COI_Dept_of_child_Safety_Redacted.pdf

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.

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.)

08/18/2023Endorsement Effective 1021108Policy No. 9Endorsement No.

Hosanna House LLCInsured Premium $

CopperPoint Indemnity Insurance CompanyInsurance Company Countersigned by

This document may have been uploaded to the CopperPoint Portal.

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

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us).

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

Schedule

State Blanket/Schedule/State

AZ STATE

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

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY

SOCIAL SERVICES AUTO ENHANCEMENT ENDORSEMENT

This endorsement modifies insurance provided under the:

BUSINESS AUTO COVERAGE FORM

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

1. TEMPORARY SUBSTITUTE AUTOS PHYSICAL

DAMAGE

The following is added to Section I ± Covered Autos:

D. Temporary Substitute Autos ± Physical Damage

If Physical Damage Coverage is provided by

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that covered "auto" is out of service because of its:

1. Breakdown;

2. Repair;

3. Servicing;

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5. Destruction

Then in that event, Physical Damage Coverage is provided for an "auto" you do not own while it is being used with the permission

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the out of service covered "auto". We will pay

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³DXWR´ 7Kis insurance covers the interest of the

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acts or omissions on your part. If we make any payment to the owner, we will obtain the owner's rights against any other party.

2. EMPLOYEES OR VOLUNTEER WORKERS AS

INSUREDS

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

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XVLQJ D FRYHUHG ³DXWR´ \RX GR QRW RZQ KLUH RU

borrow while performing duties related to the conduct of your business.

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

3. BOARD MEMBERS

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

e. Your elected or appointed board members

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hire or borrow, while performing duties related to the conduct of your business. Anyone else

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

4. ADDITIONAL INSUREDS ± CONTRACT,

AGREEMENT OR PERMIT

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

f. Any person or organization with whom you agreed, in a written contract, agreement or permit, to provide insurance such as is afforded under this Coverage Part, but only with respect to your ownership, maintenance

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applies if the written contract or agreement has been executed or permit issued prior to the

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

This coverage shall be primary and not contributory with respect to the person or

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this section. Any other insurance that person or organization has shall be excess and not contributory with respect to this insurance, but this provision only applies if it is required in the written contract, agreement or permit identified in this section, and is permitted by law.

g. $ ³)XQGLQJ 6RXUFH´ EHLQJ DQ\ SHUVRQ RU organization with respect to their liability arising out of their financial control of you.

5. EMPLOYEE HIRED AUTOS - LIABILITY

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

h. $Q ³HPSOR\HH´ DQ HOHFWHG RU DSSRLQWHG RIILFLDO of yours, or a commissioner, officer or member of your commissions, authorities, boards or

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hired or rented under a written contract or agreement in WKH QDPH RI WKDW ³HPSOR\HH´ RU elected or appointed official, with your permission, while performing duties related to the conduct of your business.

This coverage shall be primary and not contributory with respect to the person or organization included as DQ ³LQVXUHG´ XQGHU this section. Any other insurance that person or organization has shall be excess and not contributory with respect to this insurance, but this provision only applies if it is required in the written contract, agreement or permit identified in this section, and is permitted by law.

6. SUPPLEMENTARY PAYMENTS

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

(2) Up to $5,000 for cost of bail bonds (including bonds for related traffic law violations) required

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have to furnish these bonds.

(4) All reasonable expenses incurred by the

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of earnings up to $400 a day because of time off from work.

7. FELLOW EMPLOYEE

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

8. TOWING AND GLASS BREAKAGE

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

2. Towing

We will pay up to $250 per disablement for towing and labor costs incurred each time a FRYHUHG ³DXWR´ LV Gisabled. However, the labor must be performed at the place of disablement.

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

3. Glass Breakage ± Hitting A Bird Or Animal ± Falling Objects Or Missiles

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

a. Glass breakage; or

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

and

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

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

9. PHYSICAL DAMAGE ± TRANSPORTATION

EXPENSE COVERAGE

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

a. Transportation Expenses

We will pay up to $50 per day/$1,500 maximum per policy period for temporary transportation expense incurred by you because of the total

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WKRVH FRYHUHG ³DXWRV´ IRU ZKLFK \RX FDUU\

either Comprehensive or Specified Causes Of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 24 hours after the theft and

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BA 108 01 01 19 Includes copyrighted material of Insurance Services Office, Inc. with permission. Page 3 of 5

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10. PHYSICAL DAMAGE ± LOSS OF USE

EXPENSES

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

b. Loss Of Use Expenses

For Hired Auto Physical Damage, we will pay

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legally responsible to pay for loss of use of a vehicle rented or hired without a driver, under a written rental contract or agreement. We will pay for loss of use expenses if caused by:

(1) Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for any FRYHUHG ³DXWR´

(2) Specified Causes Of Loss only if the Declarations indicates that Specified Causes Of Loss Coverage is provided for

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(3) Collision only if the Declarations indicate that Collision Coverage is provided for any coveUHG ³DXWR´

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

11. COVERAGE EXTENSIONS ± PHYSICAL

DAMAGE

The following are added to Paragraph A.4.

Coverage Extensions of Section III ± Physical Damage Coverage:

c. Rental Reimbursement

We will pay for rental reimbursement expenses

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because of ³ORVV´ WR D FRYHUHG ³DXWR´ :H ZLOO pay a maximum of $30 per day for a maximum period of 30 days for each covered auto. The most we will pay for rental reimbursement expenses because of "loss" to any one covered "auto" during the policy term is $3,000. No deductible applies to this coverage.

d. Personal Effects

If Comprehensive Coverage is provided on this

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DQG WKDW FRYHUHG ³DXWR´ LV VWROHQ ZH ZLOO SD\

without application of a deductible, up to

$1,000 for personal effects stolen with that

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any other collectible insurance. Personal effects do not include tools, jewelry, money or securities.

e. Hired Auto Physical Damage

Physical Damage Coverage is provided for

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same extent as Physical Damage Coverage for FRYHUHG ³DXWRs" you own, except:

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(a) The actual cash value of the damaged or stolen property as of the time of the

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(b) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality less the Deductible shown on the Declarations page of the policy. This

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lightning.

