RED_HAWK_COI_STATE_OF_AZ__1__Redacted.pdf

PDF 55 KB Posted

Attached to
Master Agreement AZ|CTR071445
Contract number
CTR071445
Issued by
Arizona

About this file

This document is a Certificate of Liability Insurance issued by Arizona Preferred Insurance for Red Hawk Ranch LLC, with multiple insurers including Redwood Fire and Casualty Insurance Company. The certificate names the State of Arizona, Arizona Department of Child Safety, Salt River Pima-Maricopa Indian Community, and its various departments, agencies, boards, commissions, universities, officers, and employees as additional insureds.

The insurance covers multiple lines of coverage including commercial general liability, automobile liability, workers' compensation, and professional liability with policy periods from December 2024 to December 2025. The policies provide coverage for group home residential day services at Salt River Pima, with liability limits of $1,000,000 per occurrence, general aggregate limits of $2,000,000, and specific endorsements for sexual abuse/molestation coverage. Building coverage is included with a replacement cost of $1,100,000 and an aggregate limit of $3,000,000. The policies contain a waiver of subrogation endorsement in favor of the State of Arizona and the Arizona Department of Child Safety.

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Text version

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

5/8/2025

Arizona Preferred Insurance

1940 E. Camelback Rd.

Phoenix AZ 85016

6022660020 azpreferred@gmail.com

RED HAWK RANCH LLC

REDWOOD FIRE AND CASUALTY INS CO 11673

ACCREDITED SURETY AND CASUALTY CO INC

SOCIAL SERVICE CONTRACTORS INDEMNITY POO

C

✘ SEXUAL ABUSE/ MOLESTATION

Y Y 6000528-1 12/06/24 12/06/25

1,000,000

1,000,000

10,000

1,000,000

2,000,000

2,000,000

A

01 APM 032597-02 12/22/24 12/22/25

1,000,000

HIRED/NONOWNED 1,000,000

B 1AUIAZ160135459800 05/19/25 05/19/26

1,000,000

1,000,000

1,000,000

C

PROFESSIONAL LIABILITY

BUILDING COVERAGE- REPL COST

Y 6000528-1 12/06/24 12/06/25

PER OCCURRENCE 1,000,000

AGGREGATE 3,000,000

BUILDINGS 1-3 1,100,000

THE STATE OF ARIZONA AND THE ARIZONA DEPARTMENT OF CHILD SAFETY AND ITS DEPARTMENTS, AGENCIES, BOARDS, COMMISIONS, UNIVERSITIES, OFFICERS, OFFICIALS, AGENTS AND EMPLOYEES SHALL BE NAMED AS ADDITIONAL INSURED'S BUT ONLY WITH RESPECT TO LIABILITY ARISING OUT OF THE ACTIVITIES

PERFORMED BY OR ON BEHALFT OF THE CONTRACTOR. POLICY CONTAINS A WAIVER OF SUBROGATION ENDORSEMENT IN FAVOR THE STATE OF ARIZONA AND THE

ARIZONA DEPARTMENT OF CHILD SAFETY FOR LOSSES ARISING OUT OF WORK THE PERFORMED BY OR ON BEHALF OF THE CONTRACTOR. CONTRACT DESCRIPTION:

GROUP HOME RESIDENTIAL DAY. SALT RIVER PIMA.

SALT RIVER PIMA-MARICOPA INDIAN COMMUNITY AS ADDITIONAL INSURED: ITS AGENTS, EMPLOYEES, AND VOLUNTEERS, ARE HEREBY NAMED AS ADDITIONAL

INSURED AS THEIR INTEREST APPEARS.

STATE OF ARIZONA ARIZONA DEPARTMENT OF CHILD

SAFETY

3003 N CENTRAL #2000

PHOENIX AZ 85012

File details come from the government source that posted it. Updated .