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HomeMy WebLinkAboutSignvalue Inc - Insurance Certificate 2025 DATE(MM/DDIYYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 03/10/2025 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 CONTACT Shepherd CCS NAME: Shepherd Insurance,LLC. PHONE (g2g)445-4600 FAX A/C No Ext: (A/C,No): 400 White Spar Road E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Prescott AZ 86303 INSURERA: America Fire and Casualty Company 24066 INSURED INSURER B: Travelers Casualty Co of Connecticut 36170 Signvalue Inc INSURER C: 925 S Gilbert Rd Ste 203 INSURER D: INSURER E: Mesa AZ 85204 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2531059180 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 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE_7RENTE CLAIMS-MADE �OCCUR PREM SESO(Ea occur ence) $ 2,000,000 MED EXP(Any one person) $ 15,000 A Y BZA58454613 04/08/2025 04/08/2026 PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY PRO 4,000,000 JECT LOC PRODUCTS $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,000 (Ea accident) ANYAUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED BZA58454613 04/08/2025 04/08/2026 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X1 SPER TATUTE EORH AND EMPLOYERS'LIABILITY Y/N 1,000,000 D? ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ B OFFICER/MEMBER EXCLUDE NIA UB4K92525A 04/08/2025 04/08/2026 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If 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. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins,CO 80522 -0.eN40J3kiIL156 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: BUSINESSOWNERS BP 04 07 07 13 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 CHANDLER 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: However: A. The following is added to Paragraph C. Who a. The insurance afforded to such addi- Is An Insured: tional insured only applies to the ex- 3. Any state or governmental agency or tent permitted by law; and subdivision or political subdivision b. If coverage provided to the shown in the Schedule is also an addi- additional insured is required by a tional insured, subject to the following contract or agreement, the insurance additional provision: afforded to such additional insured This insurance applies only with respect will not be broader than that which to the following hazards for which the you are required by the contract or state or governmental agency or subdivi- agreement to provide for such addi- sion or political subdivision has issued a tional insured. permit or authorization in connection B. With respect to the insurance afforded to with premises you own, rent or control these additional insureds, the following is and to which this insurance applies: added to Paragraph D. Liability And Medical a. The existence, maintenance, repair, Expenses Limits Of Insurance: construction, erection or removal of If coverage provided to the additional insured advertising signs, awnings, cano- is required by a contract or agreement, the pies, cellar entrances, coal holes, most we will pay on behalf of the additional driveways, manholes, marquees, insured is the amount of insurance: hoistaway openings, sidewalk 1. Required by the contract or agreement; vaults, street banners or decoration or and similar exposures; 2. Available under the applicable Limits Of b. The construction, erection or remov- Insurance shown in the Declarations; al of elevators; or whichever is less. c. The ownership, maintenance or use This endorsement shall not increase the ap- of any elevators covered by this in- plicable Limits Of Insurance shown in the surance. Declarations. BP 04 07 07 13 © Insurance Services Office, Inc., 2012 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 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. SP 04 97 01 06 ©ISO Properties, Inc., 2004 Page 1 of 1 POLICY NUMBER: BUSINESSOWNERS BP 04 97 0106 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: 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 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 0106 ©ISO 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 endorsement 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 complete this Schedule, if not shown above,will be shown in the Declarations. BP 04 97 01 06 ©ISO Properties, Inc., 2004 Page 1 of 1 POLICY NUMBER: BUSINESSOWNERS BP 04 97 0106 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 ©ISO Properties, Inc., 2004 Page 1 of 1 BUSINESSOVVNERS BP788GO81G THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ |TCAREFULLY. BUUSUNESSOWNERSUUABUUUTY EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: 0US|NESS[)VVNERS COVERAGE FORM 0o|ovv 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 [>fEarnings B. Broadened Coverage For Damage To Premises Rented ToYou C. Incidental Medical Malpractice Injury D. Mobile Equipment E. Blanket Additional Insured ([>vvnora, Contractors Or Lessors) F. Newly Formed Or Acquired Organizations G. Aggregate Limits H. Duties In The Event [>fOccurrence, Offense, Claim Or Suit |. Liability And Medical Expenses Definitions Bodily Injury Insured Contract Personal And Advertising Injury Section U ' Liability is amended as follows: A. Supplementary Payments Section A.1. Business Liability ia modified aafollows: 1. The $250 limit shown in Paragraph A.1.f.(1)(b) Coverage Extension - Supplementary Payments for the cost of bail bonds ia replaced bya $3,000limit. 3. The $250 limit shown in Paragraph A.1.f.