CTR053007_COI_Valid_Thru_6-1-24.pdf

PDF 1 MB Posted

Attached to
Master Agreement AZ|CTR053007
Contract number
CTR053007
Issued by
Arizona

About this file

This document is a comprehensive insurance certificate and related endorsements for TEP OpCo LLC and Tower Engineering Professionals Inc., covering multiple insurance policies effective from 6/1/2023 to 6/1/2024. The policies involve several insurance carriers including Indian Harbor Insurance Company, Starr Indemnity & Liability Company, Allied World Surplus Lines Insurance Company, and National Union Fire Insurance Company. The certificate holder is the Arizona Department of Public Safety, with coverage extending to the State of Arizona, its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees.

The insurance package provides multi-layered liability coverage including Commercial General Liability (with a $2,000,000 per occurrence limit), Automobile Liability, Workers' Compensation, Pollution Liability, and Professional Liability/Errors & Omissions. The total liability coverage reaches $10,000,000, with additional endorsements ensuring the Arizona Department of Public Safety is named as an Additional Insured with primary and non-contributory status. The policies cover operations related to Solicitation BPM002972, and include waiver of subrogation provisions across General Liability, Auto Liability, and Workers' Compensation coverages. The policies are effective for a one-year term and provide comprehensive protection for the insured's business operations.

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Text version

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

E-MAIL

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

5/25/2023

NFP Corporate Services (SE), Inc.

1901 Roxborough Road Suite 300 Charlotte NC 28211

Lisa Vann 7046725166 lisa.vann@nfp.com

Indian Harbor Insurance Company 36940 TOWENGP Starr Indemnity & Liability Company - AM BEST RATI

TEP OpCo LLC, Tower Engineering Professionals Inc.

TEP Holdings, LLC 326 Tryon Road Raleigh NC 27603-3530

Allied World Surplus Lines Insurance Co 24319 National Union Fire Insurance Company of Pittsburg 19445

1466212382

C X 2,000,000 X 100,000

X 1,000 5,000

2,000,000

4,000,000 X

Y Y 6004-0343 6/1/2023 6/1/2024

4,000,000

Deductible 50,000 D 2,000,000

X

X X

Y Y 7107757 6/1/2023 6/1/2024

B X 5,000,000 X

1000586344231 6/1/2023 6/1/2024

5,000,000

D

N

Y 11967648 (AOS) 6/1/2023 6/1/2024

1,000,000

1,000,000

1,000,000 D A A

Workers Compensation Pollution Liability Professional Liability E&O

11967649 (CA)

CEO744614604

CEO744614604

6/1/2023 6/1/2023 6/1/2023

6/1/2024 6/1/2024 6/1/2024

Employers Liability 25,000 Retention 250,000 Retention

1,000,000 5,000,000 Limit 5,000,000 Agg

Excess Liability -Endurance American Specialty Insurance Company #ELD30001725103 Eff 06/01/2023 to 06/01/2024 - $5,000,000 Limit - Each Occurrence/Aggregate (This policy is Excess Limit to Policy ##1000586344231)) for a total Liability Limit of $10,000,000 RE: Solicitation BPM002972 Arizona Department of Public Safety, the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees are named as Additional Insured with respect to General Liability and Auto Liability coverage. Coverage is primary and non-contributory. Waiver of subrogation in favor of Additional Insureds with regards to General Liability, Auto Liability and Workers' Compensation coverage.

Arizona Department of Public Safety 2102 W. Encanto Blvd.

Phoenix AZ 85009

POLICY NUMBER: 6004-0343 COMMERCIAL GENERAL LIABILITY

CG 24 04 05 09

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

SCHEDULE

Name Of Person Or Organization: Any person or organization against whom you have agreed to waive your right of recovery in a fully executed written contract or written agreement, provided such contract or agreement was executed prior to the date of the "occurrence", loss, injury or damage.

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

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 we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above.

CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 □

COMMERCIAL AUTO

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

BUSINESS AUTO EXTENSION ENDORSEMENT

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

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

GENERAL DESCRIPTION OF COVERAGE – This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered.

A. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE – LOSS OF

USE – INCREASED LIMIT

B. BLANKET ADDITIONAL INSURED

I. PHYSICAL DAMAGE – TRANSPORTATION

C. EMPLOYEE HIRED AUTO EXPENSES – INCREASED LIMIT

D. EMPLOYEES AS INSURED J. PERSONAL EFFECTS

K. AIRBAGSE. SUPPLEMENTARY PAYMENTS – INCREASED

LIMITS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR

LOSSF. HIRED AUTO – LIMITED WORLDWIDE

COVERAGE – INDEMNITY BASIS M. BLANKET WAIVER OF SUBROGATION

G. WAIVER OF DEDUCTIBLE – GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS

PROVISIONS

A. BROAD FORM NAMED INSURED as an additional insured for Liability Coverage, but only for damages to which this insuranceThe following is added to Paragraph A.1., Who Is applies and only to the extent of that person's orAn Insured, of SECTION II – LIABILITY organization's liability for the conduct of anotherCOVERAGE:

"insured".

Any organization you newly acquire or form C. EMPLOYEE HIRED AUTOduring the policy period over which you maintain

50% or more ownership interest and that is not 1. The following is added to Paragraph A.1., separately insured for Business Auto Coverage. Who Is An Insured, of SECTION II – Coverage under this provision is afforded only LIABILITY COVERAGE:

until the 180th day after you acquire or form the

An "employee" of yours is an "insured" while organization or the end of the policy period, operating an "auto" hired or rented under awhichever is earlier.

contract or agreement in that "employee's"

B. BLANKET ADDITIONAL INSURED name, with your permission, while performing The following is added to Paragraph c. in A.1., duties related to the conduct of your Who Is An Insured, of SECTION II – LIABILITY business.

COVERAGE:

2. The following replaces Paragraph b. in B.5., This includes any person or organization who you Other Insurance, of SECTION IV – are required under a written contract or BUSINESS AUTO CONDITIONS:

agreement between you and that person or

b. For Hired Auto Physical Damageorganization, that is signed by you before the Coverage, the following are deemed to be

"bodily injury" or "property damage" occurs and covered "autos" you own:

that is in effect during the policy period, to name

CA T3 53 08 17 ú 2016 The Travelers Indemnity Company. All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission

D o no t a tta ch th is fo rm to a p ol ic y.

I t i s f or in fo rm at io na l u se o nl y.

Policy 810-3T654364-22-43-G

(1) Any covered "auto" you lease, hire, liability company) or members of their rent or borrow; and households.

(2) Any covered "auto" hired or rented by (1) With respect to any claim made or "suit" your "employee" under a contract in brought outside the United States of that individual "employee's" name, America, the territories and possessions with your permission, while of the United States of America, Puerto performing duties related to the Rico and Canada:

conduct of your business. (a) You must arrange to defend the

However, any "auto" that is leased, hired, "insured" against, and investigate or rented or borrowed with a driver is not a settle any such claim or "suit" and covered "auto". keep us advised of all proceedings and actions.D. EMPLOYEES AS INSURED

(b) Neither you nor any other involvedThe following is added to Paragraph A.1., Who Is "insured" will make any settlementAn Insured, of SECTION II – LIABILITY without our consent.COVERAGE:

(c) We may, at our discretion, participateAny "employee" of yours is an "insured" while in defending the "insured" against, orusing a covered "auto" you don't own, hire or in the settlement of, any claim orborrow in your business or your personal affairs.

"suit".

E. SUPPLEMENTARY PAYMENTS – INCREASED

(d) We will reimburse the "insured":LIMITS

(i) For sums that the "insured"1. The following replaces Paragraph A.2.a.(2), legally must pay as damagesof SECTION II – LIABILITY COVERAGE:

because of "bodily injury" or

(2) Up to $3,000 for cost of bail bonds "property damage" to which this

(including bonds for related traffic law insurance applies, that the violations) required because of an "insured" pays with our consent, "accident" we cover. We do not have to but only up to the limit described furnish these bonds.

in Paragraph C., Limit Of Insurance, of SECTION II –2. The following replaces Paragraph A.2.a.(4), LIABILITY COVERAGE;of SECTION II – LIABILITY COVERAGE:

(ii) For the reasonable expenses(4) All reasonable expenses incurred by the "insured" at our request, including actual incurred with our consent for your loss of earnings up to $500 a day investigation of such claims and because of time off from work. your defense of the "insured"

F. HIRED AUTO – LIMITED WORLDWIDE against any such "suit", but only COVERAGE – INDEMNITY BASIS up to and included within the limit described in Paragraph C., LimitThe following replaces Subparagraph e. in Of Insurance, of SECTION II –Paragraph B.7., Policy Term, Coverage LIABILITY COVERAGE, and notTerritory, of SECTION IV – BUSINESS AUTO

CONDITIONS: in addition to such limit. Our duty to make such payments endse. Anywhere in the world, except any country or when we have used up thejurisdiction while any trade sanction, applicable limit of insurance inembargo, or similar regulation imposed by the payments for damages,United States of America applies to and settlements or defense expenses.prohibits the transaction of business with or within such country or jurisdiction, for Liability (2) This insurance is excess over any valid Coverage for any covered "auto" that you and collectible other insurance available lease, hire, rent or borrow without a driver for to the "insured" whether primary, excess a period of 30 days or less and that is not an contingent or on any other basis.

