ACCEPTED_CTR069676_GL_AL_WC_11.01.25-11.01.26.pdf
PDF 1 MB Posted
- Attached to
- Master Agreement AZ|CTR069676
- Contract number
- CTR069676
- Issued by
- Arizona
About this file
This document is a comprehensive insurance certificate and associated endorsements for Mandel Metals, Inc. (DBA U.S. Standard Sign Co.) located in Franklin Park, IL, covering multiple insurance policies issued by various Chubb insurance companies, including Chubb National Insurance Company, Great Northern Insurance Company, Federal Insurance Company, and Chubb Indemnity Insurance Company. The certificate is issued for the benefit of the State of Arizona/ADOT (Arizona Department of Transportation), with the specific reference to Contract No. CTR069676, and is valid from November 1, 2025 to November 1, 2026.
The insurance package includes Commercial General Liability, Automobile Liability, Umbrella Liability, and Workers' Compensation policies with various coverage limits. Notable features include additional insured status for the State of Arizona/ADOT, waivers of subrogation, and primary non-contributory coverage. The policies provide comprehensive protection with limits ranging from $1,000,000 to $10,000,000 across different coverage types, and include unique endorsements such as rental agency expense coverage, personal property coverage, hybrid vehicle replacement coverage, and provisions for unintentional failure to disclose hazards. The policies are structured to provide broad protection for Mandel Metals' business operations, with specific provisions tailored to meet contract requirements for the Arizona Department of Transportation.
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Text version
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A :
NAIC #
NAME:
CONTACT
(A/C, No):
FAX
ADDRESS:
PRODUCER
(A/C, No, Ext):
PHONE
INSURED
REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
OTHER:
(Per accident)
(Ea accident)
N / A
SUBR
WVD
ADDL
INSD
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
$PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person)
COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOSAUTOS ONLY
NON-OWNED
SCHEDULEDOWNED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
ER
OTH-
STATUTE
PER
LIMITS(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
POLICY EFF
POLICY NUMBERTYPE OF INSURANCELTR
INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB $EACH OCCURRENCE
$AGGREGATE
OCCUR
CLAIMS-MADE
DED RETENTION $
$PRODUCTS - COMP/OP AGG
$GENERAL AGGREGATE
$PERSONAL & ADV INJURY
$MED EXP (Any one person)
$EACH OCCURRENCE
DAMAGE TO RENTED
$PREMISES (Ea occurrence)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY
PRO-
JECT LOC
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
11/14/2025
Hub International Midwest Limited 203 N La Salle St Ste 2000 Chicago IL 60601-1245
CSU Chicago - Midwest 312-922-5000
CSUChicago@hubinternational.com
Chubb National Insurance Company 10052 MANDMET-01 Great Northern Insurance Company 20303
Mandel Metals, Inc.
DBA U.S. Standard Sign Co.
11400 West Addison Franklin Park IL 60131
Federal Insurance Company 20281 Chubb Indemnity Insurance Company 12777
1931472479
A X 1,000,000 X 1,000,000
25,000
1,000,000
5,000,000 X
57624599 11/1/2025 11/1/2026
2,000,000
B 1,000,000
X 7364-60-19 11/1/2025 11/1/2026
C X X 10,000,0005672-53-06 11/1/2025 11/1/2026
10,000,000
D X
N
(26) 7184-13-69 11/1/2025 11/1/2026
1,000,000
1,000,000
1,000,000
RE: Subject: Award of Contract No. CTR069676
The State of Arizona/ADOT are Additional Insureds when required by written contract or agreement on the General Liability and Auto Liability policies subject to terms, conditions, and exclusions.
Waivers of Subrogation are granted in favor of the stated additional insureds on the General Liability, Auto Liability, and Workers Compensation policies only when required by written contract or agreement where allowable by law.
See Attached...
The State of Arizona/ADOT 206 S. 17th Ave Phoenix AZ 85007
ACCEPTED
ADOT Risk Management
ACORD 101 (2008/01)
The ACORD name and logo are registered marks of ACORD
© 2008 ACORD CORPORATION. All rights reserved.
