2025-06-01 INTERA GAUWPI.pdf
PDF 330 KB Posted
- Attached to
- Master Agreement AZ|CTR074225
- Contract number
- CTR074225
- Issued by
- Arizona
About this file
This document is a comprehensive insurance certificate and related endorsements for INTERA Incorporated, issued by multiple insurers including Lloyd's of London, Hartford - WC Multiple Issuing Cos, and Sentinel Insurance Company Ltd. The primary certificate holder is the Arizona Department of Environmental Quality (ADEQ), and the policy covers INTERA's professional and general liability for the period of 06/01/2024 to 06/01/2025. The insurance package includes commercial general liability, automobile liability, umbrella liability, workers' compensation, and professional liability coverage.
The contract specifically relates to Contract #CTR074225 for Capacity Development/Technical Assistance to Small Public Drinking Water Systems. The policy provides various coverage limits, including $1,000,000 for each occurrence under general liability, $1,000,000 for automobile liability, and $6,000,000 in umbrella/excess liability. The professional liability coverage offers $2,000,000 aggregate with a $1,000,000 per-claim limit and a $100,000 deductible. The policy includes additional insured provisions for the State of Arizona and its departments, agencies, and employees, with primary and non-contributory wording when required by written contract. The endorsements also include blanket waivers of subrogation and specific provisions for various states including Texas and California.
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INSR ADDL SUBR
LTR INSR WVD
DATE (MM/DD/YYYY)
PRODUCER CONTACT
NAME:
FAXPHONE
(A/C, No):(A/C, No, Ext):
ADDRESS:
INSURER A :
INSURED INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
POLICY NUMBER
POLICY EFF POLICY EXP
TYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)
COMMERCIAL GENERAL LIABILITY
AUTOMOBILE LIABILITY
UMBRELLA LIAB
EXCESS LIAB
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
INSURER(S) AFFORDING COVERAGE NAIC #
Y / N
N / A (Mandatory in NH)
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
EACH OCCURRENCE $
DAMAGE TO RENTED
$PREMISES (Ea occurrence)CLAIMS-MADE OCCUR
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG $
PRO-
OTHER:
LOCJECT
COMBINED SINGLE LIMIT
$(Ea accident)
BODILY INJURY (Per person) $ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS
AUTOS ONLY
HIRED PROPERTY DAMAGE $
AUTOS ONLY (Per accident)
OCCUR EACH OCCURRENCE $
CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below
POLICY
NON-OWNED
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
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.
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 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 any rights to the certificate holder in lieu of such endorsement(s).
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
CERTIFICATE HOLDER CANCELLATION
© 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03)
ACORDTM CERTIFICATE OF LIABILITY INSURANCE
Lloyd's of London
Hartford - WC Multiple Issuing Cos
Sentinel Insurance Company Ltd.
11/19/2024
USI Insurance Services LLC -CL 4630 North Loop 1604 West Suite 410 San Antonio, TX 78249
Danelle Touchstone 210 524-2094 610-537-1904 danelle.touchstone@usi.com
INTERA Incorporated 9600 Great Hills Trl Suite 300W Austin, TX 78759
SURPLU
00914 11000
A X X
X Pollution Liability
X BI/PD DED $10,000
X X
ENVP000025424 06/01/2024 06/01/2025 1,000,000
300,000 25,000 1,000,000 2,000,000 2,000,000
C X
X X
65UECZR3402 06/01/2024 06/01/2025 1,000,000
A X
X ENVX000020624 06/01/2024 06/01/2025 6,000,000
6,000,000
B
N
65WBOL6H7Y 06/01/2024 06/01/2025 X
1,000,000
1,000,000 1,000,000
A Professional Liab ENVP000025424
Retroactive Date
06/01/2024
01/10/2002
06/01/2025 $2,000,000 Aggregate $1,000,000 Per Claim $100,000 Deductible
RE: Contract #CTR074225 Capacity Development/Technical Assistance to Small Public Drinking Water Systems
The Excess Liability Policy sits over and follows form of the General Liability, Automobile Liability and Professional Liability limits. Professional Liability is on a claims-made basis.
