COI_2025-01-26_GL_AL_WC.pdf
PDF 35 KB Posted
- Attached to
- Master Agreement AZ|CTR058342
- Contract number
- CTR058342
- Issued by
- Arizona
About this file
This Certificate of Liability Insurance, issued on July 1, 2024, documents insurance coverage for Nathaniel D Thompson PSYD LLC, DBA Arizona Police Psychology, with the Arizona Department of Corrections, Rehabilitation, & Reentry listed as the certificate holder. The insurance is provided through Pinnacle Insurance Group, with coverage issued by State Auto Insurance Companies (NAIC #25135) and Plaza Insurance Companies (NAIC #59003). The certificate covers the policy period from January 26, 2024, through January 26, 2025.
The insurance coverage includes Commercial General Liability with limits of $2,000,000 per occurrence and $4,000,000 general aggregate; Automobile Liability with a combined single limit of $1,000,000 per accident; and Workers Compensation and Employers' Liability with limits of $1,000,000 per each accident, $1,000,000 per employee disease, and $1,000,000 policy limit. Additional coverage includes medical expense coverage of $5,000 per person, personal and advertising injury coverage of $50,000, and damage to rented premises coverage of $5,000 per occurrence. All policies are occurrence-based rather than claims-made, and the certificate confirms that coverage is in force as of the issuance date, subject to all policy terms, exclusions, and conditions.
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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
02/06/2024
Pinnacle Insurance Group
70 S Val Vista Dr Ste A3-164
Gilbert, AZ 85296
Christian Jones
480-474-0334 service@pigquote.com
Nathaniel D Thompson PSYD LLC
DBA Arizona Police Psychology
6625 S Rural Rd Ste 101
Tempe AZ 85283
State Auto Insurance Companies 25135
Plaza Insurance Companies 59003
A
10114587CB 01/26/2024 01/26/2025
2,000,000
50,000
5,000
Included
4,000,000
4,000,000
A
10114593CA 01/26/2024 01/26/2025
1,000,000
B 10114591WC 01/26/2024 01/26/2025
1,000,000
1,000,000
1,000,000
1 1 1 1 1 1 1 1 1 1 1 1 1 1988988988989898989898999999999 -20-2015 15 15 ACOACOACOACOACOACOACOCOCORD RDRDRD CORPORATION. All rigrig
NTATIVE
Arizona Department of Corrections, Rehabilitation, & Reentry 1645 W Jefferson St Mail Code 55302 Phoenix, AZ 85007
07/01/2024
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