CTR066196_-_COI_and_Endorsements.pdf

INSR ADDL SUBR

LTR INSR WVD

DATE (MM/DD/YYYY)

PRODUCER CONTACT

NAME:

FAXPHONE

(A/C, No):(A/C, No, Ext):

E-MAIL

ADDRESS:

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

POLICY NUMBER

POLICY EFF POLICY EXP

TYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)

COMMERCIAL GENERAL LIABILITY

AUTOMOBILE LIABILITY

UMBRELLA LIAB

EXCESS LIAB

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

AUTHORIZED REPRESENTATIVE

INSURER(S) AFFORDING COVERAGE NAIC #

Y / N

N / A (Mandatory in NH)

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

EACH OCCURRENCE $

DAMAGE TO RENTED

$PREMISES (Ea occurrence)CLAIMS-MADE OCCUR

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER:

PRODUCTS - COMP/OP AGG $

PRO-

OTHER:

LOCJECT

COMBINED SINGLE LIMIT

$(Ea accident)

BODILY INJURY (Per person) $ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS

AUTOS ONLY

HIRED PROPERTY DAMAGE $

AUTOS ONLY (Per accident)

OCCUR EACH OCCURRENCE $

CLAIMS-MADE AGGREGATE $

DED RETENTION $ $

PER OTH-

STATUTE ER

E.L. EACH ACCIDENT $

E.L. DISEASE - EA EMPLOYEE $

If yes, describe under

E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below

POLICY

NON-OWNED

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

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.

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.

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 any rights to the certificate holder in lieu of such endorsement(s).

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

CERTIFICATE HOLDER CANCELLATION

© 1988-2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03)

ACORDTM CERTIFICATE OF LIABILITY INSURANCE

Social Service Contractors Indemnity

CopperPoint Casualty Ins Co

Hudson Excess Insurance Company

6/03/2024

USI Insurance Services LLC 2375 E. Camelback Rd, Suite 250 Phoenix, AZ 85016

Isai Gomez 602-374-1341 isai.gomez@usi.com

Housing Solutions of Northern Arizona Inc.

PO Box 30134 Flagstaff, AZ 86003

NONE

13210 14484

A X X

X

X X 60029422 02/01/2024 02/01/2025 1,000,000 1,000,000 10,000 1,000,000 3,000,000 3,000,000

A

X X X

X X 60029422 02/01/2024 02/01/2025 1,000,000

A X X

X 10,000

60029432 02/01/2024 02/01/2025 1,000,000 1,000,000

B

Y

X 1019752 07/01/2024 07/01/2025 X 1,000,000

1,000,000 1,000,000

C A

Cyber Liabilty Crime Prof Liab /SAM

CYB303083602

60029422 60029422

02/01/2024 02/01/2024 02/01/2024

02/01/2025 02/01/2025 02/01/2025

*See Description of Ops *See Description of Ops *See Description of Ops

Cyber Liability: $1,000,000 Each Claim, $1,000,000 Aggregate Employee Dishonesty: $25,000 Limit - Deductible: $1,000 Forgery & Alteration: $25,000 Limit - Deductible: $1,000 Professional Liability: $1,000,000 Each Occurrence / $3,000,000 Aggregate Sexual Abuse & Molestation: $1,000,000 Each Occurrence / $3,000,000 Aggregate (See Attached Descriptions)

The State of Arizona and Dept of Economic Security C/O: myCOI 1075 Broad Ripple Ave, Suite 313 Indianapolis, IN 46220

#S44979284/M44978448

HOUSISOL1Client#: 1273307

IXGJD

#S44979284/M44978448

SAGITTA 25.3 (2016/03)

DESCRIPTIONS (Continued from Page 1)

RE: Contract: CTR066196 - Domestic Violence Statewide.

The General Liability and Automobile Liability policies includes an automatic Additional Insured endorsement that provides Additional Insured status to the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees, only when there is a written contract that requires such status, and only with regard to work performed by or on behalf of the named insured. The General Liability policy contains a special endorsement with Primary and Noncontributory wording, when required by written contract. The General Liability, Automobile Liability and Workers Compensation policies include a Waiver of Subrogation endorsement 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. Sexual Abuse and Molestation coverage is included.

#S44979284/M44978448

Social Service Contractors Indemnity Pool

WHO IS AN INSURED - ADDITIONAL INSURED_SSCOMMAIAZ_08/21

SSCOMMAIAZ (08-21) Includes wording © ISO Properties, Inc., used with permission Page 1 of 1

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

WHO IS AN INSURED - ADDITIONAL INSURED

Policy Number: 6002942-2 Effective Date: 02/01/2024 This endorsement modifies insurance provided under the following:

SOCIAL SERVICE AGENCY PROFESSIONAL LIABILITY COVERAGE FORM

SEXUAL OR PHYSICAL ABUSE OR MOLESTATION COVERAGE FORM

BUSINESS AUTO COVERAGE FORM (coverage applies to owned, leased, hired or borrowed vehicles) COMMERCIAL GENERAL LIABILITY COVERAGE FORM (including Products-Completed Operations Coverage)

Schedule:

Name Of Additional Insured Entities:

The State of Arizona, its departments, agencies, boards, commissions, and universities, and all officers, officials, agents, and employees of these entities, for losses arising from 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 section entitled “Who is an Insured” in each of the coverage forms set forth above is amended to include as an insured the person or organization shown in the schedule, but only with respect to liability for injury or damage resulting from your operations performed for that insured and caused by your acts or omissions.

All other terms and conditions remain unchanged.

WAIVER OF TRANSFER RIGHTS OF RECOVERY_SSCOMMWOSAZ_08/21

SSCOMMWOSAZ (08-21) Includes wording © ISO Properties, Inc., used with permission Page 1 of 1

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

WAIVER OF TRANSFER RIGHTS OF RECOVERY

Policy Number: 6002942-2 Effective Date:02/01/2024

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE FORM

BUSINESS AUTO COVERAGE FORM

SOCIAL SERVICE AGENCY PROFESSIONAL LIABILITY COVERAGE FORM

SEXUAL ABUSE LIABILITY COVERAGE FORM

SCHEDULE

Name of Person or Organization: the State of Arizona, its departments, agencies, boards, commissions, universities and all officers, officials, agents, and employees of these entities, for losses arising from work performed by or on behalf of the contractor.

1. The TRANSFER OF RIGHTS OF RECOVERY Condition (Section IV COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following:

We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damages arising out of your ongoing operations or "your work" done under a contract for that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above.

2. The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV BUSINESS AUTO CONDITIONS) is amended by the addition of the following:

We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damages for “bodily injury” or “property damage” to which this insurance applies.

3. The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV PROFESSIONAL LIABILITY CONDITIONS) is amended by the addition of the following:

We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for “damages” resulting from a “wrongful act” to which this insurance applies.

4. The TRANSFER OF RIGHTS OF RECOVERY Condition (Section D., SEXUAL OR PHYSICAL ABUSE OR MOLESTATION CONDITIONS) is amended by the addition of the following:

We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damages due to “abuse” to which this insurance applies.

All other terms and conditions remain unchanged.

SSAPLAT (01/23) Includes wording © ISO Properties, Inc., used with permission Page 1 of 6

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

PLATINUM EXPANSION ENDORSEMENT

This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM

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

A. NEWLY ACQUIRED OR FORMED ORGANIZATIONS

The following is added to Paragraph A.1. Who Is An Insured of Section II – Covered Autos Liability Coverage:

Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company or any organization excluded either by this Coverage Part or by endorsement, and over which you maintain ownership or majority interest of more than 50 percent will qualify as a Named Insured. However:

1. This insurance does not apply to any newly acquired or formed organization that is an "insured" under any other automobile liability policy or would be an "insured" under such policy but for its termination or the exhaustion of its Limit of Insurance;

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

3. Coverage under this provision is afforded only until the 90th day after you acquire or form the organization or the end of the policy period, whichever is earlier.

B. ADDITIONAL INSURED BY CONTRACT OR AGREEMENT

The following is added to Paragraph A.1., Who Is An Insured of Section II – Covered Autos Liability Coverage:

When you have agreed in a written contract or agreement to include a person or organization as an additional "insured", such person or organization is included as an "insured" subject to the following:

1. Such person or organization is an additional "insured" only to the extent such person or organization is liable for "bodily injury" or "property damage": because of the conduct of an "insured" under Paragraphs a. or b. under Paragraph A.1. Who Is An Insured of Section II – Covered Autos Liability Coverage, caused by an "accident" and resulting from the ownership, maintenance or use of a covered "auto";

2. The written contract or agreement described above must have been executed prior to the "accident" that caused the "bodily injury" or "property damage" and be in effect at the time of such "accident";

3. The insurance afforded to any such additional "insured" does not apply to any "accident" beyond the period of time required by the written contract or agreement described above;

4. The most we will pay on behalf of such additional "insured(s)" is the lesser of:

a) The coverage or l im it specified in the written contract or agreement described above;

or

b) The Limits of Insurance shown in the Declarations for this policy.

c) This provision shall not increase the Limit of Insurance shown in the Declarations in this policy or coverage part.

5. The following changes are made to Paragraph 5. Other Insurance of B. General Conditions under

Section IV - Business Auto Conditions:

a. The following is added to Paragraph 5.a.:

If required by the written contract or agreement described above, the insurance afforded to

<!-Bookmark:PLATINUM EXPANSION ENDORSEMENT_SSAPLAT_01/23:EndBoomark-!>

SSAPLAT (01/23) Includes wording © ISO Properties, Inc., used with permission Page 2 of 6 the additional insured under this provision will be primary to, and will not seek contribution from, the additional insured’s own insurance.

b. Paragraph 5.c. is deleted in its entirety.

6. Paragraph A.1.c. under Section II – Covered Autos Liability Coverage is deleted in its entirety.

7. The definition of H. "Insured contract" under Section V - Definitions is amended to add the following: An "insured contract" does not include that part of any contract or agreement:

That pertains to the ownership, maintenance or use of an "auto" and which indemnifies a person or organization for other than the vicarious liability of such person or organization for "bodily injury" or "property damage" caused by your operation or use of a covered "auto".

However, a person or organization is an additional "insured" under this provision only to the extent such person or organization is not named as an "insured" by separate endorsement to this policy.

C. EMPLOYEES AS INSUREDS

The following is added to Paragraph A.1. Who Is An Insured under Section II – Covered Autos Liability Coverage:

Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs.

D. INCREASED COVERAGE - BAIL BONDS

a. Supplementary Payments under 2. Coverage Extensions of Section II - Covered Autos Liability

Coverage is amended as follows:

The Limit of Insurance in paragraph A.2.a.(2) is increased to $5,000.

E. INCREASED COVERAGE - LOSS OF E ARN INGS

a. Supplementary Payments under Coverage Extensions of Section II – Covered Autos Liability

Coverage is amended as follows:

The Limit of Insurance in paragraph A.2.a.(4) is increased to $1,000.

F. FELLOW EMPLOYEE COVERAGE

5. Fellow Employee under B. Exclusions of Section II – Covered Autos Liability Coverage does not apply. This coverage is excess over any other collectable insurance.

G. COVERAGE EXTENSION - TRANSPORTATION EXPENSES

Paragraph A.4.a. Transportation Expenses of Section III - Physical Damage Coverage is amended as follows:

1. The Limits of Insurance are increased to $75 per day to a maximum of $2,500.

2. We will also pay reasonable and necessary expenses to facilitate the return of the stolen "auto" to you.

3. It is agreed and understood and it is our stated intent that expenses incurred by you under the

Transportation Expenses Coverage Extension will not also be covered or paid under the Rental Reimbursement Coverage provided by this endorsement or any rental reimbursement coverage added by separate endorsement to this policy.

