CTR066190_-_Evidence.pdf

LOSS PAYEE

DATE (MM/DD/YYYY)

PRODUCER NAME, NAIC NO:PHONE COMPANY NAME AND ADDRESS

CONTACT PERSON AND ADDRESS (A/C, No, Ext):

IF MULTIPLE COMPANIES, COMPLETE SEPARATE FORM FOR EACHFAX E-MAIL

(A/C, No): ADDRESS:

POLICY TYPECODE: SUB CODE:

AGENCY

CUSTOMER ID #:

NAMED INSURED AND ADDRESS LOAN NUMBER POLICY NUMBER

EFFECTIVE DATE EXPIRATION DATE

ADDITIONAL NAMED INSURED(S) THIS REPLACES PRIOR EVIDENCE DATED:

LOCATION / DESCRIPTION

LENDER SERVICING AGENT NAME AND ADDRESS

NAME AND ADDRESS

AUTHORIZED REPRESENTATIVE

CONTINUED UNTIL

TERMINATED IF CHECKED

YES NO

YES NO

CONTRACT OF SALE LENDER'S LOSS PAYABLE

MORTGAGEE

YES NO N/A

PERILS INSURED BASIC BROAD SPECIAL

COMMERCIAL PROPERTY COVERAGE AMOUNT OF INSURANCE: DED:

BUSINESS INCOME RENTAL VALUE If YES, LIMIT: Actual Loss Sustained; # of months:

BLANKET COVERAGE If YES, indicate value(s) reported on property identified above: $

TERRORISM COVERAGE Attach Disclosure Notice / DEC

IS THERE A TERRORISM-SPECIFIC EXCLUSION?

IS DOMESTIC TERRORISM EXCLUDED?

LIMITED FUNGUS COVERAGE If YES, LIMIT: DED:

FUNGUS EXCLUSION (If "YES", specify organization's form used)

REPLACEMENT COST

AGREED VALUE

COINSURANCE If YES, %

EQUIPMENT BREAKDOWN (If Applicable) If YES, LIMIT: DED:

ORDINANCE OR LAW - Coverage for loss to undamaged portion of bldg If YES, LIMIT: DED:

- Demolition Costs If YES, LIMIT: DED:

- Incr. Cost of Construction If YES, LIMIT: DED:

EARTH MOVEMENT (If Applicable) If YES, LIMIT: DED:

FLOOD (If Applicable) If YES, LIMIT: DED:

WIND / HAIL INCL Subject to Different Provisions: If YES, LIMIT: DED:

NAMED STORM INCL Subject to Different Provisions: If YES, LIMIT: DED:

PERMISSION TO WAIVE SUBROGATION IN FAVOR OF MORTGAGE

HOLDER PRIOR TO LOSS

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 EVIDENCE OF PROPERTY INSURANCE 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 EVIDENCE OF COMMERCIAL PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST.

(ACORD 101 may be attached if more space is required)

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE

DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

PROPERTY INFORMATION BUILDING OR BUSINESS PERSONAL PROPERTY

COVERAGE INFORMATION

CANCELLATION

ADDITIONAL INTEREST

© 2003-2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORDACORD 28 (2016/03)

EVIDENCE OF COMMERCIAL PROPERTY INSURANCE

Lockton Companies 8110 E. Union Avenue Suite 700 Denver CO 80237

(303) 414-6000

The ACORD name and logo are registered marks of ACORD

Property

Catholic Charities Community Services, Inc.

5151 N 19th Ave Phoenix, AZ 85015

Social Service Contractor's Indemnity Pool

60005691117987

7/1/2023 7/1/2024

25721

X X

X

38,861,044 $5,000

X X 300,000

X 38,861,044

X

X

X

X

X

X

X

X 100

X Included $5,000

X $500,000 $5,000

X $500,000 $5,000

X $500,000 $5,000

X

X X X Included $5,000 X X Included $5,000

X

11/27/2023

854092 Proof Coverage