Certificate_of_Insurance.pdf
PDF 247 KB Posted
- Attached to
- Master Agreement AZ|CTR050592
- Contract number
- CTR050592
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance for Adelante Healthcare Inc., issued by Lovitt & Touche Inc. and underwritten by Selective Insurance Company of America. The certificate covers Adelante Healthcare, located in Phoenix, Arizona, and lists the Arizona Department of Health Services (AZDHS) as the certificate holder. The insurance policy is effective from 3/1/2020 to 3/1/2021 and provides coverage for commercial general liability, automobile liability, and umbrella liability.
The insurance policy includes several key coverage limits: $1,000,000 for each occurrence of commercial general liability, $1,000,000 combined single limit for automobile liability, and $7,000,000 for umbrella liability. The policy specifically notes that AZDHS is included as an additional insured with respect to Automobile and General Liability as required by written contract or agreement. The policy was created on 7/30/2020, with a zero deductible, and covers various types of potential liability for Adelante Healthcare's operations.
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Text version
© 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
CERTIFICATE HOLDER
ACORD 25 (2016/03)
AUTHORIZED REPRESENTATIVE
CANCELLATION
DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE
LOCJECT
PRO-POLICY
GEN'L AGGREGATE LIMIT APPLIES PER:
OCCURCLAIMS-MADE
COMMERCIAL GENERAL LIABILITY
PREMISES (Ea occurrence) $
DAMAGE TO RENTED
EACH OCCURRENCE $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
$RETENTIONDED
CLAIMS-MADE
OCCUR
AGGREGATE $
EACH OCCURRENCE $UMBRELLA LIAB
EXCESS LIAB
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
INSR
LTR TYPE OF INSURANCE POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY) LIMITS
PER
STATUTE
OTH-
ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
ANY PROPRIETOR/PARTNER/EXECUTIVE
If yes, describe under DESCRIPTION OF OPERATIONS below
(Mandatory in NH)
OFFICER/MEMBER EXCLUDED?
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
AUTOMOBILE LIABILITY
ANY AUTO
OWNED SCHEDULED
HIRED AUTOS NON-OWNED
AUTOS ONLY AUTOS
AUTOS ONLY
COMBINED SINGLE LIMIT
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE $
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.
INSD
ADDL
WVD
SUBR
N / A
(Ea accident)
(Per accident)
OTHER:
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:
INSURED
PHONE
(A/C, No, Ext):
PRODUCER
ADDRESS:
FAX
(A/C, No):
CONTACT
NAME:
NAIC #
INSURER A :
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
INSURER(S) AFFORDING COVERAGE
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 Certificate of Liability Insurance was created by Selective on behalf of the agent.
ONLY
X
PO BOX 32702
TUCSON
LOVITT & TOUCHE INC 602-956-2250
AZ 85751-2702
3/1/2020 3/1/2021
X
1,000,000
S 2304520
150 N. 18th Ave.
Suite 260
Phoenix
AZDHS
AZ 85007
AZDHS is included as additional insured with respect to Automobile, General Liability as required by written contract or agreement.
X
3/1/2020 3/1/2021
XX
X
500,000
3,000,000
15,000
1,000,000
1,000,000
3,000,000
S 2304520
3033 N CENTRAL AVE
STE 145
PHOENIX
ADELANTE HEALTHCARE INC ADELANTE HEALTHCARE INC
AZ 85012-2809
A
A
A
12572SELECTIVE INS CO OF AMERICA
7/30/2020
3/1/2020 3/1/2021 X
7,000,000
7,000,000X S 2304520
ZEROX
ACORD 101 (2008/01)
The ACORD name and logo are registered marks of ACORD
© 2008 ACORD CORPORATION. All rights reserved.
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
ADDITIONAL REMARKS
ADDITIONAL REMARKS SCHEDULE
AGENCY CUSTOMER ID:
LOC #:
AGENCY
CARRIER NAIC CODE
POLICY NUMBER
NAMED INSURED
EFFECTIVE DATE:
LOVITT & TOUCHE INC
3/1/2020
3033 N CENTRAL AVE
STE 145
PHOENIX
ADELANTE HEALTHCARE INC ADELANTE HEALTHCARE INC
AZ 85012-2809
12572SELECTIVE INS CO OF AMERICA
CTR050592
S 2304520
JOB #
JOB LOCATION
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