CTR076778_COI_CGL_Auto_WC_SAM_PL_Exp_5.1.26.pdf

PDF 3 MB Posted

Attached to
Master Agreement AZ|CTR076778
Contract number
CTR076778
Issued by
Arizona

About this file

This document is a comprehensive Certificate of Liability Insurance for Phoenix Gospel Mission Inc., issued by Philadelphia Indemnity Insurance Company, with additional insurance provided by Phoenix Indemnity Insurance and CopperPoint Mutual Insurance Company. The insurance policy covers Phoenix Gospel Mission and names the State of Arizona, including its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees as additional insureds. The policy is effective from May 1, 2025 to May 1, 2026 and includes multiple coverage types such as Commercial General Liability, Automobile Liability, Umbrella Liability, Workers' Compensation, Professional Liability, and Abuse (Sexual Abuse & Molestation) coverage.

The contract specifically relates to child care services at a residential shelter, with contract number CTR076778. The insurance provides various coverage limits, including $1,000,000 per occurrence for General Liability, $1,000,000 for Automobile Liability, $5,000,000 for Umbrella Liability, and $1,000,000 for Workers' Compensation. The policy includes a 30-day notice of cancellation and provides waiver of subrogation in favor of the State of Arizona. The insurance coverage is primary and non-contributory, covering liability arising from the contractor's activities, including those involving owned, hired, and non-owned vehicles. The policy also explicitly includes Sexual Abuse & Molestation coverage with limits of $1,000,000 per occurrence and $3,000,000 aggregate.

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File Type Posted
Attachment_6_Business_Associate_Agreement.pdf PDF
CTR076778_Pre-Contract_Documents.pdf PDF
CTR076778_Contract_Document.pdf PDF
Exhibit_B__Programmatic_Report.xlsx XLSX spreadsheet
myCOI_Instructions.pdf PDF

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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

7/24/2025

(480) 385-7385 (480) 946-3512

18058

Phoenix Gospel Mission Inc dba Phoenix Rescue Mission 1540 W Van Buren St Phoenix, AZ 85007

14216

A 1,000,000

X X PHPK2682269 5/1/2025 5/1/2026 100,000

20,000

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

1,000,000A

X X PHPK2682269 5/1/2025 5/1/2026

5,000,000B

PHUB910033 5/1/2025 5/1/2026 5,000,000

10,000 C

X 1016751 5/1/2025 5/1/2026 1,000,000 Y 1,000,000

1,000,000 A Professional Liab. PHPK2682269 5/1/2025 $1M Occ w/ Agg of 3,000,000 A Abuse (SAM) PHPK2682269 5/1/2025 5/1/2026 $1M Occ w/ Agg of 3,000,000

Contract No.: CTR076778 / Child Care at Residential Shelter The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are additional insureds on a Primary and Non-Contributory Basis with respect to liability arising out of the activities performed by or on behalf of the Contractor including activities involving automobiles owned, hired and/or non-owned by the Contractor per forms CG2010 04/13, CG2037 04/13, and CA2048 10/13. Waiver of Subrogation applies in favor of the State of Arizona, and its departments, agencies, boards, commission, universities, officers, officials, agents, and employees for losses arising from work performed by or on behalf of the Contractor per forms CG2404 05/09, CA0444 10/13, & WC000313 04/84. Umbrella Liability is in excess of General, Auto, Employers, Abuse, & Professional Liability. **Sexual Abuse & Molestation coverage is included** 30 Day Notice of Cancellation Applies per form PI-CANXAICH-002 (05/11)

The State of Arizona and Department of Economic Security c/o myCOI PO Box 501970 8710 Bash Street Indianapolis, IN 46220

PHOEGOS-02 ATYE

HUB International Insurance Services (SOW) 8777 N Gainey Center Dr. Suite 100 Scottsdale, AZ 85258

Ashley Tye ashley.tye@hubinternational.com

Philadelphia Indemnity Insurance Company Phoenix Indemnity Insurance CopperPoint Mutual Insurance Company

X

5/1/2026

X X

X

X

X

X

POLICY NUMBER: COMMERCIAL GENERAL LIABILITY

CG 20 10 04 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2

ADDITIONAL INSURED – OWNERS, LESSEES OR

CONTRACTORS – SCHEDULED PERSON OR

ORGANIZATION

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE

Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but 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 or omissions of those acting on your behalf;

in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above.

