Encore-General_Parts_Certificate_of_Insurance_12.2022.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)

© 1988-2015 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

COMMERCIAL GENERAL LIABILITY

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

XTEND ENDORSEMENT FOR SERVICE INDUSTRIES

This endorsement modifies insurance provided under the following:

GENERAL DESCRIPTION OF COVERAGE – This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered.

G. Blanket Additional Insured – GovernmentalA. Who Is An Insured – Unnamed Subsidiaries Entities – Permits Or Authorizations Relating To

B. Who Is An Insured – Employees And Volunteer Premises Workers – Bodily Injury To Co-Employees And

H. Blanket Additional Insured – GovernmentalCo-Volunteer Workers Entities – Permits Or Authorizations Relating To

C. Who Is An Insured – Newly Acquired Or Formed Operations Limited Liabil ity Companies I. Blanket Additional Insured – Grantors Of

D. Blanket Additional Insured – Broad Form Franchises Vendors J. Incidental Medical Malpractice

E. Blanket Additional Insured – Controlling Interest K. Blanket Waiver Of Subrogation F. Blanket Additional Insured – Mortgagees,

b. After the date , if any, during the policy period PROVISIONS that you no longer maintain an ownership interest of more than 50% in such subsidiary.A. WHO IS AN INSURED – UNNAMED SUBSIDIARIES 1. IIFor purposes of Paragraph of Section – Who

Is An Insured, each such subsidiary will beSECTION II – WHO ISThe following is added to deemed to be designated in the Declarations as:AN INSURED:

a. A limited liability company;Any of your subsidiaries, other than a partne rship

b. An organizat ion other than a partnership,or joint venture, that is not shown as a Named joint venture or limited liability company; orInsured in the Declarations is a Named Insured if: c. A trust;

a. as indicated in its name or the documents thatYou are the sole owner of, or maintain an govern its structure.ownership interest of more than 50% i n, such subsidiary on the first day of the policy B. WHO IS AN INSURED – EMPLOYEES AND VOLUNTEER WORKERS – BODILY INJURYperiod; and TO CO-EMPLOYEES AND CO-VOLUNTEERb. Such subsidiary is not an insured under WORKERSsimilar other insurance.

2.a.(1)The following is added to Paragraph of No such subsidiary is an insured for "bodily SECTION II – WHO IS AN INSURED:

injury" or "property damage" that occurred, or

(1)(a) (b) (c)Paragraphs , and above do not"personal and advertising injury" caused by an apply to "bodily injury" to a co-"employee" whileoffense committed:

in the course of the co-"employee's" employment

a. Before you maintained an ownership interest by you or performing duties related to the of more than 50% i n such subsidiary; or conduct of your business, or to "bodily injury" to

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COMMERCIAL GENERAL LIABILITY COVERAGE PART

Assignees, Successors Or Receivers

Blanket Waiver Of Subrogation

D. BLANKET ADDITIONAL INSURED – BROADyour other "volunteer workers" while performing FORM VENDORSduties related to the conduct o f your business.

SECTION II – WHO ISThe following is added toC. WHO IS AN INSURED – NEWLY ACQUIRED

AN INSURED:OR FORMED LIMITED LIABILITY COMPANIES

Any person or organization that is a vendor and3.The following replaces Paragraph of that you have agreed in a written contract orSECTION II – WHO IS AN INSURED:

agreement to include as an additional insured on

3. Any organization you newly acquire or form, this Coverage Part is an insured, but only with other than a partnership or joint venture, and respect to liabil ity for "bodily injury" or "property of which you are the sole owner or in which damage" that:

you maintain an ownership interest of more a.than 50%, will qualify as a Named Insured if Occurs subsequent to the signing of that there is no other similar insurance available contract or agreement; and to that organization. However:

b. Arises out of "your products" that are

a. Coverage under this provision is distributed or sold in the regular course of afforded only: such vendor's business.

(1) Until the 180th day after you acquire The insurance provided to such vendor is subject or form the organization or the end to the following provisions:

of the policy period, whichever is

a. The limits of insurance provided to such earlier, if you do not report such vendor will be the minimum limits that you organization in writing to us within agreed to provide in the written contract or 180 days after you acquire or form it;

agreement, or the limits shown in the or

Declarations, whichever are less.