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: FORM TITLE:
ADDITIONAL REMARKS
ADDITIONAL REMARKS SCHEDULE Page of
AGENCY CUSTOMER ID:
LOC #:
AGENCY
CARRIER NAIC CODE
POLICY NUMBER
NAMED INSURED
EFFECTIVE DATE:
MANDMET-01
1 1
Hub International Midwest Limited Mandel Metals, Inc.
DBA U.S. Standard Sign Co.
11400 West Addison Franklin Park IL 60131
25 CERTIFICATE OF LIABILITY INSURANCE
General Liability Waiver of Subrogation - CB CG 04 0001 0320 (Page 10) General Liability Additional Insured - CB CG 04 0001 0320 (Page 6) General Liability Primary Non-Contributory - CB CG 04 0001 0320 (Page 8)
Form: 16-02-0292 (Ed. 4-24) Page 1 of 6
Includes copyrighted material of Insurance Services Office, Inc. with its permission.
COMMERCIAL AUTOMOBILE
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
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 Business Auto Coverage Form, the provisions of this endorsement apply.
1. EXTENDED CANCELLATION CONDITION
Paragraph A.2.b. – CANCELLATION of the COMMON POLICY CONDITIONS form IL 00 17 is deleted and replaced with the following:
b. 60 days before the effective date of cancellation if we cancel for any other reason.
2. BROAD FORM INSURED
A. Subsidiaries and Newly Acquired or Formed Organizations As Insureds
The Named Insured shown in the Declarations is amended to include:
(1) Any legally incorporated subsidiary in which you own more than 50% of the voting stock 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, joint venture or limited liability company;
(b) That is an “insured” under any other automobile 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.
B. Employees as Insureds
Paragraph A.1. – WHO IS AN INSURED – of SECTION II – COVERED AUTOS LIABILITY COVERAGE is amended to add the following:
d. Any “employee” of yours while using a covered “auto” you don’t own, hire or borrow in your business or your personal affairs.
C. Lessors as Insureds
Paragraph A.1. – WHO IS AN INSURED – of SECTION II – COVERED AUTOS LIABILITY COVERAGE is amended to add the following:
e. The lessor of a covered “auto” while the “auto” is leased to you under a written agreement if:
(1) The agreement requires you to provide direct primary insurance for the lessor; and
(2) The “auto” is leased without a driver.
Such leased “auto” will be considered a covered “auto” you own and not a covered “auto” you hire.
D. Persons And Organizations As Insureds Under A Written Insured Contract
Policy Number: 7364-60-19 Policy Effective: 11/1/2025-11/1/2026
Form: 16-02-0292 (Ed. 4-24) Page 2 of 6
Paragraph A.1 – WHO IS AN INSURED – of SECTION II – COVERED AUTOS LIABILITY COVERAGE is amended to add the following:
f. Any person or organization with respect to the operation, maintenance or use of a covered “auto”, provided that you and such person or organization have agreed under an express provision in a written “insured contract”, written agreement or a written permit issued to you by a governmental or public authority to add such person or organization to this policy as an “insured”.
However, such person or organization is an “insured” only:
(1) with respect to the operation, maintenance or use of a covered “auto”; and
(2) for “bodily injury” or “property damage” caused by an “accident” which takes place after:
(a) You executed the “insured contract” or written agreement; or
(b) The permit has been issued to you.
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.
This provision does not apply to other insurance to which the additional insured has also been added as an additional insured.
3. SUPPLEMENTARY PAYMENTS – INCREASED LIMITS
Under SECTION II – COVERED AUTOS LIABILITY COVERAGE, subsection A. Coverage, paragraph 2.
Coverage Extensions, subparagraph a. Supplementary Payments, subparagraphs (2) and (4) 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 $1,000 a day because of time off from work.
