CTR066193-COI.pdf

The ACORD name and logo are registered marks of ACORD

CERTIFICATE HOLDER

© 1988-2014 ACORD CORPORATION. All rights reserved.

ACORD 25 (2014/01)

AUTHORIZED REPRESENTATIVE

CANCELLATION

DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE

LOCJECT

PRO-POLICY

GEN'L AGGREGATE LIMIT APPLIES PER:

OCCURCLAIMS-MADE

COMMERCIAL GENERAL LIABILITY

PREMISES (Ea occurrence) $

DAMAGE TO RENTED

EACH OCCURRENCE $

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $

PRODUCTS - COMP/OP AGG $

$RETENTIONDED

CLAIMS-MADE

OCCUR

AGGREGATE $

EACH OCCURRENCE $UMBRELLA LIAB

EXCESS LIAB

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

INSR

LTR TYPE OF INSURANCE POLICY NUMBER

POLICY EFF

(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY) LIMITS

PER

STATUTE

OTH-

ER

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE

E.L. DISEASE - POLICY LIMIT

ANY PROPRIETOR/PARTNER/EXECUTIVE

If yes, describe under DESCRIPTION OF OPERATIONS below

(Mandatory in NH)

OFFICER/MEMBER EXCLUDED?

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY Y / N

AUTOMOBILE LIABILITY

ANY AUTO

ALL OWNED SCHEDULED

HIRED AUTOS

NON-OWNED

AUTOS AUTOS

AUTOS

COMBINED SINGLE LIMIT

BODILY INJURY (Per person)

BODILY INJURY (Per accident)

PROPERTY DAMAGE $

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.

INSD

ADDL

WVD

SUBR

N / A

(Ea accident)

(Per accident)

OTHER:

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 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:

INSURED

PHONE

(A/C, No, Ext):

PRODUCER

ADDRESS:

E-MAIL

FAX

(A/C, No):

CONTACT

NAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INSURER(S) AFFORDING COVERAGE

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

2/8/2024

BOK Financial Insurance PO Box 37063 Tucson AZ 85740

Dawn Waling 5208878682 602-230-5802 dwaling@bokf.com

Great American Alliance Insurance Company 26832 CHRYSHE-01 Great American Assurance Company 26344

Chrysalis Shelter for Victims of Domestic Violence 2055 W. Northern Ave Phoenix AZ 85021

Philadelphia Indemnity Insurance Company 18058

1787662778

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

20,000

1,000,000

3,000,000 X

PAC429677408 6/20/2023 6/20/2024

3,000,000

A 1,000,000 X

XX

CAP267176805 6/20/2023 6/20/2024

A X 9,000,000 X

EXC429677510

9,000,000

6/20/2023 6/20/2024

C Professional Liability PHSD1803649 6/20/2023 6/20/2024 Each Act, Error or Om Aggregate Limit

$1,000,000 $3,000,000

General Liability policy includes the following coverage: Abuse or Molestation - Each Abuse Limit: $1,000,000 - Aggregate Limit: $2,000,000

The State of Arizona and the Arizona Department of Economic Security are included as Additional Insured on a primary and non-contributory basis with respect to General Liability for ongoing and completed operations, where required by written contract or agreement as per attached form and Automobile Liability, where required written contract or agreement as per attached the attached form. A waiver of Subrogation in favor of additional insured applies to General Liability, Automobile Liability, where required by written contract or agreement as per the attached forms. Umbrella follows form.

Subject to all policy terms, conditions and exclusions.

The State of Arizona and Department of Economic Security c/o myCOI 1075 Broad Ripple Ave, Suite 313 Indianapolis IN 46220

* S1 * 06/21/2023 * PAC 4296774 08 GREAT AMERICAN INSURANCE COMPANY

*D/B* 639632604 253779

CG 82 82 (Ed. 12/09)

ABUSE OR MOLESTATION COVERAGE FORM

DECLARATIONS PAGE

NAMED INSURED: CHRYSALIS SHELTER FOR VICTIMS POLICY PERIOD:

OF DOMESTIC VIOLENCE, INC 06/20/2023 to 06/20/2024

Policy No. PAC 4296774 08

CG 82 82 (Ed. 12/09) (Page 1 of 1)

LIMITS OF INSURANCE:

Aggregate Limit $ 2,000,000 Each Abuse Limit $ 1,000,000

DESCRIPTION OF BUSINESS:

Form of Business CORPORATION

READ YOUR POLICY CAREFULLY, OPTIONAL COVERAGES ARE PROVIDED BY PREMIUM INSERTION.

