2023-09-01_COI_CGL_AL.pdf

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

6/22/2023

Arthur J. Gallagher Risk Management Services, LLC 30 Century Hill Drive Suite 200 Latham NY 12110

Hunter Edwards

Hunter_Edwards@ajg.com

Great American Insurance Company 16691 Great American Insurance Company of NY 22136

Cornerstone Mission Project, Inc.

3049 Sycamore Ave Kingman AZ 86409

1675558380

A X 1,000,000 X 1,000,000

5,000

1,000,000

2,000,000 X

Y Y PAC505174016 9/1/2022 9/1/2023

2,000,000

B 1,000,000

X

X X

Y Y CAP03242951100 9/1/2022 9/1/2023

A X X 1,000,000Y UMB127997607 9/1/2022Y 9/1/2023

1,000,000 X 10,000

A A

Abuse & Molestation Professional Liab

Y Y

PAC505174016

PAC505174016

9/1/2022 9/1/2022

9/1/2023 9/1/2023

$1 Mill Each Abuse $1 Mill Each Act

Agg : $2,000,000 Agg : $2,000,000

As Per Policy.

Re: #CTR066286, Housing Support Services - Pima County and Balance of State

The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees is an Additional Insured respect to liability arising out of the activities performed by or on behalf of the Contractor pursuant to and subject to the policy's terms, definitions, conditions and exclusions. Waiver of Subrogation applies to certificate holder pursuant to and subject to the policy's terms, definitions, conditions and exclusions.

The insurance provided is primary and any other insurance shall be excess only, and not contributing. The Producer will endeavor to mail 30 days written notice See Attached...

Arizona Department of Economic Security 1789 W. Jefferson, Mail Drop 1541 Phoenix AZ 85007

ACORD 101 (2008/01)

The ACORD name and logo are registered marks of ACORD

© 2008 ACORD CORPORATION. All rights reserved.

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: FORM TITLE:

ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE Page of

AGENCY CUSTOMER ID:

LOC #:

AGENCY

CARRIER NAIC CODE

POLICY NUMBER

NAMED INSURED

EFFECTIVE DATE:

1 1

Arthur J. Gallagher Risk Management Services, LLC Cornerstone Mission Project, Inc.

3049 Sycamore Ave Kingman AZ 86409

25 CERTIFICATE OF LIABILITY INSURANCE

to the Certificate Holder named on the certificate if any policy listed on the certificate is cancelled prior to the expiration date. Failure to do so shall impose no obligation or liability of any kind upon the Producer or otherwise alter the policy terms.

* S1 * 08/19/2022 * PAC 5051740 16 GREAT AMERICAN ASSURANCE COMPANY

*D/B* 837496175 262456

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED - DESIGNATED

PERSON OR ORGANIZATION

CG 20 26 (Ed. 12/19)

CG 20 26 (Ed. 12/19) © Insurance Services Office, Inc., 2018

(Page 1 of 1)

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE

Name Of Additional Insured Person(s) Or Organization(s):

THE STATE OF ARIZONA DEPARTMENT OF ECONOMIC SECURITY

P.O. BOX 6123 CODE 950A

PHOENIX, AZ 85005

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf:

1. In the performance of your ongoing operations; or

2. In connection with your premises owned by or rented to you

However:

1. The insurance afforded to such additional insured only applies to the extent permitted by law; and

2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.

B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance:

If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the Additional Insured is the amount of insurance:

1. Required by the contract or agreement; or

2. Available under the applicable limits of insurance;

whichever is less.

This endorsement shall not increase the applicable limits of insurance.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED - DESIGNATED

PERSON OR ORGANIZATION

CG 20 26 (Ed. 12/19)

CG 20 26 (Ed. 12/19) © Insurance Services Office, Inc., 2018

(Page 1 of 2)

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE

Name Of Additional Insured Person(s) Or Organization(s):

STATE OF AZ DEPT OF ECONOMIC SECURITY

1789 W JEFFERSON ST., CODE 950A

PHOENIX, AZ 85005

STATE OF ARIZONA, AND ITS DEPARTMENTS, AGENCIES, BOARDS, COMMISSIONS,

UNIVERSITIES, OFFICERS, OFFICIALS, AGENTS AND EMPLOYEES FOR LOSSES

ARISING OUT OF THE WORK PREFORMED BY OR ON BEHALF OF TH CONTRACTOR.

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf:

1. In the performance of your ongoing operations; or

2. In connection with your premises owned by or rented to you

However:

1. The insurance afforded to such additional insured only applies to the extent permitted by law; and

2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.

B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance:

If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the Additional Insured is the amount of insurance:

1. Required by the contract or agreement; or

2. Available under the applicable limits of insurance;

© Insurance Services Office, Inc., 2018 CG 20 26 (Ed. 12/19) (Page 2 of 2) whichever is less.

