CTR076712_CGL_AL_WC_PL_COI_Exp_11_01_2025.pdf

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

INSR ADDL SUBR

LTR INSD WVD

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

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

EACH OCCURRENCE $

DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence)

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT

OTHER: $

COMBINED SINGLE LIMIT

$(Ea accident)

ANY AUTO BODILY INJURY (Per person) $

OWNED SCHEDULED

BODILY INJURY (Per accident) $AUTOS ONLY AUTOS

HIRED NON-OWNED PROPERTY DAMAGE

$AUTOS ONLY 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 LIMITDESCRIPTION OF OPERATIONS below

INSURER(S) AFFORDING COVERAGE NAIC #

COMMERCIAL GENERAL LIABILITY

Y / N N / A

(Mandatory in NH)

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 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.ACORD 25 (2016/03)

CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)

The ACORD name and logo are registered marks of ACORD

6/11/2025

(480) 253-5951 (480) 730-4929

12572

Pinal-Gila Council for Senior Citizens 8969 W McCartney Rd Casa Grande, AZ 85194

40045

A 1,000,000

S2500165 11/1/2024 11/1/2025 1,000,000 20,000

1,000,000 3,000,000 3,000,000

1,000,000A S2500165 11/1/2024 11/1/2025

1,000,000A S2500165 11/1/2024 11/1/2025 1,000,000

B

BRC758451359 6/5/2025 6/5/2026 1,000,000

Y 1,000,000

1,000,000 A Professional Liabili S2500165 11/1/2024 Occurrence 1,000,000 A Professional Liabili S2500165 11/1/2024 11/1/2025 Aggregate 3,000,000

ADES - CTR076712

•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

•ADDITIONAL INSURED COVERAGE TO THE STATE FOR GENERAL LIABILITY, AUTOMOBILIE LIABILITY, PROFESSIONAL LIABILITY AND SEXUAL ABUSE MOLESTATION LIABILITY

•WAIVER OF SUBROGATION ENDORSEMENTS INCLUDED

SEE ATTACHED ACORD 101

The State of Arizona and Dept of Economic Security c/o MYCOI PO Box #501970, 8710 Bash Street Indianapolis, IN 46256

CENTARI-10 KHERTER

The Mahoney Group - Chandler 2625 W Geronimo Place, Suite 350 Chandler, AZ 85224

Kathy Herter kherter@mahoneygroup.com

Selective Insurance Company of America StarNet Insurance Company

X

11/1/2025

X X

X

X

X

X

FORM NUMBER:

EFFECTIVE DATE:

The ACORD name and logo are registered marks of ACORD

ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE

FORM TITLE:

Page of

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

ACORD 101 (2008/01)

AGENCY CUSTOMER ID:

LOC #:

AGENCY NAMED INSURED

POLICY NUMBER

CARRIER NAIC CODE

© 2008 ACORD CORPORATION. All rights reserved.

The Mahoney Group - Chandler

CENTARI-10

SEE PAGE 1

SEE PAGE 1

ACORD 25 Certificate of Liability Insurance

SEE P 1

Pinal-Gila Council for Senior Citizens 8969 W McCartney Rd Casa Grande, AZ 85194

SEE PAGE 1

KHERTER

Description of Operations/Locations/Vehicles:

•PRIMARY NON-CONTRIBUTORY ENDORSEMENTS INCLUDED

ABUSE AND MOLESTATION LIABILITY INCLUDED

•EXCESS OR UMBRELLA COVERAGE IS OVER THE PROPFESSIONAL LIABILITY

INSURED'S COPY

CG 73 00 10 23Copyright, 2023 Selective Insurance Company of America. All rights reserved.

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

S

F

ElitePac

General Liability Extension Endorsement

COMMERCIAL GENERAL LIABILITY

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SUMMARY OF COVERAGES (including index)

This is a summary of the various additional coverages and coverage modifications provided by this endorsement. No coverage is provided by this summary. Refer to the actual endorsement (Pages 3-through-9) for changes affecting your insurance protection.

DESCRIPTION

Additional Insureds — Primary and Non-Contributory Provision

Blanket Additional Insureds — As Required By Contract

· Owners, Lessees or Contractors (includes Architects, Engineers or Surveyors)

· Lessors of Leased Equipment

· Managers or Lessors of Premises

· Mortgagees, Assignees and Receivers

· Any Other person or organization other than a joint venture

· Grantors of Permits

PAGE FOUND

Broad Form Vendors Coverage

Damage To Premises Rented To You (Including Fire, Lightning or Explosion)

Electronic Data Liability ($100,000)

Employee Definition Amended

Employees As Insureds Modified

Employer's Liability Exclusion Amended (Not applicable in New York)

Incidental Malpractice Exclusion modified

Knowledge of Occurrence, Claim, Suit or Loss

Liberalization Clause

Mental Anguish Amendment (Not applicable to New York)

Newly Formed or Acquired Organizations

Non-Owned Aircraft

Non-Owned Watercraft (under 60 feet)

Not-for-profit Members — as additional insureds

Personal And Advertising Injury — Discrimination Amendment (Not applicable in New York)

Products Amendment (Medical Payments)

Supplementary Payments Amended — Bail Bonds ($5,000) and Loss of Earnings ($1,000)

Two or More Coverage Parts or Policies Issued By Us

Unintentional Failure to Disclose Hazards

Waiver of Transfer of Rights of Recovery (subrogation)

When Two or More Coverage Parts of this Policy Apply to a Loss

CG 73 00 10 23Copyright, 2023 Selective Insurance Company of America. All rights reserved.

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

THIS PAGE IS INTENTIONALLY LEFT BLANK.

Copyright, 2023 Selective Insurance Company of America. All rights reserved.

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F

ElitePac

General Liability Extension Endorsement

COMMERCIAL GENERAL LIABILITY

CG 73 00 10 23

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This endorsement modifies the insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

The SECTIONS of the Commercial General Liability Coverage Form identified in this endorsement will be amended as shown below. However, if (a) two or more Coverage Parts of this policy, or (b) two or more forms or endorsements within the same Coverage Part apply to a loss, coverage provision(s) with the broadest language will apply, unless specifically stated otherwise within the particular amendment covering that loss.

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

COVERAGES — Amendments

SECTION I — COVERAGE A BODILY INJURY AND

PROPERTY DAMAGE LIABILITY

EXCLUSIONS

Employer's Liability Amendment

(This provision is not applicable in the State of New

York).

The following is added to Exclusion e. Employer's

Liability under COVERAGE A BODILY INJURY AND

PROPERTY DAMAGE LIABILITY, 2. Exclusions:

This exclusion also does not apply to any "temporary worker".

Non-Owned Aircraft, Auto or Watercraft

A. Paragraph (2) of Exclusion g. Aircraft, Auto Or

Watercraft under COVERAGE A BODILY INJURY

AND PROPERTY DAMAGE LIABILITY, 2.

Exclusions is deleted in its entirety and replaced with the following:

(2) A watercraft you do not own that is:

(a) Less than 26 feet long and not being used to carry persons or property for a charge; or

(b) At least 26 feet, but less than 60 feet long, and not being used to carry persons or property for a charge. Any person is an insured who uses or is responsible for the use of such watercraft with your expressed or implied consent. However, if the insured has any other valid and collectible insurance for "bodily injury" or "property damage" that would be covered under this provision, or on any other basis, this coverage is then excess, and subject to Condition 4. Other

Insurance, b. Excess Insurance under

SECTION IV — COMMERCIAL GENERAL

LIABILITY CONDITIONS.

B. The following is added to Exclusion g. Aircraft, Auto Or Watercraft under COVERAGE A BODILY

INJURY AND PROPERTY DAMAGE LIABILITY, 2.

Exclusions:

This exclusion does not apply to:

(6) Any aircraft, not owned or operated by any insured, which is hired, chartered or loaned with a paid crew. However, if the insured has any other valid and collectible insurance for "bodily injury" or "property damage" that would be covered under this provision, or on any other basis, this coverage is then excess, and subject to Condition 4. Other Insurance, b. Excess

Insurance under SECTION IV —

COMMERCIAL GENERAL LIABILITY

CONDITIONS.

Damage To Premises Rented to You

A. The last paragraph of Paragraph 2. Exclusions under COVERAGE A BODILY INJURY AND

PROPERTY DAMAGE is deleted in its entirety and replaced with the following:

Exclusions c. through n. do not apply to damage by fire, lightning or explosion to premises rented to you or temporarily occupied by you with the permission of the owner. A separate limit of insurance applies to this coverage as described in SECTION III —

LIMITS OF INSURANCE.

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INSURED'S COPY

B. Paragraph 6. under SECTION III — LIMITS OF

INSURANCE is deleted in its entirety and replaced with the following:

6. Subject to Paragraph 5. above, the most we will pay under COVERAGE A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage caused by fire, lightning or explosion, while rented to you or temporarily occupied by you with permission of the owner, for all such damage caused by fire, lightning or explosion proximately caused by the same event, whether such damage results from fire, lightning or explosion or any combination of the three, is the amount shown in the Declarations for the

Damage To Premises Rented To You Limit.

C. Paragraph a. of Definition 9. "Insured contract" under SECTION V — DEFINITIONS is deleted in its entirety and replaced with the following:

a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning or explosion to premises while rented to you or temporarily occupied by you with the permission of the owner is not an "insured contract";

Electronic Data Liability

A. Exclusion p. Access or Disclosure Of

Confidential Or Personal Information And

Data-related Liability under COVERAGE A

BODILY INJURY AND PROPERTY DAMAGE

LIABILITY, 2. Exclusions is deleted in its entirety and replaced by the following:

p. Access or Disclosure Of Confidential Or

Personal Information And Data-related

Liability

Damages arising out of:

(1) Any access to or disclosure of any person's or organization's confidential or personal information, including patents, trade secrets, processing methods, customer lists, financial information, credit card information or any other type of nonpublic information;

or

(2) The loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate "electronic data" that does not result from physical injury to tangible property.

