HomeMy WebLinkAboutSIGNVALUE INC - INSURANCE CERTIFICATEDATE (MM/DD/YYYY)
A�oRo� CERTIFICATE OF LIABILITY INSURANCE
03/28/2024
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).
PRODUCER coNrncT Deann Harguess
NAME:
Shepherd Insurance, LLC. PHONE (g2g� 445-4600 FAx
A/C No Ext : (A/C, No):
400 White Spar Road o� R��cc• dharguess@shepherdins.com
INSURER(S) AFFORDING COVERAGE NAIC #
Prescott AZ 86303 iNsuRERA: America Fire and Casualty Company 24066
INSURED iNsuReR e: The Travelers Prop Cas Ins Co of America 25674
Signvalue Inc INSURER C :
925 S Gilbert Rd Ste 203 INSURER D:
INSURER E :
Mesa AZ 85204 INSURER F:
COVERAGES CERTIFICATE NUMBER: CL2432825815 REVISION NUMBER:
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.
INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTR INSD WVD (MMIDD/YYYY) (MMIDD/YYYY)
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE � 2,000,000
CLAIMS-MADE � OCCUR PREM SES�(Ea occur ence) $ 2�000,000
MED EXP (Any one person) g 15,000
A Y BZA58454613 04/08/2024 04/OS/2025 pERSONAL&ADV INJURY g
GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE � 4,000,000
X POIICY � PR� � 4,000,000
JECT LOC PRODUCTS-COMP/OPAGG $
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT g 2,000,000
(Ea accident)
ANYAUTO BODIIY INJURY (Per person) $
A OWNED SCHEDULED BZA58454613 04/08/2024 04/08/2025 BODILY INJURY (Per accident) $
AUTOS ONLY AUTOS
X HIRED � NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident)
$
UMBRELLALIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
WORKERS COMPENSATION X S ATUTE E�RH
AND EMPLOYERS' LIABILITY y� N 1,OOO,OOO
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
B OFFICER/MEMBER EXCLUDED? � N/ A UB4K92525A 04/08/2024 04/08/2�25
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000
�f yes, describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Automatic Additional Insured applies to General Liability, coverages on a Primary & Non-Contributory Basis where required by written contract subject to
policy terms, conditions & exclusions. Waiver of Subrogation applies to General Liability coverage where required by written contract subject to policy terms,
conditions & exclusions. The coverage extensions referenced on this certificate are achieved through the following forms which are included on the policy &
attached to this certificate: BP 7996 0916. BP 0497 0106.
City of Fort Collins
PO Box 580
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Fort Collins, CO
ACORD 25 (2016/03)
80522
O 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
POLICY NUMBER:
BUSINESSOWNERS
BP 04 07 07 73
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - STATE OR GOVERNMENTAL
AGENCY OR SUBDIVISION OR POLITICAL
SUBDIVISION - PERMITS OR AUTHORIZATIONS
RELATING TO PREMISES
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM
SCHEDULE
State Or Governmental Agency Or Subdivision Or Political Subdivision:
STATE OF ARIZONA ARIZONA DEPARTMENT OF TRANSP.
CITY OF SANTA CLARITA MS RENEE STOLL PROPERTY MGMT
THE CITY OF CHAN�LER
CITY OF PHOENIX-fINANCE DEPARTMENT
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Section II - Liability is amended as follows:
A. The following is added to Paragraph C. Who
is An Insured:
3. Any state or governmental agency or
subdivision or political subdivision
shown in the Schedule is also an addi-
tional insured, subject to the foilowing
additional provision:
This insurance applies only with respect
to the following hazards for which the
state or governmental agency or subdivi-
sion or political subdivision has issued a
permit or authorization in connection
with premises you own, rent or control
and to which this insurance applies:
a. The existence, maintenance, repair,
construction, erection or removai of
advertising signs, awnings, cano-
pies, cellar entrances, coal holes,
driveways, manholes, marquees,
hoistaway openings, sidewalk
vaults, street banners or decoration
and similar exposures;
b. The construction, erection or remov-
al of elevators; or
c. The ownership, maintenance or use
of any elevators covered by this in-
surance.
B.
However:
a. The insurance afforded to such addi-
tional insured only applies to the ex-
tent permitted by law; and
b. if coverage provided to the
additional insured is required by a
contract or agreement, the insurance
afforded to such additional insured
will not be broader than that which
you are required by the contract or
agreement to provide for such addi-
tional insured.
With respect to the insurance afforded to
these additional insureds, the foliowing is
added to Paragraph D. Liability And Medical
Expenses Limits Of Insurance:
If coverage provided to the additional insured
is required by a contract or agreement, the
most we will pay on behalf of the additional
insured is the amount of insurance:
7. Required by the contract or agreement;
or
2. Available under the appiicable Limits Of
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the ap-
plicable Limits Of Insurance shown in the
Decla rati ons.
BP 04 07 07 73 o Insurance Services Office, Inc., 2012 Page 7 of 7
POLICY NUMBER:
BUSINESSOWNERS
BP 04 97 01 06
THIS ENDORSEMENTCHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM
SCHEDULE*
Name Of Person Or Organization:
CITY OF TUCSON
Paragraph K. Transfer Of Rights Of Recovery
Against Others To Us in Section III - Common
Policy Conditions is amended by the addition of
the following:
We waive any right of recovery we may have
against the person or organization shown in the
Schedule above because of payments we make
for injury or damage arising out of your ongoing
operations or "your work" done under a contract
with that person or organization and included in
the "products-completed operations hazard".
This waiver applies only to the person or organi-
zation shown in the Schedule above.
* Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
BP 04 97 07 06 oISO Properties, Inc., 2004 Page 7 of 7
POLICY NUMBER:
BUSINESSOWNERS
BP 04 97 O7 O6
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREPULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the foilowing:
BUSINESSOWNERS COVERAGE FORM
SCHEDULE*
Name Of Person Or Organization:
LOWELL HOUSING AUTHORITY
Paragraph K. Transfer Of Rights Of Recovery
Against Others To Us in Section III - Common
Policy Conditions is amended by the addition of
the following:
We waive any right of recovery we may have
against the person or organization shown in the
Schedule above because of payments we make
for injury or damage arising out of your ongoing
operations or "your work" done under a contract
with that person or organization and inciuded in
the "products-completed operations hazard".
This waiver applies only to the person or organi-
zation shown in the Schedule above.
*Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
BP 04 97 07 06 oISO Properties, Inc., 2004 Page 1 of 1
POLICY NUMBER:
BUSINESSOWNERS
BP 04 97 01 06
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorseme�t modifies insurance provided under the following
BUSINESSOWNERS COVERAGE FORM
SCHEDULE"
Name Of Person Or Organization:
MARICOPA COUNTY DEPT OF TRANSPORTATION
OFFICE OF PROCUREMENT SERVICES
Paragraph K. Transfer Of Rights Of Recovery
Against Others To Us in Section III - Common
Policy Conditions is amended by the addition of
the following:
We waive any right of recovery we may have
against the person or organization shown in the
Schedule above because of payments we make
for injury or damage arising out of your ongoing
operations or "your work" done under a contract
with that person or organization and included in
the "products-completed operations hazard".
This waiver applies only to the person or organi-
zation shown in the Schedule above.
*Information required to compiete this Schedule, if not shown above, will be shown in the Declarations.
BP 04 97 01 06 oISO Properties, Inc., 2004 Page 1 of 1
POLICY NUMBER:
BUSINESSOWNERS
BP 04 97 07 06
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM
SCHEDULE"
Name Of Person Or Organization:
WILD HORSE PASS DEVELOPMENT AUTHORITY
Paragraph K. Transfer Of Rights Of Recovery
Against Others To Us in Section III - Common
Policy Conditions is amended by the addition of
the following:
We waive any right of recovery we may have
against the person or organization shown in the
Schedule above because of payments we make
for injury or damage arising out of your ongoing
operations or "your work" done under a contract
with that person or organization and included in
the "products-completed operations hazard".
This waiver applies only to the person or organi-
zation shown in the Schedule above.
*Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
BP 04 97 01 06 oISO Properties, Inc., 2004 Page 1 of 7
BUSINESSOWNERS
BP 79 96 09 16
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BUSINESSOWNERS LIABILITY EXTENSION ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM
Below is a summarization of the coverages provided by this endorsement. No coverages are given by this
summary. Actual coverage descriptions are within this endorsement.
