Jani-Serv_-_Cert_for_AZDCS_-_CTR068433.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

10/23/2025

321 Insurance, LLC

1525 S Higley Road Suite 104

Gilbert AZ 85296

Luis Valles

(602) 834-9533 luis@321ins.com

Jani-Serv, Inc.

3120 N. Arizona Ave., Ste. 105

Chandler AZ 85225

PEKIN INS CO 24228

A Y Y 006497218 05/01/2025 05/01/2026

1,000,000

100,000

5,000

1,000,000

2,000,000

2,000,000

A 006497211 05/01/2025 05/01/2026

1,000,000

A Y 006497223 05/01/2025 05/01/2026 1,000,000

1,000,000

1,000,000

Contract #: CTR068433

With respect to general liability, State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are defined as additional insured's per the provisions of the attached endorsement(s).

Arizona Department of Child Safety Office of Contracts

3003 N. Central Ave., Ste. 2000

Phoenix AZ 85012

006497218

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

COMMERCIAL GENERAL LIABILITY

CONTRACTORS ADDITIONAL INSURED/

WAIVER OF RIGHTS OF RECOVERY

EXTENSION ENDORSEMENT

N e w S C F o r m

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This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

1. Additional Insured - When Required By Written Construction Contract For Ongoing Operations Performed By You For An Additional Insured and/or Your Completed Operations

A. With respect to coverage afforded under this section of the endorsement, Section II - Who Is An Insured is amended to include as an insured any person or organization for whom you are performing operations, when you and such person or organization have agreed in a written contract effective during the policy period stated on the Declarations Page (hereinafter referred to as the "Policy Period") and executed prior to the "bodily injury" or "property damage" for which coverage is sought, that you must add that person or organization as an additional insured on a policy of liability insurance (hereinafter referred to as the "Additional Insured").

The Additional Insured is covered only with respect to vicarious liability for "bodily injury" or "property damage" imputed from You to the Additional Insured as a proximate result of:

(1) Your ongoing operations performed for that Additional Insured during the Policy Period; or

(2) "Your work" performed for the Additional Insured during the Policy Period, but only for "bodily injury" or "property damage" within the "products-completed operations hazard".

B. It is further understood that the designation of any person or organization as an Additional Insured:

(1) does not increase the scope or limits of coverage afforded by this policy; and

(2) does not apply if the person or organization is specifically named as an additional insured under any other provision of this policy.

C. With respect to the coverage afforded to the Additional Insured, the following additional exclusions apply:

This insurance does not apply to:

(1) Liability for "bodily injury" or "property damage" arising out of the rendering of, or the failure to render, any professional services, including, but not limited to:

(a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or

(b) Supervisory, inspection, architectural or engineering activities.

(2) Liability for "bodily injury" or "property damage" arising out of or in any way attributable to the claimed negligence or statutory violation of the Additional Insured, other than vicarious liability which is imputed to the Additional Insured solely by virtue of the acts or omissions of the Named Insured.

(3) Liability for "bodily injury" or "property damage" proximately caused by your ongoing operations, which takes place, in whole or in part, after the earlier of:

(a) the date that all work called for in the written contract with the Additional Insured has been completed, as defined in the definition of "products-completed operations hazard" herein; or

(b) the end of the Policy Period.

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(4) Liability for "bodily injury" or "property damage" proximately caused by "your work" included in the "products-completed operations hazard" after the earlier of:

(a) the conclusion of the period during which the written contract requiring such coverage requires it; or

(b) 1 year after completion of "your work" performed for the Additional Insured, as defined in the "products-completed operations hazard."

D. Section III - Limits Of Insurance is amended to include:

(1) The limits of insurance applicable to the Additional Insured are:

(a) those specified in the written contract that requires the person or organization to be added as an Additional Insured; or

(b) as stated on the Declarations Page of this policy, whichever is less.

These limits of insurance are inclusive of, and not in addition to the limits of insurance shown on the Declarations Page. If other insurance of any type is written by us and applicable to the Additional Insured, the maximum recovery under all coverage forms or policies combined may equal but not exceed the highest applicable per occurrence and aggregate limit of insurance under one coverage form or policy providing coverage, whether primary or excess.

