CTR066206EMERG-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

9/21/2023

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

297859156

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 Professional Liability is included under the Umbrella policy.

Regarding Worker's Compensation, no proprietor/partner/executive/officer/member is excluded.

Contract#CTR066206: Domestic Violence - Statewide If required by written contract and subject to all policy terms, conditions, definitions & exclusions:

Additional Insured: State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees shall be See Attached...

The State of Arizona and Dept of Economic Security C/O: myCOI 1075 Broad Ripple Ave, Suite 313 Indianapolis IN 46220

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

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. Coverage is Primary and Non-Contributory.

Automobile Liability: State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees 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. Coverage is Primary and Non-Contributory. General Liability includes Blanket Contractual Liability (Written and Oral).

30 day notice of cancellation applies per forms attached.

Coverage is subject to all policy terms, conditions, definitions, and exclusions.

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

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

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. 04/302023-04/30/2024

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 on behalf of Provider.

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 Provider, involving automobiles owned, leased, hired or borrowed by Provider.

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 and non-contributory; 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 on behalf of Provider.

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

PI-CXL-002 (05/19)

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

Employee Benefits Liability Occurrence Claims-Made

Company:

Policy Number:

Policy Period:

Retroactive Date:

Minimum Applicable Limits

Abusive Conduct Liability Occurrence Claims-Made

Company:

Policy Number:

Policy Period:

Retroactive Date:

Minimum Applicable Limits

Directors & Officers Liability Occurrence Claims-Made

Company:

Policy Number:

Policy Period:

Retroactive Date:

Minimum Applicable Limits

Liquor Liability Occurrence Claims-Made

Company:

Policy Number:

Policy Period:

Retroactive Date:

Minimum Applicable Limits

PI-CXL-002 (05/19)

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

Watercraft Liability Occurrence Claims-Made

Company:

Policy Number:

Policy Period:

Retroactive Date:

Minimum Applicable Limits

Other Coverages Not Included in Above Occurrence Claims-Made

Company:

Policy Number:

Policy Period:

Retroactive Date:

Minimum Applicable Limits

THESE DECLARATIONS, TOGETHER WITH THE COMMON POLICY CONDITIONS AND COVERAGE

FORM(S) AND ANY ENDORSEMENT(S), COMPLETE THE ABOVE NUMBERED POLICY.

Countersigned: By:

(Date) (Authorized Representative)

IN WITNESS WHEREOF, we have caused this policy to be executed and attested, and, if required by state law, this policy shall not be valid unless countersigned by our authorized representative.

Secretary

06/26/2023

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 01-01-23 Policy No. WCC335132A Endorsement No. 002 Insured TUCSON CENTER FOR WOMEN AND CHILDREN INC DBA EMER Premium $ INCL.

Insurance Company NATIONAL CASUALTY COMPANY

Countersigned By

WC 99 43 48

(Ed. 04-18)

Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 43 48

(Ed. 04-18)

NOTICE OF CANCELLATION TO THIRD PARTIES

Cancellation Notification

In the event we cancel this policy prior to the expiration date for any reason other than nonpayment of premium, we will notify the person(s) or organization(s) shown in the Schedule below. We will send notice to the mailing address listed in the Schedule at least 10 days, or the number of days listed in the Schedule, before the cancellation becomes effective.

The notice to the third party does not exceed the notice to the first named insured.

This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notice will not extend the policy cancellation date nor nullify the cancellation of the policy.

Name of Other Person(s) Or Organization(s):

Mailing Address: Number Of Days Notice:

ARIZONA DEPARTMENT OF ECONOMIC

SECURITY

DIVISION OF COMMUNITY ASSISTANCE

AND DEVELOPMENT

1789 W.JEFFERSON,MD 4271

PHOENIX, AZ 85007

POLICY CHANGE DOCUMENT

POLICY NO.:

CHANGE EFFECTIVE CHANGE # REVISION #

DESCRIPTION

PHPK2547605

406/15/2023

07/05/2023____________________ Issue Date

Added:

Additional Insured/30 Day Notice of Cancellation Arizona Department of Economic Security Division of Community Assistance and Development 1789 W. Jefferson, MD 4271, Phoenix AZ 85007

Per Attached

Philadelphia Indemnity Insurance Company

NAMED INSURED

18025 Lovitt & Touche, a Marsh & McLennan Ag

Tucson Centers for Women & Children DBA: Emerge! Center Against Domestic Abuse

MAILING ADDRESS 2545 E Adams St Tucson, AZ 85716-3426

POLICY PERIOD: FROM TO at 12:01 A.M. Standard Time at your mailing address shown above.

