ACCEPTED ANY_ALL GL,AL,WC 11.20.24-11.20.25.pdf
PDF 9 MB Posted
- Attached to
- Master Agreement AZ|CTR068342
- Contract number
- CTR068342
- Issued by
- Arizona
About this file
The document is a Certificate of Liability Insurance (ACORD 25 form) for Rogue Services LLC, a business located in Goodyear, Arizona. The insurance policy is issued by Liberty Mutual Insurance and provides coverage for the State of Arizona-ADOT (Arizona Department of Transportation). The certificate includes commercial general liability, automobile liability, umbrella liability, and workers' compensation insurance with an effective period from 11/20/2024 to 11/20/2025.
The insurance policy provides several key coverages with specific limits: $1,000,000 for commercial general liability and automobile liability per occurrence, $5,000,000 for umbrella liability, and workers' compensation coverage. The State of Arizona-ADOT is listed as an additional insured on the policy, with coverage applying on a primary and non-contributory basis when required by written contract. The policy includes a waiver of subrogation for general liability, commercial auto, and workers' compensation in favor of the State of Arizona-ADOT. The certificate also notes that the umbrella liability includes general liability, auto liability, and workers' compensation as underlying policies when required by written contract.
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Text version
ROGUSER-01 HBERANEK
ACORD9
CERTIFICATE OF LIABILITY INSURANCE I
DATE (MM/DD/YYYY)
~ 1/9/2025
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 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).
PRODUCER ~2~I~cT Haylie Beranek LeBaron & Carroll LLC
~g,Nrio, Ext): (480) 834-9315 I
FAX
1350 E Southern Avenue (A/C, No):
Mesa, AZ 85204 io'i>1!~ss: haylie@lebaroncarroll.com
INSURER@ AFFORDING COVERAGE NAIC#
INSURER A : Liberty Mutual 23403
INSURED INSURERB :
Rogue Services LLC INSURERC :
1830 S 174th Lane INSURERD :
Goodyear, AZ 85338
INSURERE :
INSURERF :
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.
l~J: TYPE OF INSURANCE ~9.P~ ~~ POLICY NUMBER
POUCYEFF POLICY EXP
LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
□ CLAIMS-MADE [K] OCCUR DAMAGE TO RENTED 300,000 X X BKA2568171079 11/20/2024 11/20/2025 PREMISES (Ea occurrence\ $
MED EXP (Anv one person) $ 10,000
1,000,000 PERSONAL & ADV INJURY $
2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ Fl POLICY □ ~r8r D Loc PRODUCTS - COMP/OP AGG $ 2,000,000
OTHER: HNOA $ 1,000,000
A AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
_(Ea accident\ $ 1,000,000
X ANY AUTO X X AZG68171079 11/20/2024 11/20/2025 BODILY INJURY (Per person) $
OWNED
SCHEDULED
AUTOS ONLY
AUTOS BODILY INJURY /Per accident) $ HIRED ~8roiii1~ fp~?~~~d~NAMAGE $
~ AUTOS ONLY ~
Deductible: $ 5,000
A X UMBRELLA LIAB
OCCUR EACH OCCURRENCE $ 5,000,000
USO2568171079 11/20/2024 11/20/2025 5,000,000 EXCESSLIAB CLAIMS-MADE AGGREGATE $
DED I X I RETENTION $ 10,000 $
A WORKERS COMPENSATION X I ~ifTUTE I I OTH-
AND EMPLOYERS' LIABILITY ER
Y/N X XWW2568171079 11/20/2024 11/20/2025 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE [[] E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? N/A
1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) State of Arizonia-ADOT is listed as additional insured as it pertains to general liability & Commercial Auto when required by written contract per attached form(s). State of Arizonia-ADOT is insured on the general liability policy on a primary and non-contributory basis when required by written contract per attached form(s) A Waiver of Subrogation exists on this policy as it pertains to general liability, Commercial Auto, & Workers Compensation in favor of State of Arizonia-ADOT when required by written contract per attached form(s). Umbrella Liability includes General Liability, Auto Liability, and Workers Compensation as an underlying policy when required by written contract per attached form(s).
