CTR056077_Certificate_of_Insurance_2022-03-01_GL_AL_UL_WC_PL_SAM.pdf
PDF 921 KB Posted
- Attached to
- Master Agreement AZ|CTR056077
- Contract number
- CTR056077
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for Ability360, Inc., issued by Lovitt & Touché A Marsh and McLennan Agency, LLC on July 20, 2021. The insurance coverage involves multiple insurers, including AmGUARD Insurance Company and CopperPoint Insurance Company, with the State of Arizona Department of Economic Security listed as the certificate holder. The policy covers Ability360, Inc., located in Phoenix, Arizona, and provides various liability protections including commercial general liability, automobile liability, workers' compensation, and professional liability.
The insurance policy provides comprehensive coverage with specific limits, including $1,000,000 for commercial general liability, $1,000,000 for automobile liability, and $1,000,000 for workers' compensation. The policy is effective from March 1, 2021, to March 1, 2022, and includes additional insured status for the State of Arizona, its departments, agencies, boards, commissions, universities, and employees. The coverage extends to activities performed by or on behalf of the contractor, with a waiver of subrogation for the State of Arizona. The policy also includes an umbrella liability coverage of $4,000,000, which is excess of the other liability coverages, and specifically mentions Sexual Abuse & Molestation coverage with limits of $1,000,000 per claim and $3,000,000 aggregate.
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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
7/20/2021
Lovitt & Touché A Marsh and McLennan Agency, LLC 1050 W Washington Street, Suite 233 Tempe AZ 85281
Lindsey Brundage 602-385-0535 602-956-2258 lbrundage@lovitt-touche.com
AmGUARD Insurance Company 42390 ARIZBRI-C1 CopperPoint Insurance Company 14216
Ability360, Inc.
5025 E Washington St, Ste 200 Phoenix AZ 85034
116731216
A X 1,000,000 X 1,000,000
20,000
1,000,000
3,000,000 X
Y Y C1GP200512 3/1/2021 3/1/2022
3,000,000
A 1,000,000
X
Y Y C2GP200407 3/1/2021 3/1/2022
A X X 4,000,000C3GP200216 3/1/2021 3/1/2022
4,000,000 X 10,000
B X
N
Y 1013351 3/1/2021 3/1/2022
1,000,000
1,000,000
1,000,000 A
Professional Liability Sexual Abuse & Molestation
C1GP200512 3/1/2021 3/1/2022 Per Claim $1,000,000 $1,000,000
Per Aggregate $3,000,000 $3,000,000
The above-indicated Additional Insured and Waiver of Subrogation are provided with respects to General Liability when required in a written and executed contract. Such coverage afforded by these policies (or update as applicable) for the benefit of the additional insured(s) is primary and any other coverage maintained by such additional insured(s) shall be non-contributory when required in a written and executed contract.
The above-indicated Additional Insured is provided with respects to Automobile Liability when required in a written and executed contract.
Umbrella Liability, $4,000,000 is excess of General Liability, Automobile Liability, Employers Liability, Professional Liability and Sexual Abuse & Molestation.
See Attached...
State of Arizona Department of Economic Securit 1789 W. Jefferson, Mail Drop 1541 Phoenix AZ 85007
ACORD 101 (2008/01)
The ACORD name and logo are registered marks of ACORD
© 2008 ACORD CORPORATION. All rights reserved.
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: FORM TITLE:
ADDITIONAL REMARKS
ADDITIONAL REMARKS SCHEDULE Page of
AGENCY CUSTOMER ID:
LOC #:
AGENCY
CARRIER NAIC CODE
POLICY NUMBER
NAMED INSURED
EFFECTIVE DATE:
ARIZBRI-C1
1 1
Lovitt & Touché A Marsh and McLennan Agency, LLC Ability360, Inc.
5025 E Washington St, Ste 200 Phoenix AZ 85034
25 CERTIFICATE OF LIABILITY INSURANCE
No. CTR056077, Employment Related Services - Pre-Employment Transition Services (Pre-ETS)
Sexual Abuse and Molestation Coverage is included, see details in coverage section.
General Liability:
The State of Arizona and the Department of Economic Security are named as additional insureds with respect to liability arising out of the activities performed by or on behalf of the Contractor.
Policy contains a waiver of subrogation against 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.
Automobile Liability:
The State of Arizona and the Arizona Department of Economic Security are named as additional insureds with respect to liability arising out of the activities performed by or on behalf of the Contractor, involving automobiles owned, leased, hired or borrowed by the Contractor.
Policy contains a waiver of subrogation against 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.
Workers' Compensation:
Policy contains a waiver of subrogation against 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.
The Contractor's insurance coverage is primary insurance with respect to all other available sources.
C2GP200407
03/01/2021
Ability360, Inc.
Policy contains a waiver of subrogation in favor of the State of Arizona, its departments, agencies, boards, commissions, universities and it officers, officials, agents and employees for losses arising from work performed by or on the behalf of the Contractor.
POLICY NUMBER: COMMERCIAL AUTO
CA 20 48 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED FOR
COVERED AUTOS LIABILITY COVERAGE
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement.
This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.
Named Insured:
Endorsement Effective Date:
SCHEDULE
Name Of Person(s) Or Organization(s):
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I Covered Autos Coverages of the Auto Dealers Coverage Form.
CA 20 48 10 13 Page 1 of 1c Insurance Services Office, Inc., 2011
State of Arizona, its departments, agencies, boards, commissions, universities and it's officers, officials, agents and employees for losses arising from work performed by or on the behalf of the contractor.
Ability360, Inc.
03/01/2021
C2GP200407
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL GENERAL LIABILITY
CG 20 26 12 19
POLICY NUMBER:
© Insurance Services Office, Inc., 2018 Page of CG 20 26 12 19
ADDITIONAL INSURED – DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf:
1. In the performance of your ongoing operations;
or
2. In connection with your premises owned by or rented to you.
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable limits of insurance;
whichever is less.
This endorsement shall not increase the applicable limits of insurance.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Name Of Additional Insured Person(s) Or Organization(s):
The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents and employees are named additional insured with respect to liability arising out of the activities performed by and on behalf of the contractor.
C1GP200512
1 1
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL GENERAL LIABILITY
CG 24 04 12 19
POLICY NUMBER:
© Insurance Services Office, Inc., 2018 Page of CG 24 04 12 19
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
ELECTRONIC DATA LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES
POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS
SCHEDULE
The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Conditions:
We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Name Of Person(s) Or Organization(s):
1 1
C1GP200512
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.
File details come from the government source that posted it. Updated .