CTR062830_COI_CGL__AL__3-1-24__WC_12-1-23.pdf

05/26/2023

Delta Insurance Agency Ltd PO Box 1838

Green Valley AZ 85622-1838

Client Service

(520) 399-2828 (866) 375-6028

Delta@DeltaInsAgency.com

Arizona Youth Partnership 7575 W Twin Peaks Rd Suite 165 Tucson AZ 85743

Philadelphia Insurance 018667 Wesco Insurance Company 25011 CFC/State National Insurance Co Inc./Prowriters 018604

CL2312300871

A Abuse Molestation - per attd Professional Liab - Claims Made Y Y PHPK2511241 03/01/2023 03/01/2024

1,000,000 100,000 5,000 1,000,000 3,000,000 3,000,000

Employee Benefits 1,000,000

A Y Y PHPK2511241 03/01/2023 03/01/2024

1,000,000

Uninsured motorist BI split limit

1,000,000

A 10,000

PHUB848935 03/01/2023 03/01/2024

1,000,000 1,000,000

B N Y WWC3619911 12/01/2022 12/01/2023

1,000,000 1,000,000 1,000,000

C Cyber Liability

EHJ ADL00651002 04/15/2023 04/15/2024

Cyber $1,000,000 Aggregate $1,000,000 Deductible $2,500

Contract #CTR062830 BPM004669 Homeless Youth Street Outreach and Drop-in Center Services - Umbrella coverage per the attached schedule of Underlying insurance.

General Liability: The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees are named as Additional Insured with respect to liability arising out of the activities performed by or on behalf of the Contractor. A Waiver of Subrogation (Transfer of Our Rights of Recovery Against Others to Us) in favor of the State of Arizona, and its departments, agencies, boards, commissions, Universities, officers, officials, agents and employees, for losses arising from work performed by or on behalf of the Contractor. (Attached PI-GLD-HS).

Auto: The State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents and emplo0yees are named as

Arizona Dept of Economic Security State Procurement Office 100 N 15th Avenue Suite 201

Phoenix AZ 85007

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)

© 1988-2015 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

Arizona Youth Partnership

00000211

Delta Insurance Agency Ltd

25 Certificate of Liability Insurance

Additional Insured 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 Contrctor.

A Waiver of Subrogation (Transfer of Our Rights of Recovery Against others to Us) in favor of the State of Arizona, and its departments, Agencies, boards, commissions, universities, officers, officials, agents and employees, for losses arising from work performed by or on behalf of the Contractor.

Coverage is primary and non-contributory; 30 day Notice of Cancellation applies except 10 days for non-payment.

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:

Sexual Abuse or Molestation - Incident/ Aggregate

1,000,000 2,000,000

Professional Liab - Incident/Aggregate

1,000,000 3,000,000

ADDITIONAL COVERAGES

Ref # Description Edition DateForm No.Coverage Code

Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium

Ref # Description Coverage Code Form No. Edition Date

Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium

Ref # Description Coverage Code Form No. Edition Date

Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium

Ref # Description Coverage Code Form No. Edition Date

Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium

Ref # Description Coverage Code Form No. Edition Date

Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium

Ref # Description Coverage Code Form No. Edition Date

Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium

Ref # Description Coverage Code Form No. Edition Date

Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium

Ref # Description Coverage Code Form No. Edition Date

Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium

Ref # Description Coverage Code Form No. Edition Date

Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium

Ref # Description Coverage Code Form No. Edition Date

Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium

Ref # Description Coverage Code Form No. Edition Date

Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium

Copyright 2001, AMS Services, Inc.OFADTLCV