CTR056091_COI_exp_7.01.26.pdf

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Master Agreement AZ|CTR056091
Contract number
CTR056091
Issued by
Arizona

About this file

This document is a Certificate of Liability Insurance issued by Great American Assurance Company for Educate, Empower, Succeed LLC, with the State of Arizona and the Department of Economic Security named as the certificate holder. The insurance policies cover commercial general liability, commercial auto liability, umbrella liability, and professional liability with effective dates from July 1, 2025 to July 1, 2026. The policies are issued through Drachman Insurance Services, Inc. and provide comprehensive coverage for the contractor's operations.

The contract appears to be for employment-related services, specifically pre-employment transition services (Pre-ETS), with professional liability coverage of $3,000,000 per claim and $3,000,000 annual aggregate. The policy includes additional insured provisions for the State of Arizona, its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees. The coverage extends to liability arising from the contractor's activities, including automobile liability for owned, hired, and non-owned vehicles. The policies include various endorsements that provide broadened coverage, such as waiver of subrogation, primary and non-contributory insurance status, and protection for newly formed or acquired organizations.

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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

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

6/20/2025

Drachman Insurance Services, Inc.

6300 E El Dorado Plz Ste A220 Tucson AZ 85715-4624

Deborah Olander 520-382-0351 deb@drachmanins.com

Great American Assurance Company 26344 EDUCEMP-01 Great American Insurance Company 16691

Educate, Empower, Succeed LLC 1921 S. Alma School Rd, Ste 208 Mesa AZ 85210

Great American Alliance Insurance Company 26832

242202207

A X 1,000,000 X 100,000

5,000

1,000,000

3,000,000 X

Y Y MAC4617559 11 7/1/2025 7/1/2026

3,000,000

B 1,000,000

X

X X

Y Y CAP 4617560 10 7/1/2025 7/1/2026

C X X 1,000,000Y UMB 3096090 07 7/1/2025Y 7/1/2026

1,000,000 X 10,000

B Prof Liab-Errors & Omissions Sex Abuse/Molestation

MAC4617559 11 7/1/2025 7/1/2026 Each Occorrence General Aggregate

3,000,000 3,000,000

CTR056091 Employment Related Service Pre-employment transition services (Pre-ETS)

Professional Liability $3,000,000 per claim/$3,000,000 annual aggregate - Sexual Abuse Molestation $3,000,000 per claim/$3,000,000 annual aggregate is included The State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees are added as additional insureds with respect to liabiity arising out of the activities performed by Contractor for General Liability per attached form CG2026 1219. Waiver of Subrogation applies in favor of The 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 per attached endorsement CG2404 1219. General Liabiity coverage is See Attached...

The State of Arizona and Dept of Economic Security c/o myCOI PO Box 501970 8710 Bash Street Indianapolis IN 46256

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:

EDUCEMP-01

1 1

Drachman Insurance Services, Inc. Educate, Empower, Succeed LLC 1921 S. Alma School Rd, Ste 208 Mesa AZ 85210

25 CERTIFICATE OF LIABILITY INSURANCE

Primary and Non-Contributory per attached form CG8970 11-14.

The State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees are additional insureds with respect to auto liability arising out of the activities performed by or on behalf of the contractor involving Owned, Borrowed, or Hired and Non-Owned automobiles by the contractor per attached endorsement CA2048 1013. Waiver of Subrogation appies in favor of the additional insured per attached endorsement CA0444 1013. Coverage is Primary & Non Contributory per form CA 04 49 11 16 attached. Umbrella is following form. Commercial Umbrella policy extends over the Professional Liability, Sexual Abuse and Molestation coverage, general Liability and Commercial auto Liability. 30 Day Notice of Cancellation applies per form IL 73 23 10/11 attached.

POLICY NUMBER: CAP 4617560 10 00 COMMERCIAL AUTO

CA 04 44 10 13

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

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: Educate, Empower, Succeed LLC

Endorsement Effective Date: 07-01-2025

SCHEDULE

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

Policy shall contain a Waiver of Subrogation in favor of The State of Arizona, the Department of Economic Security, all departments, boards, commissions, universities, officers, officials, agents and employees as additional insureds with respect to liability arising out of the activities performed by or on behalf of the Contractor involving automobiles owned, hired and/or non-owned by the Contractor.

