ACORD_Form_20250102-151142.pdf
PDF 21 KB Posted
- Attached to
- Master Agreement AZ|CTR073462
- Contract number
- CTR073462
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance issued on 12/6/2024 for Prentke Romich Company (DBA: PRC-Saltillo), with Hummel Group, Inc. as the insurance producer. The certificate involves The Cincinnati Insurance Company and The Cincinnati Indemnity Company as insurers, and is specifically related to a contract with the State of Arizona (Contract CTR0073462), administered through the Arizona Department of Administration's State Procurement Office.
The insurance certificate covers multiple liability types including commercial general liability, automobile liability, umbrella liability, workers' compensation, and professional liability for a speech therapist. The policy provides coverage limits ranging from $1,000,000 to $10,000,000 across different categories, with policy periods from 12/31/2024 to 12/31/2025. The State of Arizona and its departments, agencies, boards, commissions, universities, officers, and employees are listed as additional insureds, with a waiver of subrogation included for general and auto liability. The certificate holder is Larry Woo from the Arizona Department of Administration State Procurement Office, located in Phoenix, Arizona.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
12/6/2024
Hummel Group, Inc.
461 Wadsworth Rd PO Box 3 Orrville OH 44667
Stephanie Pearson CISR (330)683-1050 (330)683-1169 spearson@hummelgrp.com
Prentke Romich Company, DBA: PRC-Saltillo 1022 Heyl Rd
Wooster OH 44691
The Cincinnati Insurance Company 10677 The Cincinnati Indemnity Company 23280
Master 24-25
A
X
X
X
X Y EPP0597785 12/31/2024 12/31/2025
1,000,000
500,000
10,000
1,000,000
2,000,000
2,000,000
A
X X
Y EPP0597785 12/31/2024 12/31/2025
1,000,000
A
X X
EPP0597785 12/31/2024 12/31/2025
10,000,000
10,000,000
B EWC0462239 12/31/2024 12/31/2025
1,000,000
1,000,000
1,000,000
A Professional Liability EPP0597785 12/31/2024 12/31/2025 Each Claim $2,000,000 Agg/$4,000,000
Speech Therapist
The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are an additional insured if required by written contract or agreement, subject to the general liability automatic additional insured endorsement included on this policy.
Waiver of subrogation is included with regards to general liability and auto liability. State of AZ contract CTR0073462
Arizona Department of Administration State Procurement Office Larry Woo 1802 W Jackson, #100 Phoenix, AZ 85007 larry.woo@azdoz.gov
Tony Rohrer/SPEARS
The ACORD name and logo are registered marks of ACORD
CERTIFICATE HOLDER
© 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01)
AUTHORIZED REPRESENTATIVE
CANCELLATION
DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE
LOCJECT
PRO-
POLICY
GEN'L AGGREGATE LIMIT APPLIES PER:
OCCURCLAIMS-MADE
COMMERCIAL GENERAL LIABILITY
PREMISES (Ea occurrence) $
DAMAGE TO RENTED
EACH OCCURRENCE $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
$RETENTIONDED
CLAIMS-MADE
OCCUR
AGGREGATE $
EACH OCCURRENCE $UMBRELLA LIAB
EXCESS LIAB
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
INSR
LTR TYPE OF INSURANCE POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY) LIMITS
PER
STATUTE
OTH-
ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
ANY PROPRIETOR/PARTNER/EXECUTIVE
If yes, describe under DESCRIPTION OF OPERATIONS below
(Mandatory in NH)
OFFICER/MEMBER EXCLUDED?
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
HIRED AUTOS
NON-OWNED
AUTOS AUTOS
AUTOS
COMBINED SINGLE LIMIT
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE $
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.
INSD
ADDL
WVD
SUBR
N / A
(Ea accident)
(Per accident)
OTHER:
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 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:
INSURED
PHONE
(A/C, No, Ext):
PRODUCER
ADDRESS:
FAX
(A/C, No):
CONTACT
NAME:
NAIC #
INSURER A :
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
INSURER(S) AFFORDING COVERAGE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
INS025 (201401)
File details come from the government source that posted it. Updated .