This endorsement shall not increase the applicable limits of insurance.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US (WAIVER OF SUBROGATION)

CG 24 04 (Ed. 12/19)

CG 24 04 (Ed. 12/19)

© Insurance Services Office, Inc., 2018 (Page 1 of 1)

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

ELECTRONIC DATA LIABILITY COVERAGE PART

LIQUOR LIABILITY COVERAGE PART

POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES

POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

RAILROAD PROTECTIVE LIABILITY COVERAGE PART

UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS

SCHEDULE

Name Of Person(s) Or Organization(s):

STATE OF AZ DEPT OF ECONOMIC SECURITY

1789 W JEFFERSON ST. CODE 950A

PHOENIX, AZ 85005

STATE OF ARIZONA, AND ITS DEPARTMENTS, AGENCIES, BOARDS, COMMISSIONS,

UNIVERSITIES, OFFICERS, OFFICIALS, AGENTS AND EMPLOYEES FOR LOSSES

ARISING OUT OF THE WORK PERFORMED BY OR ON BEHALF OF THE CONTRACTOR.

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions:

We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above.

CG 89 72 (Ed. 01/15)

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED - ABUSE OR MOLESTATION

SCHEDULED PERSON OR ORGANIZATION

This Endorsement modifies and is subject to the insurance provided under the following form:

ABUSE OR MOLESTATION COVERAGE FORM

ABUSE OR MOLESTATION COVERAGE FORM CLAIMS-MADE

CG 89 72 (Ed. 01/15) (Page 1 of 2)

Schedule

Name of Additional Insured Person(s) or Organization(s)

20045-ADDITIONAL INSD -ABUSE - SCHEDULED

STATE OF AZ DEPT OF ECONOMIC SECURITY

1789 W JEFFERSON ST., CODE 950A

PHOENIX, AZ 85005

STATE OF ARIZONA, AND ITS DEPARTMENTS, AGENCIES, BOARDS, COMMISSIONS,

UNIVERSITIES, OFFICERS, OFFICIALS, AGENTS AND EMPLOYEES FOR LOSSES

ARISING OUT OF THE WORK PREFORMED BY OR ON BEHALF OF TH CONTRACTOR.

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

A. SECTION III - WHO IS AN INSURED is amended to include as an Additional Insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "damages" caused, in whole or in part, by any act of "abuse" to which this insurance applies.

However, the insurance afforded to such Additional Insured described above:

a. only applies to the extent permitted by law; and

b. will not be broader than that which you are required by the contract or agreement to provide for such Additional Insured.

B. With respect to the insurance afforded to these Additional Insureds, the following is added to Limits of Insurance:

The most we will pay on behalf of the Additional Insured is the amount of insurance:

A. required by the contract or agreement described in paragraph A.;

B. available under the applicable Limits of Insurance shown in the Declarations;

CG 89 72 (Ed. 01/15) (Page 2 of 2) whichever is less.

This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.

C. The following is added to Condition 2. Duties in The Event of an Act, Error, Omission, Claim or "Suit":

An Additional Insured under this endorsement will as soon as practicable:

a. give written notice of an act of "abuse" that may result in a claim or "suit" under this insurance to us;

b. tender the defense and indemnity of any claim or "suit" to all insurers who also have insurance available to the Additional Insured; and

c. agree to make available any other insurance which the Additional Insured has for a loss we cover under this Coverage Part.

d. we have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a claim or "suit" by the Additional Insured.

D. Primary and Non-Contributory

This provision applies to any person or organization who qualifies as an Additional Insured under this endorsement under this policy.

Under CONDITIONS, the following is added to paragraph 4. Other Insurance:

If you have agreed in a written contract or written agreement to provide the Additional Insured coverage on a primary and non-contributory basis, this policy shall be primary and we will not seek contribution from the Additional Insured's policy for damages we cover.

When a written contract or written agreement between you and an Additional Insured does not require this insurance to be primary or primary and non-contributory, this insurance is excess over any other insurance for which the Additional Insured is designated as a named insured.

Regardless of the written agreement between you and an Additional Insured, this insurance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the Additional Insured has been added as an Additional Insured on other policies.

E. Waiver of Transfer of Rights of Recovery Against Others to Us (Subrogation)

Under CONDITIONS, the following is added to paragraph 7. Transfer of Rights of Recovery Against Others to Us:

If required by a written contract or written agreement, we waive any right of recovery we may have against a person or organization because of payment we make for "damages" arising out of your operations under a contract for that person or organization regarding any act of "abuse" provided that the damage occurs subsequent to the execution of the written contract or written agreement.

F. SECTION I - PROFESSIONAL LIABILITY COVERAGE, 2. Exclusions, paragraph i. is replaced by the following:

"Damages" because of any liability of any insured to any other insured. This exclusion does not apply to "damages" for harm to one of your "volunteer workers." In addition, this exclusion does not apply to any person or organization that qualifies as an Additional Insured under this endorsement.

