COI_EXP_7-1-25.pdf
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- Attached to
- Master Agreement AZ|CTR076574
- Contract number
- CTR076574
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for Logan Simpson Design, Inc., a company located in Tempe, Arizona. The insurance is provided by multiple carriers including Ohio Security Insurance Company, Ohio Casualty Insurance Company, Crum & Forster Specialty Insurance Company, and At-Bay Specialty Insurance Company. The certificate holder is the State of Arizona, Department of Administration, located in Phoenix. The insurance policies cover various types of liability including commercial general liability, automobile liability, umbrella liability, workers compensation, professional liability, pollution liability, and cyber liability, with policy periods effective from July 1, 2024 to July 1, 2025.
The insurance policies are associated with a specific project: LS 2550195 ADOA On-Call Architectural & Landscape Architectural Services (BPM006827), which appears to be a statewide contract for architectural and landscape architectural services. The policies provide substantial coverage limits, including $2,000,000 per occurrence for commercial general liability, $1,000,000 for automobile liability, $10,000,000 for umbrella liability, and $1,000,000 for workers compensation. Additional coverage includes professional liability with a $5,000,000 aggregate limit, pollution liability with a $5,000,000 limit, and cyber liability with a $2,000,000 aggregate limit. The insurance also includes provisions for additional insured status for the State of Arizona where required by written contract.
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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
4/16/2025
Brown & Brown Insurance Services, Inc 2800 N Central Ave, Suite 1100 PO Box 2800 Phoenix AZ 85004
Marie Puetz, CISR 602-664-7043 602-664-7000 marie.puetz@bbrown.com
Ohio Security Ins Co 24082 LOGASIM-01 Ohio Casualty Insurance Co 24074
Logan Simpson Design, Inc.
222 S. Mill Avenue, Suite 222 Tempe AZ 85281
Crum & Forster Specialty Insurance Company 44520 At-Bay Specialty Insurance Company 19607
1177318854
C A
X 2,000,000 X 1,000,000
15,000
2,000,000
5,000,000 X
Y Y EPK-148285
BKS64975063
7/1/2024 7/1/2024
7/1/2025 7/1/2025
5,000,000
A 1,000,000
X
X X X Phys. Damage
Y Y BAS64975063 7/1/2024 7/1/2025
Deductible $500/$500
B X X 10,000,000Y USO64975063 7/1/2024Y 7/1/2025
10,000,000 X 10,000
B X
N
Y XWO64975063 7/1/2024 7/1/2025
1,000,000
1,000,000
1,000,000 C C D
Professional Liability Pollution Liability Cyber Liability
EPK-148285
EPK-148285
ATB-6695427-03
7/1/2024 7/1/2024 7/1/2024
7/1/2025 7/1/2025 7/1/2025
Claim/Aggregate Each Condition Aggregate
5000000/5000000 5,000,000 2,000,000
Leased or Rented Equipment - Policy No. BKS64975063 - 7/1/2024-7/1/2025 - $25,000/Deductible $1,000 Valuable Papers Coverage - Policy No. BKS 64975063 - 7/1/2024-7/1/2025 - $25,000/Deductible $1,000
Blanket Additional Insured applies to General Liability per attached form EN0111-0211. Blanket Additional Insured for Completed Operations applies to General Liability per attached form EN0320-0211. Primary and Non-Contributory wording and Blanket Waiver of Subrogation applies to General Liability per attached form EN0118-0211. Blanket Additional Insured applies to Auto Liability per attached form AC 8501 06/18. Blanket Waiver of Subrogation applies to Auto Liability per attached form AC 8501 06/18. Primary and Non-Contributory wording applies to Auto Liability per attached form AC 8501 06/18. Blanket Waiver of Subrogation applies to the Workers Compensation per attached form WC 00 03 13. Umbrella follows form over General Liability, Auto Liability, and Employers See Attached...