This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses, forensic expenses, public relations expenses or any other loss, cost or expense incurred by you or others arising out of that which is described in Paragraph (1) or (2) above.

B. The following paragraph is added to SECTION III —

LIMITS OF INSURANCE:

Subject to 5. above, the most we will pay under

COVERAGE A for "property damage" because of all loss of "electronic data" arising out of any one

"occurrence" is a sub-limit of $100,000.

SECTION I — COVERAGE C MEDICAL PAYMENTS

EXCLUSIONS

Any Insured Amendment

Exclusion a. Any Insured under COVERAGE C

MEDICAL PAYMENTS, 2. Exclusions is deleted in its entirety and replaced with the following:

a. Any Insured

To any insured.

This exclusion does not apply to:

(1) "Not-for-profit members";

(2) "Golfing facility" members who are not paid a fee, salary, or other compensation; or

(3) "Volunteer workers".

This exclusion exception does not apply if COVERAGE

C MEDICAL PAYMENTS is excluded by another endorsement to this Coverage Part.

Product Amendment

Exclusion f. Products-Completed Operations Hazard under COVERAGE C MEDICAL PAYMENTS, 2.

Exclusions is deleted in its entirety and replaced with the following:

f. Products-Completed Operations Hazard

Included within the "products-completed operations hazard".

This exclusion does not apply to "your products" sold for use or consumption on your premises, while such products are still on your premises.

This exclusion exception, does not apply if COVERAGE

C MEDICAL PAYMENTS is excluded by another endorsement to this Coverage Part.

SECTION I — SUPPLEMENTARY PAYMENTS —

COVERAGES A AND B

Expenses For Bail Bonds And Loss Of Earnings

A. Subparagraph 1.b. under SUPPLEMENTARY

PAYMENTS — COVERAGES A AND B is deleted in its entirety and replaced with the following:

b. Up to $5,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which

Bodily Injury Liability Coverage applies. We do not have to furnish these bonds.

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F

B. Subparagraph 1.d. under SUPPLEMENTARY

PAYMENTS — COVERAGES A AND B is deleted in its entirety and replaced with the following:

d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $1,000 a day because of time off from work.

SECTION II — WHO IS AN INSURED — Amendments

Not-for-Profit Organization Members

The following paragraph is added to SECTION II —

WHO IS AN INSURED:

If you are an organization other than a partnership, joint venture, or a limited liability company, and you are a not-for-profit organization, the following are included as additional insureds:

1. Your officials;

2. Your trustees;

3. Your members;

4. Your board members;

5. Your commission members;

6. Your agency members;

7. Your insurance managers;

8. Your elective or appointed officers; and

9. Your "not-for-profit members".

However only with respect to their liability for your activities or activities they perform on your behalf.

Employees As Insureds Modified

A. Subparagraph 2.a.(1)(a) under SECTION II — WHO

IS AN INSURED does not apply to "bodily injury" to a "temporary worker" caused by a co-"employee" who is not a "temporary worker".

B. Subparagraph 2.a.(2) under SECTION II — WHO IS

AN INSURED does not apply to "property damage" to the property of a "temporary worker" or "volunteer worker" caused by a co-"employee" who is not a

"temporary worker" or "volunteer worker".

C. Subparagraph 2.a.(1)(d) under SECTION II — WHO

IS AN INSURED does not apply to "bodily injury" caused by cardio-pulmonary resuscitation or first aid services administered by a co-"employee".

With respect to this provision only, Subparagraph (1) of

Exclusion 2. e. Employer's Liability under SECTION I

— COVERAGES, COVERAGE A BODILY INJURY

AND PROPERTY DAMAGE LIABILITY does not apply.

Newly Formed Or Acquired Organizations

A. Subparagraph 3.a. under SECTION II — WHO IS

AN INSURED is deleted in its entirety and replaced with the following:

a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier. However, COVERAGE A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization.

B. The following paragraph is added to SECTION

II — WHO IS AN INSURED, Paragraph 3:

If you are engaged in the business of construction of dwellings three stories or less in height, or other buildings three stories or less in height and less than 25,000 square feet in area, you will also be an insured with respect to "your work" only, for the period of time described above, for your liability arising out of the conduct of any partnership or joint venture of which you are or were a member, even if that partnership or joint venture is not shown as a

Named Insured. However, this provision only applies if you maintain or maintained an interest of at least fifty percent in that partnership or joint venture for the period of that partnership or joint venture.

This provision does not apply to any partnership or joint venture that has been dissolved or otherwise ceased to function for more than thirty-six months.

