CTR066191_Catholic_Community_Services_of_Southern_Arizona_Roman_Catholic_Church_Diocese_CGL_Auto.pdf

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

8/11/2025

Arthur J. Gallagher Risk Management Services, LLC 595 Market Street Suite 2100 San Francisco CA 94105

License#: 0D69293 Incline Casualty Company 11090 National Catholic RRG , Inc 10083

Roman Catholic Church Diocese of Tucson Catholic Community Services of So. Arizona, Inc.

268 W. Adams Street Tucson AZ 85705

57053978

B B

X 1,000,000 X 1,000,000

X E&O -Claims Made 5,000 X Sexual Abuse* 1,000,000

2,000,000 X

Y Y RRG-077-2025-1

XS-077-2025-1

7/1/2025 7/1/2025

7/1/2026 7/1/2026

2,000,000

Self Insured Limit 500,000 B 1,000,000

X

Y Y RRG-077-2025-1 7/1/2025 7/1/2026

Self Insured Limit 500,000

A XY BES 2E8000146 1 7/1/2025 7/1/2027 SIR $500,000

1,000,000

1,000,000

1,000,000 B B

Professional Liability Claims Made Retro Active Date 7/1/1987

RRG-077-2025-1

XS-077-2025-1

7/1/2025 7/1/2025

7/1/2026 7/1/2026

Each Occurrence Aggregate Self Insd Retention

$2,000,000 $3,000,000 $500,000

* Sexual Misconduct: Self Insured Retention $500,000 -Specific/Agg Limit $5,000,000 Limit, Claims-Made Coverage, Retroactive Date $500,000 xs $500,000 SIR : 7/01/2025, $4,000,000 xs $1,000,000: 7/01/2003 General Liability and Auto Liability – Self Insured Retention $500,000 Workers Compensation – Self Insured Retention $500,000

RE: Division Name: ADES Contract CTR066191 - Domestic Violence The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are included as Additional Insured for General Liability and Auto Liability as required by written contract per attached endorsement form.

See Attached...

The State of Arizona and Dept of Economic Security C/O: myCOI

P.O.BOX#501970

8710 Bash Street Indianapolis IN 46256

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:

1 1

Arthur J. Gallagher Risk Management Services, LLC Roman Catholic Church Diocese of Tucson Catholic Community Services of So. Arizona, Inc.

268 W. Adams Street Tucson AZ 85705

25 CERTIFICATE OF LIABILITY INSURANCE

No proprietor/partner/executive/officer/member is excluded on Workers Comp policy.

Waiver of Subrogation applies in favor of: State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees for Workers Compensation policies as required by written contract per attached endorsement form.

TNC-G118 (Rev. 01/01/12)

THE NATIONAL CATHOLIC RISK

RETENTION GROUP, INC.

ENDORSEMENT

No. 22 TO POLICY NO. RRG-077-2025-1

EFFECTIVE DATE 07/01/2025

Participant:

The Roman Catholic Church of the Diocese of Tucson Bishop Gerald F. Kicanas, Apostolic Administrator

☐ ADDITIONAL

PREMIUM N/A

☐ RETURN

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED ENDORSEMENT

Additional insureds are those persons for whom an insured has agreed to provide insurance protection. For all additional insureds, the insurance provided by this policy shall not exceed the amount agreed between the insured and the additional insured, or the applicable company limit of this policy, whichever is less, and shall apply only after the participant’s retained limit is exceeded by loss covered under this policy.

All other terms and conditions remain unchanged. By ________________________ Authorized Representative

TNC-G118 (Rev. 01/01/12)

No. 19 TO POLICY NO. XS-077-2025-1

EFFECTIVE DATE 07/01/2025

Participant:

The Roman Catholic Church of the Diocese of Tucson

Additional insureds are those persons for whom an insured has agreed to provide insurance protection. For all additional insureds, the insurance provided by this policy shall not exceed the amount agreed between the insured and the additional insured, or the applicable company limit of this policy, whichever is less, and shall apply only after the participant’s retained limit is exceeded by loss covered under this policy.

No.22-1 TO POLICY NO. RRG-077-2025-1

EFFECTIVE DATE 7/1/2025

Participant:

The Roman Catholic Church of the Diocese of Tucson

This endorsement applies only to liabilities arising out of activities performed by or on behalf of

Catholic Community Services of Southern Arizona (“CCS”) 268 W Adams St Tucson, AZ 85705 for its ongoing and completed operations for any contract with The State of Arizona.

It is hereby understood and agreed that the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are named as additional insureds on a primary and non-contributory basis with respect to the Policy’s General and Automobile Liability coverages, for liability arising out of the activities performed by or on behalf of CCS, including for liability arising out of the activities performed by, or on behalf of, CCS involving automobiles owned, hired, and/or non-owned by CCS.

A waiver of subrogation applies where required by written agreement, in favor of the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees for loss arising from work performed by or on behalf of

CCS.

No. 19-1 TO POLICY NO. XS-077-2025-1

EFFECTIVE DATE 7/1/2025

Participant:

The Roman Catholic Church of the Diocese of Tucson

This endorsement applies only to liabilities arising out of activities performed by or on behalf of

Catholic Community Services of Southern Arizona (“CCS”) 268 W Adams St Tucson, AZ 85705 for its ongoing and completed operations for any contract with The State of Arizona.

It is hereby understood and agreed that the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are named as additional insureds on a primary and non-contributory basis with respect to the Policy’s General and Automobile Liability coverages, for liability arising out of the activities performed by or on behalf of CCS, including for liability arising out of the activities performed by, or on behalf of, CCS involving automobiles owned, hired, and/or non-owned by CCS.

A waiver of subrogation applies where required by written agreement, in favor of the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees for loss arising from work performed by or on behalf of

CCS.