insurance and indemnification guidelines …...insurance and indemnification guidelines for state of...

INSURANCE AND INDEMNIFICATION GUIDELINES

FOR STATE OF ARIZONA CONTRACTS

TABLE OF CONTENTS (CLICK LINK BELOW TO JUMP TO MODULE)

1. Introduction

2. Professional Service Contracts 2.1. Standard Professional Service Contracts 2.2. Standard Professional Service Contracts ($50,000 or under) 2.3. Professional Service Contracts – Working with Children or Vulnerable Adults 2.4. Professional Service Contracts – Working with Children or Vulnerable Adults

($50,000 or under)

3. Service Contracts (Other than Professional Services) 3.1. Standard Service Contracts – Using Contractor Vehicles 3.2. Standard Service Contracts – Using Contractor Vehicles ($50,000 or under) 3.3. Standard Service Contracts – Contractor Vehicles Limited to Commute 3.4. Standard Service Contracts – Contractor Vehicles Limited to Commute ($50,000

or under) 3.5. Service Contracts – At a State Owned or Leased Airport 3.6. Janitorial / Building Maintenance / Caretaker Services 3.7. Janitorial / Building Maintenance / Caretaker Services ($50,000 or under) 3.8. Security Services Contracts with Use of Armored Car 3.9. Security Services Contracts without Use of Armored Car 3.10. Service Contracts – Handling Money 3.11. Service Contracts – Handling Money ($50,000 or under) 3.12. Purchase and Installation of Equipment 3.13. Purchase and Installation of Equipment ($50,000 or under) 3.14. Elevator Maintenance Contracts 3.15. Vehicle Transport / Storage / Repair 3.16. Special Events / Use of State Premises (Including Serving Liquor) 3.17. Commercial Lease / Rental Contracts 3.18. Commercial Lease / Rental Contract with Pollution 3.19. Commodity Purchase Contracts 3.20. Commodity Purchase Contracts ($50,000 or under)

4. Intergovernmental Agreements (IGA)

INSURANCE AND INDEMNIFICATION GUIDELINES.Docx

5. Environmental Services and Consulting 5.1. Remediation and Abatement Services 5.2. Disposal / Recycling / Storage 5.3. Environmental Consulting and Testing Services 5.4. Master Environmental Services 5.5. Hazardous Material Hauling

6. Information Technology Contracts 6.1. Software, Systems, Development, Hardware 6.2. Network Security Errors and Omissions 6.3. Technology Errors and Omissions 6.4. Companies Providing Content 6.5. Technology Errors and Omissions with Handling Money

7. Grants 8. Intern / Extern Work Service


INTRODUCTION

WHAT IS THE PURPOSE OF THIS MANUAL?

This manual has been developed by the Risk Management Division to assist State of Arizona staff in understanding and incorporating the State’s insurance and indemnification requirements into contracts, invitation for bids (IFBs), leases and requests for proposals (RFPs). Our goal is to provide easy-to-use guidelines that could be copied from the Internet into a contract document.

Indemnification language is required in all State contracts so that the responsibility for claims that may arise out of the course and scope of the contract will be transferred to the contractor. The insurance requirements ensure that the contractor has the financial resources to pay claims.

WHO SHOULD USE THIS MANUAL?

This manual will assist State of Arizona and University staff who:

• Negotiate or formulate contracts or leases • Administer contracts or leases • Review and approve contracts or leases • Review and track insurance certificates or binders

TRANSFERRING RISK THROUGH CONTRACTS

The State of Arizona transfers the risk of accidental loss through contracts. This transfer of risk is achieved by requiring the other party to the State of Arizona contract, i.e., the "contractor”, "vendor", “permittee”, or "lessee", to protect themselves and the State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees against claims or judgments arising from their products, services, operations, activities or use of facilities. The best way to ensure that the transfer actually takes place, i.e., loss will be paid by someone other than the State of Arizona, Department of Administration, Risk Management Division, is to require an indemnification agreement and insurance.

Bid specifications, contracts and permit requirements should contain a clear description of the required insurance. In addition, they should contain a hold harmless and indemnification clause that works in conjunction with the insurance requirements. Such a hold harmless and indemnification clause is an agreement by which one contracting party assumes the liability of another and agrees to defend them in the event of a claim. It is the legal provision that transfers risk, while insurance provides the financial guarantee.

Insurance policies that financially support the hold harmless and indemnification clause may not automatically become effective upon execution of the contract. Coverage may apply only when the contractor's insurance company issues the required insurance policies or endorses existing policies to match the insurance requirements of the contract.


As proof of coverage, most insurance agents and brokers will provide a document called a certificate of insurance. While a certificate is evidence that the contractor has an insurance policy, it does not guarantee that the required insurance provisions are in place. Even with this shortcoming, the certificate of insurance, if completed correctly, is the only practical means of confirming that coverage exists. In some situations, it may be necessary to obtain and review the actual policy and specific endorsements.

This manual provides guidance on how to establish appropriate indemnification and insurance requirements.

Insurance and indemnification requirements for a variety of contracts are discussed in this manual and sample insurance specifications are provided for each contract type.

GUIDE TO AUTOMOBILE LIABILITY EXEMPTION

Some contracts will not require the contractors to use their vehicle at all. Others may require vehicle use within a limited scope, i.e. a commute. “Commute” means a trip between the contractor’s home or principal place of business and one State agency location or destination. In these cases, where all contractors under an agreement travel only within a “commute,” or do not drive at all, the procurement officer may decide to delete the Automobile Liability Insurance Requirements from the module they have chosen.

For example, Module B-2 has been formatted to this situation for Service Contracts, where the intended vehicle use is limited to a commute. Other modules may be re-formatted by the procurement officer to implement this variable, provided the contractor’s vehicle use is limited, based on the above criteria.

It is crucial that the procurement officer know the likelihood of such limited use before deciding to eliminate the Automobile requirement. It is equally important that the procurement officer know the vehicle use under the contract before contacting Risk Management for advice regarding the Automobile Liability requirement.

STATEWIDE CONTRACTS

PLEASE BE AWARE THAT THE INDEMNITY AND INSURANCE PROVISIONS MAY APPLY TO CERTAIN COOPERATIVE PARTIES WHEN A STATEWIDE CONTRACT IS USED. RISK MANAGEMENT RECOMMENDS THAT THE CONTRACT ADMINISTRATOR IDENTIFY THOSE COOPERATIVE PARTIES IN A SECTION OF THE CONTRACT AND STATE CLEARLY, BY REFERENCE TO THE INDEMNITY AND INSURANCE PROVISIONS, THE APPLICABILITY OF SUCH PROVISIONS TO THE THOSE PARTIES.

This manual does not address all possible insurance questions that can arise, but is intended to address the most common situations. Be sure to contact Risk Management if you have any questions on the material contained herein or need guidance on insurance requirements for specific contracts.

CONTACT RISK MANAGEMENT DIVISION


If you have any questions about the information contained in this manual, or need assistance in determining the appropriate insurance and/or indemnification language, please contact the Risk Management Division at:

Department of Administration - Risk Management Division

100 North 15th Avenue, Suite 301

Phoenix, AZ 85007 Phone: (602) 542-2175


PROFESSIONAL SERVICE CONTRACTS

STANDARD PROFESSIONAL SERVICE CONTRACTS

Professional liability insurance protects against losses that occur when a "professional" fails to practice his or her art to the usual and customary standards of that profession. Therefore, there can be risks to the State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees associated with errors (or allegations of errors) in the professional’s work product or judgment. Professional liability may have a different meaning when it relates to insurance rather than a "type" of State of Arizona contract. In order to determine if you should require professional liability insurance, ask yourself:

1) Is the professional licensed or certified paramedics, attorneys, engineers, etc.); 2) Will the information developed by the professional be used in a decision-making process within the State of Arizona that could create a liability (i.e. prepares documentation used to complete an EPA permit).

