CTR066202-COI.pdf
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- Attached to
- Master Agreement AZ|CTR066202
- Contract number
- CTR066202
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for Sojourner Center, a social services contractor located in Phoenix, Arizona. The insurance is provided by CopperPoint Indemnity Insurance Company and Social Services Contractors Indemnity Pool, with coverage issued through The Mahoney Group in Mesa, Arizona. The certificate involves the State of Arizona, specifically the Department of Economic Security, and includes multiple insurance policies covering general liability, automobile liability, umbrella liability, workers' compensation, professional liability, and sexual abuse and molestation coverage.
The contract appears to be for child care services at a residential shelter, specifically referencing Contract No. CTR049449 for Child Care at Residential Shelter. The insurance policies provide various coverage limits, including $1,000,000 per occurrence for general liability, $5,000,000 for umbrella liability, and $1,000,000 for workers' compensation. The policies are effective from 10/31/2023 to 10/31/2024, with additional endorsements that include the State of Arizona and its departments as additional insureds. The documentation includes multiple waiver of subrogation clauses and ensures that the State of Arizona is protected against potential losses arising from work performed by the contractor.
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ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
INSR ADDL SUBR
LTR INSD WVD
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 EXPTYPE 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 RENTEDCLAIMS-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 AGGJECT
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 LIMITDESCRIPTION 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.ACORD 25 (2016/03)
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
The ACORD name and logo are registered marks of ACORD
1/2/2024
(480) 730-4920 (480) 730-4929
14329
Sojourner Center PO Box 20156 Phoenix, AZ 85036
13928
A 1,000,000
X X 6003188 10/31/2023 10/31/2024 100,000 5,000
1,000,000 3,000,000 3,000,000
1,000,000A
X X 6003188 10/31/2023 10/31/2024
5,000,000A 6003189 10/31/2023 10/31/2024
B X 1020185 1/1/2024 1/1/2025 1,000,000
1,000,000 1,000,000
A Professional Liab 6003188 10/31/2023 Each Occurence $1M 3,000,000 A Sex Abuse & Molest 6003188 10/31/2023 10/31/2024 Each Occurence $1M 3,000,000
Additional Insured applies as respects to General Liability. Additional Insured applies with respects to Automobile Liability per attached. Waiver of Subrogation applies as respects general liability per attached form, Automobile Liability per attached form and workers compensation per attached form. Subject to all policy terms, conditions and exclusions.
RE: Contract No. CTR049449 Child Care at Residential Shelter Additional Insured - officials, agents, and employees as additional insureds with respect to liability arising out of the activities performed by or on behalf of the Contractor. The policy shall be endorsed, as required by this written agreement, to include the State of Arizona, and its departments, agencies, boards, SEE ATTACHED ACORD 101
The State of Arizona and Department of Economic Security c/o: myCOI 1075 Broad Ripple Ave Indianapolis, IN 46220
JEWIFAM-02 PEVANS
The Mahoney Group - Mesa 1835 South Extension Road Mesa, AZ 85210
Social Services Contractor CopperPoint Indemnity Insurance Company
X
10/31/2024
X X
X
X
X X
FORM NUMBER:
EFFECTIVE DATE:
The ACORD name and logo are registered marks of ACORD
ADDITIONAL REMARKS
ADDITIONAL REMARKS SCHEDULE
FORM TITLE:
Page of
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
ACORD 101 (2008/01)
AGENCY CUSTOMER ID:
LOC #:
AGENCY NAMED INSURED
POLICY NUMBER
CARRIER NAIC CODE
© 2008 ACORD CORPORATION. All rights reserved.
The Mahoney Group - Mesa
JEWIFAM-02
SEE PAGE 1
SEE PAGE 1
ACORD 25 Certificate of Liability Insurance
SEE P 1
Sojourner Center PO Box 20156 Phoenix, AZ 85036
SEE PAGE 1
PEVANS
Description of Operations/Locations/Vehicles:
commissions, universities, officers, Waiver of Subrogation - Policy shall contain a waiver of subrogation endorsement, as required by this written agreement, in favor of the 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.
Social Service Contractors Indemnity Pool
WHO IS AN INSURED - ADDITIONAL INSURED_SSCOMMAIAZ_08/21
SSCOMMAIAZ (08-21) Includes wording © ISO Properties, Inc., used with permission Page 1 of 1
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WHO IS AN INSURED - ADDITIONAL INSURED
Policy Number: 6003188 Effective Date: 10/31/2023 This endorsement modifies insurance provided under the following:
SOCIAL SERVICE AGENCY PROFESSIONAL LIABILITY COVERAGE FORM
SEXUAL OR PHYSICAL ABUSE OR MOLESTATION COVERAGE FORM
BUSINESS AUTO COVERAGE FORM (coverage applies to owned, leased, hired or borrowed vehicles) COMMERCIAL GENERAL LIABILITY COVERAGE FORM (including Products-Completed Operations Coverage)
Schedule:
Name Of Additional Insured Entities:
The State of Arizona, its departments, agencies, boards, commissions, and universities, and all officers, officials, agents, and employees of these entities, 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 section entitled “Who is an Insured” in each of the coverage forms set forth above is amended to include as an insured the person or organization shown in the schedule, but only with respect to liability for injury or damage resulting from your operations performed for that insured and caused by your acts or omissions.
