CTR055532_2021-10-11_COI.pdf

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Attached to
Master Agreement AZ|CTR055532
Contract number
CTR055532
Issued by
Arizona

About this file

This document is a Certificate of Liability Insurance and associated endorsements for RY Services, LLC, issued by the Social Service Contractors Indemnity Pool through Breinholt Insurance Group, LLC. The insurance policy covers RY Services, LLC and names the State of Arizona, including its departments, agencies, boards, commissions, universities, and employees, as additional insureds. The certificate is dated June 25, 2021, with policy effective dates from October 11, 2020 to October 11, 2021.

The insurance provides commercial general liability coverage with policy limits of $1,000,000 per occurrence and $2,000,000 aggregate, including automobile liability and sexual abuse and molestation endorsement. The policy includes a waiver of subrogation for the Arizona Department of Child Safety and specifically covers the contractor's operations. The endorsements detail provisions for sexual injury and abuse coverage, including definitions of terms like "sexual injury" and "perpetrator," and outline the conditions under which the policy will provide coverage for medical expenses, damages, and legal defense costs related to sexual abuse claims.

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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 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 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

6/25/2021

(480) 237-2050 (480) 320-4516

RY Services, LLC 2330 W University Dr Tempe, AZ 85281

A 1,000,000

X SSCP60005093 10/11/2020 10/11/2021 1,000,000

10,000

1,000,000

2,000,000

2,000,000

1,000,000A

SSCP60005093 10/11/2020 10/11/2021

A General Liability SSCP60005093 10/11/2020 Sexual Abuse Molesta 1,000,000

Arizona Department of Child Safety is an additional insured as required by written contract. A Waiver of Subrogation applies per the attached endorsment.

Arizona Department of Child Safety 3003 N Central Avenue, 21st Floor Phoenix, AZ 85012

RISIYOU-01 HBRYCE

Breinholt Insurance Group, LLC 4115 E. Valley Auto Drive #205 Mesa, AZ 85206 info@breinholtinsurance.com

Social Service Contractors Indemnity Pool

10/11/2021

X

X

X

X

X X

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