CTR063971_COI_8.1.25.PDF

INSR ADDL SUBR

LTR INSR 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)

COMMERCIAL GENERAL LIABILITY

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

INSURER(S) AFFORDING COVERAGE NAIC #

Y / N

N / A (Mandatory in NH)

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

EACH OCCURRENCE $

DAMAGE TO RENTED

$PREMISES (Ea occurrence)CLAIMS-MADE OCCUR

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER:

PRODUCTS - COMP/OP AGG $

PRO-

OTHER:

LOCJECT

COMBINED SINGLE LIMIT

$(Ea accident)

BODILY INJURY (Per person) $ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS

AUTOS ONLY

HIRED PROPERTY DAMAGE $

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

POLICY

NON-OWNED

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 any 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)

ACORDTM CERTIFICATE OF LIABILITY INSURANCE

Church Mutual Ins Co

United Educators Ins, Recip Risk Ret Gr

CopperPoint Indemnity Insurance Company

Argonaut Insurance Company

TDC Specialty Insurance Company

5/08/2025

USI Insurance Services LLC 2375 E. Camelback Rd, Suite 250 Phoenix, AZ 85016

Taylor Crooks 602.374.1325 taylor.crooks@usi.com

Grand Canyon University 3300 W. Camelback Road Phoenix, AZ 85017

18767 10020 13928 19801 34487

A X X

X

X X 040037125777733 08/01/2024 08/01/2025 1,000,000 100,000 5,000 1,000,000 3,000,000 3,000,000

A X

X X

X X 040037109777737 08/01/2024 08/01/2025 1,000,000

B X

X X X P0572N 08/01/2024 08/01/2025 5,000,000 5,000,000

C

D N

X

X

1021953

(AZ,NM,NV,CO,UT)

WC929128744034

(All Other States)

07/01/2024

07/01/2024

07/01/2025

07/01/2025

X 1,000,000

1,000,000 1,000,000

E E A

Nurses Prof.

MedClinic Prof.

Sexual Abuse

X MFP015162404

MFP020722403

040037125777733

08/01/2024 08/01/2024 08/01/2024

08/01/2025 08/01/2025 08/01/2025

$2M Ea. Claim/$4M Agg.

$2M Ea. Claim/$4M Agg.

$1M Ea. Claim/$1M Agg.

*Sexual Abuse Policy 040037125777733 - $1,000,000 Each Claim/$1,000,000 Aggregate *Med Clinic Sexual Abuse Policy MFP020722403- $1,000,000 Each Claim/$1,000,000 Aggregate *Nurses Prof. Sexual Abuse Policy MFP015162404- $2,000,000 Each Claim/$4,000,000 Aggregate Please note the limits provided above are reflective of the limits available under the policy as required by the contract with the policy holder. The actual limits of the policy may be higher (See Attached Descriptions)

Arizona Department of Health Services 150 N 18th Avenue, Suite 530 Phoenix, AZ 85007

#S49228184/M45611597

GRANDCAN17Client#: 1789364

TYCJD

SAGITTA 25.3 (2016/03)

DESCRIPTIONS (Continued from Page 1) than those contractually required. It is the position of the policy holder that only the above limits are available to the Certificate Holder.

The General Liability, Automobile Liability, Professional Liability and Excess Liability policies include an automatic Additional Insured endorsement that provides Additional Insured status to the Certificate Holder only when there is a written contract that requires such status, and only with regard to work performed on behalf of the named insured. The General Liability and Automobile Liability policies contains a special endorsement with "Primary and Noncontributory" wording, when required by written contract. The General Liability, Automobile Liability, Excess Liability and Workers Compensation policies provide a Waiver of Subrogation when required by written contract.

Re: Nursing Programs. Additional Insured Includes: The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees.

#S49228184/M45611597

Policy Number: 0400371 09-777737

Policy Number: 0400371 09-777737

0400371 25-777733

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13

(Ed. 4-84)

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.)

This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.

Schedule

1983 National Council on Compensation Insurance.

WC 00 03 13

(Ed. 4-84) c

(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.

Endorsement No.Endorsement Effective Date: Policy No.

Carrier Name / Code:

Policy Effective Date: Premium $

Insured:

DBA:

Countersigned by

Page of1 1

WC929128744034

07/01/2024 - 07/01/2025

07/01/2024

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 43 03 05

(Ed. 7-00)

WC 43 03 05

(Ed. 7-00)

© 2004 National Council on Compensation Insurance, Inc.

UTAH WAIVER OF SUBROGATION ENDORSEMENT

This endorsement applies only to the insurance provided by the policy because Utah is shown in Item 3.A. of the Information Page.

We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.)

This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Our waiver of rights does not release your employees' rights against third parties and does not release our authority as trustee of claims against third parties.

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.

(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)

Insurance Company CopperPoint Indemnity Insurance Company Countersigned by

This document may have been uploaded to the CopperPoint Portal.

Schedule State Blanket/Schedule

UT BLANKET

Blanket Waiver: Anyone for whom you have agreed to provide this Waiver subject to the terms of this endorsement

Endorsement Effective 07/01/2024 Policy No. 1021953 Endorsement No.

Insured Grand Canyon University Premium

CO BLANKET

AZ BLANKET

NM BLANKET

Job 1: Arizona Department of Health