4. AMENDED FELLOW EMPLOYEE EXCLUSION
EXCLUSION 5. – FELLOW EMPLOYEE – of SECTION II – COVERED AUTOS LIABILITY COVERAGE is amended to add the following:
However, this exclusion only applies if the fellow “employee” is entitled to benefits under any of the following:
workers’ compensation, unemployment compensation or disability benefits law, or any similar law.
5. PHYSICAL DAMAGE – ADDITIONAL TEMPORARY TRANSPORTATION EXPENSE COVERAGE
Paragraph A.4.a. – TRANSPORTATION EXPENSES – of SECTION III – PHYSICAL DAMAGE COVERAGE is amended to provide a limit of $60 per day, subject to a maximum limit of $1,800.
6. AUTO LOAN/LEASE GAP COVERAGE
Paragraph A.4. – COVERAGE EXTENSIONS – of SECTION III – PHYSICAL DAMAGE COVERAGE is amended to add the following:
c. Unpaid Loan or Lease Amounts
In the event of a total “loss” to a covered “auto”, we will pay any unpaid amount due on the loan or lease for a covered “auto” minus:
1. The amount paid under the Physical Damage Coverage Section of the policy; and
2. Any:
a. Overdue loan/lease payments at the time of the “loss”;
b. Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage;
c. Security deposits not returned by the lessor;
Form: 16-02-0292 (Ed. 4-24) Page 3 of 6
d. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance Purchased with the loan or lease: and
e. Carry-over balances from previous loans or leases.
We will pay for any unpaid amount due on the loan or lease 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 indicate 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”.
The Auto Loan/Lease Gap Coverage insurance provided by this endorsement is excess over any other collectible insurance including but not limited to any coverage provided by or purchased from the lessor.
7. VEHICLE VINYL WRAP COVERAGE
Paragraph A.4. – COVERAGE EXTENSIONS – of SECTION III – PHYSICAL DAMAGE COVERAGE is amended to add the following:
d. Vehicle Vinyl 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 loss. Regardless of the number of “autos” deemed a total “loss”, the most we will pay under this Coverage for any one “loss” is $2,000.
For purposes of this coverage, signs or other graphics painted or magnetically affixed to the vehicle are not considered vehicle wraps.
8. PERSONAL PROPERTY COVERAGE
Paragraph A.4. – COVERAGE EXTENSIONS – of SECTION III – PHYSICAL DAMAGE COVERAGE is amended to add the following:
e. Personal Property Coverage
We will pay up to $1,000 for “loss” to wearing apparel and other personal effects which are:
(1) Owned by an “insured”; and
(2) In or on your covered “auto”.
This Coverage applies only:
(1) In the event of total theft of your covered “auto;” and
(2) If such wearing apparel or other personal effects cannot be recovered.
This Coverage is not subject to a deductible.
The limit shown above applies in addition to any other insurance for personal property provided elsewhere in this policy.
This coverage only applies to “autos” for which Comprehensive or Specified Causes of Loss coverages are provided under this Coverage Form.
9. REPLACEMENT WITH A HYBRID OR ALTERNATIVE FUEL SOURCE AUTO
Paragraph A.4. – COVERAGE EXTENSIONS – of SECTION III – PHYSICAL DAMAGE COVERAGE is amended to add the following:
f. Replacement Of A Private Passenger Auto With A Hybrid Or Alternative Fuel Source Auto
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, we will pay the actual cash value, plus an additional 10%
Form: 16-02-0292 (Ed. 4-24) Page 4 of 6
(up to a maximum of $2,500), if the replacement vehicle is a hybrid vehicle or alternative fuel source vehicle.
10. RENTAL AGENCY EXPENSE
Paragraph A.4. – COVERAGE EXTENSIONS – of SECTION III – PHYSICAL DAMAGE COVERAGE is amended to add the following:
g. Rental Expense
We will pay the following expenses that you or any of your “employees” are legally obligated to pay because of a written contract or agreement entered into for use of a rental vehicle in the conduct of your business:
MAXIMUM WE WILL PAY FOR ANY ONE CONTRACT OR AGREEMENT:
(1) $2,500 for loss of income incurred by the rental agency during the period of time that vehicle is out of use because of actual damage to, or “loss” of, that vehicle, including income lost due to absence of that vehicle for use as a replacement;
(2) $2,500 for decrease in trade-in value of the rental vehicle because of actual damage to that vehicle arising out of a covered “loss”; and
(3) $2,500 for administrative expenses incurred by the rental agency, as stated in the contract or agreement.
(4) $7,500.00 maximum total amount for paragraphs a., b. and c. combined.
11. EXTRA EXPENSE – BROADENED COVERAGE
Paragraph A.4. – COVERAGE EXTENSIONS – of SECTION III – PHYSICAL DAMAGE COVERAGE is amended to add the following:
h. Recovery Expense
We will pay for the expense of returning a stolen covered “auto” to you.
12. AIRBAG COVERAGE
Paragraph B.3.a. – EXCLUSIONS – of SECTION III – PHYSICAL DAMAGE COVERAGE does not apply to the accidental or unintended discharge of an airbag. Coverage is excess over any other collectible insurance or warranty specifically designed to provide this coverage.
13. SOUND RECEIVING AND TRANSMITTING EQUIPMENT – BROADENED COVERAGE
Paragraph a. under the statement “Exclusions 4.c. and 4.d. do not apply” under EXCLUSIONS – of SECTION III – PHYSICAL DAMAGE COVERAGE is deleted and replaced with the following:
a. Equipment designed solely for receiving or transmitting sound and accessories used with such equipment, provided such equipment is permanently installed in the covered “auto” at the time of the “loss” or such equipment is removable from the housing unit which is permanently installed in the covered “auto” at the time of the “loss”, and such equipment is designed to be operated solely by use of the power from the “auto’s” electrical system, in or upon the covered “auto”; or
14. 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.
15. TWO OR MORE DEDUCTIBLES
Paragraph D. – DEDUCTIBLE – of SECTION III – PHYSICAL DAMAGE COVERAGE is amended to add the following:
If this Coverage Form and any other Coverage Form or policy issued to you by us 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; or
Form: 16-02-0292 (Ed. 4-24) Page 5 of 6
(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.
16. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS
Paragraph A.2.a. – DUTIES IN THE EVENT OF AN ACCIDENT, CLAIM, SUIT OR LOSS of SECTION IV – BUSINESS AUTO CONDITIONS is deleted and replaced with the following:
a. In the event of “accident”, claim, “suit” or “loss”, you must promptly notify us when the “accident” is known to:
1. You or your authorized representative, if you are an individual;
2. A partner, or any authorized representative; if you are a partnership;
3. A member, if you are a limited liability company; or
4. An executive officer, insurance manager, or authorized representative, if you are an organization other than a partnership or limited liability company.
Knowledge of an “accident”, claim, “suit” or “loss” by other persons does not imply that the persons listed above have such knowledge.
Notice to us should include:
1. How, when and where the “accident” or “loss” occurred;
2. The insured’s name and address; and
3. To the extent possible, the names and addresses of any injured persons or witnesses.
17. WAIVER OF SUBROGATION
Paragraph A.5. – TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US of SECTION IV – BUSINESS AUTO CONDITIONS is deleted and replaced with the following:
5. We will waive the right of recovery we would otherwise have against another person or organization for “loss” to which this insurance applies, provided the “insured” has waived their rights of recovery against such person or organization in a written contract or agreement that is executed before such “loss”.
To the extent that the “insured’s” rights to recover damages for all or part of any payment made under this insurance has not been waived, those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after “accident” or “loss” to impair them. At our request, the insured will bring suit or transfer those rights to us and help us enforce them.
18. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
Paragraph B.2. – CONCEALMENT, MISREPRESENTATION or FRAUD of SECTION IV – BUSINESS AUTO CONDITIONS – is deleted and replaced with the following:
If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not void coverage under this Coverage Form because of such failure.