(2) Until the end of the policy period,

b. The insurance provided to such vendor does when that date is later than 180 da ys not apply to:

after you acquire or form such

(1)organization, if you report such Any express warranty not authorized by organization in writing to us within you or any distribution or sale for a 180 after you acquire or form it; purpose not authorized by you;

b. A (2)Coverage does not apply to "bodily Any change in "your products" made by such vendor;injury" or "property damage" that occurred before you acquired or formed (3) Repackaging, unless unpacked solely for the organization; and the purpose of inspection,

c. B demonstration, testing, or theCoverage does not apply to "personal and advertising injury" arising out of an substitution of parts under instructions offense committed before you acquired from the manufacturer, and then or formed the organization. repackaged in the original container;

1 (4)For the purposes of Paragraph . of Section Any failure to make such inspections, II – Who Is An Insured, each such adjustments, tests or servicing as organization will be deemed to be vendors agree to perform or normally designated in the Declarations as: undertake to perform in the regular course of business, in connection witha. A limited liability company;

the distribution or sale of "your

b. An organization, other than a products";

partnership, joint venture or limited

(5) Demonstration, installation, servicing orliability company; or repair operations, except such

c. A trust; operations performed at such vendor's as indicated in its name or the documents premises in connection with the sale of that govern its structure. "your products"; or

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days

(6) a."Your products" that, after distribution or Is "bodily injury" or "property damage" that sale by you, have been labeled or occurs, or is "personal and advertising injury" relabeled or used as a container, part or caused by an offense that is committed, ingredient of any other thing or subsequent to the signing of that contract or substance by or on behalf of such agreement; and vendor. b. Arises out of the ownership, maintenance or use of the premises for which thatCoverage under thi s provision does not apply to:

mortgagee, assignee, successor or receivera. Any person or organization from whom you is required under that contract or agreementhave acquired "your products", or any to be included as an additional insured oningredient, part or container entering into, this Coverage Part .accompanying or containing such products;

The insurance provided to such mortgagee,or assignee, successor or receiver is subject to theb. Any vendor for which coverage as an following provisions:additional insured specifically is scheduled a.by endorsement. The limits of insurance provided to such mortgagee, assignee, successor or receiverE. BLANKET ADDITIONAL INSURED – will be the minimum limits that you agreed toCONTROLLING INTEREST provide in the written contract or agreement,

1. SECTION II –The following is added to or the limits shown in the Declarations, WHO IS AN INSURED: whichever are less.

Any person or organization that has financial b. The insurance provided to such person or control of you is an insured with respect to organization does not apply to:

liability for "bodily injury", "property damage"

(1) Any "bodily injury" or "property damage"or "personal and advertising injury" that that occurs, or any "personal andarises out of:

advertising injury" caused by an offense

a. Such financial control; or that is committed, after such contract or

b. agreement is no longer in effect; orSuch person's or organization's ownership, maintenance or use of (2) Any "bodily injury", "property damage" or premises leased to or occupied by you. "personal and advertising injury" arising out of any structural alterations, newThe insurance provided to such person or construction or demolition operationsorganization does not apply to structural performed by or on behalf of suchalterations, new construction or demolition mortgagee, assignee, successor oroperations performed by or on behalf of such receiver.person or organization .

2. 4. G. BLANKET ADDITIONAL INSURED –The following is added to Paragraph of

SECTION II – WHO IS AN INSURED GOVERNMENTAL ENTITIES – PERMITS OR:

AUTHORIZATIONS RELATING TO PREMISESThis paragraph does not apply to any premises owner, manager or lessor that has SECTION II – WHO ISThe following is added to financial control of you. AN INSURED:

F. BLANKET ADDITIONAL INSURED – Any governmental entity that has issued a permit MORTGAGEES, ASSIGNEES, SUCCESSORS or authorization with respect to premises owned OR RECEIVERS or occupied by, or rented or loaned to, you and that you are required by any ordinance, law,SECTION II – WHO ISThe following is added to AN INSURED building code or written contract or agreement to:

include as an additional insured on thisAny person or organization that is a mortgagee, Coverage Part is an insured, but only withassignee, successor or receiver and that you respect to liability for "bodily injury", "propertyhave agreed in a written contract or agreement damage" or "personal and advertising injury"to include as an additional insured on this arising out of the existence, ownership, use,Coverage Part is an insured, but only with maintenance, repair, construction, erection orrespect to its liability as mortgagee, assignee, removal of any of the following for which thatsuccessor or receiver for "bodily injury", "property governmental entity has issued such permit ordamage" or "personal and advertising injury" authorization: advertising signs, awnings,that:

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canopies, cellar entrances, coal holes, medical services", first aid or "Good driveways, manholes, marquees, hoist away Samaritan services" to a person, unless openings, sidewalk vaults, elevators, street you are in the business or occupation of banners or decorations. providing professional health care services.H. BLANKET ADDITIONAL INSURED – GOVERNMENTAL ENTITIES – PERMITS OR 2. The following replaces the last paragraph of AUTHORIZATIONS RELATING TO 2.a.(1) SECTION II – WHO ISParagraph of

OPERATIONS AN INSURED:

SECTION II – WHO IS Unless you are in the business or occupationThe following is added to of providing professional health careAN INSURED:

(1)(a) (b) (c) (d)services, Paragraphs , , andAny governmental entity that has issued a permit above do not apply to "bodily injury" arising or authorization with respect to operations out of providing or failing to provide:

performed by you or on your behalf and that you

(a) "Incidental medical services" by any ofare required by any ordinance, law, building code your "employees" who is a nurse, nurseor written contract or agreement to include as an assistant, emergency medicaladditional insured on this Coverage Part is an technician, paramedic, athletic trainer,insured, but only with respect to liability for audiologist, dietician, nutritionist,"bodily injury", "property damage" or "personal occupational therapist or occupationaland advertising injury" arising out of such therapy assistant, physical therapist oroperations.