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
State of Arizona-ADOT
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
206 S. 17th Ave Phoenix, AZ 85007
AUTHORIZED REPRESENTATIVE
I
ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Cindy Lewis Accepted
COMMERCIAL GENERAL LIABILITY
CG 88 10 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL GENERAL LIABILITY EXTENSION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
INDEX
SUBJECT
NON-OWNED AIRCRAFT
PAGE
- NON-OWNED WATERCRAFT 2
I----------
PROPERTY DAMAGE LIABILITY - ELEVATORS
EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage)
MEDICAL PAYMENTS EXTENSION
EXTENSION OF SUPPLEMENTARY PAYMENTS - COVERAGES A AND B
ADDITIONAL INSUREDS - BY CONTRACT, AGREEMENT OR PERMIT
PRIMARY AND NON-CONTRIBUTORY- ADDITIONAL INSURED EXTENSION
ADDITIONAL INSUREDS - EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE"
WHO IS AN INSURED - INCIDENTAL MEDICAL ERRORS/MALPRACTICE AND WHO IS AN
INSURED - FELLOW EMPLOYEE EXTENSION - MANAGEMENT EMPLOYEES
NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES
FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES
KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT
LIBERALIZATION CLAUSE
BODILY INJURY REDEFINED
EXTENDED PROPERTY DAMAGE
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US -
WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU
© 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission.
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With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement.
A. NON-OWNED AIRCRAFT
Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability, exclusion g. Aircraft, Auto Or Watercraft does not apply to an aircraft provided:
1. It is not owned by any insured;
2. It is hired, chartered or loaned with a trained paid crew;
3. The pilot in command holds a currently effective certificate, issued by the duly constituted authority of the United States of America or Canada, designating her or him a commercial or airline pilot; and
4. It is not being used to carry persons or property for a charge.
However, the insurance afforded by this provision does not apply if there is available to the insured other valid and collectible insurance, whether primary, excess (other than insurance written to apply specifically in excess of this policy), contingent or on any other basis, that would also apply to the loss covered under this provision.
B. NON-OWNED WATERCRAFT
Under Paragraph 2. Exclusions of Section 1- Coverage A- Bodily Injury And Property Damage Liability, Subparagraph (2) of exclusion g. Aircraft, Auto Or Watercraft is replaced by the following:
This exclusion does not apply to:
(2) A watercraft you do not own that is:
(a) Less than 52 feet long; and
(b) Not being used to carry persons or property for a charge.
C. PROPERTY DAMAGE LIABILITY - ELEVATORS
1. Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liabil ity, Subparagraphs (3), (4) and (6) of exclusion j. Damage To Property do not apply if such "property damage" results from the use of elevators. For the purpose of this provision, elevators do not include vehicle lifts. Vehicle lifts are lifts or hoists used in automobile service or repair operations.
2. The following is added to Section IV - Commercial General Liability Conditions, Condition 4. Other Insurance, Paragraph b. Excess Insurance:
The insurance afforded by this provision of this endorsement is excess over any property insurance, whether primary, excess, contingent or on any other basis.
D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage)
If Damage To Premises Rented To You is not otherwise excluded from this Coverage Part:
1. Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury and Property Damage Liability:
a. The fourth from the last paragraph of exclusion j. Damage To Property is replaced by the follow ing:
Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire, lightning, explosion, smoke, or leakage from an automatic fire protection system) to:
(i) Premises rented to you for a period of 7 or fewer consecutive days; or
(ii) Contents that you rent or lease as part of a premises rental or lease agreement for a period of more than 7 days.
Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" to contents of premises rented to you for a period of 7 or fewer consecutive days.
A separate limit of insurance applies to this coverage as described in Section Ill - Limits of Insurance.
© 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 8
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E.
b. The last paragraph of subsection 2. Exclusions is replaced by the following:
Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke or leakage from automatic fire protection systems to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to Damage To Premises Rented To You as described in Section Ill - Limits Of Insurance.
