CTR066209_Endorsement_-_Auto.pdf

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M-5887 (08/2017)

M-5887 (08/2017)

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED ENDORSEMENT

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

TRUCKERS COVERAGE FORM

SCHEDULE � ADDITIONAL INSURED:

A. In consideration of payment of the additional premium listed below, LIABILITY COVERAGE is extended to include the additional insured named herein, provided that:

1) such insurance applies only to the ownership, maintenance or use of a covered �auto�; and

2) such insurance applies only to acts or omissions by you, your agents or your �employees� while such covered auto is being used in your business; and

3) such insurance does not apply to the acts or omissions of the additional insured or any of the additional insured�s agents or "employees" other than you; and

4) such insurance does not apply if the additional insured is subject to motor carrier insurance requirements and is not insured for hired "autos" under an "auto" liability insurance form that insures on a primary basis the owners of the "autos" and their agents and "employees" while the "autos" are being used exclusively in the additional insured�s business and pursuant to operating rights granted to the additional insured by a public authority.

B. The insurance afforded to such additional insured:

1) Applies only to the extent permitted by law; and

2) Will not be broader than that which you are required by a contract or agreement to provide for such additional insured.

C. The most we will pay on behalf of the additional insured is the lesser of the amount of insurance:

1) That you are required by a contract or agreement to provide for such additional insured; or

2) That is available under the applicable Limits of Insurance shown in the Declarations.

All other terms, conditions and agreements remain unchanged.

Additional Premium: $

Company Name Policy Number

Endorsement Effective

Named Insured Countersigned by

(Authorized Representative)

(The Attaching Clause need be completed only when this endorsement is issued subsequent to preparation of the policy.)

State of Arizona, and its departments, agencies, boards, commissions, universities, officers, and employees PO Box# 501970 8710 Bash Street Indianapolis, IN 46256

NATIONAL LIABILITY & FIRE INSURANCE COMPANY

73APB011956

07/02/2025 4:08 PM

WESTCARE FOUNDATION INC

M-5144a (06/2007)

WAIVER OF TRANSFER OF RIGHTS OF

RECOVERY AGAINST OTHERS TO US

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM

GARAGE COVERAGE FORM

MOTOR CARRIER COVERAGE FORM

TRUCKERS COVERAGE FORM

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

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

Endorsement Effective: Countersigned By:

Named Insured:

(Authorized Representative)

SCHEDULE

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

Additional Premium $

(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.)

The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply to the person(s) or organization(s) shown in the Schedule. We will retain the additional premium shown above, regardless of any early termination of this endorsement or the policy.

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

M-5144a (06/2007)

POLICY NUMBER: 73 APB 011956

07/02/2025 4:08 PM

WESTCARE FOUNDATION INC

State of Arizona, and its departments, agencies, boards, commissions, universities, officers, and employees PO Box# 501970 8710 Bash Street Indianapolis, IN 46256