CTR055525_2023-07-1_COI.pdf

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

INSR ADDL SUBR

LTR INSD WVD

PRODUCER CONTACT

NAME:

FAXPHONE

(A/C, No):(A/C, No, Ext):

E-MAIL

ADDRESS:

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

POLICY NUMBER POLICY EFF POLICY EXPTYPE 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 RENTEDCLAIMS-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 AGGJECT

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 LIMITDESCRIPTION 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.ACORD 25 (2016/03)

CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)

The ACORD name and logo are registered marks of ACORD

7/1/2022

10328

Casa De Los Ninos, Inc.

1120 N. 5th Avenue Tucson, AZ 85705

23787 13928

A 1,000,000

HS20212433-02 7/1/2022 7/1/2023 100,000

20,000

1,000,000 3,000,000 3,000,000

1,000,000B

ACP3019789796 7/1/2022 7/1/2023

2,000,000A

HS20212434-02 7/1/2022 7/1/2023 2,000,000

C 1003495 7/1/2022 7/1/2023 1,000,000

Y 1,000,000 1,000,000

A Professional Liab. HS20212433-02 7/1/2022 See Remarks B Crime ACP3019789796 7/1/2022 7/1/2023 SEE REMARKS

RE: Pending Contracts - FC, NPP, SENSE.

The State of Arizona, and its Departments, Agencies, Boards, Commissions, Universities, Officers, Agencies and Employees are included as additional insured with a waiver of subrogation with respect to General Liability, Auto Liability arising out of the activities performed on or on behalf of the contractor.

Blanket Waiver of Subrogation applies on the Workers Compensation.

State of Arizona, Dept of Child Safety Office of Procurement & Contracts 30003 N Central Ave 20th Floor Phoenix, AZ 85012

CASADEL-17 BSERAFIN

Tucson, AZ-The Clements Agency-HUB International Insurance Services

(NMX)

6245 E Broadway Blvd Suite 310 Tucson, AZ 85711

Jack Clements, CPA, CIC jack.clements@hubinternational.com

Capitol Specialty Insurance Corporation Nationwide Mutual Insurance Company CopperPoint Indemnity Insurance Company

X

7/1/2023

X X

X

X

X X

FORM NUMBER:

EFFECTIVE DATE:

The ACORD name and logo are registered marks of ACORD

ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE

FORM TITLE:

Page of

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

ACORD 101 (2008/01)

AGENCY CUSTOMER ID:

LOC #:

AGENCY NAMED INSURED

POLICY NUMBER

CARRIER NAIC CODE

© 2008 ACORD CORPORATION. All rights reserved.

Tucson, AZ-The Clements Agency-HUB International Insurance Services (NMX)

CASADEL-17

SEE PAGE 1

SEE PAGE 1

ACORD 25 Certificate of Liability Insurance

SEE P 1

Casa De Los Ninos, Inc.

1120 N. 5th Avenue Tucson, AZ 85705 Pima

SEE PAGE 1

BSERAFIN

Professional Professional Liability - Claims Made $1,000,000 - Each Wrongful Act $3,000,000 - Aggregate 09/14/1988 - Claims Made Retro Date

Scheduled professionals should read as follows:

- Dr Howard Lin

- Dr. Wenhui Cai

- Dr. Howard Toff

Nurse Practitioner Christine Reynolds Osarugue Sarah Etinfoh Sara Kerr

Independently Licensed Professionals Jessica Barnes Sari Emami Laura Epperson Catherine Horton Lourdes Lopez-Escobar Shawna McKee Farrah Sanchez Bruce Kahler Cassaundra Loller Sean Seeba Ruben Aroz Letha Grady Odessa Hancock Jennifer Key Cathleen Phelan Kristin Burns Maria Smith Julie Ramos Carrianne Connors Heidi Long Margaret McCane

Crime $1,000,000 - Employee Theft $10,000 – Deductible

Sexual or Physical Abuse Liability - Claims Made $1,000,000 - Each Wrongful Act $3,000,000 - Aggregate 09/14/1988 - Claims Made Retro Date