CTR078138_COI_2025-12-01.PDF

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

INSURER(S) AFFORDING COVERAGE

INSURER F :

INSURER E :

INSURER D :

INSURER C :

INSURER B :

INSURER A :

NAIC #

NAME:

CONTACT

(A/C, No):

FAX

E-MAIL

ADDRESS:

PRODUCER

(A/C, No, Ext):

PHONE

INSURED

REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES

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).

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.

OTHER:

(Per accident)

(Ea accident)

N / A

SUBR

WVD

ADDL

INSD

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.

$PROPERTY DAMAGE

BODILY INJURY (Per accident)

BODILY INJURY (Per person)

COMBINED SINGLE LIMIT

AUTOS ONLY

AUTOSAUTOS ONLY

NON-OWNED

SCHEDULEDOWNED

ANY AUTO

AUTOMOBILE LIABILITY

Y / N

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH)

DESCRIPTION OF OPERATIONS below If yes, describe under

ANY PROPRIETOR/PARTNER/EXECUTIVE

E.L. DISEASE - POLICY LIMIT

E.L. DISEASE - EA EMPLOYEE

E.L. EACH ACCIDENT

ER

OTH-

STATUTE

PER

LIMITS(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY)

POLICY EFF

POLICY NUMBERTYPE OF INSURANCELTR

INSR

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

EXCESS LIAB

UMBRELLA LIAB $EACH OCCURRENCE

$AGGREGATE

OCCUR

CLAIMS-MADE

DED RETENTION $

$PRODUCTS - COMP/OP AGG

$GENERAL AGGREGATE

$PERSONAL & ADV INJURY

$MED EXP (Any one person)

$EACH OCCURRENCE

DAMAGE TO RENTED

$PREMISES (Ea occurrence)

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY

PRO-

JECT LOC

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

CANCELLATION

AUTHORIZED REPRESENTATIVE

ACORD 25 (2016/03)

© 1988-2016 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

Willis Towers Watson Northeast, Inc.

c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA

Inspira Financial Health, Inc 2001 Spring Rd Ste 700 Oak Brook, IL 60523

This Voids and Replaces Previously Issued Certificate Dated 06/04/2025 WITH ID: W39278949.

SEE ATTACHED

Evidence of Insurance

08/20/2025

1-877-945-7378 1-888-467-2378 certificates@wtwco.com

Lloyds Syndicate 1322 E1312

Westfield Specialty Insurance Company

Fortegra Specialty Insurance Company

16992

16823

W40071089

A Cyber & Tech E&O Aggregate LimitTRCP25ES78 06/01/2025 06/01/2026

409198728274512SR ID: BATCH:

$10,000,000

WTW Certificate Center

ACORD 101 (2008/01)

The ACORD name and logo are registered marks of ACORD

© 2008 ACORD CORPORATION. All rights reserved.

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: FORM TITLE:

ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE Page of

AGENCY CUSTOMER ID:

LOC #:

AGENCY

CARRIER NAIC CODE

POLICY NUMBER

NAMED INSURED

EFFECTIVE DATE:

Inspira Financial Health, Inc 2001 Spring Rd Ste 700 Oak Brook, IL 60523

Re: Contract Award No. CTR078138 Health Savings Account and Flexible Spending Account Administration

Waiver of Subrogation applies in favor of the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees for losses arising from work performed by or on behalf of the Contractor with respects to Cyber Liability.

INSURER AFFORDING COVERAGE: Westfield Specialty Insurance Company NAIC#: 16992

POLICY NUMBER: XCE-484637R-00 EFF DATE: 06/01/2025 EXP DATE: 06/01/2026

TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:

1st Excess Cyber & Tech E&O Limit: $10,000,000

INSURER AFFORDING COVERAGE: Fortegra Specialty Insurance Company NAIC#: 16823 POLICY NUMBER: C-4MLJ-050725-CEPMM-2025 EFF DATE: 06/01/2025 EXP DATE: 06/01/2026

TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:

2xs Excess Cyber & Tech E&O Limit: $5,000,000

2 2

Willis Towers Watson Northeast, Inc.

