CTR077249_Certificate_of_Insurance_Updated_6.30.2025.pdf
PDF 524 KB Posted
- Attached to
- Master Agreement AZ|CTR077249
- Contract number
- CTR077249
- Issued by
- Arizona
About this file
This document is a comprehensive insurance certificate and policy endorsement package for Amazing Grace Arizona Families LLC, covering multiple insurance lines including commercial general liability, automobile liability, and workers' compensation. The insurance is provided by Philadelphia Indemnity Insurance Company, NGM Insurance Company, and CopperPoint Insurance Company, with Woodruff Leavitt Insurance Agency as the producer. The primary certificate holder is the State of Arizona Department of Child Safety, Office of Procurement & Contracts, located in Phoenix, Arizona, for a contract related to Family Connections & Nurturing Parenting (Contract #CTR077249).
The insurance policies provide coverage from February 1, 2025 to February 1, 2026, with various liability limits including $1,000,000 per occurrence for commercial general liability, $1,000,000 for sexual abuse and molestation coverage, and $3,000,000 aggregate for professional liability. The policies include additional insured status for the State of Arizona and its departments, agencies, boards, commissions, universities, officers, and employees. Special provisions cover liability arising from the contractor's activities, with waivers of subrogation and specific endorsements for things like vehicle usage, employee coverage, and protection against unintentional errors or omissions. The policies are designed to comprehensively protect the contractor and the state entity during the performance of services under their contractual agreement.
View the file
Other files
Show all 18
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
12/18/2024
Woodruff Leavitt Insurance Agency 111 E Monroe Avenue, Suite 200
Buckeye AZ 85326
Darlene Terry (623)386-4452 (866)836-5280 darlenet@leavitt.com
Amazing Grace Arizona Families LLC 1945 W Desert Vista Trail Unit #74
Phoenix AZ 85085
Philadelphia Indemnity Insurance Company018058 NGM Insurance Company 14788 CopperPoint Insurance Company 14216
25 26 Master
A
X
X
X
X Y PHPK2634496-005 2/1/2025 2/1/2026
1,000,000
100,000
5,000
1,000,000
3,000,000
3,000,000
B
X X X
X Y CA00036330 2/1/2025 2/1/2026
1,000,000
C 1021567 2/1/2025 2/1/2026
X
1,000,000
1,000,000
1,000,000
A Sexual/Phys Abuse/Molestation PHPK2634496-005 2/1/2025 2/1/2026 $1,000,000 Agg/$1,000,000 Ea Inc
A Professional Liability PHPK2634496-005 2/1/2025 2/1/2026 $3,000,000 Agg/$1,000,000 Ea Inc
RE: Family Connections & Nurturing Parenting CONTRACT #CTR077249 Sexual Abuse and Molestation coverage is included. The State of Arizona Department of Child Safety (ADCS), Office of Procuement & Contracts & Geena Salzman and its departments, agencies,boards,agencies,boards,commissions,universities,officers, officials,agents,and employees are additional insured per written contract with respect to liability arising out of the activities performed by or on behalf of the Contractor as per form PI-GLD-HS 1011& PI-AI-SCH 0820 attached.
State of Arizona Department of Child Safety Office of Procurement & Contracts 3003 N Central Avenue Phoenix, AZ 85012
Jay Broadbent/DT
Y
The ACORD name and logo are registered marks of ACORD
CERTIFICATE HOLDER
© 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01)
AUTHORIZED REPRESENTATIVE
CANCELLATION
DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE
LOCJECT
PRO-
POLICY
GEN'L AGGREGATE LIMIT APPLIES PER:
OCCURCLAIMS-MADE
COMMERCIAL GENERAL LIABILITY
PREMISES (Ea occurrence) $
DAMAGE TO RENTED
EACH OCCURRENCE $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
$RETENTIONDED
CLAIMS-MADE
OCCUR
AGGREGATE $
EACH OCCURRENCE $UMBRELLA LIAB
EXCESS LIAB
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
INSR
LTR TYPE OF INSURANCE POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY) LIMITS
PER
STATUTE
OTH-
ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
ANY PROPRIETOR/PARTNER/EXECUTIVE
If yes, describe under DESCRIPTION OF OPERATIONS below
(Mandatory in NH)
OFFICER/MEMBER EXCLUDED?
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
HIRED AUTOS
NON-OWNED
AUTOS AUTOS
AUTOS
COMBINED SINGLE LIMIT
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE $
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.
INSD
ADDL
WVD
SUBR
N / A
(Ea accident)
(Per accident)
OTHER:
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 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:
INSURED
PHONE
(A/C, No, Ext):
PRODUCER
ADDRESS:
FAX
(A/C, No):
CONTACT
NAME:
NAIC #
INSURER A :
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
INSURER(S) AFFORDING COVERAGE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
INS025 (201401)
RE: Family Connections & Nurturing Parenting CONTRACT #CTR077249
The State of Arizona Department of Child Safety (ADCS), Office of Procuement & Contracts & Geena Salzman, and its departments, agencies, boards,commissions,universities,officers, officials,agents,and employees are additional insured per written contract with respect to liability arising out of the activities performed by or on behalf of the Contractor involving automobiles owned, leased, hired or borrowed by the contractor per form CA7613 0120.
Waiver of Subrogation applies in favor of the State of Arizona Department of Child Safety (ADCS), Office of Procuement & Contracts & Geena Salzman, its departments, agencies, boards, commissions, universities and its officers, officials, agents, employees for losses arising from work performed by or on behalf of the contractor per forms CG2404 0509, CA7613 0120 and WC000313 0484 per written contract.