If the answer is yes to either 1 or 2, then professional liability insurance should be required. The types of losses that can occur under such circumstances are often excluded under general liability policies. They can be covered through separate professional liability insurance policies, also known as “errors and omissions” (E&O) liability insurance. Examples of services that would require professional liability coverage include, but are not limited to:

• Accountants • Appraisers • Attorneys • Auctioneers • Auditors • Computer design

• Consultants • Engineers/architects • Financial consultants • Medical professionals • Social Workers • Teachers

Note: Professional Service contracts for engineers and architects are handled through the various State agencies, departments, and universities. The contracts developed for engineering/architectural design contracts include the appropriate indemnification and insurance specifications. Please contact the appropriate department for more information about the contract process. Because professional liability insurance is usually written on a claims-made basis, there is a concern about coverage for latent defects or design errors that may result in claims after the contract has been completed. One solution to this problem is to require the contractor to maintain coverage for a specified period after the project has been completed or to purchase an extended reporting period, otherwise known as "tail coverage.” The sample specifications that follow require a two-year extended reporting period for all claims-made policies. STANDARD PROFESSIONAL SERVICE CONTRACTS


INDEMNIFICATION CLAUSE: Contractor shall defend, indemnify, and hold harmless the State of Arizona, and its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees (hereinafter referred to as “Indemnitee”) from and against any and all claims, actions, liabilities, damages, losses, or expenses (including court costs, attorneys’ fees, and costs of claim processing, investigation and litigation) (hereinafter referred to as “Claims”) for bodily injury or personal injury (including death), or loss or damage to tangible or intangible property caused, or alleged to be caused, in whole or in part, by the negligent or willful acts or omissions of Contractor or any of its owners, officers, directors, agents, employees or subcontractors. This indemnity includes any claim or amount arising out of, or recovered under, the Workers’ Compensation Law or arising out of the failure of such contractor to conform to any federal, state or local law, statute, ordinance, rule, regulation or court decree. It is the specific intention of the parties that the Indemnitee shall, in all instances, except for Claims arising solely from the negligent or willful acts or omissions of the Indemnitee, be indemnified by Contractor from and against any and all claims. It is agreed that Contractor will be responsible for primary loss investigation, defense and judgment costs where this indemnification is applicable. In consideration of the award of this contract, the Contractor agrees to waive all rights of subrogation against the State of Arizona, its officers, officials, agents and employees for losses arising from the work performed by the Contractor for the State of Arizona. This indemnity shall not apply if the contractor or sub-contractor(s) is/are an agency, board, commission or university of the State of Arizona. INSURANCE REQUIREMENTS: Contractor and subcontractors shall procure and maintain until all of their obligations have been discharged, including any warranty periods under this Contract, are satisfied, insurance against claims for injury to persons or damage to property which may arise from or in connection with the performance of the work hereunder by the Contractor, his agents, representatives, employees or subcontractors. The insurance requirements herein are minimum requirements for this Contract and in no way limit the indemnity covenants contained in this Contract. The State of Arizona in no way warrants that the minimum limits contained herein are sufficient to protect the Contractor from liabilities that might arise out of the performance of the work under this contract by the Contractor, its agents, representatives, employees or subcontractors, and Contractor is free to purchase additional insurance. A. MINIMUM SCOPE AND LIMITS OF INSURANCE: Contractor shall provide coverage with

limits of liability not less than those stated below. 1. Commercial General Liability – Occurrence Form

Policy shall include bodily injury, property damage, personal and advertising injury and broad form contractual liability coverage.

• General Aggregate $2,000,000 • Products – Completed Operations Aggregate $1,000,000 • Personal and Advertising Injury $1,000,000 • Blanket Contractual Liability – Written and Oral $1,000,000 • Damage to Rented Premises $ 50,000 • Each Occurrence $1,000,000


a. The policy shall be endorsed (blanket endorsements are not acceptable) to include the following additional insured language: “The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees shall be named as additional insureds with respect to liability arising out of the activities performed by or on behalf of the Contractor.” Such additional insured shall be covered to the full limits of liability purchased by the Contractor, even if those limits of liability are in excess of those required by this Contract.

b. Policy shall contain a waiver of subrogation endorsement (blanket endorsements are not acceptable) in favor of the State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees for losses arising from work performed by or on behalf of the Contractor.

2. Business Automobile Liability

Bodily Injury and Property Damage for any owned, hired, and/or non-owned vehicles used in the performance of this Contract.

• Combined Single Limit (CSL) $1,000,000

a. The policy shall be endorsed (blanket endorsements are not acceptable) to include the following additional insured language: “The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees shall be named as additional insureds with respect to liability arising out of the activities performed by or on behalf of the Contractor, involving automobiles owned, leased, hired or borrowed by the Contractor.” Such additional insured shall be covered to the full limits of liability purchased by the Contractor, even if those limits of liability are in excess of those required by this Contract.

b. Policy shall contain a waiver of subrogation endorsement (blanket endorsements are not acceptable) in favor of the State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees for losses arising from work performed by or on behalf of the Contractor.

c. Policy shall contain a severability of interest provision. 3. Worker's Compensation and Employers' Liability

• Workers' Compensation Statutory • Employers' Liability

Each Accident $ 500,000 Disease – Each Employee $ 500,000 Disease – Policy Limit $1,000,000

a. Policy shall contain a waiver of subrogation endorsement (blanket endorsements are not acceptable) in favor of the State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees for losses arising from work performed by or on behalf of the Contractor.


b. This requirement shall not apply to: Separately, EACH contractor or subcontractor exempt under A.R.S. § 23-901, AND when such contractor or subcontractor executes the appropriate waiver (Sole Proprietor/Independent Contractor) form.

4. Professional Liability (Errors and Omissions Liability)

Each Claim $1,000,000 Annual Aggregate $2,000,000

a. In the event that the professional liability insurance required by this Contract is written on a claims-made basis, Contractor warrants that any retroactive date under the policy shall precede the effective date of this Contract; and that either continuous coverage will be maintained or an extended discovery period will be exercised for a period of two (2) years beginning at the time work under this Contract is completed.

b. The policy shall cover professional misconduct or negligent acts for those positions defined in the Scope of Work of this contract.

B. ADDITIONAL INSURANCE REQUIREMENTS: The policies shall include, or be

endorsed (blanket endorsements are not acceptable) to include, the following provisions:

1. The Contractor's policies shall stipulate that the insurance afforded the contractor shall be primary insurance and that any insurance carried by the Department, its agents, officials, employees or the State of Arizona shall be excess and not contributory insurance, as provided by A.R.S. § 41-621 (E).

2. Coverage provided by the Contractor shall not be limited to the liability assumed under the indemnification provisions of this Contract.

C. NOTICE OF CANCELLATION: With the exception of (10) day notice of cancellation for

non-payment of premium, any changes material to compliance with this contract in the insurance policies above shall require (30) days written notice to the State of Arizona. Such notice shall be sent directly to the Department and shall be sent by certified mail, return receipt requested.

D. ACCEPTABILITY OF INSURERS: Contractors insurance shall be placed with companies

duly licensed in the State of Arizona or hold approved non-admitted status on the Arizona Department of Insurance List of Qualified Unauthorized Insurers. Insurers shall have an “A.M. Best” rating of not less than A- VII or duly authorized to transact Workers’ Compensation insurance in the State of Arizona. The State of Arizona in no way warrants that the above-required minimum insurer rating is sufficient to protect the Contractor from potential insurer insolvency.

E. VERIFICATION OF COVERAGE: Contractor shall furnish the State of Arizona with

certificates of insurance (ACORD form or equivalent approved by the State of Arizona) as required by this Contract. The certificates for each insurance policy are to be signed by an authorized representative.

All certificates and endorsements are to be received and approved by the State of Arizona before work commences. Each insurance policy required by this Contract must be in effect at or prior to commencement of work under this Contract and remain in effect for the


duration of the project. Failure to maintain the insurance policies as required by this Contract, or to provide evidence of renewal, is a material breach of contract.

All certificates required by this Contract shall be sent directly to the Department. The State of Arizona project/contract number and project description shall be noted on the certificate of insurance. The State of Arizona reserves the right to require complete copies of all insurance policies required by this Contract at any time.

F. SUBCONTRACTORS: Contractors’ certificate(s) shall include all subcontractors as insureds under its policies or Contractor shall furnish to the State of Arizona separate certificates and endorsements for each subcontractor. All coverages for subcontractors shall be subject to the minimum requirements identified above.

G. APPROVAL: Any modification or variation from the insurance requirements in this Contract

shall be made by the contracting agency in consultation with the Department of Administration, Risk Management Division. Such action will not require a formal Contract amendment, but may be made by administrative action.

H. EXCEPTIONS: In the event the Contractor or sub-contractor(s) is/are a public entity, then

the Insurance Requirements shall not apply. Such public entity shall provide a Certificate of Self-Insurance. If the contractor or sub-contractor(s) is/are a State of Arizona agency, board, commission, or university, none of the above shall apply.

OP 10' MCACORD" CERTIFICATE OF LIABILITY INSURANCE I DATE(MM/DDIYYVY)

~ 09/27/12THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsementts).

PRODUCER Phone: 520-795-8511CONTACTNAME:

THE MAHONEY GROUP - TUCSONFax: 520-795-8542 rA~gNJ'o Ev+\' liM Nol:5330 N. La Cholla Blvd

Tucson, AZ 85741-3815 E-MAILADDRESS:

Jonathan De Bake~~~~~~~~ ID1t'AVINN-1

INSURERISIAFFORDINGCOVERAGE NAIC#INSURED A V Innovations, Inc. INSURERA: Hartford I ns. Co. of Midwest 37478

Attn: Alicia Teague INSURERB .Cincinnati Insurance Company 106774408 E. Speedway Blvd

INSURERC:Tucson, AZ 85712

INSURERD:

INSURERE:

I""IIRI'R" .

