COI_Comprehensive_Mobile.pdf
PDF 84 KB Posted
- Attached to
- Master Agreement AZ|CTR066400
- Contract number
- CTR066400
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued on 6/29/2023 for Comprehensive Mobile Care, Inc., located in Phoenix, Arizona. The certificate involves multiple insurers, including Hartford Underwriters Insurance Company, National Liability & Fire Insurance Company, Hartford Accident and Indemnity Company, and Hiscox Insurance Company Inc. The certificate holder is the Arizona Department of Administration and the Arizona Department of Veteran's Services, located in Phoenix, Arizona.
The document covers a Dental, Vision and Audiology Services Contract (CTR066400) with various insurance policies and coverage periods from 3/1/2023 to 3/1/2024 and 2/23/2023 to 2/24/2024. The insurance includes Commercial General Liability with a $2,000,000 each occurrence limit and $4,000,000 general aggregate, Automobile Liability, Umbrella Liability, Workers Compensation, and Health Care Professional liability. The Health Care Professional coverage specifically includes $1,000,000 per occurrence and a $3,000,000 aggregate limit. The policies provide comprehensive coverage for Comprehensive Mobile Care, Inc.'s operations related to dental, vision, and audiology services for state agencies in Arizona.
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Other files
| File | Type | Posted |
|---|---|---|
| Best_and_Final_Price_Sheet.pdf | ||
| CTR066400_Contract_Amendment_1.pdf | ||
| CTR066400_Contract_Amendment_2.pdf | ||
| CTR066400 Contract Documents.pdf |
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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
6/29/2023
Arthur J. Gallagher Risk Management Services, LLC 101 S Main Street, Suite 200 Decatur IL 62523
217-423-2345 217-428-0865
License#: BR-724491 Hartford Underwriters Insurance Company 30104 NURSHOM-04 National Liability & Fire Insurance Co 20052
Comprehensive Mobile Care, Inc 21175 N. 9th Place, Suite 100 Phoenix AZ 85024
Hartford Accident and Indemnity Company 22357 Hiscox Insurance Company Inc. 10200
1714929114
A X 2,000,000 X 1,000,000
10,000
2,000,000
4,000,000
83SBAAW4SP0 3/1/2023 3/1/2024
4,000,000
B 1,000,000
X
X X
73APS110585 3/1/2023 3/1/2024
A X 2,000,00083SBAAW4SP0 3/1/2023 3/1/2024
X 10,000
C X83WECAB2FHT 2/23/2023 2/23/2024
1,000,000
1,000,000
1,000,000 D Health Care Professional
Health Care Professional
MEO441112723 2/24/2023 2/24/2024 Each occurrence Aggregate
$1,000,000.00 $3,000,000.00
Dental, Vision and Audiology Services Contract CTR066400
Arizona Department of Administration Arizona Department of Veteran's Services 3839 N. 3rd Street Phoenix AZ 85012
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