AZ_Dept_of_Child_Safety_EPI.pdf

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE

DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

CANCELLATION

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The ACORD name and logo are registered marks of ACORD

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 EVIDENCE OF PROPERTY INSURANCE 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 INFORMATION

LOCATION/DESCRIPTION

COVERAGE INFORMATION

COVERAGE / PERILS / FORMS AMOUNT OF INSURANCE DEDUCTIBLE

PHONE

(A/C, No, Ext):

(A/C, No):

FAX E-MAIL

ADDRESS:

AGENCY

THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST.

CUSTOMER ID #:

AGENCY

SUB CODE:CODE:

INSURED LOAN NUMBER POLICY NUMBER

TERMINATED IF CHECKED

CONTINUED UNTIL

EXPIRATION DATEEFFECTIVE DATE

THIS REPLACES PRIOR EVIDENCE DATED:

COMPANY

DATE (MM/DD/YYYY)

EVIDENCE OF PROPERTY INSURANCE

REMARKS (Including Special Conditions)

MORTGAGEE

ADDITIONAL INSURED LOSS PAYEE

ADDITIONAL INTEREST

NAME AND ADDRESS

AUTHORIZED REPRESENTATIVE

LOAN #

PERILS INSURED BASIC BROAD SPECIAL

LENDER'S LOSS PAYABLE

8/7/2025

574-245-3500 Gibson Insurance Agency Inc 202 South Michigan St., Suite 1400 South Bend, IN 46601

574-236-6399 ezimmerman@thegibsonedge.com

Philadelphia Indemnity Insurance Company One Bala Plaza, Ste 100 Bala Cynwyd, PA 19004-0950

Foster Success, Inc.

546 East 17th Street Suite 206 Indianapolis IN 46202

PHPK2653054

01/30/2025 01/30/2026

RE: Location address: 546 E 17th St, Suite 206, Indianapolis, IN 46202

X

Business Personal Property | Replacement Cost | Special Form 30,417 1,000

Arizona Department of Child Safety 3003 N Central Ave 20th Floor Phoenix, AZ 85012