COVERAGES CERTIFICATE NUMBER' REVISION NUMBER'

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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 ADDL SUBR POLICYEFF POLICYEXPLTR TYPEOFINSURANCE I'''~D .n'~ POLICYNUMBER LIMITS

GENERALLIABILITY EACHOCCURRENCE $ 1,000,00(f--

B ~ OMMERCIAL GENERALLIABILITY EPP0148851 07/01/12 07/01/13 ~~~~~~~9E~~~~r~encel $ 100,00(

f-- CLAIMS·MADE [KJ OCCUR MED EXP (Anyone person) $ 5,00(

- PERSONAL& ADV INJURY $ 1,000,00(

- GENERALAGGREGATE $ 2,000,00C

n'L AGGREnE LIMITAPnS PER: PRODUCTS- COMPlOPAGG $ 2,000,00CPOLICY ~§RT LOC $

AUTOMOBILELIABILITY COMBINEDSINGLELIMIT$ 1,000,00U- (Ea accident)

B ~ ANYAUTO EBA0148851 07/01/12 07/01/13BODILYINJURY(Perperson) $

- ALL OWNEDAUTOS BODILYINJURY(Peraccident) $SCHEDULEDAUTOS PROPERTYDAMAGE- $HIREDAUTOS (Peraccident)

-NON-OWNEDAUTOS $

-$

X UMBRELLA L1AB py OCCUR EACHOCCURRENCE $ 1,000,001I--X EXCESSLIAB CLAIMS-MADE AGGREGATE $ 1,000,00(

B EPP0148851 07/01/12 07/01/13I-- DEDUCTIBLE $

RETENTION s $

WORKERSCOMPENSATION X I -i6~-rl~¥sI IOTH-AND EMPLOYERS'LIABILITY ER

YIN 1,000,00(A ANYPROPRIETORIPARTNERlEXECUTIVED 59WECDG4479 01/01/12 01/01/13 EL. EACHACCIDENT $OFFICERlMEMBEREXCLUDED? N/A

1,000,00((Mandatory in NH) EL. DISEASE- EAEMPLOYEE $If yes. describe under 1,000,00(DESCRIPTIONOFOPERATIONSbelow EL. DISEASE- POLICYLIMIT $

DESCRIPTIONOFOPERATIONSI LOCATIONSI VEHICLES (Attach ACORD101, Additional RemarksSchedule, If more space Is required)~e: Solicitation #ADSP012-00001903

SEE NOTEPAD

CERTIFICATE HOLDER CANCELLATION

STATE-1SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

State of ArizonaACCORDANCE WITH THE POLICY PROVISIONS.

Attn: State Procurement Office100 N. 15th Ave. #201

AUTHORIZEDREPRESENTATIVE

Phoenix, AZ 85007 f\)J\2u.I

ACORD 25 (2009/09)

© 1988-2009 ACORD CORPORATION, All rights reserved,

The ACORD name and logo are registered marks of ACORD

NOTEPAD: HOLDER CODE STATE-1INSURED'S NAME A V Innovations, Inc.

AVINN-1OP ID: MC

PAGE 2DATE 09/27/12

Additional Insured and Waiver of Subrogation in favor of The State ofArizona, its departments, agencies, boards, commissionsl universities andits officers, officiaJ~ agents! ~nd employee!iJ..sul:>ject to attached formnum bers #GA233J-\L(0909),AA4004(0306), AA41 T4(1105), AA4172(0909) andWC000313(0484).

POLICY #EPP0148851

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CONTRACTORS' COMMERCIAL GENERAL LIABILITYBROADENED ENDORSEMENT

5. Medical Payments

Medical Expense Limit $ 10,000

6. Voluntary Property Damage (Coverage a.) and Care, Custody or Control Liability Coverage(Coverage b.)

Limits of Insurance (Each Occurrence)Coverage a. $1,000Coverage b. $5,000 unless otherwise stated $ _

Deductibles (Each Occurrence)Coverage a. $250Coverage b. $250 unless otherwise stated $ _

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY CDVERAGE PART

A. Endorsement» Table of Contents:

Coverage: Begins on Page:COVERAGE PREMIUM BASIS RATE ADVANCE PREMIUM

(a) Area (For Limits in Excess of (For Limits in Excess of(b) Payroll $5,000) $5,000)(c) Gross Sales

!~Ig~~rb. Care, Custody $or Control

TOTAL ANNUAL PREMIUM $

1. Employee Benefit Liability Coverage .........•..•..............•....................•..............•...............•.....•............22. Unintentional Failure to Disclose Hazards ....•..........•............................................................•.........••..73. Damage to Premises Rented to you ............•..................._....•....•.................................•..................... 84. Supplementary Payments .•.•........•...•....•...........•...............•.............................•.•...•.•.••••••...••.•.•••.•.......95. Medical Payments •.......................•............•...•....•..•...........••....•....................•..................•.•....•••....•.....•96. Voluntary Property Damage (Coverage a.) and Care, Custody or Control

Liability Coverage (Coverage b.) ..••.........•...•••..............•......•..•.........................•..................•.•.............9

•• ~:~2i~~~?~~~~~g:tt~~~.~~~:..:.~:~~.~~.~~.~~i~~~.~~=:~~~~~~~.:::::::::::::::::::::::::::::::::::::::::::::::::~~9. Automatic Additional Insured • Specified Relationships: .•.........••.......•.••••..•.•..•.••.......•.............••..••.10

Managers or Lessors of Premises;Lessor of Leased Equipment;Vendors;State or Political Subdivisions - Permits Relating to Premises;State or Political Subdivisions - Permits; andContractors' Operations

10. Broadened Contractual Liability - Work Within 50' of Railroad Property ........•..............••.•..•....•......1311. Property Damage to Borrowed Equipment .......................•..............•••.••.••.•••.•.•................................1312. Employees as Insureds - Specified Health Care Services: ..•....•.•.........•...........•............•....•...........14

Nurses;Emergency Medical Technicians; andParamedics

13. Broadened Notice of Occurrence .•.•.....•.........•........•....•....••..............................;..........•.................... 14

11. Property Damage to Borrowed Equipment

Each Occurrence Limit: $ 10,000Deductible: $ 250

B. Limits of Insurance:

The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorse-ment, except as provided below:

1. Employee Benefit Liability Coverage

Each Employee Limit: $ 1,000,000Aggregate Limit $ 3,000,000Deductible: $ 1,000

3. Damage to Premises Rented to You

The lesser of:

a. The Each Occurrence Limit shown in the Declarations; or

b. $500,000 unless otherwise stated $ _4. Supplementary Payments

a. Bail bonds: $ 1,000

b. Loss of earnings: $ 350

C. Coverages:

1. Employee Benefit Liability Coverage

a. The following is added to SECTION I• COVERAGES: Employee BenefitLiability Coverage.

(1) Insuring Agreement

(a) We will pay those sums thatthe insured becomes legallyobligated to pay as dam-ages caused by any act, er-ror or omission of the in-sured, or of any other per-son for whose acts the in-sured is legally liable, towhich this insurance ap-plies. We will have the lightand duty to defend the in-sured against any "sult"seeking those damages.However, we will have noduty to defend against any"suit" seeking damages towhich this insurance doesnot apply. We may, at ourdiscretion, investigate anyreport of an act, error oromission and settle anyclaim or "suit" that may re-sult. But:

1) The amount we will payfor damages is limitedas described in SEC-TION III - LIMITS OFINSURANCE; and

2) Our right and duty todefend ends when wehave used up the ap-plicable limit of insur-ance in the payment ofjudgments or settle-ments.

No other obligation or liabil-ity to pay sums or performacts or services is coveredunless explicitly provided forunder Supplementary Pay-ments.

(b) This insurance applies todamages only if the act, er-ror or omission, is negli-gen~y committed in the"administration" of your"employee benefit pro-gram"; and

1) Occurs during the pol-icy period; or

2) Occurred prior to theeffective date of thisendorsement provided:

a) You did not haveknowledge of aclaim or "suit" onor before the ef-fective date of thisendorsement.

You will bedeemed to have

GA233 AZ 09 09Includes copyrighted material of InsuranceServices Office, lnc., with its permission. Page 1 of14 GA 233 AZ 09 09

Includes copyrighted material of InsuranceServices Office, Inc.•with its permission. Page 2 of14

knowledge of aclaim or "sult"when any"authorized repre-sentative";

i) Reports all, orany part, of theact, error oromission to usor any otherinsurer;

ii) Receives awritten or ver-bal demand orclaim for dam-ages becauseof the act, er-ror or omis-sion; and

b) There is no otherapplicable insur-ance.

1) 'Failure of any invest-ment to perform;

2) Errors in providing in-formation on past per-formance of investmentvehicles;or

3) Advice given to anyperson with respect tothat person's decisionto participate or not toparticipate in any planincluded in the "em-ployee benefit pro-gram".

(I) Workers' Compensationand Similar Laws

Any claim arising out ofyour failure to comply withthe mandatory provisions ofany workers' compensation,unemployment compensa-tion insurance, social secu-rity or disability benefits lawor any similar law.

