CTR066206_Certificate_of_Insurance_2024-1-1_COI.pdf
PDF 698 KB Posted
- Attached to
- Master Agreement AZ|CTR066206
- Contract number
- CTR066206
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for Tucson Centers for Women & Children (doing business as Emerge! Center Against Domestic Violence), issued by Lovitt & Touche, a Marsh & McLennan Agency. The insurance coverage involves multiple entities, including National Casualty Company and Philadelphia Indemnity Insurance Company, with the Arizona Department of Economic Security as the certificate holder. The policy provides comprehensive insurance coverage for the organization, with the State of Arizona named as an additional insured across multiple liability categories.
The insurance policy covers the organization's domestic violence services under Contract #CTR066206, with policy periods from 04/30/2023 to 04/30/2024. The coverage includes Commercial General Liability ($1,000,000 per occurrence, $3,000,000 aggregate), Automobile Liability, Umbrella Liability ($3,000,000 each occurrence), Workers' Compensation, Professional Liability ($1,000,000 per incident, $3,000,000 aggregate), and Sexual Abuse Liability. The policy also includes specific provisions such as a $250,000 Employee Dishonesty limit and a waiver of subrogation for the State of Arizona. The insurance protects against various potential risks associated with the organization's operations in providing domestic violence services statewide.
View the file
Other files
Show all 23
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
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
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
6/20/2023
Lovitt & Touche A Marsh & McLennan Agency LLC Co 4703 E Camp Lowell Drive, #101 Tucson AZ 85712
Jordyn Even 520-722-3000 520-722-7245 jeven@lovitt-touche.com
National Casualty Company 11991 EMERG-1 Philadelphia Indemnity Insurance Co. 18058
Tucson Centers for Women & Children dba: Emerge! Center Against Domestic Violence 2545 E. Adams St.
Tucson AZ 85716
802099990
B X 1,000,000 X 1,000,000
20,000
1,000,000
3,000,000 X
Y Y PHPK2547605 4/30/2023 4/30/2024
3,000,000
B 1,000,000
X
Y Y PHPK2547605 4/30/2023 4/30/2024
B X X 3,000,000PHUB861429 4/30/2023 4/30/2024
3,000,000 X 10,000
A XY WCC335132A 1/1/2023 1/1/2024
1,000,000
1,000,000
1,000,000 B
Professional Laibility * Sexual Abuse Liability **
PHPK2547605 4/30/2023 4/30/2024 Limit $1,000,000 $1,000,000
Annual Aggregate $3,000,000 $1,000,000
*Professional Liability retro date: 04/30/07 **Sexual Abuse & Molestation Liability changed to OCCURRENCE FORM effective 07/01/12. Sexual Abuse and Molestation is included.
Employee Dishonesty $250,000 limit with $2,500 deductible Subject to all policy terms, conditions and exclusions Contract#CTR066206: Domestic Violence - Statewide If required by written contract and subject to all policy terms, conditions, definitions & exclusions:
Additional Insured: The State of Arizona shall be named as additional insureds with respect to liability arising out of the activities performed by or on behalf of the Contractor. Policy shall contain waiver of subrogation against the 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.
See Attached...
Arizona Department of Economic Security Office of Community Services PO Box 6123 Site Code 950A Phoenix AZ 85005
THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE
ACORD 101 (2008/01)
The ACORD name and logo are registered marks of ACORD
© 2008 ACORD CORPORATION. All rights reserved.
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: FORM TITLE:
ADDITIONAL REMARKS
ADDITIONAL REMARKS SCHEDULE Page of
AGENCY CUSTOMER ID:
LOC #:
AGENCY
CARRIER NAIC CODE
POLICY NUMBER
NAMED INSURED
EFFECTIVE DATE:
EMERG-1
1 1
Lovitt & Touche Tucson Centers for Women & Children dba: Emerge! Center Against Domestic Violence 2545 E. Adams St.
Tucson AZ 85716
25 CERTIFICATE OF LIABILITY INSURANCE
Automobile Liability: The State of Arizona & the Department of Economic Security shall be named as additional insureds with respect to liability arising out of the activities performed by or on behalf of the Contractor, involving automobiles owned, leased, hired or borrowed by the Contractor. Policy shall contain waiver of subrogation against the 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.
