24-25_Master_-_State_of_Arizona_Dept_of_Child_Safety_Redacted.pdf

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.

(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)

Endorsement Effective 08/18/2024 Policy No. WC1021108 Endorsement No. 2 Insured Hosanna House LLC Premium $ 100.00

Insurance Company CopperPoint Indemnity Insurance Company Countersigned by

Authorized Representative

WC 00 03 13

(Ed. 04-1984)

© Copyright 1983 National Council on Compensation Insurance, Inc. All Rights Reserved.

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

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.)

This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.

Schedule

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

BA 108 01 01 19 Includes copyrighted material of Insurance Services Office, Inc. with permission. Page 1 of 5

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY

SOCIAL SERVICES AUTO ENHANCEMENT ENDORSEMENT

This endorsement modifies insurance provided under the:

BUSINESS AUTO COVERAGE FORM

With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement.

1. TEMPORARY SUBSTITUTE AUTOS PHYSICAL

DAMAGE

The following is added to Section I – Covered Autos:

D. Temporary Substitute Autos – Physical Damage

If Physical Damage Coverage is provided by this Coverage Form for an “auto” you own and that covered "auto" is out of service because of its:

1. Breakdown;

2. Repair;

3. Servicing;

4. “Loss”; or

5. Destruction

Then in that event, Physical Damage Coverage is provided for an "auto" you do not own while it is being used with the permission of its owner as a temporary substitute “auto” for the out of service covered "auto". We will pay the owner for “loss” to the temporary substitute “auto”. This insurance covers the interest of the owner unless the “loss” results from fraudulent acts or omissions on your part. If we make any payment to the owner, we will obtain the owner's rights against any other party.

2. EMPLOYEES OR VOLUNTEER WORKERS AS

INSUREDS

The following is added to Paragraph A.1. Who Is An Insured of Section II – Covered Autos Liability Coverage:

d. Your “employee” or “volunteer worker” while using a covered “auto” you do not own, hire or borrow while performing duties related to the conduct of your business.

This insurance shall be excess over any other valid and collectible insurance.

3. BOARD MEMBERS

The following is added to Paragraph A.1. Who Is An Insured of Section II – Covered Autos Liability Coverage:

e. Your elected or appointed board members while using a covered “auto” you do not own, hire or borrow, while performing duties related to the conduct of your business. Anyone else who furnishes that “auto” is also an “insured”.

This insurance shall be excess over any other valid and collectible insurance.

4. ADDITIONAL INSUREDS – CONTRACT,

AGREEMENT OR PERMIT

The following is added to Paragraph A.1. Who Is An Insured of Section II – Covered Autos Liability Coverage:

f. Any person or organization with whom you agreed, in a written contract, agreement or permit, to provide insurance such as is afforded under this Coverage Part, but only with respect to your ownership, maintenance or use of a covered “auto”. This provision only applies if the written contract or agreement has been executed or permit issued prior to the “bodily injury” or “property damage”.

BA 108 01 01 19 Includes copyrighted material of Insurance Services Office, Inc. with permission. Page 2 of 5

This coverage shall be primary and not contributory with respect to the person or organization included as an “insured” under this section. Any other insurance that person or organization has shall be excess and not contributory with respect to this insurance, but this provision only applies if it is required in the written contract, agreement or permit identified in this section, and is permitted by law.

g. A “Funding Source” being any person or organization with respect to their liability arising out of their financial control of you.

5. EMPLOYEE HIRED AUTOS - LIABILITY

The following is added to Paragraph A.1. Who Is An Insured of Section II – Covered Autos Liability Coverage:

h. An “employee”, an elected or appointed official of yours, or a commissioner, officer or member of your commissions, authorities, boards or agencies while operating a covered “auto” hired or rented under a written contract or agreement in the name of that “employee” or elected or appointed official, with your permission, while performing duties related to the conduct of your business.

This coverage shall be primary and not contributory with respect to the person or organization included as an “insured” under this section. Any other insurance that person or organization has shall be excess and not contributory with respect to this insurance, but this provision only applies if it is required in the written contract, agreement or permit identified in this section, and is permitted by law.

6. SUPPLEMENTARY PAYMENTS

Paragraphs a.(2) and a.(4) of Supplementary Payments in Paragraph A.2. Coverage Extensions of Section II – Covered Autos Liability Coverage are deleted and replaced by the following:

(2) Up to $5,000 for cost of bail bonds (including bonds for related traffic law violations) required because of an “accident” we cover. We do not have to furnish these bonds.

(4) All reasonable expenses incurred by the “insured” at our request, including actual loss of earnings up to $400 a day because of time off from work.

7. FELLOW EMPLOYEE

Paragraph B.5. Exclusions of Section II – Covered Autos Liability Coverage is deleted.