COMMENTS/REMARKS
COPYRIGHT 2000, AMS SERVICES INC.OFREMARK
� � ��PI-GLD-HS�(10/11)�
Page�1�of�12�
Includes�copyrighted�material�of�Insurance�Services�Office,�Inc.,�with�its�permission.� ©�2011�Philadelphia�Indemnity�Insurance�Company�
�THIS�ENDORSEMENT�CHANGES�THE�POLICY.��PLEASE�READ�IT�CAREFULLY.�
GENERAL�LIABILITY�DELUXE�ENDORSEMENT:�
HUMAN�SERVICES��
This�endorsement�modifies�insurance�provided�under�the�following:�
COMMERCIAL�GENERAL�LIABILITY�COVERAGE�
It�is�understood�and�agreed�that�the�following�extensions�only�apply�in�the�event�that�no�other�specific�coverage�for� the�indicated�loss�exposure�is�provided�under�this�policy.��If�such�specific�coverage�applies,�the�terms,�conditions�and� limits�of�that�coverage�are�the�sole�and�exclusive�coverage�applicable�under�this�policy,�unless�otherwise�noted�on� this�endorsement.���The�following�is�a�summary�of�the�Limits�of�Insurance�and�additional�coverages�provided�by�this� endorsement.��For�complete�details�on�specific�coverages,�consult�the�policy�contract�wording.��� � � � � � �
Coverage�Applicable� Limit�of�Insurance� Page�#�
Extended�Property�Damage�� Included� 2�
Limited�Rental�Lease�Agreement�Contractual�Liability� $50,000�limit� 2�
Non-Owned�Watercraft� Less�than�58�feet� 2�
Damage�to�Property�You�Own,�Rent,�or�Occupy� $30,000�limit� 2�
Damage�to�Premises�Rented�to�You� $1,000,000� 3�
HIPAA� Clarification� 4�
Medical�Payments� $20,000� 5�
Medical�Payments�–�Extended�Reporting�Period� 3�years� 5�
Athletic�Activities� Amended� 5�
Supplementary�Payments�–�Bail�Bonds� $5,000� 5�
Supplementary�Payment�–�Loss�of�Earnings� $1,000�per�day� 5�
Employee�Indemnification�Defense�Coverage�� $25,000� 5�
Key�and�Lock�Replacement�–�Janitorial�Services�Client�Coverage� $10,000�limit� 6�
Additional�Insured�–�Newly�Acquired�Time�Period� Amended� 6�
Additional�Insured�–�Medical�Directors�and�Administrators� Included� 7�
Additional�Insured�–�Managers�and�Supervisors�(with�Fellow����� Employee�Coverage)�
Included� 7�
Additional�Insured�–�Broadened�Named�Insured�� Included� 7�
Additional�Insured�–�Funding�Source� Included� 7�
Additional�Insured�–�Home�Care�Providers�� Included� 7�
Additional�Insured�–�Managers,�Landlords,�or�Lessors�of�Premises� Included� 7�
Additional�Insured�–�Lessor�of�Leased�Equipment�� Included� 7�
Additional�Insured�–�Grantor�of�Permits� Included� 8�
Additional�Insured�–�Vendor� Included� 8�
Additional�Insured�–�Franchisor� Included� 9�
Additional�Insured�–�When�Required�by�Contract� Included� 9�
Additional�Insured�–�Owners,�Lessees,�or�Contractors� Included� 9�
Additional�Insured�–�State�or�Political�Subdivisions� Included� 10�
Policy PHPK2634496
Page�2�of�12�
Includes�copyrighted�material�of�Insurance�Services�Office,�Inc.,�with�its�permission.� ©�2011�Philadelphia�Indemnity�Insurance�Company�
Duties�in�the�Event�of�Occurrence,�Claim�or�Suit� Included� 10�
Unintentional�Failure�to�Disclose�Hazards� Included� 10�
Transfer�of�Rights�of�Recovery�Against�Others�To�Us� Clarification� 10�
Liberalization� Included� 11�
Bodily�Injury�–�includes�Mental�Anguish� Included� 11�
Personal�and�Advertising�Injury�–�includes�Abuse�of�Process,� Discrimination��
Included� 11�
A.�� Extended�Property�Damage��
� SECTION�I�–�COVERAGES,�COVERAGE�A�BODILY�INJURY�AND�PROPERTY�DAMAGE�
� LIABILITY,�Subsection�2.�Exclusions,�Paragraph�a.�is�deleted�in�its�entirety�and�replaced�by�the� � following:�� � � a.� Expected�or�Intended�Injury� � � � “Bodily�injury”�or�property�damage”�expected�or�intended�from�the�standpoint�of�the�insured.�� � � � This�exclusion�does�not�apply�to�“bodily�injury”�or�“property�damage”�resulting�from�the�use�of� � � � reasonable�force�to�protect�persons�or�property.��� B.� Limited�Rental�Lease�Agreement�Contractual�Liability��
� SECTION�I�–�COVERAGES,�COVERAGE�A.�BODILY�INJURY�AND�PROPERTY�DAMAGE�
� LIABILITY,�Subsection�2.�Exclusions,�Paragraph�b.�Contractual�Liability�is�amended�to�include�the� � following:��
� � � (3)��Based�on�the�named�insured’s�request�at�the�time�of�claim,�we�agree�to�indemnify�the�� � � � � named�insured�for�their�liability�assumed�in�a�contract�or�agreement�regarding�the�rental� � � � � or�lease�of�a�premises�on�behalf�of�their�client,�up�to�$50,000.��This�coverage�extension�� � � � � only�applies�to�rental�lease�agreements.���This�coverage�is�excess�over�any�renter’s��� � � � � liability�insurance�of�the�client.� C.� Non-Owned�Watercraft�
� SECTION�I�–�COVERAGES,�COVERAGE�A�BODILY�INJURY�AND�PROPERTY�DAMAGE�
� LIABILITY,�Subsection�2.�Exclusions,�Paragraph�g.�(2)�is�deleted�in�its�entirety�and�replaced�by�the� � following:� � � � (2)� A�watercraft�you�do�not�own�that�is:� � � � � (a)� Less�than�58�feet�long;�and� � � � � (b)� Not�being�used�to�carry�persons�or�property�for�a�charge;�� � � � This�provision�applies�to�any�person,�who�with�your�consent,�either�uses�or�is�responsible�for� � � � the�use�of�a�watercraft.��This�insurance�is�excess�over�any�other�valid�and�collectible��� � � � � insurance�available�to�the�insured�whether�primary,�excess�or�contingent.��� D.� Damage�to�Property�You�Own,�Rent�or�Occupy�
� SECTION�I�–�COVERAGES,�COVERAGE�A�BODILY�INJURY�AND�PROPERTY�DAMAGE�
Page�3�of�12�
Includes�copyrighted�material�of�Insurance�Services�Office,�Inc.,�with�its�permission.� ©�2011�Philadelphia�Indemnity�Insurance�Company�
�� LIABILITY,�Subsection�2.�Exclusions,�Paragraph�j.�Damage�to�Property,�Item�(1)�is�deleted�in�its� � entirety�and�replaced�with�the�following:�
� � � (1)� Property�you�own,�rent,�or�occupy,�including�any�costs�or�expenses�incurred�by�you,�or�� � � � � any�other�person,�organization�or�entity,�for�repair,�replacement,�enhancement,�� � � � � � � restoration�or�maintenance�of�such�property�for�any�reason,�including�prevention�of�injury� � � � � to�a�person�or�damage�to�another’s�property,�unless�the�damage�to�property�is�caused�by� � � � � your�client,�up�to�a�$30,000�limit.����A�client�is�defined�as�a�person�under�your�direct�care� � � � � and�supervision.�� E.���Damage�to�Premises�Rented�to�You�
� 1.� If�damage�by�fire�to�premises�rented�to�you�is�not�otherwise�excluded�from�this�Coverage�Part,� � � � the�word�“fire”�is�changed�to�“fire,�lightning,�explosion,�smoke,�or�leakage�from�automatic�fire�� � � protective�systems”�where�it�appears�in:� � � a.� The�last�paragraph�of�SECTION�I�–�COVERAGES,�COVERAGE�A�BODILY�INJURY�AND�� � � � PROPERTY�DAMAGE�LIABILITY,�Subsection�2.�Exclusions;�is�deleted�in�its�entirety�and�� � � � replaced�by�the�following:�
� � Exclusions�c.�through�n.�do�not�apply�to�damage�by�fire,�lightning,�explosion,�smoke,�or�� � � leakage�from�automatic�fire�protective�systems�to�premises�while�rented�to�you�or�� � � � temporarily�occupied�by�you�with�permission�of�the�owner.�A�separate�limit�of�insurance�� � � applies�to�this�coverage�as�described�in�SECTION�III�–�LIMITS�OF�INSURANCE.� � � b.� SECTION�III�–�LIMITS�OF�INSURANCE,�Paragraph�6.�is�deleted�in�its�entirety�and�replaced� � � � by�the�following:�
� � � � Subject�to�Paragraph�5.�above,�the�Damage�To�Premises�Rented�To�You�Limit�is�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�by�fire,�lightning,�explosion,� � � � � smoke,�or�leakage�from�automatic�fire�protective�systems�while�rented�to�you�or�� � � � � � � temporarily�occupied�by�you�with�permission�of�the�owner.� � � c.� SECTION�V�–�DEFINITIONS,�Paragraph�9.a.,�is�deleted�in�its�entirety�and�replaced�by�the�� � � � following:�
� � � � � 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,�� � � � � � � explosion,�smoke,�or�leakage�from�automatic�fire�protective�systems�to�premises�while�� � � � � � rented�to�you�or�temporarily�occupied�by�you�with�permission�of�the�owner�is�not�an�� � � � � � � "insured�contract";� � 2.�� SECTION�IV�–�COMMERCIAL�GENERAL�LIABILITY�CONDITIONS,�Subsection�4.�Other�� � � � Insurance,�Paragraph�b.�Excess�Insurance,�(1)�(a)�(ii)�is�deleted�in�its�entirety�and�replaced�by� � � the�following:�
That�is�insurance�for�fire,�lightning,�explosion,�smoke,�or�leakage�from�automatic�fire� protective�systems�for�premises�rented�to�you�or�temporarily�occupied�by�you�with�permission� of�the�owner;�
� 3.� The�Damage�To�Premises�Rented�To�You�Limit�section�of�the�Declarations�is�amended�to�the���������� � � greater�of:�
Page�4�of�12�
Includes�copyrighted�material�of�Insurance�Services�Office,�Inc.,�with�its�permission.� ©�2011�Philadelphia�Indemnity�Insurance�Company�
� � a.� $1,000,000;�or� � � b.���The�amount�shown�in�the�Declarations�as�the�Damage�to�Premises�Rented�to�You�Limit.� � � This�is�the�most�we�will�pay�for�all�damage�proximately�caused�by�the�same�event,�whether�such� � � damage�results�from�fire,�lightning,�explosion,�smoke,�or�leaks�from�automatic�fire�protective��� � � systems�or�any�combination�thereof.�
F.� HIPAA�
� SECTION�I�–�COVERAGES,�COVERAGE�B�PERSONAL�AND�ADVERTISING�INJURY�LIABILITY,�
� is��amended�as�follows:��
� 1.�� Paragraph�1.�Insuring�Agreement�is�amended�to�include�the�following:�
� � We�will�pay�those�sums�that�the�insured�becomes�legally�obligated�to�pay�as�damages�because� � � of�a�“violation(s)”�of�the�Health�Insurance�Portability�and�Accountability�Act�(HIPAA).��We�have�� � � the�right�and�the�duty�to�defend�the�insured�against�any�“suit,”�“investigation,”�or�“civil�proceeding”� � � seeking�these�damages.���However,�we�will�have�no�duty�to�defend�the�insured�against�any�“suit”� � � seeking�damages,�“investigation,”�or�“civil�proceeding”�to�which�this�insurance�does�not�apply.� � 2.�� Paragraph�2.�Exclusions�is�amended�to�include�the�following�additional�exclusions:� � � This�insurance�does�not�apply�to:� � � a.� Intentional,�Willful,�or�Deliberate�Violations�
� Any�willful,�intentional,�or�deliberate�“violation(s)”�by�any�insured.� b.� Criminal�Acts� � Any�“violation”�which�results�in�any�criminal�penalties�under�the�HIPAA.� c.� Other�Remedies� � Any�remedy�other�than�monetary�damages�for�penalties�assessed.� d.� Compliance�Reviews�or�Audits� � Any�compliance�reviews�by�the�Department�of�Health�and�Human�Services.�
� 3.� SECTION�V�–�DEFINITIONS�is�amended�to�include�the�following�additional�definitions:� � � a.� “Civil�proceeding”�means�an�action�by�the�Department�of�Health�and�Human�Services�(HHS)� � � � arising�out�of�“violations.”� � � b.� “Investigation”�means�an�examination�of�an�actual�or�alleged�“violation(s)”�by�HHS.��However,� � � � “investigation”�does�not�include�a�Compliance�Review.� � � c.� “Violation”�means�the�actual�or�alleged�failure�to�comply�with�the�regulations�included�in�the��
� � � HIPAA.�
Page�5�of�12�
Includes�copyrighted�material�of�Insurance�Services�Office,�Inc.,�with�its�permission.� ©�2011�Philadelphia�Indemnity�Insurance�Company�
G.��Medical�Payments�–�Limit�Increased�to�$20,000,�Extended�Reporting�Period� �� If�COVERAGE�C�MEDICAL�PAYMENTS�is�not�otherwise�excluded�from�this�Coverage�Part:�� � 1.� The�Medical�Expense�Limit�is�changed�subject�to�all�of�the�terms�of�SECTION�III�-�LIMITS�OF�� � � INSURANCE�to�the�greater�of:� � � a.� $20,000;�or�� � � b.� The�Medical�Expense�Limit�shown�in�the�Declarations�of�this�Coverage�Part.�
� 2.���SECTION�I�–�COVERAGE,�COVERAGE�C�MEDICAL�PAYMENTS,�Subsection�1.�Insuring������ ������ � Agreement,�a.�(3)�(b)�is�deleted�in�its�entirety�and�replaced�by�the�following:��
�� � � � (b)���The�expenses�are�incurred�and�reported�to�us�within�three�years�of�the�date�of�the�� � � � � � accident.� � H.�� Athletic�Activities� � SECTION�I�–�COVERAGES,�COVERAGE�C�MEDICAL�PAYMENTS,�Subsection�2.�Exclusions,� � Paragraph�e.�Athletic�Activities�is�deleted�in�its�entirety�and�replaced�with�the�following:� � e.���Athletic�Activities� � � To�a�person�injured�while�taking�part�in�athletics.� I.��� Supplementary�Payments� � SECTION�I�–�COVERAGES,�SUPPLEMENTARY�PAYMENTS�-�COVERAGE�A�AND�B�are� � amended�as�follows:� � 1.�b.�is�deleted�in�its�entirety�and�replaced�by�the�following:����������� � 1.�� b.���Up�to�$5000�for�cost�of�bail�bonds�required�because�of�accidents�or�traffic�law�violations��� � � � arising�out�of�the�use�of�any�vehicle�to�which�the�Bodily�Injury�Liability�Coverage�applies.�We� � � � do�not�have�to�furnish�these.� � 1.d.�is�deleted�in�its�entirety�and�replaced�by�the�following:� � 1.� 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.�� � J.� Employee�Indemnification�Defense�Coverage� � SECTION�I�–�COVERAGES,�SUPPLEMENTARY�PAYMENTS�–�COVERAGES�A�AND�B�the� � following�is�added:� � � We�will�pay,�on�your�behalf,�defense�costs�incurred�by�an�“employee”�in�a�criminal�proceeding�� � � occurring�in�the�course�of�employment.��� � � The�most�we�will�pay�for�any�“employee”�who�is�alleged�to�be�directly�involved�in�a�criminal� � � � � proceeding�is�$25,000�regardless�of�the�numbers�of�“employees,”�claims�or�“suits”�brought�or�� � � persons�or�organizations�making�claims�or�bringing�“suits.��
Page�6�of�12�
Includes�copyrighted�material�of�Insurance�Services�Office,�Inc.,�with�its�permission.� ©�2011�Philadelphia�Indemnity�Insurance�Company�
K.�� Key�and�Lock�Replacement�–�Janitorial�Services�Client�Coverage� � SECTION�I�–�COVERAGES,�SUPPLEMENTARY�PAYMENTS�–�COVERAGES�A�AND�B�is� � amended�to�include�the�following:�� � � We�will�pay�for�the�cost�to�replace�keys�and�locks�at�the�“clients”�premises�due�to�theft�or�other�� � � loss�to�keys�entrusted�to�you�by�your�“client,”�up�to�a�$10,000�limit�per�occurrence�and�$10,000�� � � policy�aggregate.� � � We�will�not�pay�for�loss�or�damage�resulting�from�theft�or�any�other�dishonest�or�criminal�act�that� � � you�or�any�of�your�partners,�members,�officers,�“employees”,�“managers”,�directors,�trustees,�� � � authorized�representatives�or�any�one�to�whom�you�entrust�the�keys�of�a�“client”�for�any�� � � � � purpose�commit,�whether�acting�alone�or�in�collusion�with�other�persons.��� � � The�following,�when�used�on�this�coverage,�are�defined�as�follows:�
� � a.��� "Client"�means�an�individual,�company�or�organization�with�whom�you�have�a�written�contract� � � � �or�work�order�for�your�services�for�a�described�premises�and�have�billed�for�your�services.� � � b.� "Employee"�means:��� � � � (1)� Any�natural�person:� � � � � (a)��While�in�your�service�or�for�30�days�after�termination�of�service;� � � � � (b)��Who�you�compensate�directly�by�salary,�wages�or�commissions;�and� � � � � (c)��Who�you�have�the�right�to�direct�and�control�while�performing�services�for�you;�or� � � � (2)� Any�natural�person�who�is�furnished�temporarily�to�you:� � � � � (a)� To�substitute�for�a�permanent�"employee"�as�defined�in�Paragraph�(1)�above,�who�is� � � � � � on�leave;�or� � � � � (b)� To�meet�seasonal�or�short-term�workload�conditions;�� � � � � while�that�person�is�subject�to�your�direction�and�control�and�performing�services�for�you.� � � � (3)� "Employee"�does�not�mean:� � � � � (a)� Any�agent,�broker,�person�leased�to�you�by�a�labor�leasing�firm,�factor,�commission�� � � � � � merchant,�consignee,�independent�contractor�or�representative�of�the�same�general� � � � � � character;�or� � � � � (b)� �Any�"manager,"�director�or�trustee�except�while�performing�acts�coming�within�the�� � � � � � scope�of�the�usual�duties�of�an�"employee."�
� � c.� �"Manager"�means�a�person�serving�in�a�directorial�capacity�for�a�limited�liability�company.� L.���Additional�Insureds�
� SECTION�II�–�WHO�IS�AN�INSURED�is�amended�as�follows:�
� 1.��� If�coverage�for�newly�acquired�or�formed�organizations�is�not�otherwise�excluded�from�this���
Page�7�of�12�
Includes�copyrighted�material�of�Insurance�Services�Office,�Inc.,�with�its�permission.� ©�2011�Philadelphia�Indemnity�Insurance�Company�
� � Coverage�Part,�Paragraph�3.a.�is�deleted�in�its�entirely�and�replaced�by�the�following:�
� � a.���Coverage�under�this�provision�is�afforded�until�the�end�of�the�policy�period.�
� 2.� Each�of�the�following�is�also�an�insured:� � � a.� Medical�Directors�and�Administrators�–�Your�medical�directors�and�administrators,�but�� � � � only�while�acting�within�the�scope�of�and�during�the�course�of�their�duties�as�such.��Such�� � � � duties�do�not�include�the�furnishing�or�failure�to�furnish�professional�services�of�any�physician� � � � or�psychiatrist�in�the�treatment�of�a�patient.��
� � b.�� Managers�and�Supervisors�–�Your�managers�and�supervisors�are�also�insureds,�but�� � � � � only�with�respect�to�their�duties�as�your�managers�and�supervisors.�Managers�and�� � � � � � supervisors�who�are�your�“employees”�are�also�insureds�for�“bodily�injury”�to�a�co-�� � � � � � “employee”�while�in�the�course�of�his�or�her�employment�by�you�or�performing�duties��� � � � � related�to�the�conduct�of�your�business.��
� � � This�provision�does�not�change�Item�2.a.(1)(a)�as�it�applies�to�managers�of�a�limited�� � � � � � liability�company.�� � � c.� Broadened�Named�Insured�–�Any�organization�and�subsidiary�thereof�which�you�control�and� � � � actively�manage�on�the�effective�date�of�this�Coverage�Part.���However,�coverage�does�not�� � � � apply�to�any�organization�or�subsidiary�not�named�in�the�Declarations�as�Named�Insured,�if� � � � � they�are�also�insured�under�another�similar�policy,�but�for�its�termination�or�the�exhaustion�of� � � � its�limits�of�insurance.�� � � d.� Funding�Source�–�Any�person�or�organization�with�respect�to�their�liability�arising�out�of:� � � � (1)� �Their�financial�control�of�you;�or� � � � (2)� �Premises�they�own,�maintain�or�control�while�you�lease�or�occupy�these�premises.��� � � � This�insurance�does�not�apply�to�structural�alterations,�new�construction�and�demolition�� � � � � operations�performed�by�or�for�that�person�or�organization.�� � � e.