CTR077251_COI.pdf
PDF 7 MB Posted
- Attached to
- Master Agreement AZ|CTR077251
- Contract number
- CTR077251
- Issued by
- Arizona
About this file
This document is a comprehensive insurance policy certificate for Altra, LLC, issued by multiple insurance providers including Philadelphia Indemnity Insurance Company, Tokio Marine Specialty Insurance Company, and Wesco Insurance Company. The policy is primarily for the Arizona Department of Child Safety, located in Phoenix, Arizona, and covers various insurance needs including commercial general liability, automobile liability, workers' compensation, and additional specialized coverages such as crime, professional liability, and cyber insurance.
The insurance policy provides extensive coverage with significant liability limits, including $1,000,000 for commercial general liability, $1,000,000 for automobile liability, and $1,000,000 for workers' compensation. The policy includes additional protections such as $500,000 for crime coverage, $2 million/$3 million for professional liability, and $3 million for cyber insurance. The policy is effective from 4/1/2025 to 4/1/2026 and includes provisions for additional insureds, waiver of subrogation, and coverage for staffing services. The policy specifically covers Altra, LLC's operations and includes protection for the State of Arizona, its departments, agencies, boards, commissions, universities, and offices as additional insureds.
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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
6/30/2025
License # 0F76001
(714) 779-2000 (714) 779-4129
18058
Altra, LLC 6103 E. Grant Road Tucson, AZ 85712
23850 25011
A 1,000,000
X X PHPK2675473004 4/1/2025 4/1/2026 1,000,000
20,000
1,000,000 3,000,000 3,000,000
ABUSIVE ACTS 1,000,000
1,000,000B
X X PPK2675482004 4/1/2025 4/1/2026
1,000,000A
PHUB907677004 4/1/2025 4/1/2026 1,000,000
10,000 C
X WWC3771253 3/1/2025 3/1/2026 1,000,000
Y 1,000,000
1,000,000 A Crime PHPK2675473004 4/1/2025 $500K w/ $1K DED A Professional Liab. PHPK2675473004 4/1/2025 4/1/2026 $2M/$3M / $5K DED
Cyber Insurance Coalition Insurance Company Policy #: C4LY2103364 Eff 4/1/25 - 4/1/26 Limit: $3,000,000 Deductible $10,000
SEE ATTACHED ACORD 101
Arizona Department of Child Safety Office of Contracts 3003 N. Central, Suite 2000 Site Code CH010-20 Phoenix, AZ 85012
ARIZPRN-01 PPISANO
INSURICA / CTK North American Insurance Services, LLC 1240 North Lakeview Avenue, #125 Anaheim, CA 92807
Philadelphia Indemnity Insurance Company Tokio Marine Specialty Insurance Company Wesco Insurance Company
X
4/1/2026
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.
INSURICA / CTK North American Insurance Services, LLC
ARIZPRN-01
SEE PAGE 1
SEE PAGE 1
ACORD 25 Certificate of Liability Insurance
License # 0F76001
SEE P 1
Altra, LLC 6103 E. Grant Road Tucson, AZ 85712
SEE PAGE 1
PPISANO
Description of Operations/Locations/Vehicles:
Contract #CTRO77251
The State of Arizona, it departments, agencies, boards, commissions, universities and its offices, officials, agents and employees are included as Additional Insureds on the General and Auto Liability per the attached Endorsements. Insurance is Primary and Non-Contributory per the attached Endorsements and Waivers of Subrogation on the General and Auto Liability and Workers' Compensation are attached. 30 Day Notice of Cancellation is attached.
Sexual Abuse and Molestation coverage is included.
File details come from the government source that posted it. Updated .