CTR066736_2025-010-02_COI_WC.pdf
PDF 67 KB Posted
- Attached to
- Master Agreement AZ|CTR076660
- Contract number
- CTR076660
- Issued by
- Arizona
About this file
This document is an Evidence of Property Insurance issued by Gibson Insurance Agency Inc., located in South Bend, Indiana, for Foster Success Education Services, Inc. The insurance policy is underwritten by Philadelphia Insurance Company, with the policy covering a property located at 546 E 17th St, Suite 206, Indianapolis, IN 46202. The additional interest named on the document is the Arizona Department of Child Safety, located in Phoenix, Arizona.
The insurance policy provides Business Personal Property coverage with a Replacement Cost Special Form. The policy has an amount of insurance of $10,000 with a $1,000 deductible. The policy is effective from 10/02/2024 to 10/02/2025, with the coverage being a special form that protects against a broad range of perils. The document serves as evidence of insurance and does not constitute a contract, but provides details about the property insurance coverage for the insured entity.
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Other files
| File | Type | Posted |
|---|---|---|
| CSO-2040.pdf | ||
| CTR066736_Signed_HIPPA_Business_Associate_Agreement.pdf | ||
| Amendment_2.docx | DOCX document | |
| Amendment_3.docx | DOCX document | |
| CTR066736_2025-010-02_COI.pdf | ||
| Amendment_1.docx | DOCX document | |
| Assignment_and_Agreement_Form_2025-_Signed.pdf | ||
| AZ_Dept_of_Child_Safety_COI.pdf | ||
| AZ_Dept_of_Child_Safety_EPI.pdf | ||
| CSO-1229A.pdf | ||
| CSO-1637 (1).pdf | ||
| CTR076660_Executed_Contract_5.15.2025.pdf |
Show all 12
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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.
CANCELLATION
© 1993-2015 ACORD CORPORATION. All rights reserved.ACORD 27 (2016/03)
The ACORD name and logo are registered marks of ACORD
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 EVIDENCE OF PROPERTY INSURANCE 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 INFORMATION
LOCATION/DESCRIPTION
COVERAGE INFORMATION
COVERAGE / PERILS / FORMS AMOUNT OF INSURANCE DEDUCTIBLE
PHONE
(A/C, No, Ext):
(A/C, No):
FAX E-MAIL
ADDRESS:
AGENCY
THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST.
CUSTOMER ID #:
AGENCY
SUB CODE:CODE:
INSURED LOAN NUMBER POLICY NUMBER
TERMINATED IF CHECKED
CONTINUED UNTIL
EXPIRATION DATEEFFECTIVE DATE
THIS REPLACES PRIOR EVIDENCE DATED:
COMPANY
DATE (MM/DD/YYYY)
EVIDENCE OF PROPERTY INSURANCE
REMARKS (Including Special Conditions)
MORTGAGEE
ADDITIONAL INSURED LOSS PAYEE
ADDITIONAL INTEREST
NAME AND ADDRESS
AUTHORIZED REPRESENTATIVE
LOAN #
PERILS INSURED BASIC BROAD SPECIAL
LENDER'S LOSS PAYABLE
10/1/2024
574-245-3500 Gibson Insurance Agency Inc 202 South Michigan St., Suite 1400 South Bend, IN 46601
574-236-6399 ezimmerman@thegibsonedge.com
Philadelphia Insurance Co.
450 E 96th St Indianapolis, IN 46240
Foster Success Education Services, Inc.
546 East 17th Street Suite 206 Indianapolis IN 46202
PHPK2612539
10/02/2024 10/02/2025
RE: Location address: 546 E 17th St, Suite 206, Indianapolis, IN 46202
X
Business Personal Property | Replacement Cost | Special Form 10,000 1,000
Arizona Department of Child Safety 3003 N Central Ave 20th Floor Phoenix, AZ 85012
File details come from the government source that posted it. Updated .