(See Attached Descriptions)
Arizona Department of Environmental Quality (ADEQ) 1110 W. Washington Street Phoenix, AZ 85007
#S47075028/M44945906
INTERINC22Client#: 914933
DDTHZ
#S47075028/M44945906
SAGITTA 25.3 (2016/03)
DESCRIPTIONS (Continued from Page 1)
The General Liability and Automobile Liability policies include a blanket Additional Insured endorsement that provides Additional Insured status to State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees when there is a written contract that requires such status and only with regard to work performed on behalf of the named insured.
The General Liability and Automobile Liability policies contain a special endorsement with Primary and Noncontributory wording when required by written contract.
The General Liability, Automobile Liability, and Workers Compensation policies provide a blanket Waiver of Subrogation in favor of State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees when required by written contract.
A thirty (30) days prior written notice of cancellation to certificate holder applies when required by written contract.
#S47075028/M44945906
COMMERCIAL AUTOMOBILE BROAD FORM
ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
To the extent that the provisions of this endorsement provide broader benefits to the "insured" than other provisions of the Coverage Form, the provisions of this endorsement apply.
COMMERCIAL AUTOMOBILE
HA 99 16 12 21
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
1. BROAD FORM INSURED
Paragraph .1. - WHO IS AN INSURED - of Section II - Liability Coverage is amended to add the following:
d. Subsidiaries and Newly Acquired or Formed Organizations
The Named Insured shown in the Declarations is amended to include:
(1) Any legal business entity other than a partnership or joint venture, formed as a subsidiary in which you have an ownership interest of more than 50% on the effective date of the Coverage Form.
However, the Named Insured does not include any subsidiary that is an "insured" under any other automobile policy or would be an "insured" under such a policy but for its termination or the exhaustion of its Limit of Insurance.
(2) Any organization that is acquired or formed by you and over which you maintain majority ownership. However, the Named Insured does not include any newly formed or acquired organization:
(a) That is a partnership or joint venture,
(b) That is an "insured" under any other policy,
(c) That has exhausted its Limit of Insurance under any other policy, or
(d) 180 days or more after its acquisition or formation by you, unless you have given us notice of the acquisition or formation.
Coverage does not apply to "bodily injury" or "property damage" that results from an "accident" that occurred before you formed or acquired the organization.
e. Employees as Insureds
(1). Any "employee" of yours while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs.
f. Lessors as Insureds
(1). The lessor of a covered "auto" while the "auto" is leased to you under a written agreement if:
(a) The agreement requires you to provide direct primary insurance for the lessor and
(b) The "auto" is leased without a driver.
Such a leased "auto" will be considered a covered "auto" you own and not a covered "auto" you hire.
g. Additional Insured if Required by Contract
(1) When you have agreed, in a written contract or written agreement, that a person or organization be added as an additional insured on your business auto policy, such person or organization is an "insured", but only to the extent such person or organization is liable for "bodily injury" or "property damage" caused by the conduct of an "insured" under paragraphs a. or b. of Who Is An Insured with regard to the ownership, maintenance or use of a covered "auto."
The insurance afforded to any such additional insured applies only if the "bodily injury" or "property damage" occurs:
(a) During the policy period, and
(b) Subsequent to the execution of such written contract, and
Form HA 99 16 12 21 Page 1 of 5 © 2021, The Hartford
(Includes copyrighted material of Insurance Services Office, Inc. with its permission.)
Danelle.Touchstone Highlight
(c) Prior to the expiration of the period of time that the written contract requires such insurance be provided to the additional insured.
(2) How Limits Apply
If you have agreed in a written contract or written agreement that another person or organization be added as an additional insured on your policy, the most we will pay on behalf of such additional insured is the lesser of:
(a) The limits of insurance specified in the written contract or written agreement;
or
(b) The Limits of Insurance shown in the Declarations.
Such amount shall be a part of and not in addition to Limits of Insurance shown in the Declarations and described in this Section.
(3) Additional Insureds Other Insurance
If we cover a claim or "suit" under this Coverage Part that may also be covered by other insurance available to an additional insured, such additional insured must submit such claim or "suit" to the other insurer for defense and indemnity.
