COI_Well_Women_-_ADHS_12.1.24_-_12.1.25.pdf

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Attached to
Master Agreement AZ|CTR070059
Contract number
CTR070059
Issued by
Arizona

About this file

This is an ACORD Certificate of Liability Insurance for Maricopa County Special Health Care District (doing business as Valleywise Health) located in Phoenix, Arizona. The document involves multiple insurance carriers including Sentry Insurance A Mutual Co, Copic Insurance Company, and additional excess/workers' compensation insurers such as Arch Specialty Insurance Company, Capitol Specialty Insurance Corporation, and Endurance American Specialty Ins. Co. The insurance is managed through Marsh USA LLC, with the primary certificate holder being the Arizona Department of Health Services.

The insurance coverage includes Commercial General Liability, Automobile Liability, Workers' Compensation, and Medical Professional Liability, with policy periods from 12/01/2024 to 12/01/2025. Key coverage limits include $1,000,000 per occurrence for general liability and automobile liability, and workers' compensation with employers' liability limits of $1,000,000 per accident, per employee disease, and aggregate disease. The policies reference a specific solicitation (ADHS19-00008459) for the Well Woman HealthCheck Program, and include multiple excess and buffer layers with varying limits ranging from $2M to $40M across different insurance carriers.

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Text version

Deductible: 500,000

LOS-002496583-09

1,000,000

AZ

11860

AggregateXS of $2M/$2M Buffer XS $2M SIR

Phoenix, AZ 85016

N

X12/01/2024

12/01/2025

12/01/2024

9018935002

Medical Prof Liab Claims Made

A

N/A

Copic Insurance Company

1,000,000

X

B

12/06/2024

15,000,000

15,000,000

RE: Organization: Well Woman HealthCheck Program, SOLICITATION NO. ADHS19-00008459 The placements for Automobile policy #901893502 and Workers Compensation policies #901893501 and 901893503 were made by Lovitt-Touche. Marsh USA Inc. has only acted in the role of a consultant to the

Street Address: 150 N. 18th Ave, Suite 310 Phoenix, AZ 85007

Arizona Department of Health Services client with respect to these placements, which are indicated here for your convenience.

N/A

CN101622780-STND-AWXE-24-25

Each Incident/Occurrence

12/01/2025

1,000,000

& GL/Umbrella Occurrence

AZ

24988

1,000,000

12/01/2025

9018935001

2325 E. Camelback Road

MARSH USA LLC.

Suite 600

Attn: healthcare.accountscss@marsh.com Fax: 212-948-1307

District dba Valleywise Health Maricopa County Special Health Care

Phoenix, AZ 85008 2601 E. Roosevelt

UAZ0000127

12/01/2024

Attn: Program Director

A

Sentry Insurance A Mutual Co

Expiration Date: 12/01/25

Policy Number: UHE5000070

Expiration Date: 12/1/25

Limits: $10M xs $30M

Expiration Date: 12/01/25

States: AZ

Policy Number: 9018935003

Effective Date: 12/01/24

Additional Workers Comp:

Sentry Casualty Company

Capitol Specialty Insurance Corporation

Employers Liability Each Accident: $1,000,000

Effective Date: 12/01/24

Employers Liability Disease-Each Employee: $1,000,000

Limits: $5M part of $10M xs $40M

Excess Layer:

Effective Date: 12/01/24

Arch Specialty Insurance Company

Endurance American Specialty Ins. Co.

Limits: $5M part of $10M xs $40M

Policy Number: HX20241035

MARSH USA LLC.

District dba Valleywise Health Maricopa County Special Health Care

Phoenix, AZ 85008 2601 E. Roosevelt

Expiration Date: 12/01/25

Effective Date: 12/01/24

Policy Number: HHF30049060201

Employers Liability Disease-Policy Limit: $1,000,000

File details come from the government source that posted it. Updated .