CTR066268_-_WOS.pdf
PDF 130 KB Posted
- Attached to
- Master Agreement AZ|CTR066268
- Contract number
- CTR066268
- Issued by
- Arizona
About this file
This document is a Commercial Auto Insurance Policy Endorsement issued by Pennsylvania Manufacturers' Association Insurance Company for Ross Innovative Employment Solutions Corporation. The policy involves the State of Arizona and its various departments, agencies, boards, commissions, universities, officers, officials, agents, and employees. The policy number is 152375-14-89-67-3, with an effective date of 09/30/2023 and an expiration date of 09/30/2024.
The endorsement includes two specific modifications: a Waiver of Transfer of Rights of Recovery (Waiver of Subrogation) and a Lessor - Additional Insured and Loss Payee amendment. The coverage applies to leased automobiles, with the State of Arizona designated as an additional insured. The policy covers liability for activities performed by or on behalf of the contractor, including owned, hired, and non-owned automobiles. The endorsement provides protection for losses arising from work performed by the contractor, with specific provisions for coverage, cancellation, and loss payable conditions.
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Text version
INSURED COPY
Pennsylvania Manufacturers’
Association Insurance Company
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
IL 12 01 11 85 Copyright, Insurance Services Office, Inc., 1983 Copyright, ISO Commercial Risk Services, Inc., 1983
Page
POLICY CHANGES
Policy Change Number
POLICY NUMBER POLICY
CHANGES
EFFECTIVE
COMPANY
NAMED INSURED AUTHORIZED REPRESENTATIVE
COVERAGE PARTS AFFECTED
CHANGES
Authorized Representative Signature
152375-14-89-67-3
09-30-23
ROSS INNOVATIVE EMPLOYMENT
THOMPSON FLANAGAN EXECUTIVE
LIABILITY GROUP LLC
626 W. JACKSON BLVD.
SUITE 500
CHICAGO IL 60661-0000
COMMERCIAL BUSINESS AUTO COVERAGE PART
NO CHARGE TO BE ADJUSTED AT AUDIT
THE FOLLOWING FORM(S) HAS BEEN ADDED:
CA 04 44 10-13 WVR OF TRNSFR OF RGHTS OF RCVRY AGNST
THE FOLLOWING FORM(S) HAS BEEN AMENDED:
CA 20 01 11-20 LESSOR-ADDL INSURED AND LOSS PAYEE
ALL OTHER TERMS AND CONDITIONS REMAIN THE SAME
INSURED COPY
POLICY NUMBER: COMMERCIAL AUTO
CA 04 44 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CA 04 44 10 13 Insurance Services Office, Inc., 2011 Page 1 of 1
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER 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.
Named Insured:
Endorsement Effective Date:
SCHEDULE
Name(s) Of Person(s) Or Organization(s):
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
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, but only to the extent that subrogation is waived prior to the ‘‘accident’’ or the ‘‘loss’’ under a contract with that person or organization.
152375-14-89-67-3
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.
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