However, this provision does not apply to the extent that you have agreed in a written contract or written agreement that this insurance is primary and non-contributory with the additional insured's own insurance.
(4) Duties in The Event Of Accident, Claim, Suit or Loss
If you have agreed in a written contract or written agreement that another person or organization be added as an additional insured on your policy, the additional insured shall be required to comply with the provisions in LOSS CONDITIONS 2. -
DUTIES IN THE EVENT OF ACCIDENT,
CLAIM , SUIT OR LOSS – OF SECTION
IV – BUSINESS AUTO CONDITIONS, in the same manner as the Named Insured.
2. Primary and Non-Contributory if Required by Contract
Only with respect to insurance provided to an additional insured in A.1.g. - Additional Insured If Required by Contract, the following provisions apply:
(1) Primary Insurance When Required By Contract
This insurance is primary if you have agreed in a written contract or written agreement that this insurance be primary.
If other insurance is also primary, we will share with all that other insurance by the method described in Other Insurance 5.d.
(2) Primary And Non-Contributory To Other Insurance When Required By Contract
If you have agreed in a written contract or written agreement that this insurance is primary and non-contributory with the additional insured's own insurance, this insurance is primary and we will not seek contribution from that other insurance.
Paragraphs (1) and (2) do not apply to other insurance to which the additional insured has been added as an additional insured.
When this insurance is excess, we will have no duty to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers.
When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of:
(1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and
(2) The total of all deductible and self-insured amounts under all that other insurance.
We will share the remaining loss, if any, by the method described in SECTION IV- Business Auto Conditions, B. General Conditions, Other Insurance 5.d.
3. AUTOS RENTED BY EMPLOYEES
Any "auto" hired or rented by your "employee" on your behalf and at your direction will be considered an "auto" you hire.
The SECTION IV- Business Auto Conditions, B.
General Conditions, 5. OTHER INSURANCE Condition is amended by adding the following:
e. If an "employee’s" personal insurance also applies on an excess basis to a covered "auto" hired or rented by your "employee" on your behalf and at your direction, this insurance will be primary to the "employee’s" personal insurance.
Page 2 of 5 Form HA 99 16 12 21
Marnell Gorman
4. AMENDED FELLOW EMPLOYEE EXCLUSION
EXCLUSION 5. - FELLOW EMPLOYEE - of SECTION II - LIABILITY COVERAGE does not apply if you have workers' compensation insurance in-force covering all of your "employees".
Coverage is excess over any other collectible insurance.
5. HIRED AUTO PHYSICAL DAMAGE COVERAGE
If hired "autos" are covered "autos" for Liability Coverage and if Comprehensive, Specified Causes of Loss, or Collision coverages are provided under this Coverage Form for any "auto" you own, then the Physical Damage Coverages provided are extended to "autos" you hire or borrow, subject to the following limit.
The most we will pay for "loss" to any hired "auto" is:
(1) $100,000;
(2) The actual cash value of the damaged or stolen property at the time of the "loss"; or
(3) The cost of repairing or replacing the damaged or stolen property, whichever is smallest, minus a deductible. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage.
No deductible applies to "loss" caused by fire or lightning. Hired Auto Physical Damage coverage is excess over any other collectible insurance.
Subject to the above limit, deductible and excess provisions, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own.
We will also cover loss of use of the hired "auto" if it results from an "accident", you are legally liable and the lessor incurs an actual financial loss, subject to a maximum of $1000 per "accident".
This extension of coverage does not apply to any "auto" you hire or borrow from any of your "employees", partners (if you are a partnership), members (if you are a limited liability company), or members of their households.
6. PHYSICAL DAMAGE - ADDITIONAL
TEMPORARY TRANSPORTATION EXPENSE
COVERAGE
Paragraph A.4.a. of SECTION III - PHYSICAL DAMAGE COVERAGE is amended to provide a limit of $50 per day and a maximum limit of $1,000.
7. LOAN/LEASE GAP COVERAGE
Under SECTION III - PHYSICAL DAMAGE COVERAGE, in the event of a total "loss" to a covered "auto", we will pay your additional legal obligation for any difference between the actual cash value of the "auto" at the time of the "loss" and the "outstanding balance" of the loan/lease.
