2026.04.03 COI GL AL PL.pdf

PDF 3 MB Posted

Attached to
Master Agreement AZ|CTR070647
Contract number
CTR070647
Issued by
Arizona

About this file

This document is a Certificate of Liability Insurance issued by CFC Underwriting Limited for Arizona Precision Medicine PLLC, located in Phoenix, Arizona. The certificate lists Underwriters at Lloyds London as the insurer and is issued for the benefit of the State of Arizona, specifically the Department of Health Services. The insurance covers various liability types, including commercial general liability, automobile liability, and professional liability (E&O) for a policy period from 4/3/2025 to 4/3/2026.

The policy provides coverage for BPM006001 – PART 1, LOT 1, ROUND 1, specifically for a CLIA Laboratory Director and Consultant role. The insurance includes multiple coverage limits: $1,000,000 per occurrence for general liability, $250,000 for damaged premises, and $3,000,000 for general aggregate. The State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are listed as additional insureds under the general liability coverage. The policy is issued with primary wording and a waiver of subrogation, providing comprehensive protection for the state and the insured entity during the specified contract period.

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Other files

File Type Posted
CTR070647_Pricing.xls XLS spreadsheet
CTR070647_Contract_Documents.pdf PDF
2025.04.03_COI_GL_AL_PL.pdf PDF
CTR070647_Contract_Amend_1_FE.pdf PDF
Independent Contractor Agreement form - 18352.pdf PDF

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Text version

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 LIMITDESCRIPTION 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

4/2/2025

(623) 594-7531

15792

Arizona Precision Medicine PLLC 1 N 1st Street Ste 700 Phoenix, AZ 85004

A 1,000,000

X X BSN0140300612 4/3/2025 4/3/2026 250,000

5,000

1,000,000 3,000,000

1,000,000A

BSN0140300612 4/3/2025 4/3/2026

A E&O/Professional Lia BSN0140300612 4/3/2025 Aggregate 3,000,000 A E&O/Professional Lia BSN0140300612 4/3/2025 4/3/2026 Occurrence 1,000,000

RE: BPM006001 – PART 1, LOT 1, ROUND 1/ CLIA Laboratory Director and Consultant State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are additional insureds with respect to general liability including primary wording and WOS per endorsement attached

State of Arizona Department of Health Services 150 North 18th Ave, Suite 530 Phoenix, AZ 85007

ARIZPRE-03 TRACIEOBERMILLER

NFP Property & Casualty Services, Inc.

NFP P & C Mountain PO Box 840801 Los Angeles, CA 90084-0801

Carol Miller carol.miller@nfp.com

Underwriters at Lloyds London (IL)

4/3/2026

X X

X X

File details come from the government source that posted it. Updated .