AFS4K_-_Current_COI_-_25-26_Redacted.pdf
PDF 78 KB Posted
- Attached to
- Master Agreement AZ|CTR071405
- Contract number
- CTR071405
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance for A Fresh Start for Kids, LLC, issued by Insurance Depot - AZ. The certificate names the Arizona Department of Child Safety as the certificate holder, with Pennsylvania Manufacturers ASN Insurance Company and National Liability & Fire Insurance Company serving as the insurers. The policy provides coverage for the state of Arizona, including its departments, agencies, boards, commissions, universities, officials, agents, and employees.
The insurance policy includes Commercial General Liability coverage with a $1,000,000 each occurrence limit, $3,000,000 general aggregate, and sexual abuse/molestation coverage of $500,000. Workers' Compensation and Employers' Liability are also included, with $1,000,000 limits for each accident and disease. Additionally, the policy includes Professional Liability (Errors and Omissions) with a $1,000,000 per claim limit and $3,000,000 annual aggregate. The policies are effective from July 27, 2025, to August 4, 2026, with the State of Arizona named as an additional insured for liabilities arising from the contractor's activities.
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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
7/28/2025
Insurance Depot - AZ
PO BOX 2053
Queen Creek AZ 85142
JAMES TEBBS
(480) 888-1880 (480) 882-1904 jimtebbs@insdepotgroup.com
A FRESH START FOR KIDS, LLC
PENNSYLVANIA MANUFACTURERS ASN INS CO 12262
NATIONAL LIABILITY & FIRE INSURANCE CO 20052
A Y 07/27/2025 07/27/2026
SEXUAL ABUSE/MOLESTATION IS INCLUDED IN COMMERCIAL GENERAL LIABILITY POLICY (500,00/500,00)
THE STATE OF ARIZONA, AND ITS DEPARTMENTS, AGENCIES, BOARDS, COMMISSIONS, UNIVERSTITIES, OFFICIALS, AGENTS, AND EMPLOYEES
SHALL BE NAMED AS ADDITIONAL INSURED WITH RESPECTS TO LIABILITY ARISING OUT OF THE ACTIVITES PERFORMED BY OR ON BEHALF OF
THE CONTRACTOR.
ARIZONA DEPARTMENT OF CHILD SAFETY
PO BOX 6030
SITE CODE C010-20
PHOENIX AZ 85005
1,000,000 500,000
15,000 1,000,000 3,000,000 3,000,000
Y
A9WC447400
3825011403807
08/04/2025 08/04/2026 X
1,000,000 1,000,000
1,000,000
*Professional Liability (Errors and Omissions Liability) - Each claim $1,000,000; Annual Aggregate $3,000,000
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