speech-language p athologist; or

The insurance provided to such governmental

(b) First aid or "Good Samaritan services"entity does not apply to:

by any of your "employees" or "volunteer

a. Any "bodily injury", "property damage" or workers", other than an employed or

"personal and advertising injury" arising out volunteer doctor. Any such "employees" of operations performed for the or "volunteer workers" providing or failing governmental entity; or to provide first aid or "Good Samaritan services" during their work hours for youb. Any "bodily injury" or "property damage" will be deemed to be acting within theincluded in the "products-completed scope of their employment by you oroperations hazard".

performing duties related to the conduct

I. BLANKET ADDITIONAL INSURED – of your business.

GRANTORS OF FRANCHISES

3. The following replaces the last sentence of SECTION II – WHO ISThe following is added to 5. SECTION III – LIMITS OFParagraph of

AN INSURED: INSURANCE:

Any person or organization that grants a For the purposes of determining the franchise to you is an insured, but only with applicable Each Occurrence Limit, all related respect to liability for "bodily injury", "property acts or omissions committed in providing or failing to provide "incidental medicaldamage" or "personal and advertising injury" services", first aid or "Good Samaritanarising out of your operations in the franchise services" to any one person will be deemedgranted by that person or organization.

to be one "occurrence".

If a written contract or agreement exists between

4. The following exclusion is added toyou and such additional insured, the limits of

2. Exclusions SECTION I –Paragraph , , ofinsurance provided to such insured will be the COVERAGES – COVERAGE A – BODILYminimum limits that you agreed to provide in the INJURY AND PROPERTY DAMAGEwritten contract or agreement, or the limits LIABILITY:shown in the Declarations, whichever are less.

Sale Of PharmaceuticalsJ. INCIDENTAL MEDICAL MALPRACTICE "Bodily injury" or "property damage" arising

1. b.The following replaces Paragraph of the out of the violation of a penal statute or definition of "occurrence" in the ordinance relating to the sale of DEFINITIONS Section: pharmaceuticals committed by, or with the

b. An act or omission committed in knowledge or consent of, the insured.

providing or failing to provide "incidental

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5. DEFINITIONS 2.a.(1) IIThe following is added to the subject to Paragraph of Section – Section: Who Is An Insured.

K. BLANKET WAIVER OF SUBROGATION"Incidental medical services" means:

a. Medical, surgical, dental, laboratory, x- 8. TransferThe following is added to Paragraph , ray or nursing service or treatment, Of Rights Of Recovery Against Others To Us, advice or instruction, or the related SECTION IV – COMMERCIAL GENERALof furnishing of food or beverages; or LIABILITY CONDITIONS:

b. The furnishing or dispensing of drugs or If the insured has agreed in a contract ormedical, dental, or surgical supplies or agreement to waive that insured's right ofappliances.

recovery against any person or organization, we

6. 4.b.The following is added to Paragraph , waive our right of recovery against such person Excess Insurance SECTION IV –, of or organizat ion, but only for payments we makeCOMMERCIAL GENERAL LIABILITY because of:CONDITIONS:

a. "Bodily injury" or "property damage" thatThis insurance is excess over any valid and occurs; orcollectible other insurance, whether primary, excess, contingent or on any other basis, b. "Personal and advertising injury" caused by that is available to any of your "employees" an offense that is committed;

for "bodily injury" that arises out of providing subsequent to the execution of the contract oror failing to provide "incidental medical agreement.services" to any person to the extent not

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BLANKET WAIVER OF SUBROGATION

Transfer

LIABILITY CONDITIONS:

SECTION IV – COMMERCIAL GENERAL

Of Rights Of Recovery Against Others To Us, State of Arizona, and its departments, agencies, boards, commission, universities, officers, officials, agents, and employees for losses arising from work performed by or on behalf of the Contractor.

1789 W. Jefferson St., Phoenix, AZ 85007

1789 W. Jefferson St., Phoenix, AZ 85007

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

ENDORSEMENT WC 00 03 13 (00) -

POLICY NUMBER:

EMPLOYERS LIABILITY POLICY

AND

WORKERS COMPENSATION

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

ONE TOWER SQUARE

HARTFORD CT 06183

UB-9066X588-21-51-R

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 any one not named in the Schedule.

SCHEDULE

DESIGNATED ORGANIZATION:

DESIGNATED PERSON:

ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED

BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS

WAIVER.

INCLUDING:

STATE OF ARIZONA, AND ITS DEPARTMENTS, AGENCIES, BOARDS,

COMMISSION, UNIVERSITIES, OFFICERS, OFFICIALS, AGENTS, AND

EMPLOYEES FOR LOSSES ARISING FROM WORK PERFORMED BY OR ON

BEHALF OF THE CONTRACTOR.

DATE OF ISSUE: PAGEST ASSIGN: OF08-30-22 1 1