19. AUTOS RENTED BY EMPLOYEES
Paragraph 5.b. – OTHER INSURANCE of SECTION IV – BUSINESS AUTO CONDITIONS – is deleted and replaced with the following:
e. Any “auto” hired or rented by your “employee” on your behalf and at your direction will be considered an “auto” you hire. 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.
20. HIRED AUTO – COVERAGE TERRITORY
Paragraph B.7.e. (1) – POLICY PERIOD, COVERAGE TERRITORY of SECTION IV – BUSINESS AUTO CONDITIONS is deleted and replaced with the following:
(1) A covered “auto” of the private passenger type is leased, hired, rented or borrowed without a driver for a period of 60 days or less; and
Form: 16-02-0292 (Ed. 4-24) Page 6 of 6
21. RESULTANT MENTAL ANGUISH COVERAGE
Paragraph C. of – SECTION V – DEFINITIONS is deleted and 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.
All other terms and conditions remain unchanged.
CB CG 04 0001 0320 Includes copyrighted material of Insurance Services Office, with its permission. Page 5 of 9
With respect to “bodily injury” only, the limitations described in Paragraph 3.a.(1) above do not apply to:
(i) You or to your directors, managers, members, “executive officers”, partners or supervisors as insureds;
(ii) Your “employees” as insureds, with respect to such damages caused by cardiopulmonary resuscitation or first aid services administered by such an “employee”; or
(iii) Your “employees” who are nurses, emergency medical technicians, or paramedics as insureds, with respect to such damages that are caused by providing or failing to provide professional healthcare services, but only if you are not engaged in the business or occupation of providing medical, paramedical, surgical, dental, x-ray or nursing services.
(2) "Property damage" to any property owned, occupied or used by you or by any of your directors, managers, members, “executive officers” or partners (whether or not an “employee”) or by any of your “employees”. This limitation does not apply to “property damage” to premises while rented to you or temporarily occupied by you with the permission of the owner.
L. Additional Insureds
Paragraph 3. under Section II – Who Is An Insured is amended by including the following:
Controlling Interest
Any person or organization that has financial control of you or owns, maintains or controls premises while you lease or occupy such premises, but only with respect to their liability arising out of:
(1) Their financial control of you; or
(2) Premises they own, maintain or control while you lease or occupy these premises.
However, no such person or organization is an insured with respect to structural alterations, new construction or demolition operations performed by or for that person or organization.
Lessors Of Leased Equipment
Any person or organization from whom you lease equipment, but only with respect to the maintenance or use by you of such equipment, and only if you are obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by this Coverage Part. However, no such person or organization is an insured with respect to an “occurrence” that takes place, or an offense that is committed, after the equipment lease ends.
Managers Or Lessors Of Premises
Any person or organization from whom you lease premises, but only with respect to the ownership, maintenance or use of that particular part of such premises leased to you and only if you are obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by this Coverage Part. However, no such person or organization is an insured with respect to:
(1) An “occurrence” that takes place, or an offense that is committed, after you cease to be a tenant in such premises; or
(2) Any structural alteration, new construction or demolition operations performed by or on behalf of them.
Mortgagee, Assignee Or Receiver
A mortgagee, assignee or receiver of premises, but only with respect to such mortgagee, assignee or receiver’s liability for “bodily injury”, “property damage” or “personal and advertising injury” arising out of your ownership, maintenance or use of a premises by you. However, no such person or organization is an insured with respect to structural alterations, new construction or demolition operations performed by, on behalf of, or for such additional insured.
Other Persons Or Organizations Pursuant To A Contract Or Agreement
Any person or organization that you are obligated pursuant to a contract or agreement to provide with such insurance as is afforded by this policy are insureds.
Policy Number: 57624599 Policy Effective: 11/1/2025-11/1/2026
CB CG 04 0001 0320 Includes copyrighted material of Insurance Services Office, with its permission. Page 6 of 9
However, the person or organization is an insured only:
(1) To the extent such contract or agreement requires the person or organization to be afforded status as an insured;
(2) For activities that did not occur, in whole or in part, before the execution of the contract or agreement; and
(3) With respect to damages, loss, cost or expense for injury or damage to which this insurance applies.
