CTR066189_-_coi__1_.pdf
PDF 442 KB Posted
- Attached to
- Master Agreement AZ|CTR066189
- Contract number
- CTR066189
- Issued by
- Arizona
About this file
This is a Certificate of Liability Insurance document for the Area Agency On Aging, Region One, Inc., located in Phoenix, Arizona. The insurance is provided by multiple insurers, including Philadelphia Indemnity Insurance Company and CopperPoint Indemnity Insurance Company. The certificate involves the State of Arizona, specifically the Department of Economic Security, and includes various insurance coverages such as Commercial General Liability, Automobile Liability, Umbrella Liability, and Workers Compensation.
The insurance policy covers multiple aspects, with significant liability limits including $1,000,000 for each occurrence under General Liability, $1,000,000 for Automobile Liability, and a $7,000,000 Umbrella Liability coverage. The policy includes specific endorsements for additional insured status for the State of Arizona, with waivers of subrogation. The policy periods are from 11/05/2024 to 11/05/2025 for most coverages, with Workers Compensation effective from 10/01/2024 to 10/01/2025. Additional specialized coverages include Sex Abuse & Molest and Professional Liability, each with $1,000,000 limits. The policy is associated with contract numbers ADES-CTR048037 and ADES-CTR066189.
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Text version
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
INSR ADDL SUBR
LTR INSD WVD
PRODUCER CONTACT
NAME:
FAXPHONE
(A/C, No):(A/C, No, Ext):
ADDRESS:
INSURER A :
INSURED INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
POLICY NUMBER POLICY EFF POLICY EXPTYPE 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 RENTEDCLAIMS-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 AGGJECT
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 LIMITDESCRIPTION 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.ACORD 25 (2016/03)
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
The ACORD name and logo are registered marks of ACORD
12/4/2024
(480) 214-2709 (480) 730-4929
18058
Area Agency On Aging 1366 E. Thomas Rd. #108 Phoenix, AZ 85014
13928
A 1,000,000
X X PHPK2622467 11/5/2024 11/5/2025 100,000
10,000
1,000,000 3,000,000 3,000,000
1,000,000A
X X PHPK2622467 11/5/2024 11/5/2025
7,000,000A
PHUB888759 11/5/2024 11/5/2025 7,000,000
10,000 B
X 1009539 10/1/2024 10/1/2025 1,000,000 1,000,000 1,000,000
A Sex Abuse & Molest PHPK2622467 11/5/2024 Occurrence Limit 1,000,000 A Professional Liab PHPK2622467 11/5/2024 11/5/2025 Each Incident Limit 1,000,000
Contract No: ADES-CTR048037 and ADES-CTR066189 Mary Lynn Kasunic is excluded on the worker compensation policy General Liability includes Primary and Non-Contributory Waiver of Subrogation applies to State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees.
The State or Arizona and Dept of Economic Security C/O: myCOI 1075 Broad Ripple Ave, Suite 313 Indianapolis, IN 46220
AREAAGE-01 CCOMPTON
The Mahoney Group - Mesa 1835 South Extension Road Mesa, AZ 85210
Connie Compton ccompton@mahoneygroup.com
Philadelphia Indemnity Ins. Co CopperPoint Indemnity Insurance Company
X
11/5/2025
X X
X X X
X
X
X
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