CTR055532_2024-12-3_COI_WC.pdf
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- Attached to
- Master Agreement AZ|CTR055532
- Contract number
- CTR055532
- Issued by
- Arizona
About this file
This document is a comprehensive insurance policy from the Social Service Contractors Indemnity Pool (SSCP), specifically a Sexual or Physical Abuse or Molestation Coverage Form for RY Services, LLC, located in Tempe, Arizona. The policy covers RY Services and names the Arizona Department of Child Safety as an additional insured, with coverage extending across the United States, Puerto Rico, and Canada. The insurance is provided through the Social Service Contractors Indemnity Pool and was brokered by Breinholt Insurance Group, LLC.
The policy provides liability coverage for bodily injury caused by abuse, with policy limits of $1,000,000 per occurrence and a $2,000,000 aggregate limit. The coverage period is from October 11, 2023, to October 11, 2024, and includes protection against claims related to negligent hiring, training, retention, investigation, supervision, and reporting of potential abuse. The policy specifically covers RY Services' activities in social service contracting, with particular emphasis on protecting against sexual or physical abuse, molestation, and related incidents. The insurance includes defense expenses and applies to the insured's employees, volunteer workers, and operations within the defined coverage territory.
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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):
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
1/2/2024
(480) 237-2050 (480) 320-4516
RY Services, LLC 2330 W University Dr. Suite 5 Tempe, AZ 85281
A 1,000,000
X SSCP60005096 10/11/2023 10/11/2024 1,000,000
10,000
1,000,000
2,000,000
2,000,000
1,000,000A
SSCP60005096 10/11/2023 10/11/2024
A General Liability SSCP60005096 10/11/2023 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 RCURRAN
Breinholt Insurance Group, LLC 4115 E. Valley Auto Drive #205 Mesa, AZ 85206 info@breinholtinsurance.com
Social Service Contractors Indemnity Pool
10/11/2024
X
X
X
X
X
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