No person or organization is an insured:
(1) That is more specifically identified under any other provision of Section II – Who Is an Insured (regardless of any limitation applicable thereto).
(2) With respect to any assumption of liability (of another person or organization) by them in a contract or agreement. This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contract or agreement.
Trade Show Event Lessor
With respect to your participation in a trade show event as an exhibitor, presenter or displayer, any person or organization whom you are required to include as an additional insured, but only with respect to such person or organization’s liability for “bodily injury”, “property damage” or “personal and advertising injury” caused by:
(1) Your acts or omissions; or
(2) The acts or omissions of those acting on your behalf, in the performance of your ongoing operations at the trade show event premises during the trade show event.
However, no such person or organization is an insured with respect to “bodily injury” or “property damage” included within the “products-completed operations hazard”.
Vendors
Any person or organization who is a vendor of “your products”, but only with respect to liability for “bodily injury” or “property damage” resulting from the distribution or sale of “your product” in the regular course of their business.
However, no such person or organization is an insured with respect to any:
(1) Assumption of liability (of another person or organization) by them in a contract or agreement. This limitation does not apply to the liability for damages for “bodily injury” or ”property damage” that such person or organization would have in the absence of such contract or agreement;
(2) Representation or warranty unauthorized by you;
(3) Physical or chemical change in “your product” made intentionally by the vendor;
(4) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container;
(5) Failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of “your product”;
(6) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor’s premises in connection with the sale of “your product”; or
(7) Of “your products” which, after distribution or sale by you, have been labeled or relabeled or used as a container, ingredient or part of any other thing or substance by or for the vendor.
Further, no person or organization is an insured from whom you have acquired “your product”, or any ingredient, part or container entering into, accompanying or containing “your product”.
Limitations Applicable To Additional Insureds
With respect any person or organization that qualifies as an additional insured under paragraph L. above, the following limitations apply to such insured:
Policy Number: 57624599 Policy Effective: 11/1/2025-11/1/2026
CB CG 04 0001 0320 Includes copyrighted material of Insurance Services Office, with its permission. Page 7 of 9
(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.
Limits Of Insurance Applicable to Additional Insureds
With respect any person or organization that qualifies as an additional insured under paragraph L. above, 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.
However, the above paragraph shall not increase the applicable limits of insurance.
M. Medical Expense Limit – $15,000
Paragraph 7. under Section III – Limits Of Insurance is amended by including the following:
The Medical Expense Limit is the greater of:
a. $15,000; or
b. The amount shown in the Declarations for the Medical Expense Limit.
N. Knowledge/Notice Of Occurrence
Paragraph 2. under Section IV – Commercial General Liability Conditions is amended to include the following:
f. Knowledge of an “occurrence” or offense by an agent or “employee” of the insured will not constitute knowledge by the insured, unless an “executive officer” (whether or not an “employee”) of any insured or an “executive officer’s” designee knows about such “occurrence” or offense.
g. Failure of an agent or “employee” of the insured, other than an “executive officer” (whether or not an “employee”) of any insured or an “executive officer’s” designee, to notify us of an “occurrence” or offense that such person knows about will not affect the insurance afforded to you.
h. If a claim or loss does not reasonably appear to involve this insurance, but it later develops into a claim or loss to which this insurance applies, the failure to report it to us will not violate this condition, provided the insured gives us immediate notice as soon as the insured is aware that this insurance may apply to such loss or claim.
O. Primary And Non-Contributory
Subparagraph 4.a. under Section IV – Commercial General Liability Conditions is amended to include the following:
However, if you are obligated to a written contract or agreement to provide a person or organization that is included in Section II – Who Is an Insured with primary insurance such as is afforded by this policy, then this insurance is primary and we will not seek contribution from insurance available to such person or organization.
