COI_Redacted.pdf

PDF 519 KB Posted

Attached to
Master Agreement AZ|CTR071444
Contract number
CTR071444
Issued by
Arizona

About this file

This document is a Certificate of Liability Insurance issued by Haggary-Haynes Insurance Inc. for P.O.W.E.R. House Youth Facility, Inc., with Social Service Contractors Indemnity Pool as the primary insurer. The certificate is for the State of Arizona Department of Child Safety (DCS), located in Phoenix, Arizona, and covers various insurance policies effective from 06/27/2023 to 06/27/2024.

The insurance coverage includes Commercial General Liability, Automobile Liability, Umbrella Liability, and Professional Liability with various policy limits. Key coverage details include $1,000,000 per occurrence for commercial general liability, sexual abuse and molestation coverage, and automobile liability for owned, hired, and non-owned vehicles. Professional liability is set at $1,000,000 per occurrence and $2,000,000 aggregate. The policy also includes an endorsement that adds the State of Arizona, its departments, agencies, boards, commissions, and universities as additional insureds for losses arising from work performed by or on behalf of the contractor.

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File Type Posted
2-Attachment_3-D__PHYF_Redacted.pdf PDF
Business_associate_Agreement_HITECH-signed.pdf PDF
COI_Worker_Comp-_State_of_Arizona_DCS_-_2024_05_08_Redacted.pdf PDF
Congregate_Care_Services_Amendment_4.pdf PDF
Congregate_Care_Services_SOW_2024_with_Terms_and_Conditions.pdf PDF
Contract_Amendment_3.pdf PDF
Exhibit IV - Medication Error Report.pdf PDF
Exhibit XVI Facility Modification Request.pdf PDF
License_and_Op_Cert_Redacted.pdf PDF
Offer_and_Acceptance_Redacted.pdf PDF
ACORD_Form_20250122-093822_Redacted.pdf PDF
COIJune2025_Redacted.pdf PDF
Congregate_Care_Services_Amendment.pdf PDF
Contract_Amendment_1.pdf PDF
Exhibit CS0-1015A.pdf PDF
Exhibit III - Medication Log.pdf PDF
Exhibit IX Clothing and Property Inventory.pdf PDF
Exhibit V - Blood Sugar Log.pdf PDF
Exhibit VII Clothing Allowance Ledger.pdf PDF
Exhibit VIII Personal Allowance Ledger.pdf PDF
Exhibit X Returned Allowances Form.xlsx XLSX spreadsheet
Exhibit XIV Provider Census Report.xlsm XLSM spreadsheet
Exhibit XVII Quarterly Report.xlsm XLSM spreadsheet
Exhibit XXII ADJC Residential Services Invoice.docx DOCX document
2-Attachment_3-E___PHYF_1_Redacted.pdf PDF
Award_Letter-Power_House_Youth_Facility_Redacted.pdf PDF
COIs_ACORD_Form_2025_Redacted.pdf PDF
Congregate_Care_Services_SOW_Amendment_1.pdf PDF
Congregate_Care_Services_SOW_Amendment_3.pdf PDF
Directions_to_Procurement_File.docx DOCX document
Exhibit I - DCS 06-01 Limited English Proficiency.pdf PDF
Exhibit II - Personalized Service Plan.pdf PDF
Exhibit XV Discharge Summary.pdf PDF
Exhibit XVIII ADJC Monthly Attendance Report.doc DOC document
Congregate_Care_Services_SOW_Amendment_2.pdf PDF
Exhibit VI Fees Log.pdf PDF
Exhibit XI One on One Supervision.pdf PDF
Exhibit XII Bed Hold.pdf PDF
Exhibit XIX ADJC Census Report.doc DOC document
Exhibit XX ADJC-5002 ADJC Service Providers Protocol ADJC.doc DOC document
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