E. Section IV - Other Insurance is amended to include:

(1) When required under a written contract with the Additional Insured which is executed prior to "bodily injury" or "property damage" for which coverage is sought by the Additional Insured hereunder, the coverage provided to the Additional Insured under this section of the endorsement shall apply on a primary and noncontributory basis with any other insurance upon which the Additional Insured is listed as a Named Insured.

F. Section IV - Transfer Of Rights Of Recovery Against Others To Us is amended to include:

(1) When required under a written contract executed prior to the "occurrence" for which we make payment under this coverage part, we waive any right of recovery we may have against any person or organization who is an Additional Insured because of payments we make under this section of the endorsement.

2. Additional Insured - State Or Political Subdivisions - Permits

A. With respect to coverage afforded under this section of the endorsement, Section II - Who Is An Insured is amended to include as an insured any state or political subdivision which has issued a permit to you when you and such state or political subdivision have agreed in a written contract or agreement effective during the policy period stated on the Declarations Page and executed prior to "bodily injury", "property damage", or "personal and advertising injury" for which coverage is sought that you must add the state or political subdivision as an additional insured on a policy of liability insurance.

Such state or political subdivision is an insured only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit.

B. With respect to the coverage afforded to the additional insured provided by this section of the endorsement, the following additional exclusions apply:

This insurance does not apply to:

(1) "Bodily injury", "property damage," or "personal and advertising injury" arising out of operations performed for the state, municipality, or political subdivision; or

(2) "Bodily injury" or "property damage" included within the "products-completed operations hazard".

If an additional insured endorsement is attached to this coverage part or policy that specifically names a state or political subdivision as an insured or additional insured, then coverage under this endorsement does not apply for adding the state or political subdivision as an additional insured if the state or political subdivision would, in whole or in part, also be covered as an additional insured under this endorsement.

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12. Newly Formed or Acquired Organizations

a. Paragraph 4.a. of SECTION II - WHO IS AN INSURED is removed and replaced by:

a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier;

13. Construction Project General Aggregate Limit

a. Paragraph 2. of SECTION III - LIMITS OF INSURANCE, is removed and replaced by:

2. The General Aggregate Limit is the most we will pay for the sum of:

a. Medical expenses under Coverage

C MEDICAL PAYMENTS;

b. Damages under Coverage

A BODILY INJURY AND

PROPERTY DAMAGE LIABILITY,

except damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard"; and

c. Damages under Coverage B

PERSONAL AND ADVERTISING

INJURY LIABILITY.

This General Aggregate Limit will not apply if the Construction Project General Aggregate Limit of Insurance, paragraph 9. applies.

b. Under SECTION III - LIMITS OF INSURANCE, the following is added:

9. When it is agreed in a written contract by you and a person or organization for whom you are performing operations effective during the policy period stated on the Declarations Page and executed prior to the "bodily injury", "property damage", or "personal and advertising injury" for which coverage is sought to provide a Construction Project General Aggregate Limit of Insurance, a separate Construction Project General Aggregate Limit of Insurance, equal to the amount of the General Aggregate Limit shown in the Declarations, shall apply to each "construction project" for such person or organization and is the most we will pay for the sum of:

a. Medical expenses under Coverage

C MEDICAL PAYMENTS;

b. Damages under Coverage

A BODILY INJURY AND

PROPERTY DAMAGE LIABILITY,

except damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard"; and

c. Damages under Coverage B

PERSONAL AND ADVERTISING

INJURY LIABILITY

which can be attributed only to your ongoing operations for such person or organization and only at a single "construction project" occurring away from a premises owned by, rented to, or leased to you.

For the purpose of this provision, "construction project" means: a location you do not own, rent, or lease where ongoing improvements, alterations, installation, demolition, or maintenance work is performed by you or on your behalf. All connected ongoing improvements, alterations, installation, demolition, or maintenance work performed by you or on your behalf at the same location for the same persons or organizations, no matter how often or under how many different contracts, will be deemed to be a single construction project.