Premium

Abuse or Molestation Coverage $ 975

TOTAL ADVANCE PREMIUM $ 975

Premium shown is payable: $ at inception;

FORMS AND ENDORSEMENTS Applicable to this Coverage Part and made part of this Policy at time of issue are listed on the attached Forms and Endorsements Schedule CG 88 01 (11/85).

* S1 * 09/14/2023 * PAC 4296774 08 GREAT AMERICAN INSURANCE COMPANY

BOK FINANCIAL INSURANCE, INC.

1600 BROADWAY FL 9TH

DENVER, CO 80202 4927

IL 70 02 (Ed. 10/07)

IL 70 02 (Ed. 10/07) (Page 1 of 2)

Policy No. PAC 4296774 08

Effective Date of Change 09/05/2023

POLICY CHANGES

NAMED INSURED

AND ADDRESS:

CHRYSALIS SHELTER FOR VICTIMS

OF DOMESTIC VIOLENCE, INC

2055 W. NORTHERN AVE

PHOENIX, AZ 85021

THIS ENDORSEMENT

CHANGES THE POLICY.

PLEASE READ IT

CAREFULLY.

POLICY ALTERNATE MAILING ADDRESS: AGENT'S NAME AND ADDRESS:

BOK FINANCIAL INSURANCE, INC.

1600 BROADWAY FL 9TH

DENVER, CO 80202 4927

Insurance is afforded by the Company named below, a Capital Stock Corporation:

GREAT AMERICAN INSURANCE COMPANY

POLICY PERIOD: From 06/20/2023 To 06/20/2024

12:01 A.M. Standard Time at the address of the Named Insured

NO CHANGE IN PREMIUM

IT IS HEREBY UNDERSTOOD AND AGREED THAT THIS POLICY IS AMENDED AS FOLLOWS:

DELETED FORM CG2024.

ADDED FORM CG2404 (WAIVER OF SUBROGATION) AS FOLLOWS:

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.

ENDORSEMENT 2

ANY AMENDED FORMS ATTACHED TO THIS CHANGE DISPLAY PREMIUMS FOR A FULL POLICY TERM.

Forms and Endorsement Activity

CG2024 12/19 ADDL INS-OWNERS OR OTHER INTEREST DELETED

IL 70 02 (Ed. 10/07) (Page 2 of 2)

CG2404 12/19 WAIVER OF TRANSFER OF RIGHTS OF REC ADDED

Agent Signature Date

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US (WAIVER OF SUBROGATION)

CG 24 04 (Ed. 12/19)

CG 24 04 (Ed. 12/19)

© Insurance Services Office, Inc., 2018 (Page 1 of 1)

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

ELECTRONIC DATA LIABILITY COVERAGE PART

LIQUOR LIABILITY COVERAGE PART

POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES

POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

RAILROAD PROTECTIVE LIABILITY COVERAGE PART

UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS

SCHEDULE

Name Of Person(s) Or Organization(s):

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.

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions:

We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above.

* 081 * 06/21/2023 * EXC 4296775 10 GREAT AMERICAN ALLIANCE INS CO

GAI 6600 (Ed. 06 97)

COMMERCIAL EXCESS LIABILITY DECLARATIONS PAGE

Policy No. EXC 4296775 10

Renewal Of EXC 4296775 09

1. NAMED INSURED AND ADDRESS: 2. POLICY PERIOD:

CHRYSALIS SHELTER FOR VICTIMS 12 : 01 A. M. Standard Time at the OF DOMESTIC VIOLENCE, INC address of the Named Insured 2055 W. NORTHERN AVE shown at left.

PHOENIX, AZ 85021 From 06/20/2023 to 06/20/2024

IN RETURN FOR PAYMENT OF THE PREMIUM, AND SUBJECT TO PRODUCER'S NAME AND ADDRESS

TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE BOK FINANCIAL INSURANCE, INC.

THE INSURANCE AS STATED IN THIS POLICY.

1600 BROADWAY FL 9TH

DENVER, CO 80202 4927

Insurance is afforded by: GREAT AMERICAN ALLIANCE INS CO

3. PREMIUM : Total Advance Premium 8,795.00

Total 8,795.00

BASIS OF PREMIUM: Non - Auditable ( X ) Auditable ( )

In the event of cancellation by the Named Insured, the company will receive and retain no less than $ 1,759.00 as a policy minimum premium.