State of Arizona, Department of Administration 100 N 15th Avenue, Suite 302 Phoenix AZ 85007
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:
LOGASIM-01
1 1
Brown & Brown Insurance Services, Inc Logan Simpson Design, Inc.
222 S. Mill Avenue, Suite 222 Tempe AZ 85281
25 CERTIFICATE OF LIABILITY INSURANCE
Liability.
Errors and Omissions/Professional Liability – The Limits of Insurance shall not exceed $2,000,000 Errors and Omissions Each Claim Limit and $4,000,000 General Aggregate Limit for “claims” because of a “wrongful act” that occurs on or after 08/23/1990 and before 10/05/2022; and The Limits of Insurance shall not exceed $2,000,000 Errors and Omissions Each Claim Limit and $5,000,000 General Aggregate Limit for “claims” because of a “wrongful act” that occurs on or after 10/05/2022 and before 01/15/2025; and The Limits of Insurance shall not exceed $5,000,000 Errors and Omissions Each Claim Limit and $5,000,000 General Aggregate Limit for “claims” because of a “wrongful act” that occurs on or after 01/15/2025 and before the end of the “policy period”."
Project Name/Number: LS 2550195 ADOA On-Call Architectural & Landscape Architectural Services / BPM006827 ON-CALL ARCHITECTURAL AND
LANDSCAPE ARCHITECTURAL SERVICES
Additional insured: State of Arizona where required per written contract.
EN0320-0211 Page 1 of 1
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS –
COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Additional Person(s) or Organization(s):
Location And Description Of Completed Operations
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section III – Who Is An Insured within the Common Provisions is amended to include as an insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for “bodily injury” or “property damage” caused, in whole or in part, by “your work” at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the “products-completed operations hazard”.
Blanket where required by written contract
Policy Number: EPK-148285
EN0111-0211 Page 1 of 1
ADDITIONAL INSURED – OWNERS, LESSEES OR
CONTRACTORS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
CONTRACTORS POLLUTION LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) or Organization(s)
SECTION III – WHO IS AN INSURED within the Common Provisions is amended to include as an additional insured the person(s) or organization(s) indicated in the Schedule shown above, but only with respect to liability caused, in whole or in part, by “your work” for that insured which is performed by you or by those acting on your behalf.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED.
Blanket where required by written contract
EN0118-0211 Page 1 of 1
PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED
WITH WAIVER OF SUBROGATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
CONTRACTORS POLLUTION LIABILITY COVERAGE PART
ERRORS AND OMISSIONS LIABILITY COVERAGE PART
THIRD PARTY POLLUTION LIABILITY COVERAGE PART
SCHEDULE
Name of Additional Insured Person(s) or Organization(s)
A. SECTION III – WHO IS AN INSURED within the Common Provisions is amended to include as an additional insured the person(s) or organization(s) indicated in the Schedule shown above, but solely with respect to “claims” caused in whole or in part, by “your work” for that person or organization performed by you, or by those acting on your behalf.
This insurance shall be primary and non-contributory, but only in the event of a named insured’s sole negligence.
B. We waive any right of recovery we may have against the person(s) or organization(s) indicated in the Schedule shown above because of payments we make for “damages” arising out of “your work” performed under a designated project or contract with that person(s) or organization(s).
C. This Endorsement does not reinstate or increase the Limits of Insurance applicable to any “claim” to which the coverage afforded by this Endorsement applies.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED.
Blanket where required by written contract
AC 85 01 06 18 © 2017 Liberty Mutual Insurance Page 1 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission.
POLICY NUMBER: COMMERCIAL AUTO
AC 85 01 06 18
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BUSINESS AUTO COVERAGE ENHANCEMENT
ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement.
If the policy to which this endorsement is attached also contains a Business Auto Coverage Enhancement Endorsement with a specific state named in the title, this endorsement does not apply to vehicles garaged in that specified state.