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.

POLICY NUMBER: MAC 4617559 11 00 COMMERCIAL GENERAL LIABILITY

CG 24 04 12 19

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1

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

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

Policy shall contain a Waiver of Subrogation in favor of The State of Arizona, the Department of Economic Security, all departments, boards, commissions, universities, officers, officials, agents and employees for losses arising out of work performed by or on behalf of the contractor

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 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.

POLICY NUMBER: CAP 4617560 10 00 COMMERCIAL AUTO

CA 20 48 10 13

CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

DESIGNATED INSURED FOR

COVERED AUTOS LIABILITY COVERAGE

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 this endorsement.

This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.

Named Insured: Educate, Empower, Succeed LLC Endorsement Effective Date: 07-01-2025

SCHEDULE

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

The State of Arizona, the Department of Economic Security, all departments, boards, commissions, universities, officers, officials, agents and employees are additional insured for Automobile Liability arising out of the activities performed by or on behalf of the Contractor involving automobiles owned, hired and/or non-owned by the Contractor (See CA8802)

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

Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II – Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I – Covered Autos Coverages of the Auto Dealers Coverage Form.

* 81 * 06/09/2025 * MAC 4617559 11 00 Great American Assurance Company

*D/B* 429067286 253739

CG 89 70 (Ed. 11/14) (Page 1 o f 12)

CG 89 70 (Ed. 11/14)

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

SIGNATURE GENERAL LIABILITY BROADENING ENDORSEMENT

This Endorsement modifies and is subject to the insurance provided under the fol lowing form:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

The fol lowing extension only applies in the event that no other specific coverage f o r the indicated loss exposure is provided under this Policy. I f other specific coverage applies, the terms, conditions and limits o f that Coverage are the exclusive coverage applicable under this Policy, unless otherwise noted in this Endorsement. This is a summary o f the various additional coverages and coverage modifications provided by this Endorsement. For complete details on specific coverages, consult the actual policy wording.

Coverage Description Limit of Insurance Page

Non-Owned Aircraft Included 2

Non-Owned Watercraft Included 2

Bodily Injury - Mental Injury, Mental Anguish, Humiliation or Shock Included 3

Medical Payments $ 20,000 3

Damage to Premises Rented to You $ 1,000,000 3

Supplementary Payments - Bail Bonds $ 3,000 4

Supplementary Payments - Loss o f Earnings $ 1,000 per day 4

Newly Formed or Acquired Organizations Included 4

Unintentional Failure to Disclose Hazards Included 5

Knowledge o f Occurrence, Claim or Suit Included 5

Property Damage Liability - Elevators Included 5

Property Damage Liability - Borrowed Equipment Included 5

Liberalization Clause Included 6

Amendment o f Pollution Exclusion (Premises) Included 6

Limited Property Damage to Property o f Others $ 5,000 6

Additional Insured - Manager or Lessor o f Premises Included 7

CG 89 70 (Ed. 11/14) (Page 2 o f 12)

Coverage Description Limit of Insurance Page

Additional Insured - Funding Sources Included 7

Additional Insured - By Contract Included 8

Primary and Non-Contributory Additional Insured Extension Included 10

Additional Insureds - Protection o f Your Limits Included 10

Blanket Waiver o f Transfer o f Rights o f Recovery Against Others Included to Us (Subrogation) 11

Property Damage Extension With Voluntary Payments $ 1,000/$ 5,000 11

Who Is An Insured - Fellow Employee Extension - Management Included Employees 12

Broadened Personal and Advertising Injury Included 12

A. Non-Owned Aircraft

Under paragraph 2. Exclusions o f SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability, exclusion g. Aircraft, Auto or Watercraft does not apply to an aircraft provided:

1. it is not owned by any insured;

2. it is hired, chartered or loaned with a trained paid crew;

3. the pilot in command holds a currently effect ive certificate, issued by the duly constituted authority o f the United States o f America or Canada, designating him or her a commercial or airline pilot; and

4. it is not being used to carry persons or property f o r a charge.

However, the insurance afforded by this provision does not apply i f there is available to the Insured other valid and collectible insurance, whether primary, excess (other than insurance written to apply specifically in excess o f this Policy), contingent or on any other basis, that would also apply to the loss covered under this provision.

