COI_2025-01-26_GL_AL_WC.pdf

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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

E-MAIL

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

File details come from the government source that posted it. Updated .