CTR079338-_cgl_al_ul_wc_03-19-26.pdf

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Master Agreement AZ|CTR079338
Contract number
CTR079338
Issued by
Arizona

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Document Summary

This is a Certificate of Liability Insurance and supporting policy endorsements for Charlie Pepper Inc DBA Salt Works, issued by Southwest Risk Management, LLC on behalf of Westfield Insurance Company and Nutmeg Insurance Company. The certificate is effective March 19, 2025, through March 19, 2026, and names the Arizona Game and Fish Department (AZGFD) as the certificate holder and additional insured. The contract reference BPM007206 relates to AZGFD Salt (Block and Granular) procurement. The policy includes commercial general liability, automobile liability, workers' compensation, umbrella liability, and equipment floater and property coverage with various endorsements providing broadened coverage provisions.

The insurance policy provides general liability coverage with limits of $1,000,000 per occurrence and $3,000,000 aggregate, automobile liability at $1,000,000 per occurrence, umbrella liability at $3,000,000, and workers' compensation coverage at $1,000,000 per accident and disease. The policy includes additional insured status for AZGFD with primary and non-contributory coverage, waiver of subrogation provisions across general liability, automobile liability, and workers' compensation, and damage to rented premises coverage of $500,000. The certificate confirms that AZGFD and its affiliated entities are named as additional insureds with respect to liability arising from contractor activities, with coverage effective through March 19, 2026.

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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

11/4/2025

(480) 924-1200 (480) 924-1211

24112

Charlie Pepper Inc DBA Salt Works PO Box 22273 Mesa, AZ 85277-2273

39608

A 1,000,000

X X 471634Y 3/19/2025 3/19/2026 500,000 5,000

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

EPLI 250,000

1,000,000A

X X 471634Y 3/19/2025 3/19/2026

3,000,000A 471634Y 3/19/2025 3/19/2026 3,000,000

B

X 59WECBR30US 3/19/2025 3/19/2026 1,000,000

1,000,000 1,000,000

A Equipment Floater 471634Y 3/19/2025 A Property 471634Y 3/19/2025 3/19/2026

RE: BPM007206 - AZGFD Salt (Block and Granular). The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents and employees shall be named as additional insured with respect to liability arising out of the activities performed by or on behalf of the Contractor for (General Liability) and involving automobiles owned, leased hired or borrowed by the contractor (Automobile liability). Coverage is Primary & Non-Contributory (General Liability). Waiver of Subrogation against losses arising from work performed by or on behalf of the contractor (General Liability, Automobile Liability & Workers Compensation) applies. This form is subject to all policy forms, terms, endorsements, conditions, definitions & exclusions.

Arizona Game and Fish Department (AZGFD) 5000 W. Carefree Hwy Phoenix, AZ 85086

CHARPEP-01 CUERO1

Southwest Risk Management, LLC 4801 E McKellips Mesa, AZ 85215 service@southwestrisk.com

WESTFIELD INSURANCE COMPANY

Nutmeg Insurance Company

X

3/19/2026

X X

X

X

X X

CG 71 18 11 12

COMMERCIAL GENERAL LIABILITY

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

COMMERCIAL GENERAL LIABILITY ENDORSEMENT

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE FORM

SCHEDULE

The coverage provided by this endorsement is summarized below and is intended to provide a general coverage description only. For the details affecting each coverage, please refer to the terms and condi-tions in this endorsement.

A. Expected or Intended Injury

Reasonable Force B. Non-owned Watercraft

Increased to 60 feet C. Non-owned Aircraft D. Property Damage - Elevators E. Damage To Premises Rented To You

Limit increased to $500,000 F. Personal and Advertising Injury

Exclusions G. Medical Payments - Volunteer Workers H. Voluntary Property Damage I. Care, Custody and Control J. Supplementary Payments

Bail Bonds - $2500 Loss of Earnings - $1000

K. Who Is An Insured broadened:

Limited Liability Partnership Joint Ventures / Partnership / Limited Liability Company Health Care Professionals (Incidental Medical Malpractice) Newly Formed or Acquired Entities (up to 365 days) Individual Owners of Buildings

L. Knowledge and Notice Of Occurrence M. Unintentional Failure To Disclose Hazards N. Liberalization O. Definitions

Bodily Injury redefined Expanded Personal and Advertising Injury definition Unintentional Damage or Destruction added

In addition to the policy amendments contained in A through O listed above, the endorsements listed below will automatically be attached to your policy to complete the coverage provided by the Signature Series Commercial General Liability Endorsement:

Additional Insured - Co-Owners of Insured Premises - CG 20 27 Additional Insured - Concessionaire - CG 20 03 Additional Insured - Controlling Interest - CG 20 05 Additional Insured - Grantor of Franchise - CG 20 29 Additional Insured - Lessor of Leased Equipment - CG 20 34 Additional Insured - Managers or Lessors of Premises - CG 20 11 Additional Insured - Mortgagee, Assignee or Receiver - CG 20 18 Additional Insured - Owners or Other Interests From Whom Land Has Been Leased - CG 20 24 Additional Insured - State or Governmental Agency or Subdivision or Political Subdivision -

Permits or Authorizations - CG 20 12 Additional Insured - Vendors - CG 20 15 Waiver of Transfer of Rights of Recovery - CG 24 04

A. EXPECTED OR INTENDED INJURY

Under SECTION I. COVERAGES, COVER-

AGE A BODILY INJURY AND PROPERTY

DAMAGE LIABILITY, Item 2. Exclusions a.

is replaced with the following:

a. Expected Or Intended Injury

"Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This ex-clusion does not apply to "bodily in-jury" or "property damage" resulting from the use of reasonable force for the purpose of protecting persons or property.

B. NON-OWNED WATERCRAFT

DAMAGE LIABILITY, Item 2. Exclusions

g. (2) (a) is replaced with the following:

(a) Less than 60 feet long; and

C. NON-OWNED AIRCRAFT

DAMAGE LIABILITY, Item 2. Exclusions

g. Aircraft, Auto or Watercraft, the follow-ing is added:

(6) An aircraft you do not own, provided that:

(a) The pilot in command holds a currently effective certifi-cate issued by the duly con-stituted authority of the United States of America or Canada, designating that person as a commercial or airline transport pilot;

(b) It is rented with a trained, paid crew; and

(c) It does not transport per-sons or cargo for a charge.

D. PROPERTY DAMAGE – ELEVATORS

With respect to Exclusions of SECTION I

COVERAGES, COVERAGE A. BODILY

INJURY AND PROPERTY DAMAGE LIA-

BILITY, item 2. Exclusions, paragraphs (3),

(4) and (6) Exclusion j. Damage to Proper-ty and Exclusion K Damage To Your Prod-uct do not apply to the use of elevators. The insurance afforded by this provision is ex-cess over any valid and collectible property insurance (including any deductible) availa-ble to the insured, and the Other Insurance Condition is changed accordingly.

E. DAMAGE TO PREMISES RENTED TO YOU

DAMAGE LIABILITY, Item 2. Exclusions, the last paragraph of item 2. Exclusions, is replaced with the following:

Exclusions c. through n. do not apply to damage by fire or explosion to premises while rented to you or temporarily occu-pied by you with permission of the own-

er. A separate limit of insurance applies to this coverage as described in Section

III - LIMITS OF INSURANCE.

F. PERSONAL AND ADVERTISING INJURY

Under SECTION I - COVERAGES, COV-

ERAGE B PERSONAL AND ADVERTIS-

INGINJURY LIABILITY, the following are added to Item 2. Exclusions:

q. Discrimination Relating To Room, Dwelling or Premises

Caused by discrimination directly or indirectly related to the sale, rental, lease or sub-lease or prospective sale, rental, lease or sub-lease of any room, dwelling or premises by or at the direction of any insured.

r. Fines or Penalties

Fines or penalties levied or imposed by a governmental entity because of discrimination.