B. Non-Owned Watercraft

Under paragraph 2. Exclusions o f SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability, subparagraph (2) o f exclusion g. Aircraft, Auto or Watercraft is replaced by the following:

This exclusion does not apply to:

(2) A watercraft you do not own that is:

(a) less than 60 feet long; and

CG 89 70 (Ed. 11/14) (Page 3 o f 12)

(b) not being used to carry persons or property f o r a charge.

C. Bodily Injury - Mental Injury, Mental Anguish, Humiliation or Shock

Under SECTION V - DEFINITIONS, Definition 3. is replaced by the following:

3. "Bodily Injury" means physical injury, sickness, or disease, including death o f a person. "Bodily Injury" also means mental injury, mental anguish, humiliation, or shock i f directly resulting f rom physical injury, sickness, or disease to that person.

D. Medical Payments

I f Coverage C Medical Payments is not otherwise excluded, the Medical Payments provided by this Policy are amended as follows:

The Medical Expense Limit in paragraph 7. o f SECTION III - LIMITS OF INSURANCE is replaced by the fol lowing Medical expense Limit:

The Medical Expense Limit provided by this Policy shall be the greater of:

a. $ 20,000; or

b. the amount shown in the Declarations f o r Medical Expense Limit

This provision 7. is subject to all the terms o f SECTION III - LIMITS OF INSURANCE.

E. Damage to Premises Rented to You

I f Damage to Premises Rented to You is not otherwise excluded f rom this Coverage Part:

1. Under paragraph 2. Exclusions o f SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability:

3. The last paragraph o f paragraph 2. Exclusions is deleted in its entirety and replaced by the following:

Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke, leakage f rom an automatic f i re protection system or water to premises while rented to you or temporarily occupied by you with permission o f the owner. A separate Limit o f Insurance applies to this coverage as described in SECTION III - LIMITS OF INSURANCE.

However, this insurance does not apply to damage to premises while rented to you, or temporarily occupied by you with the permission o f the owner, caused by:

i. rupture, bursting, or operation o f pressure relief devices;

ii. rupture or bursting due to expansion or swelling o f the contents o f any building or structure, caused by or resulting f rom water;

iii. explosion o f steam boilers, steam pipes, steam engines, or steam turbines; or

iv. f lood

2. Paragraph 6. Under SECTION III - LIMITS OF INSURANCE is deleted in its entirety and replaced with the following:

CG 89 70 (Ed. 11/14) (Page 4 o f 12)

6. Subject to paragraph 5. above, the most we will pay under Coverage A f o r damages because o f "property damage" to any one premises, while rented to you, or in the case o f damage caused by fire, lightning, explosion, smoke, leakage f rom automatic f i re protection system or water while rented to you or temporarily occupied by you with the permission o f the owner, f o r all such damage caused by fire, lightning, explosion, smoke, leakage f rom automatic f i re protection systems or water proximately caused by the same event, whether such damage results f rom fire, lightning, explosion, smoke, leakage f rom automatic f i re protection systems or water or any combination o f the six, is the higher o f $ 1,000,000 or the amount shown in the Declarations f o r the Damage to Premises Rented to You Limit.

3. Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, subsection 4. Other Insurance, paragraph b. Excess Insurance where the words "Fire insurance" appear they are changed to "insurance f o r fire, lightning, explosion, smoke, leakage f rom an automatic f i re protection system or water."

4. As regards coverage provided by this provision I. Damage to Premises Rented to You -paragraph 9.a. o f Definitions is replaced with the following:

9. a. a contract f o r a lease o f premises. However, that portion o f the contract f o r a lease o f premises that indemnifies any person or organization f o r damage by fire, lightning, explosion, smoke, leakage f rom automatic f i re protection systems or water to premises while rented to you or temporarily occupied by you with the permission o f the owner is not an "insured contract";

F. Supplementary Payments

1. In the Supplementary Payments - Coverages A and B provision, paragraph 1.b. is replaced with:

b. Up to $ 3,000 f o r the cost o f bail bonds required because o f accidents or t raf f ic law violations arising out o f the use o f any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds.

2. Paragraph 1.d. is replaced by the following:

d. All reasonable expenses incurred by the Insured at our request to assist us in the investigation or defense o f the claim or "suit," including actual loss o f earnings up to $ 1,000 a day because o f time o f f work.

