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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ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

INSR ADDL SUBR

LTR INSD WVD

PRODUCER CONTACT

NAME:

FAXPHONE

(A/C, No):(A/C, No, Ext):

E-MAIL

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 .