CTR055545_2023-03-04_COI.pdf

ACORD

CERTIFICATE OF LIABILITY INSURANCE I

DATE (MM/DD/YYYY)

� 03/17/2022

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).

PRODUCER NAME�"' Ann Marie Bess

Oakley Insurance Group wg N ifo Ext): 520-887-5555 l(AJC. No):

7040 N Oracle Road iiD��SS: annmarie@oakleyinsurancegroup.com

INSURER(S) AFFORDING COVERAGE

Tucson AZ 85704 INSURER A: American Alternative Insurance Corporation

INSURED INSURER B: United Financial Casualty Company

Lifetran Corporation INSURER C: Continental Casualty Company

2923 N Campbell Ave INSURER D:

INSURER E:

Tucson AZ 85719 INSURER F:

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

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.

''i..rR

A

B

A

C

A

TYPE OF INSURANCE

" COMMERCIAL GENERAL LIABILITY

1 CLAIMS-MADE 00 OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER: � □ PRO- 00

POLICY JECT LOC

)( OTHER: Hired/Non-owned Auto

AUTOMOBILE LIABILITY -

ANY AUTO-

OWNED "")l SCHEDULED

AUTOS ONLY AUTOS

_.K HIRED

X

NON-OWNED

AUTOS ONLY AUTOS ONLY

UMBRELLA LIAB

1l EXCESS LIAB �

OCCUR

CLAIMS-MADE

DED I I RETENTION $

WORKERS COMPENSATION

AND EMPLOYERS" LIABILITY Y/N

ANY PROPRIETOR/PARTNER/EXECUTIVE [TI

OFFICER/MEMBER EXCLUDED? Y

(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below

Professional Liability with $2500 ded Sexual Abuse and Molestation

INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMmoivm, y y 99A2CP0005669-00 03-04-2022 03-04-2023 y y 04033889 08-01-2021 08-01-2022 y y 99 A2FF000 1659-00 03-04-2022 03-04-2023

N/A y 6025027472 11-28-2021 11-28-2022 y y 99A2PL0017427-00 03-04-2022 03-04-2023

LIMITS

EACH OCCURRENCE $

..,r.,.,,.,,._,.._ IV .. ._, ICLI

PREMISES (Ea occurrence) $

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $

PRODUCTS - COMP/OP AGG $

Hired/Non-owned Auto $

<>INl.,LC:LIMII $ (Ea accident) BODILY INJURY (Per person) $

BODILY INJURY (Per accident) $

(Peraccic1'e�1'i"' M

""'c $

EACH OCCURRENCE $

AGGREGATE $

KlsrATUTE I l�R M-

E.L. EACH ACCIDENT $

E.L. DISEASE - EA EMPLOYEE $

E.L. DISEASE - POLICY LIMIT $

Professional Aggregate

Professional Each 0cc

NAIC#

19720

11770

20443

1,000,000

100,000

5,000

1,000,000

3,000,000

3,000,000

1,000,000

1,000,000

1,000,000

1,000,000

1,000,000

1,000,000

1,000,000

$3,000,000

$1,000,000

Sexual Abuse/Molestatic $500,000/$500,000

DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

#CTR055545 Certificate holder and 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 is named as an additional insured with respect to the General Liability and Business Auto Policy. Wavier of Subrogation applies to the General Liability, Business auto and Work Comp. Primary and non-contributory wording applies to the General Liability. Sexual Abuse and Molestation Coverage is included. Endorsements attached.

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

State of Arizona Department of Child Safety Office of Procurement & THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

Contracts

ACCORDANCE WITH THE POLICY PROVISIONS.

3003 N Central, Suite 2000 AUTHORIZED REPRESENTATIVE

Site Code CH0l0-20 A""/.1..,i.t-l3t.j,j

1 Phoenix AZ 85012

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