G. Newly Formed or Acquired Organizations

Paragraph 3. o f SECTION II - WHO IS AN INSURED is replaced by the following:

3. Any organization you newly acquire or fo rm and over which you maintain ownership or majority interest, will qualify as a named insured i f there is no other similar insurance available to that organization. However:

a. coverage under this provision is afforded only until the expiration o f the policy period in which the entity was acquired or formed by you;

b. coverage A does not apply to "bodily injury" or property damage that occurred before you acquired or formed the organization; and

c. coverage B does not apply to "personal and advertising injury" arising out o f an offense committed before you acquired or formed the organization.

CG 89 70 (Ed. 11/14) (Page 5 o f 12)

d. records and descriptions o f operations must be maintained by the f i rst named insured.

No person or organization is an insured with respect to the conduct o f any current or past partnership, joint venture or limited liability company that is not shown as a named insured in the Declarations or qualifies as an insured under this provision.

H. Unintentional Failure to Disclose Hazards

Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the fol lowing is added to Condition 6. Representations:

Failure o f the Insured to disclose all hazards existing as o f the inception date o f this Policy shall not prejudice the insurance with respect to the coverage afforded by this Policy, provided such failure or omission is not intentional on the part o f the Insured.

I. Knowledge of Occurrence, Claim or Suit

Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the fol lowing is added to Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit:

Knowledge o f any occurrence, claim, or suit by any agent, servant or employee o f the Named Insured does not in itself constitute knowledge by the Insured unless notice o f such injury, claim or suit shall have been received by:

a. you, i f you are an individual;

b. a partner, i f you are a partnership

c. an executive of f icer or insurance manager, i f you are a corporation.

J. Property Damage Liability - Elevators

1. Under paragraph 2. Exclusions o f SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability, subparagraphs (3), (4) and (6) o f exclusion j. Damage to Property do not apply i f such property damage results f rom the use o f elevators.

2. The fol lowing is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, Condition 4. Other Insurance, paragraph b. Excess Insurance:

The insurance afforded by this provision o f this Endorsement is excess over any property insurance, whether primary, excess, contingent or on any other basis.

K. Property Damage Liability - Borrowed Equipment

1. Under paragraph 2. Exclusions o f SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability, subparagraph (4) o f exclusion j. Damage to Property does not apply to "property damage" to borrowed equipment while not being used to perform operations at a job site.

2. The fol lowing is added to SECTION IV - COMMERCIAL GENERAL LIABILITY Conditions, Condition 4. Other Insurance, paragraph b. Excess Insurance:

The insurance afforded by this provision o f this Endorsement is excess over any property insurance, whether primary, excess, contingent or on any other basis.

CG 89 70 (Ed. 11/14) (Page 6 o f 12)

L. Liberalization Clause

I f we revise this Signature General Liability Broadening Endorsement to provide more coverage without additional premium charge, your policy will automatically provide the coverage as o f the date the revision is effect ive in your state.

M. Amendment of Pollution Exclusion (Premises)

1. The fol lowing is added to paragraph (1)(a) o f Exclusion f. o f SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability:

(iv) "Bodily injury" or "property damage" arising out o f the actual discharge, dispersal, seepage, migration, release or escape o f "pollutants."

As used in this Endorsement, the actual discharge, dispersal, seepage, migration, release or escape o f pollutants must:

(aa) commence on a clearly identifiable day during the policy period; and

(bb) end, in its entirety, within seventy- two (72) hours o f the commencement o f the discharge, dispersal, seepage, migration, release or escape o f "pollutants"; and

(cc) be discovered and reported to us within f i f teen (15) days o f the clearly identifiable day that the discharge, dispersal, seepage, migration, release or escape o f "pollutants" commences; and

(dd) be neither expected nor intended f rom the standpoint o f any insured; and

(ee) be unrelated to any previous discharge, dispersal, seepage, migration, release or escape; and

(ff) not originate at or f rom a storage tank or other container, duct or piping which:

a. is below the surface o f the ground or water; or

b. at any time has been buried under the surface o f the ground or water and then is subsequently exposed.

2. For the purposes o f this coverage, the fol lowing is added to the definition o f "property damage" o f SECTION V - DEFINITIONS and applies only as respects this coverage:

Land or water, whether below ground level or not, is not tangible property.