8. TOWING AND GLASS BREAKAGE

Paragraph A.2. Towing of Section III – Physical Damage Coverage is deleted and replaced by the following:

2. Towing

We will pay up to $250 per disablement for towing and labor costs incurred each time a covered “auto” is disabled. However, the labor must be performed at the place of disablement.

Paragraph A.3. Glass Breakage of Section III – Physical Damage Coverage is deleted and replaced by the following:

3. Glass Breakage – Hitting A Bird Or Animal

– Falling Objects Or Missiles

If you carry Comprehensive Coverage for the damaged covered "auto", we will pay for the following under Comprehensive Coverage, without application of a deductible:

a. Glass breakage; or

b. "Loss" caused by hitting a bird or animal;

and

c. "Loss" caused by falling objects or missiles.

However, you have the option of having glass breakage caused by a covered "auto's" collision or overturn considered a "loss" under Collision Coverage.

9. PHYSICAL DAMAGE – TRANSPORTATION

EXPENSE COVERAGE

Paragraph A.4.a. Transportation Expenses of Section III – Physical Damage Coverage is deleted and replaced by the following:

a. Transportation Expenses

We will pay up to $50 per day/$1,500 maximum per policy period for temporary transportation expense incurred by you because of the total theft of a covered “auto”. We will pay only for those covered “autos” for which you carry either Comprehensive or Specified Causes Of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 24 hours after the theft and ending, regardless of the policy’s expiration, BA 108 01 01 19 Includes copyrighted material of Insurance Services Office, Inc. with permission. Page 3 of 5 when the covered “auto” is returned to use or we pay for its “loss”.

10. PHYSICAL DAMAGE – LOSS OF USE

EXPENSES

Paragraph A.4.b. Loss Of Use Expenses of Section III – Physical Damage Coverage is deleted and replaced by the following:

b. Loss Of Use Expenses

For Hired Auto Physical Damage, we will pay expenses for which an “insured” becomes legally responsible to pay for loss of use of a vehicle rented or hired without a driver, under a written rental contract or agreement. We will pay for loss of use expenses if caused by:

(1) Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for any covered “auto”;

(2) Specified Causes Of Loss only if the Declarations indicates that Specified Causes Of Loss Coverage is provided for any covered “auto”; or

(3) Collision only if the Declarations indicate that Collision Coverage is provided for any covered “auto”.

However, the most we will pay for any expenses for loss of use is $50 per day, subject to a maximum of $1,500 per policy period.

11. COVERAGE EXTENSIONS – PHYSICAL

DAMAGE

The following are added to Paragraph A.4.

Coverage Extensions of Section III – Physical Damage Coverage:

c. Rental Reimbursement

We will pay for rental reimbursement expenses incurred by you for the rental of an “auto” because of “loss” to a covered “auto”. We will pay a maximum of $30 per day for a maximum period of 30 days for each covered auto. The most we will pay for rental reimbursement expenses because of "loss" to any one covered "auto" during the policy term is $3,000. No deductible applies to this coverage.

d. Personal Effects

If Comprehensive Coverage is provided on this coverage form for a covered “auto” you own and that covered “auto” is stolen, we will pay, without application of a deductible, up to

$1,000 for personal effects stolen with that covered “auto”. This coverage is excess over any other collectible insurance. Personal effects do not include tools, jewelry, money or securities.

e. Hired Auto Physical Damage

Physical Damage Coverage is provided for covered “autos” you hire without drivers to the same extent as Physical Damage Coverage for covered “autos" you own, except:

(1) The most we will pay for “loss” in any one “accident” is the lesser of:

(a) The actual cash value of the damaged or stolen property as of the time of the “loss”; or

(b) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality less the Deductible shown on the Declarations page of the policy. This deductible is applicable to any “loss” except “loss” caused by fire or lightning.

(2) Subject to Paragraph e.(1) of this endorsement, we will provide coverage equal to the broadest Physical Damage coverage applicable to any covered “auto".

f. Limited Physical Damage Deductible Coverage For Employees Or Volunteer Workers

At your request, we will pay up to $1,000 as reimbursement of deductible payments made by your "employee" or “volunteer worker” under the Physical Damage Coverage of the "employee's" or “volunteer worker’s” policy of automobile insurance but only if:

(1) The "loss" is to an "auto" owned by the "employee" or “volunteer worker” but not hired or borrowed by you; and

(2) The "auto" was being used at the time of the “loss” in the course and scope of the “employee's” employment by you or while the “volunteer worker” was performing duties related to the conduct of your business. With regards to this endorsement, travel to and from a normal place of employment is not within the course and scope of employment by you unless such travel is in response to an emergency summons of that “employee” or “volunteer worker”.