"auto" you lease, hire, rent or borrow from

(3) This insurance is not a substitute for any of your "employees", partners (if you are required or compulsory insurance in any a partnership), members (if you are a limited country outside the United States, its

Page 2 of 4 ú 2016 The Travelers Indemnity Company. All rights reserved. CA T3 53 08 17 Includes copyrighted material of Insurance Services Office, Inc. with its permission

D o no t a tta ch th is fo rm to a p ol ic y.

I t i s f or in fo rm at io na l u se o nl territories and possessions, Puerto Rico Personal Effects and Canada. We will pay up to $400 for "loss" to wearing You agree to maintain all required or apparel and other personal effects which are:

compulsory insurance in any such (1) Owned by an "insured"; and country up to the minimum limits required

(2) In or on your covered "auto".by local law. Your failure to comply with compulsory insurance requirements will This coverage applies only in the event of a total not invalidate the coverage afforded by theft of your covered "auto".

this policy, but we will only be liable to the No deductibles apply to this Personal Effects same extent we would have been liable coverage.

had you complied with the compulsory

K. AIRBAGSinsurance requirements.

(4) It is understood that we are not an The following is added to Paragraph B.3., admitted or authorized insurer outside the Exclusions, of SECTION III – PHYSICAL United States of America, its territories DAMAGE COVERAGE:

and possessions, Puerto Rico and

Exclusion 3.a. does not apply to "loss" to one or Canada. We assume no responsibility for more airbags in a covered "auto" you own that the furnishing of certificates of insurance, inflate due to a cause other than a cause of "loss" or for compliance in any way with the set forth in Paragraphs A.1.b. and A.1.c., but laws of other countries relating to only:

insurance.

a. If that "auto" is a covered "auto" for G. WAIVER OF DEDUCTIBLE – GLASS Comprehensive Coverage under this policy;

The following is added to Paragraph D.,

b. The airbags are not covered under any

Deductible, of SECTION III – PHYSICAL warranty; and

DAMAGE COVERAGE:

c. The airbags were not intentionally inflated.

No deductible for a covered "auto" will apply to We will pay up to a maximum of $1,000 for anyglass damage if the glass is repaired rather than one "loss".replaced.

L. NOTICE AND KNOWLEDGE OF ACCIDENT ORH. HIRED AUTO PHYSICAL DAMAGE – LOSS OF

LOSSUSE – INCREASED LIMIT

The following is added to Paragraph A.2.a., ofThe following replaces the last sentence of SECTION IV – BUSINESS AUTO CONDITIONS:Paragraph A.4.b., Loss Of Use Expenses, of

SECTION III – PHYSICAL DAMAGE Your duty to give us or our authorized COVERAGE: representative prompt notice of the "accident" or

"loss" applies only when the "accident" or "loss" isHowever, the most we will pay for any expenses known to:for loss of use is $65 per day, to a maximum of

$750 for any one "accident". (a) You (if you are an individual);

I. PHYSICAL DAMAGE – TRANSPORTATION (b) A partner (if you are a partnership);

EXPENSES – INCREASED LIMIT

(c) A member (if you are a limited liability The following replaces the first sentence in company);

Paragraph A.4.a., Transportation Expenses, of

(d) An executive officer, director or insurance

SECTION III – PHYSICAL DAMAGE

manager (if you are a corporation or other

COVERAGE:

organization); or We will pay up to $50 per day to a maximum of

(e) Any "employee" authorized by you to give $1,500 for temporary transportation expense notice of the "accident" or "loss".

incurred by you because of the total theft of a

M. BLANKET WAIVER OF SUBROGATIONcovered "auto" of the private passenger type.

The following replaces Paragraph A.5., TransferJ. PERSONAL EFFECTS Of Rights Of Recovery Against Others To Us, The following is added to Paragraph A.4., of SECTION IV – BUSINESS AUTO

Coverage Extensions, of SECTION III –

CONDITIONS:

PHYSICAL DAMAGE COVERAGE:

CA T3 53 08 17 ú 2016 The Travelers Indemnity Company. All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission

D o no t a tta ch th is fo rm to a p ol ic y.