3. Coverage provided hereunder does not apply to any discharge, dispersal, seepage, migration, release or escape that is merely threatened or alleged rather than shown to have actually occurred.

N. Limited Property Damage to Property of Others

The fol lowing is added under SECTION I - SUPPLEMENTARY PAYMENTS - COVERAGES A and B:

3. We will pay up to $ 5,000 f o r loss to personal property o f others while in the temporary care, custody or control o f an insured caused by any person participating in your organized activities.

For the purpose o f this supplementary payment, loss shall mean damage or destruction but does not include mysterious disappearance or loss o f use. In the event o f a theft, a police report must be filed. This supplementary payment does not apply if:

a. coverage is otherwise provided by the Property Coverage part (if any) o f this Policy; or

CG 89 70 (Ed. 11/14) (Page 7 o f 12)

b. the loss is covered by any other insurance you have or by any insurance o f such person who causes such loss.

These payments will not reduce the Limits o f Insurance.

O. Additional Insured - Manager or Lessor of Premises

1. SECTION II - WHO IS AN INSURED is amended to include as an additional insured any person or organization f rom whom you lease or rent property and which requires you to add such person or organization as an additional insured on this Policy under:

(a) a written contract; or

(b) an oral agreement or contract where a Certificate o f Insurance showing that person or organization as an additional insured has been issued;

but the written or oral contract or agreement must be an "insured contract," and,

(i) currently in e f fec t or become effect ive during the term o f this Policy; and

(ii) executed prior to the "bodily injury," "property damage," "personal and advertising injury."

2. With respect to the insurance afforded to the Additional Insured identified in paragraph 1.

above, the fol lowing additional provisions apply:

(a) This insurance applies only with respect to the liability arising out o f the ownership, maintenance or use o f that part o f the premises leased to you.

(b) The Limits o f Insurance applicable to the Additional Insured are the lesser o f those specified in the written contract or agreement or in the Declarations f o r this Policy and subject to all the terms, conditions and exclusions f o r this Policy. The Limits o f Insurance applicable to the Additional Insured are inclusive o f and not in addition to the Limits o f Insurance shown in the Declarations.

(c) In no event shall the coverages or Limits o f Insurance in this Coverage Form be increased by such contract.

(d) Coverage provided herein is excess over any other valid and collectible insurance available to the Additional Insured whether the other insurance is primary, excess, contingent or on any other basis unless a written contractual arrangement specifically requires this insurance to be primary.

(e) This insurance applies only to the extent permitted by law.

3. This insurance does not apply to:

(a) Any "occurrence" or offense which takes place after you cease to be a tenant in that premises.

(b) Structural alterations, new construction or demolition operations performed by or on behalf o f the Additional Insured.

P. Additional Insured - Funding Sources

1. SECTION II - WHO IS AN INSURED is amended to include as an additional insured any Funding Source which requires you in a written contract to name the Funding Source as an additional insured but only with respect to liability arising out of:

CG 89 70 (Ed. 11/14) (Page 8 o f 12)

a. your premises; or

b. "your work" f o r such additional insured; or

c. acts or omissions o f such additional insured in connection with the general supervision o f "your work" and only to the extent set for th as follows:

a. The Limits o f Insurance applicable to the Additional Insured are the lesser o f those specified in the written contract or agreement or in the Declarations f o r this Policy and subject to all the terms, conditions and exclusions f o r this Policy. The Limits o f Insurance applicable to the Additional Insured are inclusive o f and not in addition to the Limits o f Insurance shown in the Declarations.

b. The insurance afforded to the Additional Insured only applies to the extent permitted by law

c. I f 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 f o r such additional insured.

d. In no event shall the coverages or Limits o f Insurance in this Coverage Form be increased by such contract.

Q. Additional Insureds - By Contract

1. SECTION II - WHO IS AN INSURED is amended to include as an insured any person or organization whom you have agreed to add as an additional insured in a written contract, written agreement or permit. Such person or organization is an additional insured but only with respect to liability f o r "bodily injury," "property damage" or "personal and advertising injury" arising out of:

a. your acts or omissions, or the acts or omissions o f those acting on your behalf, in the performance o f your ongoing operations f o r the Additional Insured that are subject o f the written contract or written agreement provided that the "bodily injury" or "property damage occurs, or the "personal and advertising injury" is committed, subsequent to the signing o f such written contract or written agreement; or

b. the maintenance, operation or use by you o f equipment rented or leased to you by such person or organization; or

c. the Additional Insureds financial control o f you; or

d. operations performed by you or on your behalf f o r which the state or political subdivision has issued a permit

However:

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

2. i f coverage provided to the Additional Insured is required by 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 such additional insured.

