CTR077261_Certificate_of_Insurance.pdf

PDF 280 KB Posted

Attached to
Master Agreement AZ|CTR077261
Contract number
CTR077261
Issued by
Arizona

About this file

This document is a Certificate of Liability Insurance issued by Oakley Insurance Group for LifeTran Corp, covering multiple insurance policies for a Parenting Time Services Contract (CTR077261) with the Arizona Department of Child Safety. The certificate involves multiple insurers, including Manufacturers Alliance Insurance Company, Coast National Insurance Company, Pennsylvania Manufacturers Association Insurance, and Valley Forge Insurance Company.

The contract provides comprehensive insurance coverage including Commercial General Liability, Automobile Liability (Hired/Non-Owned Auto), Umbrella Liability, and Workers Compensation. Key policy limits include $1,000,000 for each occurrence on General Liability, $1,000,000 for Hired/Non-Owned Auto, and $500,000 for Workers Compensation. The policies are effective from various dates between March 2025 and November 2024, with most expiring in 2026. Additional coverage specifics include Professional Liability with a $2,500 deductible and Sexual Abuse and Molestation coverage with a $500,000 aggregate limit. The certificate names the State of Arizona, its departments, agencies, boards, and universities as additional insureds, with a 30-day cancellation notice provision.

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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.

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

6/16/2025

OAKLEY INSURANCE GROUP

7040 N Oracle Rd.

Tucson AZ 85704

Jessica Richards-Finley

(520) 887-5555 certificates@oakleyinsurancegroup.com

LIFETRAN CORP

3430 N 1st Ave

TUCSON AZ 85719

MANUFACTURERS ALLIANCE INS CO 36897

COAST NATL INS CO 25089

PENNSYLVANIA MANUFACTURERS ASSOC INS 12262

VALLEY FORGE INS CO 20508

A

✘ Hired/Non-Owned Auto

Y Y 822501-14-44-66-0 03/04/2025 03/04/2026

1,000,000

100,000

5,000

1,000,000

3,000,000

3,000,000

Hired/Non-Owned Auto 1,000,000

B

Y Y M00-0050764-01 08/01/2024 08/01/2026

500,000

C ✘

Y Y 602501-14-44-66-0 03/04/2025 03/04/2026

1,000,000

1,000,000

D Y Y 6025027472 11/28/2024 11/28/2026 1,000,000

1,000,000

1,000,000

A Professional Liability with $2500 ded

Sexual Abuse and Molestation Y 3825011444660 03/04/2025 03/04/2026

Each Occurrence 1,000,000

General Aggregate 3,000,000

SA & M 500,000

PARENTING TIME SERVICES CONTRAC T CTR077261. Certificate holder and The State of Arizona , its Departments, agencies, boards, commissions, universities, officers, agents, and employees for losses arising from work performed by or on behalf of the contractor is named as an additional insured with respect to General Liability and Business Auto Policy. Waiver of Subrogation applies to General Liability , Excess Liability, Business Auto and Workers

Compensation. Primary and Non-Contributory wording applies to General Liability. Sexual Abuse and Molestation is included on the Professional Liability only. Endorsements are attached **30 day Notice of Cancellation

Contract CTR077261 Arizona Dept of Child Safety Office Contracts

Parenting Time Services Contract CTR077261

3003 N CENTRAL AVE STE 2000 CODE CH 010-20

PHOENIX AZ 85012

File details come from the government source that posted it. Updated .