DATE:
CARRIER NAIC CODE
POLICY NUMBER
NAMED INSUREDAGENCY
See Certificate Number:
See Certificate Number:
Aon Risk Services Central, Inc.
570000073826
570116187212
570116187212
Page _ of _
American Medical Response, Inc.
Professional Medical Transport, Inc. dba Life Line Ambulance dba PMT Ambulance dba ComTrans Ambulance Inc. dba ComTrans Ambulance Service dba Promed Transport dba American ComTrans dba American Medical Response dba AMR 8465 N. Pima Rd., Scottsdale, AZ 85258 (CON 71), American Medical Response of Maricopa, LLC dba American Medical Response dba AMR dba SW General, Inc. dba Southwest Ambulance dba Southwest Ambulance of Casa Grande, Inc. dba Southwest Ambulance and Rescue of Arizona, 617 E. Main Street, Mesa, AZ 85201 (CON 136), Rural/Metro Corporation (Maricopa) dba Rural/Metro Ambulance Service dba Arizona Medical Transport dba AMT, 8465 N. Pima Rd., Scottsdale, AZ 85258 (CON 109), Southwest Ambulance of Tucson, Inc. dba Kord's Southwest dba American Medical Response dba AMR 3759 N. Commerce Dr., Tucson, AZ 85705 (CON 54), Life Line Ambulance, Inc., 1099 W. Iron Springs Road, Prescott, AZ 85258 (CON 62), R/M Arizona Holdings, Inc. dba Canyon State Ambulance dba Payson Medical Transport dba LifeStar EMS dba Life Line Ambulance, 8465 N. Pima Road, Scottsdale, AZ 85258 (CON 58), Southwest Ambulance of Casa Grande, Inc. dba Southwest Ambulance of Casa Grande dba American Medical Response dba AMR, 3759 N.
Commerce Dr., Tucson, AZ 85705 (CON 85).
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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