COI_-_Exp_7-1-2026.pdf
PDF 169 KB Posted
- Attached to
- Master Agreement AZ|CTR078548
- Contract number
- CTR078548
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance issued on 05/12/2025 for Northwest Media, Inc., located in Eugene, Oregon. The certificate involves multiple insurers including Hartford Casualty Insurance, Rated by Multiple Companies, and Federal Insurance Company. The primary certificate holder is the Arizona Department of Child Safety, located in Phoenix, Arizona.
The insurance coverage includes Commercial General Liability with a $2,000,000 each occurrence limit and a $4,000,000 general aggregate limit, Automobile Liability, Umbrella/Excess Liability, Workers' Compensation, and Internet Liability/Professional Liability. The policies are effective from 07/01/2025 to 07/01/2026 for most coverages, with the Internet Liability/Professional Liability running from 11/06/2024 to 11/06/2025. The State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are listed as Additional Insured, with coverage designated as Primary Non-Contributory and including a Waiver of Subrogation.
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Other files
| File | Type | Posted |
|---|---|---|
| AZ_Extension_Agreement-lee_northwestmedia.com.pdf |
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Text version
05/12/2025
PBC Insurance 450 Country Club Road #330
Eugene OR 97401
Jennifer Stuve
(541) 484-6624 (541) 686-2726 jstuve@pbcins.com
Northwest Media, Inc 326 W 12th Ave
Eugene OR 97401
Hartford Casualty Insurance 29424 Rated by Multiple Companies 00914 Federal Insurance Company 20281
CL2551247917
A Y 52SBAUM7850 07/01/2025 07/01/2026
2,000,000 1,000,000 10,000
4,000,000 4,000,000
Employment Practices Liability Insurance
5,000
A 52SBAUM7850 07/01/2025 07/01/2026
A 10,000
52SBAUM7850 07/01/2025 07/01/2026
B 52WECPH2491 08/01/2025 08/01/2026
1,000,000 1,000,000 1,000,000
C Internet LiabilityProfessional Liability
81704403 11/06/2024 11/06/2025 1,000,000
State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees are Additional Insured, the coverage is Primary Non-Conributory and Waiver of Subrogation applies per blanket form #SS0008 04 05.
Arizona Dept of Child Safety 3003 N Central Ave, 20th Floor
Phoenix AZ 85012
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
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