Path ID 16646636

0.00

NO CHANGE

COUNTERSIGNED BY

(Date) (Authorized Representative)

04/30/2023 04/30/2024

In consideration of the premium reflected, the policy is amended as indicated below:

Total Annual 0.00Additional/Return Premium $ Additional/Return Premium $

Total Prorate

NO CHANGE

Insurance Policy

PI-AI-SCH (08/20)

Page of

Additional Insured Schedule

Policy Number:

Philadelphia Indemnity Insurance Company

Additional Insured

Pima County Behavioral Health 3950 S Country Club Rd

The State of Arizona, Department of

Tucson, AZ 85714-2099

1789 W Jefferson St

CG2026 - General Liability Re: A Child Care Voucher Program

Additional Insured

Economic Security, and Arizona Dept of Health Services

CA2048 - Commercial Automobile

Phoenix, AZ 85007-3202

1789 W Jefferson St Phoenix, AZ 85007-3202

Additional Insured

CA2048 - Commercial Automobile

Pima County Behavioral Health 3950 S Country Club Rd

Additional Insured

Tucson, AZ 85714-2099

The State of Arizona, Department of

CG2026 - General Liability

Economic Security, and Arizona Dept of Health Services

1 3

Page of

Additional Insured

City of Tucson and its agents, officials or employees

The Arizona Foundation for Legal

Business Services Department

Business Services Department

Tucson, AZ 85701-1303

CA2048 - Commercial Automobile

Additional Insured

Services & Education

255 W Alameda St Fl 6

The State of Arizona

Tucson, AZ 85701-1303

255 W Alameda St Fl 6

Department of Economic Security 4201 N 24th St Ste 210

CG2026 - AZ - Loc #ALL - ADDL INS PRIMARY & NON-CONTRIBUTORY INS

Phoenix, AZ 85016-6295

CG2026 - General Liability

Additional Insured

City of Tucson and its agents, officials or employees

2 3

Page of

Additional Insured

Arizona Department of Economic Security Division of Community Assistance and Development 1789 W Jefferson St # MD4271 Phoenix, AZ 85007-3202

CG2026 - General Liability

30 DAY NOC

3 3

PI-CANXAICH-002 (05/11)

Page of

CANCELLATION NOTICE TO SCHEDULED ADDITIONAL INSURED OR

CERTIFICATE HOLDER

This endorsement modifies insurance provided under the following:

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

The following is added to A. CANCELLATION of the Common Policy Conditions of the above applicable coverage part:

A. In the event we cancel the policy in accordance with the policy’s terms and conditions, we will endeavor to mail written notice of cancellation to Additional Insureds or Certificate Holders, shown in the above SCHEDULE within the time frame listed below. However, failure to mail such notice shall impose no obligation of any kind upon us, our agents or representatives.

1. days before the effective date of cancellation if we cancel for any reason other than for non - payment of premium.

As respects Additional Insureds, the above cancellation provision applies only when the Additional Insured shown in the above SCHEDULE is added to the policy by a separate additional insured endorsement as the CANCELLATION NOTICE TO ADDITIONAL INSURED OR CERTIFICATE HOLDER does not provide additional insured coverage.

AI State of Arizona PO Box 4067, Flagstaff, AZ

1 3

CANCELLATION NOTICE TO SCHEDULED ADDITIONAL INSURED OR

CERTIFICATE HOLDER

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PROFESSIONAL LIABILITY COVERAGE PART

COMMERCIAL CRIME COVERAGE PART

COMMERCIAL INLAND MARINE COVERAGE PART

shown in the above SCHEDULE within the time frame listed below. However, failure to mail such notice shall impose no obligation of any kind upon us, our agents or representatives.

1. days before the effective date of cancellation if we cancel for any reason other than for

AI City of Tucson and its agents, Business Services Department officials or employees See manuscript

2 3

CANCELLATION NOTICE TO SCHEDULED ADDITIONAL INSURED OR

CERTIFICATE HOLDER

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PROFESSIONAL LIABILITY COVERAGE PART

COMMERCIAL CRIME COVERAGE PART

COMMERCIAL INLAND MARINE COVERAGE PART

shown in the above SCHEDULE within the time frame listed below. However, failure to mail such notice shall impose no obligation of any kind upon us, our agents or representatives.

1. days before the effective date of cancellation if we cancel for any reason other than for

AI AZ Department of Economic Security Div 1789 W. Jefferson, MD 4271 of Community Assistance & Development Phoenix AZ 85007

3 3