CTR066194_-_COI__1_.pdf
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- Attached to
- Master Agreement AZ|CTR066194
- Contract number
- CTR066194
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance issued by Mrs. DL Beaver Insurance Agency Inc. for Colorado River Crisis Services, located in Parker, Arizona. The certificate involves the State of Arizona's Department of Economic Security and is supported by S.S.C.I.P/Southwest Risk Services as the primary insurance provider. The certificate is dated 09/06/2024 and covers insurance policies valid from 09/15/2024 to 09/15/2025.
The insurance coverage includes commercial general liability, automobile liability, umbrella liability, and professional liability policies. Key coverage limits include $1,000,000 for each occurrence in general liability, with a $2,000,000 aggregate limit. The policy specifically includes sexual abuse and molestation coverage, with a waiver of subrogation in favor of the State of Arizona and its various departments, agencies, boards, commissions, universities, officers, officials, agents, and employees. The contract is identified as CTR064829 and provides additional insured status to the State of Arizona across multiple policy types, with various coverage limits ranging from $1,000,000 to $2,000,000 depending on the specific policy category.
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Text version
09/06/2024
Mrs. DL Beaver Insurance Agency Inc.
914 Arizona Ave Parker, AZ 85344 License #: 1338710
Jessica Shontz
(928)669-2255 (928)669-8955 jessica@beaverins.com
00001064-186933 14
Colorado River Crisis Services 1301 Joshua Avenue Ste C Parker, AZ 85344
S.S.C.I.P/Southwest Risk Services
A Y Y 6000262 09/15/2024 09/15/2025X X
X Sexual Abuse & Mole X station Cov Inc
X
1,000,000 500,000 10,000
1,000,000 2,000,000 2,000,000
S.S.C.I.P/Southwest Risk Services
A Y Y 6000262 09/15/2024 09/15/2025
X X X
1,000,000
S.S.C.I.P/Southwest Risk Services
A Y Y 6000486 09/15/2024 09/15/2025X X
1,000,000 1,000,000
S.S.C.I.P/Southwest Risk Services
A Y Y 6000262 09/15/2024 09/15/2025Professional Liab Aggregate $2,000,000
S.S.C.I.P/Southwest Risk Services
A 6000262 09/15/2024 09/15/2025Professional Liab Each act, error or $2,000,000
Contract ID: CTR064829; “Sexual Abuse and Molestation coverage is included”
- Waiver of Subrogation applies in favor of:State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees
- Additional Insured: State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees
The State of Arizona, Department of Economic Security, C/O myCOI 1075 Broad Ripple Ave, Suite 313 Indianapolis, IN 46220
Phone: 542-6655
(JRS)
Printed by JRS on 09/06/2024 at 10:17AM
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
INSR ADDL SUBR
LTR INSD WVD
DATE (MM/DD/YYYY)
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 EXP
TYPE 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 RENTED
CLAIMS-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 AGG $JECT
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 LIMIT $DESCRIPTION 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.
The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03)
CERTIFICATE OF LIABILITY INSURANCE
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