COVERAGE INDEX
SUBJECT PROVISION NUMBER
ACCIDENTAL AIRBAG DEPLOYMENT 13
ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT 4
AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS 21
AMENDED FELLOW EMPLOYEE EXCLUSION 6
AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE 15
BODILY INJURY REDEFINED 25
EMPLOYEES AS INSUREDS (Including Employee Hired Auto) 3
EXTRA EXPENSE – BROADENED COVERAGE 11
GLASS REPAIR – WAIVER OF DEDUCTIBLE 17
HIRED AUTO COVERAGE TERRITORY 23
HIRED AUTO PHYSICAL DAMAGE (Including Employee Hired Auto) 7 LOAN / LEASE GAP (Coverage Not Available In New York) 16
NEWLY FORMED OR ACQUIRED SUBSIDIARIES 2
PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) 18
PERSONAL EFFECTS COVERAGE 12
PHYSICAL DAMAGE – ADDITIONAL TRANSPORTATION EXPENSE COVERAGE 9
PHYSICAL DAMAGE DEDUCTIBLE – VEHICLE TRACKING SYSTEM 14
PRIMARY AND NON–CONTRIBUTORY – WRITTEN CONTRACT OR WRITTEN AGREEMENT 24
RENTAL REIMBURSEMENT 10
SUPPLEMENTARY PAYMENTS 5
TOWING AND LABOR 8
TRAILERS – INCREASED LOAD CAPACITY 1
TWO OR MORE DEDUCTIBLES 19
UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS 20
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US 22
SECTION I – COVERED AUTOS is amended as follows:
1. TRAILERS – INCREASED LOAD CAPACITY
The following replaces Paragraph C.1. Certain Trailers, Mobile Equipment And Temporary Substitute Autos of SECTION I – COVERED AUTOS:
BAS64975063
Page 2 of 9 © 2017 Liberty Mutual Insurance AC 85 01 06 18
"Trailers" with a load capacity of 3,000 pounds or less designed primarily for travel on public roads.
SECTION II – LIABILITY COVERAGE is amended as follows:
2. NEWLY FORMED OR ACQUIRED SUBSIDIARIES
SECTION II – LIABILITY COVERAGE, Paragraph A.1. Who Is An Insured is amended to include the following as an "insured":
d. Any legally incorporated subsidiary of which you own more than 50 percent interest during the policy period.
Coverage is afforded only for 90 days from the date of acquisition or formation. However, "insured" does not include any organization that:
(1) Is a partnership or joint venture; or
(2) Is an "insured" under any other automobile policy except a policy written specifically to apply in excess of this policy; or
(3) Has exhausted its Limit of Insurance or had its policy terminated under any other automobile policy.
Coverage under this provision d. does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization.
3. EMPLOYEES AS INSUREDS
SECTION II – LIABILITY COVERAGE, Paragraph A.1. Who Is An Insured is amended to include the following as an "insured":
e. Any "employee" of yours while using a covered "auto" you do not own, hire or borrow but only for acts within the scope of their employment by you. Insurance provided by this endorsement is excess over any other insurance available to any "employee".
f. Any "employee" of yours while operating an "auto" hired or borrowed under a written contract or agreement in that "employee’s" name, with your permission, while performing duties related to the conduct of your business and within the scope of their employment. Insurance provided by this endorsement is excess over any other insurance available to the "employee".
4. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT
SECTION II – LIABILITY COVERAGE, Paragraph A.1. Who Is An Insured is amended to include the following as an "insured":
g. 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 in a written contract, written agreement, or permit issued to you by governmental or public authority, to add such person, or organization, or governmental or public authority to this policy as an "insured".
However, such person or organization is an "insured":
(1) Only with respect to the operation, maintenance or use of a covered "auto";
(2) Only for "bodily injury" or "property damage" caused by an "accident" which takes place after you executed the written contract or written agreement, or the permit has been issued to you; and
(3) Only for the duration of that contract, agreement or permit.