� Home�Care�Providers�–�At�the�first�Named�Insured's�option,�any�person�or�organization�� � � � under�your�direct�supervision�and�control�while�providing�for�you�private�home�respite�or��� � � � foster�home�care�for�the�developmentally�disabled.��� � � f.� Managers,�Landlords,�or�Lessors�of�Premises�–�Any�person�or�organization�with�respect�� � � � to�their�liability�arising�out�of�the�ownership,�maintenance�or�use�of�that�part�of�the�premises�� � � � leased�or�rented�to�you�subject�to�the�following�additional�exclusions:� � � � This�insurance�does�not�apply�to:� � � � (1)���Any�“occurrence”�which�takes�place�after�you�cease�to�be�a�tenant�in�that�premises;�or� � � � (2)���Structural�alterations,�new�construction�or�demolition�operations�performed�by�or�on�� � � � � � behalf�of��that�person�or�organization.��� � � g.� Lessor�of�Leased�Equipment�–�Automatic�Status�When�Required�in�Lease�Agreement�� � � � With�You�–�Any�person�or�organization�from�whom�you�lease�equipment�when�you�and�such� � � � person�or�organization�have�agreed�in�writing�in�a�contract�or�agreement�that�such�person�or� � � � organization�� is�to�be�added�as�an�additional�insured�on�your�policy.��Such�person�or��� �
Page�8�of�12�
Includes�copyrighted�material�of�Insurance�Services�Office,�Inc.,�with�its�permission.� ©�2011�Philadelphia�Indemnity�Insurance�Company�
� � � organization�is�an�insured�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.���� � � � A�person’s�or�organization’s�status�as�an�additional�insured�under�this�endorsement�ends�� � � � when�their�contract�or�agreement�with�you�for�such�leased�equipment�ends.� � � � 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.�� � � h.� Grantors�of�Permits�–�Any�state�or�political�subdivision�granting�you�a�permit�in�connection� � � � with�your�premises�subject�to�the�following�additional�provision:� � � � (1)� This�insurance�applies�only�with�respect�to�the�following�hazards�for�which�the�state�or�� � � � � political�subdivision�has�issued�a�permit�in�connection�with�the�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.� � � i.� Vendors�–�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,�subject�
� � � to�the�following�additional�exclusions:�� � � � (1)� 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.�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,�except�when�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�distribution�or�sale�of�the�products;�� � � � � (f)� Demonstration,�installation,�servicing�or�repair�operations,�except�such�operations�� � � � � � performed�at�the�vendor's�premises�in�connection�with�the�sale�of�the�product;��
Page�9�of�12�
Includes�copyrighted�material�of�Insurance�Services�Office,�Inc.,�with�its�permission.� ©�2011�Philadelphia�Indemnity�Insurance�Company�
� � � � (g)� Products�which,�after�distribution�or�sale�by�you,�have�been�labeled�or�relabeled�or�� � � � � � used�as�a�container,�part�or�ingredient�of�any�other�thing�or�substance�by�or�for�the�� � � � � � vendor;�or� � � � � (h)� "Bodily�injury"�or�"property�damage"�arising�out�of�the�sole�negligence�of�the�vendor� � � � � � for�its�own�acts�or�omissions�or�those�of�its�employees�or�anyone�else�acting�on�its�� � � � � � behalf.��However,�this�exclusion�does�not�apply�to:� � � � � � (i)� The�exceptions�contained�in�Sub-paragraphs�(d)�or�(f);�or� � � � � � (ii)� 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�distribution�or�sale�of�the�products.� � � � (2)��This�insurance�does�not�apply�to�any�insured�person�or�organization,�from�whom�you�� � � � � have�acquired�such�products,�or�any�ingredient,�part�or�container,�entering�into,�� � � � � � � accompanying�or�containing.� � � j.� Franchisor�–�Any�person�or�organization�with�respect�to�their�liability�as�the�grantor�of�a��� � � � franchise�to�you.�� � � k.� As�Required�by�Contract�–�Any�person�or�organization�where�required�by�a�written�contract� � � � executed�prior�to�the�occurrence�of�a�loss.��Such�person�or�organization�is�an�additional��� � � � insured�for�"bodily�injury,"�"property�damage"�or�"personal�and�advertising�injury"�but�only�for� � � � liability�arising�out�of�the�negligence�of�the�named�insured.�The�limits�of�insurance�applicable� � � � to�these�additional�insureds�are�the�lesser�of�the�policy�limits�or�those�limits�specified�in�a�� � � � contract�or�agreement.��These�limits�are�included�within�and�not�in�addition�to�the�limits�of�� � � � insurance�shown�in�the�Declarations� � � l.� Owners,�Lessees�or�Contractors�–�Any�person�or�organization,�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�when�required�by�a� � � � contract.��
� � � 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:� � � � � (a)� 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� � � � � (b)� 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.��
Page�10�of�12�
Includes�copyrighted�material�of�Insurance�Services�Office,�Inc.,�with�its�permission.� ©�2011�Philadelphia�Indemnity�Insurance�Company�
� � m.��State�or�Political�Subdivisions�–�Any�state�or�political�subdivision�as�required,�subject�to�� � � � the�following��provisions:�� � � � (1)��This�insurance�applies�only�with�respect�to�operations�performed�by�you�or�on�your�behalf� � � � � � for�which�the�state�or�political�subdivision�has�issued�a�permit,�and�is�required�by��� � � � � � � contract.� � � � (2)��This�insurance�does�not�apply�to:�� � � � � (a)� "Bodily�injury,"�"property�damage"�or�"personal�and�advertising�injury"�arising�out�of�� � � � � � operations�performed�for�the�state�or�municipality;�or�� � � � � (b)� "Bodily�injury"�or�"property�damage"�included�within�the�"products-completed��� � � � � � � operations�hazard."�� M.� Duties�in�the�Event�of�Occurrence,�Claim�or�Suit� � SECTION�IV�–�COMMERCIAL�GENERAL�LIABILITY�CONDITIONS,�Paragraph�2.�is�amended�as� � follows:� � a.�is�amended�to�include:�
