COI 2026-02-06 CGL WC.pdf

ACORD

CERTIFICATE OF LIABILITY INSURANCE I

DATE (MM/DD/YYYY)

� 12/12/2024

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).

PRODUCER CONTACT Sondra Getz/Julie Burnett

NAME·

State Farm JULIE BURNETT wgN:o Extl: 520-885-2321 I FAX IA/C Nol:

A® 6590 E TANOUE VERDE RD, STE B �;._"""J�ss: julie.burnett.mrsn@statefarm.com

TUCSON AZ. 85715 INSURER(S) AFFORDING COVERAGE NAIC#

INSURER A: State Farm Fire and Casualty Company 25143

INSURED INSURER B: G

MINDFUL LACTATION LLC INSURER C: G

7339 N YUCCA VIA INSURER D: G

TUCSON AZ. 85704-6226 INSURER E: �

INSURER F: 1::::1

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

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.

INSR

LTR

A

A

TYPE OF INSURANCE

X COMMERCIAL GENERAL LIABILITY

f--

□ CLAIMS-MADE [X] OCCUR

f--f--

GEN'L AGGREGATE LIMIT APPLIES PER: Fl □ PRO-

POLICY JECT

OTHER:

AUTOMOBILE LIABILITY

ANY AUTO

f-- OWNED f--

AUTOS ONLY

HIRED

f--

AUTOS ONLY

DLoc

SCHEDULED

AUTOS

NON-OWNED

AUTOS ONLY

UMBRELLA LIAB

H

OCCUR

f--

EXCESS LIAB CLAIMS-MADE

DED I I RETENTION $

WORKERS COMPENSATION

AND EMPLOYERS" LIABILITY

ANY PROPRIETOR/PARTNER/EXECUTIVE

y / N

OFFICER/MEMBER EXCLUDED? Y

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

ADD SUB POLICY EFF POLICY EXP

INSD WVD POLICY NUMBER IMM/DD/YYYYl IMM/DD/YYYYl y y 93-AA-4704-0 10/03/2025 10/03/2026

N IA 93-J2-A675-7 02/06/2025 02/06/2026

LIMITS

EACH OCCURRENCE $ 1,000,000

DAMAGE TO RENTED

$ 300,000PREMISES IEa occurrence\ MED EXP (Any one person) $ 5,000

PERSONAL & ADV INJURY $ 1,000,000

GENERAL AGGREGATE $ 2,000,000

PRODUCTS - COMP/OP AGG $ 2,000,000

COMBINED SINGLE LIMIT

IEa accident\ $

BODILY INJURY (Per person) $

BODILY INJURY (Per accident) $

• 1,vr 1...1'\ I T U1-\Ml-\\.,C.

/Per accident\ $

EACH OCCURRENCE $

AGGREGATE $

I

PER

I STATUTE I ��

H-

E.L. EACH ACCIDENT $ 1000000

E.L. DISEASE - EA EMPLOYEE $ 1000000

E.L. DISEASE - POLICY LIMIT $ 1000000

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

CMP-4786 ADDITIONAL INSURED; THE STATE OF ARIZONA, ITS DEPARTMENTS, AGENCIES, BOARDS,COMMISSIONS, UNIVERSITIES, AND ITS

OFFICERS, OFFICIALS, AND EMPLOYEES 150 N 18TH AVE PHOENIX AZ. 85007

ADHS SOLICITATION BPM000400

CONTRACT# CTR074772

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ARIZONA DEPARTMENT OF HEAL TH SERVICES ACCORDANCE WITH THE POLICY PROVISIONS.

150 N 18TH AVE AUTHORIZED REPRESENTATIVE

PHOENIX AZ 85007 Completed by an authorized State Farm representative. If signature is required, please contact a State Farm agent.

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