APPROVED CTR059322 GL, AL, WC 04.01.22 - 04.01.23.pdf

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Attached to
Master Agreement AZ|CTR059322
Contract number
CTR059322
Issued by
Arizona

About this file

This document is a Certificate of Liability Insurance issued by Aon Risk Insurance Services West, Inc. for PFVT Motors, LLC dba Peoria Ford, with policies underwritten by multiple insurers including ACE American Insurance Company, ACE Property & Casualty Insurance Co., and Old Republic Union Insurance Company. The certificate covers insurance for the State of Arizona, its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees, with the state included as an Additional Insured.

The insurance coverage includes Commercial General Liability, Automobile Liability, Umbrella Liability, and Workers' Compensation, with policy periods from 04/01/2022 to 04/01/2023. Key coverage limits include $2,000,000 for General Liability each occurrence, $5,000,000 Umbrella Liability aggregate, and $1,000,000 for Workers' Compensation. The policy provides a waiver of subrogation in favor of the State of Arizona and includes provisions for primary and non-contributory insurance. The certificate also includes Garagekeepers Legal Liability with a $5,000,000 limit per location and details multiple insurance carriers participating in the property coverage.

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AC�® CERTIFICATE OF LIABILITY INSURANCE I

DATE(MMIODIYYYY)

I,.,._...--· 04/07/2022

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), A UTHORIZED

REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

IMPORTANT: If the cerliflcate holder Is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED1 subject to the terms and condilions 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

Aon Risk Insurance services Phoenix AZ. office 2555 East camelback Rd.

suite 700 Phoenix AZ 85016 USA

INSURED

PFVT Motors, LLC dba Peoria Ford 9130 W. Bell Rd, Peoria AZ 85382 USA

COVERAGES

CONTACT

West, rnc, NAME:

PHONE

(NC. No. Ext}:

E-MAIL

ADDRESS:

INSURER A:

INSURER B:

INSURER C:

INSURER D:

INSURER E:

INSURER F:

CERTIFICATE NUMBER: 570092607106

(866) 283-7122 j r�. Ho.l:

(800) 363-010S

INSURER(S) AFFORDING COVERAGE NAIC#

ACE American Insurance company 22667 ACE Property & casualty Insurance Co. 20699

Old Republic union Insurance company 31143

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, TEAM 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. limits shown are as reauested

1TfR A

A

B

A

A

C

TYPE OF INSURANCE

X COMMERCIAL GENERAL LIABILITY -

� CLA!MS·MAOE 0occuR -

'LAGGREGATE LIMIT APPLIES Pm □ PRO· □ POLICY JECT LOC

OTHER:

AUTOMOBILE LIABILITY

X ANY AUTO - - SCHEDULED OWNED

� AUTOS ONLY � AUTOS

HIRED AUTOS NON-OWNED

� ONLY � AUTOS ONLY

X UMBRELLA LIAB

� EXCESS LIAB

OCCUR

CLA!MS·MADE

OED IX !RETENTION $2S, 000

WORKERS COMPENSATION ANO

EMPLOYERS' LIABILITY

ANY PROPRIETOR/ PARTNER I EXECUTIVE

OFFICERiMEMBER EXCLUDED?

(Mandatory In Nii) �lii�[;;{@� tff�PERATlONS below 0cc Accident

VIN

lNSD

NIA

WVD POLICY NUMBER ·MMIDoivV�:. 'MMIDD VYY LIMITS GAR HL.>.J.JUU"1.l. " EACH OCCURRENCE

D '""

PREMISES /Ea mx:urrencel MED EXP (Any one person)

PERSONAL & ADV INJURY

GENERAL AGGREGATE

PRODUCTS· COMP/OP AGG

GAR H25556641 04/01/2022 04/01/2023 COMBINED SINGLE LIMIT

'Ea acciden11 BODll Y INJURY { Per person) BODIL y INJURY (Per accident)

