COI_-_Exp_7-1-2026.pdf

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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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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

E-MAIL

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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