All other terms and conditions remain unchanged.
WAIVER OF TRANSFER RIGHTS OF RECOVERY_SSCOMMWOSAZ_08/21
SSCOMMWOSAZ (08-21) Includes wording © ISO Properties, Inc., used with permission Page 1 of 1
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER RIGHTS OF RECOVERY
Policy Number: 6003188 Effective Date:10/31/2023
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
SOCIAL SERVICE AGENCY PROFESSIONAL LIABILITY COVERAGE FORM
SEXUAL ABUSE LIABILITY COVERAGE FORM
SCHEDULE
Name of Person or Organization: the State of Arizona, its departments, agencies, boards, commissions, universities and all officers, officials, agents, and employees of these entities, for losses arising from work performed by or on behalf of the contractor.
1. The TRANSFER OF RIGHTS OF RECOVERY Condition (Section IV COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following:
We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damages arising out of your ongoing operations or "your work" done under a contract for that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above.
2. The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV BUSINESS AUTO CONDITIONS) is amended by the addition of the following:
We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damages for “bodily injury” or “property damage” to which this insurance applies.
3. The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV PROFESSIONAL LIABILITY CONDITIONS) is amended by the addition of the following:
We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for “damages” resulting from a “wrongful act” to which this insurance applies.
4. The TRANSFER OF RIGHTS OF RECOVERY Condition (Section D., SEXUAL OR PHYSICAL ABUSE OR MOLESTATION CONDITIONS) is amended by the addition of the following:
We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damages due to “abuse” to which this insurance applies.
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13
(Ed. 4-84)
WC 00 03 13
(Ed. 4-84)
© 1983 National Council on Compensation Insurance.
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
01/01/2024Endorsement Effective 1020185Policy No. 1Endorsement No.
Insured Sojourner Center Premium $
CopperPoint Indemnity Insurance CompanyInsurance Company Countersigned by
This document may have been uploaded to the CopperPoint Portal.
State Waiver: State of Arizona, its departments, agencies, boards, commissions, universities, and its officers, officials, agents, and employees for losses arising from work performed by or on behalf of the Contractor.
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us).
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule State Blanket/Schedule/State
AZ STATE
pevans Highlight State Waiver: State of Arizona, its departments, agencies, boards, commissions, universities, and its officers, officials, pevans Highlight agents, and employees for losses arising from work performed by or on behalf of the Contractor.
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
INSR ADDL SUBR
LTR INSD WVD
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 EXPTYPE 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 RENTEDCLAIMS-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 AGGJECT
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 LIMITDESCRIPTION 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.ACORD 25 (2016/03)
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
The ACORD name and logo are registered marks of ACORD
1/2/2024
(480) 730-4920 (480) 730-4929
14329
Sojourner Center PO Box 20156 Phoenix, AZ 85036
13928
A 1,000,000
X X 6003188 10/31/2023 10/31/2024 100,000 5,000
1,000,000 3,000,000 3,000,000
1,000,000A
X X 6003188 10/31/2023 10/31/2024
5,000,000A 6003189 10/31/2023 10/31/2024
B X 1020185 1/1/2024 1/1/2025 1,000,000
1,000,000 1,000,000
A Professional Liab 6003188 10/31/2023 Each Occurence $1M 3,000,000 A Sex Abuse & Molest 6003188 10/31/2023 10/31/2024 Each Occurence $1M 3,000,000
Additional Insured applies as respects to General Liability. Additional Insured applies with respects to Automobile Liability per attached. Waiver of Subrogation applies as respects general liability per attached form, Automobile Liability per attached form and workers compensation per attached form. Subject to all policy terms, conditions and exclusions.
RE: Solicitation #BPM005148 Contract No. CTR066202 Arizona Department of Economic Security - Domestic Violence - Statewide Additional Insured - officials, agents, and employees as additional insureds with respect to liability arising out of the activities performed by or on behalf of the Contractor. The policy shall be endorsed, as required by this written agreement, to include the State of Arizona, and its departments, agencies, boards, SEE ATTACHED ACORD 101
The State of Arizona and Department of Economic Security c/o myCOI 1075 Broad Ripple Ave Indianapolis, IN 46220
JEWIFAM-02 PEVANS
The Mahoney Group - Mesa 1835 South Extension Road Mesa, AZ 85210
Social Services Contractor CopperPoint Indemnity Insurance Company
X
10/31/2024
X X
X
X
X X
FORM NUMBER:
EFFECTIVE DATE:
The ACORD name and logo are registered marks of ACORD
ADDITIONAL REMARKS
ADDITIONAL REMARKS SCHEDULE
FORM TITLE:
Page of
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
ACORD 101 (2008/01)
AGENCY CUSTOMER ID:
LOC #:
AGENCY NAMED INSURED
POLICY NUMBER
CARRIER NAIC CODE
© 2008 ACORD CORPORATION. All rights reserved.