BA 108 01 01 19 Includes copyrighted material of Insurance Services Office, Inc. with permission. Page 4 of 5

12. LOAN/LEASE GAP

Paragraph A.5. Loan/Lease Gap is added to Section III - Physical Damage Coverage.

5. In the event of a total "loss" to a covered "auto" shown in the Schedule or Declarations for which a specific premium charge indicates that Auto Loan/Lease GAP Coverage applies, we will pay any unpaid amount due on the lease or loan for a covered "auto", less:

a. The amount paid under the Physical Damage Coverage Section of the policy;

and

b. Any:

(1). Overdue lease/loan payments at the time of the "loss";

(2). Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage.

(3). Security deposits not returned by the lessor;

(4). Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and

(5). Carry-over balances from previous loans or leases.

13. AIRBAG COVERAGE AND FREEZING OF

PERMANENTLY ATTACHED EQUIPMENT

The following is added to Paragraph B.3.a. of Section III – Physical Damage Coverage:

The exclusion relating to mechanical breakdown does not apply to the accidental discharge of an airbag.

The exclusion relating to freezing does not apply to any “loss” caused by freezing to permanently attached special equipment common to a fire or rescue emergency vehicle, unless the “loss” is caused by your failure to properly maintain such equipment. Such equipment includes, but is not limited to, pumps, gauges, valves, fill lines, drains and tanks. In no event will any “loss” caused by freezing to an automobile engine be covered by this policy.

14. ELECTRONIC EQUIPMENT – BROADENED

COVERAGE

Paragraph B.4.c. of Section III – Physical Damage Coverage is deleted and replaced by the following:

c. Any electronic equipment that receives or transmits audio, visual or data signals, and that is not designed solely for the reproduction of sound unless permanently installed in the covered “auto” or unless the housing unit for removable equipment is permanently installed in the covered “auto”.

15. PHYSICAL DAMAGE – COMPREHENSIVE

COVERAGE – DEDUCTIBLE

The following is added to Paragraph D. Deductible of Section III – Physical Damage Coverage:

Regardless of the number of covered “autos” damaged or stolen, the maximum deductible that will be applied to Comprehensive Coverage for all “loss” from any one cause is $5,000.

16. KNOWLEDGE AND NOTICE OF ACCIDENT

The following is added to Paragraph A.2. Duties In The Event Of Accident, Claim, Suit Or Loss of Section IV. Business Auto Conditions:

d. The failure of any agent, servant, “volunteer worker” or “employee” of the “insured”, other than an “employee” authorized by you to give or receive notice of an “accident”, claim, “suit” or “loss”, to notify us of any “accident” of which he or she has knowledge, shall not invalidate insurance afforded by this policy.

17. EMPLOYEE HIRED AUTOS – PHYSICAL

DAMAGE

Paragraph B.5. Other Insurance, subparagraph b.

of Section IV – Business Auto Conditions, is deleted and replaced by the following:

b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered “autos” you own:

(1) Any covered “auto” you lease, hire, rent or borrow; and

(2) Any “auto” hired or rented under a written contract or agreement entered into by an “employee” or elected or appointed official with your permission while being operated within the course and scope of that "employee's" or elected or appointed official’s employment by you.

However, any “auto” that is leased, hired, rented or borrowed with a driver is not a covered “auto”.

BA 108 01 01 19 Includes copyrighted material of Insurance Services Office, Inc. with permission. Page 5 of 5

18. VOLUNTEER WORKER

The following is added to Section V – Definitions:

“Volunteer worker” means a person who is not your “employee”, and who donates his or her work and acts at the direction of and within the scope of duties determined by you, and is not paid a fee, salary or other compensation by you or anyone else for their work performed for you.

All other terms and conditions of the policy remain the same.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

COMMERCIAL GENERAL LIABILITY

CG 24 04 12 19

POLICY NUMBER:

© Insurance Services Office, Inc., 2018 Page of CG 24 04 12 19

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US (WAIVER OF SUBROGATION)

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

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.

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

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

1 1

C1GP506677

The state of Arizona, it's departments, agencies, Boards, commissions, universities and it's Officers, officials, agents, and employees as additional insureds with liability arising out of the activities performed on or on behalf

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

COMMERCIAL GENERAL LIABILITY

CG 20 26 12 19

POLICY NUMBER:

© Insurance Services Office, Inc., 2018 Page of CG 20 26 12 19

ADDITIONAL INSURED – DESIGNATED

PERSON OR ORGANIZATION

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE

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.

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

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

The state of Arizona, it's departments, agencies, Boards, commissions, universities and it's Officers, officials, agents, and employees as additional insureds with liability arising out of the activities performed on or on behalf of the contractor.

C1GP506677

1 1