YH25-0076-05_COI_Exp_071026.pdf

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

06/11/2025 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 SUBROGATIONIS 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).

PRODUCER

INSZONE INSURANCE SERVICES LLC

57129672

2721 CITRUS RD SUITE A

RANCHO CORDOVA CA 95742

CONTACT NAME:

PHONE

(A/C, No, Ext):

(877) 308-9663 FAX

(A/C, No):

(916) 503-6271

E-MAIL ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC#

INSURER A : Sentinel Insurance Company Ltd. 11000

INSURED

JANINE ROUMAIN, MD, MPH

901 W AVALON DR

PHOENIX AZ 85013-4015

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

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.

INSR

LTR

TYPE OF INSURANCE ADDL

INSR

SUBR

WVD

POLICY NUMBER POLICY EFF

(MM/DD/YYYY)

POLICY EXP

(MM/DD/Y YYY)

LIMITS

A

COMMERCIAL GENERAL LIABILITY

57 SBM UI2215 07/10/2025 07/10/2026

EACH OCCURRENCE $1,000,000

CLAIMS-MADE X OCCUR DAMAGE TO RENTED

PREMISES (Ea occurrence) $1,000,000

X General Liability MED EXP (Any one person) $10,000

PERSONAL & ADV INJURY $1,000,000

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000

POLICY PRO-

JECT X LOC PRODUCTS - COMP/OP AGG $2,000,000

OTHER:

A

AUTOMOBILE LIABILITY

57 SBM UI2215 07/10/2025 07/10/2026

COMBINED SINGLE LIMIT

(Ea accident)

$1,000,000 ANY AUTO BODILY INJURY (Per person)

ALL OWNED

AUTOS

SCHEDULED

AUTOS BODILY INJURY (Per accident)

X HIRED

AUTOS X NON-OWNED

AUTOS

PROPERTY DAMAGE

(Per accident)

UMBRELLA LIAB

EXCESS LIAB

OCCUR

CLAIMS-

MADE

EACH OCCURRENCE

AGGREGATE

DED RETENTION $

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

ANY

PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below

N/ A

PER

STATUTE

OTH-

ER

Y/N E.L. EACH ACCIDENT

E.L. DISEASE -EA EMPLOYEE

E.L. DISEASE - POLICY LIMIT

A EMPLOYMENT PRACTICES

LIABILITY

57 SBM UI2215 07/10/2025 07/10/2026 Each Claim Limit Aggregate Limit

$10,000 $10,000

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

Those usual to the Insured's Operations. RE: Contract Number: YH21-0005-06.

CERTIFICATE HOLDER CANCELLATION

AHCCCS

701 E JEFFERSON ST MD 5700

PHOENIX AZ 85034

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED

BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED

IN ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE

© 1988-2015 ACORD CORPORATION. All rights reserved.

ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD