CTR062830_-_Endorsements_2.pdf
PDF 2 MB Posted
- Attached to
- Master Agreement AZ|CTR062830
- Contract number
- CTR062830
- Issued by
- Arizona
About this file
This document is an insurance policy endorsement from Philadelphia Indemnity Insurance Company for Arizona Youth Partnership Inc, with a policy number of PHPK2647728. The policy includes additional insured entities such as the State of Arizona, Arizona Supreme Court, City of Tucson, Arizona Department of Economic Security, AHCCCS, Treatment Assessment Screening Center, AZ Department of Housing, and various state agencies, boards, commissions, universities, and their respective officials, agents, and employees.
The endorsement appears to be a Commercial General Liability policy change effective from 04/04/2024 to 03/01/2025, covering additional insured parties primarily related to contract requirements. The policy provides liability coverage for activities performed by or on behalf of the contractor, involving automobiles owned, leased, hired, or borrowed. The additional insured status is granted under specific forms like CG2026 and CG2037, with coverage limited to the extent permitted by law and any contractual agreements. The policy does not indicate specific goods or services, but rather provides liability protection for the named insured and additional parties across various state and local government entities in Arizona.
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Text version
POLICY NUMBER:
IL 12 09 08 23
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
IL 12 09 08 23 © Insurance Services Office, Inc., 2022 Page 1
ARIZONA POLICY CHANGES
Policy Change Number:
Policy Number: Company:
From: 12:01 AMPolicy Changes Effective:
To: 12:01 AM
At the named insured's mailing address shown below.
Named Insured: Authorized Representative:
Named Insured's Mailing Address:
Coverage Parts Affected:
Changes
The above amendments result in a change in the premium as follows:
NO CHANGES TO BE ADJUSTED AT AUDIT ADDITIONAL PREMIUM
RETURN PREMIUM
{See Additional Page(s)}
Path ID
Revision No.:
Philadelphia Indemnity Insurance Company
PHPK2647728
PHPK2647728
Delta Insurance Agency Ltd
03/01/2025
Arizona Youth Partnership Inc
Tucson, AZ 85743-1538
04/04/2024
7575 W Twin Peaks Rd. Ste 165
Additional Interests
17486218
X
IL 12 09 08 23 © Insurance Services Office, Inc., 2022
ARIZONA POLICY CHANGES ENDORSEMENT DESCRIPTION
REMOVAL PERMIT
If this policy includes the Commercial Property Coverage Part, the following applies with respect to such Coverage Part(s):
If Covered Property is removed to a new location that is described on this Policy Change, you may extend this insurance to include that Covered Property at each location during the removal. Coverage at each location will apply in the proportion that the value at each location bears to the value of all Covered Property being removed. This permit applies up to 10 days after the effective date of this Policy Change; after that, this insurance does not apply at the previous location.
Countersignature Of Authorized Representative Name:
Title:
Signature:
Date:
04/09/2024Issue Date:
Added:
Form CG2037- Additional Insured - Owners, Lessees or Contractors - Completed operations With respects to Additional Insured The State of Arizona and Department of Economic Security
Per Attached
P# 17486218
In consideration of the premium reflected, the policy is amended as indicated below:
PI-AI-SCH (08/20)
Page of
Additional Insured Schedule
Policy Number:
Philadelphia Indemnity Insurance Company
PHPK2647728
Additional Insured
Additional Insured
The State of Arizona, Arizona Supreme
The State of Arizona & its departments, City of Tucson, its elected & appointed
(See Manuscript for full name) agents & volunteers
Tucson, AZ 85705-1799
PO Box 27210 Tucson, AZ 85726-7210
CG2026 - General Liability
CG2026 - General Liability
Court,and their agencies, boards, agencies, boards, commissions, commissions, officials, agents, and universities, officers, officials, officials, directors,officers,employees, 333 E Wetmore Rd Ste 500 employees shall be named as additional insureds with respect to liability agents and employees are additional insured arising out of the activities performed by or on behalf of the Contractor, See Manuscript Endorsement involving automobiles owned, leased, hired or borrowed by the Contractor
1740 W Adams St
1501 W Washington St
Phoenix, AZ 85007-2607
Phoenix, AZ 85007-3222
CG2026 - General Liability
CG2026 - General Liability
Additional Insured
Additional Insured
Cenpatico Integrated Care of Arizona
1 3
Page of
Additional Insured
AHCCCS - AZ Health Care Cost Containment Services
The State of Arizona, and its depart-
701 E Jefferson St
Inc
Phoenix, AZ 85004-4530
CG2026 - General Liability
Additional Insured ments, agencies, boards, commissions, MD5700 universities, officers, officials, Phoenix, AZ 85034-2215
340 E Palm Ln Ste 230 agents, and employees 3003 N Central Ste 2000 SC C010-20
CG2005 - AZ - Loc #ALL - ADDL INS PRIMARY & NON-CONTRIBUTORY INS
Phoenix, AZ 85012-2928
Re: Contract #YH21-0003-02
CG2026 - General Liability Re: Contract requirement
Additional Insured
Treatment Assessment Screening Center, 2 3
Page of
1075 Broad Ripple Ave Ste 313
Additional Insured
Indianapolis, IN 46220-2034
State of Arizona, its departments
CG2010 - General Liability
CG2026 - General Liability
Additional Insured
The State of Arizona and Department of Economic Security C/O myCOI agencies, boards, commissions, Contract ID: CTR062830 universities, officers, officials, agents & employees
CG2037 - General Liability
CA2048 - AZ - Veh #0 - MANUSCRIPT ENDORSEMENT - AUTO
Additional Insured
AZ Department of Housing 1110 W Washington St Ste 280 Phoenix, AZ 85007-2963
3 3
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
CG 20 37 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page of
ADDITIONAL INSURED – OWNERS, LESSEES OR
CONTRACTORS – COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
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.
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" 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.
PHPK2647728
The State of Arizona and Department of Economic Security
1 1
| Insurance Policy |
| Arizona Policy Changes (Part 1) |
| Arizona Policy Changes (Part 2) |
| Additional Insured Schedule |
| Addl Ins-Owners,Lessees, Contractors Completed Oper |
File details come from the government source that posted it. Updated .