See Page 1

See Page 1 See Page 1 See Page 1

25 Certificate of Liability Insurance

W40071089CERT:4091987BATCH:28274512SR ID:

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

INSURER(S) AFFORDING COVERAGE

INSURER F :

INSURER E :

INSURER D :

INSURER C :

INSURER B :

INSURER A :

NAIC #

NAME:

CONTACT

(A/C, No):

FAX

E-MAIL

ADDRESS:

PRODUCER

(A/C, No, Ext):

PHONE

INSURED

REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES

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).

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.

OTHER:

(Per accident)

(Ea accident)

N / A

SUBR

WVD

ADDL

INSD

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.

$PROPERTY DAMAGE

BODILY INJURY (Per accident)

BODILY INJURY (Per person)

COMBINED SINGLE LIMIT

AUTOS ONLY

AUTOSAUTOS ONLY

NON-OWNED

SCHEDULEDOWNED

ANY AUTO

AUTOMOBILE LIABILITY

Y / N

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH)

DESCRIPTION OF OPERATIONS below If yes, describe under

ANY PROPRIETOR/PARTNER/EXECUTIVE

E.L. DISEASE - POLICY LIMIT

E.L. DISEASE - EA EMPLOYEE

E.L. EACH ACCIDENT

ER

OTH-

STATUTE

PER

LIMITS(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY)

POLICY EFF

POLICY NUMBERTYPE OF INSURANCELTR

INSR

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

EXCESS LIAB

UMBRELLA LIAB $EACH OCCURRENCE

$AGGREGATE

OCCUR

CLAIMS-MADE

DED RETENTION $

$PRODUCTS - COMP/OP AGG

$GENERAL AGGREGATE

$PERSONAL & ADV INJURY

$MED EXP (Any one person)

$EACH OCCURRENCE

DAMAGE TO RENTED

$PREMISES (Ea occurrence)

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY

PRO-

JECT LOC

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

CANCELLATION

AUTHORIZED REPRESENTATIVE

ACORD 25 (2016/03)

© 1988-2016 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

Willis Towers Watson Northeast, Inc.

c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA

Inspira Financial Health, Inc 2001 Spring Rd Ste 700 Oak Brook, IL 60523

This Voids and Replaces Previously Issued Certificate Dated 12/22/2024 WITH ID: W36816673.

SEE ATTACHED

Evidence of Insurance

08/20/2025

1-877-945-7378 1-888-467-2378 certificates@wtwco.com

National Fire Insurance Company of Hartfor 20478

Continental Insurance Company

American Casualty Company of Reading Penns

35289

20427

Hanover Insurance Company 22292

Beazley Insurance Company Inc 37540

Endurance American Insurance Company 10641

W40071090

A

1,000,000

100,000

15,000

1,000,000

2,000,000

2,000,000

6079891414 12/01/2024 12/01/2025

A 12/01/2025

1,000,000

12/01/20246079890473

B 20,000,000

10,000

6079891428 12/01/2024 12/01/2025 20,000,000

6079891381 C 1,000,000

12/01/2024 12/01/2025 1,000,000

1,000,000

B Worker's Compensation and

Employer's Liability - (CA)

E.L. EACH ACCIDENT6079908423 12/01/2024 12/01/2025

E.L. DISEASE-EACH Emp

Per Statute E.L. DISEASE-POL Lim

409198728274512SR ID: BATCH:

$1,000,000

$1,000,000

$1,000,000

WTW Certificate Center

© 2008 ACORD CORPORATION. All rights reserved.

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: FORM TITLE:

ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE Page of

AGENCY CUSTOMER ID:

LOC #:

AGENCY

CARRIER NAIC CODE

POLICY NUMBER

NAMED INSURED

EFFECTIVE DATE:

Inspira Financial Health, Inc 2001 Spring Rd Ste 700 Oak Brook, IL 60523

Re: Contract Award No. CTR078138 Health Savings Account and Flexible Spending Account Administration

The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are included as Additional Insureds as respects to General Liability and Auto Liability.

