APPROVED CTR059318 GL, AL, WC 03.01.22 - 03.01.23.pdf
PDF 291 KB Posted
- Attached to
- Master Agreement AZ|CTR070729
- Contract number
- CTR070729
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by Lockton Companies for Asbury Automotive Group Inc., with insurance provided by National Union Fire Insurance Company of Pittsburgh, PA and AIU Insurance Company. The certificate is specifically issued for the State of Arizona or Arizona Department of Transportation, located in Phoenix, AZ, and includes additional insured parties such as LHM PNX, LLC dba Larry H Miller Toyota Peoria.
The insurance policy covers multiple liability areas including commercial general liability, automobile liability, umbrella liability, and workers' compensation, with various coverage limits. The policy is effective from 3/1/2022 to 3/1/2023, with a combined single limit of $5,000,000 for automobile liability. The policy includes provisions for additional insured status, waiver of subrogation, and coverage for leased vehicles. Garage Keeper Liability is set at $1,000,000, and the policy provides coverage for owned, hired, and non-owned vehicles. The endorsements include provisions for lessor protection, primary and noncontributory insurance conditions, and specific clauses related to leased equipment and premises.
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Text version
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
INSR ADDL SUBR
LTR INSD WVD
DATE (MM/DD/YYYY)
PRODUCER CONTACT
NAME:
FAXPHONE
(A/C, No):(A/C, No, Ext):
ADDRESS:
INSURER A :
INSURED INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
POLICY NUMBER
POLICY EFF POLICY EXP
TYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)
AUTOMOBILE LIABILITY
UMBRELLA LIAB
EXCESS LIAB
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
EACH OCCURRENCE $
DAMAGE TO RENTED
CLAIMS-MADE OCCUR $PREMISES (Ea occurrence)
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
PRO-
POLICY LOC PRODUCTS - COMP/OP AGG $JECT
OTHER: $
COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident)
OCCUR EACH OCCURRENCE $
CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below
INSURER(S) AFFORDING COVERAGE NAIC #
COMMERCIAL GENERAL LIABILITY
Y / N
N / A (Mandatory in NH)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
CERTIFICATE HOLDER CANCELLATION
© 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03)
CERTIFICATE OF LIABILITY INSURANCE
Lockton Companies 3280 Peachtree Road NE, Suite #250 Atlanta GA 30305
(404) 460-3600
Asbury Automotive Group Inc 2905 Premiere Parkway Ste 300 Duluth GA 30097
AIU Insurance Company 19399 National Union Fire Ins Co Pitts. PA 19445
X X
5,000,000 1,000,000 10,000 5,000,000 25,000,000 10,000,000
X 5,000,000
XXXXXXX
XXXXXXX
XXXXXXX
Comp/Collision 1,000,000
X X
X 25,000
10,000,000 10,000,000
XXXXXXX
N
X
1,000,000 1,000,000 1,000,000
Garage Keeper Liability $1,000,000
A .CA 6890195 3/1/2022 3/1/2023
A CA 6890195 3/1/2022 3/1/2023
A CA 6890195 3/1/2022 3/1/2023
A 14572164 3/1/2022 3/1/2023
B 35901705 3/1/2022 3/1/2023
3/1/2023
1496428
Y Y
Y Y
Y Y
Y
5/6/2022
Y Y
18398668
18398668 XXXXXXX
The State of Arizona or Arizona Department of Transportation 1324 N. 22nd Ave. MD 128A Phoenix AZ 85009
THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER, APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERM(S) REFERENCED.
LHM PNX, LLC dba Larry H Miller Toyota Peoria (8425 W. Bell Rd. Peoria AZ 85382) The State of Arizona or Arizona Department of Transportation is included as additional insured with respects to General, Auto, Umbrella, and Garage Keeper Liability policies, as per written contract, subject to terms, conditions, and exclusions. A waiver of subrogation applies in favor of LHM HYN, LLC dba Larry H Miller Hyundai Peoria as required by written agreement, with respects to General Liability, Auto Liability, Umbrella Liability, Garage Keeper Liability, and Workers Compensation, subject to terms, conditions, and exclusions.