CG 89 73 (Ed. 01/15)

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED - PROFESSIONAL LIABILITY

SCHEDULED PERSON OR ORGANIZATION

This Endorsement modifies and is subject to the insurance provided under the following form:

PROFESSIONAL LIABILITY INSURANCE

PROFESSIONAL LIABILITY INSURANCE CLAIMS-MADE

CG 89 73 (Ed. 01/15) (Page 1 of 3)

Schedule

Name of Additional Insured Person(s) or Organization(s)

01210-ADDITIONAL INSD -PROFESSIONAL-SCHEDULED

STATE OF AZ DEPT OF ECONOMIC SECURITY

1789 W JEFFERSON ST., CODE 950A

PHOENIX, AZ 85005

STATE OF ARIZONA, AND ITS DEPARTMENTS, AGENCIES, BOARDS, COMMISSIONS,

UNIVERSITIES, OFFICERS, OFFICIALS, AGENTS AND EMPLOYEES FOR LOSSES

ARISING OUT OF THE WORK PREFORMED BY OR ON BEHALF OF TH CONTRACTOR.

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

A. SECTION III - WHO IS AN INSURED is amended to include as an Additional Insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "damages" caused, in whole or in part, by any act, error, or omission in the rendering of or failure to render "Professional Services" to which this insurance applies.

However, the insurance afforded to such Additional Insured described above:

a. only applies to the extent permitted by law; and

b. will not be broader than that which you are required by the contract or agreement to provide for such Additional

CG 89 73 (Ed. 01/15) (Page 2 of 3)

Insured.

B. With respect to the insurance afforded to these Additional Insureds, the following is added to Limits of Insurance:

The most we will pay on behalf of the Additional Insured is the amount of insurance:

A. required by the contract or agreement described in paragraph A.;

B. available under the applicable Limits of Insurance shown in the Declarations;

whichever is less.

This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.

C. The following is added to Condition 2. Duties in The Event of an Act, Error, Omission, Claim or "Suit":

An Additional Insured under this endorsement will as soon as practicable:

a. give written notice of an act, error, or omission in the rendering or failure to render a "Professional Service" that may result in a claim or "suit" under this insurance to us;

b. tender the defense and indemnity of any claim or "suit" to all insurers who also have insurance available to the Additional Insured; and

c. agree to make available any other insurance which the Additional Insured has for a loss we cover under this Coverage Part.

d. we have no duty to defend or indemnify an Additional Insured under this endorsement until we receive written notice of a claim or "suit" by the Additional Insured.

D. Primary and Non-Contributory

This provision applies to any person or organization who qualifies as an Additional Insured under this endorsement under this policy.

Under CONDITIONS, the following is added to paragraph 4. Other Insurance:

If you have agreed in a written contract or written agreement to provide the Additional Insured coverage on a primary and non-contributory basis, this policy shall be primary and we will not seek contribution from the Additional Insured's policy for damages we cover.

When a written contract or written agreement between you and an Additional Insured does not require this insurance to be primary or primary and non-contributory, this insurance is excess over any other insurance for which the Additional Insured is designated as a named insured.

Regardless of the written agreement between you and an Additional Insured, this insurance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the Additional Insured has been added as an Additional Insured on other policies.

E. Waiver of Transfer of Rights of Recovery Against Others to Us (Subrogation)

Under CONDITIONS, the following is added to paragraph 7. Transfer of Rights of Recovery Against Others to Us:

If required by a written contract or written agreement, we waive any right of recovery we may have against a person

CG 89 73 (Ed. 01/15) (Page 3 of 3) or organization because of payment we make for "damages" arising out of your operations under a contract for that person or organization regarding any act, error, or omission in the rendering of or failure to render "Professional Services" provided that the damage occurs subsequent to the execution of the written contract or written agreement.

F. SECTION I - PROFESSIONAL LIABILITY COVERAGE, 2. Exclusions, paragraph i. is replaced by the following:

"Damages" because of any liability of any insured to any other insured. This exclusion does not apply to "damages" for harm to one of your "volunteer workers." In addition, this exclusion does not apply to any person or organization that qualifies as an Additional Insured under this endorsement.

* 81 * 08/18/2022 * CAP 0324295 11 00 Great American Insurance Company of New York

POLICY NUMBER: CAP 0324295 11 00 COMMERCIAL AUTO

CA 04 44 10 13

CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US (WAIVER OF SUBROGATION)

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.

Named Insured: Cornerstone Mission Project, Endorsement Effective Date: 09-01-2022

SCHEDULE

Name(s) Of Person(s) Or Organization(s):

State of AZ Dept. of Economic Security

1789 W. Jefferson St. Code 950A

Phoenix, AZ 85005

State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees for losses arising out of the work performed by or on behalf of the contractor.

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

The Transfer Of Rights Of Recovery Against Others To Us 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.

* 81 * 08/18/2022 * CAP 0324295 11 00 Great American Insurance Company of New York

POLICY NUMBER: CAP 0324295 11 00 COMMERCIAL AUTO

CA 20 48 10 13

CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

DESIGNATED INSURED FOR

COVERED AUTOS LIABILITY COVERAGE

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 Autos 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.

Named Insured: Cornerstone Mission Project, Endorsement Effective Date: 09-01-2022

SCHEDULE

Name Of Person(s) Or Organization(s):

The State of Arizona (see CA8802) 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 A.1. of Section II – Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I – Covered Autos Coverages of the Auto Dealers Coverage Form.