(g) ERISA

Damages for which any in-sured is liable because ofliability imposed on a fiduci-ary by the Employee Re-tirement Income SecurityAct of 1974, as now orhereafter amended, or byany similar federal, state orlocal laws.

(h) Available Benefits

Any claim for benefits to theextent that such benefitsare available, with reason-able effort and cooperationof the insured, from the ap-plicable funds accrued orother collectible insurance.

(i) Taxes, Fines or Penalties

Taxes, fines or penalties,including those imposedunder the Internal RevenueCode or any similar state orlocal law.

(j) Employment-RelatedPractices

Any liability arising out ofany:

(1) Refusal to employ;

(2) Termination of em-ployment;

(3) Coercion, demotion,evaluation, reassign-

ment, discipline, defa-mation, harassment,humiliation, discrimina-tion or other employ-ment-related practices,acts or omissions; or

(4) Consequential liabilityas a result of (1), (2) or(3) above.

This exclusion applieswhether the insured may beheld liable as an employeror in any other capacity andto any obligation to sharedamages with or repaysomeone else who mustpay damages because ofthe injury.

(3) Supplementary Payments

SECTION I - COVERAGES,SUPPLEMENTARY PAY-MENTS - COVERAGES A ANDB also apply to this Coverage.

b. Who is an Insured

As respects Employee Benefit Liabil-ity Coverage, SECTION II - WHO ISAN INSURED is deleted in its en-tirety and replaced by the following:

(1) If you are designated in theDeclarations as:

(a) An individual, you and yourspouse are insureds, butonly with respect to theconduct of a business ofwhich you are the soleowner.

(b) A partnership or joint ven-ture, you are an insured.Your members, your part-ners, and their spouses arealso insureds but only withrespect to the conduct ofyour business.

(c) A limited liability company,you are an insured. Yourmembers are also insureds,but only with respect to theconduct of your business.Your managers are in-sureds, but only with re-spect to their duties as yourmanagers.

(d) An organization other thana partnership, joint ventureor limited liability company,you are an insured. Your"executive officers" and di-rectors are insureds, butonly with respect to theirduties as your officers or di-

(2) Exclusions

This insurance does not applyto:

(a) Bodily Injury, PropertyDamage or Personal andAdvertising Injury

"Bodily injury", "propertydamage" or "personal andadvertising injury".

(b) Dishonest, Fraudulent,Criminal or Malicious Act

Damages arising out of anyintentional, dishonest,fraudulent, criminal or mali-cious act, error or omission,committed by any insured,including the willful or reck-less violation of any statute.

(c) Failure to Perform a Con-tract

Damages arising out of fail-ure of performance of con-tract by any insurer.

(d) Insufficiency of Funds

Damages arising out of aninsufficiency of funds tomeet any obligations underany plan included in the"employee benefit pro-gram".

(e) Inadequacy of Perform-ance of Investment I Ad-vice Given With Respectto Participation

Any claim based upon:

GA 233 AZ. 09 09Includes copyrighted material of InsuranceServices Office, lnc., with its permission. GA 233 AZ. 09 09

Includes copyrighted material of InsuranceServices Office, Inc., with its permission. Page 4 of14Page 3 of14

rectors. Your stockholdersare also insureds, but onlywith respect to their liabilityas stockholders.

(e) A trust, you are an insured.Your trustees are also in-sureds, but only with re-spect to their duties astrustees.

(2) Each of the following is also aninsured:

(a) Each of your "employees"who is or was authorized toadminister your "employeebenefit program".

(b) Any persons, organizationsor "employees" havingproper temporary authori-zation to administer your"employee benefit program"if you die, but only until yourlegal representative is ap-pointed.

(c) Your legal representative ifyou die, but only with re-spect to duties as such.That representative willhave all your rights and du-ties under this CoveragePart,

(3) Any organization you newly ac-quire or form, other than a part-nership, joint venture or limitedliability company, and overwhich you maintain ownershipor majority interest, will qualifyas a Named Insured if no othersimilar insurance applies to thatorganization. However, cover-age under this provision:

(a) Is afforded only until the180th day after you acquireor form the organization orthe end of the policy period,whichever is earlier; and

(b) Does not apply to any act,error or omission that wascommitted before you ac-quired or formed the or-ganization.

c. Limits of InsuranceAs respects Employee Benefit Liabil-ity Coverage, SECTION III - LIMITSOF INSURANCE is deleted in its en-tirety and replaced by the following:

(1) The Limits of Insurance shownin Section B. Limits of Insur-ance, 1. Employee Benefit Li-ability Coverage and the rules

(d) Acts, errors or omissions; or

(e) Benefits included in your"employee benefit pro-gram".

(2) The Aggregate Limit shown inSection B. Limits of Insurance,1. Employee Benefit LiabilityCoverage of this endorsementis the most we will pay for alldamages because of acts, er-rors or omissions negligentlycommitted in the "administra-tion" of your "employee benefitprogram".

(3) Subject to the limit described in(2) above, the Each EmployeeLimit shown in Section B. Limitsof Insurance, 1. EmployeeBenefit Liability Coverage ofthis endorsement is the most wewill pay for all damages sus-tained by anyone "employee",including damages sustained bysuch "employee's" dependentsand beneficiaries, as a result of:

(a) An act, error or omission; or

(b) A series of related acts, er-rors or omissions, regard-less of the amount of timethat lapses between suchacts, errors or omissions,

negligently committed in the"administration" of your "em-ployee benefit program".

However, the amount paid un-der this endorsement shall notexceed, and will be subject tothe limits and restrictions thatapply to the payment of benefitsin any plan included in the "em-ployee benefit program".

(4) Deductible Amount

(a) Our obligation to pay dam-ages on behalf of the in-sured applies only to theamount of damages in ex-cess of the deductibleamount slated in the Decla-rations as applicable toEach Employee. The limitsof insurance shall not be

Includes copyrighted material of InsuranceServices Office, lnc.,with its permission.

below fix the most we will payregardless of the number of:

(a) Insureds;

(b) Claims made or "suits"brought;

(c) Persons or organizationsmaking claims or bringing"suits";

GA 233 AZ 09 09

reduced by the amount ofthis deductible.

(b) The deductible amountslated in the Declarationsapplies to all damagessustained by anyone "em-ployee", including such"employee's" dependentsand beneficiaries, becauseof all acts, errors or omis-sions to which this insur-ance applies.

(c) The terms of this insurance,including those with respectto:

1) Our right and duty todefend the insuredagainst any "suits"seeking those dam-ages; and

2) Your duties, and theduties of any other in-volved insured, in theevent of an act, error oromission, or claim,

apply irrespective of theapplication of the deductibleamount.

(d) We may pay any part or allof the deducJible amount toeffect settlement of anyclaim or "sult" and, uponnotification of the actiontaken, you shall promptlyreimburse us for such partof the deducJible amount aswe have paid.

d. Additional Conditions

As respects Employee Benefit li-ability Coverage, SECTION IV -COMMERCIAL GENERAL LIABIL-ITY CONDITIONS is amended asfollows:

(1) Item 2. Duties in the Event ofOccurrence, Offense, Claim orSuit is deleted in its entirety andreplaced by the following:

2. Duties in the Event of an Act, Error orOmission, or Claim or Suit

a. You must see to it that we are noti-fied as soon as practicable of an act,error or omission which may result ina claim. To the extent possible, no-tice should include:

(1) What the act, error or omissionwas and when it occurred; and

(2) The names and addresses ofanyone who may suffer dam-

ages as a result of the act, erroror omission.

b. If a claim is made or "suif' is broughtagainst any insured, you must:

(1) Immediately record the specificsof the claim or "suit" and thedate received; and

(2) Notify us as soon as practicable.

You must see to it that we receivewritten notice of the claim or "suit" assoon as pracJicable.

c. You and any other involved insuredmust:

(1) Immediately send us copies ofany demands, notices, sum-monses or legal papers re-ceived in connection with theclaimor "sult";

(2) Authorize us to obtain recordsand other information;

(3) Cooperate with us in the investi-gation or settlement of the claimor defense against the "suit";and

(4) Assist us, upon our request, inthe enforcement of any rightagainst any person or organiza-tion which may be liable to theinsured because of an act, erroror omission to which this insur-ance may also apply.

d. No insured will, except at that in-sured's own cost, voluntarily make apayment, assume any obligation, orincur any expense without our con-sent.

