CTR058022_-_Endorsements__1_.pdf

PDF 2 MB Posted

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

About this file

This document is a Commercial General Liability Insurance Policy from Philadelphia Indemnity Insurance Company, with policy number PHPK2661586-003, involving multiple parties including the State of Arizona, the Department of Economic Security, Knowledge Services, Live Oak Banking Company, and Pueblo Plaza II, LLC. The policy includes multiple endorsements such as Additional Insured schedules for Designated Persons/Organizations, Owners/Lessees/Contractors, and Covered Autos Liability Coverage.

The insurance policy provides comprehensive liability coverage for the State of Arizona and its associated entities, specifically protecting against bodily injury, property damage, and personal/advertising injury arising from the contractor's operations. The coverage extends to automobiles owned, hired, and non-owned by the contractor, with additional insured status granted to various state departments, agencies, boards, commissions, universities, officers, officials, agents, and employees. The policy includes specific provisions for defending, indemnifying, and holding harmless the State of Arizona from claims, with the contractor responsible for primary loss investigation, defense, and judgment costs.

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Text version

PI-AI-SCH (08/20)

Page of

Additional Insured Schedule

Policy Number:

Philadelphia Indemnity Insurance Company

PHPK2661586-003

the State of Arizona 9800 Crosspoint Blvd

Live Oak Banking Company, ISAOA

Indianapolis, IN 46256-3552

1741 Tiburon Dr

CG2037 - General Liability

CG2037 - General Liability

Knowledge Services &

Wilmington, NC 28403-6244

CG2026 - General Liability

CG2026 - General Liability

CG2026 - General Liability the State of Arizona,and its departments agencies,boards,commissions,universities

State of Arizona officers, officials,agents,and employees and the Department of Economic Security

[as additional insureds] with respect to liability arising out of

The State of Arizona, its departments, the activities performed by, or on behalf of, the Contractor involving agencies, boards, commissions, universities and its officers, officials, agents automobiles owned, hired and/or non-owned by the Contractor.

and employees

PO Box 6123

PO Box 6123

Phoenix, AZ 85005-6123

Phoenix, AZ 85005-6123

1 2

Page of

Additional Insured Schedule

Policy Number:

Philadelphia Indemnity Insurance Company

PHPK2661586-003

Pueblo Plaza II, LLC 3955 N Arosa Way

LOAN # CTR044676

CG2037 - General Liability

Flagstaff, AZ 86004-6860

CG2011 - AZ - Loc #7

The State of Arizona and Department of Economic Security c/o myCOI 1075 Broad Ripple Ave Ste 313 Indianapolis, IN 46220-2034

CG2026 - General Liability

2 2

POLICY NUMBER: COMMERCIAL GENERAL LIABILITY

CG 20 26 04 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page of

ADDITIONAL INSURED – DESIGNATED

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):

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 your acts or omissions or the acts or omissions of those acting on your behalf:

1. In the performance of your ongoing operations;

or

2. In connection with your premises owned by or rented to you.

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 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.

PHPK2661586-003

Knowledge Services & the State of Arizona

1 4

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

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 your acts or omissions or the acts or omissions of those acting on your behalf:

1. In the performance of your ongoing operations;

or

2. In connection with your premises owned by or rented to you.

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 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.

PHPK2661586-003

State of Arizona and the Department of Economic Security The State of Arizona, its departments, 3 4

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

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 your acts or omissions or the acts or omissions of those acting on your behalf:

1. In the performance of your ongoing operations;

or

2. In connection with your premises owned by or rented to you.

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 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.

PHPK2661586-003

The State of Arizona and Department of Economic Security

4 4

CG 20 37 04 13

CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page of

ADDITIONAL INSURED – OWNERS, LESSEES OR

CONTRACTORS – COMPLETED OPERATIONS

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

Name Of Additional Insured 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.

include as an additional 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".

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 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.

PHPK2661586-003

Per Written Contract

Per Written Contract

Per Written Contract

State of Arizona

The State of Arizona and Department the State of Arizona,and its departments and the Department of Economic Security of Economic Security agencies,boards,commissions,universities

The State of Arizona, its departments, officers, officials,agents,and employees

1 1

PI-MANU-1 (01/00)

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY

All other terms and conditions of this Policy remain unchanged.

To the fullest extent permitted by law, Contractor shall defend, indemnify, and hold harmless the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees (hereinafter referred to as "Indemnitee") from and against any and all claims, actions, liabilities, damages, losses, or expenses (including court costs, attorneys' fees, and costs of claim processing, investigation and litigation) (hereinafter referred to as "Claims") for bodily injury or personal injury (including death), or loss or damage to tangible or intangible property caused, or alleged to be caused, in whole or in part, by the negligent or willful acts or omissions of Contractor or any of its owners, officers, directors, agents, employees or subcontractors. This indemnity includes any claim or amount arising out of, or recovered under, the Workers' Compensation Law or arising out of the failure of such

Contractor to conform to any federal, state, or local law, statute, ordinance, rule, regulation, or court decree. It is the specific intention of the parties that the Indemnitee shall, in all instances, except for

Claims arising solely from the negligent or willful acts or omissions of the

Indemnitee, be indemnified by Contractor from and against any and all claims. It is agreed that Contractor will be responsible for primary loss investigation, defense, and judgment costs where this indemnification is applicable. In consideration of the award of this contract, the Contractor agrees to waive all rights of subrogation against the State of Arizona, its officers, officials, agents, and employees for losses arising from the work performed by the Contractor for the State of Arizona.

Additional Insured-State of Arizona

PI-CA-044 (09/23)

PI-CA-044 (09/23)

Page of

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

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

SCHEDULE - DESIGNATED INSURED FOR

COVERED AUTOS LIABILITY COVERAGE

This schedule is used with endorsement CA 20 48 Designated Insured for Covered Autos Liability Coverage to provide additional space to complete the schedule.

SCHEDULE

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

[as additional insureds] with respect to liability arising out of

State of Arizona the activities performed by, or on behalf of, the Contractor involving

Indianapolis, IN 46256-3552

CA2048 - Commercial Automobile

CA2048 - Commercial Automobile the State of Arizona,and its departments agencies,boards,commissions,universities officers, officials,agents,and employees and the Department of Economic Security automobiles owned, hired and/or non-owned by the Contractor.

The State of Arizona, its departments, PO Box 6123

LOAN # CTR044676

agencies, boards, commissions, universities and its officers, officials, agents

Phoenix, AZ 85005-6123 and employees PO Box 6123

CA2048 - Commercial Automobile

Phoenix, AZ 85005-6123

The State of Arizona and Department

CA2048 - Commercial Automobile of Economic Security c/o myCOI

Knowledge Services &

1075 Broad Ripple Ave Ste 313 the State of Arizona

Indianapolis, IN 46220-2034

9800 Crosspoint Blvd

1 1

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