With respect to the insurance provided by this provision, Newly Formed or Acquired Organizations, the following is added to SECTION IV — COMMERCIAL

GENERAL LIABILITY , Paragraph 4. Other Insurance, Subparagraph b. Excess Insurance:

The insurance provided by this provision, Newly

Formed or Acquired Organizations, is excess over any other insurance available to the insured, whether primary, excess, contingent or on any other basis.

(All other provisions of this section remain unchanged)

Blanket Additional Insureds — As Required By

Contract

A. Subject to the Primary and Non-Contributory provision set forth in this endorsement, SECTION II

— WHO IS AN INSURED is amended to include as an additional insured:

1. Owners, Lessees or Contractors/Architects, Engineers and Surveyors

a. Any person or organization for whom you are performing operations when you and such person or organization have agreed in a written contract, written agreement or written permit that such person or organization be added as an additional insured on your commercial general liability policy; and

CG 73 00 10 23

INSURED'S COPY

b. Any other person or organization, including any architects, engineers or surveyors not engaged by you, whom you are required to add as an additional insured under your policy in the contract or agreement in

Paragraph a. above:

Such person or organization is an additional insured 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 of omissions of those acting on your behalf;

in the performance of your ongoing operations performed for the additional insured in

Paragraph a., above.

However, this insurance does not apply to:

"Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services by or for you, including:

(1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and

(2) Supervisory, inspection, architectural or engineering activities.

Professional services do not include services within construction means, methods, techniques, sequences and procedures employed by you in connection with your operations in your capacity as a construction contractor.

A person or organization's status as an additional insured under this endorsement ends when your operations for the person or organization described in Paragraph a. above are completed.

2. Other Additional Insureds

Any of the following persons or organizations with whom you have agreed in a written contract, written agreement or written permit that such persons or organizations be added as an additional insured on your commercial general liability policy:

a. Lessors of Leased Equipment

Any person or organization from whom you lease equipment, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person or organization.

With respect to the insurance afforded to these additional insureds, this insurance does not apply to any "occurrence" which takes place after the equipment lease expires.

b. Managers or Lessors of Premises

Any person or organization from whom you lease premises, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by you or those acting on your behalf in connection with the ownership, maintenance or use of that part of the premises leased to you.

This insurance does not apply to any

"occurrence" which takes place after you cease to be a tenant of that premises.

c. Mortgagees, Assignees or Receivers

Any person or organization with respect to their liability as mortgagee, assignee or receiver and arising out of the ownership, maintenance or use of your premises.

This insurance does not apply to any

"occurrence" which takes place after the mortgage is satisfied, or the assignment or receivership ends.

d. Any Person or Organization Other Than

A Joint Venture

Any person or organization (other than a joint venture of which you are a member), but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts of omissions of those acting on your behalf in the performance of your ongoing operations or in connection with property owned by you.

e. State or Governmental Agency or

Political Subdivision — Permits or

Authorizations

Any state or governmental agency or subdivision or political subdivision, but only with respect to:

(1) Operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization; or

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(2) The following hazards for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization in connection with premises you own, rent or control and to which this insurance applies:

(a) The existence, maintenance, repair, construction, erection or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decorations and similar exposures;

(b) The construction, erection or removal of elevators; or

(c) The ownership, maintenance or use of any elevators covered by this insurance.

This insurance does not apply to:

i. "Bodily injury" or "property damage" arising out of operations performed for the federal government, state or municipality; or

ii. "Bodily injury" or "property damage" included within the

"products-completed operations hazard".

With respect to Paragraphs 2.b. through

2.d., this insurance does not apply to structural alterations, new construction or demolition operations performed by or on behalf of such person or organization.

B. The insurance coverage afforded to the additional insureds in this coverage extension:

1. Does not apply unless the written contract or written agreement has been signed by the

Named Insured or written permit issued prior to the "bodily injury" or "property damage" or

"personal and advertising injury";

2. Only applies to the extent permitted by law; and

3. Will not be broader than that which you are required by the written contract, written agreement, or written permit to provide to such additional insured.

Broad Form Vendors Coverage

Subject to the Primary and Non-Contributory provision set forth in this endorsement, SECTION II —

WHO IS AN INSURED is amended to include as an additional insured any person or organization (referred to below as vendor) for whom you have agreed in a written contract or written agreement to provide coverage as an additional insured under your policy.

Such person or organization is an additional insured only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor’s business.

However, the insurance afforded the vendor does not apply to:

a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement; however this exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement;

b. Any express warranty unauthorized by you;

c. Any physical or chemical change in the product made intentionally by the vendor;

d. Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container;

e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business in connection with the sale of the product; or

f. Products which, after distribution or sale by you, have been labeled or re-labeled or used as a container, part of ingredient of any other thing or substance by or for the vendor; however this insurance does not apply to any insured person or organization, from who you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products.

The provisions of this coverage extension do not apply unless the written contract or written agreement has been signed by the Named Insured prior to the "bodily injury" or "property damage".