SECTION
SUBJECT
A. Supplementary Payments
Bail Bonds
Loss Of Earnings
B. Broadened Coverage For Damage To Premises Rented To You
C. Incidental Medical Malpractice Injury
D. Mobile Equipment
E. Blanket Additional Insured (Owners, Contractors Or Lessors)
F. Newly Formed Or Acquired Organizations
G. Aggregate Limits
H. Duties In The Event Of Occurrence, Offense, Claim Or Suit
Liability And Medical Expenses Definitions
Bodily Injury
Insured Contract
Personal And Advertising Injury
Section II - Liability is amended as follows:
A. Supplementary Payments
Section A.1. Business Liability is modified as follows:
1. The $250 limit shown in Paragraph A.1.f.(1)(b) Coverage Extension - Supplementary Payments for the
cost of bail bonds is replaced by a$3,000 limit.
2. The $250 limit shown in Paragraph A.1.f.(1)(d) Coverage Extension - Supplementary Payments for
reasonable expenses and loss of earnings is replaced by a$500 limit.
B. Broadened Coverage For Damage To Premises Rented To You
1. The last paragraph of Section B.1. Exclusions - Applicable To Business Liability Coverage is replaced
by the following:
With respect to the premises which are rented to you or temporarily occupied by you with the permis-
sion of the owner, Exclusions c., d., e., g., h., k., I., m., n. and o. do not apply to "property damage".
� 2016 Liberty Mutual Insurance
BP 79 96 09 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 Of 4
2. Paragraph D.2. Liability And Medical Expenses Limits Of Insurance is replaced by the following:
The most we will pay under this endorsement for the sum of all damages because of all "property
damage" to premises while rented to you or temporarily occupied by you with the permission of the
owner is the Limit of Insurance shown in the Declarations.
3. Paragraph D.3. Liability And Medical Expenses Limits Of Insurance does not apply.
C. Incidental Medical Malpractice Injury
1. Paragraph (4) under Paragraph B.1.j. Exclusions - Applicable To Business Liability Coverage - Profes-
sional Services does not apply to "Incidental Medical Malpractice Injury" coverage.
2. With respect to this endorsement, the following is added to Section F. Liability And Medical Expenses
Definitions:
a. "Incidental Medical Malpractice Injury" means bodily injury arising out of the rendering of or
failure to render, during the policy period, the following services:
(1) Medical, surgical, dental, x-ray or nursing service or treatment or the furnishing of food or
beverages in connection therewith; or
(2) The furnishing or dispensing of drugs or medical, dental or surgical supplies or appliances.
b. This coverage does not apply to:
(1) Expenses incurred by the insured for first-aid to others at the time of an accident and the
Duties in the Event of Occurrence, Offense, Claim or Suit Condition is amended accordingly.
(2) Any insured engaged in the business or occupation of providing any of the services described
under a. above.
(3) Injury caused by any indemnitee if such indemnitee is engaged in the business or occupation
of providing any of the services described under a. above.
D. Mobile Equipment
Section C. Who Is An Insured is amended to include any person driving "mobile equipment" with your
permission.
E. Blanket Additional Insured (Owners, Contractors Or Lessors)
1. Section C. Who Is An Insured is amended to include as an insured any person or organization whom
you are required to name as an additional insured on this policy under a written contract or written
agreement. The written contract or agreement must be:
a. Currently in effect or becoming effective during the term of this policy; and
b. Executed prior to the "bodily injury", "property damage", or "personal and advertising injury".
2. The insurance afforded to the additional insured is limited as follows:
a. The person or organization is only an additional insured with respect to liability arising out of:
(1) Real property, as described in a written contract or written agreement, you own, rent, lease,
maintain or occupy; and
(2) Caused in whole or in part by your ongoing operations performed for that insured.
b. The Limit of Insurance applicable to the additional insured are those specified in the written
contract or written agreement or the limits available under this policy, as stated in the Declara-
tions, whichever are less. These limits are inclusive of and not in addition to the Limit of Insurance
available under this policy.
c. The insurance afforded to the additional insured does not apply to:
(1) Liability arising out of the sole negligence of the additional insured;
(2) "Bodily injury", "property damage", "personal and advertising injury", or defense coverage
under the Supplementary Payments section of the policy arising out of an architect's, en-
gineer's or surveyor's rendering of or failure to render any professional services including:
� 2016 Liberty Mutual Insurance
BP 79 96 09 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 Of 4
(a) The preparing or approving of maps, shop drawings, opinions, reports, surveys, field
orders, change orders, or drawings and specifications; and
(b) Supervisory, inspection, architectural or engineering activities.