14. Broadened Notice of an Occurrence

a. Under SECTION IV - COMMERCIAL

GENERAL LIABILITY CONDITIONS,

paragraphs 2.a. and 2.b. of Duties In The Event Of Occurrence, Offense, Claim Or Suit are removed and replaced by:

a. You must see to it that we are notified as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, notice should include:

(1) How, when, and where the "occurrence" or offense took place;

(2) The names and addresses of any injured persons and witnesses; and

(3) The nature and location of any injury or damage arising out of the "occurrence" or offense.

luis Highlight

006497211

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

COMMERCIAL AUTO ENHANCEMENT ENDORSEMENT

N e w S C F o r m

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This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

Coverages provided by this endorsement are subject to the provisions applying to the Business Auto Coverage Form unless otherwise noted. All policy provisions not in conflict with this endorsement shall apply. This endorsement is a valid part of the policy only when the form number is shown in the Declarations. The policy's deductible provisions will apply unless otherwise noted.

The following changes apply to SECTION ll -

LIABILITY:

1. Broad Form Insureds

A. Newly Formed Or Acquired Organizations

The following is added as an "insured" under A.1. Who Is An Insured:

a. Any organization you newly form or acquire, other than:

(1) A partnership, joint venture, or limited liability company; or

(2) An organization excluded either by the provisions of this Business Auto Coverage Form, or by endorsement, and over which you maintain ownership or majority interest of more than 50%, subject to the following additional provisions:

b. This insurance does not apply to:

(1) Any newly formed or acquired organization that is an "insured" under any other automobile policy or would be an "insured" under such policy but for such automobile policy's termination or the exhaustion of such automobile policy's limits of insurance;

(2) "Bodily injury", "property damage" or "covered pollution cost or expense" resulting from an "accident" that occurred before you acquired or formed the organization.

c. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier.

B. Employees As Insureds

The following is added as an "insured" under A.1. Who Is An Insured:

a. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs.

C. Employees As Insureds- Autos Hired In The Employees' Name

The following is added as an "insured" under A.1. Who Is An Insured:

a. An "employee" of yours is an "insured" while operating an "auto" hired or rented under a written contract executed prior to "loss" for which coverage is sought in that "employee's" name, with your permission, while performing duties related to the conduct of your business.

b. With respect to coverage afforded under this section of the endorsement, paragraph 5.b. of the Other Insurance Condition is removed and replaced by the following:

(1) For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own:

(a) Any covered "auto" you lease, hire, rent or borrow; and

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(b) Any covered "auto" hired or rented by your "employee" under a written contract in the "employee's" own name and executed prior to the "loss" for which coverage is sought, 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".

D. Additional Insured - When Required By Written Contract - Primary and Noncontributory

The following is added as an "insured" under A.1. Who Is An Insured:

a. Any person or organization is an "insured" for liability coverage as afforded under SECTION II - LIABILITY COVERAGE, when you and such person or organization have agreed in a written contract effective during the policy period stated on the Declarations Page (hereinafter referred to as the "Policy Period") and executed prior to the "bodily injury", "property damage" or "covered pollution cost or expense" for which coverage is sought, that you must add that person or organization as an additional "insured" on a policy of automobile liability insurance (hereinafter referred to as the "Additional Insured").

The "Additional Insured" is covered only with respect to vicarious liability for "bodily injury", "property damage" or "covered pollution cost or expense" resulting from your ownership, maintenance, or use of a covered "auto" during the "Policy Period".

b. It is further understood that the designation of any person or organization as an "Additional Insured" does not increase the scope or limits of coverage afforded by this policy.

c. C. Limits of Insurance is amended to include:

(1) The limits of insurance applicable to the "Additional Insured" are:

(a) those specified in the written contract that requires the person or organization to be added as an "Additional Insured"; or

(b) as stated on the Declarations Page of this policy, whichever is less.

These limits of insurance are inclusive of, and not in addition to the limits of insurance shown on the Declarations Page.

d. When required under a written contract with the "Additional Insured" which is executed prior to "bodily injury", "property damage" or "covered pollution cost or expense" for which coverage is sought by the "Additional Insured" hereunder, the coverage provided to the "Additional Insured" under this endorsement shall apply on a primary and noncontributory basis with any other insurance upon which the "Additional Insured" is listed as a Named Insured.

e. If an endorsement is attached to this coverage form or policy that specifically names a person or organization as an "insured" or additional "insured", then coverage under this endorsement does not apply to that entity.

