CTR057399_COI_Auto_WC_PL_Exp._12.01.24.pdf

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

E-MAIL

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)

© 1988-2016 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

N/A

AZ

24988

UAZ0000127 15,000,000

12/01/2024 X

N/A

Medical Prof Liab Claims Made

CN101622780-STND-AWXE-23-24

1,000,000

11860

12/01/2024

LOS-002563248-12

12/01/2023

X

02/01/2024

15,000,000

Indianapolis, IN 46220

& GL/Umbrella Occurrence Aggregate

1,000,000 1,000,000

A

12/01/2023

12/01/2023

N/A

9018935002

Each Incident/Occurrence

9018935001

Deductible: 500,000

XS of $2M/$2M Buffer XS $2M SIR

RE: Contract CT057399, BPM003737, Refugee Program – Health Promotion; Contract # CTR060932 - Refugee Program - Health Promotion for Foreign Nationals.

Sexual Abuse and Molestation coverage is included.

N/A District

Maricopa County Special Health Care

Phoenix, AZ 85008 2601 E. Roosevelt

Sentry Insurance A Mutual Co

2325 E. Camelback Road

MARSH USA LLC.

Phoenix, AZ 85016

Suite 600

Attn: healthcare.accountscss@marsh.com Fax: 212-948-1307

Copic Insurance Company

N

C/O: myCOI

1075 Broad Ripple Ave, Suite 313

The State of Arizona and Dept of

Economic Security

AZ

A

1,000,000

B

12/01/2024

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:

MARSH USA LLC.�

Expiration Date: 12/01/24�

States: AZ� Policy Number: 9018935003 �

Effective Date: 12/01/23�

Additional Workers Comp: �

Arch Specialty Insurance Company �

Limits: $10M xs $40M�

Employers Liability Each Accident: $1,000,000 �

Policy Number: HHF30049060200�

Limits: $10M xs $30M �

Endurance American Specialty Ins. Co.�

Phoenix

Certificate of Liability Insurance

Policy Number: UHE5000070-00 �

Excess Layer:�

Effective Date: 12/01/23�

The Automobile placement was made by Lovitt-Touche (Auto Policy 9018935002). Marsh USA Inc. has only acted in the role of a consultant to the client with respect to this

Employers Liability Disease-Policy Limit: $1,000,000 �

Effective Date: 12/01/23� placement, which is indicated here for your convenience. The Workers Compensation placements were made by Lovitt-Touche (Workers Compensation Policies 9018935001 and

Sentry Casualty Company �

Employers Liability Disease-Each Employee: $1,000,000 �

District� Maricopa County Special Health Care�

2601 E. Roosevelt�

Expiration Date: 12/01/24�

CN101622780

Phoenix, AZ 85008

Expiration Date: 12/01/24�

9018935003). Marsh USA Inc. has only acted in the role of a consultant to the client with respect to these placements, which is indicated here for your convenience.