"Outstanding balance" means the amount you owe on the loan/lease at the time of "loss" less any amounts representing taxes; overdue payments; penalties, interest or charges resulting from overdue payments; additional mileage charges; excess wear and tear charges; lease termination fees; security deposits not returned by the lessor; costs for extended warranties, credit life Insurance, health, accident or disability insurance purchased with the loan or lease; and carry-over balances from previous loans or leases.
8. AIRBAG COVERAGE
Under Paragraph B. EXCLUSIONS - of SECTION III - PHYSICAL DAMAGE COVERAGE, the following is added:
The exclusion relating to mechanical breakdown does not apply to the accidental discharge of an airbag.
9. ELECTRONIC EQUIPMENT - BROADENED
COVERAGE
a. The exceptions to Paragraphs B.4 - EXCLUSIONS - of SECTION III - PHYSICAL DAMAGE COVERAGE are replaced by the following:
Exclusions 4.c. and 4.d. do not apply to equipment designed to be operated solely by use of the power from the "auto's" electrical system that, at the time of "loss", is:
(1) Permanently installed in or upon the covered "auto";
(2) Removable from a housing unit which is permanently installed in or upon the covered "auto";
(3) An integral part of the same unit housing any electronic equipment described in Paragraphs (1) and (2) above; or
(4) Necessary for the normal operation of the covered "auto" or the monitoring of the covered "auto's" operating system.
b. Section III, Physical Damage Coverage, Limit of Insurance, Paragraph C.2. is amended to add the following:
$1,500 is the most we will pay for "loss" in any one "accident" to all electronic equipment (other than equipment designed solely for the reproduction of sound, and accessories used with such equipment) that reproduces, receives or transmits audio, visual or data signals which, at the time of "loss", is:
Form HA 99 16 12 21 Page 3 of 5
(1) Permanently installed in or upon the covered "auto" in a housing, opening or other location that is not normally used by the "auto" manufacturer for the installation of such equipment;
(2) Removable from a permanently installed housing unit as described in Paragraph 2.a. above or is an integral part of that equipment; or
(3) An integral part of such equipment.
c. For each covered "auto", should loss be limited to electronic equipment only, our obligation to pay for, repair, return or replace damaged or stolen electronic equipment will be reduced by the applicable deductible shown in the Declarations, or $250, whichever deductible is less.
10. EXTRA EXPENSE - BROADENED COVERAGE
Under Paragraph A. - COVERAGE - of SECTION III - PHYSICAL DAMAGE COVERAGE, we will pay for the expense of returning a stolen covered "auto" to you.
11. GLASS REPAIR - WAIVER OF DEDUCTIBLE
Under Paragraph D. - DEDUCTIBLE - of
SECTION III - PHYSICAL DAMAGE COVERAGE,
the following is added:
No deductible applies to glass damage if the glass is repaired rather than replaced.
12. TWO OR MORE DEDUCTIBLES
Under Paragraph D. - DEDUCTIBLE - of
SECTION III - PHYSICAL DAMAGE COVERAGE,
the following is added:
If another Hartford Financial Services Group, Inc.
company policy or coverage form that is not an automobile policy or coverage form applies to the same "accident", the following applies:
(1) If the deductible under this Business Auto Coverage Form is the smaller (or smallest) deductible, it will be waived;
(2) If the deductible under this Business Auto Coverage Form is not the smaller (or smallest) deductible, it will be reduced by the amount of the smaller (or smallest) deductible.
13. AMENDED DUTIES IN THE EVENT OF
ACCIDENT, CLAIM, SUIT OR LOSS
The requirement in LOSS CONDITIONS 2.a. -
DUTIES IN THE EVENT OF ACCIDENT, CLAIM,
SUIT OR LOSS - of SECTION IV - BUSINESS AUTO CONDITIONS that you must notify us of an "accident" applies only when the "accident" is known to:
(1) You, if you are an individual;
(2) A partner, if you are a partnership;
(3) A member, if you are a limited liability company; or
(4) An executive officer or insurance manager, if you are a corporation.