X
See Attachments e6906
ACCEPTED
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
This endorsement changes the policy to which it is attached effective on inception date of the policy unless a different date is indicated below.
This endorsement, effective 12:01 AM 03/01/2022 forms a part of Policy No. WC 035-90-1705 Issued to ASBURY AUTOMOTIVE GROUP, INC.
By A I U INSURANCE COMPANY
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 any one not named in the Schedule.
Schedule
ANY PERSON OR ORGANIZATION WITH WHOM YOU HAVE
ENTERED INTO A CONTRACT, A CONDITION OF WHICH
REQUIRES YOU TO OBTAIN THIS WAIVER FROM US.
THIS ENDORSEMENT DOES NOT APPLY TO BENEFITS OR
DAMAGES PAID OR CLAIMED:
1. PURSUANT TO THE WORKERS' COMPENSATION OR
EMPLOYERS' LIABILITY LAWS OF KENTUCKY, NEW
HAMPSHIRE, OR NEW JERSEY; OR,
2. BECAUSE OF INJURY OCCURRING BEFORE YOU
ENTERED INTO SUCH A CONTRACT.
This form is not applicable in Kansas for private construction contracts as defined in K.S.A. 16-1801 through K.S.A 16-1807 or public construction contracts as defined in K.S.A. 16-1901 through 16-1908, except where permitted by statute or other applicable law, such as for use in wrap-up insurance programs.
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.
This form is not applicable in California, Kentucky, New Hampshire, New Jersey, Texas, or Utah.
WC 00 03 13 Countersigned by (Ed. 04/84)
Authorized Representative
Standard Attachment: S608295 Certificate ID: 18398668
ENDORSEMENT
This endorsement, effective 12:01 A.M. 03/01/2022 forms a part of Policy No. 689-01-95 issued to ASBURY AUTOMOTIVE GROUP, INC by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
SECTION IV - CONDITIONS, A. - Loss Conditions, 5. - Transfer of Rights of Recovery Against Others to Us, is deleted in its entirety and replaced by the following:
If any person or organization to or for whom we make payment under this Coverage Form has rights to recover damages from another, 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.
However, we will waive any right of recovery we have against any person or organization with whom you have entered into a contract or agreement because of payments we make under this Coverage Form arising out of an "accident" or "loss" if:
(1) The "accident" or "loss" is due to operations undertaken in accordance with the contract existing between you and such person or organization; and
(2) The contract or agreement was entered into prior to any "accident" or "loss".
No waiver of the right of recovery will directly or indirectly apply to your employees or employees of the person or organization, and we reserve our rights or lien to be reimbursed from any recovered funds obtained by any injured employee.
This condition does not apply to damages under Paragraph C. Locations And Operations Medical Payments Coverage of Section II - General Liability Coverages
Authorized Representative or Countersignature (in States Where Applicable)
87960 (8/15) Includes copyrighted material of Insurance Services Office, Inc. with its permission.Page 1 of 1
Standard Attachment: S608296 Certificate ID: 18398668
Standard Attachment: S608296 Certificate ID: 18398668
ENDORSEMENT
This endorsement, effective 12:01 A.M. 03/01/2022 forms a part of Policy No. 689-01-95 issued to ASBURY AUTOMOTIVE GROUP, INC by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA.
ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT
(PROFESSIONAL SERVICES EXCLUSION)
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
SECTION I COVERED AUTOS COVERAGES 1. - Coverage, 2. - Who Is An Insured, is amended to add:
6. Any person or organization to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into, excluding contracts or agreements for professional services, which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability covered by the terms of this policy, arising out of the use of a covered "auto" you own, hire or borrow. However, the insurance provided herein will not exceed the lesser of:
1. The coverage and/or limits of this policy, or
2. The coverage and/or limits required by said contract or agreement.
Authorized Representative or Countersignature (in States Where Applicable)
87953 (9/14) Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1
Standard Attachment: S608297 Certificate ID: 18398668
Standard Attachment: S608297 Certificate ID: 18398668
POLICY NUMBER: 689-01-95 COMMERCIAL AUTO
CA 20 01 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
LESSOR - ADDITIONAL INSURED AND LOSS PAYEE
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.
