CTR066203-COI.pdf
PDF 358 KB Posted
- Attached to
- Master Agreement AZ|CTR066203
- Contract number
- CTR066203
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for Stepping Stones Foundations Inc., doing business as Stepping Stones Agencies, issued by The Mahoney Group in Mesa, Arizona. The insurance policy is underwritten by Tri-State Insurance Company of Minnesota and covers the State of Arizona, its departments, agencies, boards, commissions, universities, and their associated officers, officials, agents, and employees. The policy is associated with Contract #CTR066203 and provides comprehensive liability coverage across multiple insurance categories.
The insurance policy includes Commercial General Liability, Automobile Liability, Umbrella Liability, Workers' Compensation, and Professional Liability coverage. The policy limits are $1,000,000 per occurrence for general liability, with a $2,000,000 aggregate limit. Professional Liability is set at $1,000,000 per claim and $2,000,000 aggregate. The policy includes Sexual Abuse & Molestation coverage with $1,000,000/$2,000,000 limits. The policy is effective from November 2, 2023, to November 2, 2024, and covers all Arizona operations. Additional endorsements provide a waiver of subrogation rights and additional insured status for the State of Arizona and its entities.
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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 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 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
12/6/2023
(480) 253-5951 (480) 730-4929
14329
Stepping Stones Foundations Inc.
dba: Stepping Stones Agencies 2651 N Industrial Way, Suite A Prescott Valley, AZ 86314
31003
A 1,000,000
X X 60004696 11/2/2023 11/2/2024 1,000,000
10,000
1,000,000
2,000,000
2,000,000
ABUSE MOLESTATI 1,000,000
1,000,000A
X X 60004696 11/2/2023 11/2/2024
2,000,000A 60005535 11/2/2023 11/2/2024
2,000,000
B
X PWC950058712 1/1/2024 1/1/2025 1,000,000
N
1,000,000
1,000,000
A Professional Liabili 60004696 11/2/2023 Occurrence 1,000,000
A Professional Liabili 60004696 11/2/2023 11/2/2024 Aggregate 2,000,000
RE: Contract # CTR066203 State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees additional insured and waiver of subrogation applies.
Sexual Abuse & Molestation coverage is included: $1,000,000/$2,000,000 No excluded owners on the work comp.
SEE ATTACHED ACORD 101
The State of Arizona and Dept of Economic Security c/o myCOI 1075 Broad Ripple Ave, Suite 313 Indianapolis, IN 46220
STEPSTO-02 KHERTER
The Mahoney Group - Mesa 1835 South Extension Road Mesa, AZ 85210
Kathy Herter kherter@mahoneygroup.com
Social Services Contractor
Tri-State Insurance Company of Minnesota
Aggregate
X
11/2/2024
X
X
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
STEPSTO-02
SEE PAGE 1
SEE PAGE 1
ACORD 25 Certificate of Liability Insurance
SEE P 1
Stepping Stones Foundations Inc.
dba: Stepping Stones Agencies 2651 N Industrial Way, Suite A Prescott Valley, AZ 86314
SEE PAGE 1
KHERTER
Description of Operations/Locations/Vehicles:
Professional Liability limits are $1,000,000 Each Claim/Occurence/Offense/Wrongfull Act with $2,000,000 Aggregate. Professional Liability is included under the Excess Liability policy schedule & limits.
No Owner Exclusions on work comp
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: 6000469- 6 Effective Date: 11/02/2023
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.
NAMED INSURED ENDORSEMENT_SSCOMMNAMED_01/21
SSCOMMNAMED (01 21) Includes wording © ISO Properties, Inc., used with permission Page 1 of 1
NAMED INSURED ENDORSEMENT
It is hereby understood and agreed that Item 1. Named Insured, of the Common Coverages Declarations, Form SSCOMMDEC (01 21), is amended to read as follows:
Stepping Stones Foundation Inc. dba Stepping Stones Agencies Gratitude Foundation Inc. dba Stepping Stones Agencies Be Better Foundation Inc. dba Stepping Stones Agencies Step One Foundation Inc. dba Stepping Stones Agencies
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: 6000469- 6 Effective Date:11/02/2023
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.
DocuSign Envelope ID: 9B485F86-AB5C-46FC-A051-691D79074297
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