4. LIMITS OF INSURANCE: $ 9,000,000 Each Occurrence

$ 9,000,000 Aggregate Limit (Where Applicable)

These Limits of Insurance apply in excess of the Underlying Limits of Insurance indicated in item 5. of the Declarations.

GAI 66 00 (Ed. 06/97) (Page 1 of 3)

5. UNDERLYING INSURANCE:

Carrier Information Type of Coverage Limits of Insurance

First Underlying Insurance GR AMER ALLIANCE CO COMM AUTO LIABILITY $1,000,000 combined CAP 2671768 single limit 06/20/2023 06/20/2024

* 081 * 06/21/2023 * EXC 4296775 10 GREAT AMERICAN ALLIANCE INS CO

GAI 6600 (Ed. 06/97) (Page 2 of 3)

Carrier Information Type of Coverage Limits of Insurance

First Underlying Insurance GR AMER ASSURANCE CO EMPLOYEE BENEFIT COV $1,000,000 each claim PAC 4296774 $1,000,000 annual aggregate 06/20/2023 06/20/2024

Carrier Information Type of Coverage Limits of Insurance

First Underlying Insurance

COPPERPOINT MUTUAL EMPLOYERS LIABILITY $1,000,000 EACH ACCIDENT

1002331 $1,000,000 DISEASE POL LIMIT

07/01/2022 $1,000,000 DISEASE EA EMPLOYEE

07/01/2023

Carrier Information Type of Coverage Limits of Insurance

First Underlying Insurance GR AMER ASSURANCE CO General Liability $1,000,000 each occurrence PAC 4296774 $3,000,000 general aggregate 06/20/2023 $3,000,000 products-completed 06/20/2024 operations aggregate

$1,000,000 personal and advertising injury

Carrier Information Type of Coverage Limits of Insurance

First Underlying Insurance GR AMER ASSURANCE CO LIQUOR LIABILITY $2,000,000 annual aggregate PAC 4296774 $1,000,000 each common cause 06/20/2023 06/20/2024

Carrier Information Type of Coverage Limits of Insurance

First Underlying Insurance

GR AMER ASSURANCE CO ABUSE/MOLESTATION $2,000,000 AGGREGATE LIMIT

PAC 4296774 $1,000,000 EACH ABUSE LIMIT

06/20/2023 06/20/2024

Carrier Information Type of Coverage Limits of Insurance

First Underlying Insurance

GR AMER ASSURANCE CO PROFESSIONAL LIAB $3,000,000 AGGREGATE LIMIT

PAC 4296774 $1,000,000 PER CLAIM LIMIT

06/20/2023 06/20/2024

6. FORMS AND ENDORSEMENTS applicable to all Coverage Forms and made part of this Policy at time of issue are listed on the attached Forms and Endorsements Schedule, GAI 6013 ( Ed .06/97 ) .

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED - DESIGNATED

PERSON OR ORGANIZATION

CG 20 26 (Ed. 12/19)

CG 20 26 (Ed. 12/19) © Insurance Services Office, Inc., 2018

(Page 1 of 2)

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE

Name Of Additional Insured Person(s) Or Organization(s):

STATE OF ARIZONA, AND ITS DEPARTMENTS, AGENCIES, BOARDS, COMMISSIONS,

UNIVERSITIES, OFFICERS, OFFICIALS, AGENTS, AND EMPLOYEES AS ADDITIONAL

INSUREDS WITH RESPECT TO LIABILITY ARISING OUT OF THE ACTIVITIES

PERFORMED BY OR ON BEHALF OF THE CONTRACTOR

STATE OF ARIZONA (DCAD) SERVICES

DEPT OF ECONOMIC SECURITY

1789 W JEFFERSON ST MAIL DROP 6271

PHOENIX, AZ 85007

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf:

1. In the performance of your ongoing operations; or

2. In connection with your premises owned by or rented to you

However:

1. The insurance afforded to such additional insured only applies to the extent permitted by law; and

2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.

B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance:

If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the Additional Insured is the amount of insurance:

1. Required by the contract or agreement; or

© Insurance Services Office, Inc., 2018 CG 20 26 (Ed. 12/19) (Page 2 of 2)

2. Available under the applicable limits of insurance;

whichever is less.

This endorsement shall not increase the applicable limits of insurance.