With respect to paragraph 1.a. above, a person's or organization's status as an additional insured under this Endorsement ends when:

CG 89 70 (Ed. 11/14) (Page 9 o f 12)

(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 f o r or on behalf o f the Additional Insured(s) at the location o f the covered operations has been completed;

or

(2) that portion o f "your work" out o f 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 f o r a principal as a part o f the same project.

With respect to paragraph 1.b. above, this insurance does not apply to any "occurrence" which takes place after the equipment rental or lease agreement has expired or you have returned such equipment to the lessor.

The insurance provided by this Endorsement applies only i f the written contract or written agreement is signed prior to the "bodily injury" or "property damage."

We have no duty to defend an additional insured under this Endorsement until we receive written notice o f a "suit" by the Additional Insured as required in paragraph b. o f Condition 2.

Duties in the Event of Occurrence, Offense, Claim or Suit under SECTION IV -

COMMERCIAL GENERAL LIABILITY CONDITION.

2. With respect to the insurance provided by this Endorsement, the fol lowing are added to paragraph 2. Exclusions under SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability:

This insurance does not apply to:

a. "Bodily injury" or "property damage" that occurs prior to your commencing operations at the location where such "bodily injury" or "property damage" occurs.

b. "Bodily injury," "property damage" or "personal and advertising injury" arising out o f the rendering of , or failure to render, any professional architectural, engineering or surveying services, including:

(1) the preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications;

or

(2) supervisory, inspection, architectural or engineering activities.

This exclusion applies even i f the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring o f others by that Insured, i f the "occurrence" which caused the "bodily injury" or "property damage," or the offense which caused the "personal and advertising injury," involved the rendering of , or failure to render, any professional architectural, engineering or surveying services.

c. "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 f o r or on behalf o f the Additional Insured(s) at the location o f the covered operations has been completed; or

(2) that portion o f "your work" out o f 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 f o r a principal as a part o f the same project.

CG 89 70 (Ed. 11/14) (Page 10 o f 12)

d. Any person or organization specifically designated as an additional insured f o r ongoing operations by a separate additional insured endorsement issued by us and made part o f this Policy.

3. With respect to the insurance afforded to these Additional Insureds, the fol lowing is added to

SECTION III - LIMITS OF INSURANCE:

I f coverage provided to the Additional Insured is required by a contract or agreement, the most we will pay on behalf o f the Additional Insured is the amount o f insurance:

a. required by the contract or agreement; or

b. available under the applicable Limits o f Insurance shown in the Declarations;

whichever is less.

This Endorsement shall not increase the applicable Limits o f Insurance shown in the Declarations.

R. Primary and Non-Contributory Additional Insured Extension

This provision applies to any person or organization who qualifies as an additional insured under any fo rm or endorsement under this Policy.

Condition 4. Other Insurance o f SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows:

a. The fol lowing is added to paragraph a. Primary Insurance:

This insurance is primary to and will not seek contribution f rom 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 f rom any other insurance available to the Additional Insured.

b. The fol lowing is added to paragraph b. Excess Insurance:

When a written contract or written agreement, other than a premises lease, facilities rental contract or agreement, an equipment rental or lease contract or agreement or permit issued by a state or political subdivision between you and an additional insured does not require this insurance to be primary or primary and non-contributory, this insurance is excess over any other insurance f o r which the Additional Insured is designated as a named insured.

Regardless o f the written agreement between you and an additional insured, this insurance is excess over any other insurance whether primary, excess, contingent or on any other basis f o r which the Additional Insured has been added as an additional insured on other policies.

S. Additional Insureds - Protection of Your Limits

This provision applies to any person or organization who qualifies as an additional insured under any fo rm or endorsement under this Policy.

