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
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
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