CTR076698__WC_Exp_10_01_2025__GL_AL_SAM_COI_Exp_11.5.25.pdf
PDF 1 MB Posted
- Attached to
- Master Agreement AZ|CTR076698
- Contract number
- CTR076698
- Issued by
- Arizona
About this file
This document is a comprehensive insurance certificate and related endorsements for Area Agency On Aging, Region One Inc., issued by Philadelphia Indemnity Insurance Company and CopperPoint Indemnity Insurance Company. The insurance covers the State of Arizona, including its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees. The certificate includes multiple coverage types such as Commercial General Liability, Automobile Liability, Umbrella Liability, Workers Compensation, Professional Liability, and Sex Abuse & Molest coverage.
The insurance policies provide various coverage limits, including $1,000,000 for Commercial General Liability, $1,000,000 for Automobile Liability, $7,000,000 for Umbrella Liability, and $1,000,000 for Workers Compensation. The policies are effective from November 5, 2024, to November 5, 2025, with a contract ID of CTR076698 under the Arizona Department of Economic Security. Additional endorsements include provisions for Additional Insured status, Waiver of Transfer of Rights of Recovery, and Primary and Noncontributory conditions, which extend protection to the State of Arizona and its various entities under specific terms and conditions.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| CTR076698_Contract_Documents.pdf | ||
| CTR076698_Pre_Contract_Documents.pdf | ||
| CTR076698_myCOI_Instructions.pdf | ||
| CTR076698_Contract_Amendment_1.pdf |
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Text version
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
7/30/2025
(480) 214-2709 (480) 730-4929
18058
Area Agency On Aging, Region One Inc.
1366 E. Thomas Rd. #108 Phoenix, AZ 85014
13928
A 1,000,000
X X PHPK2622467-019 11/5/2024 11/5/2025 100,000
10,000
1,000,000 3,000,000 3,000,000
1,000,000A
X X PHPK2622467-019 11/5/2024 11/5/2025
7,000,000A
PHUB888759 11/5/2024 11/5/2025 7,000,000
10,000 B
X 1009539 10/1/2024 10/1/2025 1,000,000 1,000,000 1,000,000
A Sex Abuse & Molest PHPK2622467-019 11/5/2024 Occurrence Limit 1,000,000 A Professional Liab PHPK2622467-019 11/5/2024 11/5/2025 Each Incident Limit 1,000,000
Division Name: ADES - Contract ID: CTR076698
The State of Arizona and Dept of Economic Security c/o myCOI P.O. Box 501970 8710 Bash Street Indianapolis, IN 46256
AREAAGE-01 CCOMPTON
The Mahoney Group - Chandler 2625 W Geronimo Place, Suite 350 Chandler, AZ 85224
Connie Compton ccompton@mahoneygroup.com
Philadelphia Indemnity Ins. Co CopperPoint Indemnity Insurance Company
X
11/5/2025
X X
X X X
X
X
X
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