CTR079343_COI.pdf
PDF 29 KB Posted
- Attached to
- Master Agreement AZ|CTR079343
- Contract number
- CTR079343
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance for Alliance Evaluation Services, issued by Midwest Risk DBA Arnold Insurance, with multiple insurance carriers including Hartford Fire Insurance Co., Hartford Mutual, Amtrust Insurance Company, and Evanston Insurance Co. The certificate is for a contract (Contract No. CTR079343) with the Arizona Department of Administration's State Procurement Office, located in Phoenix, AZ.
The insurance certificate covers multiple types of liability, including commercial general liability, automobile liability, umbrella liability, workers' compensation, professional liability, and cyber liability. The policies are effective from various dates in 2025 to 2026, with each coverage type having a $1,000,000 limit. The professional liability and cyber liability policies also carry a $1,000,000 limit per claim/aggregate. The certificate holder is the Arizona Department of Administration State Procurement Office, indicating this is likely a statewide contract or service agreement for evaluation services.
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Other files
| File | Type | Posted |
|---|---|---|
| CTR079343_Pricing.xlsx | XLSX spreadsheet | |
| CTR079343_Contract_Summary_Document.pdf |
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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
11/6/2025
(573) 651-0509 (573) 651-4456
Alliance Evaluation Services 18631 N 19th Ave Ste 158-458 Phoenix, AZ 85027
14141 524210 35378
A 1,000,000
84SBABI6549 5/6/2025 5/6/2026 1,000,000
10,000
1,000,000 2,000,000 2,000,000
1,000,000B
84UECBD0205 8/21/2025 8/21/2026
1,000,000A
84SBABI6549 5/6/2025 5/6/2026 1,000,000
10,000 C
TWC4600309 5/1/2025 5/1/2026 1,000,000
1,000,000 1,000,000
D Professional Liabili MKLV5PEO003099 5/6/2025 Each Claim/Aggregate 1,000,000 A Cyber Liability 84SBABI6549 5/6/2025 5/6/2026 Limit 1,000,000
Contract No. CTR079343
Arizona Department of Administration State Procurement Office 1400 W Washington St, Ste 3100 Phoenix, AZ 85007
ALLIEVA-01 LHERMANN
Midwest Risk DBA Arnold Ins 875 N Kingshighway St Cape Girardeau, MO 63701 info@myarnoldteam.com
Hartford Fire Insurance Co.
HARTFORD MUTUAL
Amtrust Insurance Company Evanston Insurance Co
X
5/6/2026
X X
X
X
X
X
X
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