� � This�condition�applies�only�when�the�“occurrence”�or�offense�is�known�to:� � � � (1)��You,�if�you�are�an�individual;� � � � (2)��A�partner,�if�you�are�a�partnership;�or� � � � (3)��An�executive�officer�or�insurance�manager,�if�you�are�a�corporation.�� � b.�is�amended�to�include:�
� � This�condition�will�not�be�considered�breached�unless�the�breach�occurs�after�such�claim�or�“suit”� � � is�known�to:� � � � (1)��You,�if�you�are�an�individual;� � � � (2)��A�partner,�if�you�are�a�partnership;�or� � � � (3)��An�executive�officer�or�insurance�manager,�if�you�are�a�corporation.�� N.� Unintentional�Failure�To�Disclose�Hazards� � SECTION�IV�–�COMMERCIAL�GENERAL�LIABILITY�CONDITIONS,�6.�Representations�is� � amended�to�include�the�following:�
� � It�is�agreed�that,�based�on�our�reliance�on�your�representations�as�to�existing�hazards,�if�you��� � � should�unintentionally�fail�to�disclose�all�such�hazards�prior�to�the�beginning�of�the�policy�period�of� � � this�Coverage�Part,�we�shall�not�deny�coverage�under�this�Coverage�Part�because�of�such�failure.��� O.� Transfer�of�Rights�of�Recovery�Against�Others�To�Us�
� SECTION�IV�–�COMMERCIAL�GENERAL�LIABILITY�CONDITIONS,�8.�Transfer�of�Rights�of��
Page�11�of�12�
Includes�copyrighted�material�of�Insurance�Services�Office,�Inc.,�with�its�permission.� ©�2011�Philadelphia�Indemnity�Insurance�Company�
� Recovery�Against�Others�To�Us�is�deleted�in�its�entirety�and�replaced�by�the�following:�
� � If�the�insured�has�rights�to�recover�all�or�part�of�any�payment�we�have�made�under�this�Coverage� � � Part,�those�rights�are�transferred�to�us.�The�insured�must�do�nothing�after�loss�to�impair�them.�At� � � our�request,�the�insured�will�bring�"suit"�or�transfer�those�rights�to�us�and�help�us�enforce�them.��
� � Therefore,�the�insured�can�waive�the�insurer’s�rights�of�recovery�prior�to�the�occurrence�of�a��� � � loss,�provided�the�waiver�is�made�in�a�written�contract.� P.� Liberalization� � SECTION�IV�–�COMMERCIAL�GENERAL�LIABILITY�CONDITIONS,�is�amended�to�include�the� � following:�
� � If�we�revise�this�endorsement�to�provide�more�coverage�without�additional�premium�charge,�we�� � � will�automatically�provide�the�additional�coverage�to�all�endorsement�holders�as�of�the�day�the�� � � revision�is�effective�in�your�state.� Q.���Bodily�Injury�–�Mental�Anguish� � SECTION�V�–�DEFINITIONS,�Paragraph�3.�Is�deleted�in�its�entirety�and�replaced�by�the�following:� � � “Bodily�injury”�means:�� � � a.� Bodily�injury,�sickness�or�disease�sustained�by�a�person,�and�includes�mental�anguish�� � � � � resulting�from�any�of�these;�and� � � b.� Except�for�mental�anguish,�includes�death�resulting�from�the�foregoing�(Item�a.�above)�at�any� � � � time.�
R.� Personal�and�Advertising�Injury�–�Abuse�of�Process,�Discrimination� � If�COVERAGE�B�PERSONAL�AND�ADVERTISING�INJURY�LIABILITY�COVERAGE�is�not� � otherwise�excluded�from�this�Coverage�Part,�the�definition�of�“personal�and�advertising�injury”�is� � amended�as�follows:� � 1.� SECTION�V�–�DEFINITIONS,�Paragraph�14.b.�is�deleted�in�its�entirety�and�replaced�by�the�� � � � following:� � � b.� Malicious�prosecution�or�abuse�of�process;� � 2.���SECTION�V�–�DEFINITIONS,�Paragraph�14.�is�amended�by�adding�the�following:��� � � Discrimination�based�on�race,�color,�religion,�sex,�age�or�national�origin,�except�when:� � � a.� Done�intentionally�by�or�at�the�direction�of,�or�with�the�knowledge�or�consent�of:� � � � (1)� Any�insured;�or� � � � (2)� Any�executive�officer,�director,�stockholder,�partner�or�member�of�the�insured;��� � � � b.� Directly�or�indirectly�related�to�the�employment,�former�or�prospective�employment,� � � � � � termination�of�employment,�or�application�for�employment�of�any�person�or�persons�by�an�� � � � insured;��
Page�12�of�12�
Includes�copyrighted�material�of�Insurance�Services�Office,�Inc.,�with�its�permission.� ©�2011�Philadelphia�Indemnity�Insurance�Company�
� � � c.� Directly�or�indirectly�related�to�the�sale,�rental,�lease�or�sublease�or�prospective�sales,�rental,� � � � lease�or�sub-lease�of�any�room,�dwelling�or�premises�by�or�at�the�direction�of�any�insured;�or�
� � � d.� Insurance�for�such�discrimination�is�prohibited�by�or�held�in�violation�of�law,�public�policy,�� � � � legislation,�court�decision�or�administrative�ruling.�
� � The�above�does�not�apply�to�fines�or�penalties�imposed�because�of�discrimination.����
������������� � !��"#$%&"'(�)(%*+'(#��,,+'(-��"'.-�/001�� 2345�6�78�6
9��:����;�����<;����;����=�<��;�����:�����
?@+#�("AB%#(C("D�CBA+,+(#�+"#$%&"'(�E%B*+A(A�$"A(%�D@(�,BFFBG+"H
�� ����I��J����I����I
���?����K��IJ���I�?�
���L��?)M�� ���?�L�����I?���)���I
���?����K��IJ���I�?�
<�=�N>���
�3O5��8�25PQ7R��P��P43RST3US7RV��
�",B%C&D+B"�%(W$+%(A�DB�'BCEF(D(�D@+#�)'@(A$F(-�+,�"BD�#@BG"�&XB*(-�G+FF�X(�#@BG"�+"�D@(�L('F&%&D+B"#.�
?@(�,BFFBG+"H�+#�&AA(A�DB��&%&H%&E@�YZ��P3RQ85P��8�
�S4[UQ��8��5\7]5P̂��43SRQU��U[5PQ��7�>Q�B,�
<5\US7R��:�_��7R̀SUS7RQV�
a(�G&+*(�&"b�%+H@D�B,�%('B*(%b�G(�C&b�@&*(�&H&+"#D� D@(�E(%#B"�B%�B%H&"+c&D+B"�#@BG"�+"�D@(�)'@(A$F(� &XB*(�X('&$#(�B,�E&bC("D#�G(�C&d(�,B%�+"e$%b�B%� A&C&H(�&%+#+"H�B$D�B,�bB$%�B"HB+"H�BE(%&D+B"#�B%� fbB$%�GB%df�AB"(�$"A(%�&�'B"D%&'D�G+D@�D@&D�E(%#B"� B%�B%H&"+c&D+B"�&"A�+"'F$A(A�+"�D@(�fE%BA$'D#g 'BCEF(D(A�BE(%&D+B"#�@&c&%Af.�?@+#�G&+*(%�&EEF+(#� B"Fb�DB�D@(�E(%#B"�B%�B%H&"+c&D+B"�#@BG"�+"�D@(�
)'@(A$F(�&XB*(.��
hihjklmnnolpqqr stuvwxyxuvz{v|}~�z�y�v~x�v�u�y}x�u�x��vy�u��~u��v�zy}���v�z��~��~z��� ��~�u}�~x~u�vy��v~x�vz{{~�u}��vz{{~�~y���vy�u�x��vy��vu���z�uu�v{z}v�z��u� y}~�~��v{}z�v�z}�v�u}{z}�u�v��vz}vz�v�uty�{vz{vxtuv�z�x}y�xz}�
POLICY NUMBER: COMMERCIAL AUTO
CA 76 13 01 20
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BUSINESS AUTO POLICY ENHANCEMENT ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO 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
Countersigned by
Endorsement Effective
1. BLANKET ADDITIONAL INSURED
SECTION Il - COVERED AUTOS LIABILITY COVERAGE, Paragraph A. Coverage, Item 1.