(1)(d) Coverage Extension ' Supplementary Payments for reasonable expenses and loss of earnings ia replaced bya $500limit. B. Broadened Coverage For Damage Te Premises Rented TeYou 1. The last paragraph of Section B.1. Exclusions - Applicable To Business Liability Coverage iareplaced by the following: With respect to the premises which are rented to you or temporarily occupied by you with the permis- sionoftheovvner' Exc|uaionac.'d.'e.'g.' h.' k.' |.' mn.' m. ande. donotapp|yto ^proportydannage^ (�) cOl6 Liberty Mutual Insurance BP79 96O8 16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page of 3. Paragraph 0.3. Liability And Medical Expenses Limits 0f Insurance ia replaced by the following: The most we will pay under this endorsement for the aunn of all damages because of all "property damage" to premises vvhi|o rented to you or temporarily occupied by you with the permission of the owner ia the Limit of Insurance shown in the Declarations. 3. Paragraph D.3. Liability And Medical Expenses Limits Of Insurance does not apply. C. |mcidamts| 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. 3. With respect to this endorsement, the following is added to Section F. Liability And K0ediom| Eopammem 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 forfirat'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 undora. ubove. (3) Injury caused by any indononiteo if such indonnnitoo 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 in amended to include any person driving "mobile oquipnnent^ with your permission. E. Blanket Additional Insured (Oxvmems,Contractors OrLessors) 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 written contract orwritten agreement. The written contract or agreement must be: a. Currently in effect or becoming effective during the term of this policy; and b. Exocutodpriortotho ''bodi|yinjury'', ''propertydannago'', or ''poraona| andadvortiainginjury" 2. The insurance afforded to the additional insured ia limited aafollows: a. The person or organization in only an additional insured with respect to liability arising out of: (1) Real property, as described in a written contract orwritten agreement, you own, rent |oaao, 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. o. 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 ofan architect's, en- gineer's or surveyor's rendering of or failure to render any professional services including: (�) c0l8 Liberty Mutual Insurance BP79 96O8 16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page of (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 "oocunonoo" that takes place after you cease toboa 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- abletotho additional insured whether primary, excess, contingent oron any other basis unless contract specifically requires that this insurance be primary oryou request that it apply on a primary basis. F. Newly Formed Or Acquired Organizations The following ia added to Section C.Who|mAmInsured: 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. SocdonA.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 iaan 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 Limits The following is added to Paragraph 0.4. 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 toyou. For the purpose of this endorsement only, "location" nnoana pronniaoa involving the aanno orconnect- ing lots, or premises vvhoao connection is interrupted only by a street, roadway, waterway or right- of-way of a ra i I road. H. Duties |m The Event Of Occurrence,Offense,Claim OrSuit 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" ia 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 "occunonco" orclaim. 3. Paragraph E.3.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 ofan "occunenco" orclaim. (�) cOl6 Liberty Mutual Insurance BP79 96O8 16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 3ef4 |. Section F. Liability And Medical Expenses Definitions iu modified aafollows: 1. Paragraph F.3. is replaced by the following: 3. "Bodily Injury" nnoana 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. ia replaced by the following: 9. "Insured contract" means: a. A contract for a |oaao of premises. However, that portion of the contract for a lease of prem- ises that inclemnifies 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 ofa railroad; d. An obligation, as required by ordinance, to indemnify municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to your business (including anindem- nification of municipality in connection with work performed fora municipality) under which you assume thotort |iabi|ityofanotherpartytopayfor ''bodi|yinjury'' or ''proportydannago" to a third person or organization, provided the "bodily injury" or "property dannago" is caused, in vvho|o or in part, by you or by those acting on your behalf. However, such part ofa contract or agreement shall only be considered an "insured oontract" 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 oragreement. Paragraph f. does not include that part of any contract oragreement: (1) That indemnifies a railroad for "bodily injury" or "property damage" arising out ofcon- struction or demolition operations, within 50 foot of any railroad property and affecting any railroad bridge or trestle,tracks, road-beds,tunnel, underpass or crossing; (2) That inclemnifies 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, aaaunnea liability for an injury or damage arising out of the inaurod'a 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 ofprocess; (�) c0l8 Liberty Mutual Insurance BP79 96O8 16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 4ef4 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 endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE* Name Of Person Or Organization: ARIZONA DEPARTMENT OF TRANSPORTATION PROCUREMENT GROUP 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 ©ISO Properties, Inc., 2004 Page 1 of 1 POLICY NUMBER: 13Z58454 613 BUSINESSOWNERS BP 04 97 0106 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: ARIZONA DEPARTMENT OF TRANSPORTATION PROCUREMENT GROUP 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. i i *Information required to complete this Schedule, if not shown above,will be shown in the Declarations. BP 04 97 0106 @ISO Properties, Inc., 2004 Page 1 of 1 TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE HARTFORD CT 06183 EMPLOYERS LIABILITY POLICY AR ENDORSEMENT WC 00 03 13 (00) - 001 POLICY NUMBER: UB-4K92525A-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: J DESIGNATED ORGANIZATION: ARIZONA DEPARTMENT OF TRANSPORTATION PROCUREMENT GROUP 1739 W JACKSON STREET, STE A MD 100P PHOENIX, AZ 85007 N ` a� m= o� o� o� cn— v� o-= o� o� u- 009452 DATE OF ISSUE: 02-26-21 STASSIGN: PAGE 1 OF 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- 2. You have agreed in writing in a contract surance of Section III - Common Policy Condi- or agreement that this insurance would tions and supersedes any provision to the con- be primary and would not seek contribu- " trary: tion from any other insurance available Primary And Noncontributory Insurance to the additional insured. 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 © Insurance Services Office, Inc., 2012 Page 1 of 1 Coverage Is Provided In: Policy Number: Liberty American Fire and Casualty Company BZA(25) 58 45 4613 Mutual, Policy Period: INSURANCE From 04/08/2024 To 04/08/2025 Endorsement Period: Policy Change Endorsement From 08/02/2024 To 04/08/2025 12:01 am Standard Time at Insured Mailing Location Named Insured & Mailing Address Agent Mailing Address & Phone No. SIGNVALUE INC (928) 445-4600 925 S GILBERT RD STE 203 SHEPHERD INSURANCE LLC MESA, AZ 85204 400 WHITE SPAR RD PRESCOTT, AZ 86303-4626 CHANGES TO POLICY - TRANSACTION # 2 This Policy Change Endorsement Results In A Change In The Charges As Follows: No Change in Premium Description of Change(s) WAIVER OF SUBROGATION HAS BEEN ADDED IN FAVOR OF NORFOLK SOUTHERN RAILROAD; NORFOLK SOUTHERN RAILROAD FOR AMENDMENT OF CANCELLATION PROVISION IS ADDED. See The Revised Declarations and Declarations Schedule SUMMARY OF LOCATION(S) & PREMIUM(S) 0001 925 S Gilbert Rd Ste 203, Mesa, AZ 85204-4440 $302.00 POLICY FORMS AND ENDORSEMENTS This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE BP 00 03 07 13 Businessowners Coverage Form BP 0138 04 21 Arizona Changes BP 04 04 01 10 Hired Auto and Non-Owned Auto Liability BP 04 07 07 13 Additional Insured- State or Governmental Agency or Subdivision or Political Subdivision - Permits or Authorizations Relating to Premises BP 04 17 01 10 Employment-Related Practices Exclusion "BP 04 97 01 06 Waiver Of Transfer Of Rights Of Recovery Against Others To Us BP 05 17 01 06 Exclusion -Silica Or Silica-Related Dust BP 05 23 01 15 Cap On Losses From Certified Acts Of Terrorism BP 05 65 01 15 Conditional Exclusion of Terrorism Involving Nuclear, Biological or Chemical Terrorism (Relating to Disposition of Federal Terrorism Risk Insurance Act) Issue Date 08/06/2024 Authorized Representative To report a claim, call your Agent or 1-844-325-2467 DS 70 27 01 08 Page 2 019 !. 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 endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE* Name Of Person Or Organization: Norfolk Southern Railroad 650 W. Peachtree Street NW Atlanta, GA 30308. 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 ©ISO Properties, Inc., 2004 Page 1 of 1 Page 7 of 8 BUSINESSOWNERS BP 89 45 04 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF CANCELLATION PROVISIONS This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE 1. Name: Norfolk Southern Railroad 2. Mailing Address or Email Address: 650 W. Peachtree Street NW, Atlanta, GA 30308 3. Number of Days Advance Notice: 30 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Section III—Common Policy Conditions: A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the person or organization shown in the Schedule above. In no event will the notice to the person or organization scheduled above exceed the notice to the first named insured. B. Our obligation to send notice to the person or organization listed in the Schedule above will terminate at the earlier of the current policy period expiration or when you no longer have a legal or contractual obligation to such person or organization to maintain insurance coverage under a policy which requires that such person or organization be notified in the event of cancellation. ©2018 Liberty Mutual Insurance BP 89 45 04 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Page 8 of 8 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 endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE* Name Of Person Or Organization: Norfolk Southern Railroad 650 W. Peachtree Street NW Atlanta, GA 30308. 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 ©ISO Properties, Inc., 2004 Page 1 of 1 Page 7 of 8 BUSINESSOWNERS BP 89 45 0418 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF CANCELLATION PROVISIONS This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE 1. Name: Norfolk Southern Railroad 2. Mailing Address or Email Address: 650 W. Peachtree Street NW, Atlanta, GA 30308 3. Number of Days Advance Notice: 30 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Section III—Common Policy Conditions: A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the person or organization shown in the Schedule above. In no event will the notice to the person or organization scheduled above exceed the notice to the first named insured. B. Our obligation to send notice to the person or organization listed in the Schedule above will terminate at the earlier of the current policy period expiration or when you no longer have a legal or contractual obligation to such person or organization to maintain insurance coverage under a policy which requires that such person or organization be notified in the event of cancellation. ©2018 Liberty Mutual Insurance BP 89 45 04 18 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 1 of 1 Page 8 of 8