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

E-MAIL

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

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