However:

1. The insurance afforded to such additional insured only applies to the extent permitted by law; and

2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.

B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:

This insurance does not apply to "bodily injury" or "property damage" occurring after:

1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or

2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project.

PHPK2682269

The State of Arizona, its departments, agencies, boards commissions, universities and its officers, officials

Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13

C. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance:

If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:

1. Required by the contract or agreement; or

2. Available under the applicable Limits of Insurance shown in the Declarations;

whichever is less.

This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.

CG 20 37 04 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CG 20 37 04 13 © Insurance Services Office, Inc., 2012

ADDITIONAL INSURED – OWNERS, LESSEES OR

CONTRACTORS – COMPLETED OPERATIONS

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

SCHEDULE

Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard".

However:

1. The insurance afforded to such additional insured only applies to the extent permitted by law; and

2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.

B. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance:

If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:

1. Required by the contract or agreement; or

2. Available under the applicable Limits of

Insurance shown in the Declarations;

whichever is less.

This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.

PHPK2682269

The State of Arizona, its departments, agencies, boards commissions, universities and its officers, officials

1 1

CG 24 04 05 09

CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

SCHEDULE

Name Of Person Or Organization:

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Conditions:

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 damage arising out of your ongoing operations or "your work" done under a contract with 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.

PHPK2682269-001

The State of Arizona, and its departments, agencies, boards, commissions universities, officers, agents, and employees for losses arising from work performed by or on behalf of the Contractor.

POLICY NUMBER: COMMERCIAL AUTO

CA 20 48 10 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1

DESIGNATED INSURED FOR

COVERED AUTOS LIABILITY COVERAGE

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 this endorsement.

This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.

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 Of Person(s) Or Organization(s): SEE SCHEDULE PI-CA-044

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II – Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I – Covered Autos Coverages of the Auto Dealers Coverage Form.

PHPK2682269-001

05/01/2025

Phoenix Gospel Mission, Inc. DBA: P

PI-CA-044 (09/23)

PI-CA-044 (09/23)

Page of

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

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

SCHEDULE - DESIGNATED INSURED FOR

COVERED AUTOS LIABILITY COVERAGE

This schedule is used with endorsement CA 20 48 Designated Insured for Covered Autos Liability Coverage to provide additional space to complete the schedule.

SCHEDULE

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

The State of Arizona, its departments, agencies, boards commissions, universities and its officers, officials agents, and employees and the Department of Economic Security for losses arising out of the work performed by or on behalf of the Contractor 1789 W Jefferson Phoenix, AZ 85007

CA2048 - AZ - Veh #0 - AUTO DELUXE - AUTO

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 of

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.

PHPK2682269-001

05/01/2025

Phoenix Gospel Mission, Inc. DBA: P

The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, agents, and employees for losses arising from work performed by or on behalf of the Contractor.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13

(Ed. 4-84)

© 1983 National Council on Compensation Insurance.

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 STATE

State Waiver: State of Arizona, its departments, agencies, boards, commissions, universities, and its officers, officials, agents, and employees for losses arising from work performed by or on behalf of the Contractor.

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 No.

Premium $ 100

Endorsement Effective 05/01/2023 Policy No. 1016751 Insured Phoenix Gospel Mission

Insurance Company CopperPoint Indemnity Insurance Company

WC 00 03 13

(Ed. 4-84)

Countersigned by

PI-CANXAICH-002 (05/11)

Page of

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CANCELLATION NOTICE TO SCHEDULED ADDITIONAL INSURED OR

CERTIFICATE HOLDER

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PROFESSIONAL LIABILITY COVERAGE PART

COMMERCIAL CRIME COVERAGE PART

COMMERCIAL INLAND MARINE COVERAGE PART

COMMERCIAL PROPERTY COVERAGE PART

COMMERCIAL AUTOMOBILE COVERAGE PART

SCHEDULE OF ADDITIONAL INSUREDS OR CERTIFICATE HOLDERS

AI or CH Additional Insured or Certificate Holder Address

The following is added to A. CANCELLATION of the Common Policy Conditions of the above applicable coverage part:

A. In the event we cancel the policy in accordance with the policy’s terms and conditions, we will endeavor to mail written notice of cancellation to Additional Insureds or Certificate Holders, shown in the above SCHEDULE within the time frame listed below. However, failure to mail such notice shall impose no obligation of any kind upon us, our agents or representatives.

1. days before the effective date of cancellation if we cancel for any reason other than for non - payment of premium.