I t i s f or in fo rm at io na l u se o

5. Transfer Of Rights Of Recovery Against N. UNINTENTIONAL ERRORS OR OMISSIONS Others To Us The following is added to Paragraph B.2., We waive any right of recovery we may have Concealment, Misrepresentation, Or Fraud, of against any person or organization to the SECTION IV – BUSINESS AUTO CONDITIONS:

extent required of you by a written contract The unintentional omission of, or unintentional signed and executed prior to any "accident" error in, any information given by you shall not or "loss", provided that the "accident" or "loss" prejudice your rights under this insurance.

arises out of operations contemplated by However this provision does not affect our right to such contract. The waiver applies only to the collect additional premium or exercise our right of person or organization designated in such cancellation or non-renewal.

contract.

Page 4 of 4 ú 2016 The Travelers Indemnity Company. All rights reserved. CA T3 53 08 17 Includes copyrighted material of Insurance Services Office, Inc. with its permission

D o no t a tta ch th is fo rm to a p ol ic y.

I t i s f or in fo rm at io na l u se o

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313

(Ed. 4-84)

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.

Blanket Waiver

Person/ Organization:

Job Description All FL & OR Operations

Schedule

Blanket Waiver - Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver.

Waiver Premium 0.00

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: 06/01/2022 Policy No.: TEWC224079 Endorsement No.:

Insured : Premium

Insurance Company Redwood Fire and Casualty Ins Co WC 00 0313 Countersigned by

© 1983 National Council on Compensation Insurance

POLICY NUMBER: COMMERCIAL GENERAL LIABILITY

CG 20 10 04 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2

ADDITIONAL INSURED OWNERS, LESSEES OR

CONTRACTORS SCHEDULED PERSON OR

ORGANIZATION

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE

Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations

Any owner, lessee, or contractor whom you have agreed to include as an additional insured under a fully executed written contract or written agreement, provided that such was executed prior to an "occurrence", loss, injury or damage.

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

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:

1. Your acts or omissions; or

2. The acts or omissions of those acting on your behalf;

in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above.

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 additional exclusions apply:

This insurance does not apply to "bodily injury" or "property damage" occurring after:

1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or

2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project.

Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13

C. 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 shown in the Declarations;

whichever is less.

This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313

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.

Blanket Waiver

Person/ Organization:

Job Description All Operations in Following States:

AK, AL, AZ, CO, GA, IL, IN,

MD, MS, MT, NC, NY, SC,

TN, VA

Schedule

Blanket Waiver - Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver.

Waiver Premium 0.00

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: 06/01/2022 Policy No.: TEWC223831 Endorsement No.:

Insured : Premium$

Insurance Company Redwood Fire and Casualty Ins Co

WC 00 0313 Countersigned by

© 1983 National Council on Compensation Insurance

D o no t a dd th is fo rm to a p ol ic y.

It is fo r i nf or m at io na l p ur po se s o nl y.

COMMERCIAL AUTO

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

BLANKET ADDITIONAL INSURED PRIMARY AND

NON-CONTRIBUTORY WITH OTHER INSURANCE

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

PROVISIONS 2. The following is added to Paragraph B.5., Other Insurance of SECTION IV BUSINESS AUTO1. The following is added to Paragraph A.1.c. , Who CONDITIONS:Is An Insured , of SECTION Il COVERED

AUTOS LIABILITY COVERAGE: Regardless of the provisions of paragraph a. and paragraph d. of this part 5. Other Insurance, thisAny person or organization who is required under insurance is primary to and non-contributory witha written contract or agreement between you and applicable other insurance under which an addi-that person or organization, that is signed and executed by you before the "bodily injury" or tional insured person or organization is the first "property damage" occurs and that is in effect named insured when the written contract or during the policy period, to be named as an addi- agreement between you and that person or or-tional insured is an "insured" for Covered Autos ganization, that is signed and executed by you Liability Coverage, but only for damages to which before the "bodily injury" or "property damage" this insurance applies and only to the extent that occurs and that is in effect during the policy pe-person or organization qualifies as an "insured" riod, requires this insurance to be primary andunder the Who Is An Insured provision contained non-contributory.in SECTION II.

CA T4 74 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission.

Policy 810-3T654364-22-43-G

COMMERCIAL GENERAL LIABILITY

CG 20 01 04 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1

PRIMARY AND NONCONTRIBUTORY

OTHER INSURANCE CONDITION

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

The following is added to the Other Insurance Condition and supersedes any provision to the contrary:

Primary And Noncontributory Insurance

This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that:

(1) The additional 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 the additional insured.

Policy 6004-0343

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