14. UNINTENTIONAL FAILURE TO DISCLOSE
HAZARDS
If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure.
15. HIRED AUTO - COVERAGE TERRITORY
SECTION IV, BUSINESS AUTO CONDITIONS,
PARAGRAPH B. GENERAL CONDITIONS, 7. -
POLICY PERIOD, COVERAGE TERRITORY - is added to include the following:
(6) For short-term hired "autos", the coverage territory with respect to Liability Coverage is anywhere in the world provided that if the "insured's" responsibility to pay damages for "bodily injury" or "property damage" is determined in a "suit," the "suit" is brought in the United States of America, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to.
16. WAIVER OF SUBROGATION
Paragraph 5. TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - of
SECTION IV - BUSINESS AUTO CONDITIONS
A. Loss Conditions is amended by adding the following:
We waive any right of recovery we may have against any person or organization with whom you have a written contract that requires such waiver because of payments we make for damages under this Coverage Form.
17. RESULTANT MENTAL ANGUISH COVERAGE
The definition of "bodily injury" in SECTION V- DEFINITIONS, C. is replaced by the following:
"Bodily injury" means bodily injury, sickness or disease sustained by any person, including mental anguish or death resulting from any of these.
18. EXTENDED CANCELLATION CONDITION
Paragraph 2. of the COMMON POLICY CONDITIONS - CANCELLATION - applies except as follows:
If we cancel for any reason other than nonpayment of premium, we will mail or deliver to the first Named Insured written notice of cancellation at least 60 days before the effective date of cancellation.
Page 4 of 5 Form HA 99 16 12 21
Danelle.Touchstone Highlight
Danelle.Touchstone
19. HYBRID, ELECTRIC, OR NATURAL GAS
VEHICLE PAYMENT COVERAGE
In the event of a total loss to a "non-hybrid" auto for which Comprehensive, Specified Causes of Loss, or Collision coverages are provided under this Coverage Form, then such Physical Damage Coverages are amended as follows:
a. If the auto is replaced with a "hybrid" auto or an auto powered solely by electricity or natural gas, we will pay an additional 10%, to a maximum of $2,500, of the "non-hybrid" auto’s actual cash value or replacement cost, whichever is less,
b. The auto must be replaced and a copy of a bill of sale or new lease agreement received by us within 60 calendar days of the date of "loss,"
c. Regardless of the number of autos deemed a total loss, the most we will pay under this Hybrid, Electric, or Natural Gas Vehicle Payment Coverage provision for any one "loss" is $10,000.
For the purposes of the coverage provision,
a. A "non-hybrid" auto is defined as an auto that uses only an internal combustion engine to move the auto but does not include autos powered solely by electricity or natural gas.
b. A "hybrid" auto is defined as an auto with an internal combustion engine and one or more electric motors; and that uses the internal combustion engine and one or more electric motors to move the auto, or the internal combustion engine to charge one or more electric motors, which move the auto.
20. VEHICLE WRAP COVERAGE
In the event of a total loss to an "auto" for which Comprehensive, Specified Causes of Loss, or Collision coverages are provided under this Coverage Form, then such Physical Damage Coverages are amended to add the following:
In addition to the actual cash value of the "auto", we will pay up to $1,000 for vinyl vehicle wraps which are displayed on the covered "auto" at the time of total loss. Regardless of the number of autos deemed a total loss, the most we will pay under this Vehicle Wrap Coverage provision for any one "loss" is $5,000. For purposes of this coverage provision, signs or other graphics painted or magnetically affixed to the vehicle are not considered vehicle wraps.
Form HA 99 16 12 21 Page 5 of 5
Endorsement Title
Additional Insured – Owners, Lessees or Contractors – Completed Operations Amendatory Endorsement Named Insured
INTERA, Inc.