H. EXTENDED COVERAGE – AIRBAGS

The following is added to Exclusion B.3.a. of Section III - Physical Damage Coverage: However, this exclusion does not apply to the unintended discharge of an airbag.

This coverage is excess over any other collectible insurance or warranty providing such airbag coverage.

I. AUTO LOAN/LEASE GAP COVERAGE

The following is added to Section III - Physical Damage Coverage, Paragraph C. Limits of Insurance,

4. In the event of a total "loss" to a covered "auto", we will pay any unpaid amount due on the lease or loan for a covered "auto", less:

a. The amount under Section III - Physical Damage Coverage section of the policy; and

b. Any:

(1) Overdue lease/loan payments at the time of the "loss";

SSAPLAT (01/23) Includes wording © ISO Properties, Inc., used with permission Page 3 of 6

(2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage;

(3) Security deposits not returned by the lessor;

(4) Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability

Insurance purchased with the loan or lease; and

(5) Carry-over balances from previous loans or leases.

J. GLASS REPAIR - NO DEDUCTIBLE

The following is added to Paragraph D. Deductible of Section III - Physical Damage Coverage:

Any Comprehensive Coverage deductible shown in the Declarations does not apply to "loss" to glass when you elect to patch, repair, or replace the glass.

K. EXTENDED COVERAGE - PERSONALPROPERTY

The following is added to Paragraph A.4. Coverage Extensions of Section III - Physical Damage Coverage:

Physical Damage Coverage on a covered "auto" may be extended to "loss" to your personal property or, if you are an individual, the personal property of a family member, that is in the covered "auto" at the time of "loss" and caused by an "accident" and resulting from the ownership, maintenance or use of a covered "auto".

The insurance provided by this coverage extension is excess over any other collectible insurance. The most we will pay for any one "loss" under this coverage extension is $500. However, our payment for "loss" to personal property will only be for the account of the owner of the property.

Under this provision, personal property does not include and we will not pay for "loss" of currency, coins, securities or contraband.

No deductible applies to this coverage extension.

L. TOWING

Paragraph A.2. Towing of Section II I - Physical Damage Coverage, is replaced by the following:

If a private passenger type covered “auto” or light truck “auto” (0-10,000 Lbs. GVW) is provided both Comprehensive and Collision Coverage, we will pay up to $150 for towing and labor costs incurred each time such “auto” is disabled, as caused by a covered “loss”. If a medium, heavy or extra-heavy truck or extra-heavy Truck-tractor covered “auto” (greater than 10,000 Lbs. GVW) is provided both Comprehensive and Collision Coverage, we will pay up to $250 for towing and labor costs incurred each time such “auto” is disabled, as caused by a covered “loss”. However, the labor must be performed at the place of disablement.

M. FIRE EXTINGUISHER RECHARGE

The following is added to Paragraph A.4. Coverage Extensions of Section III - Physical Damage Coverage:

When fire extinguishers are kept in your covered "auto" and any are discharged in an attempt to extinguish a fire, we will pay the lesser of the actual cost of recharging or replacing such fire extinguisher(s).

No deductible applies to this coverage.

N. HIRED AUTO PHYSICAL DAMAGE COVERAGE

The following is added to Paragraph A.4. Coverage Extensions of Section III - Physical Damage Coverage:

If hired "autos" are covered "autos" for Section II – Covered Autos Liability Coverage and if Section III - Physical Damage Coverage is provided for any "auto" you own, then the Physical Damage coverages provided are extended to "autos" you lease, rent, hire or borrow from someone other than your "employees", partners or members of their households subject to the following:

1. The most we will pay in any one "loss" is the lesser of:

a. The actual cash value of the "auto";

b. The cost to repair or replace the "auto"; or

c. $100,000.

2. Paragraph 1. directly above is subject to a deductible. The deductible shall be equal to the amount of the highest deductible shown for any owned "auto" of the same classification for that coverage. In

SSAPLAT (01/23) Includes wording © ISO Properties, Inc., used with permission Page 4 of 6 the event there is no owned “auto” of the same classification, the highest deductible for any owned “auto” will apply for that coverage.

No deductible will apply to "loss" caused by fire or lightning.

3. Hired Auto Physical Damage Coverage is subject to the following:

a. If symbol 8 is shown in Section I - Covered Autos on of the Declarations page for any of the Physical Damage coverages, then the Hired Auto Physical Damage coverage described in this endorsement does not apply.

b. Other than indicated in Paragraph a. directly above, coverage provided under this provision will be excess over any other collectible insurance or coverage.

4. In addition to the limit set forth in Paragraph 1. above we will pay up to $500 per day, to a maximum of $3,500 per "loss" for:

a. Any costs or fees associated with the "loss" to a hired "auto"; and

b. Loss of use of the hired "auto", provided it is the consequence of an "accident" for which you are legally liable, and as a result of which a monetary loss is sustained by the leasing or rental concern.

However, Paragraph A.4.b. Loss of Use Expenses under Section III - Physical Damage Coverage does not apply.

O. RENTAL REIMBURSEMENT COVERAGE

We will pay for rental reimbursement expenses incurred by you for the rental of an "auto" because of "loss" to a covered "auto".

1. Payment applies in addition to the otherwise applicable amount of each coverage you have on the covered "auto".

2. No deductible applies to this coverage.

3. We will pay only for those expenses incurred during the policy period beginning 24 hours after the "loss" and ending, regardless of the expiration date of the policy, with the lesser of the following number of days:

a. The number of days when the covered "auto" has been repaired or replaced, or

b. 30 days.

4. Our payment is limited to the lesser of the following amounts:

a. Necessary and actual expenses incurred; or

b. Not more than $100 for any one day;

5. We will pay up to an additional $300 for the reasonable and necessary expenses you incur to remove your materials and equipment from the covered "auto" and replace such materials and equipment on the rental "auto".

6. This coverage does not apply while there are spare or reserve "autos" available to you for your operations.

7. If "loss" results from the total theft of a covered "auto" of the "private passenger type", we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided for under Section III - Physical Damage Coverage or any endorsements.

However, this provision does not apply to the extent that rental reimbursement is provided by separate endorsement to this policy.

P. DRIVE OTHER CAR COVERAGE

1. The following is added to Section II - Covered Autos Liability Coverage:

a. Any "auto" you don't own, hire or borrow is a covered "auto" for Liability Coverage while being used by:

(1) You, if you are designated in the Declarations as an individual;

(2) Your partners or members, if you are designated in the Declarations as a partnership or joint venture; Your members or managers, if you are designated in

SSAPLAT (01/23) Includes wording © ISO Properties, Inc., used with permission Page 5 of 6 the Declarations as a limited liability company;

(3) Your executive officers if you are designated in the Declarations as an organization other than an individual, partnership, joint venture or limited liability company; and

(4) The spouse of any person named in Paragraphs 1.a.(1). through 1.a.(4) while a resident of the same household;

Except:

(a) Any "auto" owned by that individual or by any member of his or her household.

(b) Any "auto" used by that individual or his or her spouse while working in a business of selling, servicing, repairing or parking "autos".

2. Changes to Section III -Physical Damage Coverage

Any private passenger type "auto" you don't own, hire or borrow is a covered "auto" while in the care, custody or control of any individual named in P.1.a. directly above or his or her spouse while a resident of the same household except:

a. Any "auto" owned by that individual or by any member of his or her household; or

b. Any "auto" used by that individual or his or her spouse while working in a business of selling, servicing, repairing or parking "autos".

3. The most we will pay for the total of all dam ages under Covered Autos Liability Uninsured Motorists

Coverage and Underinsured Motorists Coverage is the Limit Of Insurance shown in the Declarations as applicable to owned "autos".