PROPERTY DAMAGE

/Per accident

XEUG27968788007 04/01/2022 04/01/2023 EACH OCCURRENCE

AGGREGATE

WLRC68912325 04/01/2022 04/01/2023 X I PER STATUTE I l:?XH·

AOS

WCUC68912283 04/01/2022 04/01/2023 E.l. EACH ACCIDENT AZ E.L. DISEASE-EA El.'.PLOYEE

E.l. OISEASE·POLICY LIMIT ORNSOL00005000 04/01/2022 04/01/2023 Per Policy Texas Nonsubscriber EEL Per Employee SIR applies per policy ter 1s & condi ions

DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Addll!onal Remarks Schedule, may be allached II more space Is required)

$2,000,000 $300,000 Excluded

$2,000,000 $5,000,000 $2,000,000

$2,000,000

$5,000,000 $5,000,000

$1,000,000 $1,000,000 $1,000,000

$25,000,000 $5,000,000

State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents 1 and employees is included as Additional Insured in accordance with the policy i;irovisions of the General Liability and Automobile Liability policies. A waiver of subrogation is granted in favor of State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees for losses arising from work performed by or on behalf of the contractor in accordance with the policy provisions of the General Liability, workers compensation and Automobile Liability �olicies.

General Liability evidenced herein is Primary and Non-contributory to other insurance availab e to an Additional Insured, but

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE

EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE

POLICY PROVISIONS.

The state of Arizona or ADOT AUTHORIZED REPRESENTATIVE 1324 N. 22 nd Ave.

Phoenix AZ 85009 USA d, f§f.,,,tJ --- S:..,a.1 �Jn..

©1988-2015 ACORD CORPORATION. All rlghls reserved.

ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD

:r:

E7470 Highlight

E7470 Highlight

E7470 Highlight e6906

ACCEPTED

only in accordance with the policy's provisions. 30 Day Notice of Cancellation.

FORM TITLE:FORM NUMBER:

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

ADDITIONAL REMARKS

EFFECTIVE DATE:

CARRIER NAIC CODE

POLICY NUMBER

Aon Risk Insurance Services West, Inc.

NAMED INSUREDAGENCY

LOC #:

570000063184 AGENCY CUSTOMER ID:

© 2008 ACORD CORPORATION. All rights reserved.

See Certificate Numbe

See Certificate Numbe

The ACORD name and logo are registered marks of ACORD

570092083092

570092083092

ACORD 25 Certificate of Liability Insurance Additional Description of Operations / Locations / Vehicles:

ACORD 101 (2008/01)

ADDITIONAL REMARKS SCHEDULE Page _ of _

PFVT Motors, LLC dba

KReeves Highlight

H ol d er

I d en ti fi er

77777 77707

07070 00777

61616 04557

11107 74737

02632 65552

07662 20575

25073 00070

67377 52653

22210 75073

73132 57232

20721 50067

02662 13107

26130 66010

21550 07061

01366 60315

55072 61155

12136 50020

76727 24203

57720 00777

77770 70007

07007

77777 77707

07070 00735

25677 11545

60007 66045

40612 71130

07231 14502

46211 60073

30055 16562

15710 74263

33242 07601

10702 33626

03026 11107

02333 62420

63011 07132

23735 30720

11070 33336

35207 30000

77756 16335

17655 40777

77770 70007

07007

C E

R T

IF

IC

A T

E N

U M

B E

R

CERTIFICATE OF PROPERTY INSURANCE DATE (MM/DD/YYYY)

03/21/2022

Aon Risk Insurance Services West, Inc.

PRODUCER

Phoenix AZ Office 2555 East Camelback Rd.

Suite 700 Phoenix AZ 85016 USA

(866) 283-7122 (800) 363-0105

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.

CONTACT

NAME:

PHONE

(A/C. No. Ext):

E-MAIL

ADDRESS:

PRODUCER

CUSTOMER ID #:

FAX

(A/C. No.):

INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A:INSURED National Fire & Marine Ins Co 20079

INSURER B:

570000063184

PFVT Motors, LLC dba

INSURER D:

INSURER E:

INSURER F:

INSURER C:Peoria Ford 9130 W. Bell Rd.

