CTR066194_-_COI.pdf
PDF 44 KB Posted
- Attached to
- Master Agreement AZ|CTR066194
- Contract number
- CTR066194
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance for Colorado River Regional Crisis Services, issued by Mrs. DL Beaver Insurance Agency Inc. in Parker, Arizona. The certificate involves multiple insurers, including SSCIP/Southwest Risk and Carolina Casualty Insurance Company, and is specifically designed to provide coverage for the State of Arizona and the Department of Economic Security as the certificate holder.
The insurance policy provides comprehensive coverage with multiple components, including Commercial General Liability with a $1,000,000 per occurrence limit, Sexual Abuse/Molestation coverage, Automobile Liability, Umbrella Liability, Directors & Officers coverage, and Professional Liability. The policy is effective from 09/15/2023 to 09/15/2024, with a Contract ID of CTR064289. Notable features include Sexual Abuse and Molestation coverage, a Waiver of Subrogation in favor of the State of Arizona, and Additional Insured status for the state's departments, agencies, boards, commissions, universities, officers, officials, agents, and employees.
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Text version
06/24/2024
Mrs. DL Beaver Insurance Agency Inc.
914 Arizona Ave Parker, AZ 85344
Jessica Shontz
(928)669-2255 (928)669-8955 jessica@beaverins.com
00001064-2451375 14
Colorado River Regional Crisis Services 1301 Joshua Avenue Ste C Parker, AZ 85344
SSCIP/Southwest Risk
A Y Y 6000262 09/15/2023 09/15/2024X X
X Sexual Abuse/Molest X ation cov included
X
1,000,000 500,000 10,000
1,000,000 2,000,000 2,000,000
SSCIP/Southwest Risk
A Y Y 6000262 09/15/2023 09/15/2024
X
1,000,000
SSCIP/Southwest Risk
A Y Y 6000486 09/15/2023 09/15/2024
X
1,000,000 1,000,000
Carolina Casualty Insurance Company
B 1430493 09/15/2023 09/15/2024Directors & Officers Each Claim 1,000,000
SSCIP/Southwest Risk
A Y Y 6000262 09/15/2023 09/15/2024Professional Liab Agg/Occ 2MIL/2MIL
Contract ID: CTR064289; “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 and Dept of Economic Security, C/O myCOI 1075 Broad Ripple Ave, Suite 313 Indianapolis, IN 46220
(JRS)
Printed by JRS on 06/24/2024 at 02:01PM
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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