4. Our obligation to pay for, repair, return or re place damaged or stolen property under Physical Damage Coverage, will be reduced by a deductible equal to the amount of the highest deductible shown for any owned private passenger type "auto" applicable to that cover- age. If there are no owned private passenger type "autos", the deductible shall be $250 for Comprehensive Coverage and $500 for Collision Coverage. No deductible will apply to "loss" caused by fire or lightning.

5. Additional Definition As used in P. DRIVE OTHER CAR COVERAGE:

"Family member" means a person related to the individual named in 1.a. by blood, marriage or adoption who is a resident of the individual's household, including a ward or foster child.

Q. KNOWLEDGE OF AN ACCIDENT, CLAIM, SUIT OR LOSS

The following is added to Paragraph A.2. of Section VII - Business Auto Conditions:

Your obligation to provide prompt notice of an “accident", claim, "suit" or "loss" is satisfied if you or a person designated by you to be responsible for insurance matters is notified of, or in any manner made aware of an "accident", claim, "suit" or "loss" and provides us such notice as soon as practicable.

R. WAIVER OF SUBROGATION BY CONTRACT OR AGREEMENT

The following is added to Paragraph A.5 of Section IV- Business Auto Conditions:

We waive any right of recovery we may have against a person or organization because of payments we make for "bodily injury" or "property damage" when you and such person or organization have agreed in writing in a contract or agreement to waive such right of recovery, provided:

1. Such written contract or agreement was:

a. Made prior to the "accident" or "loss" resulting in the covered "bodily injury" or "property damage"; and

b. Was in effect at the time of the covered "bodily injury" or "property damage".

2. The covered "bodily injury" or "property damage" must arise out of the operations specified in such written contract or agreement.

3. At our request you must provide us with a copy of the aforementioned written contract or agreement.

S. UNINTENTIONAL OMISSIONS

The following is added Paragraph B.2. of Section IV- Business Auto Conditions:

If you fail to disclose any hazards existing at the inception date of this policy, such failure will not prejudice

SSAPLAT (01/23) Includes wording © ISO Properties, Inc., used with permission Page 6 of 6 the coverage provided to you. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or nonrenewal.

T. LIBERALIZATION

If we revise this endorsement to provide greater coverage without additional premium charge, we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your state.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13

(Ed. 4-84)

WC 00 03 13

(Ed. 4-84)

© 1983 National Council on Compensation Insurance.

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.

(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)

Endorsement Effective 1019752Policy No. Endorsement No.

Housing Solutions Of Northern ArizonaInsured Premium

CopperPoint Casualty Insurance CompanyInsurance Company Countersigned by

This document may have been uploaded to the CopperPoint Portal.

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us).

This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.

Schedule State Blanket/Schedule/State AZ The State of Arizona, Department of Economic Security. 1789

W. Jefferson Street, Mail Drop 6271, Phoenix, AZ 85007 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.

jenn.decker Typewritten text 07/01/2024

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 08

(Ed. 1-00)

PARTNERS, OFFICERS AND OTHERS EXCLUSION ENDORSEMENT

The policy does not cover bodily injury to any person described in the Schedule.

The premium basis for the policy does not include the remuneration of such persons.

You will reimburse us for any payment we must make because of bodily injury to such persons.

Schedule

Partners Officers Others

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.

(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)

Endorsement Effective 1019752Policy No. 10Endorsement No.

Housing Solutions Of Northern ArizonaInsured Premium $

CopperPoint Casualty Insurance CompanyInsurance Company Countersigned by

This document may have been uploaded to the CopperPoint Portal.

WC 00 03 08

(Ed. 1-00)

© 1996–1999 National Council on Compensation Insurance, Inc.

McIntire, David Sharp, Jennifer

Gimenez, Kathleen Fockler, John

DeBoard, Ashley Leuenberger, Monika

Jones, Nathan Kelly-Cutlip, Deborah, M

Flores, Sandi Edgar, Cheryl

Guay, Amanda Milazzo, Moses

Guard, Mark Fockler, John

Alexander, Caleb Silveus, Brenda

Muller-Stotts, Stacie Branson, Kim

Miller, Gary isai.gomez Typewritten text 07/01/2024