Certificate.pdf

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

INSR ADDL SUBR

LTR INSD WVD

PRODUCER CONTACT

NAME:

FAXPHONE

(A/C, No):(A/C, No, Ext):

E-MAIL

ADDRESS:

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)

AUTOMOBILE LIABILITY

UMBRELLA LIAB

EXCESS LIAB

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

AUTHORIZED REPRESENTATIVE

EACH OCCURRENCE $

DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence)

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT

OTHER: $

COMBINED SINGLE LIMIT

$(Ea accident)

ANY AUTO BODILY INJURY (Per person) $

OWNED SCHEDULED

BODILY INJURY (Per accident) $AUTOS ONLY AUTOS

HIRED NON-OWNED PROPERTY DAMAGE

$AUTOS ONLY AUTOS ONLY (Per accident)

OCCUR EACH OCCURRENCE

CLAIMS-MADE AGGREGATE $

DED RETENTION $

PER OTH-

STATUTE ER

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE $

If yes, describe under

E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below

INSURER(S) AFFORDING COVERAGE NAIC #

COMMERCIAL GENERAL LIABILITY

Y / N N / A

(Mandatory in NH)

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

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.

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.

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).

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

CERTIFICATE HOLDER CANCELLATION

© 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03)

CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)

The ACORD name and logo are registered marks of ACORD

6/25/2025

(520) 624-3456

Casa De Los Ninos, Inc.

1120 N. 5th Avenue Tucson, AZ 85705

23787 13928

A 1,000,000

X X 6006698 7/1/2025 7/1/2026 1,000,000 10,000

1,000,000 3,000,000 3,000,000

1,000,000B

X X ACP3039789796 7/1/2025 7/1/2026

5,000,000A 6006699 7/1/2025 7/1/2026

5,000,000 C

1003495 7/1/2025 7/1/2026 1,000,000 1,000,000 1,000,000

A Professional Liabili 6006698 7/1/2025 See Remarks A Sexual/Phys Abuse 6006698 7/1/2025 7/1/2026 See Remarks

Certificate Holder, Owner and all others as required by written contract are Additional Insured(s) on a Primary Non-Contributory basis including Waiver of Subrogation with respects to General Liability per attached endorsements. Commercial Auto Liability Additional Insured including Waiver of Subrogation applies per attached endorsements. Umbrella Liability is Excess over General Liability, Sexual or Physical Abuse or Molestation and Professional Liability.

APPLICABLE FORMS ATTACHED

CTR045624-2 – for Foster and Adoption Support (FAS)

SEE ATTACHED ACORD 101

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

CASADEL-17 RPETETIT

Tucson, AZ-The Clements Agency-HUB International Insurance Services

(NMX)

6245 E Broadway Blvd Suite 310 Tucson, AZ 85711

Matt Gomez matt.gomez@hubinternational.com

Social Service Contractors Indemnity Pool Nationwide Mutual Insurance Company CopperPoint Indemnity Insurance Company

X

7/1/2026

X X

XX

X

X X

FORM NUMBER:

EFFECTIVE DATE:

The ACORD name and logo are registered marks of ACORD

ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE

FORM TITLE:

Page of

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

ACORD 101 (2008/01)

AGENCY CUSTOMER ID:

LOC #:

AGENCY NAMED INSURED

POLICY NUMBER

CARRIER NAIC CODE

© 2008 ACORD CORPORATION. All rights reserved.

Tucson, AZ-The Clements Agency-HUB International Insurance Services (NMX)

CASADEL-17

SEE PAGE 1

SEE PAGE 1

ACORD 25 Certificate of Liability Insurance

SEE P 1

Casa De Los Ninos, Inc.

1120 N. 5th Avenue Tucson, AZ 85705 Pima

SEE PAGE 1

RPETETIT

Description of Operations/Locations/Vehicles:

The State of Arizona, and its Departments, Agencies, Boards, Commissions, Universities, Officers, Agencies and Employees are included as additional insured with a waiver of subrogation with respect to General Liability, Auto Liability arising out of the activities performed on or on behalf of the contractor. Blanket Waiver of Subrogation applies on the Workers Compensation.

Additional Info Sexual or Physical Abuse or Molestation Occurrence $1,000,000 Aggregate $3,000,000

Professional Liability Each Claim/Occurrence/Offense/Wrongful Act $1,000,000 Aggregate $3,000,000 Retroactive Date: 07/01/2010