AC 85 01 06 18 © 2017 Liberty Mutual Insurance Page 3 of 9
The "insured" is required to submit a claim to any other insurer to which coverage could apply for defense and indemnity. Unless the "insured" has agreed in writing to primary noncontributory wording per enhancement number 24, this policy is excess over any other collectible insurance.
5. SUPPLEMENTARY PAYMENTS
SECTION II – LIABILITY COVERAGE, Coverage Extensions, 2.a. Supplementary Payments, Paragraphs
(2) and (4) are replaced by the following:
(2) Up to $3,000 for cost of bail bonds (including bonds for related traffic 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 $500 a day because of time off from work.
6. AMENDED FELLOW EMPLOYEE EXCLUSION
In those jurisdictions where, by law, fellow "employees" are not entitled to the protection afforded to the employer by the workers compensation exclusivity rule, or similar protection, the following provision is added:
SECTION II – LIABILITY, Exclusion B.5. Fellow Employee does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire if you have workers compensation insurance in force for all of your "employees" at the time of "loss".
This coverage is excess over any other collectible insurance.
SECTION III – PHYSICAL DAMAGE COVERAGE is amended as follows:
7. HIRED AUTO PHYSICAL DAMAGE
Paragraph A.4. Coverage Extensions of SECTION III – PHYSICAL DAMAGE COVERAGE, is amended by adding the following:
If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of Loss or Collision coverage are provided under the Business Auto Coverage Form for any "auto" you own, then the Physical Damage coverages provided are extended to "autos":
a. You hire, rent or borrow; or
b. Your "employee" hires or rents under a written contract or agreement in that "employee’s" name, but only if the damage occurs while the vehicle is being used in the conduct of your business, subject to the following limit and deductible:
a. The most we will pay for "loss" in any one "accident" or "loss" is the smallest of:
(1) $50,000; or
(2) The actual cash value of the damaged or stolen property as of the time of the "loss"; or
(3) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality, minus a deductible.
b. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage.
c. Subject to the limit, deductible and excess provisions described in this provision, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own.
Page 4 of 9 © 2017 Liberty Mutual Insurance AC 85 01 06 18
d. Subject to a maximum of $1,000 per "accident", we will also cover the actual loss of use of the hired "auto" if it results from an "accident", you are legally liable and the lessor incurs an actual financial loss.
e. This coverage extension does not apply to:
(1) Any "auto" that is hired, rented or borrowed with a driver; or
(2) Any "auto" that is hired, rented or borrowed from your "employee" or any member of your "employee’s" household.
Coverage provided under this extension is excess over any other collectible insurance available at the time of "loss".
8. TOWING AND LABOR
SECTION III – PHYSICAL DAMAGE COVERAGE, Paragraph A.2. Towing, is amended by the addition of the following:
We will pay towing and labor costs incurred, up to the limits shown below, each time a covered "auto" classified and rated as a private passenger type, "light truck" or "medium truck" is disabled:
a. For private passenger type vehicles, we will pay up to $75 per disablement.
b. For "light trucks", we will pay up to $75 per disablement. "Light trucks" are trucks that have a gross vehicle weight (GVW) of 10,000 pounds or less.
c. For "medium trucks", we will pay up to $150 per disablement. "Medium trucks" are trucks that have a gross vehicle weight (GVW) of 10,001 – 20,000 pounds.
However, the labor must be performed at the place of disablement.
9. PHYSICAL DAMAGE – ADDITIONAL TRANSPORTATION EXPENSE COVERAGE
Paragraph A.4.a. Coverage Extensions, Transportation Expenses of SECTION III – PHYSICAL DAMAGE COVERAGE, is amended to provide a limit of $50 per day and a maximum limit of $1,500.
