CTR055524__2022-10-31_COI.pdf

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

12/17/2021

Crest Insurance Group, LLC 5285 E. Williams Circle Suite 4500 Tucson AZ 85711

Nathalia Jimenez 520-881-5760 520-325-3757 njimenez@crestins.com

Philadelphia Indemnity Ins Co 18058 JEWIFAM-01 CopperPoint General Insurance Company 13043

Jewish Family & Children's Service 4747 N 7th Street #100 Phoenix AZ 85014

1830144635

A X 1,000,000 X 100,000

5,000

1,000,000

3,000,000 X

Y Y PHPK2343236 10/31/2021 10/31/2022

3,000,000

A 1,000,000

X

X X

Y Y PHPK2343236 10/31/2021 10/31/2022

A X X 5,000,000PHUB790969 10/31/2021 10/31/2022

5,000,000 X 10,000

B X

N

Y 1020185 1/1/2022 1/1/2023

1,000,000

1,000,000

1,000,000 A Professional Liability

Sexual Abuse and Molestation PHPK2343236 10/31/2021 10/31/2022 Each Occurrence

1,000,000 1,000,000

Aggregate 3,000,000 2,000,000

Additional Insured applies as respects to general liability per attached form PI-GLD-HS (10/11), when required by written contract. Additional Insured applies with respects to automobile liability per attached form CA2048 02 99. Waiver of Subrogation applies as respects general liability per attached form PI-GLD-HS (10/11) and automobile liability per attached form PI-CA-001 (05-10)Subject to all policy terms, conditions and exclusions.

contract # CTR055524.

Per attached endorsement:

The State of Arizona and the Arizona Department of Child Safety (ADCS) shall be named as additional insureds with respect to liability arising out of the activities performed by or on behalf of the Contractor.

See Attached...

Arizona Department of Child Safety 1789 W Jefferson St.

Phoenix AZ 85007

ACORD 101 (2008/01)

The ACORD name and logo are registered marks of ACORD

© 2008 ACORD CORPORATION. All rights reserved.

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: FORM TITLE:

ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE Page of

AGENCY CUSTOMER ID:

LOC #:

AGENCY

CARRIER NAIC CODE

POLICY NUMBER

NAMED INSURED

EFFECTIVE DATE:

JEWIFAM-01

1 1

Crest Insurance Group, LLC Jewish Family & Children's Service 4747 N 7th Street #100 Phoenix AZ 85014

25 CERTIFICATE OF LIABILITY INSURANCE

Automobile Liability:

The State of Arizona and the Arizona Department of Child Safety (ADCS) shall be named as additional insureds with respect to liability arising out of the activities performed by or on behalf of the Contractor, involving automobiles owned, leased, hired or borrowed by the Contractor.

The Policy shall contain a waiver of subrogation against the State of Arizona, 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.

The State of Arizona and the Arizona Department of Child Safety (ADCS), wherever additional insured status is required such additional insured shall be covered to the full limits of the liability purchased by the contractor, even if those limits of liability are in excess of those required by this contract.

The Contractors insurance shall be primary insurance with respect to all other available sources.

General Liability Includes Blanket Contractual Liability - Written & Oral"