The Contractor's insurance coverage shall be primary insurance with respect to all other available sources. General Liability includes Blanket Contractual Liability (Written and Oral).
30 Day NOC requested from carrier
1983 National Council on Compensation Insurance.
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13
(Ed. 4-84)
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
Insured Copy
MANUSCRIPT (06/11)
Revised 6/13/12 Page 1 of 1
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED – STATE OF ARIZONA
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
HUMAN SERVICES ORGANIZATION PROFESSIONAL LIABILITY COVERAGE FORM
SEXUAL OR PHYSICAL ABUSE OR MOLESTATION VICARIOUS LIABILITY COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
Policy No. PHPK2547605 Policy Term. 04/30/2023 to 04/30/2024
SCHEDULE
Name of Person or Organization:
The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, employees, shall be named as additional insured with respect to liability arising out of the activities performed by or on behalf of Contractor.
The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, employees, shall be named as additional insured with respect to liability arising out of the activities performed by or on behalf of Contractor, involving automobiles owned, leased, hired or borrowed by Contractor.
The following provisions are added to the policy:
1. WHO IS AN INSURED is amended to include as an insured the person or organization shown in the above SCHEDULE, but only with respect to their liability for activities performed by you or on your behalf relating to the conduct of your business;
2. The coverage provided by this endorsement includes the assumption of liability in a written or oral contract between the named insured and the person or organization shown in the above SCHEDULE for work performed by you or on your behalf relating to the conduct of your business;
3. The coverage provided by this endorsement only is primary. Any other applicable insurance will apply as excess; and
4. We agree to waive any right of subrogation against the 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 Contractor.
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.)
Endorsement Effective Policy No. Endorsement No.
Insured Premium $
Insurance Company
Countersigned By
WC 00 03 13
(Ed. 4-84)
1983 National Council on Compensation Insurance.
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13
(Ed. 4-84)
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
Insured Copy
PI-CXL-002 (05/19)
POLICY NUMBER:
PI-CXL-002 (05/19)
Includes copyrighted material of Insurance Services Office, Inc., with permission.
COMMERCIAL UMBRELLA LIABILITY INSURANCE
POLICY DECLARATIONS
NAMED INSURED:
MAILING ADDRESS:
POLICY PERIOD: FROM TO AT 12:01 A.M. STANDARD
TIME AT YOUR MAILING ADDRESS SHOWN ABOVE
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS
POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY.
LIMITS OF INSURANCE
EACH OCCURRENCE LIMIT
(LIABILITY COVERAGE) $
PERSONAL & ADVERTISING INJURY LIMIT $ Any one person or organization
PRODUCTS COMPLETED OPERATIONS AGGREGATE LIMIT $
GENERAL AGGREGATE LIMIT (LIABILITY COVERAGE) (except with respect to Auto Liability and Products Completed Operations) $
RETAINED LIMIT
RETAINED LIMIT: $
PI-CXL-002 (05/19)
POLICY NUMBER:
PI-CXL-002 (05/19)
Includes copyrighted material of Insurance Services Office, Inc., with permission.
SCHEDULE OF UNDERLYING INSURANCE
Employers' Liability Company:
Policy Number:
Policy Period:
Minimum Applicable Limits
Bodily injury by accident $ Each Accident Bodily injury by disease $ Each Employee Bodily injury by disease $ Policy Limit
Commercial General Liability Occurrence Claims-Made Company:
Policy Number:
Policy Period:
Retroactive Date:
Minimum Applicable Limits:
General Aggregate $ Products-Completed Operations Aggregate $ Personal And Advertising Injury $ Each Occurrence $
Commercial Auto Liability Company:
Policy Number:
Policy Period:
Minimum Applicable Limits
Garage Aggregate Limit For Other Than Autos (if applicable) $ Each Accident $
Professional Liability Occurrence Claims-Made Company:
Policy Number:
Policy Period:
Retroactive Date:
Minimum Applicable Limits
File details come from the government source that posted it. Updated .