COI_1.2025_STATE_OF_AZ_-_Sportscom_Inc_dba_HMA_Public_Relations_UPDATED_SIGNED.pdf

PDF 1 MB Posted Sep 1, 2021

Attached to: Master Agreement AZ|CTR056869
Contract number: CTR056869
Issued by: Arizona

About this file

Written by GovTribe AI · Oct 8, 2025

This document is a Certificate of Liability Insurance issued by State Farm Fire and Casualty Company for SPORTSCOM, INC. DBA HMA PUBLIC RELATIONS, located in Scottsdale, Arizona. The certificate is produced by Chavez Insurance Agency Inc. in Phoenix, Arizona, and is designated for the State of Arizona as the certificate holder, with an effective date of 01/20/2025.

The insurance certificate covers Commercial General Liability with a policy number 93-KU-5683-2, providing $1,000,000 per occurrence and $2,000,000 general aggregate. The policy includes coverage for personal and advertising injury, with a $5,000 medical expense limit. The policy is effective from 01/01/2025 to 01/10/2026, demonstrating a standard one-year insurance term for a business liability policy. No specific goods, services, or contract details are explicitly outlined in this insurance certificate beyond the standard liability coverage for the insured business.

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CTR056869_Contract_Amendment__4.pdf	PDF	Sep 1, 2021
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CTR056869_Contract_Amendment__2.pdf	PDF	Sep 1, 2021
CTR056869_Contract_Amendment__3.pdf	PDF	Sep 1, 2021
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1001486 132849.14 04-13-2022

INSR

LTR TYPE OF INSURANCE

ADD

INSD

SUB

WVD POLICY NUMBER

POLICY EFF

(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY) LIMITS

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY

PRO-

JECT LOC

OTHER:

EACH OCCURRENCE $

DAMAGE TO RENTED

PREMISES (Ea occurrence) $

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $

PRODUCTS - COMP/OP AGG $

AUTOMOBILE LIABILITY

ANY AUTO

OWNED

AUTOS ONLY

SCHEDULED

AUTOS

HIRED

AUTOS ONLY

NON-OWNED

AUTOS ONLY

COMBINED SINGLE LIMIT

(Ea accident) $

BODILY INJURY (Per person) $

BODILY INJURY (Per accident) $

PROPERTY DAMAGE

(Per accident) $

UMBRELLA LIAB OCCUR

EXCESS LIAB CLAIMS-MADE

DED RETENTION $

EACH OCCURRENCE $

AGGREGATE $

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below

Y / N N / A

PER

STATUTE

OTH-

ER $

E.L. EACH ACCIDENT $

E.L. DISEASE - EA EMPLOYEE $

E.L. DISEASE - POLICY LIMIT $

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

E-MAIL

ADDRESS:

CONTACT

NAME:

PHONE

(A/C, No, Ext):

FAX

(A/C, No):

INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

PRODUCER

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.

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.

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

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

ACORD 25 (2016/03)

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

AUTHORIZED REPRESENTATIVE

1001486 132849.14 04-13-2022

INSR LTR

TYPE OF INSURANCE

ADD INSD

SUB

WVD

POLICY NUMBER

POLICY EFF

(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY)

LIMITS

GEN'L AGGREGATE LIMIT APPLIES PER:

EACH OCCURRENCE

DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person)

PERSONAL & ADV INJURY

GENERAL AGGREGATE

PRODUCTS - COMP/OP AGG

AUTOMOBILE LIABILITY

COMBINED SINGLE LIMIT

(Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident)

PROPERTY DAMAGE

(Per accident)

EACH OCCURRENCE

AGGREGATE

WORKERS COMPENSATION AND EMPLOYERS' LIABILITYANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) If yes, describe underDESCRIPTION OF OPERATIONS below N / A

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE

E.L. DISEASE - POLICY LIMIT

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

E-MAILADDRESS:

CONTACT

NAME:

PHONE

(A/C, No, Ext):

FAX(A/C, No):

INSURER(S) AFFORDING COVERAGE

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

PRODUCER

INSURED

C:\Users\GAHL\Desktop\Logos R\Red_SF_logo_vert_small_R_1.png State Farm Logo registered

COVERAGES

IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.

REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

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

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

ACORD 25 (2016/03)

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

AUTHORIZED REPRESENTATIVE

Certificate of Liability Insurance

PageNumbering:

The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the general liability policy. :

Check the box (if applicable): Indicates the claims made or occurrence option applies for the general liability policy. : 1

Indicates the claims made applies for the general liability policy. :

Indicates the occurrence option applies for the general liability policy. : 1

Indicates other coverage not found on the form exists for the general liability policy. :

Description of other coverage (not the limit) on the general liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). :

Indicates other coverage not found on the form exists for the general liability policy. :

The description of other coverage (not the limit) on the general liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). :

genlAgrgtePerPolicy:

genlAgrgtePerProject:

genlAgrgtePerLocation:

genlAgrgtePerOther:

Enter text: The description of the other option to which the general liability policy, general aggregate limit applies. :

Y for a “Yes” response. N for “No” response. Indicates if the certificate holder has been named as an additional insured on the general liability policy. :

Y for a “Yes” response. N for “No” response. Indicates if subrogation has been waived on the general liability policy. :

The identifier assigned by the insurer to the general liability policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. :

The effective date of the general liability policy. The date that the terms and conditions of the policy commence. :

The date on which the terms and conditions of the general liability policy will expire. :