The Mahoney Group - Mesa
JEWIFAM-02
SEE PAGE 1
SEE PAGE 1
ACORD 25 Certificate of Liability Insurance
SEE P 1
Sojourner Center PO Box 20156 Phoenix, AZ 85036
SEE PAGE 1
PEVANS
Description of Operations/Locations/Vehicles:
commissions, universities, officers, Waiver of Subrogation - Policy shall contain a waiver of subrogation endorsement, as required by this written agreement, in favor of the 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.
Umbrella Liability Extends over $1Million Professional to comply with contract requirements of $2Million Occurence/ $2Million Aggregate
WHO IS AN INSURED - ADDITIONAL INSURED_SSCOMMAIAZ_08/21
SSCOMMAIAZ (08-21) Includes wording © ISO Properties, Inc., used with permission Page 1 of 1
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WHO IS AN INSURED - ADDITIONAL INSURED
Policy Number: 6003188 Effective Date: 10/31/2023 This endorsement modifies insurance provided under the following:
SOCIAL SERVICE AGENCY PROFESSIONAL LIABILITY COVERAGE FORM
SEXUAL OR PHYSICAL ABUSE OR MOLESTATION COVERAGE FORM
BUSINESS AUTO COVERAGE FORM (coverage applies to owned, leased, hired or borrowed vehicles) COMMERCIAL GENERAL LIABILITY COVERAGE FORM (including Products-Completed Operations Coverage)
Schedule:
Name Of Additional Insured Entities:
The State of Arizona, its departments, agencies, boards, commissions, and universities, and all officers, officials, agents, and employees of these entities, 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 section entitled “Who is an Insured” in each of the coverage forms set forth above is amended to include as an insured the person or organization shown in the schedule, but only with respect to liability for injury or damage resulting from your operations performed for that insured and caused by your acts or omissions.
WAIVER OF TRANSFER RIGHTS OF RECOVERY_SSCOMMWOSAZ_08/21
SSCOMMWOSAZ (08-21) Includes wording © ISO Properties, Inc., used with permission Page 1 of 1
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER RIGHTS OF RECOVERY
Policy Number: 6003188 Effective Date:10/31/2023
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
SOCIAL SERVICE AGENCY PROFESSIONAL LIABILITY COVERAGE FORM
SEXUAL ABUSE LIABILITY COVERAGE FORM
SCHEDULE
Name of Person or Organization: the State of Arizona, its departments, agencies, boards, commissions, universities and all officers, officials, agents, and employees of these entities, for losses arising from work performed by or on behalf of the contractor.
1. The TRANSFER OF RIGHTS OF RECOVERY Condition (Section IV COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following:
We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damages arising out of your ongoing operations or "your work" done under a contract for that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above.
2. The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV BUSINESS AUTO CONDITIONS) is amended by the addition of the following:
We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damages for “bodily injury” or “property damage” to which this insurance applies.
3. The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV PROFESSIONAL LIABILITY CONDITIONS) is amended by the addition of the following:
We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for “damages” resulting from a “wrongful act” to which this insurance applies.
4. The TRANSFER OF RIGHTS OF RECOVERY Condition (Section D., SEXUAL OR PHYSICAL ABUSE OR MOLESTATION CONDITIONS) is amended by the addition of the following:
We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damages due to “abuse” to which this insurance applies.
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13
(Ed. 4-84)
WC 00 03 13
(Ed. 4-84)
© 1983 National Council on Compensation Insurance.
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
01/01/2024Endorsement Effective 1020185Policy No. 1Endorsement No.
Insured Sojourner Center Premium $
CopperPoint Indemnity Insurance CompanyInsurance Company Countersigned by
This document may have been uploaded to the CopperPoint Portal.
State Waiver: State of Arizona, its departments, agencies, boards, commissions, universities, and its officers, officials, agents, and employees for losses arising from work performed by or on behalf of the Contractor.
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us).
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule State Blanket/Schedule/State
AZ STATE
pevans Highlight State Waiver: State of Arizona, its departments, agencies, boards, commissions, universities, and its officers, officials, pevans Highlight agents, and employees for losses arising from work performed by or on behalf of the Contractor.
File details come from the government source that posted it. Updated .