G. MEDICAL PAYMENTS - VOLUNTEER

WORKERS

Under SECTION I - COVERAGES, COV- ERAGE C MEDICAL PAYMENTS, item 2.

Exclusions b. Hired Person is replaced with the following:

b. Hired Person

To a person hired to do work for or on behalf of any insured or tenant of any insured; however this exclusion does not apply to "volunteer work-ers" while engaged in maintenance or repair of your premises.

Under SECTION I - COVERAGES, the fol-lowing are added:

H. VOLUNTARY PROPERTY DAMAGE

1. Insuring Agreement

We will pay, at your request, for "proper-ty damage" to property of others caused by you, or while in your possession aris-ing out of your business operations.

2. Exclusions

Coverage for Voluntary Property Dam-age does not apply to:

a. "Loss" of property at premises owned, rented, leased, operated or used by you.

b. "Loss" of property while in transit;

c. "Loss" of property owned by, rented to, leased to, borrowed by or used by you;

d. The cost of repairing or replacing:

(1) "Your work" defectively or in-correctly done by you;

(2) "Your product" manufactured, sold or supplied by you; or unless the "property damage" is caused directly by you after delivery of "your product" or completion of "your work" and resulting from a subsequent undertaking.

e. "Loss" of property caused by or aris-ing out of the "products-completed operations hazard."

3. Deductible

We will not pay for "loss" in any one "occur-rence" until the amount of "loss" exceeds $250. We will then pay the amount of "loss" in excess of $250, up to the applicable limit of insurance.

4. Actual Cost

In the event of covered "loss", you shall, if requested by us, replace the damaged property or furnish the labor and materials necessary for repairs thereto at your actual cost, excluding profit or overhead charges.

The most we will pay under Voluntary Prop-erty Damage for "loss" arising out of any one "occurrence" is $250. The most we will pay for the sum of all "losses" under this cover-age is $1,000.

I. CARE, CUSTODY OR CONTROL

1. Insuring Agreement

We will pay those sums the insured be-comes legally obligated to pay as dam-ages because of "property damage" to property of others while in your care, custody or control or property as to which you are exercising physical con-trol if the "property damage" arises out of your business operations.

2. Exclusions

Coverage for Care, Custody or Control does not apply to:

a. "Property damage" to property at any premises owned, rented, leased, operated or used by you;

b. "Property damage" to property while in transit;

c. The cost of repairing or replacing;

(1) "Your work" defectively or incor-rectly done by you; or

(2) "Your product" manufactured, sold or supplied by you; unless the "property damage" is caused directly by you after de-livery of "your product" or com-pletion of "your work" and result-ing from a subsequent undertak-ing.

d. "Property damage" to property caused by or arising out of the" products-completed operations haz-ard".

3. Deductible

We will not pay for "property damage" in any one "occurrence" until the amount of "property damage" exceeds $250. We will then pay the amount of "property damage" in excess of $250, up to the applicable limit of insurance.

4. Actual Cost

In the event of covered "property dam-age", you shall, if requested by us, re-place the property or furnish the labor and materials necessary for repairs thereto at your actual cost, excluding profit or overhead charges.

The most we will pay under Care, Cus-tody or Control for "property damage" is $1,000 for each occurrence. The most we will pay for the sum of all damages because of "property damage" under this coverage is $5,000.

J. SUPPLEMENTARY PAYMENTS

Under SECTION I - SUPPLEMENTARY PAYMENTS COVERAGES A AND B, item 1.b. is replaced with the following:

b. Up to $2,500 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 bonds.