As respects Additional Insureds, the above cancellation provision applies only when the Additional Insured shown in the above SCHEDULE is added to the policy by a separate additional insured endorsement as the CANCELLATION NOTICE TO ADDITIONAL INSURED OR CERTIFICATE HOLDER does not provide additional insured coverage.

AI The State of Arizona & Dept. of 1075 Broad Ripple Ave Ste 313 Economic Security c/o MYCOI Indianapolis, IN 46220

POLICY NUMBER:

IL 12 09 08 23

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

IL 12 09 08 23 © Insurance Services Office, Inc., 2022 Page 1

ARIZONA POLICY CHANGES

Policy Change Number:

Policy Number: Company:

From: 12:01 AMPolicy Changes Effective:

To: 12:01 AM

At the named insured's mailing address shown below.

Named Insured: Authorized Representative:

Named Insured's Mailing Address:

Coverage Parts Affected:

Changes

The above amendments result in a change in the premium as follows:

NO CHANGES TO BE ADJUSTED AT AUDIT ADDITIONAL PREMIUM

RETURN PREMIUM

{See Additional Page(s)}

Path ID

Revision No.:

Philadelphia Indemnity Insurance Company

PHPK2682269-001

PHPK2682269-001

Hub International Insurance Services In

05/01/2026

Phoenix Gospel Mission, Inc. DBA: P

Phoenix, AZ 85007-2414 1540 W Van Buren St

05/01/2025

Additional Insured

18692112

IL 12 09 08 23 © Insurance Services Office, Inc., 2022

ARIZONA POLICY CHANGES ENDORSEMENT DESCRIPTION

REMOVAL PERMIT

If this policy includes the Commercial Property Coverage Part, the following applies with respect to such Coverage Part(s):

If Covered Property is removed to a new location that is described on this Policy Change, you may extend this insurance to include that Covered Property at each location during the removal. Coverage at each location will apply in the proportion that the value at each location bears to the value of all Covered Property being removed. This permit applies up to 10 days after the effective date of this Policy Change; after that, this insurance does not apply at the previous location.

Countersignature Of Authorized Representative Name:

Title:

Signature:

Date:

Issue Date: 08/06/2025

Amended:

Additional Insured:

State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees

Per attached

In consideration of the premium reflected, the policy is amended as indicated below:

PI-AI-SCH (08/20)

PI-AI-SCH (08/20)

Page of

Additional Insured Schedule

Policy Number:

Philadelphia Indemnity Insurance Company

PHPK2682269-001

State of Arizona,and its departments, agencies,boards commissions,universities officers, officials,agents,and employees 1789 W Jefferson Phoenix, AZ 85007

CG2010 - General Liability

CG2026 - General Liability

CG2037 - General Liability

CG 20 10 04 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2

ADDITIONAL INSURED – OWNERS, LESSEES OR

CONTRACTORS – SCHEDULED PERSON OR

ORGANIZATION

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE

Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but 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 or omissions of those acting on your behalf;

in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above.

However:

1. The insurance afforded to such additional insured only applies to the extent permitted by law; and

2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.

B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:

This insurance does not apply to "bodily injury" or "property damage" occurring after:

1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or

2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project.

PHPK2682269-001

State of Arizona,and its departments, agencies,boards commissions,universities officers, officials,agents,and employees

Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13

C. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance:

If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:

1. Required by the contract or agreement; or

2. Available under the applicable Limits of Insurance shown in the Declarations;

whichever is less.

This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.

CG 20 37 04 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page of

ADDITIONAL INSURED – OWNERS, LESSEES OR

CONTRACTORS – COMPLETED OPERATIONS

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

SCHEDULE

Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard".

However:

1. The insurance afforded to such additional insured only applies to the extent permitted by law; and

2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.

B. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance:

If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:

1. Required by the contract or agreement; or

2. Available under the applicable Limits of

Insurance shown in the Declarations;

whichever is less.

This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.

PHPK2682269-001

State of Arizona,and its departments, agencies,boards commissions,universities officers, officials,agents,and employees

CTR076778 25-26 CPKG ENDT State of AZ.pdf
Insurance Policy
Arizona Policy Changes (Part 1)
Arizona Policy Changes (Part 2)
Additional Insured Schedule
Addl Ins - Owners, Lessees, Or Contractors-Sched Pers
Addl Ins-Owners,Lessees, Contractors Completed Oper

File details come from the government source that posted it. Updated .