(2) Item 5. Other Insurance is de-leted in its entirety and replacedby the following:

5. Other Insurance

If other valid and collectibleinsurance is available to theinsured for a loss we coverunder this Coverage Part,our obligations are limitedas follows:

a. Primary Insurance

This insurance is pri-mary except when c.below applies. If this in-surance is primary, ourobligations are not af-fected unless any ofthe other insurance isalso primary. Then, wewill share with all thatother insurance by the

method described in b.below.

b. Method of Sharing

If all of the other insur-ance permits contribu-tion by equal shares,we will follow thismethod also. Underthis approach each in-surer contributes equalamounts until it haspaid its applicable limitof insurance or none ofthe loss remains,whichever comes first

If any of the other in-surance does not per-mit contribution byequal shares, we willcontribute by limits.Under this method,each insurer's share isbased on the ratio of itsapplicable limit of in-surance to the total ap-plicable limits of insur-ance of all insurers.

c. No Coverage

This insurance shall notcover any loss forwhich the insured isentitled to recovery un-der any other insur-ance in force previousto the effective date ofthis Coverage Part

e. Additional Definitions

As respects Employee Benefit Li-ability Coverage, SECTION V -DEFINITIONS is amended as fol-lows:

(1) The following definitions areadded:

1. "Administration" means:

a. Providing information to"employees", includingtheir dependents andbeneficiaries, with re-spect to eligibility for orscope of "employeebenefit programs";

b. lnterpretinq the "em-ployee benefit pro-grams":

c. Handling records inconnection with the"employee benefit pro-grams";or

Page 5 of14 GA 233 AZ 09 09Includes copyrighted material of InsuranceServices Office, Inc., with its permission. Page 6 of14

3. "Employee benefit pro-grams'l means a programproviding some or all of thefollowing benefits to "em-ployees", whether providedthrough a "cafeteria plan" orotherwise:

a. Group life insurance;group accident orhealth insurance; den-tal, vision and hearingplans; and flexiblespending accounts;provided that no oneother than an "em-ployee" may subscribeto such benefits andsuch benefits are madegenerally available tothose "employees" whosatisfy the plan's eligi-bility requirements;

b. Profit sharing plans,employee savingsplans, employee stockownership plans, pen- SECTION IV _ COMMERCIAL GENERALsion plans and stock LIABILITY CONDITIONS, 7. Represen-subscription plans, tations is hereby amended by the addi-~i~~~de~a~ata~o ,,~:! tion of the following:ployee" may subscribe Based on our dependence upon yourto such benefits and representations as to existing hazards, ifsuch benefits are made unintentionally you should fail to disclosegenerally available to all such hazards at the inception date ofall "employees" who your policy, we will not reject coverageare eligible under the under this Coverage Part based solely onplan for such benefrts; such failure.

Includes copyrighted material of InsuranceServices Office, Inc., with its permission.

d. Effecting, continuing orterminating any "em-ployee's" participationin any benefit includedin the "employee bene-fit program".

However, "administration"does not include:

a. Handling payroll de-ductions; or

b. The failure to effect ormaintain any insuranceor adequate limits ofcoverage of insurance,including but not limitedto unemployment in-surance, social securitybenefits, workers' com-pensation and disabilitybenefits.

2. "Cafeteria plans" meansplan authorized by applica-ble law to allow "employ-ees" to elect to pay for cer-tain benefits with pre-taxdollars.

GA 233 AZ 09 09

Unemployment insur-ance, social securitybenefits, workers' com-pensation and disabilitybenefits; and

d. Vacation plans, includ-ing buy and sell pro-grams; leave of ab-sence programs, in-cluding military, mater-nity, family, and civilleave; tuition assis-tance plans; transpor-tation and health clubsubsidies.

3. Damage to Premises Rented to You

a, The last Subparagraph of Paragraph2. SECTION I - COVERAGES,COVERAGE A. - BODILY INJURYAND PROPERTY DAMAGE, 2. LI-ABILITY Exclusions is hereby de-leted and replaced by the following:

Exclusions c. through q. do not applyto damage by fire, explosion, light-ning, smoke or soot to premiseswhile rented to you or temporarilyoccupied by you with permission ofthe owner.

b. The insurance provided under SEC-TION I - COVERAGES, COVERAGEA. BODILY INJURY AND PROP-ERTY DAMAGE UABIUTY appliesto "property damage" arising out ofwater damage to premises that areboth rented to and occupied by you.

(1) As respects Water Damage Le-gal Uability, as provided inParagraph 3.b. above:

The exclusions under SECTIONI - COVERAGES, COVERAGEA. BODILY INJURY ANDPROPERTY DAMAGE LIABIL-ITY, 2. Exclusions, other than i.War and the Nuclear EnergyLiability Exclusion, are deletedand the following are added:

This insurance does not applyto:

(a) "Property damage":

1) Assumed in any con-tract; or

2) Loss caused by or re-sulting from any of thefollowing:

a) Wear and tear;

b) Rust, corrosion,fungus, decay,deterioration, hid-den or latent de-fect or any qualityin property thatcauses it to dam-age or destroy it-self;

c) Smog;

d) Mechanicalbreakdown in-cluding rupture orbursting causedby centrifugalforce;

e) Settling, cracking,shrinking or ex-pansion; or

f) Nesting or infesta-tion, or dischargeor release ofwaste products orsecretions, by in-sects, birds, ro-dents or otheranimals.

(b) Loss caused directly or indi-rectly by any of the follow-ing:

1) Earthquake, volcaniceruption, landslide orany other earth move-ment;

2) Water that backs up oroverflows from asewer, drain or sump;

3) Water under theground surface press-ing on, or flowing orseeping through:

a) Foundations,walls, floors orpaved surfaces;

b) Basements,whether paved ornot; or

c) Doors, windows orother openings.

(c) Loss caused by or resultingfrom water that leaks orflows from plumbing, heat-ing, air conditioning, or fireprotection systems causedby or resulting from freez-ing, unless:

1) You did your best tomaintain heat in thebuilding or structure; or

2) You drained theequipment and shut offthe water supply if theheat was not main-tained.

(d) Loss to or damage to:

1) Plumbing, heating, airconditioning, fire pro-tection systems, orother equipment or ap-pliances; or

2) The interior of anybuilding or structure, orto personal property inthe building or structure

c.

(2) The following definitions aredeleted in their entirety and re-placed by the following:

21. "Suit" means a civil pro-ceeding in which moneydamages because of anact, error or omission towhich this insurance appliesare alleged. "Suit" includes:

a. An arbitration pro-ceeding in which suchdamages are claimedand to which the in-sured must submit ordoes submit with ourconsent;

b. Any other alternativedispute resolution pro-ceeding in which suchdamages are claimedand to which the in-sured submits with ourconsent; or

2.

c. An appeal of a civilproceeding.

8. "Employee" means a per-son actively employed, for-merly employed, on leaveof absence or disabled, orretired. "Employee" includesa "leased worker". "Em-ployee" does not include a"temporary worker".

Unintentional Failure to Disclose Haz-ards

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4.

caused by or resultingfrom rain, snow, sleetor ice, whether drivenby wind or not

c. Limit oflnsurance

The Damage to Premises Rented toYou Limit as shown in the Declara-tions is amended as follows:

(2) Paragraph 6. of SECTIDN III •LIMITS OF INSURANCE ishereby deleted and replaced bythe following:

6. Subject to 5. above, theDamage to PremisesRented to You Limit is themost we will pay underCOVERAGE A. BODILYINJURY AND PROPERTYDAMAGE LIABILITY, fordamages because of"property damage" topremises while rented toyou or temporarily occupiedby you with permission ofthe owner, arising out ofanyone "occurrence" towhich this insurance ap·'plies.

(3) The amount we will pay is Ilrn-ited as described in Section B.Limits of Insurance, 3. Darn-age to Premises Rented toYou of this endorsement.

Supplementary Payments

Under SECTION I • COVERAGE, SUP.PLEMENTARY PAYMENTS· COVER.AGESAANDB:

a. Paragraph 2. is replaced by the fol-lowing:

Up to the limit shown in Section B.Limits of Insurance, 4.a. BailBonds of this endorsement for costof bail bonds required because ofaccidents or traffic law violationsarising out of the use of any vehicleto which the Bodily Injury LiabilityCoverage applies. We do not have tofurnish these bonds.

b. Paragraph 4. is replaced by the fol-lowing:

All reasonable expenses incurred bythe insured at our request to assistus in the investigation or defense ofthe claim or "suit", including actualloss of earnings up to the limit shownin Section B. Limits of Insurance,4.b. Loss of Earnings of this en-dorsement per day because of timeoff from work.

5. Medical Payments

The Medical Expense Limit of Any OnePerson as stated in the Declarations isamended to the limit shown in Section B.Limits of Insurance, 5. Medical Pay-ments of this endorsement.

6. Voluntary Property Damage and Care,Custody or Control Liability Coverage

a. Voluntary Property Damage Cov-erage

We will pay for "property damage" toproperty of others arising out of op-erations incidental to the insured'sbusinesswhen:

(1) Damage is caused by the in-sured; or

(2) Damage occurs while in the in-sured'spossession.

With your consent, we will makethese payments regardless of fault,

b. Care, Custody or Control LiabilityCoverage

SECTION I - COVERAGES, COV.ERAGE A. BODILY INJURY ANDPROPERTY DAMAGE LIABILITY, 2.Exclusions, j. Damage to Property,Subparagraphs (3), (4) and (5) donot apply to "property damage" tothe property of others describedtherein.

