DCS_Certificates_of_liability_23-24_Redacted.pdf
PDF 206 KB Posted
- Attached to
- Master Agreement AZ|CTR071452
- Contract number
- CTR071452
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance for The U-turn Foundation, issued by NFP Property & Casualty Services, Inc. on 7/26/2023. The certificate involves multiple insurers, including Social Services Contractors Indemnity Pool and Nationwide Insurance Company of America, and is specifically related to Contract #DES090034-29 with the Arizona Department of Child Safety. The certificate lists the State of Arizona, its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees as additional insured parties.
The insurance coverage includes Commercial General Liability with a $1,000,000 each occurrence limit, including sexual abuse coverage, and a $3,000,000 general aggregate. Automobile liability is also covered at $1,000,000, along with a $1,000,000 umbrella liability policy. Workers' compensation is provided with $1,000,000 limits, and professional liability (E&O) coverage is set at $1,000,000 per occurrence and $3,000,000 aggregate. The policies are effective from 8/1/2023 to 8/1/2024, with some variations in effective dates, and specifically reference the state contract with additional insured provisions for the Arizona Department of Child Safety.
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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 EXP
TYPE 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
7/26/2023
(480) 458-6064 (480) 556-0242
XXXXXX
The U-turn Foundation
25453
A 1,000,000
X 6000314-5 8/1/2023 8/1/2024 1,000,000
Sexual Abuse Include 10,000
1,000,000
3,000,000
3,000,000
1,000,000A
6000314-5 8/1/2023 8/1/2024
1,000,000A 6000603-5 8/1/2023 8/1/2024 1,000,000
B
WCC335166A 8/15/2023 8/15/2024 1,000,000
N 1,000,000
1,000,000
A E&O/Professional Lia 6000314-5 8/1/2023 Limit 1,000,000
A E&O/Professional Lia 6000314-5 8/1/2023 8/1/2024 Agg 3,000,000
RE: Contract #DES090034-29 Subject to Policy Terms, Conditions and Exclusions
The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents and employees are Additional insured with respects to General Liability when required by written contract per endorsement SSGLAI 08-17 attached.
Arizona Department of Child Safety Office of Procurement 3003 N. Central Ave., 20th Floor Phoenix, AZ 85012
U-TUFOU-01 BRITTANYKOCIS
NFP Property & Casualty Services, Inc.
8777 North Gainey Center Drive Suite 260 Scottsdale, AZ 85258
Chandra Jackson chjackson@nfp.com
Social Services Contractors Indemnity Pool Nationwide Insurance Company of America
X
8/1/2024
X X
X
X
X X
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