CTR066198_-_COI_and_Endorsements__1_.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

1/21/2025

Lovitt-Touche A Marsh & McLennan Agency LLC Co 4703 E Camp Lowell Drive, #101 Tucson AZ 85712

Julie Reed 520-722-3000 julie.reed@marshmma.com

Philadelphia Indemnity Insurance Co. 18058 MARIPCOMMU Security National Insurance Company 19879

Mariposa Community Health Center Inc 825 N. Grand Ave., Suite 100 Nogales AZ 85621

891403620

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

20,000

1,000,000

2,000,000 X

Y Y PHPK2633403005 1/1/2025 1/1/2026

2,000,000

A 1,000,000

X

Y Y PHPK2633403005 1/1/2025 1/1/2026

B X

N

Y SWC1533021 1/1/2025 1/1/2026

1,000,000

1,000,000

1,000,000 A Abuse/Molestation Liability PHPK2633403005 1/1/2025 1/1/2026 Each Occurrence

Aggregate 1,000,000 2,000,000

Sexual Abuse and Molestation coverage is included on the GL policy with separate limits of $1,000,000 Each Occurrence and $2,000,000 Aggregate.

Re: Contract No. CTR066198, Domestic Violence - Statewide Certificate Holder and others as named (if applicable) are Additional insured’s on the general liability, automobile liability if required by written contract. Primary & Non-Contributory wording applies if required by written contact. Waiver of Subrogation applies to the general liability, automobile liability and workers compensation if required in a written contract. Subject to all policy terms, conditions, definitions and exclusions. Notice of cancellation applies per the attached forms.

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

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13

(Ed. 04-84)

(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)

WC 00 03 13

PI-GL-005 (07/12)

Page of Includes copyrighted material of Insurance Services Office, Inc., with its permission.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED

PRIMARY AND NON-CONTRIBUTORY INSURANCE

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE

Effective Date:

Name of Person or Organization (Additional Insured):

SECTION II – WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the endorsement Schedule, but only with respect to liability for “bodily injury,” “property damage” or “personal and advertising injury” arising out of or relating to your negligence in the performance of “your work” for such person(s) or organization(s) that occurs on or after the effective date shown in the endorsement Schedule.

This insurance is primary to and non-contributory with any other insurance maintained by the person or organization (Additional Insured), except for loss resulting from the sole negligence of that person or organization.

This condition applies even if other valid and collectible insurance is available to the Additional Insured for a loss or ”occurrence” we cover for this Additional Insured.

The Additional Insured’s limits of insurance do not increase our limits of insurance, as described in

SECTION III – LIMITS OF INSURANCE.

All other terms, conditions, and exclusions under the policy are applicable to this endorsement and remain unchanged.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CANCELLATION NOTICE TO SCHEDULED ADDITIONAL INSURED OR

CERTIFICATE HOLDER

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PROFESSIONAL LIABILITY COVERAGE PART

COMMERCIAL CRIME COVERAGE PART

COMMERCIAL INLAND MARINE COVERAGE PART

COMMERCIAL PROPERTY COVERAGE PART

COMMERCIAL AUTOMOBILE COVERAGE PART

SCHEDULE OF ADDITIONAL INSUREDS OR CERTIFICATE HOLDERS

AI or CH Additional Insured or Certificate Holder Address

A. CANCELLATION

A.

SCHEDULE

CANCELLATION NOTICE TO ADDITIONAL INSURED

OR CERTIFICATE HOLDER

CERTIFICATE HOLDER –

NOTICE OF CANCELLATION

The Person(s) or Organization(s) listed in the Schedule below have requested that they receive written notice of cancellation (for any reason other than non-payment of premium) when this policy is cancelled by us. If possible, we will mail or deliver to the Person(s) or Organization(s) listed in the Schedule below a copy of the written notice of cancellation that we send to you.

This notice does not entitle the Person(s) or Organization(s) listed in the Schedule below to any benefit, rights or protection under this policy. Furthermore, failure to provide such notification will not extend any policy cancellation date, impact or negate any cancellation of the policy, nor impose any obligation or liability of any kind upon the company, its agent or representatives.

Notice of cancellation (for other than nonpayment of premium) may be mailed or delivered not less than [45] days prior to the effective date of cancellation.

Schedule

Person(s) or Organization(s) including mailing address:

The State of Arizona and Department of Economic Se

1075 Broad Ripple Ave, Suite 313 Indianapolis IN 46220 Arizona Department of Health Services

150 N 18th Ave, Suite 260 Phoenix AZ 85007 Notice of cancellation is only provided to the Person(s) or Organization(s) listed in the Schedule above where notice of the cancellation of this policy is required by written contract, permit or agreement with the Named Insured.