CTR065118_-_COI_and_Endorsements.pdf

05/23/2024

Powers-Leavitt Insurance Agency, Inc.

111 E Monroe Avenue, Suite 200

Buckeye AZ 85326

Liz Millwee

(623) 386-4452 (866) 836-5280 elizabeth-millwee@leavitt.com

Office Keepers LLC DBA: Keepers Commercial Cleaning 2260 E. University Dr.

Mesa AZ 85213

Cincinnati Insurance Company 10677 Cincinnati Indemnity Company 23280

24/25 MASTER

A Y Y EPP0715923 05/15/2024 05/15/2025

1,000,000 500,000 10,000 1,000,000 2,000,000 2,000,000

A Y Y EBA0715923 05/15/2024 05/15/2025

1,000,000

A EPP0715923 05/15/2024 05/15/2025

3,000,000 3,000,000

B Y Y EWC0715924 05/15/2024 05/15/2025

1,000,000 1,000,000 1,000,000

DIVISION NAME: ADES.

CONTRACT ID: CTR065118

ENDORSEMENTS ATTACHED

THE STATE OF ARIZONA AND DEPT OF ECONOMIC SECURITY

C/O MYCOI

1075 BROAD RIPPLE AVE STE 313

INDIANAPOLIS IN 46220

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

AA 4004 03 06

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED - DESIGNATED

PERSON OR ORGANIZATION

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.

Endorsement Effective: Policy Number:

Named Insured:

Countersigned by:

(Authorized Representative)

The person or organization named in the following schedule is an "insured" to the extent of their liability for the conduct of another "insured" as provided in SECTION II - LIABILITY COVERAGE, A. Coverage, 1. Who is an Insured, Paragraph c.

Schedule

Additional Insured

Address:

elizabeth-millwee Typewritten text 05-15-2024 elizabeth-millwee Typewritten text

EBA0715923

elizabeth-millwee Typewritten text

OFFICE KEEPERS LLC DBA KEEPERS COMMERCIAL CLEANING

elizabeth-millwee Typewritten text

STATE OF ARIZONA, AND ITS DEPARTMENTS, AGENCIES, BOARDS, COMMISSIONS,

UNIVERSITIES, OFFICERS, OFFICIALS, AGENTS AND EMPLOYEES

elizabeth-millwee Typewritten text

C/O: MYCOI

1075 BROAD RIPPLE AVE STE 313

INDIANAPOLIS, IN 46220-2034

AA 4174 11 05

THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY

PRIMARY AND NONCONTRIBUTORY INSURANCE

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

This endorsement changes the policy effective on the inception date of the policy unless another date is indi cated below

Endorsement Effective: Policy Number:

Named Insured:

Countersigned by:

(Authorized Representative)

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

1 Noncontributory Insurance

SECTION IV BUSINESS AUTO CONDI

TIONS, B General Conditions, 5 Other In surance is replaced by the following:

c Regardless of the provisions of Para graph a above, this Coverage Form’s Li ability Coverage is primary and we will not seek contribution from any other in surance for any liability assumed under an "insured contract" that requires liability to be assumed on a primary noncon tributory basis elizabeth-millwee Typewritten text 05-15-2024 elizabeth-millwee Typewritten text

EBA0715923

elizabeth-millwee Typewritten text

OFFICE KEEPERS LLC DBA KEEPERS COMMERCIAL CLEANING

AA 4195 01 07

WAIVER OF SUBROGATION - AUTO

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

This endorsement changes the policy effective on the inception date of the policy unless another date is indi-cated below.

Endorsement Effective: Policy Number:

Named Insured:

Countersigned by:

(Authorized Representative)

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

SCHEDULE

Name of person(s) or organization(s):

Job location: Job and/or Contract Number:

1. Waiver of Subrogation

SECTION IV - BUSINESS AUTO CONDI-

TIONS, A. Loss Conditions, 5. is amended by the addition of the following:

With regard to the person(s) or organiza-tion(s), job location, and job and / or contract number shown in the Schedule of this en-dorsement, we waive any right of recovery we may have against any person or organization because of payments we make for "bodily in-jury" or "property damage" arising out of the operation of a covered "auto" when you have assumed liability for such "bodily injury" or "property damage" under an "insured con-tract", provided the "bodily injury" or "property damage" occurs subsequent to the execution of the "insured contract".

elizabeth-millwee Typewritten text 05-15-2024 elizabeth-millwee Typewritten text

EBA0715923

elizabeth-millwee Typewritten text

OFFICE KEEPERS LLC DBA KEEPERS COMMERCIAL CLEANING

elizabeth-millwee Typewritten text

STATE OF ARIZONA, AND ITS DEPARTMENTS, AGENCIES, BOARDS, COMMISSIONS,

UNIVERSITIES, OFFICERS, OFFICIALS, AGENTS AND EMPLOYEES

elizabeth-millwee Typewritten text

C/O: MYCOI

1075 BROAD RIPPLE AVE STE 313

INDIANAPOLIS, IN 46220-2034

elizabeth-millwee Typewritten text

ANY LOCATION AT WHICH WORK OR

OPERATIONS ARE PERFORMED BY YOU OR

ON YOUR BEHALF

elizabeth-millwee Typewritten text

DIVISION NAME: ADES

CONTRACT ID: CTR065118

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

POLICY NUMBER: COMMERCIAL GENERAL LIABILITY

CG 24 04 12 19

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:

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):

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 Sec-tion IV – Conditions:

We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above be-cause 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 organi-zation(s) shown in the Schedule above.

elizabeth-millwee Typewritten text STATE OF ARIZONA, AND ITS DEPARTMENTS, AGENCIES, BOARDS, COMMISSIONS,UNIVERSITIES, OFFICERS, OFFICIALS, AGENTS AND EMPLOYEES

C/O: MYCOI

1075 BROAD RIPPLE AVE STE 313

INDIANAPOLIS, IN 46220-2034

elizabeth-millwee

EPP0715923

CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2

CG 20 10 12 19

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

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

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) desig-nated 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 insur-ance afforded to such additional insured will not be broader than that which you are re-quired 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 ex-clusions apply:

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

1. All work, including materials, parts or equip-ment 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 in-tended use by any person or organization other than another contractor or subcontractor en-gaged in performing operations for a principal as a part of the same project.

elizabeth-millwee Typewritten text

EPP0715923

elizabeth-millwee Typewritten text

STATE OF ARIZONA, AND ITS DEPARTMENTS,

AGENCIES, BOARDS, COMMISSIONS, UNIVERSITIES

OFFICERS, OFFICIALS, AGENTS AND EMPLOYEES

elizabeth-millwee Typewritten text

ANY LOCATION AT WHICH WORK OR

OPERATIONS ARE PERFORMED BY YOU

OR ON YOUR BEHALF

CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 2 of 2

C. With respect to the insurance afforded to these additional insureds, the following is added to Sec-tion 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 insur-ance;

whichever is less.

This endorsement shall not increase the applica-ble limits of insurance.

CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1

CG 20 37 12 19

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

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;

whichever is less.

This endorsement shall not increase the applicable limits of insurance.

elizabeth-millwee Typewritten text

EPP0715923

elizabeth-millwee Typewritten text

STATE OF ARIZONA, AND ITS DEPARTMENTS,

AGENCIES, BOARDS, COMMISSIONS,

UNIVERSITIES OFFICERS, OFFICIALS, AGENTS

AND EMPLOYEES

elizabeth-millwee Typewritten text

ANY LOCATION AT WHICH WORK OR OPERATIONS

ARE PERFORMED BY YOU OR ON YOUR BEHALF

GA 4094 09 20 Page 1 of 1

PRIMARY/NONCONTRIBUTORY - OTHER INSURANCE

CONDITION - SCHEDULED PERSON

OR ORGANIZATION

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

LIQUOR LIABILITY COVERAGE PART

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

SCHEDULE

Name Of Person Or Organization:

The following is added to the Other Insurance Condition and supercedes any provision to the con-trary:

Primary And Noncontributory Insurance

This insurance is primary to and will not seek con-tribution from any other insurance available to an additional insured described in the Schedule of this endorsement 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 prima-ry and would not seek contribution from any other insurance available to the additional in-sured.

elizabeth-millwee

POLICY NUMBER: EPP0715923

IA 4087 09 17

CANCELLATION OR NONRENEWAL BY US

NOTIFICATION TO A DESIGNATED ENTITY

This endorsement modifies insurance provided under the following:

BUSINESSOWNERS PACKAGE POLICY

CLAIMS-MADE EXCESS LIABILITY COVERAGE PART

COMMERCIAL AUTO COVERAGE PART

COMMERCIAL GENERAL LIABILITY COVERAGE PART

COMMERCIAL UMBRELLA LIABILITY COVERAGE PART

DENTIST'S PACKAGE POLICY

ELECTRONIC DATA LIABILITY COVERAGE PART

EXCESS LIABILITY COVERAGE PART

LIQUOR LIABILITY COVERAGE PART

OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART

POLLUTION LIABILITY COVERAGE PART

PRODUCTS/COMPLETED OPERATIONS COVERAGE PART

PRODUCT WITHDRAWAL COVERAGE PART

PROFESSIONAL LIABILITY COVERAGE PART

PROFESSIONAL UMBRELLA LIABILITY COVERAGE PART

PROFESSIONAL UMBRELLA LIABILITY COVERAGE PART - CLAIMS-MADE

RAILROAD PROTECTIVE LIABILITY COVERAGE PART

UNDERGROUND STORAGE TANK POLICY

SCHEDULE

Name and mailing address of person(s) or organization(s):

Number of days notice (other than nonpayment of premium):

A. If we cancel or nonrenew this policy for any statutorily permitted reason other than nonpayment of premium we will mail notice to the person or organization shown in the Schedule. We will mail such notice at least the number of days shown in the Schedule before the effective date of cancellation or nonrenewal.

B. If we cancel this policy for nonpayment of premium, we will mail notice to the person or organization shown in the Schedule. We will mail such notice at least 10 days before the effective date of cancellation.

C. If notice is mailed, proof of mailing to the mailing address shown in the Schedule will be sufficient proof of notice.

D. In no event will coverage extend beyond the actual expiration, termination or cancellation of the policy.

elizabeth-millwee Typewritten text

STATE OF ARIZONA, AND ITS DEPARTMENTS, AGENCIES, BOARDS, COMMISSIONS,

UNIVERSITIES, OFFICERS, OFFICIALS, AGENTS AND EMPLOYEES

C/O: MYCOI

1075 BROAD RIPPLE AVE STE 313

INDIANAPOLIS, IN 46220-2034

elizabeth-millwee Typewritten text elizabeth-millwee Typewritten text

POLICY NUMBER: EPP0715923 & EBA0715923

elizabeth-millwee Typewritten text

STATE OF ARIZONA, AND ITS DEPARTMENTS, AGENCIES, BOARDS, COMMISSIONS,

UNIVERSITIES, OFFICERS, OFFICIALS, AGENTS AND EMPLOYEES

C/O: MYCOI

1075 BROAD RIPPLE AVE STE 313

INDIANAPOLIS, IN 46220-2034

elizabeth-millwee

THE CINCINNATI INDEMNITY COMPANY

elizabeth-millwee Typewritten text

OFFICE KEEPERS LLC DBA KEEPERS COMMERCIAL CLEANING

elizabeth-millwee Typewritten text

INCL

elizabeth-millwee Typewritten text

EWC0715924

elizabeth-millwee Typewritten text STATE OF ARIZONA, AND ITS DEPARTMENTS, AGENCIES, BOARDS, COMMISSIONS, UNIVERSITIES, OFFICERS, OFFICIALS, AGENTS AND EMPLOYEES