Enter limit: The general liability, each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as governed by the policy.: 1000000.00

The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the policy. :

anyAuto:

ownedAutosOnly:

scheduledAutos:

hiredAutosOnly:

nonOwnedAutos:

Vehicle_OtherCoveredAutoIndicator_A:

Description of the other covered autos. :

Vehicle_OtherCoveredAutoIndicator_B:

Description of the other covered autos. :

Y for a “Yes” response. N for “No” response. Indicates if the certificate holder has been named as an additional insured on the automobile liability policy. :

Y for a “Yes” response. N for “No” response. Indicates if subrogation has been waived on the automobile policy. :

The identifier assigned by the insurer to the automobile liability policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. :

The effective date of the automobile liability policy. The date that the terms and conditions of the policy commence. :

The date on which the terms and conditions of the automobile liability policy will expire. :

Description of the coverage. :

The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the commercial excess or umbrella liability policy. :

umbrellaLiabInd:

occurrenceInd:

excessLiabInd:

claimsMadeInd:

retentionInd:

The excess or umbrella liability deductible or retention amount. :

Y for a “Yes” response. N for “No” response. Indicates if the certificate holder has been named as an additional insured on the umbrella/excess liability policy. Place a "Y" next to each coverage where an additional insured endorsement has been issued or for umbrella / excess where there is an additional insured on the underlying primary policy and this umbrella / excess is follow form. :

Y for a “Yes” response. N for “No” response. Indicates if subrogation has been waived on the excess policy. For umbrella / excess, place a "Y" next to each coverage where subrogation has been waived on the underlying primary policy and this umbrella / excess is follow form. :

Enter identifier: The identifier assigned by the insurer to the excess liability policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. :

Enter date: The effective date of the excess liability policy. The date that the terms and conditions of the policy commence. :

Enter date: The date on which the terms and conditions of the excess liability policy will expire. :

Description of other coverage (not the limit) on the excess or umbrella liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). :

The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the commercial workers compensation and employers liability policy. :

Y for a “Yes” response. N for “No” response. Indicates whether the workers compensation and employers liability policy excludes any proprietor, partner, executive officer, or member. As used here, the DESCRIPTION OF OPERATIONS section is available, if needed, to provide details of any "Yes" response. In NH, if "Yes" response is indicated, it is mandatory to provide corresponding details in the DESCRIPTION OF OPERATIONS section.:

Y for a “Yes” response. N for “No” response. Indicates if subrogation has been waived on the workers compensation policy. :

Enter identifier: The identifier assigned by the insurer to the workers' compensation and employers liability policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. :

Enter date: The effective date of the workers' compensation and employers liability policy. The date that the terms and conditions of the policy commence. .:

Enter date: The date on which the terms and conditions of the workers' compensation and employers liability policy will expire. :

perStatute:

otherInd:

The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the other policy. :

The description of the other policy not listed on the form. :

Y for a “Yes” response. N for “No” response. Indicates if the certificate holder has been named as an additional insured on the other policy. :

Y for a “Yes” response. N for “No” response. Indicates subrogation has been waived on the other policy. :

The other policy number exactly as it appears on the policy, including prefix and suffix symbols. :

The date on which the terms and conditions of the other policy commence. :

The date on which the terms and conditions of the other policy expires. :

The coverage code for the other policy. :

The other policy, coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as governed by the policy.:

The coverage code for the other policy. :

Producer's contact person's e-mail address. :

Name of the individual at the producer's establishment that is the primary contact. :

Producer's contact person's phone number with area code if applicable.:

Fax number of the producer / agency. :

Insurer’s full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer’s group name or trade name. As used here, this is Insurer A. :

Identification code assigned to the insurer by the National Association of Insurance Commissioners (NAIC). As used here, this is Insurer A.:

Identification code assigned to the insurer by the National Association of Insurance Commissioners (NAIC). As used here, this is Insurer B.:

Identification code assigned to the insurer by the National Association of Insurance Commissioners (NAIC). As used here, this is Insurer C.:

Identification code assigned to the insurer by the National Association of Insurance Commissioners (NAIC). As used here, this is Insurer D.:

Identification code assigned to the insurer by the National Association of Insurance Commissioners (NAIC). As used here, this is Insurer E.:

Identification code assigned to the insurer by the National Association of Insurance Commissioners (NAIC). As used here, this is Insurer F.:

Full name of the producer / agency. :

Mailing address line one of the producer / agency. :

Mailing address line two of the producer / agency. :

City name of the producer / agency. :

State or province code of the producer / agency. :

Postal code of the producer / agency. :

Named insured(s) as it / they will appear on the policy declarations page. :

Named insured's mailing address line one. :

Named insured's mailing address line two. :

Named insured's city.:

Named insured's state. :

Named insured's mailing address postal code. :

revisionNumber:

certificateNumber:

date this form is completed. (MM/DD/YYYY) :

The certificate holder's full name. :

The certificate holder's mailing address line one. :

The certificate holder's mailing address line two. :

The certificate holder's mailing address city name. :

The certificate holder's mailing address state or province code. :

The certificate holder's mailing address postal code. :

The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM).:

The Certificate Of Liability Insurance general remarks. The additional comments or special conditions that may exist upon the policy. ACORD 101, Additional Remarks Schedule, may be attached if more space is required. As used here, records information necessary to identify the operations, locations and vehicles for which the certificate was issued.:

Signature chooses:

File details come from the government source that posted it. Updated Oct 8, 2025.