2022.04.19 CoI GL WC.pdf
PDF 3 MB Posted
- Attached to
- Master Agreement AZ|CTR059314
- Contract number
- CTR059314
- Issued by
- Arizona
About this file
The documents are a set of insurance certificates and endorsements for commercial auto and workers' compensation coverage issued by Federated Mutual Insurance Company and USI Insurance Services LLC for Courtesy Chevrolet, Inc. and Courtesy Auto of Mesa, LLC, with the Arizona Department of Transportation (ADOT) listed as a designated insured. The certificates cover multiple insurance forms including Auto Dealers Coverage, Business Auto Coverage, and Motor Carrier Coverage, effective from June 1, 2021 to June 1, 2022.
The insurance policies provide comprehensive liability coverage, including $10,000,000 in total coverage across various categories. Key provisions include primary and noncontributory insurance status, waiver of subrogation rights, and designated insured status for the Arizona Department of Transportation. The Workers' Compensation policy includes a blanket waiver endorsement, and the auto liability coverage includes provisions for additional insureds and specific coverage limits for bodily injury, property damage, and other potential incidents. The policies are structured to provide broad protection for the insured entities across their business operations.
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Text version
a8812 Accepted
© Insurance Services Office, Inc., 2011
POLICY NUMBER: 6074187
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.
COURTESY CHEVROLET, INC
06-01-2021
ARIZONA DEPARTMENT OF
TRANSPORTATION
1739 W JACKSON ST STE B-MD #
100P
PHOENIX AZ 85007
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization.
CA 04 44 10 13 Page 1 of 1
COMMERCIAL AUTO
CA 04 44 10 13
Named Insured:
Endorsement Effective Date:
SCHEDULE
Name(s) Of Person(s) Or Organization(s):
Transfer Of Rights Of Recovery Against Others To Us
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
© Insurance Services Office, Inc., 2016
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.
The following is added to the Condition in the Business Auto Coverage Form and the in the Motor Carrier Coverage Form and supersedes any provision to the contrary:
This Coverage Form's Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that:
Such "insured" is a Named Insured under such other insurance; and
You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured".
The following is added to the Condition in the Auto Dealers Coverage Form and supersedes any provision to the contrary:
This Coverage Form's Covered Autos Liability Coverage and General Liability Coverages are primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that:
Such "insured" is a Named Insured under such other insurance; and
You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured".
CA 04 49 11 16 Page 1 of 1
COMMERCIAL AUTO
CA 04 49 11 16
A. Other Insurance
Other Insurance - Primary And Excess Insurance Provisions
1.
2.
B. Other Insurance
1.
2.
PRIMARY AND NONCONTRIBUTORY -
OTHER INSURANCE CONDITION
© Insurance Services Office, Inc., 2011
POLICY NUMBER: 6074187
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement.
This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Auto Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.
COURTESY CHEVROLET, INC
06-01-2021
ARIZONA DEPARTMENT OF TRANSPORTATION
1739 W JACKSON ST STE B-MD # 100P
PHOENIX AZ 85007
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph of Section - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph of Section - Covered Autos Coverages of the Auto Dealers Coverage Form.
CA 20 48 10 13 Page 1 of 1
COMMERCIAL AUTO
CA 20 48 10 13
Named Insured:
Endorsement Effective:
SCHEDULE
Name of Person(s) Or Organization(s):
A.1. II
D.2.
I
DESIGNATED INSURED FOR
COVERED AUTOS LIABILITY COVERAGE
Courtesy Auto of Mesa, LLC 6130 E Auto Park Dr.
Mesa, AZ 85206-4358 a8812 Accepted
| CTR059315 Certificate of Insurance.pdf |
| ECM converted document |
| Page 1 |
| Page 2 |
| CA 04 44 Waiver of Transfer of Rights of Recovery Against Others to Us |
| Page 1 |
| CA 04 49 Primary and Noncontributory - Other Insurance Condition |
| Page 1 |
| CA 20 48 Designated Insured For Covered Autos Liability Coverage |
| Page 1 |
| Page 2 |
| The State of Arizona COIWaiver of sub R.pdf |
| The State of Arizona.pdf (p.1-2) |
| IMPORTED FROM PDF PRINT DRIVER.PDF (p.3) |
File details come from the government source that posted it. Updated .