CTR058022_-_Cancellation_Endorsement__1_.pdf

PDF 370 KB Posted

Attached to
Master Agreement AZ|CTR058022
Contract number
CTR058022
Issued by
Arizona

About this file

This document is a cancellation notice endorsement modifying various insurance coverage parts, specifically addressing notification procedures for the State of Arizona and Department of Economic Security. The endorsement is issued by an insurance provider and details the process for providing cancellation notices to additional insureds or certificate holders.

The endorsement outlines that in the event of policy cancellation, the insurance provider will attempt to mail a written notice to the additional insured (the State of Arizona and Department of Economic Security) at 1075 Broad Ripple Ave Ste 313, Indianapolis, IN 46220, 30 days before the effective cancellation date for reasons other than non-payment of premium. However, the document explicitly states that failure to mail such notice does not impose any obligation on the insurance provider, its agents, or representatives. The cancellation provision applies only when the additional insured is added to the policy through a separate endorsement, and the notice itself does not provide additional insured coverage.

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Text version

PI-CANXAICH-002 (05/11)

Page of

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CANCELLATION NOTICE TO SCHEDULED ADDITIONAL INSURED OR

CERTIFICATE HOLDER

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PROFESSIONAL LIABILITY COVERAGE PART

COMMERCIAL CRIME COVERAGE PART

COMMERCIAL INLAND MARINE COVERAGE PART

COMMERCIAL PROPERTY COVERAGE PART

COMMERCIAL AUTOMOBILE COVERAGE PART

SCHEDULE OF ADDITIONAL INSUREDS OR CERTIFICATE HOLDERS

AI or CH Additional Insured or Certificate Holder Address

The following is added to A. CANCELLATION of the Common Policy Conditions of the above applicable coverage part:

A. In the event we cancel the policy in accordance with the policy’s terms and conditions, we will endeavor to mail written notice of cancellation to Additional Insureds or Certificate Holders, shown in the above SCHEDULE within the time frame listed below. However, failure to mail such notice shall impose no obligation of any kind upon us, our agents or representatives.

1. days before the effective date of cancellation if we cancel for any reason other than for non - payment of premium.

As respects Additional Insureds, the above cancellation provision applies only when the Additional Insured shown in the above SCHEDULE is added to the policy by a separate additional insured endorsement as the CANCELLATION NOTICE TO ADDITIONAL INSURED OR CERTIFICATE HOLDER does not provide additional insured coverage.

AI The State of Arizona and Department 1075 Broad Ripple Ave Ste 313 of Economic Security c/o myCOI Indianapolis, IN 46220

2 2

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