Waiver of Subrogation applies in favor of the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees for losses arising from work performed by or on behalf of the Contractor with respects to General Liability, Auto Liability and Workers Compensation as permitted by law.

INSURER AFFORDING COVERAGE: Hanover Insurance Company NAIC#: 22292

POLICY NUMBER: BLY1006206 EFF DATE: 12/01/2024 EXP DATE: 12/01/2025

TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:

Surety Bond $2,000,000

INSURER AFFORDING COVERAGE: Beazley Insurance Company Inc NAIC#: 37540

POLICY NUMBER: V299CE240601 EFF DATE: 12/01/2024 EXP DATE: 12/01/2025

TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:

Commercial Crime Limit: $10,000,000 ���������������� deductible: $10,000

INSURER AFFORDING COVERAGE: Endurance American Insurance Company NAIC#: 10641

POLICY NUMBER: FIX30028807602 EFF DATE: 12/01/2024 EXP DATE: 12/01/2025

TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:

Excess Crime $10,000,000 ������������ limit excess of $10,000,000

2 4

Willis Towers Watson Northeast, Inc.

See Page 1

See Page 1 See Page 1 See Page 1

W40071090CERT:4091987BATCH:28274512SR ID:

© 2008 ACORD CORPORATION. All rights reserved.

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: FORM TITLE:

ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE Page of

AGENCY CUSTOMER ID:

LOC #:

AGENCY

CARRIER NAIC CODE

POLICY NUMBER

NAMED INSURED

EFFECTIVE DATE:

Inspira Financial Health, Inc 2001 Spring Rd Ste 700 Oak Brook, IL 60523

INSURER AFFORDING COVERAGE: United States Fire Insurance Company NAIC#: 21113

POLICY NUMBER: 626-040421-2 EFF DATE: 12/01/2024 EXP DATE: 12/01/2025

TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:

Excess Crime $10,000,000 ������������ limit excess of $20,000,000

INSURER AFFORDING COVERAGE: Westfield Select Insurance Company NAIC#: 17105

POLICY NUMBER: FXC-456170V-00 EFF DATE: 12/01/2024 EXP DATE: 12/01/2025

TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:

Excess Crime $10,000,000 ������������ limit excess of $30,000,000

INSURER AFFORDING COVERAGE: Berkshire Hathaway Specialty Insurance Company NAIC#: 22276

POLICY NUMBER: 47-EPF-309936-06 EFF DATE: 12/01/2024 EXP DATE: 12/01/2025

TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:

Excess Crime $5,000,000 part of ������������ $10,000,000 ������������ limit excess of $40,000,000

INSURER AFFORDING COVERAGE: Old Republic Insurance Company NAIC#: 24147

POLICY NUMBER: ORPRO 12 105863 EFF DATE: 12/01/2024 EXP DATE: 12/01/2025

TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:

Excess Crime $5,000,000 part of ������������ $10,000,000 ������������ limit excess of $40,000,000

3 4

Willis Towers Watson Northeast, Inc.

See Page 1

See Page 1 See Page 1 See Page 1

© 2008 ACORD CORPORATION. All rights reserved.

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: FORM TITLE:

ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE Page of

AGENCY CUSTOMER ID:

LOC #:

AGENCY

CARRIER NAIC CODE

POLICY NUMBER

NAMED INSURED

EFFECTIVE DATE:

Inspira Financial Health, Inc 2001 Spring Rd Ste 700 Oak Brook, IL 60523

INSURER AFFORDING COVERAGE: National Fire & Marine Insurance Company NAIC#: 20079

POLICY NUMBER: 42-EPF-302064-09 EFF DATE: 12/01/2024 EXP DATE: 12/01/2025

TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:

Asset Management Liability Limit: $10,000,000 Professional Liability (D&O/E&O)

INSURER AFFORDING COVERAGE: QBE Insurance Corporation NAIC#: 39217

POLICY NUMBER: 130003883 EFF DATE: 12/01/2024 EXP DATE: 12/01/2025

TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:

Excess D&O/E&O $5,000,000 �������������� limit excess of $10,000,000

INSURER AFFORDING COVERAGE: Midvale Indemnity Company NAIC#: 27138

POLICY NUMBER: BFX-7734777-04 EFF DATE: 12/01/2024 EXP DATE: 12/01/2025

TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:

Excess D&O/E&O $5,000,000 �������������� limit excess of $15,000,000

INSURER AFFORDING COVERAGE: Endurance American Insurance Company NAIC#: 10641

POLICY NUMBER: FIX30001388605 EFF DATE: 12/01/2024 EXP DATE: 12/01/2025

TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:

Excess D&O/E&O $5,000,000 �������������� limit excess of $20,000,000

4 4

Willis Towers Watson Northeast, Inc.

See Page 1

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Business Auto Policy Policy Endorsement

ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY

It is understood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as follows:

SCHEDULE

Name of Additional Insured Person Or Organization

ANY PERSON OR ORGANIZATION THAT YOU ARE REQUIRED BY WRITTEN CONTRACT OR WRITTEN

AGREEMENT TO NAME AS AN ADDITIONAL INSURED.

1. In conformance with paragraph A.1.c. of Who Is An Insured of Section II - LIABILITY COVERAGE, the person or organization scheduled above is an insured under this policy.

2. The insurance afforded to the additional insured under this policy will apply on a primary and non-contributory basis if you have committed it to be so in a written contract or written agreement executed prior to the date of the “accident” for which the additional insured seeks coverage under this policy.

All other terms and conditions of the policy remain unchanged

This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy.

BUA 6079890473

Endorsement No: 13; Page: 1 of 1 Policy Page: 63 of 78

Underwriting Company: National Fire Insurance Company of Hartford, 151 N Franklin St, Chicago, IL 60606

Form No: CNA71527XX (10-2012) Endorsement Effective Date:

Policy No:

Policy Effective Date: 12/01/2024Endorsement Expiration Date:

© Copyright CNA All Rights Reserved.

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US (WAIVER OF SUBROGATION)

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

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: INSPIRA FINANCIAL TRUST, LLC

Endorsement Effective Date: 12/01/2024

SCHEDULE

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

ANY PERSON OR ORGANIZATION FOR WHOM OR WHICH YOU ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT TO OBTAIN THIS WAIVER FROM US. YOU MUST AGREE TO THAT REQUIREMENT PRIOR

TO LOSS.

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.

BUA 6079890473

Endorsement No: 4; Page: 1 of 1 Policy Page: 43 of 78

Underwriting Company: National Fire Insurance Company of Hartford, 151 N Franklin St, Chicago, IL 60606

Form No: CA 04 44 10 13 Endorsement Effective Date:

Policy No:

© Copyright Insurance Services Office, Inc., 2011

LESSOR - ADDITIONAL INSURED AND LOSS PAYEE

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

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: INSPIRA FINANCIAL TRUST, LLC

Endorsement Effective Date: 12/01/2024

SCHEDULE

Insurance Company: National Fire Insurance Company of Hartford

Policy Number: 6079890473 Effective Date: 12/01/2024

Expiration Date: 12/01/2025

Named Insured: INSPIRA FINANCIAL TRUST, LLC

Address: 2001 SPRING RD STE 700

OAK BROOK, IL 60523-1890

Additional Insured (Lessor):

Address:

Designation Or Description Of "Leased Autos":

Coverages Limit Of Insurance Or Deductible

Liability $1,000,000 Each"Accident"

Comprehensive Deductible For Each Covered "Leased Auto"

Collision Deductible For Each Covered "Leased Auto"

Specified Causes Of Loss Deductible For Each Covered "Leased Auto"

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

BUA 6079890473

Endorsement No: 5; Page: 1 of 2 Policy Page: 44 of 78

Underwriting Company: National Fire Insurance Company of Hartford, 151 N Franklin St, Chicago, IL 60606

Form No: CA 20 01 11 20 Endorsement Effective Date:

Policy No:

© Copyright Insurance Services Office, Inc., 2019

A. Coverage

1. Any "leased auto" designated or described in the Schedule will be considered a covered "auto" you own and not a covered "auto" you hire or borrow.

