CTR077264_Certificate_of_Insurance.pdf

1 MB Posted

Attached to
Master Agreement AZ|CTR077264
Contract number
CTR077264
Issued by
Arizona

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Written by GovTribe AI ·

This document is a comprehensive insurance policy package issued by Berkshire Hathaway Direct Insurance Company for MIH Ventures LLC (doing business as Echelon Services), located in Surprise, Arizona. The policy is specifically for the Arizona Department of Child Safety, Office of Contracts, with the policy effective from 12/14/2024 to 12/14/2025. The insurance package includes multiple coverage types: Commercial General Liability, Automobile Liability, Umbrella Liability, Workers' Compensation, and Professional Liability (Errors & Omissions).

The policy provides significant coverage limits, including $1,000,000 per occurrence for Commercial General Liability, $1,000,000 for Umbrella Liability, and $1,000,000 for Professional Liability. The policy covers consultants under the classification "Consultants - All Other" with a business location at 13954 West Waddell Rd, Suite 101-299 in Surprise, Arizona. The State of Arizona is listed as an additional insured, with specific provisions for non-owned and hired auto coverage, and a waiver of transfer of rights of recovery. The insurance is primary and will not seek contribution from other insurance sources, providing comprehensive protection for the insured's business operations.

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Other files

File Type Posted
2-Attachment 2C Facility Location and Staffing Chart.pdf PDF
2-Attachment 3A Method of Approach.pdf PDF
2-Attachment 3B Key Personnel.pdf PDF
2-Attachment 5A confidential Information designation.pdf PDF
CTR077264_Boycott_of_Israel_Disclosure.pdf PDF
CTR077264_Listing_of_Employees___Subcontractors_Redacted.pdf PDF
CTR077264_PTS_Executed_Contract.pdf PDF
2-Attachment 2B Offerors Experience and Capacity.pdf PDF
2-Attachment 2E Experience and References.pdf PDF
2-Attachment 3C Proposed Subcontractors.pdf PDF
2-Attachment 3D Boycott of Israel Disclosure.pdf PDF
CTR077264_Amendment_1_Text_Errors_NCNS_Rate_Request.pdf PDF
CTR077264_Business_Associate_Agreement_with_HITECH.pdf PDF
MIH_BAFO.pdf PDF
2-Attachment 2A Organizational Profile.pdf PDF
2-Attachment 2D Listing of Employees and Subcontractors_Redacted.pdf PDF
2-Attachment 4 Statewide Coverage.pdf PDF
2-Attachment 3E Forced Labor of Ethnic Uyghurs Ban.pdf PDF
2-Attachment 5B Conformance Statements.pdf PDF
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Arizona Department of Child Safety, Office of Contracts 3003 N. Central, Suite 2000, Phoenix, AZ 85012

Deborah.Garcia Rectangle

Deborah.Garcia Typewriter Arizona Department of Child Safety, Office of Contracts 3003 N. Central, Suite 2000 Site Code CH010-20 Phoenix, AZ 85012

Included

Berkshire Hathaway Direct Insurance Company 10391

05/15/2025

Arizona Department of Child Safety, Office of Contracts

3003 N. Central, Suite 2000, Phoenix, AZ 85012

X

X

X

N9BP953965 12/14/2024 12/14/2025A 5,000

1,000,000

50,000

2,000,000

2,000,000

MIH VENTURES LLC

Echelon Services

13954 WEST WADDELL RD, SUITE 101-299,

Surprise, AZ 85379

BIBERK

P.O. Box 113247 Stamford, CT 06911

Professional Liability (Errors & Omissions): Claims-Made

Per Occurrence/ Aggregate

203-654-3613844-472-0967 customerservice@biBERK.com

See attached Acord 101/Additional Remarks

Deborah.Garcia Rectangle

Deborah.Garcia Typewriter Arizona Department of Child Safety, Office of Contracts 3003 N. Central, Suite 2000 Site Code CH010-20 Phoenix, AZ 85012