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INSURED'S COPY

Incidental Malpractice

Subparagraph 2.a.(1)(d) under SECTION II — WHO IS

AN INSURED is deleted in its entirety and replaced with the following:

(d) Arising out of his or her providing or failing to provide professional health care services.

This does not apply to nurses, emergency medical technicians or paramedics if you are not in the business or occupation of providing any such professional services.

This also does not apply to "bodily injury" caused by cardio-pulmonary resuscitation or first aid services administered by a co-"employee".

This provision does not apply if you are a Social Service or Senior Living risk.

SECTION IV — COMMERCIAL GENERAL LIABILITY

CONDITIONS — Amendments

Knowledge Of Occurrence, Claim, Suit Or Loss

The following is added to Paragraph 2. Duties in the

Event of Occurrence, Offense, Claim or Suit under

SECTION IV — COMMERCIAL GENERAL LIABILITY

CONDITIONS:

The requirements under this paragraph do not apply until after the "occurrence" or offense is known to:

1. You, if you are an individual;

2. A partner, if you are a partnership;

3. An "executive officer" or insurance manager, if you are a corporation;

4. Your members, managers or insurance manager, if you are a limited liability company; or

5. Your elected or appointed officials, officers, members, trustees, board members, commission members, agency members, or your administrator or your insurance manager if you are an organization other than a partnership, joint venture, or limited liability company.

Primary and Non-Contributory Provision

The following is added to Paragraph 4. Other

Insurance, b. Excess Insurance under SECTION IV —

COMMERCIAL GENERAL LIABILITY CONDITIONS:

This insurance is primary to and we will not seek contribution from any other insurance available to an additional insured under this policy provided that:

(1) The additional insured is a Named Insured under such other insurance; and

(2) You have agreed in a written contract, written agreement or written permit that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured.

Unintentional Failure To Disclose Hazards

The following is added to Paragraph 6.

Representations under SECTION IV —

COMMERCIAL GENERAL LIABILITY CONDITIONS:

However, if you should unintentionally fail to disclose any existing hazards in your representations to us at the inception date of the policy, or during the policy period in connection with any additional hazards, we shall not deny coverage under this Coverage Part based upon such failure to disclose hazards.

Waiver Of Transfer Of Rights Of Recovery

The following is added to Paragraph 8. Transfer of

Rights Of Recovery Against Others To Us under

SECTION IV — COMMERCIAL GENERAL LIABILITY

CONDITIONS :

We will waive any right of recovery against a person or organization because of payments we make under this

Commercial General Liability Coverage Part. This waiver applies only if the insured has agreed in a written contract or written agreement to:

1. Waive any right of recovery against that person or organization; or

2. Assume the liability of that person or organization pursuant to a written contract or written agreement that qualifies as an "insured contract"; and

3. Include such person or organization as an additional insured on your policy.

Such waiver by us applies only to that person or organization identified above, and only to the extent that the insured has waived its right of recovery against such person or organization prior to loss.

Liberalization

The following condition is added to SECTION IV —

COMMERCIAL GENERAL LIABILITY CONDITIONS:

If we revise this Coverage Part to provide more coverage without additional premium charge, subject to our filed company rules, your policy will automatically provide the additional coverage as of the day the revision is effective in your state.

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Two or More Coverage Parts or Policies Issued By

Us

(This provision is not Applicable in the state of New York or Wisconsin).

The following condition is added to SECTION IV —

COMMERCIAL GENERAL LIABILITY CONDITIONS:

It is our intention that the various coverage parts or policies issued to you by us, or any company affiliated with us, do not provide any duplication or overlap of coverage. We have exercised diligence to draft our coverage parts and policies to reflect this intention.

However, if the facts and circumstances that will respond to any claim or "suit" give rise to actual or claimed duplication or overlap of coverage between the various coverage parts or policies issued to you by us or any company affiliated with us, the limit of insurance under all such coverage parts or policies combined shall not exceed the highest applicable limit under this coverage, or any one of the other coverage forms or policies.

This condition does not apply to any Excess or Umbrella policy issued by us specifically to apply as excess insurance over this coverage part or policy to which this coverage part is attached.

SECTION V — DEFINITIONS

Discrimination

(This provision does not apply in New York).

A. The following is added to Definition 14. "Personal and advertising injury":

"Personal and advertising injury" also means

"discrimination" that results in injury to the feelings or reputation of a natural person, however only if such "discrimination" or humiliation is:

1. Not done by or at the direction of:

a. The insured; or

b. Anyone considered an insured under

SECTION II — WHO IS AN INSURED;

2. Not done intentionally to cause harm to another person.

3. Not directly or indirectly related to the employment, prospective employment or termination of employment of any person or persons by any insured.