2. For a "leased auto" designated or described in the Schedule, the Who Is An Insured provision under Covered Autos Liability Coverage is changed to include as an "insured" the lessor named in the Schedule. However, the lessor is an "insured" only for "bodily injury" or "property damage" resulting from the acts or omissions by:

a. You;

b. Any of your "employees" or agents; or

c. Any person, except the lessor or any "employee" or agent of the lessor, operating a "leased auto" with the permission of any of the above.

3. The coverages provided under this endorsement apply to any "leased auto" described in the Schedule until the expiration date shown in the Schedule, or when the lessor or his or her agent takes possession of the "leased auto", whichever occurs first.

B. Loss Payable Clause

1. We will pay, as interest may appear, you and the lessor named in this endorsement for "loss" to a "leased auto".

2. The insurance covers the interest of the lessor unless the "loss" results from fraudulent acts or omissions on your part.

3. If we make any payment to the lessor, we will obtain his or her rights against any other party.

C. Cancellation

1. If we cancel the Policy, we will mail notice to the lessor in accordance with the Cancellation Common Policy Condition.

2. If you cancel the Policy, we will mail notice to the lessor.

3. Cancellation ends this agreement.

D. The lessor is not liable for payment of your premiums.

E. Additional Definition

As used in this endorsement:

"Leased auto" means an "auto" leased or rented to you, including any substitute, replacement or extra "auto" needed to meet seasonal or other needs, under a leasing or rental agreement that requires you to provide direct primary insurance for the lessor.

BUA 6079890473

Endorsement No: 5; Page: 2 of 2 Policy Page: 45 of 78

Underwriting Company: National Fire Insurance Company of Hartford, 151 N Franklin St, Chicago, IL 60606

Form No: CA 20 01 11 20 Endorsement Effective Date:

Policy No:

© Copyright Insurance Services Office, Inc., 2019

CN

I

Schedule

The premium charge for the endorsement is reflected in the Schedule of Operations.

All other terms and conditions of the policy remain unchanged.

Endorsement Expiration Date:

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

Workers Compensation And Employers Liability Insurance Policy Endorsement

’S’ o

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.

Any Person or Organization on whose behalf you are required to obtain this waiver of our right to recover from under a written contract or agreement.

r* s

Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual.

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Policy No: WC 6 79891381 Policy Effective Date: 12/01/2024 Policy Page: 315 of 558

Form No: WC 00 03 13 (04-1984) Endorsement Effective Date:

Endorsement No: 5; Page: 1 of 1 Underwriting Company: American Casualty Company of Reading, Pennsylvania, 151 N Franklin St, Chicago, IL 60606

Copyright 1983 National Council on Compensation Insurance.

This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below.

A

CN

I

All other terms and conditions of the policy remain unchanged.

Endorsement Expiration Date:

® Copyright CNA All Rights Reserved.

BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS

s

Workers Compensation And Employers Liability Insurance Policy Endorsement

Policy No: WC 6 79908423 Policy Effective Date: 12/01/2024 Policy Page: 47 of 68

’d’ o

CM

ca o o o o

This endorsement changes the policy to which it is attached.

It is agreed that Part One - Workers' Compensation Insurance G. Recovery From Others and Part Two - Employers' Liability insurance H. Recovery From Others are amended by adding the following:

We will not enforce our right to recover against persons or organizations. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.)

PREMIUM CHARGE - Refer to the Schedule of Operations

The charge will be an amount to which you and we agree that is a percentage of the total standard premium for California exposure. The amount is 3%.

o o o 'd’ o

Form No: G-1916O-B (11-1997) Endorsement Effective Date:

Endorsement No: 3; Page: 1 of 1 Underwriting Company: The Continental Insurance Company, 151 N Franklin St, Chicago, IL 60606

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CQ

’d’ kO rd •*3’ O

This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. _