Under SECTION I - SUPPLEMENTARY

PAYMENTS COVERAGES A AND B,

item 1.d. is replaced with the following:

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

K. WHO IS AN INSURED BROADENED

Under SECTION II - WHO IS AN INSURED Item 1.b. is replaced with the following:

b. A partnership (including a limited li-ability partnership) or joint venture, you are an insured. Your members, your partners, and their spouses are also insured, but only with respect to the conduct of your business.

the following is added to item 1:

f. Joint Ventures/Partnership/Limited

Liability Company Coverage

You are an insured when you had an interest in a joint venture, part-nership or limited liability company which is terminated or ended prior to or during this policy period but only to the extent of your interest in such joint venture, partnership or limited liability company. This coverage does not apply:

(1) Prior to the termination date of any joint venture, partnership or limited liability company; or

(2) If there is other valid and collect-ible insurance purchased specif-ically to insure the partnership, joint venture or legal liability company.

Under SECTION II - WHO IS AN INSURED, item 2.a. is replaced with the following:

a. Your "employees" or volunteer workers, other than either your "ex-ecutive officers" (if you are an or-ganization other than a partnership, joint venture or limited liability com-pany) or your managers (if you are a limited liability company), but only for acts within the scope of their employment by you or while per-forming duties related to the conduct of your business. However, none of these "employees" or volunteer workers are an insured for:

(1) "Bodily injury" or "personal and advertising injury":

(a) To you, to your partners or members (if you are a part-nership or joint venture), to your members (if you are limited liability company), or to a co-"employee" or co-volunteer worker while that is either in the course of his or her employment or per-forming duties related to the conduct of your business;

(b) To the spouse, child, parent, brother or sister of that co- "employee" or co-volunteer worker as a consequence of paragraph (1)(a) above;

(c) For which there is any obli-gation to share damages with or repay someone else who must pay damages be-cause of the injury de-scribed in paragraphs (1)(a) or (b) above; or

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

This does not apply to nurs-es, emergency medical technicians or paramedics employed by you to provide health care services, but on-ly if you are not in the busi-ness or occupation of providing such professional services.

(2) "Property damage" to property:

(a) Owned, occupied or used by,

(b) Rented to, in the care, cus-tody or control of, or over which physical control is be-ing exercised for any pur-pose by you, any of your "employees" or volunteer workers, any partner or member (if you are a partnership or joint venture), or any member (if you are a limited liability company).

item 3.a. is replaced with the following:

a. Coverage under this provision is af-forded only until the end of the poli-cy period or the next anniversary of this policy's effective date after you acquire or form the organization, whichever is earlier.

the following is added:

4. For COVERAGE A and COVERAGE B only the owner of any building leased to you, but only if the building owner is a shareholder in your corporation or a partner in your partnership insured in this policy, and only with respect to lia-bility arising out of the ownership, maintenance or use of that part of the premises leased to you. However, this insurance does not apply:

a. To any "occurrence" or offense which takes place after you cease to be a tenant in the premises; or

b. To structural alterations, new con-struction or demolition operations performed by or on behalf of the building owner.

the last paragraph of this section is replaced with the following:

Except as provided in 3. above, no per-son or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a named insured in the Declarations.

L. KNOWLEDGE AND NOTICE OF OCCUR-

RENCE

Under SECTION IV - COMMERCIAL GEN- ERAL LIABILITY CONDITIONS, 2. Duties in the Event of Occurrence, Offense, Claim Or Suit, the following is added:

e. The requirement in Condition 2.a.

applies only when the "occurrence" or offense is known to:

(1) You, if you are an individual;

(2) A partner, if you are a partner-ship;

(3) An "executive officer" or insur-ance manager, if you are a cor-poration; or

(4) A manager, if you are a limited liability company.

f. The requirement in Condition 2. b.

will not be 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 partner-ship;

(3) An "executive officer" or insur-ance manager, if you are a cor-poration; or

(4) A manager, if you are a limited liability company.

g. Your rights under this Coverage Part will not be prejudiced if you fail to give us notice of an "occurrence," offense, claim, or "suit" and that fail-ure is solely due to your reasonable belief that the "bodily injury" or "property damage" is not covered under this Coverage Part. However, you shall give written notice of this "occurrence," offense, claim, or "suit" to us as soon as you are aware this insurance may apply to such "occurrence", offense, claim, or "suit".