10. RENTAL REIMBURSEMENT
SECTION III – PHYSICAL DAMAGE COVERAGE, A. Coverage, is amended by adding the following:
a. We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of an "auto" because of "accident" or "loss", to an "auto" for which we also pay a "loss" under Comprehensive, Specified Causes of Loss or Collision Coverages. We will pay only for those expenses incurred after the first 24 hours following the "accident" or "loss" to the covered "auto."
b. Rental Reimbursement requires the rental of a comparable or lesser vehicle, which in many cases may be substantially less than $75 per day, and will only be allowed for the period of time it should take to repair or replace the vehicle with reasonable speed and similar quality, up to a maximum of 30 days.
c. We will also pay up to $500 for reasonable and necessary expenses incurred by you to remove and replace your tools and equipment from the covered "auto". This limit is excess over any other collectible insurance.
d. This coverage does not apply unless you have a business necessity that other "autos" available for your use and operation cannot fill.
e. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided under Paragraph 4. Coverage Extension.
AC 85 01 06 18 © 2017 Liberty Mutual Insurance Page 5 of 9
f. No deductible applies to this coverage.
g. The insurance provided under this extension is excess over any other collectible insurance.
If this policy also provides Rental Reimbursement Coverage you purchased, the coverage provided by this Enhancement Endorsement is in addition to the coverage you purchased.
For the purposes of this endorsement provision, materials and equipment do not include "personal effects" as defined in provision 12.B.
11. EXTRA EXPENSE – BROADENED COVERAGE
Under SECTION III – PHYSICAL DAMAGE COVERAGE, A. Coverage, we will pay for the expense of returning a stolen covered "auto" to you. The maximum amount we will pay is $1,000.
12. PERSONAL EFFECTS COVERAGE
A. SECTION III – PHYSICAL DAMAGE COVERAGE, A. Coverage, is amended by adding the following:
If you have purchased Comprehensive Coverage on this policy for an "auto" you own and that "auto" is stolen, we will pay, without application of a deductible, up to $600 for "personal effects" stolen with the "auto."
The insurance provided under this provision is excess over any other collectible insurance.
B. SECTION V – DEFINITIONS is amended by adding the following:
For the purposes of this provision, "personal effects" mean tangible property that is worn or carried by an "insured." "Personal effects" does not include tools, equipment, jewelry, money or securities.
13. ACCIDENTAL AIRBAG DEPLOYMENT
SECTION III – PHYSICAL DAMAGE COVERAGE, B. Exclusions is amended by adding the following:
If you have purchased Comprehensive or Collision Coverage under this policy, the exclusion for "loss" relating to mechanical breakdown does not apply to the accidental discharge of an airbag.
Any insurance we provide shall be excess over any other collectible insurance or reimbursement by manufacturer’s warranty. However, we agree to pay any deductible applicable to the other coverage or warranty.
14. PHYSICAL DAMAGE DEDUCTIBLE – VEHICLE TRACKING SYSTEM
SECTION III – PHYSICAL DAMAGE COVERAGE, D. Deductible, is amended by adding the following:
Any Comprehensive Deductible shown in the Declarations will be reduced by 50% for any "loss" caused by theft if the vehicle is equipped with a vehicle tracking device such as a radio tracking device or a global position device and that device was the method of recovery of the vehicle.
15. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE
SECTION III – PHYSICAL DAMAGE COVERAGE, B. Exclusions, Paragraph a. of the exception to exclusions 4.c. and 4.d. is deleted and replaced with the following:
Exclusions 4.c. and 4.d. do not apply to:
a. Electronic equipment that receives or transmits audio, visual or data signals, whether or not designed solely for the reproduction of sound, if the equipment is:
Page 6 of 9 © 2017 Liberty Mutual Insurance AC 85 01 06 18
(1) Permanently installed in the covered "auto" at the time of the "loss" or removable from a housing unit that is permanently installed in the covered "auto"; and
(2) Designed to be solely operated by use from the power from the "auto's" electrical system; and
(3) Physical damage coverages are provided for the covered "auto".
