CTR052634_Certificate_of_Insurance_10.8.23.pdf

INSURED'S COPY

IL 72 14 12 21Copyright, 2021 Selective Insurance Company of America. All rights reserved.

Includes copyrighted material of Insurance Services Office, Inc., with its permission.

S

F

ADDITIONAL INSURED AND WAIVER OF SUBROGATION —

STATE OF ARIZONA

POLICY NUMBER:

S 2500676

IL 72 14 12 21

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE FORM

SOCIAL SERVICE ORGANIZATION PROFESSIONAL LIABILITY COVERAGE FORM

ABUSE OR MOLESTATION COVERAGE FORM

BUSINESS AUTO COVERAGE FORM

SCHEDULE

Name of Person or Organization:

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

1789 W JEFFERSON ST

PHOENIX, AZ 85007

The following provisions are added to the policy:

A. Additional Insured

1. WHO IS AN INSURED is amended to include the person or organization shown in the

Schedule and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees, but only with respect to liability arising out of:

a. Your acts or omissions or the acts or omissions of those acting on your behalf in the performance of your ongoing operations;

b. “Your work” performed for that insured and included in the “products-completed operations hazard”;

c. Your acts or omissions or the acts or omissions of those acting on your behalf in connection with property owned by you;

d. The rendering of or failure to render professional services to others; or

e. Your ownership, maintenance or use of a covered “auto”.

2. The insurance provided by this endorsement is primary to and will not seek contribution from any other insurance available to the person or organization in the Schedule

INSURED'S COPY

IL 72 14 12 21Copyright, 2021 Selective Insurance Company of America. All rights reserved.

Includes copyrighted material of Insurance Services Office, Inc., with its permission.

B. Waiver of Rights of Recovery

1. The following is added to SECTION IV, Paragraph 8. Transfer of Rights Of Recovery

Against Others to Us of the COMMERCIAL

GENERAL LIABILITY COVERAGE FORM:

We agree to waive any right of recovery we may have against the person or organization shown in the Schedule and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees for payments we make for injury or damage arising out of your ongoing operations or “your work” performed under a written contract or written agreement and included in the “products-completed operations” hazard.

2. The following is added to SECTION IV, Paragraph 9. Transfer of Rights Of Recovery

Against Others to Us of the SOCIAL SERVICE

ORGANIZATION PROFESSIONAL LIABILITY

COVERAGE FORM:

We agree to waive any right of recovery we may have against the person or organization shown in the Schedule and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees for payments we make for injury or damage arising out of your acts, errors or omissions in the rendering or failure to render professional services to others.

3. The following is added to SECTION IV, Paragraph 8. Transfer of Rights Of Recovery

Against Others to Us of the ABUSE OR

MOLESTATION LIABILITY COVERAGE

FORM:

We agree to waive any right of recovery we may have against the person or organization shown in the Schedule and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees for payments we make for injury or damage because of “abuse” or “molestation”.

4. The following is added to SECTION IV, Paragraph 5. Transfer of Rights Of Recovery

Against Others to Us of the BUSINESS AUTO

COVERAGE FORM:

We agree to waive any right of recovery we may have against the person or organization shown in the Schedule and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees for payments we make for injury or damage arising out of your ownership, maintenance or use of a covered “auto”.

C. This endorsement only applies if:

1. You have agreed in a written contract or written agreement to include the provisions in A. and B.

above in your insurance policy(ies); and

2. The injury or damage occurs subsequent to the execution of this written contract or written agreement.