AZDCS_SSCIP_COI_SacredJourney_Redacted.pdf

PDF 856 KB Posted

Attached to
Master Agreement AZ|CTR071447
Contract number
CTR071447
Issued by
Arizona

About this file

This document is a Certificate of Liability Insurance issued by Insurance Professionals of Arizona for Sacred Journey, Inc., with coverage provided by the Social Service Contractors Indemnity Pool. The certificate is for the State of Arizona Department of Child Safety, specifically covering a contract numbered ADCS15-074992. The policy is effective from 09/07/2023 to 09/07/2024 and includes multiple types of coverage such as Commercial General Liability, Automobile Liability, Professional Liability, and Sexual Abuse & Molestation Liability.

The contract involves providing residential group home services, with insurance coverage limits including $1,000,000 per occurrence for Commercial General Liability, $1,000,000 for Professional Liability (with a retroactive date of 9/7/2004), and Sexual Abuse & Molestation Liability included in the policy. The insurance also provides Employee Benefits coverage up to $1,000,000 and includes the State of Arizona, its departments, agencies, boards, commissions, and universities as additional insured entities for losses arising from work performed by or on behalf of the contractor.

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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

4/10/2024

Insurance Professionals of Arizona

3521 E Brown Rd. Ste 101

Mesa AZ 85213

Kirsten Walters

(480) 981-6338 (480) 981-6339 kirsten@insuranceproaz.com

Sacred Journey, Inc.

Social Service Contractors Indemnity Pool 524126

A

✘ Sexual Abuse & Molestation Liab

Y Y 6000340-7 09/07/2023 09/07/2024

1,000,000

1,000,000

10,000

1,000,000

3,000,000

3,000,000

Employee Benefits $1,000,000

A

Y Y 6000340-7 09/07/2023 09/07/2024

1,000,000

A Professional Liability

Retro date 9/7/2004 6000340-7 09/07/2023 09/07/2024

Each claim $1,000,000

Aggregate $3,000,000

Contract # ADCS15-074992 providing residential group home

Sexual abuse and molestation liability is included in the policy.

State of Arizona Department of Child Safety

3003 N Central Avenue

Site Code C010-20

Phoenix AZ 85012

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