COI_thru_9.4.24.pdf
PDF 23 KB Posted
- Attached to
- Master Agreement AZ|CTR066000
- Contract number
- CTR066000
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for New Freedom, LLC, issued by Lockton Companies on 9/4/2024, with insurance coverage provided by Social Service Contractor's Indemnity Pool and CopperPoint Indemnity Insurance Company. The certificate is for a contract (CTR066000) with the State of Arizona, specifically the Department of Corrections, Rehabilitation & Reentry, located in Phoenix, Arizona.
The insurance policy covers multiple types of liability, including commercial general liability, automobile liability, umbrella liability, and workers' compensation, with various coverage limits ranging from $1,000,000 to $5,000,000. Notable specific coverages include professional liability with a claims-made policy, sexual abuse/molestation coverage ($1M per claim, $2M aggregate), and additional insured status for the State of Arizona. The policy is effective from 9/4/2023 to 9/4/2024, with a waiver of subrogation in favor of the State of Arizona for losses arising from work performed by the contractor.
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Text version
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
INSR ADDL SUBR
LTR INSD WVD
DATE (MM/DD/YYYY)
PRODUCER CONTACT
NAME:
FAXPHONE
(A/C, No):(A/C, No, Ext):
ADDRESS:
INSURER A :
INSURED INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
POLICY NUMBER
POLICY EFF POLICY EXP
TYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)
AUTOMOBILE LIABILITY
UMBRELLA LIAB
EXCESS LIAB
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
EACH OCCURRENCE $
DAMAGE TO RENTED
CLAIMS-MADE OCCUR $PREMISES (Ea occurrence)
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
PRO-
POLICY LOC PRODUCTS - COMP/OP AGG $JECT
OTHER: $
COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident)
OCCUR EACH OCCURRENCE $
CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below
INSURER(S) AFFORDING COVERAGE NAIC #
COMMERCIAL GENERAL LIABILITY
Y / N
N / A (Mandatory in NH)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
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.
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.
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).
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
CERTIFICATE HOLDER CANCELLATION
© 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03)
CERTIFICATE OF LIABILITY INSURANCE
Lockton Companies 8110 E Union Avenue Suite 100 Denver CO 80237
(303) 414-6000
New Freedom, LLC 10851 N Black Canyon Hwy, Ste. 400 Phoenix, AZ 85029
Social Service Contractor's Indemnity Pool 0 CopperPoint Indemnity Insurance Company 13928
X X
1,000,000 1,000,000 10,000 1,000,000 2,000,000 2,000,000
X X X
X Comp/Coll X $1,000 Ded
1,000,000
XXXXXXX
XXXXXXX
XXXXXXX
XXXXXXX
X X
X $0
5,000,000 5,000,000
XXXXXXX
N
X
1,000,000 1,000,000 1,000,000
Prof Liab - Claims Made
Sexual Abuse/Molest
$1M Ea. Claim $2M Agg.
Retro Date: 9/4/20 $1M Ea. Act of Abuse $2M Agg.
A 6001564-6 9/4/2023 9/4/2024
A 6001564-6 9/4/2023 9/4/2024
A 6001564-6 9/4/2023 9/4/2024
A 6001564-6 9/4/2023 9/4/2024
A 6001565-4 9/4/2023 9/4/2024
B 1028190 9/4/2023 9/4/2024
9/4/2024
1523668
Y Y
Y Y
N N
Y
4/11/2024
N N
19883178
19883178 XXXXXXX
State of Arizona Dept of Corrections, Rehabilitation & Reentry Procurement Services 701 E Jefferson St.
Phoenix AZ 85034
RE: CTR066000. The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees are included as Additional Insureds if required by written contract with respect to General Liability and Auto Liability arising out of the activities performed by or on behalf of the Contractor, including those involving automobiles owned, leased, hired or borrowed by the Contractor. Sexual Abuse and Molestation is included.
X
CONTINUATION DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS (Use only if more space is required)
ACORD 25 (2016/03)
Waiver of Subrogation in favor of the State of Arizona, and its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees for losses arising from work performed by or on behalf of the Contractor as respects General Liability, Auto Liability and Workers' Compensation if required by written contract.
Certificate Holder ID: 19883178
File details come from the government source that posted it. Updated .