M. UNINTENTIONAL FAILURE TO DIS-

CLOSE HAZARDS

Under SECTION IV - COMMERCIAL GEN- ERAL LIABILITY CONDITIONS, 6. Repre-sentations, the following is added:

d. Your failure to disclose all hazards or prior "occurrences" existing as of the inception date of this policy shall not prejudice the coverage afforded by this policy, provided such failure to disclose all hazards or prior "oc-currences" is not intentional.

N. LIBERALIZATION

Under SECTION I - COVERAGES, SEC-

TION II - WHO IS AN INSURED, SECTION

III - LIMITS OF INSURANCE, SECTION IV -

COMMERCIAL GENERAL LIABILITY

CONDITIONS AND SECTION V - DEFINI-

TIONS, the following is added:

Liberalization

If we adopt any revision that would broaden the coverage under this en-dorsement without additional premium within 45 days prior to or during the poli-cy period, the broadened coverage will immediately apply to this endorsement.

O. DEFINITIONS

Under SECTION V - DEFINITIONS, item 3.

is deleted and replaced with the following:

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

Under SECTION V - DEFINITIONS, item 14.

The following is added to the definition of "Personal and advertising injury":

h. Discrimination or humiliation that re-sults in injury to the feelings or repu-tation of a natural person but only if such discrimination or humiliation is:

(1) not done intentionally by or at the direction of:

(a) The insured; or

(b) Any "executive officer," di-rector, stockholder, partner, member or manager (if you are a limited liability compa-

ny) of the insured; and

(2) Not directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person or persons by any insured.

Under SECTION V - DEFINITIONS, the follow-ing definition is added:

23. "Loss" means unintentional damage or de-struction but does not include disappear-ance, theft, or loss of use.

POLICY NUMBER: COMMERCIAL GENERAL LIABILITY

CG 24 04 12 19

CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US (WAIVER OF SUBROGATION)

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

ELECTRONIC DATA LIABILITY COVERAGE PART

LIQUOR LIABILITY COVERAGE PART

POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES

POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

RAILROAD PROTECTIVE LIABILITY COVERAGE PART

UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS

SCHEDULE

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

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 against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above.

COMMERCIAL AUTO

BUSINESS AUTO ENDORSEMENT

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

SCHEDULE

The coverage provided by this endorsement is summarized below and is intended to provide a general coverage description only. For the details affecting each coverage, please refer to the terms and condi tions in this endorsement.

A. Who Is An Insured broadened:

• Additional Insured by Contract, Agreement or Permit

• Legally Incorporated Subsidiaries

• Newly Acquired Organizations

B. Supplementary Payments

• Bail Bonds - $5000

• Loss of Earnings - $500

C. Fellow Employee Exclusion Amendment D. Coverage Extensions

• Transportation Expenses

• Personal Effects (Excess Basis)

E. Additional Coverages

• Expenses paid for returning a stolen covered auto

• Fire Department Service Charge

F. Airbag Coverage - Accidental Discharge G. Glass Repair - Waiver of Deductible H. Knowledge and Notice of an Accident, Claim or Suit I. Unintentional Failure To Disclose Hazards J. Worldwide Coverage K. Definitions

• Bodily Injury Redefined

In addition to the policy amendments contained in A. through K. listed above, the endorsements listed below will automatically be attached to your policy to complete the coverage provided by the Signature Series Business Auto Endorsement:

• Audio, Visual and Data Electronic Equipment Coverage Added Limits - CA 99 60

• Auto Loan/Lease Gap Coverage - CA 20 71

• Drive Other Car Coverage - Broadened Coverage For Named Individuals - (Executive

Officers/Spouses) - CA 99 10

• Employee Hired Autos - CA 20 54

• Employees As Insureds - CA 99 33

• Hired Auto Physical Damage (Refer to Auto Declarations page)

• Rental Reimbursement Coverage - CA 99 23

• Waiver of Transfer of Rights of Recovery (Waiver of Subrogation) - CA 04 44

A. WHO IS AN INSURED BROADENED

SECTION II - COVERED AUTOS LIABILITY

COVERAGE, item A. Coverage, 1. Who Is An Insured is amended to include the following additional paragraphs:

d. Any legally incorporated subsidiary of yours in which you own more than

50% of the voting stock on the ef fective date of this endorsement.

