CTR058022_Certificate_of_Insurance.pdf

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

RINS ADDL SUBR

LTR INSD WVD

DATE (MM/DD/YYYY)

PRODUCER CONTACT

NAME:

FAXPHONE

(A/C, No):(A/C, No, Ext):

E-MAIL

ADDRESS:

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

POLICY NUMBER

POLICY EFF POLICY EXP

TYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)

AUTOMOBILE LIABILITY

UMBRELLA LIAB

EXCESS LIAB

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

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

AUTHORIZED REPRESENTATIVE

EACH OCCURRENCE $

DAMAGE TO RENTED

CLAIMS-MADE OCCUR $PREMISES (Ea occurrence)

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

PRO-

POLICY LOC PRODUCTS - COMP/OP AGG $JECT

OTHER: $

COMBINED SINGLE LIMIT $(Ea accident)

ANY AUTO BODILY INJURY (Per person) $

OWNED SCHEDULED BODILY INJURY (Per accident) $

AUTOS ONLY AUTOS

HIRED NON-OWNED PROPERTY DAMAGE $

AUTOS ONLY AUTOS ONLY (Per accident)

OCCUR EACH OCCURRENCE $

CLAIMS-MADE AGGREGATE $

DED RETENTION $ $

PER OTH-

STATUTE ER

E.L. EACH ACCIDENT $

E.L. DISEASE - EA EMPLOYEE $

If yes, describe under

E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below

INSURER(S) AFFORDING COVERAGE NAIC #

COMMERCIAL GENERAL LIABILITY

Y / N

N / A

(Mandatory in NH)

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

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.

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).

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

CERTIFICATE HOLDER CANCELLATION

© 1988-2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03)

CERTIFICATE OF LIABILITY INSURANCE

PINNACLE INSURANCE CONSULTANTS

16420 N. 92nd St, Suite E226 Scottsdale, AZ 85260

(480)585-9770 (480)538-5027 brittany@pinnacleinsuranceco.com

Odyssey Services Corporation 8947 E. Quill St.

Mesa, AZ 85207

Philadelphia Indemnity Co.

A x X

Y Y

PHPK2227220

1/29/21

1/29/22

1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000

Y Y

PHPK2227220

PHUB753349

Professional Liability

PHPK2227220 1/29/21 1/29/22 Each Claim/Agg. $1M/$2M

Abusive Conduct Liability PHPK2227220 1/29/21 1/29/22 Each Claim/Agg. $1M/$1M

The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees shall be named as additional insured with respect to liability arising out of the activities performed by, or on behalf of the Contractor. Policy contains a Waiver of Subrogation endorsement in favor of the State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees arising out of the activities performed by, or on behalf of the Contractor.

For a schedule of services please see attached memo.

The State of Arizona Department of Economic Security 1789 W. Jefferson St.

2nd Fl, NW, Mail Drop 53C1 Phoenix, AZ 85007

11/19/2021

MEMO

FROM:

FAX:

PINNACLE INSURANCE CONSULTANTS

16420 N. 92nd St, Suite E226 Scottsdale, AZ 85260 (480)585-9770 (480)538-5027

Policy #PHUB753349

Policy #PHPK2227220

TO: Odyssey Services Corporation

CTR058022- Small Business Consultation (Pre-ETS) BPM003395- Employment Related Services. Pre-Employment Transition Services CTR051931- Supported Education Services for Vocational Rehabilitation (VR)Clients CTR044676- Tutoring Service ADES17-191579- Pre-Employment Transition Services

ADES16-127508- Small Business Consultation

CTR049906- Career Exploration borrowed by the Contractor."

performed by, or on behalf of, the Contractor, involving automobiles, hired or additional insureds with respect to liability arising out of the activities uunniivveerrssiittiieess,, ooffffiicceerrss,, ooffffiicciiaallss,, aaggeennttss,, aanndd eemmppllooyyeeeess sshhaallll bbee nnaammeedd aass "The State of Arizona, and its departments, agencies, boards, commissions, $100,000.

Fire Legal Liability $100,000 is shown on certificate as Damage to Rented Premises

Liability (CGL) coverage.

Blanket Contractual Liability both written and Oral are included under the General Limits $2,000,000

Professional Liability is included in the Umbrella. Total Professional Liability Abusive Conduct Liability is included.

11/19/2021

Date:

Arizona Vocational Rehabiliation Services Department of Economic Security 1789 W Jefferson St., 2nd FL, Mail Drop 53C1 Phoenix, AZ 85007

ACORD 5145254 0942/16043448

CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)

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

PAYCHEX INSURANCE AGENCY, INC.

150 SAWGRASS DRIVE

ROCHESTER, NY 14620

CONTACT

NAME:

PHONE FAX

(A/C, NO. EXT): (A/C, No):

E-MAIL

ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A:

INSURER B:

INSURER C:

INSURER D:

INSURER E:

INSURER F:

INSURED

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.

INSR

LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS

INSR WVD (MM/DD/YYYY) (MM/DD/YYYY)

GENERAL LIABILITY

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY PROJECT LOC

AUTOMOBILE LIABILITY

ANY AUTO

ALL OWNED SCHEDULED

AUTOS AUTOS

NON-OWNED

HIRED AUTOS AUTOS

UMBRELLA LIAB OCCUR

EXCESS LIAB CLAIMS-MADE

DED RETENTION $

WORKERS COMPENSATION AND

EMPLOYERS' LIABILITYA

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED? Y/N

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

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

EACH OCCURRENCE

DAMAGE TO RENTED

PREMISES (Ea occurrence) MED EXP (Any one person)

PERSONAL & ADV INJURY

GENERAL AGGREGATE

PRODUCTS - COMP/OP AGG

COMBINED SINGLE LIMIT

(Ea accident)

BODILY INJURY

(Per person)

BODILY INJURY

(Per accident)

PROPERTY DAMAGE

(Per accident)

EACH OCCURRENCE

AGGREGATE

WC STATU-

TORY LIMITS

OTH-

ER

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE

E.L. DISEASE - POLICY LIMIT

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE

ACORD 25 (2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

11/23/2021

ODYSSEY SERVICES CORP.

8947 E. QUILL ST.

MESA, AZ 85207

Paychex Insurance Agency Inc

877-266-6850 585-389-7426 Certs@paychex.com

Wesco Insurance Company 25011

03/10/2021 03/10/2022WWC3515087

Arizona Vocational Rehabiliation Services Department of Economic Security 1789 W Jefferson St., 2nd FL, Mail Drop 53C1 Phoenix, AZ 85007

Y N/A X

X 1,000,000.00

1,000,000.00

1,000,000.00

Career Exploration and Supportive Education CTR058022: Small BUsiness Consultation ADES BPM003842 Pre-Employment transitional services CTR044676: Tutoring services

Waiver of Subrogation granted in favor of the certificate holder