(3) Any "occurrence" that takes place after you cease to be a tenant in the premises described in
the Declarations; or
(4) Structural alterations, new construction or demolition operations performed by or for the
person or organization designated in the Declarations.
3. Any coverage provided hereunder shall be excess over any other valid and collectible insurance avail-
able to the additional insured whether primary, excess, contingent or on any other basis unless a
contract specifically requires that this insurance be primary or you request that it apply on a primary
basis.
F. Newly Formed Or Acquired Organizations
The following is added to Section C. Who Is An Insured:
Any business entity acquired by you or incorporated or organized by you under the laws of any individual
state of the United States of America over which you maintain majority ownership interest exceeding fifty
percent. Such acquired or newly formed organization will qualify as a Named Insured if there is no similar
insurance available to that entity. However:
1. Coverage under this provision is afforded only until the 180th day after the entity was acquired or
incorporated or organized by you or the end of the policy period, whichever is earlier;
2. Section A.1. Business Liability does not apply to:
a. "Bodily injury" or "property damage" that occurred before the entity was acquired or incorporated
or organized by you; and
b. "Personal and advertising injury" arising out of an offense committed before the entity was ac-
quired or incorporated or organized by you.
3. Records and descriptions of operations must be maintained by the first Named Insured.
No person 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.
G. Aggregate Limi#s
The following is added to Paragraph D.4. Aggregate Limits Liability and Medical Expenses Limits Of
Insurance:
1. The Aggregate Limits apply separately to each of the "locations" owned by or rented to you or
temporarily occupied by you with the permission of the owner.
2. The Aggregate Limits also apply separately to each of your projects away from premises owned by or
rented to you.
For the purpose of this endorsement only, "location" means premises involving the same or connect-
ing lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-
of-way of a railroad.
H. Duties In The Event Of Occurrence, Offense, Claim Or Suit
1. Paragraph E.2.a. Duties In The Event Of Occurrence, Offense, Claim Or Suit Liability And Medical
Expenses General Condition applies only when the "occurrence" is known to any insured listed in
Paragraph C.1. Who Is An Insured or any "employee" authorized by you to give or receive notice of an
"occurrence" or claim.
2. Paragraph E.2.b. Duties In The Event Of Occurrence, Offense, Claim Or Suit Liability And Medical
Expenses General Condition will not be considered breached unless the breach occurs after such claim
or "suit" is known to any insured listed under Paragraph C.1. Who Is An Insured or any "employee"
authorized by you to give or receive notice of an "occurrence" or claim.
� 2016 Liberty Mutual Insurance
BP 79 96 09 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 Of 4
Section F. Liability And Medical Expenses Definitions is modified as follows:
1. Paragraph F.3. is replaced by the following:
3. "Bodily Injury" means bodily injury, sickness, disease, or incidental medical malpractice injury
sustained by a person, and includes mental anguish resulting from any of these; and including
death resulting from any of these at any time.
2. Paragraph F.9. is replaced by the following:
9. "Insured contract" means:
a. A contract for a lease of premises. However, that portion of the contract for a lease of prem-
ises that indemnifies any person or organization for damage by fire to premises while rented
to you or temporarily occupied by you with permission of the owner is not an "insured
contract";
b. A sidetrack agreement;
c. Any easement or license agreement, except in connection with construction or demolition
operations on or within 50 feet of a railroad;
d. An obligation, as required by ordinance, to indemnify a municipality, except in connection
with workfora municipality;
e. An elevator maintenance agreement;
f. That part of any other contract or agreement pertaining to your business (including an indem-
nification of a municipality in connection with work performed for a municipality) under which
you assume the tort liability of another party to pay for "bodily injury" or "property damage"
to a third person or organization, provided the "bodily injury" or "property damage" is
caused, in whole or in part, by you or by those acting on your behalf. However, such part of a
contract or agreement shall only be considered an "insured contract" to the extent your
assumption of the tort liability is permitted by law. Tort liability means a liability that would be
imposed by law in the absence of any contract or agreement.
