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
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
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