Pilgrim_Rest_CMP-4860_-_AI.pdf
PDF 81 KB Posted
- Attached to
- Master Agreement AZ|CTR055548
- Contract number
- CTR055548
- Issued by
- Arizona
About this file
This document contains two insurance policy endorsements (CMP-4543 and CMP-4787) for a Businessowners Coverage Form issued by State Farm Mutual Automobile Insurance Company. The policy is for Pilgrim Rest Foundation Inc. located in Phoenix, Arizona, with the Arizona Department of Child Safety designated as an additional insured and recovery rights waiver recipient. The policy number is 93 163126 4, with a specific endorsement number 1328-FB43, dated April 8, 2019.
The endorsements modify the insurance policy to include the Arizona Department of Child Safety as an additional insured, primarily covering liability for bodily injury, property damage, and personal and advertising injury arising from Pilgrim Rest Foundation's premises, ongoing operations, and completed work. The endorsements also include a waiver of subrogation, meaning State Farm waives its right to seek recovery against the Arizona Department of Child Safety for any payments made for injury or damage resulting from the insured's ongoing operations or completed work under contract.
View the file
Other files
Show all 25
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
CMP-4543
CMP-4543 ADDITIONAL INSURED — DESIGNATED PERSON OR ORGANIZATION
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
JBL Policy No. 93 163126 4 1328-FB43
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM
SCHEDULE
Policy Number:
Named Insured:
93 163126 4
PILGRIM REST FOUNDATION INC
1401 E JEFFERSON ST
PHOENIX AZ 85034-2315
1. SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to include, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by:
a. Premises And Ongoing Operations
Your acts or omissions or the acts or omissions of those acting on your behalf:
(1) In connection with your premises; or
(2) In the performance of your ongoing operations; or
b. Products-Completed Operations
"Your work" performed for that additional insured and included in the "products-completed opera-tions hazard".
2. Any insurance provided to the additional insured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage.
3. Primary Insurance. The insurance afforded the additional insured shall be primary insurance. Any insurance carried by the additional insured shall be noncontributory with respect to coverage pro-vided by you.
All other policy provisions apply.
Name And Address Of Additional Insured Person Or Organization:
ARIZONA DEPARTMENT OF CHILD SAFETY
PO BOX 6030 SITE CODE C010-23
PHOENIX AZ 85005-6030
© , Copyright, State Farm Mutual Automobile Insurance Company, 2018 Includes copyrighted material of Insurance Services Office, Inc., with its permission.
CMP-4543 155604 04-08-2019
Name And Address Of Person Or Organization:
ARIZONA DEPARTMENT OF CHILD SAFETY
PO BOX 6030 SITE CODE C010-23
PHOENIX AZ 85005-6030
The following is added to Paragraph 10.b. of SECTION I AND SECTION II — COMMON POLICY
CONDITIONS:
We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of:
a. Your ongoing operations; or
b. "Your work" done under contract with that person or organization and included in the "products-completed operations hazard".
This waiver applies only to the person or organization shown in the Schedule.
All other policy provisions apply.
1006225 137715.1 11-19-2013
CMP-4787
CMP-4787
CMP-4787 WAIVER OF TRANSFER OF RIGHTS OR RECOVERY AGAINST
OTHERS TO US
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
JBL Policy No. 93 163126 4 1328-FB43
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM
SCHEDULE
Policy Number:
Named Insured:
PILGRIM REST FOUNDATION INC
1401 E JEFFERSON ST
PHOENIX AZ 85034-2315
, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission.
93 163126 4
File details come from the government source that posted it. Updated .