Paragraph f. does not include that part of any contract or agreement:
(1) That indemnifies a railroad for "bodily injury" or "property damage" arising out of con-
struction or demolition operations, within 50 feet of any railroad property and affecting
any railroad bridge or trestle, tracks, road-beds, tunnel, underpass or crossing;
(2) That indemnifies an architect, engineer or surveyor for injury or damage arising out of:
(a) Preparing, approving, or failing to prepare or approve, maps, shop drawings, opin-
ions, reports, surveys, field orders, change orders or drawings and specifications; or
(b) Giving directions or instructions, or failing to give them, if that is the primary cause of
the injury or damage; or
(3) Under which the insured, if an architect, engineer or surveyor, assumes liability for an
injury or damage arising out of the insured's rendering or failure to render professional
services, including those listed in (2) above and supervisory, inspection, architectural or
engineering activities.
3. Paragraph F.14.b. Personal And Advertising Injury is replaced by the following:
b. Malicious prosecution or abuse of process;
� 2016 Liberty Mutual Insurance
BP 79 96 09 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 Of 4
POLICY NUMBER:
BUSINESSOWNERS
BP 04 97 47 06
THIS ENDORSEMENT CNANGES THE POLICY. PLEASE READ IT CAREFUlLY.
1NAiVER OF TRANSFER UF RlGHTS 4F RECOVERY
AGAINST (�THERS T4 US
This endorsement modifies insurance prov'scied under the #ollawing:
BUSiNESSOWNERS COVERAGE FORM
SCHEDULE"'
Name Of Person Or Organization:
ARIZONA DEPARTMENT OF TRAN5PQRTATION
PRQCUREMENT GROUP
__.��
Paragraph K. Transfer Of Rights Of Recavery
Against Others To Us in Sectian III - Common
Poticy Conditions is amended by the addition of
the following:
We waive any right o# recovery we may have
against the person or arganization shown in the
Schedule above because of payments we make
for injury or damage arising out of your ongoing
operations or "your work" done under a contract
with ihat person or orgsnization and included in
the "products-cornpleted operations hazard".
This waiver applies only to the person or organi-
zatian shown in the Schedu{e above.
*fnformation required to complete this Schedule, if not shown above, w'ill be shown in the Declarations.
BP 04 97 01 �6 �ISO Properties, Inc., 2004 Page 1 of 'I
POLICY NUMBER: B258454613
BUSINESSOWNERS
BP 04 97 01 06
THIS ENDORSEMENT CHqNGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRAIV5FER OF RIGHTS O� RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM
SCHEDULE"
Name Of Person Or Organization:
AR120NA DEPARTMENT OF TRANSPORTATION
PROCUREMEN7 GROUP
Paragraph K. Transfer Of Rights Of Recovery
Against Others Tn Us In Section III - Common
Policy Conditions is amended by tha additfon of
the foliowing:
We waive any right of recovery we may hava
against the person or organizatlon shown in the
Schedule a6ove because of payments we make
for injury or damage arfsing out of your ongoing
operations or "your work" done under a contract
with that person or organization and included in
the "products-completed operetions hazard".
This waiver applies only to the person or organi-
zation shown in the Schedule above.
*Information required to complete thls Schedule, if not shown above, will be shown in the Declarations.
BP 04 97 01 O6 mISO Properties, Inc., 2004 Page 1 of 1
T�AVELERSJ�
ONE TOWER SQUARE
HARTFORD CT 06183
WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
ENDORSEMENT WC 00 03 13 (00) - 001
POLICY NUMBER: UB-4R92525A-21-42-G
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
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 PERSON:
� •
DESIGNATED ORGANIZATION:
ARIZONA DEPARTMENT OF TRANSPORTATION PROCUREMENT GROUP 1739
W JACKSON STREET, STE A NID 100P PHOENIX, AZ 85007
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ooaa5� DATE OF ISSUE: 02-26-21 STASSIGN: PAGE 1 OF1
BUSINESSOWNERS
BP 14 88 07 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY -
OTHER INSURANCE CONDITION
�
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM
The following is added to Paragraph H. Other In-
surance of Section III - Common Policy Condi-
tions and supersedes any provision to the con-
trary:
Primary And Noncontributory Insurance
This insurance is primary to and will not seek
contribution from any other insurance avail-
able to an additional insured under your poli-
cy provided that:
1. The additional insured is a Named In-
sured under such other insurance; and
BP 14 88 07 13
2. You have agreed in writing in a contract
or agreement that this insurance would
be primary and would not seek contribu-
tion from any other insurance available
to the additional insured.
� Insurance Services Office, Inc., 2012
Page 1 of 1