COIs_ACORD_Form_2025_Redacted.pdf

PDF 2 MB 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 Corporate Insurance Solutions for P.O.W.E.R. House Youth Facility, Inc., with the Social Service Contractors Indemnity Pool as the primary insurer. The certificate is dated 06/16/2025 and involves multiple parties including the State of Arizona Department of Child Safety (DCS) and PPI Delta LLC as certificate holders. The insurance producer is Corporate Insurance Solutions, located in Scottsdale, Arizona.

The insurance policy provides comprehensive coverage including commercial general liability, automobile liability, umbrella liability, and professional liability. Key coverage limits include $1,000,000 per occurrence for most categories, with specific provisions for sexual abuse and molestation, medical expenses, and professional liability. The policy period runs from 06/27/2025 to 08/27/2026, with policy numbers 6000145-8 for most coverages and 6003049-4 for excess liability. Additional insureds include B2B Behavioral Health Services, and the policy includes specific endorsements for sexual abuse and molestation coverage.

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Other files

File Type Posted
2-Attachment_3-E___PHYF_1_Redacted.pdf PDF
Award_Letter-Power_House_Youth_Facility_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
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
COI_Redacted.pdf PDF
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
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
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