With respect to the insurance provided bythis section of the endorsement, the fol-lowing additional provisions apply:

a. The Limits of Insurance shown in theDeclarations are replaced by the lim-its designated in Section B. Limits ofInsurance, 6. Voluntary PropertyDamage and Care, Custody orControl Liability Coverage of thisendorsement with respect to cover-age provided by this endorsement.These limits are inclusive of and notin addition to the limits being re-placed. The Limits of Insuranceshown in Section B. Limits of Insur-ance, 6. Voluntary Property Dam-age and Care, Custody or ControlLiability Coverage of this endorse-ment fix the most we will pay in anyone "occurrence" regardless of thenumber of:

(1) Insureds;

(2) Claims made or "suils" brought;or

~8.

(3) Persons or organizations mak-ing claimsor bringing"suits".

GA 233 AZ 09 09Includes copyrighted material of InsuranceServices Office, Inc., with its permission. Page 9 of14

7.

b. Deductible Clause

(1) Our obligation to pay damageson your behalf applies only tothe amount of damages for each"occurrence" which are in ex-cess of the deductible amountstated in Section B. Limits ofInsurance, 6. Voluntary Prop-erty Damage and Care, Cus-tody or Control Liability Cov-erage of this endorsement. Thelimits of insurance will not be re-duced by the application of suchdeductible amount

(2) Condition 2. Duties in the Eventof Occurrence; Offense I Claimor Suit, applies to each claim or"suit" irrespectiveof the amount

(3) We may pay any part or all ofthe deductible amount to effectsettlement of any claim or "suit"and, upon notification of the ac-tion taken, you shall promptlyreimburse us for such part of thedeductible amount as has beenpaid by us.

180 Day Coverage for Newly Formed orAcquired Organizations

SECTION II • WHO IS AN INSURED isamended as follows:

Subparagraph a. of Paragraph 4. ishereby deleted and replaced by the fol-lowing:

a. Insurance under this provision is af-forded only until the 180th day afteryou acquire or form the organizationor the end of the policy period,whichever is earlier;

Waiver of Subrogation

SECTION IV. COMMERCIAL GENERALLIABILITY CONDITIONS, 9. Transfer ofRights of Recovery Against Others toUs is hereby amended by the addition ofthe following:

We waive any right of recovery we mayhave because of payments we make forinjury or damage arising out of your on-going operations or "your work" done un-der a written contract requiring suchwaiver with that person or organizationand included in the "products-completedoperations hazard". However, our rightsmay only be waived prior to the "occur-rence" giving rise to the injury or damagefor which we make payment under thisCoverage Part The insured must donothing after a loss to impair our rights. Atour request, the insured will bring "suit" ortransfer those rights to us and help usenforce those rights.

-=p9. Automatic Additional Insured • Speci·fied Relationships

a. The following is hereby added toSECTION 11-WHO IS AN INSURED:

(1) Any person or organization de-scribed in Paragraph 9.a.(2)below (hereinafter referred to asadditional insured) whom youare required to add as an addi-tional insured under this Cover-age Part by reason of:

(a) A written contract oragreement; or

(b) An oral agreement or con-tract where a certificate ofinsurance showing that per-son or organization as anadditional insured has beenissued,

is an insured, provided:

(a) The written or oral contractor agreement is:

1) Currently in effect orbecomes effectiveduring the policy pe-riod; and

2) Executed prior to an"occurrence"or offenseto which this insurancewould apply; and

(b) They are not specificallynamed as an additional in-sured under any other pro-vision of, or endorsementadded to, this CoveragePart

(2) Only the following persons ororganizations are additional in-sureds under this endorsement,and insurance coverage pro-vided to such additional in-sureds is limited as providedherein:

(a) The manager or lessor of apremises leased to you withwhom you have agreed perParagraph 9.a.(1) above toprovide insurance, but onlywith respect to liability aris-ing out of the ownership,maintenance or use of thatpart of a premises leased toyou, subject to the followingadditional exclusions:

This insurance does notapply to:

1) Any "occurrence"which takes place after

GA 233 AZ 09 09Includes copyrighted material of InsuranceServices Office, lnc., with its permission. Page 10 of14

you cease to be a ten-ant in that premises.

2) Structural alterations,new construction ordemolition operationsperformed by or on be-half of such additionalinsured.

(b) Any person or organizationfrom which you leaseequipment with whom youhave agreed per Paragraph9.a.(1) above to provide in-surance. Such person(s) ororganization(s) are insuredssolely with respect to theirliability arising out of themaintenance, operation oruse by you of equipmentleased to you by such per-son(s) or organization(s).However. this insurancedoes not apply to any "oc-currence" which takes placeafter the equipment leaseexpires.

(c) Any person or organization(referred to below as ven-dor) with whom you haveagreed per Paragraph9.a.(1) above to provide in-surance, but only with re-spect to "bodily injury" or"property damage" arisingout of "your products" whichare distributed or sold in theregular course of the ven-dor's business, subject tothe following additional ex-clusions:

1) The insurance affordedthe vendor does notapply to:

a) "Bodily injury" or"property damage"for which the ven-dor is obligated topay damages byreason of the as-sumption of liabil-ity in a contract oragreement. Thisexclusion does notapply to liability fordamages that thevendor wouldhave in the ab-sence of the con-tract or agree-ment;

b) Any express war-ranty unauthorizedby you;

GA 233 AZ 09 09Includes copyrighted material of InsuranceServices Office, Inc.•with its permission.

c) Any physical orchemical changein the productmade intentionallyby the vendor;

d) Repackaging, un-less unpackedsolely for the pur-pose of inspection,demonstration,testing, or thesubstitution ofparts under in-structions from themanufacturer, andthen repackagedin the Originalcontainer;

e) Any failure tomake such in-spections, adjust-ments, tests orservicing as thevendor hasagreed to make ornormally under-takes to make inthe usual courseof business, inconnection withthe distribution orsale of the prod-ucts;

f) Demonstration, in-stallation, servic-ing or repair op-erations, exceptsuch operationsperformed at thevendor's premisesin connection withthe sale of theproduct;

g) Products which,after distribution orsale by you, havebeen labeled orrelabeled or usedas a container,part or ingredientof any other thingor substance by orfor the vendor.

2) This insurance doesnot apply to any in-sured person or or-ganization:

a) From whom youhave acquiredsuch products, orany ingredient,part or container,entering into, ac-

Page 11 of14 GA 233 AZ 09 09

companying orcontaining suchproducts; or

b) When liability in-cluded within the"products-completed opera-tions hazard" hasbeen excludedunder this Cover-age Part with re-spect to suchproducts.

Any state or political subdi-vision with which you haveagreed per Paragraph9.a.(1) above to provide in-surance, subject to the fol-lowing additional provision:

This insurance applies onlywith respect to the followinghazards for which the stateor political subdivision hasissued a permit in connec-tion with premises you own,rent or control and to whichthis insurance applies:

1) The existence, mainte-nance, repair, con-struction, erection, orremoval of advertisingsigns. awnings, cano-pies, cellar entrances,coal holes, driveways,manholes, marquees,hoist away openings,sidewalk vaults, streetbanners, or decora-tions and similar expo-sures; or

2) The construction, erec-tion, or removal of ele-vators; or

3) The ownership, main-tenance, or use of anyelevators covered bythis insurance.

(e) Any state or political subdi-vision with which you haveagreed per Paragraph9.a.(1) above to provide in-surance, SUbject to the fol-lowing provisions:

1) This insurance appliesonly with respect to op-erations performed byyou or on your behalffor which the state orpolltical subdivision hasissued a permit

2) This insurance doesnot apply to "bodily in-jury", "property dam-age" or "personal andadvertising injury" aris-ing out of operationsperformed for the stateor political subdivision.

(f) Any person or organizationwith which you have agreedper Paragraph 9.a.(1)above to provide insurance,but only with respect to li-ability caused, in whole or inpart, by your ongoing op-erations performed for thatadditional insured by you oron your behalf. A person ororganization's status as aninsured under this provisionof this endorsement endswhen your operations forthat insured are completed.

(3) Any insurance provided to anadditional insured designatedunder Paragraph 9.a.(2):

(a) Subparagraphs (e) and (f)does not apply to "bodilyinjury" or "property damage"included within the "prod-ucts-completed operationshazard";

(b) Subparagraphs (a), (b), (d)and (e) does not apply to"bodily injury", "propertydamage" or "personal andadvertising injury" arisingout of the sole negligenceor willful misconduct of theadditional insured or theiragents, "employees" or anyother representative of theadditional insured; or

(c) Subparagraph (f) does notapply to "bodily injury","property damage" or "per-sonal and advertising injury"arising out of:

1) The rendering of orfailure to render anyprofessional servicesby you or on your be-half, but only with re-spect to either or bothof the following opera-tions:

a) Providing engi-neering, architec-tural or surveyingservices to others;and

(d)

Includes copyrighted material of InsuranceServices Office, Inc.• with its permission. Page 12 of14

b) Providing or hiringindependent pro-fessionals to pro-vide engineering,architectural orsurveying servicesin connection withthe constructionwork you perform.