Named Insured: ASBURY AUTOMOTIVE GROUP, INC
Endorsement Effective Date: 03/01/2022
Countersignature Of Authorized Representative Name:
Title:
Signature:
Date:
SCHEDULE
Insurance Company:
Policy Number: 689-01-95 Effective Date: 03-01-2022
Expiration Date: 03-01-2023
Named Insured: ASBURY AUTOMOTIVE GROUP, INC
Address: 2905 PREMIERE PKWY # 300, DULU
Additional Insured (Lessor): ASBURY AUTOMOTIVE GROUP, INC
Address: 2905 PREMIERE PKWY # 300 DULUTH, GA 30097
Designation Or Description Of "Leased Autos" : ALL AUTOS UNDER A LEASING OR RENTAL AGREEMENT
BETWEEN THE INSURED AND THE LESSOR LISTED ABOVE AS THE ADDITIONAL INSURED THAT
REQUIRES DIRECT PRIMARY INSURANCE.
Coverages Limit Of Insurance
Covered Autos Liability $ 5,000,000 Each "Accident"
Comprehensive Actual Cash Value Or Cost Of Repair,Whichever Is Less, Minus $ Deductible For Each Covered "Leased Auto"
Collision Actual Cash Value Or Cost Of Repair,Whichever Is Less, Minus $ Deductible For Each Covered "Leased Auto"
Specified Causes Of Loss Actual Cash Value Or Cost Of Repair,Whichever Is Less, Minus $ Deductible For Each Covered "Leased Auto"
CA 20 01 10 13 Insurance Services Office, Inc., 2011 Page 1 of 2
Standard Attachment: S608298 Certificate ID: 18398668
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Coverage
1. Any "leased auto" designated or described in the Schedule will be considered a covered "auto" you own and not a covered "auto" you hire or borrow.
2. For a "leased auto" designated or described in the Schedule, the Who Is An Insured pro-vision under Covered Autos Liability Coverage is changed to include as an "insured" the lessor named in the Schedule.
However, the lessor is an "insured" only for "bodily injury" or "property damage" result-ing from the acts or omissions by:
a. You;
b. Any of your "employees" or agents; or
c. Any person, except the lessor or any
"employee" or agent of the lessor, op-erating a "leased auto" with the per-mission of any of the above.
3. The coverages provided under this endorse-ment apply to any "leased auto" described in the Schedule until the expiration date shown in the Schedule, or when the lessor or his or her agent takes possession of the "leased auto", whichever occurs first.
B. Loss Payable Clause
1. We will pay, as interest may appear, you and the lessor named in this endorsement for "loss" to a "leased auto".
2. The insurance covers the interest of the lessor unless the "loss" results from fraud-ulent acts or omissions on your part.
3. If we make any payment to the lessor, we will obtain his or her rights against any other party.
C. Cancellation
1. If we cancel the policy, we will mail notice to the lessor in accordance with the Cancellation Common Policy Condition.
2. If you cancel the policy, we will mail notice to the lessor.
3. Cancellation ends this agreement.
D. The lessor is not liable for payment of your premiums.
E. Additional Definition
As used in this endorsement:
"Leased auto" means an "auto" leased or rented to you, including any substitute, replacement or extra "auto" needed to meet seasonal or other needs, under a leasing or rental agreement that requires you to provide direct primary insurance for the lessor.
Page 2 of 2 Insurance Services Office, Inc., 2011 CA 20 01 10 13
POLICY NUMBER: COMMERCIAL AUTO
CA 25 09 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
RENTED LAND OR PREMISES
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.
