CTR056121_-_COI_and_Endorsements.pdf
PDF 4 MB Posted
- Attached to
- Master Agreement AZ|CTR056121
- Contract number
- CTR056121
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for The Centers for Habilitation, a company located in Tempe, Arizona. The insurance is provided by multiple insurers, including AMCO Insurance Company, Nationwide Mutual Insurance Company, and Pacific Compensation Insurance Co. The certificate of insurance is issued for The State of Arizona, specifically the Department of Economic Security, with coverage effective from 4/1/2024 to 4/1/2025.
The insurance policy covers multiple types of liability, including commercial general liability, automobile liability, umbrella liability, workers' compensation, professional liability, and sexual abuse & molestation coverage. The policy includes several key contract references: CTR056121, ADES16-099585, and ADES17-191574. Total professional liability limits are $6,000,000 per occurrence and $8,000,000 per aggregate. The State of Arizona is named as an additional insured, with coverage extending to the state's departments, agencies, boards, commissions, universities, and their respective officers, officials, agents, 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
3/29/2024
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
AMCO Insurance Company 19100 CENTE-9 Nationwide Mutual Insurance Company 23787
The Centers for Habilitation The Centers for Habilitation Enterprises, LLC dba ASDD 215 W. Lodge Drive Tempe AZ 85283
Pacific Compensation Insurance Co 11555
1076077430
B X 1,000,000 X 100,000
10,000
1,000,000
3,000,000 X
Y Y ACP013059178513 4/1/2024 4/1/2025
3,000,000
B 1,000,000
X
Y Y BA013059178513 4/1/2024 4/1/2025
A X X 5,000,000CU013059178513 4/1/2024 4/1/2025
5,000,000 X 0
C X
N
Y 1015685 4/1/2024 4/1/2025
1,000,000
1,000,000
1,000,000 B
Professional Liability Sexual Abuse & Molestation
ACP013059178513 4/1/2024 4/1/2025 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. The above-indicated Additional Insured is provided with respects to Automobile Liability when required in a written and executed contract. Umbrella Liability, $5,000,000 is excess of General Liability, Automobile Liability, Employers Liability, Professional Liability and Sexual Abuse & Molestation.
Contract #CTR056121, ADES16-099585 and ADES17-191574 Sexual Abuse and Molestation Coverage is included as evidenced on certificate. Professional Liability coverage is written on a Claims Made basis, 2/14/2005 Retroactive Date. Umbrella Liability is in addition to Professional Liability limits stated on certificate. Total insured Professional Liability limits $6,000,000 per occurrence and $8,000,000 per aggregate. General Liability: The State of Arizona, its See Attached...
The State of Arizona Department of Economic Security c/o myCOI 1075 Broad Ripple Ave, Ste 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:
CENTE-9
1 1
Lovitt & Touché A Marsh and McLennan Agency, LLC The Centers for Habilitation The Centers for Habilitation Enterprises, LLC dba ASDD 215 W. Lodge Drive Tempe AZ 85283
25 CERTIFICATE OF LIABILITY INSURANCE
departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees are additional insureds with respect to liability arising out of the activities performed by, or on behalf of Vendor. Policy contains a waiver of subrogation, as required by this written agreement, in favor of The State of Arizona, and its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees for losses arising from work performed by or on behalf of Vendor. Business Automobile Liability: The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees are additional insureds with respect to liability arising out of the activities performed by, or on behalf of, Vendor involving automobiles owned, hired and/or non-owned by Vendor. Policy contains a waiver of subrogation as required by this written agreement in favor of 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 Vendor. Workers' Compensation and Employers' Liability: Policy contains a waiver of subrogation as required by this written agreement in favor of 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 Vendor.
ACP013059178513
Policy Number: BA013059178513
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