Subject to .the finalparagraph of this ex-clusion below, profes-sional services include:

plicable to the additional insured arethose specified in the Declarations ofthis Coverage Part The limits of in-surance are inclusive of and not inaddition to the limits of insuranceshown in the Declarations.

Limits of Insurance shown inSection B, Limits of Insurance,11. of this endorsement fix themost we will pay in anyone "oc-currence" regardless of thenumber of:

(a) Insureds;

(b) Claims made or "suits"brought; or

(c) Persons or organizationsmaking claims or bring"suits".

c. SECTION IV - COMMERCIAL GEN-ERAL liABiliTY CONDITIONS,S.Other Insurance is hereby amendedas follows:

Any insurance provided by this en-dorsement shall be primary to otherinsurance available to the additionalinsured except

(1) As otherwise provided in SEC-TION IV - COMMERCIAL GEN-ERAL liABiliTY CONDITIONS,5. Other Insurance, b. ExcessInsurance; or

(2) For any other valid and collecti-ble insurance available to theadditional insured as an addi-tional insured by attachment ofan endorsement to another in-surance policy that is written onan excess basis. In such case,the coverage provided underthis endorsement shall also beexcess.

(2) Deductible Clause

(a) Our obligation to pay dam-ages on your behalf appliesonly to the amount of dam-ages for each "occurrence"which are in excess of theDeductible amount stated inSection B. Limits of Insur-ance, 11. of this endorse-ment The limits of insur-ance will not be reduced bythe application of such De-ductible amount.

(b) Condition 2. Duties in theEvent of Occurrence, Of-fense, Claim or Suit, ap-plies to each claim or "sult"irrespective of the amount.

(c) We may pay any part or allof the deductible amount toeffect settlement of anyclaim or "suit" and. uponnotification of the actiontaken, you shall promptlyreimburse us for such partof the deductible amount ashas been paid by us.

Preparing, ap-proving or failingto prepare or ap-prove, maps, shopdrawings, opin-ions, reports, sur-veys' field orders,change orders ordrawings andspecifications; and

b) Supervisory or in-spection activitiesperformed as apart of any archi-tectural or engi-neering activities.

Professional servicesdo not include serviceswithin constructionmeans, methods, tech-niques, sequences andprocedures employedby you in connectionwith construction workyou perform.

2) "Your work" for which aconsolidated (wrap-up)insurance program hasbeen provided by theprime contractor-project manager orowner of the construc-tion project in whichyou are involved.

a)

b.

10. Broadened Contractual Liability - WorkWithin 50' of Railroad Property

It is hereby agreed that Paragraph f.(1) ofDefinition 12. "Insured contract" (SEC-TION V - DEFINITIONS) is deleted.

11. Property Damage to Borrowed Equip-ment

a. The following is hereby added to Ex-clusion j. Damage to Property ofParagraph 2., Exclusions of SEC-TION I - COVERAGES, COVERAGEA. BODILY INJURY AND PROP-ERTY DAMAGE LIABILITY:

Paragraphs (3) and (4) of this exclu-sion do not apply to tools or equip-ment loaned to you, provided theyare not being used to perform opera-tions at the time of loss.

b, With respect to the insurance pro-vided by this section of the en-dorsement, the following additionalprovisions apply:

(1) The Limits of insurance shownin the Declarations are replacedby the limits designated in Sec-tion B. Limits of Insurance, 11.of this endorsement with respectto coverage provided by thisendorsement. These limits areinclusive of and not in addition tothe limits being replaced. The

Includes copyrighted material of InsuranceServices Office, lnc., with its permission. GA 233 AZ. 09 09

includes copyrighted material of InsuranceServices Office, Inc.•with its permission. Page 14 of14

Only with regard to insurance pro-vided to an additional insured desig-nated under Paragraph 9.a.(2) Sub-paragraph (f) above, SECTION III -liMITS OF INSURANCE is amendedto include:

The limits applicable to the additionalinsured are those specified in thewritten contract or agreement or inthe Declarations of this CoveragePart, whichever are less. If no limitsare specified in the written contractor agreement, or if there is no writtencontract or agreement, the limits ap-

GA 233 AZ. 09 09 Page 13 of 14

12. Employees as Insureds - SpecifiedHealth Care Services

It is hereby agreed that Paragraph2.a.(1)(d) of SECTION II - WHO IS ANINSURED, does not apply to your "em-ployees' who provide professional healthcare services on your behalf as duly li-censed:

a. Nurses;

b. Emergency Medical Technicians; or

c. Paramedics,

in the jurisdiction where an 'occurrence"or offense to which this insurance appliestakes place.

13. Broadened Notice of Occurrence

Paragraph a. of Condition 2. Duties inthe Event of Occurrence, Offense,Claim or Suit (SECTION IV • COMMER-CIAL GENERAL LIABILITY CONDI-TIONS) is hereby deleted and replacedby the following:

a. You must see to it that we are noti-fied as soon as practicable of an"occurrence" or an offense whichmay result in a claim. To the extentpossible, notice should include:

(1) How, when and where the "oc-currence" or offense took place;

(2) The names and addresses ofany injured persons and wit-nesses; and

(3) The nature and location of anyinjury or damage arising out ofthe "occurrence" or offense.

This requirement applies only whenthe "occurrence"or offense is knownto an "authorized representative".


ADDITIONAL INSURED .. DESIGNATEDPERSON OR ORGANIZATION


BUSINESS AUTO COVERAGE FORM

This endorsement changes the policy effective on the inception date of the policy unless another date isindicated below.

Endorsement Effective: Policy Number:9-27-12 EBA0148851

Named Insured:

A V Innovations, Inc.

The person or organization named in the following schedule is an "insured" to the extent of their liability for theconduct of another "insured" as provided in SECTION II • LIABILITY COVERAGE, A. Coverage, 1. Who isan Insured, Paragraph c.

Schedule

Additional Insured

The State of Arizona, its departments, agencies, boards, commissions,universities and its officers, officials, agents and employees.

AA4004 0306


PRIMARY AND NONCONTRIBUTORY INSURANCE



This endorsement changes the policy effective on the inception date of the policy unless another date is indi-cated below.

Endorsement Effective:9-27-12 I

Policy Number:EBA0148851

Named Insured:


With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unlessmodified by the endorsement.

1. Noncontributory Insurance

SECTION IV • BUSINESS AUTO CONDI·TIONS, B. General Conditions, 5. other In-surance is replaced by the following:

c. Regardless of the provisions of Para-graph a. above, this Coverage Form's Li-ability Coverage is primary and we willnot seek contribution from any other in-surance for any liability assumed underan "insured contract" that requires liabilityto be assumed on a primary noncon-tributory basis.

AA41741105


BLANKET WAIVER OF SUBROGATION - AUTO



This endorsement changes the policy effective on the inception date of the policy unless another date is indi-cated below.

Endorsement Effective:9-27-12 IPolicy Number:

EBA0148851Named Insured:


With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unlessmodified by the endorsement.

1. Blanket Waiver of Subrogation

SECTION IV - BUSINESS AUTO CONDI-TIONS, A. Loss Conditions, 5. Transfer ofRights of Recovery Against Others to Us isamended by the addition of the following:

We waive any right of recovery we may haveagainst any person or organization because

of payments we make for "bodily injury" or"property damage" arising out of the operationof a covered "auto" when you have assumedliability for such "bodily injury" or "propertydamage" under. an "insured contract", pro-vided the "bodily injury" or "property damage"occurs subsequent to the execution of the "in-sured contract".

AA 41720909

POLlC¥ #59WECDG4479WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 000313

(Ed. 4-84)

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 enforceour right against the person or organization named in the Schedule. (This agreement applies only to the extent thatyou 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 anyone not named in the Schedule.

Schedule

Any person or organization for whom you perform work under a written contract that requires you to obtain this agreement from us.

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.

(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)

we 00 0313(Ed. 4-84-)

e 1437

ACORD~ CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYWY) 10/25/2011

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: i f the certificate holder is an ADDITIONAL INSURED, the pol~cy(~es) must be endorsed. i f SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certlflcate does not confer rights to the certificate holder in lleu of such endorsement(s).

PRODUCER I CONTACT

Commercial Lines - 602-528-3000

Wells Fargo Insurance Services USA. inc.

100 West Washington Street. 4th Floor

Phoenix. AZ 85003-1808 - INSURED

Dircks Moving Services. Inc. 4340 W. Mohave Street

. . ~

ADDRESS:

lNSURER(Sl&OROlNG COVEMGE

INSURER/\: VaJer lnsurance Company -

.- -- INSURER 0: .,.