Deborah.Garcia Typewriter X X

Deborah.Garcia Typewriter X Primary & Non-contributory

Deborah.Garcia Typewriter X Hired & Non-Owned

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Deborah.Garcia Typewriter A

Deborah.Garcia Typewriter X

Deborah.Garcia Typewriter X

Deborah.Garcia Typewriter X

Deborah.Garcia Typewriter 10,000

Deborah.Garcia Typewriter

N9UM954671 12/14/2024 12/14/2025

Deborah.Garcia Typewriter 1,000,000

Deborah.Garcia Typewriter 1,000,000

Deborah.Garcia Typewriter B

Deborah.Garcia Typewriter N

Deborah.Garcia Typewriter

N9WC958148 12/14/2024 12/14/2025

Deborah.Garcia Typewriter X

Deborah.Garcia Typewriter 1,000,000

Deborah.Garcia Typewriter 1,000,000

Deborah.Garcia Typewriter 1,000,000

Deborah.Garcia Typewriter A

Deborah.Garcia Typewriter

N9PL957556 12/14/2024 12/14/2025

Deborah.Garcia Typewriter 1,000,000

Deborah.Garcia Typewriter 1,000,000

Deborah.Garcia Typewriter X

Deborah.Garcia Typewriter THE STATE OF ARIZONA, ISAOMA/ATIMA, ITS DEPARTMENTS,AGENCYIES, BOARDS, COMMISSIONS, UNIVERSITIES AND ITS OFFICERS, OFFICIALS, AGENTS, AND EMPLOYEE ARE LISTED AS AN ADDITIONAL INSURED AND A WAIVER OF TRANSFER AS IT PERTAINS TO GENERAL LIABILITY.(SEE ENDORSEMENT ATTACHED) Hired And Non-Owned Auto is included in the general liability policy limits (see endorsement attached) A Blanket Waiver of Subrogation exists on this policy as it pertains to worker's compensation. (see endorsement attached) This policy is primary as to losses it covers, and the Insurer will not seek contribution if there is a written agreement between the insured and the certificate holder

Berkshire Hathaway Direct Insurance Company 10391

N9BP953965

ACORD 25 CERTIFICATE OF LIABILITY INSURANCE

BIBERK MIH VENTURES LLC

Echelon Services

13954 WEST WADDELL RD, SUITE 101-299,

Surprise, AZ 85379

3 3

(MM/DD/YYYY)

DATE (MM/DD/YYYY)

05/15/2025

DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES - CONTINUANCE

12/14/2024-12/14/2025

Non-Owned Auto coverage is included in the general liability policy limits. Hired Auto coverage is included in the general liability policy limits. This policy is primary as to losses it covers, and the Insurer will not seek contribution if there is a written agreement between the insured and the certificate holder. A waiver of transfer of rights exists on this policy as it pertains to general liability in favor of State of Arizona ISAOA ATIMA. State of Arizona ISAOA ATIMA is listed as additional insured as it pertains to general liability.

Deborah.Garcia Rectangle

Arizona Department of Child Safety, Office of Contracts 3003 N. Central, Suite 2000, Phoenix, AZ 85012

Deborah.Garcia Rectangle

Deborah.Garcia Typewriter Arizona Department of Child Safety, Office of Contracts 3003 N. Central, Suite 2000

05/15/2025

Berkshire Hathaway Direct Insurance Company

X

X

12/14/2024 12/14/2025

Arizona Department of Child Safety, Office of Contracts

3003 N. Central, Suite 2000, Phoenix, AZ 85012

N9BP953965

Bldg #001: Consultants - All Other - 4167702

Location: 13954 WEST WADDELL RD, SUITE 101-299,Surprise, AZ 85379 n/a n/a n/a

MIH VENTURES LLC

Echelon Services

13954 WEST WADDELL RD, SUITE 101-299,

Surprise, AZ 85379

BIBERK

P.O. Box 113247 Stamford, CT 06911

541611

(203) 654-3613 salessupport@biberk.com

(844) 472-0967

Deborah.Garcia Rectangle

Deborah.Garcia Typewriter Arizona Department of Child Safety, Office of Contracts 3003 N. Central, Suite 2000

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