Endorsement Number
Policy Form
GAPLESS
Policy Number
ENVP0000254-24
Policy Period
06/01/2024 to 06/01/2025 Enviant Endorsement Number
GAP 10 04 6/1/2020
Issued by
Certain Underwriters at Lloyd’s, London/ Hudson Excess Insurance Company
Effective Date of Endorsement
06/01/2024
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – COMPLETED OPERATIONS
AMENDATORY ENDORSEMENT
Solely with respect to §I. COVERAGES, Section 1. COMMERCIAL GENERAL LIABILITY AND POLLUTION LIABILITY the Policy is amended as follows:
SCHEDULE
Name of Additional Insured Person(s) or Organization(s)
Location and Description of Completed Operations
Where required by written insured contract All locations
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
1. §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 bodily injury, property damage or environmental damage caused, in whole or in part, by your work at the location designated and described in the schedule of this endorsement performed for that additional insured and that is included in the products-completed operations hazard.
2. Notwithstanding §VI. CONDITIONS, Paragraph I. Other Insurance, with respect to the insurance afforded to the additional insureds added by this Endorsement, this Policy shall be primary to, and non-contributory with, any other insurance available to that person or organization when required by written insured contract.
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED.
Additional Insured Primary and Non-Contributory Amendatory Endorsement Named Insured
INTERA, Inc.
Endorsement Number
Policy Form
GAPLESS
Policy Number
ENVP0000254-24
Policy Period
06/01/2024 to 06/01/2025 Enviant Endorsement Number
GAP 10 05 7/1/2019
Issued by
Certain Underwriters at Lloyd’s, London/ Hudson Excess Insurance Company
ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY AMENDATORY ENDORSEMENT
LIABILITY, Coverage 1A - General Liability and Section 2. OTHER LIABILITY COVERAGES, Coverage 2A - Personal and Advertising Injury the Policy is amended as follows:
Name of Additional Insured Person(s) or Organization(s)
Where required by written insured contract
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
1. The person(s) or organization(s) shown in the Schedule above are insureds under §III. WHO IS AN INSURED Paragraph F. of this Policy subject to all of the terms and condition of such paragraph.
2. Notwithstanding §VI. CONDITIONS, Paragraph I. Other Insurance, with respect to the insurance afforded to the additional insureds added by this Endorsement, this Policy shall be primary to, and non-contributory with, any other insurance available to that person or organization when required by written insured contract.
Advice of Cancellation Amendatory Endorsement Named Insured
INTERA, Inc.
Endorsement Number
Policy Form
GAPLESS
Policy Number
ENVP0000254-24
Policy Period
06/01/2024 to 06/01/2025 Enviant Endorsement Number
GAP 10 07 6/1/2016
Issued by
Certain Underwriters at Lloyd’s, London/ Hudson Excess Insurance Company
ADVICE OF CANCELLATION AMENDATORY ENDORSEMENT
It is hereby agreed that §VI. CONDITIONS is amended by the addition of the following:
In the event that we cancel this Policy for any reason other than non-payment of premium, and
1. the cancellation effective date is prior to this Policy's expiration date;
2. you are under an existing contractual obligation to notify a certificate holder when this Policy is canceled (hereinafter, the "Certificate Holder(s)") and have provided to us, either directly or through your broker of record, the email address of a contact at each such entity; and
3. we received this information after you received notice of cancellation of this Policy and prior to this Policy's cancellation effective date, via an electronic spreadsheet that is acceptable to us, we will provide advice of cancellation (the "Advice") via e-mail to each such Certificate Holders within 30 days after you provide such information to us.
Proof of our emailing the Advice, using the information provided by you, will serve as proof that we have fully satisfied our obligations under this Endorsement.
This Endorsement does not affect, in any way, coverage provided under this Policy or the cancellation of this Policy or the effective date thereof, nor shall this Endorsement invest any rights in any entity not insured under this Policy.
Certificate Holder:
Blanket where required by written insured contract
Additional Insured – Owners, Lessees or Contractors – On-Going Operations Amendatory Endorsement Named Insured
INTERA, Inc.
Endorsement Number
Policy Form
GAPLESS
Policy Number
ENVP0000254-24
Policy Period
06/01/2024 to 06/01/2025 Enviant Endorsement Number
GAP 10 28 7/1/2019
Issued by
Certain Underwriters at Lloyd’s, London/ Hudson Excess Insurance Company
ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – ON-GOING OPERATIONS
AMENDATORY ENDORSEMENT
LIABILITY the Policy is amended as follows:
Name of Additional Insured Person(s) or Organization(s)
Where required by written insured contract
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
1. §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 bodily injury, property damage or environmental damage caused, in whole or in part, by your work that is not included in the products-completed operations hazard.
