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
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
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