CTR056077-RenewalCOI.pdf
PDF 415 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, with insurance coverage provided by CopperPoint Indemnity Insurance Company and Philadelphia Indemnity Insurance Company. The certificate is for the State of Arizona and the Department of Economic Security, covering the period from 03/01/2024 to 03/01/2025.
The insurance policy provides comprehensive coverage including Commercial General Liability ($1,000,000 per occurrence), Automobile Liability, Umbrella Liability ($4,000,000 excess), Workers' Compensation, Professional Liability, and Sexual Abuse & Molestation coverage. The State of Arizona is named as an additional insured across multiple liability categories, with the contractor's insurance designated as primary. The policy includes waivers of subrogation for the State of Arizona, its departments, agencies, boards, commissions, universities, and employees for losses arising from work performed by or on behalf of the contractor.
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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
3/4/2024
Lovitt & Touché A Marsh and McLennan Agency, LLC 8605 E. Raintree Drive, Suite 200 Scottsdale AZ 85260
Lindsey Brundage 602-385-0535 602-956-2258 lindsey.brundage@marshmma.com
CopperPoint Indemnity Insurance Company 13928 ARIZBRI-C1 Philadelphia Indemnity Insurance Co. 18058
Ability360, Inc.
5025 E Washington St, Ste 200 Phoenix AZ 85034
674521213
B X 1,000,000 X 100,000
5,000
1,000,000
3,000,000 X
Y Y PHPK2662246 3/1/2024 3/1/2025
3,000,000
B 1,000,000
X
Y Y PHPK2662246 3/1/2024 3/1/2025
B X X 4,000,000PHUB902949 3/1/2024 3/1/2025
4,000,000 X 10,000
A XY 1013351 3/1/2024 3/1/2025
1,000,000
1,000,000
1,000,000 B
Professional Liability Sexual Abuse & Molestation
PHPK2662246 3/1/2024 3/1/2025 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 and Waiver of Subrogation are provided with respects to Automobile 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.
See Attached...
The State of Arizona and Dept of Economic Security C/O: myCOI 1075 Broad Ripple Ave, Suite 313 Indianapolis IN 46220
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
Umbrella Liability, $4,000,000 is excess of General Liability, Automobile Liability, Employers Liability, Professional Liability and Sexual Abuse & Molestation.
ADES - CTR056077
Sexual Abuse and Molestation coverage is included.
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, its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees are additional insured with respect to liability arising out of the activities performed by or on behalf of the Contractor, involving automobiles owned, hired and/or non-owned 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.
MANUSCRIPT (06/11)
Revised 6/27/12 Page 1 of 1
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED – STATE OF ARIZONA
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SEXUAL OR PHYSICAL ABUSE OR MOLESTATION VICARIOUS LIABILITY COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
Policy No. PHPK2662246 Policy Term. 03/01/2024 – 03/01/2025
SCHEDULE
Name of Person or Organization:
The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees shall be named as additional insureds with respect to liability arising out of the activities performed by or on behalf of the Contractor.
The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees shall be 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.
The following provisions are added to the policy:
1. WHO IS AN INSURED is amended to include as an insured the person or organization shown in the above SCHEDULE, but only with respect to their liability for activities performed by you or on your behalf relating to the conduct of your business;
2. The coverage provided by this endorsement includes the assumption of liability in a written or oral contract between the named insured and the person or organization shown in the above SCHEDULE for work performed by you or on your behalf relating to the conduct of your business;
3. The coverage provided by this endorsement only is primary. Any other applicable insurance will apply as excess; and
4. We agree to waive any right 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.
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