Peoria AZ 85382 USA

LOCATION OF PREMISES/ DESCRIPTION OF PROPERTY (Attach ACORD 101, Additional Remarks Schedule, if more space is required)

CERTIFICATE NUMBER: 570092082855 COVERAGES 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.

POLICY EXPIRATION

DATE (MM/DD/YYYY)

LIMITS COVERED PROPERTY

POLICY EFFECTIVE

DATE (MM/DD/YYYY)

POLICY NUMBER TYPE OF INSURANCE

INSR

LTR

PROPERTY

CAUSES OF LOSS

BASIC

BROAD

EARTHQUAKE

FLOOD

BUILDING

PERSONAL PROPERTY

BUSINESS INCOME

EXTRA EXPENSE

BLANKET BUILDING

BLANKET PERS PROP

BLANKET BLDG & PP

X

X

X

$10,000,000

A 92SRD103014 03/01/2022 03/01/2023

Property

WIND

DEDUCTIBLES

BUILDING

CONTENTS

RENTAL VALUE

SPECIAL

Blkt B&PP Ded

ALL RISK-Subject to Exclusions

INLAND MARINE

TYPE OF POLICY

CAUSES OF LOSS

NAMED PERILS

POLICY NUMBER

CRIME

TYPE OF POLICY

BOILER & MACHINERY /

EQUIPMENT BREAKDOWN

SPECIAL CONDITIONS / OTHER COVERAGES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

Coverage Includes: Garagekeepers Legal Liability - Limit: $5,000,000 per location. See addendum for additional coverage and carrier participation.

CERTIFICATE HOLDER CANCELLATION

AUTHORIZED

REPRESENTATIVE

The State of Arizone or ADOT 1324 N. 22 nd Ave.

Phoenix AZ 85009 USA

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION

DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

ACORD 24 (2016/03)

© 1995-2015 ACORD CORPORATION. All rights reserved

The ACORD name and logo are registered marks of ACORD

Insurer Security - Participation

ADDITIONAL REMARKS SCHEDULE

AGENCY CUSTOMER ID:

LOC #:

ADDITIONAL REMARKS

FORM NUMBER: Certificate of Property InsuranceFORM TITLE:ACORD 24

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

AGENCY

POLICY NUMBER

CARRIER

See Certificate Number:

EFFECTIVE DATE:

NAIC CODE

NAMED INSURED

See Certificate Number:

Aon Risk Insurance Services West, Inc.

570092082855

570092082855

570000063184

Page _ of _

PFVT Motors, LLC dba

Attachment Insurer - Policy Number Layer Part % - Participation $5,000,000 xs Deductible - National Fire & Marine Insurance Company - 92SRD103014 $5,000,000 xs Deductible - Lloyds Syndicate (IQUW, Beazley) - PTNAM2202434 $5,000,000 xs Deductible - Lloyds Syndicate (Inigo) - PTNAM2207993 $5,000,000 xs Deductible - Starr Surplus Lines Insurance Company - SLSTPTY11576622 $25,000,000 xs Deductibles - Allied World Assurance Company - 031224931A $25,000,000 xs Deductibles - Ironshore Specialty Insurance Company - 100038331603 $50,000,000 xs Deductibles - General Star Indemnity Company - IAG968226B $10,000,000 xs $15,000,000 - Lloyds Syndicate (Canopius, Blenheim, Unicorn + ACT) - PTNAM2204850 $20,000,000 xs $5,000,000 - Landmark American Insurance Company - LHD922688 $20,000,000 xs $5,000,000 - GuideOne National Insurance Company - 099002388 $95,000,000 xs $5,000,000 - Everest Indemnity Insurance Company - IM8CM00327221

The ACORD name and logo are registered marks of ACORD

© 2008 ACORD CORPORATION. All rights reserved.ACORD 101 (2008/01)

DA-9U74c (03/16) Page 1 of 1

ADDITIONAL INSURED – DESIGNATED PERSONS OR ORGANIZATIONS

ADDITIONAL INSURED –

DESIGNATED PERSONS OR ORGANIZATIONS

Named Insured Berkshire Hathaway Automotive Inc. Endorsement Number

Policy Symbol

GAR

Policy Number

H25556641 Policy Period

04/01/2022 TO 04/01/2023

Effective Date of Endorsement

Issued By (Name of Insurance Company)

ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

AUTO DEALERS COVERAGE FORM

MOTOR CARRIER COVERAGE FORM

EXCESS BUSINESS AUTO COVERAGE FORM

Additional Insured(s): Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss

A. For a covered “auto,” Who Is Insured is amended to include as an “insured,” the persons or organizations named in this endorsement. However, these persons or organizations are an “insured” only for “bodily injury” or “property damage” resulting from acts or omissions of:

1. You.

2. Any of your “employees” or agents.

3. Any person operating a covered “auto” with permission from you, any of your “employees” or agents.

B. The persons or organizations named in this endorsement are not liable for payment of your premium.

Authorized Representative

PRIMARY INSURANCE - ADDITIONAL INSURED

MS-312613.1 (04/21) ©Chubb. 2016. All rights reserved. Page 1 of 1

Named Insured Berkshire Hathaway Automotive Inc. Endorsement Number

Policy Symbol

GAR

Policy Number

H25556641 Policy Period

04/01/2022 TO 04/01/2023

Effective Date of Endorsement

Issued By (Name of Insurance Company)

ACE American Insurance Company

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING:

AUTO DEALERS COVERAGE FORM

Notwithstanding the Other Insurance Condition, or any selection in the Declarations regarding Direct Coverage Options for Garagekeepers Coverages this policy is amended where required by written contract or government entity, to be primary and non-contributory to other insurance and programs of self-insurance maintained by any “insureds” under this policy but only to the extent so required by written contract or agreement.

DA-13115a (06/14) Page 1 of 1

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS

Named Insured Berkshire Hathaway Automotive Inc. Endorsement Number

Policy Symbol

GAR

Policy Number

H25556641 Policy Period

04/01/2022 TO 04/01/2023

Effective Date of Endorsement

Issued By (Name of Insurance Company)

ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This Endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

MOTOR CARRIERS COVERAGE FORM

AUTO DEALERS COVERAGE FORM

We waive any right of recovery we may have against the person or organization shown in the Schedule below because of payments we make for injury or damage arising out of the use of a covered auto. The waiver applies only to the person or organization shown 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.

Authorized Representative

WC 00 03 13 (11/05) © Copyright 1983–2017 National Council on Compensation Insurance, Inc. All Rights Reserved.

Workers' Compensation and Employers' Liability Policy Named Insured

BERKSHIRE HATHAWAY AUTOMOTIVE INC.

8333 ROYAL RIDGE PARKWAY, SUITE 100

IRVING TX 75063

Endorsement Number

Policy Number

Symbol: WLR Number: C68912325

Policy Period

04-01-2022 TO 04-01-2023

Effective Date of Endorsement

04-01-2022

Issued By (Name of Insurance Company)

ACE AMERICAN INSURANCE COMPANY

Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

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

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 any one 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 the states of CA, UT, TX, refer to state specific endorsements.

This endorsement is not applicable in KY, NH, and NJ.

The endorsement does not apply to policies in Missouri where the employer is in the construction group of code classifications. According to Section 287.150(6) of the Missouri statutes, a contractual provision purporting to waive subrogation rights against public policy and void where one party to the contract is an employer in the construction group of code classifications.

For Kansas, use of this endorsement is limited by the Kansas Fairness in Private Construction Contract Act(K.S.A..

16-1801 through 16-1807 and any amendments thereto) and the Kansas Fairness in Public Construction Contract

Act(K.S.A 16-1901 through 16-1908 and any amendments thereto). According to the Acts a provision in a contract for private or public construction purporting to waive subrogation rights for losses or claims covered or paid by liability or workers compensation insurance shall be against public policy and shall be void and unenforceable except that, subject to the Acts, a contract may require waiver of subrogation for losses or claims paid by a consolidated or wrap-up insurance program.

Authorized Agent

File details come from the government source that posted it. Updated .