2. Paragraph 6. under Section Ill - Limits Of Insurance is replaced by the following:
6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to:
a. Any one premise:
(1) While rented to you; or
(2) While rented to you or temporarily occupied by you with perm1ss1on of the owner for damage by fire, lightning, explosion, smoke or leakage from automatic protection sys tems; or
b. Contents that you rent or lease as part of a premises rental or lease agreement.
3. As regards coverage provided by this provision D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) - Paragraph 9.a. of Definitions is replaced with the following:
9.a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, or leakage from automatic fire protection systems to premises while rented to you or temporarily occupied by you with the permission of the owner, or for damage to contents of such premises that are included in your premises rental or lease agreement, is not an "insured contract".
MEDICAL PAYMENTS EXTENSION
If Coverage C Medical Payments is not otherwise excluded, the Medical Payments provided by this policy are amended as follows:
Under Paragraph 1. Insuring Agreement of Section I - Coverage C - Medical Payments, Subparagraph
(b) of Paragraph a. is replaced by the following:
(b) The expenses are incurred and reported within three years of the date of the accident; and
F. EXTENSION OF SUPPLEMENTARY PAYMENTS -COVERAGESAAND B
1. Under Supplementary Payments - Coverages A and B, Paragraph 1.b. is replaced by the following:
b. Up to $3,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds.
2. Paragraph 1.d. is replaced by the following:
d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $500 a day because of time off from work.
G. ADDITIONAL INSUREDS - BY CONTRACT, AGREEMENT OR PERMIT
1. Paragraph 2. under Section II - Who Is An Insured is amended to include as an insured any person or organization whom you have agreed to add as an additional insured in a written contract, written agreement or permit. Such person or organization is an additional insured but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused in whole or in part by:
a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your on going operations for the additional insured that are the subject of the written contract or written agreement provided that the "bodily injury" or "property damage" occurs, or the "per sonal and advertising injury" is committed, subsequent to the signing of such written contract or written agreement; or
© 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 8
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b. Premises or facilities rented by you or used by you; or
c. The maintenance, operation or use by you of equipment rented or leased to you by such person or organization; or
d. Operations performed by you or on your behalf for which the state or political subdivision has issued a permit subject to the following additional provisions:
(1) This insurance does not apply to "bodily injury", "property damage", or "personal and ad vertising injury" arising out of the operations performed for the state or political subdivision;
(2) This insurance does not apply to "bodily injury" or "property damage" included within the "completed operations hazard".
(3) Insurance applies to premises you own, rent, or control but only with respect to the following hazards:
(a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners, or decorations and similar expo sures; or
(b) The construction, erection, or removal of elevators; or
(c) The ownership, maintenance, or use of any elevators covered by this insurance.
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 insur ance 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.
With respect to Paragraph 1.a. above, a person's or organization's status as an additional insured under this endorsement ends when:
(1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or
(2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project.
With respect to Paragraph 1.b. above, a person's or organization's status as an additional insured under this endorsement ends when their written contract or written agreement with you for such premises or facilities ends.
With respects to Paragraph 1.c. above, this insurance does not apply to any "occurrence" which takes place after the equipment rental or lease agreement has expired or you have returned such equipment to the lessor.
The insurance provided by this endorsement applies only if the written contract or written agreement is signed prior to the "bodily injury" or "property damage".
We have no duty to defend an additional insured under this endorsement until we receive written notice of a "suit" by the additional insured as required in Paragraph b. of Condition 2. Duties In the Event Of Occurrence, Offense, Claim Or Suit under Section IV - Commercial General Liability Condi tions.
CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 8
2. With respect to the insurance provided by this endorsement, the following are added to Paragraph 2.
Exclusions under Section I - Coverage A - Bodily Injury And Property Damage Liability:
This insurance does not apply to:
a. "Bodily injury" or "property damage" arising from the sole negligence of the additional insured.
b. "Bodily injury" or "property damage" that occurs prior to you commencing operations at the location where such "bodily injury" or "property damage" occurs.
c. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the render ing of, or the failure to render, any professional architectural, engineering or surveying services, including:
(1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or
(2) Supervisory, inspection, architectural or engineering activities.
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occur rence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of, or the failure to render, any professional architectural , engineering or surveying services.
d. "Bodily injury" or "property damage" occurring after:
e.
(1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or
(2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project.
Any person or organization specifically designated as an additional insured for ongoing operations by a separate ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS endorsement is sued by us and made a part of this policy.
3. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill
- 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:
a. Required by the contract or agreement; or
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 Declaratio ns.
H. PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED EXTENSION
This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this policy.
Condition 4. Other Insurance of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is amend ed as follows:
a. The following is added to Paragraph a. Primary Insurance:
If an additional insured's policy has an Other Insurance provision making its policy excess, and you have agreed in a written contract or written agreement to provide the additional insured coverage on a primary and noncontributory basis, this policy shall be primary and we will not seek contribution from the additional insured's policy for damages we cover.
© 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 8
b. The following is added to Paragraph b. Excess Insurance:
When a written contract or written agreement, other than a premises lease, facilities rental contract or agreement, an equipment rental or lease contract or agreement, or permit issued by a state or political subdivision 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 addi tional 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.
I. ADDITIONAL INSUREDS - EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE"
This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this policy.
1. The following is added to Condition 2. Duties In The Event Of Occurrence, Offense, Claim or Suit:
An additional insured under this endorsement will as soon as practicable:
a. Give written notice of an "occurrence" or an offense 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 whom 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 "suit" by the additional insured.
2. The limits of insurance applicable to the additional insured are those specified in a written contract or written agreement or the limits of insurance as stated in the Declarations of this policy and defined in Section Ill - Limits of Insurance of this policy, whichever are less. These limits are inclusive of and not in addition to the limits of insurance available under this policy.
J. WHO IS AN INSURED - INCIDENTAL MEDICAL ERRORS/ MALPRACTICE
WHO IS AN INSURED - FELLOW EMPLOYEE EXTENSION - MANAGEMENT EMPLOYEES
Paragraph 2.a.(1) of Section II -Who Is An Insured is replaced with the following:
(1) "Bodily injury" or "personal and advertising injury":
(a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability company), to a co-"employee" while in the course of his or her employ ment or performing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the conduct of your business;
(b) To the spouse, child, parent, brother or sister of that co-"employee" or "volunteer worker'' as a consequence of Paragraph (1) (a} above;
(c} For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1) (a} or (b} above; or
(d} Arising out of his or her providing or failing to provide professional health care services. However, if you are not in the business of providing professional health care services or providing profes sional health care personnel to others, or if coverage for providing professional health care ser vices is not otherwise excluded by separate endorsement, this provision (Paragraph (d)) does not apply.
Paragraphs (a) and (b} above do not apply to "bodily injury" or "personal and advertising injury" caused by an "employee" who is acting in a supervisory capacity for you. Supervisory capacity as used herein means the "employee's" job responsibilities assigned by you, includes the direct supervision of other "employ ees" of yours. However, none of these "employees" are insureds for "bodily injury" or "personal and
CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 8 advertising injury" arising out of their willful conduct, which is defined as the purposeful or willful intent to cause "bodily injury" or "personal and advertising injury", or caused in whole or in part by their intoxica tion by liquor or controlled substances.
The coverage provided by provision J. is excess over any other valid and collectable insurance available to your "employee".
K. NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES
L.
Paragraph 3. of Section II - Who Is An Insured is replaced by the following:
3. Any organization you newly acquire or form and over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no other similar insurance available to that organization. However:
a. Coverage under this provision is afforded only until the expiration of the policy period in which the entity was acquired or formed by you;
b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and
c. Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization.
d. Records and descriptions of operations must be maintained by the first Named Insured.
No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations or qualifies as an insured under this provision.
FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES
Under Section IV - Commercial General Liability Conditions, the following is added to Condition 6. Repre sentations:
Your failure to disclose all hazards or prior "occurrences" existing as of the inception date of the policy shall not prejudice the coverage afforded by this policy provided such failure to disclose all hazards or prior "occurrences" is not intentional.
M. KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT
Under Section IV - Commercial General Liability Conditions, the following is added to Condition 2. Duties In The Event of Occurrence, Offense, Claim Or Suit:
Knowledge of an "occurrence", offense, claim or "suit" by an agent, servant or "employee" of any insured shall not in itself constitute knowledge of the insured unless an insured listed under Paragraph
1. of Section II - Who Is An Insured or a person who has been designated by them to receive reports of "occurrences", offenses, claims or "suits" shall have received such notice from the agent, servant or "employee".
N. LIBERALIZATION CLAUSE
If we revise this Commercial General Liability Extension Endorsement to provide more coverage without additional premium charge, your policy will automatically provide the coverage as of the day the revision is effective in your state.
0. BODILY INJURY REDEFINED
Under Section V - Definitions, Definition 3. is replaced by the following:
3. "Bodily Injury" means physical injury, sickness or disease sustained by a person. This includes mental anguish, mental injury, shock, fright or death that results from such physical injury, sick ness or disease.
CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 8
P. EXTENDED PROPERTY DAMAGE
Exclusion a. of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY is replaced by the following:
a. Expected Or Intended Injury
"Bodily injury" or "property damage" expected or intended from the standpoint of the insured.
This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property.
Q. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - WHEN REQUIRED IN A
CONTRACT OR AGREEMENT WITH YOU
Under Section IV - Commercial General Liability Conditions, the following is added to Condition 8. Trans fer Of Rights Of Recovery Against Others To Us:
We waive any right of recovery we may have against a person or organization because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard" provided:
1. You and that person or organization have agreed in writing in a contract or agreement that you waive such rights against that person or organization; and
2. The injury or damage occurs subsequent to the execution of the written contract or written agree ment.
© 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 8 of 8
11/22/2024
2. Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your permission, while performing duties related to the conduct of your business.
However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto".
3. Employees As Insureds
The following is added to the SECTION II - COVERED AUTOS LIABILITY COVERAGE, Paragraph A.1. Who Is An Insured:
f. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs.
4. Additional Insured By Contract, Agreement Or Permit
The following is added to SECTION II - COVERED AUTOS LIABILITY COVERAGE, Paragraph A.1. Who Is An Insured:
g. Any person, organization or governmental or public authority with respect to the operation, maintenance or use of a covered "auto", provided that you and such person, organization, or governmental or public authority have agreed in a written contract, written agreement, or permit, to add such person, or organization, or governmental or public authority to this policy as an "insured".
However, such person, organization or governmental or public authority is an "insured":
(1) Only with respect to the operation, maintenance or use of a covered "auto";
(2) Only for "bodily injury" or "property damage" caused by an "accident" which takes place after you exhausted the written contract or written agreement, or the permit has been issued to you; and
(3) Only for the duration of that contract, agreement or permit.
The "insured" is required to submit a claim to any other insurer to which coverage could apply for defense and indemnity. Unless the "insured" has agreed in writing to be primary and noncontributory per provision 13. of this endorsement, this policy is excess over any other collectible insurance.
5. Supplementary Payments
SECTION II - COVERED AUTOS LIABILITY COVERAGE, 2. Coverage Extensions, a. Supplementary Payments, Paragraph (4) is replaced by the following:
(4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 per day because of time off from work.
SECTION Ill - PHYSICAL DAMAGE COVERAGE is amended as follows:
6. Physical Damage - Additional Transportation Expense Coverage
Paragraph A.4.a. Coverage, Coverage Extensions, Transportation Expenses of SECTION Ill - PHYSICAL DAMAGE COVERAGE, is amended to provide a limit of $50 per day and a maximum limit of $1,500 per day.
