COI.pdf
PDF 83 KB Posted
- Attached to
- Master Agreement AZ|CTR068937
- Contract number
- CTR068937
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for Haven Family Resource Center, issued by Fountain, Parker, Harbarger & Associates, LLC, with insurance coverage provided by Philadelphia Insurance Companies and Cincinnati Insurance Companies. The certificate involves the State of Arizona, specifically the Department of Child Safety, as the certificate holder, and covers multiple insurance policies including Commercial General Liability, Automobile Liability, and Directors & Officers/Employment Practices Liability Insurance.
The insurance policies are effective from January 19, 2024 to January 19, 2025, with various coverage limits. The Commercial General Liability policy includes professional liability with limits of $1M/$3M and abuse coverage of $1M/$2M. The policy provides additional insured status to the State of Arizona, its departments, agencies, boards, commissions, universities, and employees when required by written contract. The total aggregate limit is $3,000,000, with each occurrence limit of $1,000,000 and a medical expense limit of $5,000. The Directors & Officers/Employment Practices Liability Insurance has a limit of $1,000,000.
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Other files
| File | Type | Posted |
|---|---|---|
| Amendment_2.pdf | ||
| Amendment_1.pdf | ||
| COI_-_Haven_-_Exp_1-19-24.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
11/22/2024
Fountain, Parker, Harbarger & Associates, LLC 201 Washington Street NE Huntsville AL 35801
License#: 0079647 Philadelphia Insurance Companies HAVEFAM-01 Cincinnati Insurance Companies 10677
Haven Family Resource Center 2174 McCulloch Blvd Lake Havasu City AZ 86406
1508230582
A X 1,000,000 X 100,000
X Prof $1M/$3M 5,000 X Abuse $1M/$2M 1,000,000
3,000,000 X
Y Y PHPK2647439 1/19/2024 1/19/2025
3,000,000
A 1,000,000
X X
PHPK2647439 1/19/2024 1/19/2025
B D&O/EPLI EMN 0641848 1/19/2022 1/19/2025 Limit 1,000,000
State of Arizona, its deparments, agencies, boards, commissions, universities and its officers, officials, agents and employees are included as Additional Insured for General Liability coverage when required by written contract, subject to the policy terms and conditions per form PI-GLD-HS 10/11. Waiver of Subrogation applies in favor of The Additional Insured with respect to General Liability, per form PI-GLD-HS 10/11.
State of Arizona, Department of Child Safety 3003 N. Central Avenue Phoenix AZ 85012
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