NEWLIFECENTER-COI.pdf

11/2/2023

Powers-Leavitt Insurance Agency, Inc.

111 E Monroe Avenue, Suite 200

Buckeye AZ 85326

April Tuzon (623)386-4452 (866)836-5280 april-tuzon@leavitt.com

New Life Center P.O. Box 5005

Goodyear AZ 85338

Philadelphia Indemnity Company 018058 CopperPoint Indemnity Insurance 13928

23/24

A

X

X

X

X Y PHPK2606161 9/15/2023 9/15/2024

1,000,000

100,000

5,000

1,000,000

3,000,000

3,000,000

A X

X Y PHPK2606161 9/15/2023 9/15/2024

1,000,000

A

X X

X 10,000

PHUB882800

9/15/2023 9/15/2024

2,000,000

2,000,000

B N

1024845 9/1/2023 9/1/2024

X

1,000,000

1,000,000

1,000,000

A Sexual Abuse/Molestation PHSD1815427 9/15/2023 9/15/2024 Occurrence / Aggregate $1M / $3M

Professional Liability 9/15/2023 9/15/2024 Occurrence / Aggregate $1M / $3M

Contract ID: CTR066200 Division Name: ADES

*** See Notes ***

Coverage subject to policy terms, conditions, limitations, and exclusions.

State of Arizona and Dept of Economic Security C/O myCOI 1075 Broad Ripple Ave Ste 313 Indianapolis, IN 46220 upload myCOI

Tyler Woodruff/APTUZO

Y

The ACORD name and logo are registered marks of ACORD

CERTIFICATE HOLDER

© 1988-2014 ACORD CORPORATION. All rights reserved.

ACORD 25 (2014/01)

AUTHORIZED REPRESENTATIVE

CANCELLATION

DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE

LOCJECT

PRO-

POLICY

GEN'L AGGREGATE LIMIT APPLIES PER:

OCCURCLAIMS-MADE

COMMERCIAL GENERAL LIABILITY

PREMISES (Ea occurrence) $

DAMAGE TO RENTED

EACH OCCURRENCE $

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $

PRODUCTS - COMP/OP AGG $

$RETENTIONDED

CLAIMS-MADE

OCCUR

AGGREGATE $

EACH OCCURRENCE $UMBRELLA LIAB

EXCESS LIAB

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

INSR

LTR TYPE OF INSURANCE POLICY NUMBER

POLICY EFF

(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY) LIMITS

PER

STATUTE

OTH-

ER

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE

E.L. DISEASE - POLICY LIMIT

ANY PROPRIETOR/PARTNER/EXECUTIVE

If yes, describe under DESCRIPTION OF OPERATIONS below

(Mandatory in NH)

OFFICER/MEMBER EXCLUDED?

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY Y / N

AUTOMOBILE LIABILITY

ANY AUTO

ALL OWNED SCHEDULED

HIRED AUTOS

NON-OWNED

AUTOS AUTOS

AUTOS

COMBINED SINGLE LIMIT

BODILY INJURY (Per person)

BODILY INJURY (Per accident)

PROPERTY DAMAGE $

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.

INSD

ADDL

WVD

SUBR

N / A

(Ea accident)

(Per accident)

OTHER:

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 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:

INSURED

PHONE

(A/C, No, Ext):

PRODUCER

ADDRESS:

E-MAIL

FAX

(A/C, No):

CONTACT

NAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INSURER(S) AFFORDING COVERAGE

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

INS025 (201401)

RE: Contract ID: CTR066200 Division Name: ADES

The State of Arizona, and its departments, agencies, boards, commission, universities, officers, officials, agents and employees are included as Additional Insureds if a written contract is in effect for each, as required by form PI-MANU-1 01/00 with regard to General Liability.

The State of Arizona, and its departments, agencies, boards, commission, universities, officers, officials, agents and employees have Waiver of Subrogation if a written contract is in effect for each, as required by form CG2404 05/09 with regard to General Liability.

The State of Arizona, and its departments, agencies, boards, commission, universities, officers, officials, agents and employees are included as Additional Insured if a written contract is in effect for each, as required by form PI-MANU-1 01/00 with regard to Auto Liability.

The State of Arizona, and its departments, agencies, boards, commission, universities, officers, officials, agents and employees have Waiver of Subrogation if a written contract is in effect for each, as required by form CA0444 10/13 with regard to Auto Liability.

The State of Arizona, and its departments, agencies, boards, commission, universities, officers, officials, agents and employees have Waiver of Subrogation if a written contract is in effect for each, as required by form WC000313 04/84 with regard to Workers Compensation. No member or officer exclusions.

30 day notice of cancellation applies per attached.

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