2. Broadened Supplementary Payments

a. Under 2. Coverage Extensions, Paragraph 2.a.(2) of Supplementary Payments is removed and replaced by:

(2) Up to $5,000 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.

b. Under 2. Coverage Extensions, Paragraph 2.a. (4) of Supplementary Payments is removed and replaced by:

(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.

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3. Amended Fellow Employee Exclusion

a. Under B., Exclusions, 5. Fellow Employee exclusion is removed and replaced by:

5. Fellow Employee

"Bodily injury" to:

a. Any fellow "employee" of the "insured" arising out of and in the course of the fellow "employee's" employment or while performing duties related to the conduct of your business; or

b. The spouse, child, parent, brother or sister of the fellow "employee" as a consequence of Paragraph a.

above.

But this exclusion does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire.

The coverage provided under this section of the endorsement shall be excess over any other insurance, whether such other insurance is stated to be primary, contributory, excess, contingent or otherwise, unless such other insurance is written only as specific excess insurance over the Limits of Liability provided in this endorsement.

The following changes apply to SECTION Ill -

PHYSICAL DAMAGE COVERAGE:

1. Towing and Labor

Under SECTION Ill - PHYSICAL DAMAGE COVERAGE, 2. Towing is replaced by the following:

We will pay up to the following limits for towing and labor costs incurred each time a covered "auto" is disabled:

a. $100 for a covered "auto" rated and classified as a private passenger vehicle or "light truck".

b. $150 for a covered "auto" rated and classified as a "medium truck".

However, labor must be performed at the place of disablement.

c. With respect to this section of this endorsement, the following definitions are added under SECTION V - DEFINITIONS:

(1) "Light truck" means a truck or van that has a "gross vehicle weight" (GVW) of 10,000 pounds or less.

(2) "Medium truck" means a truck or van that has a "gross vehicle weight" (GVW) of 10,001-20,000 pounds.

(3) "Gross Vehicle Weight" (GVW) means the maximum loaded weight for which a single "auto" is designed, as specified by the manufacturer.

2. Broadened Transportation Expenses Including Limited Rental Reimbursement Coverage

Under 4. Coverage Extensions, a., Transportation Expenses is removed and replaced by:

a. Transportation Expenses

We will pay up to $75 per day to a maximum of $2,250 for necessary and actual temporary transportation expense incurred by you because of a "loss" to a covered "auto", but only if the covered "auto" carries the coverages and meets the requirements described in (1) or (2) below:

(1) We will pay the above temporary transportation expense because of the total theft of a covered "auto" if you carry Comprehensive Coverage on that covered "auto". We will only pay for such 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".

(2) For "loss" other than the total theft of a covered "auto" if you carry Comprehensive Coverage on that covered "auto" or for a "loss" under Collision Coverage to that covered "auto", we will pay the above temporary transportation expense because of "loss" to that covered "auto" rendering the covered "auto" inoperable. We will only pay for those expenses incurred during the policy period beginning 24 hours after the "loss" and ending, regardless of the policy's expiration, with the lesser of:

(a) the number of days reasonably required to repair or replace the covered "auto"; or

(b) 30 days.

(3) This coverage extension does not apply while there are spare or reserve "autos" available to you for your operations.

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(4) The Broadened Transportation Expenses Coverage described above does not apply to a covered "auto" that is described or designated as a covered "auto" on Rental Reimbursement Coverage Endorsement CA9923 attached to this coverage form.

3. Accidental Discharge Of An Airbag

a. Under B., Exclusions, 3. is removed and replaced by:

3. We will not pay for "loss" due and confined to:

a. Wear and tear, freezing, mechanical or electrical breakdown. However, "loss" due to mechanical and electrical breakdown does not apply to the accidental discharge of an airbag.

Coverage for accidental discharge of an airbag is excess over any other collectable insurance or warranty.

b. Blowouts, punctures or other road damage to tires.

This exclusion does not apply to such "loss" resulting from the total theft of a covered "auto".