1. The fol lowing is added to Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit:

An additional insured under this Endorsement will as soon as practicable:

CG 89 70 (Ed. 11/14) (Page 11 o f 12)

a. give written notice o f an "occurrence" or an offense that may result in a claim or "suit" under this insurance to us;

b. tender the defense and indemnity o f any claim or "suit" to all insurers whom also have insurance available to the Additional Insured; and

c. agree to make available any other insurance which the Additional Insured has f o r a loss we cover under this Coverage Part.

d. we have no duty to defend or indemnify an additional insured under this Endorsement until we receive written notice o f a "suit" by the Additional Insured.

2. The Limits o f Insurance applicable to the Additional Insured are those specified in a written contract or written agreement or the Limits o f Insurance stated in the Declarations o f this Policy and defined in SECTION III - LIMITS OF INSURANCE o f this Policy, whichever are less. These limits are inclusive o f and not in addition to the Limits o f Insurance available under this Policy.

T. Blanket Waiver of Transfer of Rights of Recovery Against Others to Us (Subrogation)

Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the fol lowing is added to Condition 8. Transfer of Rights of Recovery Against Others to Us:

I f required by a written contract or written agreement, we waive any right o f recovery we may have against a person or organization because o f payment we make f o r injury or damage arising out o f your ongoing operations or "your work" done under a contract f o r that person or organization and included in the "products-completed operations hazard" provided that the injury or damage occurs subsequent to the execution o f the written contract or written agreement.

U. Property Damage Extension with Voluntary Payments

1. The fol lowing is added to paragraph 1. Insuring Agreement o f SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability:

At your request we will pay f o r "loss" to property o f others caused by your business operations f o r which this Policy provides liability insurance. Such payment will be made without regard to your legal obligation to do so. The "loss" must occur during the policy period and must take place in the "coverage territory."

2. With respect to the coverage afforded under paragraph 1. above, paragraph 2. Exclusions o f SECTION I - COVERAGES A - Bodily Injury and Property Damage Liability is amended as follows:

Exclusions j.(3), j.(4), j.(5) and j.(6) are deleted.

3. As respects coverage afforded by this coverage, SECTION III - LIMITS OF INSURANCE is replaced by the following:

Regardless o f the number o f insureds, claims made or "suits" brought or persons or organizations making claims or bring "suits":

1. Subject to 2. Below, the most we will pay f o r one or more "loss" arising out o f any one "occurrence" is $ 1,000.

2. The aggregate amount we will pay f o r the sum o f all "loss" in an annual period is $ 5,000.

This aggregate amount is part o f and not in addition to the General Aggregate Limit described in paragraph 2. o f SECTION III - LIMITS OF INSURANCE.

CG 89 70 (Ed. 11/14) (Page 12 o f 12)

V. Who Is an Insured - Fellow Employee Extension - Management Employees

1. The fol lowing is added to paragraph 2.a.(1) o f SECTION II - WHO IS AN INSURED:

Paragraph (a) and (b) above do not apply to "bodily injury" or "personal and advertising injury" caused by an "employee" who is acting in a supervisory capacity f o r you. Supervisory capacity as used herein means the "employee's" job responsibilities assigned by you, including the direct supervision o f other "employee" o f yours. However, none o f these "employees" are insureds f o r "bodily injury" or "personal and advertising injury" arising out o f their willful conduct, which is defined as the purposeful or willful intent to cause "bodily injury" or "personal and advertising injury," caused in whole or in part by their intoxication by liquor or controlled substances.

This coverage is excess over any other valid and collectable insurance available to your "employee."

W. Broadened Personal and Advertising Injury

1. Unless "Personal and Advertising Injury" is excluded f rom this Policy, the fol lowing is added to SECTION V - DEFINITIONS Item 14.:

h. mental injury, mental anguish, humiliation, or shock, i f directly resulting f rom Items 14.a.

through 14.e.

COMMERCIAL AUTO

CA 04 49 11 16

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CA 04 49 11 16 © Insurance Services Office, Inc., 2016 Page 1 of 1

PRIMARY AND NONCONTRIBUTORY –

OTHER INSURANCE CONDITION

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.

A. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance – Primary And Excess Insurance Provisions in the Motor Carrier Coverage Form 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 writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured".

B. The following is added to the Other Insurance Condition in the Auto Dealers Coverage Form and supersedes any provision to the contrary:

This Coverage Form's Covered Autos Liability Coverage and General Liability Coverages are 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 writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured".

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