Who Is An Insured, is amended by adding the following:
d. Any person or organization that you are required to include as an additional insured on this Coverage Form in a written contract or agreement that is signed and executed by you before the "bodily injury/' or "property damage" occurs and that is in effect during the policy period is an "insured' for Liability Coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an "Insured' under the Who Is An Insured provision contained in Section ll.
This coverage does not apply to lessors of leased "autos".
2. BROAD FORM NAMED INSURED
SECTION II – COVERED AUTOS LIABILITY
COVERAGE, Paragraph A. Coverage, Item 1.
Who Is An Insured, is amended by adding the following:
e. Any business entity in which you own more than 50% on the effective date of the Coverage Form.
f. Any business entity newly acquired or formed by you during the policy period, provided you own 50% or more of the business entity. Coverage is extended up to a maximum of 180 days following acquisition or formation of the business entity.
Coverage does not apply to "bodily injury” or "property damage" that results from an
"accident' that occurred before you formed or acquired the organization.
Provisions d. and e. do not apply:
(1) To any person or organization for which coverage is excluded by endorsement.
(2) To any person or organization that has exhausted its Limit of Insurance under any other policy.
(3) To any person or organization that is an "Insured' under any other automobile policy.
3. AUTOS RENTED BY EMPLOYEES
SECTION II – LIABILITY COVERAGE,
Paragraph A. Coverage, Item 1. Who Is An Insured, is amended by adding the following:
g. An "employee" of yours 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.
SECTION IV - BUSINESS AUTO
CONDITIONS, Paragraph B. General Conditions, Item 5b. Other Insurance, is deleted 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 in that individual "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".
darlenet Typewritten text Woodruff Leavitt Insurance Agency darlenet Typewritten text
CA00036330
darlenet Typewritten text Amazing Grace Arizona Families LLC darlenet Typewritten text 2-1-2025
CA 76 13 01 20 Page 2 of 4
4. EXTRA EXPENSE - BROADENED
COVERAGE
SECTION Ill PHYSICAL DAMAGE COVERAGE, Paragraph A. Coverage is amended to add the following:
5. We will pay for the direct expense of returning a stolen covered "auto" to you. This coverage will only apply to vehicles recovered inside the 48 contiguous United States.
5. AUTOS - TRANSPORTATION
COVERAGE
The following is added to SECTION III
PHYSICAL DAMAGE COVERAGE,
Paragraph A. Coverage, Item 4. Coverage Extensions a. Transportation Expenses:
For the purposes of this coverage, private passenger type includes "autos" of any type.
6. ACCIDENTAL AIRBAG INFLATION
SECTION Ill PHYSICAL DAMAGE COVERAGE Paragraph B. Exclusions is amended by the addition of the following:
Exclusion 3.a. does not apply to the accidental inflation of an airbag.
7. COVERAGE EXTENSION - AUDIO,
VISUAL AND DATA ELECTRONIC
EQUIPMENT NOT DESIGNED SOLELY
FOR THE REPRODUCTION OF SOUND
SECTION Ill - PHYSICAL DAMAGE COVERAGE, B. Exclusions, exception paragraph a. to exclusions 4.c. & 4.d. is deleted and replaced with the following:
a. Equipment and accessories used with such equipment, except tapes, records or discs, provided such equipment is permanently installed in the covered "auto" at the time of the "loss" or is removable from a housing unit which is permanently installed in the covered "auto" at the time of the "loss", and such equipment is designed to be solely operated by use of the power from the "auto's" electrical system, in or upon the covered "auto"; or
8. REPLACEMENT COST - PRIVATE
PASSENGER VEHICLE
SECTION Ill PHYSICAL DAMAGE COVERAGE, Paragraph C. Limit of Insurance, Item 2. is amended by adding the following:
If, however, we deem a covered "auto" of the private passenger type to be a total loss within 365 days of your purchase of the "auto" and it has not been previously titled under the motor vehicle laws of any state, at our option we will pay the lesser of:
a. the cost to replace the covered "auto" with a new auto of like make, model and year, or
b. an amount equal to the original purchase price you paid to acquire the vehicle, including taxes, This coverage does not apply to a leased auto.
9. GLASS REPAIR - WAIVER OF
DEDUCTIBLE
SECTION Ill PHYSICAL DAMAGE COVERAGE, Paragraph D. Deductible is amended by adding the following:
No deductible applies to glass damage if the glass is repaired rather than replaced.
10. AMENDED DUTIES IN THE EVENT OF
ACCIDENT, CLAIM, SUIT OR LOSS
In SECTION IV - BUSINESS AUTO
CONDITIONS,
Paragraph A. Loss Conditions, Item 2.a. Duties in the Event Of Accident, Claim, Suit or Loss, the requirement that you must notify us of an "accident" applies only when the "accident' is known to:
(1) You, if you are an individual;
(2) A partner, if you are a partnership;
(3) A member, if you are a limited liability company; or
(4) An executive officer or insurance manager, if you are a corporation.
