INSURANCE_-_For_current-contract-numer-CTR056325_COI_expires_11.01.25.pdf

10/02/2024

Conservation United PO Box 759

Higley AZ 85236

Leslie Babcock

(855) 570-2797 (602) 388-8110 leslie@insuranceunited.com

Arizona Center For Afterschool Excellence 301 E Bethany Home Rd Ste A222 Suite A222 Phoenix AZ 85012-1269

Hartford Underwriters Insurance Company 30104 Hartford Insurance Company of the Southeast 38261

2025-11/01 Master

A Y Y 59SBAAU1YT1 11/01/2024 11/01/2025

1,000,000 1,000,000 10,000 1,000,000 2,000,000 2,000,000

A Y Y 59SBAAU1YT1 11/01/2024 11/01/2025

1,000,000

A 10,000

Y Y 59SBAAU1YT1 11/01/2024 11/01/2025

1,000,000 1,000,000

B Y Y 59WECAU2Y9J 11/01/2024 11/01/2025

1,000,000 1,000,000 1,000,000

A Employment Practices Liability Insurance 59SBAAU1YT1 11/01/2024 11/01/2025

Each Claim Limit $25,000 Aggregate Limit $25,000

State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees as additional insureds with respect to liability arising out of the activities performed by or on behalf of the Contractor. Primary and non contributory wording applies. No Company owned vehicles coverage. Waiver of Subrogation applies to: State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees Contract No.: CTR056325 Description: Program Development - Arizona Out of School Time Accreditation Services

The State of Arizona and Department of Economic Security C/O myCOI 1075 Broad Ripple Ave Suite 31 Indianapolis IN 46220

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

00032208

Conservation United

25 Certificate of Liability Insurance

Excluded Susan & Colton Appenzeller

ACORD 101 (2008/01)

The ACORD name and logo are registered marks of ACORD

© 2008 ACORD CORPORATION. All rights reserved.

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: FORM TITLE:

ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE Page of

AGENCY CUSTOMER ID:

LOC #:

AGENCY

CARRIER NAIC CODE

POLICY NUMBER

NAMED INSURED

EFFECTIVE DATE:

Policy Change:

Business Owner’s Policy

Form SC 00 06 10 18 Page 1 of 2 Process Date: 10/15/2024 © 2018, The Hartford Policy Expiration Date: 11/01/2025

(May include copyrighted material of Insurance Services Office, Inc., with its permission)

Policy Number: 59 SBA AU1YT1

Policy Period: 11/01/2024 to 11/01/2025

Named Insured and Mailing Address:

Arizona Center for Afterschool Excellence, AZCASE, 301 E BETHANY HOME RD STE A222, PHOENIX, AZ 85012-1269

Policy Change Number: 001

Policy Change Effective Date: 11/01/2024, Effective hour is the same as stated in the Declarations Page of the Policy.

Insurer:

Hartford Underwriters Insurance Company, a property and casualty company of The Hartford

One Hartford Plaza, Hartford, CT 06155

Name of Agent/Broker:

INSURANCE UNITED INC

PO BOX 759

HIGLEY, AZ 85236

Code: 59305967

Coverage Parts Affected:

Common Liability

This is NOT a bill. However, any changes in your premium will be reflected in your next billing statement. You will receive a separate bill from The Hartford. If you are enrolled in repetitive EFT draws from your bank account, changes in premium will change future draw amounts.

As a result of the changes described herein, there is an additional premium in the amount of: $39

*Price is subject to fees and surcharges

Countersigned by: 10/15/2024

Authorized Representative Date

Policy Change:

Business Owner’s Policy

Form SC 00 06 10 18 Page 2 of 2 Process Date: 10/15/2024 © 2018, The Hartford Policy Expiration Date: 11/01/2025

(May include copyrighted material of Insurance Services Office, Inc., with its permission)

Waiver of Subrogation has been added and modifies your Liability coverage. The following schedule applies.

Person or Organization: Address:

State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees Waiver Name Overflow

1705 Broad Ripple Ave Suite 313 , Indianapolis , IN 46220

Policy is amended to add the following Endorsement Forms reflecting the changes made to your policy.

FORM NUMBER FORM NAME COVERAGE PART

SC 00 06 10 18 POLICY CHANGE Common

SL 30 03 10 18 WAIVER OF SUBROGATION Liability

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

Form SL 30 03 10 18 Page 1 of 1 © 2018, The Hartford

(May include copyrighted material of Insurance Services Office, Inc., with its permission)

WAIVER OF SUBROGATION

This endorsement modifies insurance provided under the following:

BUSINESS LIABILITY COVERAGE FORM

Except as otherwise stated in this endorsement, the terms and conditions of the Policy apply.

The following is added to Section E. LIABILITY AND MEDICAL EXPENSES GENERAL CONDITIONS:

We waive any right of recovery we may have against:

a. Any person or organization shown in the Declarations, or

b. Any person or organization with whom you have a contract that requires such waiver.

Countersigned by

Authorized Representative

Form WC 99 00 06 B (1) Printed in U.S.A. Page 1 Process Date: 10/11/24 Policy Expiration Date: 11/01/25

CHANGE IN INFORMATION PAGE

INSURER: Hartford Insurance Company of the Southeast NCCI Company Number: 20621

Policy Number: 59 WEC AU2Y9J Endorsement Number: 002 Effective Date: 11/01/24 Effective hour is the same as stated on the Information Page of the policy.

Named Insured and Address: ARIZONA CENTER FOR AFTERSCHOOL EXCELLENCE

301 E BETHANY HOME RD STE A222

PHOENIX AZ 85012

FEIN Number: 86-1009220

It is agreed that the policy is amended as follows:

This is NOT a bill. However, any changes in your premium will be reflected in your next billing statement. You will receive a separate bill from The Hartford. If you are enrolled in repetitive EFT draws from your bank account, changes in premium will change future draw amounts.

In consideration of no change in premium, it is agreed that:

Policy is amended to add the following condition(s):

Waiver of Our Right to Recover from Others Endorsement

Policy is amended to delete the following condition(s):

Waiver of Our Right to Recover from Others Endorsement

Policy is amended to revise the following Endorsement Forms reflecting the changes made to your policy.

WC990006B(.1P)

WC000313

Authorized Representative

Form WC 00 03 13 Printed in U.S.A.

Process Date: 10/11/24 Policy Expiration Date: 11/01/25

WAIVER OF OUR RIGHT TO RECOVER

FROM OTHERS ENDORSEMENT

Policy Number: 59 WEC AU2Y9J Endorsement Number: 002 Effective Date: 11/01/24 Effective hour is the same as stated on the Information Page of the policy.

Named Insured and Address: Arizona Center for Afterschool Excellence

301 E BETHANY HOME RD STE A222

PHOENIX AZ 85012

We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule.

This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.

SCHEDULE

State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees, 1075 BROAD RIPPLE AVE, Suite 313, INDIANAPOLIS, IN, 46220

Authorized Representative

Form WC 00 03 13 Printed in U.S.A.

Process Date: 10/11/24 Policy Expiration Date: 11/01/25

WAIVER OF OUR RIGHT TO RECOVER

FROM OTHERS ENDORSEMENT

Policy Number: 59 WEC AU2Y9J Endorsement Number: 002 Effective Date: 11/01/24 Effective hour is the same as stated on the Information Page of the policy.

Named Insured and Address: Arizona Center for Afterschool Excellence

301 E BETHANY HOME RD STE A222

PHOENIX AZ 85012

We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule.

This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.

SCHEDULE

State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees, 1075 BROAD RIPPLE AVE, Suite 313, INDIANAPOLIS, IN, 46220