However, " insured " does not include any subsidiary that is an " insured" under any other liability policy or would be an " insured" under such a policy but for its termination or the exhaustion of its limit of insurance.

CA 70 77 10 13

Coverage under this provision is af forded only for the first 180 days af ter you acquire or form the organization or until the end of the policy period , whichever comes first.

e. Any organization you newly acquire or form , other than a partnership or joint venture , and over which you maintain ownership or a majority in terest. However, coverage under this provision:

(1) Does not apply if the organiza tion you acquire or form is an " insured" under another auto li ability policy or would be " in sured" under such a policy but for its termination or the ex haustion of its limits of insur ance ;

(2) Does not apply to "bodily injury" or "property damage" that oc curred before you acquired or formed the organization ; and

(3) Is afforded only for the first 180 days after you acquire or form the organization or until the end of the policy period , whichever comes first.

f. Any person or organization with whom you agreed in writing in a contract , agreement or permit, to provide insurance such as is af forded under this policy.

This provision only applies if the written contract or agreement has been executed or permit has been issued, prior to the " bodily injury" or "property damage" .

B. SUPPLEMENTAL PAYMENTS

SECTION 11 - COVERED AUTOS LIABILITY

COVERAGE, item A. Coverage, 2. Coverage Extensions, a. Supplementary Payments, sub paragraphs (2) and (4) are deleted and re placed with the following:

(2) Up to $5,000 for cost of bail bonds (including bonds for re lated traffic law violations) re quired because of an "accident" we cover. We do not have to furnish these bonds.

(4) All reasonable expenses in curred by the " insured" at our request , including actual loss of earnings up to $500 per day be cause of time off from work.

C. FELLOW EMPLOYEE EXCLUSION AMEND

MENT

SECTION 11 - COVERED AUTOS LIABILITY

COVERAGE, item B. Exclusions, 5. Fellow Employee does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire.

D. COVERAGE EXTENSIONS

SECTION 111 - PHYSICAL DAMAGE COVER

AGE, Item A. Coverage, 4. Coverage Exten sions, a. Transportation Expenses is replaced with the following :

a. Transportation Expenses

We will pay up to $100 per day to a maximum of $1 ,800 for transporta tion expense incurred by you be cause of the total theft of a covered "auto" of the private passenger type.

We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage. We will pay for transportation expenses incurred during the period beginning 48 hours after the theft and ending , regardless of the policy' s expiration , when the covered "auto" is returned to use or we pay for its " loss" .

The following is added to Item 4. Cover age Extensions:

c. Personal Effects

We will pay up to $500 for the " loss" of your personal effects that are contained in a covered "auto" due to the total theft of the covered "auto. " We will pay only for those personal effects that are contained in covered "autos" for which you carry either Comprehensive or Specified Causes Of Loss Coverage.

Our payment for " loss" of or damage to personal effects will apply only on an excess basis over other collect ible insurance.

E. ADDITIONAL COVERAGES

SECTION 111 - PHYSICAL DAMAGE COVER

AGE, A. Coverage , is amended to include the following additional coverage items:

5. We will pay the expense of returning a stolen covered "auto" to you.

6. Fire Department Service Charge

When a fire department is called to save or protect a covered "auto", its equip ment, its contents or occupants from a Covered Cause Of Loss, we will pay up to $1 ,000 for your liability for Fire De partment Service Charges:

(a) Assumed by contract or agreement prior to loss; or

(b) Required by local ordinance.