11. UNINTENTIONAL ERRORS,
OMISSIONS OR FAILURE TO
DISCLOSE HAZARDS
SECTION IV - BUSINESS AUTO
CONDITIONS, Paragraph B. General Conditions, Item 2. Concealment, Misrepresentation, Or Fraud is amended by adding the following:
If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal.
12. MENTAL ANGUISH
SECTION V DEFINITIONS, Item C. is amended by adding the following:
"Bodily injury” also includes mental anguish but only when the mental anguish arises from other bodily injury, sickness or disease. Bodily Injury does not include mental anguish unless it arises out of actual physical injury to the same person.
13. AMENDED FELLOW EMPLOYEE
EXCLUSION
SECTION ll COVERED AUTOS LIABILITY COVERAGE, Paragraph B. Exclusions, 5. Fellow Employees Item a. does not apply if you have workers compensation insurance in force covering all of your “employees”. Coverage is excess over any other collectible insurance .
14. PHYSICAL DAMAGE COVERAGE –
ADDITIONAL TEMPORARY
TRANSPORTATION COVERAGE
SECTION III PHYSICAL DAMAGE
COVERAGE Paragraph A. Coverage Item 4.a.
Transportation Expense, is amended to provide $75 a day and a maximum limit of $2250.
15. WAIVER OF SUBROGATION
SECTION IV BUSINESS AUTO
CONDITIONS, Item 5. Transfer Of Rights Of Recovery Against Others To Us is amended by adding the following: We waive any right of recovery we may have against any person or organization to or for whom we make a payment and with whom you have a written contract that requires such waiver because of payments we make for damages under this Coverage Form.
16. VEHICLE WRAP COVERAGE
SECTION III PHYSICAL DAMAGE
COVERAGE, Paragraph A. Coverage, Item 1. is amended to include the following additional paragraphs:
Vehicle Wrap In the event of a “loss” to a covered “auto”, we will provide the following coverage if such “loss” is caused by:
d. Other than collision only if the Declarations indicates that comprehensive Coverage is provided for the covered “auto”;
e. Specified Causes Of Loss only if the Declarations indicates that Specified Causes Of Loss Coverage is provided for the covered “auto”; or
f. Collision only if the Declarations indicates that Collision Coverage is provided for the covered “auto”.
g. We will pay for “loss” to a “vehicle wrap” that is installed on the covered “auto”.
We will not pay for “loss” due to and confined to wear and tear; or damage to paint or the vehicle caused by faulty installation of a “vehicle wrap”.
The “vehicle wrap” is subject to the Comprehensive deductible for the covered “auto”, except in the event of a “loss” to a covered “auto” for which such vehicle is involved in a collision and there is both:
1. Collision damage to the vehicle; and
2. Damage to the “vehicle wrap”
h. Then the collision deductible will apply. If the
“vehicle wrap” is damaged in a collision the lesser of replacement cost or original purchase cost of the “vehicle wrap” will apply.
SECTION V. DEFINITIONS is amended to include the following additional definition Q.
“Vehicle Wrap” means self-adhesive vinyl decals or sheets applied to the exterior body or window of a covered “auto”. Signs or other graphics painted or magnetically affixed to the vehicle are not considered vehicle wraps.
17. FIRE DEPARTMENT SURCHARGE
SECTION III PHYSICAL DAMAGE
COVERAGE, Paragraph A.4. Coverage Extensions, is amended by adding the following:
c. Fire Department Service Charge When a fire department is called to save or protect a covered “auto”, its equipment, its contents, or occupants from a covered cause of loss, we will pay up to $1,500 for your liability for fire department service charges:
(1) Assumed by contract or agreement prior to loss; or
(2) Required by local ordinance No deductible applies to this additional coverage.
18. EXTENDED COVERAGE – BAIL
BONDS
SECTION II COVERED AUTOS LIABILITY
COVERAGE, Paragraph A. 2. Coverage Extensions, Item a. (2) is replaced by the following:
(2) Up to $3,000 for cost of bail bonds (including bonds for related traffic law violations) required because of an “accident” we cover. We do not have to furnish these bonds.
19. EXTENDED COVERAGE – LOSS OF
EARNINGS
SECTION II COVERED AUTOS LIABILITY
COVERAGE Paragraph A.2. Coverage Extensions, Item a. (4) is replaced by the following:
(4) All reasonable expenses incurred by the “insured” at our request, including actual loss of earnings up to $500 a day because of time off from work.
20. TEMPORARY SUBSTITUTE
PHYSICAL DAMAGE
SECTION I COVERED AUTOS, Paragraph C.
Certain Trailers, Mobile Equipment And Temporary Substitute Autos is amended by the addition of the following:
If Physical Damage Coverage is provided by this Coverage Form, the following type of vehicle is also a covered “auto” for Physical Damage Coverage: Any “auto” you do not own while used
CA 76 13 01 20 Page 4 of 4 with the permission of its owner as a temporary substitute for a covered “auto” you own that is out of service because of its:
a. Breakdown
b. Repair
c. Servicing
d. “Loss”; or
e. Destruction
21. LOSS OF USE TO RENTAL CAR
SECTION III PHYSICAL DAMAGE
COVERAGE Paragraph A.4. Coverage Extensions is amended by adding the following:
d. Rental Expense We will pay the following expenses that you or any of your “employees” are legally obligated to pay because of a written contract or agreement entered into for use of a rental vehicle in the conduct of your business:
MAXIMUM WE WILL PAY FOR ANY ONE
CONTRACT OR AGREEMENT:
1. $1,000 for loss of income incurred by the rental agency during the period of time that vehicle is out of use because of actual damage to, or “loss” of, that vehicle, including income lost due to absence of that vehicle for use as a replacement;
2. $500 for administrative expenses incurred by the rental agency, as stated in the contract or agreement.
22. EXTENDED COVERAGE – BUSINESS
PERSONAL PROPERTY AND
PERSONAL EFFECTS
SECTION III - PHYSICAL DAMAGE
COVERAGE Paragraph A.4 Coverage Extensions is amended by adding the following:
e. Business Personal Property and Personal Effects Physical Damage Coverage on a covered “auto” may be extended to “loss” to your “business personal property” or “personal effects”, not otherwise covered in the policy or, if you are an individual, the personal property of a family member, that is in the covered “auto” at the time of “loss”.
This is the start of the file's text. The full file is on GovTribe.
File details come from the government source that posted it. Updated .