If the "loss" occurs solely to audio, visual or data electronic equipment or accessories used with this equipment, then our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by a $100 deductible.
16. LOAN / LEASE GAP COVERAGE (Not Applicable In New York)
A. Paragraph C. Limit Of Insurance of SECTION III – PHYSICAL DAMAGE COVERAGE is amended by adding the following:
The most we will pay for a "total loss" to a covered "auto" owned by or leased to you in any one "accident" is the greater of the:
1. Balance due under the terms of the loan or lease to which the damaged covered "auto" is subject at the time of the "loss" less the amount of:
a. Overdue payments and financial penalties associated with those payments as of the date of the "loss";
b. Financial penalties imposed under a lease due to high mileage, excessive use or abnormal wear and tear;
c. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease;
d. Transfer or rollover balances from previous loans or leases;
e. Final payment due under a "Balloon Loan";
f. The dollar amount of any unrepaired damage which occurred prior to the "total loss" of a covered "auto";
g. Security deposits not refunded by a lessor;
h. All refunds payable or paid to you as a result of the early termination of a lease agreement or as a result of the early termination of any warranty or extended service agreement on a covered "auto";
i. Any amount representing taxes;
j. Loan or lease termination fees; or
2. The actual cash value of the damage or stolen property as of the time of the "loss".
An adjustment for depreciation and physical condition will be made in determining the actual cash value at the time of the "loss". This adjustment is not applicable in Texas.
B. Additional Conditions
This coverage applies only to the original loan for which the covered "auto" that incurred the "loss" serves as collateral, or lease written on the covered "auto" that incurred the "loss".
AC 85 01 06 18 © 2017 Liberty Mutual Insurance Page 7 of 9
C. SECTION V – DEFINITIONS is changed by adding the following:
As used in this endorsement provision, the following definitions apply:
"Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash value.
A "balloon loan" is one with periodic payments that are insufficient to repay the balance over the term of the loan, thereby requiring a large final payment.
17. GLASS REPAIR – WAIVER OF DEDUCTIBLE
Paragraph D. Deductible of SECTION III – PHYSICAL DAMAGE COVERAGE is amended by the addition of the following:
No deductible applies to glass damage if the glass is repaired rather than replaced.
18. PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE)
Paragraph D. Deductible of SECTION III – PHYSICAL DAMAGE COVERAGE is amended by the addition of the following:
The deductible does not apply to "loss" caused by collision to such covered "auto" of the private passenger type or light weight truck with a gross vehicle weight of 10,000 lbs. or less as defined by the manufacturer as maximum loaded weight the "auto" is designed to carry while it is:
a. In the charge of an "insured";
b. Legally parked; and
c. Unoccupied.
The "loss" must be reported to the police authorities within 24 hours of known damage.
The total amount of the damage to the covered "auto" must exceed the deductible shown in the Declarations.
This provision does not apply to any "loss" if the covered "auto" is in the charge of any person or organization engaged in the automobile business.
19. TWO OR MORE DEDUCTIBLES
Under SECTION III – PHYSICAL DAMAGE COVERAGE, if two or more company policies or coverage forms apply to the same "accident", the following applies to Paragraph D. Deductible:
a. If the applicable Business Auto deductible is the smaller (or smallest) deductible, it will be waived; or
b. If the applicable Business Auto deductible is not the smaller (or smallest) deductible, it will be reduced by the amount of the smaller (or smallest) deductible; or
c. If the "loss" involves two or more Business Auto coverage forms or policies, the smaller (or smallest) deductible will be waived.
For the purpose of this endorsement, company means any company that is part of the Liberty Mutual Group.