Blanket Waiver of Subrogation Condition Amendatory Endorsement Named Insured
INTERA, Inc.
Endorsement Number
Policy Form
GAPLESS
Policy Number
ENVP0000254-24
Policy Period
06/01/2024 to 06/01/2025 Enviant Endorsement Number
GAP 10 30 6/1/2016
Issued by
Certain Underwriters at Lloyd’s, London/ Hudson Excess Insurance Company
BLANKET WAIVER OF SUBROGATION CONDITION AMENDATORY ENDORSEMENT
It is hereby agreed that §VI. CONDITIONS Paragraph O. Subrogation is deleted in its entirety and replaced with the following:
O. Subrogation If the insured has rights to recover all or part of any payment we have made under this Policy, those rights are transferred to us and the insured shall not do anything to impair such rights. At our request, the insured will bring suit or transfer those rights to us and help us enforce them. Any amounts so recovered by us shall be allocated first to the expenses incurred in such recovery prorated in accordance with each interested party's share in the total recovery, then to the insured to the extent of any Deductible it actually has paid and any payments it actually has made in excess of the applicable Limits of Liability, and last to us to the extent of our payment under this Policy. However, if the insured has waived rights of recovery against any person or organization in a written insured contract or agreement prior to a claim or loss, we also waive such right of recovery we may have under this Policy against such person or organization.
Countersigned by
Authorized Representative
Form WC 00 03 13 Printed in U.S.A.
Process Date: 05/03/24 Policy Expiration Date: 06/01/25
WAIVER OF OUR RIGHT TO RECOVER
FROM OTHERS ENDORSEMENT
Policy Number: 65 WB OL6H7Y Endorsement Number:
Effective Date: 06/01/24 Effective hour is the same as stated on the Information Page of the policy.
Named Insured and Address: INTERA Incorporated
9600 GREAT HILLS TRL
AUSTIN TX 78759
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule.
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
SCHEDULE
Any person or organization for whom you are required by contract or agreement to obtain this waiver from us.
Endorsement is not applicable in KY, NH, NJ or for any MO construction risk
Form WC 42 03 04 B Printed in U.S.A.
Process Date: 05/03/24 Policy Expiration Date: 06/01/25
TEXAS WAIVER OF OUR RIGHT TO
RECOVER FROM OTHERS ENDORSEMENT
Policy Number: 65 WB OL6H7Y Endorsement Number:
Effective Date: 06/01/24 Effective hour is the same as stated on the Information Page of the policy.
Named Insured and Address: INTERA Incorporated
9600 GREAT HILLS TRL
AUSTIN TX 78759
This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page.
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us.
This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
The premium for this endorsement is shown in the Schedule.
Schedule
1. ( ) Special Waiver Name of person or organization
(X) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver.
2. Operations:
All Texas Operations
3. Premium:
The premium charge for this endorsement shall be 2 percent of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described.
4. Advance Premium:
Countersigned by
Authorized Representative
Form WC 04 03 06 (1) Printed in U.S.A.
Process Date: 05/03/24 Policy Expiration Date: 06/01/25
WAIVER OF OUR RIGHT TO RECOVER FROM
OTHERS ENDORSEMENT - CALIFORNIA
Policy Number: 65 WB OL6H7Y Endorsement Number:
Effective Date: 06/01/24 Effective hour is the same as stated on the Information Page of the policy.
Named Insured and Address: INTERA Incorporated
9600 GREAT HILLS TRL
AUSTIN TX 78759
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.)
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule.
The additional premium for this endorsement shall be 2 % of the California workers' compensation premium otherwise due on such remuneration.
SCHEDULE
Person or Organization Job Description
Any person or organization for whom you are required by written contract or agreement to obtain this waiver of rights from us
Job 1: Arizona Department of
File details come from the government source that posted it. Updated .