4. Not arising out of any "advertisement" by the insured.

B. The following definition is added to SECTION V —

DEFINITIONS:

"Discrimination" means:

a. Any act or conduct that would be considered discrimination under any applicable federal, state, or local statute, ordinance or law;

b. Any act or conduct that results in disparate treatment of, or has disparate impact on, a person, because of that person's race, religion, gender, sexual orientation, age, disability or physical impairment; or

c. Any act or conduct characterized or interpreted as discrimination by a person based on that person's race, religion, gender, sexual orientation, age, disability or physical impairment.

It does not include acts or conduct characterized or interpreted as sexual intimidation or sexual harassment, or intimidation or harassment based on a person's gender.

Electronic Data

The following definition is added to SECTION V —

DEFINITIONS:

"Electronic data" means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, including systems and applications software, hard or floppy disks, CD-ROMS, tapes, drives, cell, data processing devices or any other media which are used with electronically controlled equipment. For the purpose of the Electronic Data

Liability coverage provided by this endorsement, Definition 17. "Property damage" is deleted in its entirety and replaced by the following:

17. "Property damage" means:

a. Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; or

b. Loss of, loss of use of, damage to, corruption of, inability to access, or inability to properly manipulate "electronic data", resulting from physical injury to tangible property. All such loss of "electronic data" shall be deemed to occur at the time of the "occurrence" that caused it.

For the purpose of the Electronic Data Liability coverage provided by this endorsement, "electronic data" is not tangible property.

Employee Amendment

Definition 5. "Employee" under SECTION V —

DEFINITIONS is deleted in its entirety and replaced by the following:

5. "Employee" includes a "leased worker", or a

"temporary worker". If you are a School, "Employee" also includes a student teacher.

Golfing Facility

The following definition is added to SECTION V —

DEFINITIONS:

"Golfing facility" means a golf course, golf club, driving range, or miniature golf course.

CG 73 00 10 23

INSURED'S COPY

Mental Anguish Amendment

(This provision does not apply in New York).

Definition 3. "Bodily injury" under SECTION V —

DEFINITIONS is deleted in its entirety and replaced with the following:

3. "Bodily injury" means bodily injury, sickness or disease sustained by a person, including death resulting from any of these at any time. This includes mental anguish resulting from any bodily injury, sickness or disease sustained by a person.

(In New York, mental anguish has been determined to be "bodily injury").

Not-for-profit Member

The following definition is added to SECTION V —

DEFINITIONS:

"Not-for-profit member" means a person who is a member of a not-for-profit organization, including clubs and churches, who receives no financial or other compensation.

CA 78 09 04 24Copyright, 2023 Selective Insurance Company of America. All rights reserved.

F

ElitePac

Commercial Automobile Extension

COMMERCIAL AUTO

CA 78 09 04 24

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

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

AMENDMENT TO SECTION I - COVERED AUTOS

COVERAGES AND SECTION II - COVERED AUTOS

LIABILITY COVERAGE

If this policy provides Auto Liability coverage for Owned

Autos, the following extension is applicable:

EMPLOYEE OWNED AUTOS - BUSINESS USE

Solely for purposes of the coverage extended by this endorsement:

A. The following is added to SECTION I, A.

Description of Covered Auto Designation

Symbols:

Coverage symbols 1, 2, 3, 4, 5, 6 and 7 are amended to include the following:

Any “auto” owned by an “employee” specifically described on the Declarations page or on file with us when issued on a non-specified “auto” basis is considered an “auto” you own and not a covered

“auto” you hire, borrow or lease; and

B. The following is added to SECTION II, A.1. Who Is

An Insured:

An “employee” who is the owner of a specifically described “auto” on the Declarations page or on file with us when issued on a non-specified “auto” basis is an “insured”.

If the “employee” owned “auto” is used:

1. Without your permission;

2. Outside the scope of any policies and procedures your business has for acceptable vehicle usage;

3. For any purpose other than the conduct of your business; or

4. By anyone other than the “employee” who owns the “auto”, except another “employee”, the limits of liability available to the “employee” or anyone other than a named “insured” under all coverages shall be limited to the higher of:

1. $250,000; or

2. The compulsory or financial responsibility law limits where the “auto” is licensed and principally garaged.

AMENDMENTS TO SECTION II - LIABILITY

COVERAGE

A. If this policy provides Auto Liability coverage for

Owned Autos, the following extensions are applicable accordingly:

NEWLY ACQUIRED OR FORMED

ORGANIZATIONS

The following is added to SECTION II, A.1. - Who

Is An Insured:

Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no similar insurance available to that organization. However:

1. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier;

2. Coverage does not apply to “bodily injury” or

“property damage” resulting from an “accident” that occurred before you acquired or formed the organization.

No person or organization is an “insured” with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the

Declarations.

CA 78 09 04 24Copyright, 2023 Selective Insurance Company of America. All rights reserved.

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

EXPENSES FOR BAIL BONDS AND LOSS OF

EARNINGS

Paragraphs (2) and (4) of SECTION II, A.2.a. -

Supplementary Payments are deleted in their entirety and replaced with the following:

(2) Up to the Limit of Insurance shown on the

ElitePac Schedule for the cost of bail bonds

(including bonds for related traffic law violations) required because of an “accident” covered under this policy. We do not have to furnish these bonds.