Named Insured:
Endorsement Effective Date:
SCHEDULE
Description Of Premises Or Land Leased Or Rented To You
Name Of Person Or Organization Premium
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Paragraph D. Who Is An Insured under Section is changed to include as an
"insured" the person or organization named in the Schedule, but only for liability arising out of the ownership, maintenance and use of that part of the described land or premises which is leased or rented to you.
B. The insurance afforded by this endorsement does not apply to:
1. Any "accident" which occurs after you cease to be a tenant in the premises.
2. Structural alterations, new construction or demolition operations performed by or for the designated person or organization.
Standard Attachment: S608299 Certificate ID: 18398668
CA 25 09 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1
Standard Attachment: S608299 Certificate ID: 18398668
COMMERCIAL AUTO
CA 25 45 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
REQUIRED IN LEASE AGREEMENT WITH YOU
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.
A. Paragraph D. Who Is An Insured of General Liability Coverages is amended to include as an additional "insured" any person or organization from whom you lease equipment when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional "insured" on your policy. Such person or organization is an "insured" only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of the maintenance, operation or use by you of equipment leased to you by such person or organization.
additional "insured" under this endorsement ends when their contract or agreement with you for such leased equipment ends.
B. With respect to the insurance afforded to these additional "insureds", this insurance does not apply to:
1. Any "accident" which takes place, or offense which is committed, after the equipment lease expires.
2. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the sole negligence of the person or organization described in Paragraph A. of this endorsement.
3. "Bodily injury", "property damage" or "personal and advertising injury" arising out of "work you performed" in connection with such leased equipment.
Standard Attachment: S608300 Certificate ID: 18398668
CA 25 45 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1
Standard Attachment: S608300 Certificate ID: 18398668
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Coverage
1. Any "leased auto" designated or described in the Schedule will be considered a covered "auto" you own and not a covered "auto" you hire or borrow.
2. For a "leased auto" designated or described in the Schedule, the Who Is An Insured pro-vision under Covered Autos Liability Coverage is changed to include as an "insured" the lessor named in the Schedule.
However, the lessor is an "insured" only for "bodily injury" or "property damage" result-ing from the acts or omissions by:
a. You;
b. Any of your "employees" or agents; or
c. Any person, except the lessor or any
"employee" or agent of the lessor, op-erating a "leased auto" with the per-mission of any of the above.
3. The coverages provided under this endorse-ment apply to any "leased auto" described in the Schedule until the expiration date shown in the Schedule, or when the lessor or his or her agent takes possession of the "leased auto", whichever occurs first.
B. Loss Payable Clause
1. We will pay, as interest may appear, you and the lessor named in this endorsement for "loss" to a "leased auto".
2. The insurance covers the interest of the lessor unless the "loss" results from fraud-ulent acts or omissions on your part.
3. If we make any payment to the lessor, we will obtain his or her rights against any other party.
C. Cancellation
1. If we cancel the policy, we will mail notice to the lessor in accordance with the Cancellation Common Policy Condition.
2. If you cancel the policy, we will mail notice to the lessor.
3. Cancellation ends this agreement.
D. The lessor is not liable for payment of your premiums.
E. Additional Definition
As used in this endorsement:
"Leased auto" means an "auto" leased or rented to you, including any substitute, replacement or extra "auto" needed to meet seasonal or other needs, under a leasing or rental agreement that requires you to provide direct primary insurance for the lessor.
Page 2 of 2 Insurance Services Office, Inc., 2011 CA 20 01 10 13
POLICY NUMBER: 689-01-95 COMMERCIAL AUTO
CA 04 49 11 16
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY -
OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.
A. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance - Primary And Excess Insurance Provisions in the Motor Carrier Coverage Form and supersedes any provision to the contrary:
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 writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured".
B. The following is added to the Other Insurance Condition in the Auto Dealers Coverage Form and supersedes any provision to the contrary:
This Coverage Form's Covered Autos Liability Coverage and General Liability Coverages are 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 writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured".
CA 04 49 11 16 Insurance Services Office, Inc., 2016 Page 1 of 1
Standard Attachment: S608760 Certificate ID: 18398668
File details come from the government source that posted it. Updated .