CTR066209_State_of_Arizona_Auto_AI.pdf
PDF 69 KB Posted
- Attached to
- Master Agreement AZ|CTR066209
- Contract number
- CTR066209
- Issued by
- Arizona
About this file
This document is an Additional Insured Endorsement form issued by National Liability & Fire Insurance Company, with WestCare Foundation Inc. as the named insured. The endorsement extends liability coverage to the State of Arizona, including its departments, agencies, boards, commissions, universities, officers, and employees. The policy is associated with Business Auto Coverage Form and Truckers Coverage Form, with an effective date of 07/02/2025 and policy number 73APB011956.
The endorsement specifically modifies auto insurance coverage, providing liability protection that applies only to the ownership, maintenance, or use of covered vehicles. The insurance is limited in scope, covering only acts or omissions by the insured's agents or employees while using vehicles in business operations. The coverage is constrained by several conditions, including restrictions on applying to additional insured's own acts and specific motor carrier insurance requirements. The maximum insurance payment will be the lesser of the amount required by contract or the available limits shown in the policy declarations.
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Text version
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
File details come from the government source that posted it. Updated .