No deductible applies to this additional coverage.

F. AIRBAG COVERAGE - ACCIDENTAL DIS

CHARGE

SECTION Ill - PHYSICAL DAMAGE COVER AGE, Item B. Exclusions, subparagraph 3.a.

is deleted and replaced with the following:

a. Wear and tear, freezing , mechanical or electrical breakdown.

Mechanical breakdown does not ap ply to the accidental discharge of an airbag.

G. GLASS REPAIR - WAIVER OF DEDUCTIBLE

SECTION Ill - PHYSICAL DAMAGE COVER AGE, item D. Deductible the following para graph is added:

No deductible shall apply to glass dam age if the glass is repaired rather than replaced.

H. KNOWLEDGE AND NOTICE OF AN ACCI

DENT, CLAIM OR SUIT

SECTION IV - BUSINESS AUTO CONDITIONS,

Item A. Loss Conditions is amended as fol lows:

Subparagraph a. under Item 2. Duties In The Event Of Accident, Claim, Suit Or Loss, is amended to include the following paragraphs:

This requirement applies when the "accident," claim , "suit" or " loss" is first known to:

(1) You , if you are an individual ;

(2) A partner, if you are a partner ship; or

(3) An executive officer or insur ance manager, if you are a cor poration.

Subparagraph b.(2) under 2. Duties In The Event Of Accident, Claim, Suit Or Loss is amended as follows:

(2) Immediately send us copies of any request , demand, order, notice, summons or legal paper received concerning the claim or "suit. "

Your employees may know of documents received concerning a claim or "suit" . This will not mean that you have such know ledge, unless receipt of such documents is known to you , any of your executive officers or partners or your insurance manager.

I. UNINTENTIONAL FAILURE TO DISCLOSE

HAZARDS

Under SECTION IV - BUSINESS AUTO CON DITIONS, B. General Conditions, 2.

Concealment, Misrepresentation Or Fraud is amended to include the following additional paragraph:

If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not deny coverage under this Coverage Part because of such failure.

J. WORLDWIDE COVERAGE

Under SECTION IV - BUSINESS AUTO CON DITIONS, B. General Conditions, 7. Policy Period, Coverage Territory, subparagraph (5) is deleted and replaced with the following:

(5) Anywhere in the world , if:

(a) A covered "auto" of the private passenger type is leased, hired , rented or borrowed without a driver for a period of 45 days or less; and

(b) The " insured' s" responsibility to pay damages is determined in a "suit" on the merits, in the United States of America, Puerto Rio or Canada or in a settlement we agree to.

(c) If, for such "autos" a "suit" is brought outside the territory de scribed in 7.(1) through 7.(4) above , we will reimburse the insured for defense expenses incurred with our written con sent, but we will make no pay ment, nor will we reimburse the insured for damages.

K. DEFINITIONS

Under SECTION V - DEFINITIONS, Item C. is replaced by the following:

C. "Bodily injury" means bodily injury, sick ness or disease sustained by a person , including mental anguish , mental injury or death resulting from any of these.

"Bodily injury" includes mental anguish or other mental injury resulting from "bodily injury" .

Countersigned by Authorized Representative

Form WC 00 03 13 Printed in U.S.A.

Process Date: 03/17/25 Policy Expiration Date: 03/19/26

WAIVER OF OUR RIGHT TO RECOVER

FROM OTHERS ENDORSEMENT

Policy Number: 59 WEC BR2GYE Endorsement Number:

Effective Date: 03/19/25 Effective hour is the same as stated on the Information Page of the policy.

Named Insured and Address: Charlie Pepper AZ Inc

PO Box 22273

MESA AZ 85277

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 shall not operate directly or indirectly to benefit anyone not named in the Schedule.

SCHEDULE

Any person or organization for whom you are required by contract or agreement to obtain this waiver from us.

Endorsement is not applicable in KY, NH, NJ or for any MO construction risk

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