4. Audio, Visual And Data Electronic Equipment Increased Limit

a. Under C. Limit Of Insurance, 2. is removed and replaced by:

2. $1,500 is the most we will pay for "loss" in any one "accident" to all electronic equipment that reproduces, receives or transmits audio, visual or data signals which, at the time of "loss", is:

a. Permanently installed in or upon the covered "auto" in a housing, opening or other location that is not normally used by the "auto" manufacturer for the installation of such equipment;

b. Removable from a permanently installed housing unit as described in Paragraph 2.a. above; or

c. An integral part of such equipment as described in Paragraphs 2.a.

and 2.b. above.

d. The Audio, Visual And Data Electronic Equipment Increased Limit Coverage described above does not apply to a covered "auto" that is described or designated as a covered "auto" on Audio, Vlsual And Data Electronlc Equipment Coverage Added Limits Endorsement CA9960 or Loss Payable Clause - Audio, Visual And Data Electronic Equipment Coverage Added Limits Endorsement CA9961 attached to this policy or coverage form.

5. Glass Repair - Waiver Of Deductible

a. Under Paragraph D. Deductible, for "loss" covered under SECTION Ill - PHYSICAL DAMAGE COVERAGE, the following is added:

No deductible applies to glass damage otherwise covered under SECTION Ill - PHYSICAL DAMAGE COVERAGE, if the glass is repaired rather than replaced.

6. Collision Deductible Amendment For Loss To Two (or More) Covered Autos In One Accident

a. If a Collision "loss" from one "accident" involves two or more covered "autos" under this policy or coverage form, only the highest deductible applicable to those coverages will be applied to the "loss" , if the cause of "loss" is covered for those vehicles. This provision only applies if you carry Collision Coverage for those vehicles, and does not extend coverage to any covered "autos" for which you do not carry such coverage.

7. Hired Auto Physical Damage Coverage (Limited)

Under Paragraph A. Coverage of SECTION Ill - PHYSICAL DAMAGE COVERAGE, the following is added:

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a. If hired "autos" are covered "autos" for Liability Coverage in this policy or coverage form and if Comprehensive or Collision coverages are provided under this policy or coverage form for any "auto" you own, then the Physical Damage Coverages provided are extended to "autos" you hire subject to the following additional provisions:

(1) The most we will pay for "loss" to any hired "auto" is:

(a) The actual cash value of the damaged or stolen property at the time of the "loss" ;

(b) The cost of repairing or replacing the damaged or stolen property, with other property of like kind or quality; or

(c) $75,000 whichever is smallest, minus a deductible.

(2) The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. No deductible applies to "loss" caused by fire or lightning.

(3) Hired Auto Physical Damage Coverage is excess over any other collectible insurance.

(4) Subject to the above limit, deductible and excess provisions, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own scheduled in the Declarations under this policy or coverage part.

(5) This extension of coverage does not apply to:

(a) Any "auto" you hire or borrow from any of your "employees", partners (if you are a partnership), members (if you are a limited liability company), or members of their households; or

(b) Any "auto" you hire or borrow:

(i) For a period of more than 30 days; or

(ii) With a driver.

b. For any "auto" which is a covered "auto" under this extension, 7. Hired Auto Physical Damage Coverage (Limited), and subject to the coverages provided to 7.a.

above, we will also pay expenses for loss of use of such "auto", subject to the following additional provisions:

(1) Such "auto" is rented or hired under a written rental contract or agreement executed prior to "loss" of such "auto" for which coverage is sought;

(2) Such loss of use is a direct consequence of a "loss" covered under this extension, 7. Hired Auto Physical Damage Coverage (Limited):

(a) For which an "insured" is legally responsible; and

(b) As a result of which the rental agency sustains a monetary "loss";

(3) The most we will pay for any expenses for loss of use is $50 per day, subject to a maximum of $1,500; and

(4) With respect to coverage afforded by this section of the endorsement, Paragraph b. Loss Of Use Expenses of Paragraph 4. Coverage Extensions in SECTION Ill - PHYSICAL DAMAGE COVERAGE does not apply.

Coverage under this extension, 7. Hired Auto Physical Damage Coverage (Limited) will be excess over any other valid and collectible insurance available to the "insured", except that no coverage will be afforded if any physical damage coverage is provided for hired or borrowed "autos" under

ITEM FOUR - SCHEDULE OF HIRED OR

BORROWED COVERED AUTO COVERAGE

AND PREMIUMS in the BUSINESS AUTO DECLARATIONS in this policy or coverage form (or which would have been provided except for the application of an exclusion).

