ArizonaDepartmentofChildSafety18162276__1__Redacted.pdf
PDF 1010 KB Posted
- Attached to
- Master Agreement AZ|CTR071415
- Contract number
- CTR071415
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for Courageux, LC, with insurance provided by AmGuard Insurance Company and Service American Indemnity Company. The certificate is issued for the Arizona Department of Child Safety, Office of Contracts, located in Phoenix, Arizona. The insurance covers multiple policy types including Commercial General Liability, Automobile Liability, Workers Compensation, and Professional Liability, with various endorsements adding the Arizona Department of Child Safety as an additional insured.
The insurance policies are effective from March 20, 2025 to March 20, 2026, with coverage limits including $1,000,000 per occurrence for Commercial General Liability, $1,000,000 for Automobile Liability, and $1,000,000 for Workers Compensation. The Professional Liability policy has a retroactive date of February 20, 2017, with $1,000,000 per claim and $2,000,000 aggregate limits. The certificate includes multiple endorsements providing waivers of subrogation and additional insured status for the Arizona Department of Child Safety, ensuring comprehensive insurance coverage across different types of potential liability.
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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
4/9/2025
Insurance Professionals of Arizona
3521 E Brown Rd. Ste 101
Mesa AZ 85213
Kirsten Walters
(480) 981-6338 (480) 981-6339 kirsten@insuranceproaz.com
Courageux, LC
AmGuard Insurance Company 42390
Service American Indemnity Company 39152
A
C1GP607495 03/20/2025 03/20/2026
1,000,000
100,000
5,000
1,000,000
2,000,000
2,000,000
A
C2GP605117 03/20/2025 03/20/2026
1,000,000
B Y SATIS0414804 03/31/2025 03/31/2026
1,000,000
1,000,000
1,000,000
A
PROFESSIONAL LIABILITY
Retroactive Dated 02/20/2017
C1GP607495 03/20/2025 03/20/2026
EACH CLAIM $1,000,000
AGGREGATE $2,000,000
Certificate holder is additional insured per attached endorsement. A Waiver of subrogation applies in favor of the certificate holder per attached endorsements.
Arizona Department of Child Safety
Office of contracts
3003 N Central #2000 Site Code C010-20
Phoenix AZ 85012
COMMERCIAL AUTO
BA 99 04 06 18
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED WHEN REQUIRED BY CONTRACT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.
This provision does not appl
Additional Insured When Required by Contract
(1) Paragraph A.1. WHO IS AN INSURED of Section II Liability Coverage is amended to add:
d. When you have agreed, in a written contract or written agreement, that a person or organization be added as an additional insured on your business auto policy, such person or organization is an person or organization is liable for under paragraphs a. or b. of Who Is An Insured with regard to the ownership, maintenance or use of a covered
The insurance afforded to any such additional insured applies only if the occurs:
(1) During the policy period, and
(2) Subsequent to the execution of such written contract, and
(3) Prior to the expiration of the period of time that the written contract requires such insurance be provided to the additional insured.
(2) How Limits Apply
If you have agreed in a written contract or written agreement that another person or organization be added as an additional insured on your policy, the most we will pay on behalf of such additional insured is the lesser of:
(a) The limits of insurance specified in the written contract or written agreement; or
(b) The Limits of Insurance shown in the Declarations.
Such amount shall be a part of and not in addition to Limits of Insurance shown in the Declarations and described in this Section.
(3) Additional Insureds Other Insurance
Coverage Part that may also be covered by other insurance available to an additional insured, such additional to the other insurer for defense and indemnity.
However, this provision does not apply to the extent that you have agreed in a written contract or written agreement that the insurance is primary and non-own insurance.
(4) Duties in The Event Of Accident, Claim, Suit or Loss
If another person or organization is added as an additional insured on your policy, the additional insured shall be required to comply with the provisions in A. Loss Conditions 2. Duties In The Event Of Accident, Claim, Suit Or Loss of SECTION IV BUSINESS AUTO CONDITIONS, in the same manner as the Named Insured.
BA 99 04 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1
COMMERCIAL AUTO
BA 99 04 06 18
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED WHEN REQUIRED BY CONTRACT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.
This provision does not appl
Additional Insured When Required by Contract
(1) Paragraph A.1. WHO IS AN INSURED of Section II Liability Coverage is amended to add:
d. When you have agreed, in a written contract or written agreement, that a person or organization be added as an additional insured on your business auto policy, such person or organization is an person or organization is liable for under paragraphs a. or b. of Who Is An Insured with regard to the ownership, maintenance or use of a covered
The insurance afforded to any such additional insured applies only if the occurs:
(1) During the policy period, and
(2) Subsequent to the execution of such written contract, and
(3) Prior to the expiration of the period of time that the written contract requires such insurance be provided to the additional insured.
(2) How Limits Apply
If you have agreed in a written contract or written agreement that another person or organization be added as an additional insured on your policy, the most we will pay on behalf of such additional insured is the lesser of:
(a) The limits of insurance specified in the written contract or written agreement; or
(b) The Limits of Insurance shown in the Declarations.
Such amount shall be a part of and not in addition to Limits of Insurance shown in the Declarations and described in this Section.
(3) Additional Insureds Other Insurance
Coverage Part that may also be covered by other insurance available to an additional insured, such additional to the other insurer for defense and indemnity.
However, this provision does not apply to the extent that you have agreed in a written contract or written agreement that the insurance is primary and non-own insurance.
(4) Duties in The Event Of Accident, Claim, Suit or Loss
If another person or organization is added as an additional insured on your policy, the additional insured shall be required to comply with the provisions in A. Loss Conditions 2. Duties In The Event Of Accident, Claim, Suit Or Loss of SECTION IV BUSINESS AUTO CONDITIONS, in the same manner as the Named Insured.
BA 99 04 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1
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