ADHS_2526_Master_9-23-2025_1637460961_ste_530.pdf
PDF 102 KB Posted
- Attached to
- AZ|CTR073341
- Contract number
- CTR073341
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance for the Arizona Hospital and Healthcare Association (AzHHA), issued by Brown & Brown Insurance Services, Inc. The certificate involves multiple insurers, including Continental Casualty Company, National Union Fire Insurance Company of Pittsburg, American Casualty Company of Reading PA, and Transportation Insurance Co. The primary certificate holder is the Arizona Department of Health Services, located in Phoenix, Arizona.
The insurance coverage includes Commercial General Liability with a $1,000,000 per occurrence limit and a $2,000,000 aggregate limit, Automobile Liability with a $1,000,000 combined single limit, Umbrella/Excess Liability with a $5,000,000 each occurrence and aggregate limit, and Workers' Compensation with a $1,000,000 per statute limit. Additional coverages include Business Travel Accident and Professional Liability, with the latter having a $1,000,000 limit and a retroactive date of 07/01/2021. The policies are effective from various dates in 2024-2025, with most expiring on 10/1/2026. The certificate includes a blanket additional insured and waiver of subrogation provision for the Arizona Department of Health Services as required by written contract.
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Other files
| File | Type | Posted |
|---|---|---|
| CTR073341_Pre-Contract_Documents.pdf | ||
| CTR073341_Contract_Documents.pdf | ||
| CTR073341_Pricing.pdf | ||
| CTR073341_A1.pdf | ||
| CTR073341_CI_Determination.pdf | ||
| 2025.10.01_COI_CGl_AL_UL_WC_PL.pdf |
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Text version
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
9/23/2025
Brown & Brown Insurance Services, Inc 2800 N Central Ave, Suite 1100 PO Box 2800 Phoenix AZ 85004
Valerie Fischer 602-494-6734 valerie.fischer@bbrown.com
Continental Casualty Company 20443 AZHHA11-02 National Union Fire Insurance Company of Pittsburg 19445
Arizona Hospital and Healthcare Association AzHHA 2800 N. Central Ave, Suite 1450 Phoenix AZ 85004
American Casualty Company of Reading PA 20427 Continental Casualty Company 20443 Transportation Insurance Co 20494
1637460961
E X 1,000,000 X 1,000,000
10,000
1,000,000
2,000,000 X
Y Y 6021669115 10/1/2025 10/1/2026
2,000,000
E 1,000,000
X X
6021669115 10/1/2025 10/1/2026
A X X 5,000,0006021669177 10/1/2025 10/1/2026
5,000,000 X 10,000
C XWC 6 25518480 4/1/2025 4/1/2026
1,000,000
1,000,000
1,000,000 B D
Business Travel Accident Professional Liability
GTP 0009120606-A
5096737293
10/1/2024 10/1/2025
10/1/2027 10/1/2026
Limit/ Ded Prof Liab -Retro Date
$1,000,000/ $5,000 07/01/2021
Blanket Additional Insured(s) and Blanket Waiver of Subrogation applies with respects to General Liability per attached form #SB146932G ED. (10-19) Arizona Department of Health Services - 150 N 18th Avenue Suite 530, Phoenix, AZ 85007
Arizona Department of Health Services where required per written contract.
Arizona Department of Health Services 150 N 18th Avenue Suite 530 Phoenix AZ 85007
File details come from the government source that posted it. Updated .