8. Loan Or Lease GAP Coverage

Under SECTION Ill - PHYSICAL DAMAGE COVERAGE, the following is added under 4.

Coverage Extensions:

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a. In the event of a "total loss" to a covered "auto" which is either owned by you or is leased by you for a period of 6 consecutive months or longer, we will pay any unpaid amount due on the original lease or loan for a covered "auto" which carries Comprehensive and Collision Coverage on the Business Auto Coverage form to which this endorsement attaches. The amount payable will be reduced by:

(1) The amount paid under SECTION Ill - PHYSICAL DAMAGE COVERAGE of the policy; and

(2) Any:

(a) Overdue lease/loan payments at the time of the "loss";

(b) Deductibles applicable under SECTION Ill - PHYSICAL

DAMAGE COVERAGE;

(c) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage;

(d) Security deposits not refunded by the lessor;

(e) Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease;

and

(f) Carry-over balances from previous loans or leases.

b. With respect to this section of the endorsement, the following definition is added under SECTION V - DEFINITIONS:

"Total loss" means a "loss" in which the cost of repair plus the salvage value exceeds the actual cash value.

c. This Loan/Lease Gap Coverage extension shall only apply when the Auto Loan/Lease GAP Coverage Endorsement CA2071 is not included in or a part of this policy issued to you by us.

The following changes apply to SECTION IV -

BUSINESS AUTO CONDITIONS:

1. Broadened Knowledge Of Accident, Claim, Suit Or Loss

Under SECTION IV - BUSINESS AUTO CONDITIONS, Paragraph 2.a. of Duties In The Event Of Accident, Claim, Suit Or Loss is removed and replaced by:

a. In the event of "accident", claim, "suit" or "loss", you must give us or our authorized representative prompt notice of the "accident" or "loss".

Include:

(1) How, when and where the "accident" or "loss" occurred;

(2) The "insured's" name and address; and

(3) To the extent possible, the names and addresses of any injured persons and witnesses.

This condition applies only when the "accident" or "loss" is known to:

(1) You, if you are an individual;

(2) A partner, if you are a partnership;

(3) An executive officer or the "employee" designated by you to give such notice, if you are a corporation; or

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

2. Waiver Of Transfer Of Rights Of Recovery Against Others To Us When Required By Written Contract

Under SECTION IV - BUSINESS AUTO CONDITIONS, the following is added under A.

Loss Conditions, 5. Transfer Of Rights Of Recovery Against Others To Us:

However, we waive the right of recovery we may have against any person or organization because of payment we make for "bodily injury" , "property damage" or "covered pollution cost or expense" arising out of the ownership, maintenance or use of a covered "auto" when you and such person or organization have agreed in a written contract executed prior to the "bodily injury", "property damage" or "covered pollution cost or expense" "loss" to waive your right of recovery against such person or organization.

This waiver applies only to such person or organization designated in such written contract executed prior to the "bodily injury", "property damage" or "covered pollution cost or expense" "loss" for which you have agreed to waive your right of recovery.

CA 31 34 10 18 with its permission. Page 7 of 7

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3. Unintentional Failure To Disclose Hazards

Under SECTION IV - BUSINESS AUTO CONDITIONS, B. General Conditions, 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 this policy or coverage form, we will not deny coverage under this policy or 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 nonrenewal.

The following change applies to SECTION V -

DEFINITIONS:

1. Broadened Bodily Injury Definition

Under SECTION V - DEFINITIONS, definition C.

"Bodily injury", is removed and replaced by:

C. "Bodily injury" means bodily injury, sickness or disease sustained by a person, including mental anguish or death resulting from physical bodily injury, physical sickness, or physical disease sustained by that person.

N e w S C F o r m

006497223

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

WC 00 03 13 (04-84) Copyright 1983 National Council on Compensation Insurance. Page 1 of 1

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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

Any person or organization for whom you are performing work when you and such person or organization have agreed in a written contract, executed prior to the accident or loss for which we make payment under this workers compensation policy, that you must add that person or organization under a Waiver Of Our Right To Recover From Others Endorsement on a policy of Workers Compensation insurance.

State: Arizona