(4) All reasonable expenses incurred by the

“insured” at our request. This includes actual loss of earnings because of time off from work, which we will pay up to the Limit of Insurance shown on the ElitePac Schedule.

EMPL OYE E INDEM NIF ICATION AND

EMPLOYER’S LIABILITY AMENDMENT

The following is added to SECTION II, B.4. -

Exclusions:

This exclusion does not apply to a “volunteer worker” who is not entitled to workers compensation, disability or unemployment compensation benefits.

FELLOW EMPLOYEE COVERAGE

The Fellow Employee Exclusion, SECTION II, B.5.

- is deleted in its entirety.

CARE, CUSTODY OR CONTROL AMENDMENT

The following is added to SECTION II, B.6. -

Exclusions:

This exclusion does not apply to property owned by anyone other than an “insured”, subject to the following:

1. The most we will pay under this exception for any one “accident” is the Limit of Insurance stated in the ElitePac Schedule; and

2. A per “accident” deductible as stated in the

ElitePac Schedule applies to this exception.

This coverage extension does not apply to

Emergency Services Organizations and

Governmental Entities.

B. If this policy provides Auto Liability coverage for

Owned Autos, Non-Owned Autos or Hired Autos, the following extensions are applicable accordingly:

LIMITED LIABILITY COMPANIES

The following is added to SECTION II, A.1. - Who

Is An Insured:

If you are a limited liability company, your members and managers are “insureds” while using a covered

“auto” you don’t own, hire or borrow during the course of their duties for you.

BLANKET ADDITIONAL INSUREDS - As

Required By Contract

The following is added to SECTION II, A.1. - Who

Is An Insured:

Any person or organization whom you have agreed in a written contract, written agreement or written permit that such person or organization be added as an additional “insured” on the Business Auto

Coverage Part on your policy is an additional

“insured”, but only with respect to liability for “bodily injury” or “property damage” caused, in whole or in part, by your ownership, maintenance or use of a covered “auto”. This coverage shall be primary and non-contributory with respect to the additional

“insured”. This provision only applies if:

1. It is required in the written contract, written agreement or written permit identified in this section;

2. It is permitted by law; and

3. The written contract or written agreement has been executed (executed means signed by a named insured) or written permit issued prior to the “bodily injury” or “property damage”.

C. If this policy provides Auto Liability coverage for

Non-Owned Autos, the following extension is applicable accordingly:

EMPLOYEES AS INSUREDS

If this policy provides Auto Liability coverage for

Non-Owned Autos, the following is added to

SECTION II, A.1. - Who Is An Insured:

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.

An “employee” of yours is an “insured” while operating an “auto” hired or rented under a contract or agreement in that “employee’s” name with your permission, while performing duties related to the conduct of your business.

AMENDMENTS TO SECTION III - PHYSICAL

DAMAGE COVERAGE

For those covered “autos” for which Comprehensive, Specified Causes of Loss or Collision coverage shown in the Declaration, the following extensions of coverage are applicable:

CA 78 09 04 24

F

TOWING AND LABOR

SECTION III, A.2. - Towing is deleted in its entirety and replaced with the following:

We will pay all reasonable towing and labor costs up to the applicable Limit of Insurance shown on the ElitePac

Schedule per tow each time a covered “Private

Passenger Auto”, “Social Service Van or Bus”, “Light

Truck” or any commercial “auto” with a gross vehicle weight rating or gross combination weight greater than

10,000 pounds is disabled.

For labor charges to be eligible for reimbursement the labor must be performed at the place of disablement.

Coverage for towing and labor costs afforded by any other endorsement added to the commercial auto policy shall apply in excess of the coverage afforded by this

ElitePac.

This coverage extension does not apply to Emergency

Services Organizations and Governmental Entities.

GLASS BREAKAGE DEDUCTIBLE

The following is added to SECTION III, A.3. - Glass

Breakage - Hitting A Bird Or Animal - Falling Objects or Missiles:

If damaged glass is repaired rather than replaced, no deductible will apply for such repair. This extension does not apply to Emergency Services Organizations and

Governmental Entities.

ADDITIONAL TRANSPORTATION EXPENSES

SECTION III, A.4.a. - Transportation Expenses is deleted in its entirety and replaced with the following:

We will pay up to the Limit of Insurance shown on the

ElitePac Schedule for temporary transportation expenses that you incur because of any “loss” to a covered “auto”, but only if the covered “auto” carries the coverages and meets the requirements described in

Paragraphs 1. or 2. below:

1. We will pay temporary transportation expenses for total theft of a covered “auto”. We will only pay for such expenses incurred during the period beginning

24 hours after the theft and ending, regardless of the policy’s expiration, when the covered “auto” is returned to use or we pay for its “loss”.

