The_State_of_Arizona_-_Copy_-_Copy_-_Copy_-_Copy_-_Copy_Redacted.pdf
PDF 54 KB Posted
- Attached to
- Master Agreement AZ|CTR071407
- Contract number
- CTR071407
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for Another Chance Program, LLC, issued by Kenny Ong Financial Services in Tolleson, Arizona. The certificate involves multiple insurers including American Alternative Insurance Corporation, Progressive Insurance, and National Liability & Fire Insurance Company. The certificate holder is the State of Arizona and the Arizona Department of Child Safety, located in Phoenix, Arizona.
The insurance coverage includes Commercial General Liability, Automobile Liability, Workers Compensation, and Professional Liability policies effective from 06/01/2024 to 06/01/2025. The Commercial General Liability policy has a $1,000,000 each occurrence limit and a $2,000,000 general aggregate limit. The Professional Liability coverage provides $1,000,000 per occurrence and a $3,000,000 aggregate limit. The certificate includes provisions for the State of Arizona and the Arizona Department of Child Safety to be named as Additional Insureds, with a waiver of subrogation endorsement for losses arising from work performed by the contractor.
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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
05/31/2024
Kenny Ong Financial Services - AZ
9059 West McDowell Road
Suite 100
Tolleson AZ 85353
Jerry Avila
(602) 492-1378 (602) 492-9669 jerryavilajr@gmail.com
Another Chance Program, LLC
American Alternative Insurance Corporation
Progressive Insurance
National Liability & Fire Insurance Company
A
Y Y 302301 1461821 06/01/2024 06/01/2025
1,000,000
500,000
5,000
1,000,000
2,000,000
2,000,000
B ✘
✘ Y Y 02183850 06/01/2024 06/01/2025
1,000,000
C Y Y A9WC209978 06/01/2024 06/01/2025
1,000,000
1,000,000
1,000,000
A Professional Liability
Y Y 382301 1461821 06/01/2024 06/01/2025
Each Occurrence $ 1,000,000
Aggregate $ 3,000,000
The State of Arizona and the Arizona Department of Child Safety shall be named as Additional Insureds with respect to liability arising out of the activities performed by or on behalf of the Contractor.
Waiver of subrogation endorsement against the State of Arizona, its departments, agencies, boards, commissions universitites and its officers, officials, agents and employees for losses arising from work performed by or on behalf of the contractor.
The State of Arizona and the Arizona Department of Child Safety
3003 N Central Ave
Phoenix, AZ 85012
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