COI_Eastside_Loop_-_exp_4.1.25.pdf
PDF 152 KB Posted
- Attached to
- Master Agreement AZ|CTR075175
- Contract number
- CTR075175
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for Beacon Group, Inc. and Beacon Group SW, Inc., issued by Lovitt & Touche, a Marsh & McLennan Agency, with primary insurance provided by Philadelphia Indemnity Insurance Co. and CopperPoint Indemnity Insurance Company. The certificate is specifically for a contract with the Arizona Department of Child Safety, located in Phoenix, Arizona, covering various insurance policies for the period of 4/1/2024 to 4/1/2025.
The contract relates to Janitorial Services at 1450 & 1470 S. Eastside Loop, with contract number ADCS19-209612. The insurance coverage includes Commercial General Liability, Automobile Liability, Umbrella Liability, Workers' Compensation, Professional Liability, Sexual Abuse/Molestation Liability, and Employee Dishonesty. The policies provide additional insured status and a waiver of subrogation for the State of Arizona, its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees. Coverage limits range from $1,000,000 to $9,000,000 depending on the specific type of liability, with various aggregate and occurrence limits.
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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
3/26/2024
Lovitt & Touche A Marsh & McLennan Agency LLC Co 4703 E Camp Lowell Drive, #101 Tucson AZ 85712
Julie Reed, CISR 520-722-3000 jreed@lovitt-touche.com
Philadelphia Indemnity Insurance Co. 18058 BEACOGROUP3 CopperPoint Indemnity Insurance Company 13928
Beacon Group, Inc.
Beacon Group SW, Inc.
308 W. Glenn Street Tucson AZ 85705
1414903077
A X 1,000,000 X 1,000,000
20,000
1,000,000
2,000,000 X
PHPK2670530 4/1/2024 4/1/2025
2,000,000
A 1,000,000
X
PHPK2670530 4/1/2024 4/1/2025
A X X 9,000,000PHUB905732 4/1/2024 4/1/2025
9,000,000 X 10,000
B X1014648 4/1/2024 4/1/2025
1,000,000
1,000,000
1,000,000 A Professional Liability
Sex Abuse/Molestation Liability Employee Dishonesty
PHPK2670530 4/1/2024 4/1/2025 $1,000,000 Occ $1,000,000 Occ $500,000 Occ
$2,000,000 Agg $2,000,000 Agg $5,000 Deduct
Professional Liability-Occurrence Form coverage is included per limits shown, and is also included in Umbrella Limits.
Sexual Abuse/Molestation Liability-Occurrence Form coverage is included per limits shown, and is also included in Umbrella Limits.
RE: ADCS19-209612 Janitorial Services, 1450 & 1470 S. Eastside Loop Additional Insured/ Waiver of Subrogation Per attached State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees as additional insured with respect to liability arising out of the activities performed by or on behalf of the Contractor Workers Compensation Waiver of Subrogation In favor of the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees for losses arising from work performed by or on behalf of the Contractor
Arizona Department of Child Safety Office of Contracts 3003 N. Central, Suite 2000, Site Code CH010-20 Phoenix AZ 85012
MANUSCRIPT (06/11)
Revised 6/13/12 Page 1 of 1
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED – STATE OF ARIZONA
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
HUMAN SERVICES ORGANIZATION PROFESSIONAL LIABILITY COVERAGE FORM
SEXUAL OR PHYSICAL ABUSE OR MOLESTATION VICARIOUS LIABILITY COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
Policy No. PHPK2670530 Policy Term. 04/01/2024 to 04/01/2025
SCHEDULE
Name of Person or Organization:
The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, employees, shall be named as additional insured with respect to liability arising out of the activities performed on behalf of Contractor.
The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, employees, shall be named as additional insured with respect to liability arising out of the activities performed by or on behalf of Provider, involving automobiles owned, leased, hired or borrowed by Contractor.
The following provisions are added to the policy:
1. WHO IS AN INSURED is amended to include as an insured the person or organization shown in the above SCHEDULE, but only with respect to their liability for activities performed by you or on your behalf relating to the conduct of your business;
2. The coverage provided by this endorsement includes the assumption of liability in a written or oral contract between the named insured and the person or organization shown in the above SCHEDULE for work performed by you or on your behalf relating to the conduct of your business;
3. The coverage provided by this endorsement only is primary and non-contributory; and
4. We agree to waive any right of subrogation against the State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees for losses arising from work performed on behalf of Contractor.
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