7. Extra Expense - Broadened Coverage
The following is added to SECTION Ill - PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions:
c. We will pay up to $1,000 for costs incurred to return a stolen auto to you.
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68171079 N0106638 EC Insured Copy
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8. Accidental Airbag Deployment
SECTION Ill - PHYSICAL DAMAGE COVERAGE, B. Exclusions Paragraph 3.a. is replaced by the following:
a. Wear and tear, freezing, mechanical or electrical breakdown. However, this exclusion does not apply to the accidental discharge of an airbag if Comprehensive or Collision Coverage is shown in the Declarations.
Any insurance we provide shall be excess over any other collectible insurance or reimbursement by manufacturer's warranty. However, we agree to pay any deductible applicable to the other insurance or warranty.
9. Glass Repair - Waiver Of Deductible (Coverage Not Applicable In FL)
SECTION Ill - PHYSICAL DAMAGE COVERAGE, D. Deductible is amended by the addition of the following:
No deductible will apply to covered glass damage if the glass is repaired rather than replaced.
SECTION IV - BUSINESS AUTO CONDITIONS is amended as follows:
10. Amended Duties In The Event Of Accident, Claim, Suit, Or Loss
SECTION IV - BUSINESS AUTO CONDITIONS, Paragraph A.2.a. is replaced in its entirety by the following:
a. In the event of "accident", claim, "suit" or "loss", you must promptly notify us when it is known to:
(1) You, if you are an individual;
(2) A partner, if you are a partnership;
(3) Member, if you are a limited liability company;
(4) An executive officer or the "employee" designated by the Named Insured to give such notice, if you are a corporation.
To the extent possible, notice to us should include:
(a) How, when and where the "accident" or "loss" took place;
(b) The "insured's" name and address; and
(c) The names and addresses of any injured persons and witnesses.
11. Waiver Of Transfer Of Rights Of Recovery Against Others To Us
SECTION IV - BUSINESS AUTO CONDITIONS, Paragraph A.5., Transfer of Rights of Recovery Against Others to Us, is amended by the addition of the following:
If the person or organization has in a written agreement waived those rights before an "accident" or "loss", our rights are waived also.
12. Hired Auto Coverage Territory
SECTION IV- BUSINESS AUTO CONDITIONS, Paragraph B. General Conditions, Item 7.b.(5), Policy Period, Coverage Territory, is replaced with the following:
Anywhere in the world, for covered "autos" hired for thirty (30) days or less.
This extension of coverage does not apply to an "auto" hired, leased, rented or borrowed with a driver.
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13. Primary And Non-Contributory If Required By Written Contract Or Written Agreement
The following is added to SECTION IV - BUSINESS AUTO CONDITIONS, B. GENERAL CONDITIONS, 5.
Other Insurance and supersedes any provision to the contrary:
e. Subject to the applicable limits of liability, 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:
(1) Such "insured" is a Named Insured under such other insurance; and
(2) You have agreed in a written contract or written agreement that this insurance would be primary and would not seek contribution from any other insurance collectible to such "insured".
SECTION V - DEFINITIONS is amended as follows:
14. Bodily Injury Redefined
Under SECTION V - DEFINITIONS, Paragraph C. is replaced by the following:
"Bodily injury" means physical injury, sickness or disease sustained by a person, including mental anguish, mental injury, shock, fright or death resulting from any of these at any time.
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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
WC 00 0313
Ed. 4-84
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 agree ment from us.)
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule
Where required by contract or written agreement prior to loss and allowed by law. Applies to State of AZ.
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 ii! the policy.)
'6
Endorsement Effective
Policy Effective 11/20/2024
State
Policy No. XWW (25) 68 17 10 79
Insured ROGUE SERVICES LLC
DBA ROGUE INFRASTRUCTURE
Endorsement No. 0002
Premium
Insurance Company West American Insurance Company 11576
WC 00 0313
(Ed. 4-84)
Countersigned by _______ _
Copyright 1983 National Council on Compensation Insurance, Inc.
File details come from the government source that posted it. Updated .