(2) Subject to Paragraph e.(1) of this endorsement, we will provide coverage equal to the broadest Physical Damage coverage

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

At your request, we will pay up to $1,000 as reimbursement of deductible payments made

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under the Physical Damage Coverage of the

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automobile insurance but only if:

(1) The "loss" is to an "auto" owned by the

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hired or borrowed by you; and

(2) The "auto" was being used at the time of

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³HPSOR\HH V´ employment by you or while WKH ³YROXQWHHU ZRUNHU´ ZDV performing duties related to the conduct of your business. With regards to this endorsement, travel to and from a normal place of employment is not within the course and scope of employment by you unless such travel is in response to an emergency summons RI WKDW ³HPSOR\HH´ RU

³YROXQWHHU ZRUNHU´

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

12. LOAN/LEASE GAP

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

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

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

and

b. Any:

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

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

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

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

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

13. AIRBAG COVERAGE AND FREEZING OF

PERMANENTLY ATTACHED EQUIPMENT

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

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

The exclusion relating to freezing does not apply to any ³ORVV´ FDXVHG E\ IUHH]LQJ WR SHUPDQHQWO\ attached special equipment common to a fire or

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caused by your failure to properly maintain such equipment. Such equipment includes, but is not limited to, pumps, gauges, valves, fill lines, drains

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freezing to an automobile engine be covered by this policy.

14. ELECTRONIC EQUIPMENT ± BROADENED

COVERAGE

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

c. Any electronic equipment that receives or transmits audio, visual or data signals, and that is not designed solely for the reproduction of sound unless permanently installed in the FRYHUHG ³DXWR´ RU XQOHVV WKH KRXVLQJ XQLt for removable equipment is permanently installed

LQ WKH FRYHUHG ³DXWR´

15. PHYSICAL DAMAGE ± COMPREHENSIVE

COVERAGE ± DEDUCTIBLE

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

Regardless of the number of coYHUHG ³DXWRV´ damaged or stolen, the maximum deductible that will be applied to Comprehensive Coverage for all

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16. KNOWLEDGE AND NOTICE OF ACCIDENT

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

d. 7KH IDLOXUH RI DQ\ DJHQW VHUYDQW ³YROXQWHHU

ZRUNHU´ RU ³HPSOR\HH´ RI WKH ³LQVXUHG´ RWKHU

WKDQ DQ ³HPSOR\HH´ DXWKRUL]HG E\ \RX WR JLYH

or receive QRWLFH RI DQ ³DFFLGHQW´ FODLP ³VXLW´

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he or she has knowledge, shall not invalidate insurance afforded by this policy.

17. EMPLOYEE HIRED AUTOS ± PHYSICAL

DAMAGE

Paragraph B.5. Other Insurance, subparagraph b.

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

b. For Hired Auto Physical Damage Coverage, WKH IROORZLQJ DUH GHHPHG WR EH FRYHUHG ³DXWRV´ you own:

(1) $Q\ FRYHUHG ³DXWR´ \RX OHDVH KLUH UHQW RU

borrow; and

(2) $Q\ ³DXWR´ KLUHG RU UHQWHG XQGHU D ZULWWHQ

contract or agreement entered into by an

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with your permission while being operated within the course and scope of that "employee's" or elected or appointed RIILFLDO¶V employment by you.

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rented or borrowed with a driver is not a

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

18. VOLUNTEER WORKER

The following is added to Section V ± Definitions:

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³HPSOR\HH´ DQG ZKR GRQDWHV KLV RU KHU ZRUN DQG

acts at the direction of and within the scope of duties determined by you, and is not paid a fee, salary or other compensation by you or anyone else for their work performed for you.

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

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

COMMERCIAL GENERAL LIABILITY

CG 20 26 12 19

POLICY NUMBER:

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

ADDITIONAL INSURED – DESIGNATED

PERSON OR ORGANIZATION

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE

A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf:

1. In the performance of your ongoing operations;

or

2. In connection with your premises owned by or rented to you.

However:

1. The insurance afforded to such additional insured only applies to the extent permitted by law; and

2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.

B. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance:

If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:

1. Required by the contract or agreement; or

2. Available under the applicable limits of insurance;

whichever is less.

This endorsement shall not increase the applicable limits of insurance.

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

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

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

C1GP404908

1 1

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

COMMERCIAL GENERAL LIABILITY

CG 24 04 12 19

POLICY NUMBER:

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

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US (WAIVER OF SUBROGATION)

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

ELECTRONIC DATA LIABILITY COVERAGE PART

LIQUOR LIABILITY COVERAGE PART

POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES

POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

RAILROAD PROTECTIVE LIABILITY COVERAGE PART

UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS

SCHEDULE

The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Conditions:

We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above.

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

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

1 1

C1GP404908

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

POLICY NUMBER: COMMERCIAL AUTO

CA 04 44 10 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US (WAIVER OF SUBROGATION)

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:

Endorsement Effective Date:

SCHEDULE

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

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

The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization.

CA 04 44 10 13 Page 1 of 1c Insurance Services Office, Inc., 2011

C2GP403462

08/13/2023

Hosanna House LLC.

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