CTR055542_2026-06-04_COI.pdf
PDF 1 MB Posted
- Attached to
- Master Agreement AZ|CTR055542
- Contract number
- CTR055542
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for Family Service Aides LLC, issued by The Arizona Group and underwritten by S.S.C.I.P. (Social Service Contractors Indemnity Pool) and AmTrust Insurance Company. The certificate is for a contract with the State of Arizona, specifically the Department of Child Safety, and covers multiple lines of insurance including Commercial General Liability, Automobile Liability, Workers' Compensation, Professional Liability, and Sexual Abuse & Molestation coverage. The policy is effective from 6/4/2025 to 6/4/2026, with a solicitation number of BPM003267.
The insurance provides comprehensive coverage with various liability limits, including $1,000,000 per occurrence for Commercial General Liability, $1,000,000 for Automobile Liability, and $1,000,000 for Workers' Compensation. The Professional Liability and Sexual Abuse & Molestation coverage includes an aggregate and each incident limit of $2 million/$1 million. The State of Arizona, its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are listed as additional insured entities, with a waiver of subrogation applied. The certificate covers operations performed by or on behalf of the contractor, with protection against various potential liability scenarios.
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Text version
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
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
6/3/2025
The Arizona Group 1125 East Southern Avenue, Suite 101 Mesa AZ 85204
Krystle Hodge, CIC 480-584-4518 480-892-7625 krystle.hodge@arizonagroup.com
S.S.C.I.P. 14329 FAMISER-01 AmTrust Insurance Company 15954
Family Service Aides LLC 201 W Indian School Rd Phoenix AZ 85013
992580525
A X 1,000,000 X 1,000,000
10,000
1,000,000
2,000,000 X
Y Y SS6000337-8 6/4/2025 6/4/2026
2,000,000
A 1,000,000
X X X
Y Y SS6000337-8 6/4/2025 6/4/2026
B X
N
KWC1396092 6/4/2025 6/4/2026
1,000,000
1,000,000
1,000,000 A Professional Liability
Sexual Abuse & Molestation SS6000337-8 6/4/2025 6/4/2026 Agg/Each Incident
Agg/Each Incident $2Mil/$1Mil $2Mil/$1Mil
Solicitation #: BPM003267 State of Arizona, its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are additional insured and waiver of subrogation applied subject to attached forms SSCOMMAIAZ 08/21 and SSCOMMWOSAZ 08/21.
State of Arizona Department of Child Safety Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.
Phoenix AZ 85012
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