Page 8 of 9 © 2017 Liberty Mutual Insurance AC 85 01 06 18
SECTION IV – BUSINESS AUTO CONDITIONS is amended as follows:
20. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
SECTION IV– BUSINESS AUTO CONDITIONS, Paragraph B.2. is amended by adding the following:
If you unintentionally fail to disclose any hazards, exposures or material facts existing as of the inception date or renewal date of the Business Auto Coverage Form, the coverage afforded by this policy will not be prejudiced.
However, you must report the undisclosed hazard of exposure as soon as practicable after its discovery, and we have the right to collect additional premium for any such hazard or exposure.
21. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS
SECTION IV – BUSINESS AUTO CONDITIONS, Paragraph A.2.a. is replaced in its entirety by the following:
a. In the event of "accident", claim, "suit" or "loss", you must promptly notify us when it is known to:
(1) You, if you are an individual;
(2) A partner, if you are a partnership;
(3) Member, if you are a limited liability company;
(4) An executive officer or the "employee" designated by the Named Insured to give such notice, if you are a corporation.
To the extent possible, notice to us should include:
(a) How, when and where the "accident" or "loss" took place;
(b) The "insured's" name and address; and
(c) The names and addresses of any injured persons and witnesses.
22. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US
SECTION IV – BUSINESS AUTO CONDITIONS, Paragraph A.5. Transfer Of Rights Of Recovery Against Others To Us, is amended by the addition of the following:
If the person or organization has in a written agreement waived those rights before an "accident" or "loss", our rights are waived also.
23. HIRED AUTO COVERAGE TERRITORY
SECTION IV – BUSINESS AUTO CONDITIONS, Paragraph B.7. Policy Period, Coverage Territory, is amended by the addition of the following:
f. For "autos" hired 30 days or less, the coverage territory is anywhere in the world, provided that the "insured’s" responsibility to pay for damages is determined in a "suit", on the merits, in the United States, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to.
This extension of coverage does not apply to an "auto" hired, leased, rented or borrowed with a driver.
AC 85 01 06 18 © 2017 Liberty Mutual Insurance Page 9 of 9
24. PRIMARY AND NON–CONTRIBUTING IF REQUIRED BY WRITTEN CONTRACT OR WRITTEN
AGREEMENT
The following is added to SECTION IV – BUSINESS AUTO CONDITIONS, General Conditions, B.5. Other Insurance 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 a written contract or written agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured".
SECTION V – DEFINITIONS is amended as follows:
25. BODILY INJURY REDEFINED
Under SECTION V – DEFINITIONS, Definition C. is replaced by the following:
"Bodily injury" means physical injury, sickness or disease sustained by a person, including mental anguish, mental injury, shock, fright or death resulting from any of these at any time.
of
Any entity required by written contract executed prior to the date of loss
07/01/2024
XWO 64 97 50 63
LOGAN SIMPSON DESIGN, INC
The Ohio Casualty Insurance Company 11363
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13
(Ed. 4-84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
WC 00 03 13
(Ed. 4-84)
Copyright 1983 National Council on Compensation Insurance, Inc.
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agree-ment from us.)
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule
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 Endorsement No.
Policy Effective Premium
State
Policy No.
Insured
Insurance Company
Countersigned by ___________________ of
Any entity required by written contract executed prior to the date of loss
07/01/2024
XWO 64 97 50 63
LOGAN SIMPSON DESIGN, INC
The Ohio Casualty Insurance Company 11363
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 43 03 05
(Ed. 7-00)
UTAH WAIVER OF SUBROGATION ENDORSEMENT
WC 43 03 05
(Ed. 7-00)
2000 National Council on Compensation Insurance, Inc.
This endorsement applies only to the insurance provided by the policy because Utah is shown in Item 3.A.
of the Information Page.
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 you perform work under a written contact 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. Our waiver of rights does not release your employees’ rights against third parties and does not release our authority as trustee of claims against third parties.
Schedule
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 Endorsement No.
Policy Effective Premium
State
Policy No.
Insured
Insurance Company
Countersigned by ___________________
File details come from the government source that posted it. Updated .