P. Unintentional Failure To Disclose Hazards
Paragraph 6. under Section IV – Commercial General Liability Conditions is amended to include the following:
Unintentional failure of an “employee” of the insured to disclose a hazard or other material information will not violate this condition, unless an “executive officer” (whether or not an “employee”) of any insured knows about such hazard or other material information.
Q. Waiver Of Subrogation Required By Contract
Paragraph 8. under Section IV – Commercial General Liability Conditions is deleted and replaced by the
CB CG 04 0001 0320 Includes copyrighted material of Insurance Services Office, with its permission. Page 7 of 9
(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.
Limits Of Insurance Applicable to Additional Insureds
With respect any person or organization that qualifies as an additional insured under paragraph L. above, 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.
However, the above paragraph shall not increase the applicable limits of insurance.
M. Medical Expense Limit – $15,000
Paragraph 7. under Section III – Limits Of Insurance is amended by including the following:
The Medical Expense Limit is the greater of:
a. $15,000; or
b. The amount shown in the Declarations for the Medical Expense Limit.
N. Knowledge/Notice Of Occurrence
Paragraph 2. under Section IV – Commercial General Liability Conditions is amended to include the following:
f. Knowledge of an “occurrence” or offense by an agent or “employee” of the insured will not constitute knowledge by the insured, unless an “executive officer” (whether or not an “employee”) of any insured or an “executive officer’s” designee knows about such “occurrence” or offense.
g. Failure of an agent or “employee” of the insured, other than an “executive officer” (whether or not an “employee”) of any insured or an “executive officer’s” designee, to notify us of an “occurrence” or offense that such person knows about will not affect the insurance afforded to you.
h. If a claim or loss does not reasonably appear to involve this insurance, but it later develops into a claim or loss to which this insurance applies, the failure to report it to us will not violate this condition, provided the insured gives us immediate notice as soon as the insured is aware that this insurance may apply to such loss or claim.
O. Primary And Non-Contributory
Subparagraph 4.a. under Section IV – Commercial General Liability Conditions is amended to include the following:
However, if you are obligated to a written contract or agreement to provide a person or organization that is included in Section II – Who Is an Insured with primary insurance such as is afforded by this policy, then this insurance is primary and we will not seek contribution from insurance available to such person or organization.
P. Unintentional Failure To Disclose Hazards
Paragraph 6. under Section IV – Commercial General Liability Conditions is amended to include the following:
Unintentional failure of an “employee” of the insured to disclose a hazard or other material information will not violate this condition, unless an “executive officer” (whether or not an “employee”) of any insured knows about such hazard or other material information.
Q. Waiver Of Subrogation Required By Contract
Paragraph 8. under Section IV – Commercial General Liability Conditions is deleted and replaced by the
CB CG 04 0001 0320 Includes copyrighted material of Insurance Services Office, with its permission. Page 8 of 9 following:
8. Waiver Of Subrogation Required By Contract
We will waive the rights of recovery we would otherwise have had against another person or organization, for loss to which this insurance applies, provided the insured has waived their rights of recovery against such person or organization in a contract or agreement that is executed before such loss.
To the extent that the insured’s rights to recover all or part of any payment made under this Coverage Part have not been waived, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring “suit” or transfer those rights to us and help us enforce them. This paragraph does not apply to Coverage C.
R. In Rem
The following is added to Section IV – Commercial General Liability Conditions:
Any “suit” brought as an action In Rem against any watercraft owned or operated by or for the insured shall in all respects be treated in the same manner as though such “suit” were brought against the insured.
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 11-01-25 Policy No. 71841369 Endorsement No.
Insured MANDEL METALS INC Premium $ Incl.
Insurance Company Chubb Indemnity Insurance Company
Countersigned By
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13
(Ed. 4-84)
WC 00 03 13
(Ed. 4-84)
1983 National Council on Compensation Insurance.
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
Any person or organization against whom you have agreed to waive your right of recovery in a written contract, provided such contract was executed prior to the date of loss.
For policies or exposure in Missouri:
Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual.
Insured Copy
File details come from the government source that posted it. Updated .