Comp Ded $1000 HIRED AUTOS

(Mandatory In NH) If BS descdbe under D~SCRIPTION OF OPERATIONS below

A A

Warehouse Liability Total Movers Cargo Legal Llabllily

DESCRIPTION OFOPEW4TIONSILOCATIONSIVEHlCLES (AnashACORo101,Addltlonsl Remark~Sohedule. Ifmore space lbrequlred) RE:Contract #290904 - Household and Office Moving Services. General Liability: The State of Arizona. its departments, agencies, boards, wmmisslons, universities and its officers, officials, agents, and employees as addltlonal insureds with respect to liability arlslng out of the activities performed by or on behalf of Dircks per Policy form CG2037 07/04 Additional lnsured - Owners, Lessees or Contractors - Completed Operations under the General Liabillty Coverage afforded by Vanliner Insurance and Additional Insured - Designated Person or Organlzatlon. Coverage is primary non contributory, Waiver of Subrogation applies as respects Commercial General Llablllty per policy Form VLCG2026 07/04 while performlng moves durlng the policy period shown above. Auto: The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees as additional

CERTIFICATE HOLDER CANCELLATION

CGV-4137100-05 CGV-4137100-05

Arizona State Unlversity Purchasing and Business Services PO Box 575212 Tempe AZ 85281

r-\,

I j:

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

_ ,

11/1/2011 11/1/2011

o 1988-2010 ACORD CORPORATIO~. AII rights resewed. ACORD 25 (ii76105)

11/1/2012 11/1/2012

EL. DISEASE - POLICY LIMIT I $ 1,000.W0

$6 300000 $2 5OOOed $~00,~60~ggl$$00,0~0 Llmll: Oed $2.500

CID. 1437 SID 3431236

r ~ d d i t i o n a l Remarks Schedule (Continued from Page 1) insureds with respect to liability arising out of the activities performed by or on behalf of Dircks, involving automobiles owned, leased, hired or borrowed by Dircks per policy form VL4002 0700. Waiver of subrogation applies with respect to Automobile General Liability per policy form VL4236. Workers Compensation: Waiver of subrogation against the State of Arizona, Its departments, agencies, boards, commission, universities and its officers, officials, agents, and employees for losses arising from work performed by or on behalf of Dircks applies with respect to Workers Compensation per policy form WC000313 -10102.

POLICY NUMBER: CMG-4137100-01 . . . . . . . . . . .. . .

I THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDlTlONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS

I This endorsement modifies Insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

Section I1 - Who Is An lnsured is amended to Include as an addltlonal lnsured the person(s) or organlzatlon(s) shown in the Schedule, but only with respect to llablllty for "bodily Injury" orVproperty damage" caused, In whole or In part, by "your work" at the locetlon designated and described In the schedule of thls endorsement performed for that addltlonal lnsured end Included In the "products-completed operations hazard".

SCHEDULE

Q IS0 Properties, Inc., 2004

Name Of Additional lnsured Person(%) Or Organlzation(s):

BLANKET ADDITIONAL INSURED APPLIES AS REQUIRED BY WRITTEN CONTRACT.

. .

Page 1 of I

! I

Location And Desorlptlon Of Completed Operations

VARIOUS LOCATIONS IN THE STATE OF ARIZONA

l IIlllP lll lllllll llll llllllllll Y Ill1 lllll lllll lllll I l l i l l 1 1111 Ill1 Ill1 I

'I:"0.11\2L101,11*1 350 JlOC

Information required to complete this Schedule, If not shown above, wlll be shown in the Declaralions.

POLICY NUMBER: CMG-4137100-01 COMMERClAL GENERAL LiABlLlTY VLCG2026 07 04


ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION

This endorsement modifies insurance provided under the following'

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE

Or Organizatlon(s) refor to the Named lnsured

Any person or organization where required under written contract or agreement with the Named insured and not addressed by another Addltional lnsured endorsement more pertinent to the relationshlp. When agreed under wrltten contract between Named lnsured and the Addltional Insured, or other party in order to fulflli a wrltten contract between the Named lnsured and thls Additional lnsured. (1) coverage for the benefit of the Addltlonai lnsured shall be primary to and non.contributlng with any maintained by the Additional lnsured for Its own benefit; andlor (ii) subrogation against the Additional lnsured is waived.

Coverage is only afforded to the additional insured as respect to liability arising out of the Named insured's sole negligence and only for an "occurrence" arising Out of the named insured's "Worfc" and not for any other liability faced by the addltlonal insured.

All other poilcy language remalns unchanged. lnformatlon required to complete thls Schedule, If not shown above, wlll be shown In the Declarations.

Sectlon iI - Who Is An insured 16 amended to include as an addltionai insured the person(s) or organization(~) shown in the Schedule, but only with respect to liablilty for "bodily injury". "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those actlng on your behalf: A. in the performance of your ongoing operations; or 6. In conneonon with your premlses owned by or

rented to you.

VLCE2026 07 04 includes copyrighted material o i Insurance Services OMce. Inc. with its permisslon.

Page 1 o f 1 13

Commercial Lines - 602-528-3000 Wells Fargo Insurance Services USA, inc. 100 West Washington Street, 4th Floor Phoenix, AZ 85003-1808

Arizona State University

purchasing and Business Services PO Box 57521 2 Tempe AZ 85281

FREQUENTLY ASKED QUESTIONS

CERTIFICATES OF INSURANCE

What is a Certificate of Insurance?

It is evidence of insurance coverage that the insured has purchased to cover losses. It does not provide rights or benefits to the State. It does give us a legal trail to find the insurance policies that do give the contractor coverage.

When are certificates needed?

Whenever required in your contract which is located in the insurance provisions, Special Terms and Conditions and the section that states “Verification of Insurance”.

What if I am not sure if a certificate is needed, if there is no contract?

If you are using a PO (form of Contract) then there is an indemnification requirement in the Terms and Conditions but there are usually no insurance requirements unless you add them as an addendum to the PO. It may be advisable in some situations to do this if the contractor is providing a service on State property. For example: Maintenance or installation of equipment.

What insurance module should I use for and RFP or RFQ?

Depending on the “Scope of Work” you can select an Insurance Module located on our web site. We have standardized our requirements for most types of services, commodities, professional services, intergovernmental agreements, IT, grants, intern/externs, etc. If you have a very complicated “Scope of Work” please call your insurance analyst to discuss and we may have to modify the insurance requirements based on your specifics of the contract. However, most of your contracts will fall within the provided Modules.

http://www.azrisk.state.az.us/agency_information/insurance/insurance_module_guidelines.asp

Are lower limits permitted for small contractors or artisans who are performing small jobs for the State?

No. With the exception of contracts less than $50,000, these are the people we want the limits from, since they may not have the assets to indemnify us in case of a serious, underinsured loss.

If a contractor’s insurance does not meet our insurance requirements, should we alter the requirements to fit the contractor’s insurance?

http://www.azrisk.state.az.us/agency_information/insurance/insurance_module_guidelines.asp

No. This language has been carefully worded to afford us as much protection as legally possible. Altering the language would weaken our position. If the contractor is unable to comply with the limits requested, contact the Insurance Analyst for guidance.

Should I always ask for the State and the contracting agency to be named as an “Additional Insured”?

Additional insured means that we will be named as an “insured” on the contractor’s insurance policy. If the contractor is negligent and a claim is filed against the State, the contractor’s insurance company defends the claim for the State. The insured may or may not pay an additional premium. We can only be named as additional insured on General Liability and Automobile Liability policies and various other specialty types of coverages. The only acceptable wording for the Additional Insured is as stated in the contract “Special Terms and Conditions”. Don’t accept anything else. Don’t reverse or rearrange the names or accept abbreviations. You don’t need your division named. If the Additional Insured does not match the contract requirements you must ask the vendor to correct.

Who should be the “Certificate Holder”?

The Certificate Holder should be the agency and can include the State of Arizona. If the Certificate Holder is not the agency then you must not accept and return to the contractor for correction. If they have it made out to to the contractor, then the certificate is for “information only” and does not have the correct language for Additional Insured, Waiver of Subrogation and the primary statement. It is very important that all language match the contract requirements

What if we don’t have the certificate when the contractor starts the work?

It is the recommendation of State Risk Management that the contractor not start work without the approved certificate of insurance on file with the agency. If the contractor starts work and there is an injury it would be very difficult to obtain after the fact. We would then rely on the indemnification the contractor signed.

What is the ACORD form?

ACORD Corporation is a publisher that provides many industry forms widely used by the insurance companies and their agents, and is a standard format for insurance certification. It is acceptable for your contractor to submit evidence of coverage using this form.

Is there training or a checklist for the items on the form?

Training is available from your Risk Management Insurance Analyst. The checklist that appears on our website is attached. You can access this document on www.azrisk.state.az.us Select “Insurance” on the homepage, then

http://www.azrisk.state.az.us/

scroll half way down to the explanation of the Insurance Unit, where there is a link for “Procuring Services by Contract”, which will open to various options, including “Checklist for Vendors Certificates”.

If we receive a form that states “Policy Declaration” and not a Certificate of Insurance what does that mean?

What the contractor has provided is a photo copy of their actual policy page and is not acceptable as proof of current coverage.

3/6/13

insurance and indemnification guidelines …...insurance and indemnification guidelines for state of...

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