AZ_DCS_COI_Redacted.pdf

PDF 56 KB Posted

Attached to
Master Agreement AZ|CTR062904
Contract number
CTR062904
Issued by
Arizona

About this file

This document is a Certificate of Liability Insurance issued by Upside Insurance Services for Adonai Partners, LLC, with the Arizona Department of Child Safety listed as the certificate holder. The insurance is provided by two primary insurers: Social Service Contractors Indemnity Pool (Insurer A) and AmGuard Insurance Company (Insurer B), with coverage effective from August 23, 2025, to August 23, 2026.

The certificate outlines comprehensive insurance coverage including Commercial General Liability with a $1,000,000 per occurrence limit, $2,000,000 general aggregate, and $1,000,000 in personal and advertising injury coverage. Automobile liability is also included with a $1,000,000 combined single limit, and workers' compensation coverage with $1,000,000 limits for each accident and disease. The policy provides umbrella/excess liability with a $1,000,000 each occurrence limit, protecting Adonai Partners, LLC across multiple insurance categories for their operations related to service contracts with the Arizona Department of Child Safety.

View the file

Other files

File Type Posted
Contract_Amendment_17.pdf PDF
Contract_Amendment_27.pdf PDF
Contract_Extension_Amendment.pdf PDF
DCS_COI_Redacted.pdf PDF
Contract_Amendment_22.pdf PDF
Contract_Amendment_26.pdf PDF
Contract_Amendment_28.pdf PDF
Contract_Amendment_29.pdf PDF
Contract_Extension.pdf PDF
Contract_Amendment_20.pdf PDF
Contract_Amendment_21.pdf PDF
Contract_Amendment_24.pdf PDF
Transitional_Housing_SOW.pdf PDF
Contract_Amendment_30.pdf PDF
Contract_Amendment_18.pdf PDF
Contract_Amendment_23.pdf PDF
Contract_Amendment_25.pdf PDF
Contract_Amendment_31.pdf PDF
Show all 18

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

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

8/28/2025

Upside Insurance Services

8801 N Central Ave

Suite 100

Phoenix AZ 85020

Bethany Gilmore

(602) 526-1810 bethany@upsideins.com

Adonai Partners, LLC

Social Service Contractors Indemnity Pool

AmGuard Insurance Company 42390

A 6002638 08/23/2025 08/23/2026

1,000,000

1,000,000

10,000

1,000,000

2,000,000

2,000,000

A 6002638 08/23/2025 08/23/2026

1,000,000

A

6003754 08/23/2025 08/23/2026

1,000,000

1,000,000

B Y R2WC671342 05/02/2025 05/02/2026

1,000,000

1,000,000

1,000,000

Arizona Department of Child Safety

P.O. Box 6030, S/C C010-23

Phoenix AZ 85005

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