2. For “loss” other than total theft of a covered “auto” under Comprehensive or Specified Causes of Loss

Coverage, or for any “loss” under Collision

Coverage to a covered “auto”, we will only pay for those temporary transportation expenses incurred during a period of time reasonably required to repair or replace the covered “auto”, even if that time period extends beyond the policy expiration date.

Paragraph 2. of this extension does not apply while there are spare or reserve “autos” available to you for your operations.

The 24 hour waiting period found on any other form endorsed onto the Auto Coverage part does not apply for any covered Rental Reimbursement “loss”.

This coverage extension does not apply to Emergency

Services Organizations and Governmental Entities.

HIRED AUTO PHYSICAL DAMAGE COVERAGE

If Comprehensive, Specified Causes of Loss or Collision coverage applies to a covered “auto”, the following is added to SECTION III, A.4. - Coverage Extensions:

Physical Damage coverage is hereby extended to apply to Physical Damage “loss” to “autos” leased, hired, rented or borrowed without a driver. We will provide coverage equal to the broadest coverage available to any covered “auto” shown on the Declarations; however, the most we will pay for “loss” to each “auto” under this coverage extension is the lesser of:

1. The Limit of Insurance stated in the ElitePac

Schedule; or

2. The actual cash value of the damaged or stolen property as of the time of the “loss”; or

3. The actual cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. A part is of like kind and quality when it is of equal or better condition than the pre-accident part. We will use the original equipment from the manufacturer when:

(a) The operational safety of the vehicle might otherwise be impaired;

(b) Reasonable and diligent efforts to locate the appropriate rebuilt, aftermarket or used part have been unsuccessful; or

(c) A new original equipment part of like kind and quality is available and will result in the lowest overall repair cost.

For each leased, hired, rented or borrowed covered

“auto” our obligation to pay each applicable “loss” will be reduced by the hired “auto” deductible on this policy. If there is no hired “auto” coverage symbol 8 for physical damage coverage on the policy, our obligation to pay for each “loss” will be reduced by the deductible equal to the highest deductible applicable to any owned “auto” for that coverage. No deductible will be applied to any “loss” caused by fire or lightning.

CA 78 09 04 24

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SECTION IV, B.5. Other Insurance Condition, Paragraph 5.b. is deleted in its entirety and replaced by the following:

For Hired Auto Physical Damage Coverage, the following are deemed to be covered “autos’” you own:

1. Any covered “auto” you lease, hire, rent, or borrow;

and

2. Any covered “auto” hired or rented by your

“employee” under a contract or agreement in that

“employee’s” name, with your permission, while performing duties related to the conduct of your business.

However, any “auto” that is leased, hired, rented or borrowed with a driver is not a covered “auto”.

This coverage extension does not apply to Emergency

Services Organizations and Governmental Entities.

HIRED AUTO LOSS OF USE COVERAGE

If Comprehensive, Specified Causes of Loss or Collision coverage applies to a covered “auto”, the following is added to SECTION III, A.4. - Coverage Extensions:

We will pay expenses for which you are legally responsible to pay for loss of use of a leased, hired, rented or borrowed “auto” if it results from an “accident”.

The per day limit in the Business Auto Coverage form does not apply and the most we will pay per “accident” is the Limit of Insurance shown on the ElitePac Schedule.

Loss of Use Expense limits afforded by any endorsement added to the commercial auto policy shall apply in excess of the coverage afforded by this

ElitePac form.

This coverage extension does not apply to Emergency

Services Organizations, Governmental Entities, and

Schools.

AUTO LOAN/LEASE GAP COVERAGE (Not

Applicable in New York)

If Comprehensive, Specified Causes of Loss or Collision coverage applies to a covered “auto”, the following is added to SECTION III, A.4. - Coverage Extensions:

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:

1. The amount paid under the Physical Damage

Coverage Section of the policy; and

2. Any:

a. Overdue or any deferred lease/loan payments at the time of “loss”;

b. Financial penalties imposed under a lease for excessive use, abnormal wear and tear, high mileage or similar charges;

c. Security deposits not refunded by the lessor or financial institution;

d. Costs for extended warranties, credit life, health, accident, or disability insurance purchased with the loan or lease; and

e. Carry-over balances from previous leases or loans.

You are responsible for the deductible applicable to the

“loss” for the covered “auto”.

The insurance provided by this coverage provision is excess over any other collectible insurance including but not limited to any coverage provided by or purchased from the lessor or any financial institution.

PERSONAL EFFECTS

The following is added to SECTION III, A.4. - Coverage

Extensions:

If this policy provides Comprehensive Coverage for a covered “auto” you own and that covered “auto” is stolen, we will pay up to the Limit of Insurance shown on the ElitePac Schedule, without application of a deductible, for lost personal effects that were in the covered “auto” at the time of theft. Personal effects do not include jewelry, tools, money, or securities. This coverage is excess over any other collectible insurance.

AIRBAG COVERAGE

The following is added to SECTION III, B.3.a. -

Exclusion…