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CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
07/19/2022
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
NAME:
Southwest Professional Insurance Consultants
Southwest Professional Insurance Consultants
7689 E. Paradise Lane, Suite 5
Scottsdale AZ 85260
PHONE
(A/C, No. Ext):
(480) 368-1800
FAX
(A/C, No): (480) 368-1702
E-MAIL
ADDRESS
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURED
INSURER A:
INSURER B:
RLI Insurance Company
RLI Insurance Company
13056
13056
ENTELLUS INC.
3033 N. 44th Street
Phoenix, AZ 85018
INSURER C:
RLI Insurance Company
13056
INSURER D:
RLI Insurance Company
13056
INSURER E:
INSURER F:
COVERAGES
CERTIFICATE NUMBER:
15826
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
LTR
TYPE OF INSURANCE
ADDL
INSRD
SUBR
WVD
POLICY EFF
DATE (MM/DD/YY)
POLICY EXP
DATE (MM/DD/YY)
X
POLICY NUMBER
EACH OCCURRENCE
LIMITS
$
1,000,000
A
COMMERCIAL GENERAL LIABILITY
X
X
PSB0001271
11/01/21
11/01/22
DAMAGE TO RENTED
PREMISES (Ea occurence)
$
1,000,000
CLAIMS MADE X
OCCUR
10,000
MED EXP (Any one person)
$
1,000,000
PERSONAL & ADV INJURY
$
2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO-
JECT
GENERAL AGGREGATE
$
2,000,000
POLICY
LOC
PRODUCTS-COMP/OP AGG
$
OTHER:
PSA0001072
11/01/22
COMBINED SINGLE LIMIT
(Ea accident)
$
B
AUTOMOBILE LIABILITY
X
X
11/01/21
$
1,000,000
X
ANY AUTO
BODILY INJURY (Per person)
$
OWNED
AUTOS ONLY
SCHEDULED
AUTOS
BODILY INJURY (Per accident)
$
X
HIRED
AUTOS ONLY
X
NON-OWNED
AUTOS ONLY
PROPERTY DAMAGE
$
(Per accident)
$
C
X
UMBRELLA LIAB
OCCUR
X
X
PSE0001219
11/01/21
11/01/22
EACH OCCURRENCE
$
5,000,000
EXCESS LIAB
CLAIMS-MADE
AGGREGATE
$
5,000,000
DED
RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
PER
STATUTE
OTH-
ER
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
Y/N N/A
E.L. EACH ACCIDENT
$
E.L. DISEASE-EA EMPLOYEE
$
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE-POLICY LIMIT
$
D
Professional Liability
RDP0045135
11/01/21
11/01/22
Per Claim
$2,000,000
Aggregate
$4,000,000
Professional Liability - Claims Made - Retroactive Date 12/06/1985
City, its officers, officials, and agents and employees are added as additional insureds with respect to liability arising out of activities
performed by, or on behalf of consultants; products and completed operations of consultant and automobiles owned, leased, hired,
or borrowed by consultant.
Project Name/Number: Detroit Basin / Gazelle Meadows Park Sanitary Sewer and Potable Water Project No. ST2101.202
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER
CANCELLATION
City of Chandler
215 E. Buffalo Street
Chandler, AZ 85225
paula.brown@chndleraz.gov
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Attention:
Paula Brown
Dan HardestyLic # 43395
ACORD 25 (2016/03) Certificate # 15826
© 1988-2015 ACORD CORPORATION. All right reserved.
The ACORD name and logo are registered marks of ACORD
Entellus Endorsement Packet
1.) Commercial Package Policy #PSB0001271
□PPB 304 02 12- Blanket Additional Insured Endorsement
(covering any/all additional insured named on the COi)
Primary and Non-Contributory language included.
D PPB 101 07 16- Separation of Insured language page 42 of
Policy
2.) Workers Compensation Policy #PSW0001258
□WC 00 03 13- Waiver Right to Recover
(also called waiver of subrogation)
3.) Excess Liability Policy #PSE0001219
□PPU 304 06 10- Excess Liability Enhancement containing
Additional Insured language and Waiver of Subrogation.
4.) Commercial Auto Policy #PSA0001072
D PPA 300 03 13- Business Auto Enhancement
Containing Blanket Additional Insured and Waiver of
Subrogation language.
Policy Number: PSB0001271
Named Insured: Entellus, Inc.
RLI Insurance Company
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
RLIPack® FOR PROFESSIONALS
BLANKET ADDITIONAL INSURED ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM - SECTION II - LIABILITY
1.
C. WHO IS AN INSURED is amended to include as
an additional insured any person or organization that
you agree in a contract or agreement requiring
insurance to include as an additional insured on this
policy, but only with respect to liability for "bodily
injury",
"property
damage" or "personal and
advertising injury" caused in whole or in part by you
or those acting on your behalf:
a.
In the performance of your ongoing operations;
b.
In connection with premises owned by or rented
to you; or
c.
In connection with "your work" and included
within
the
"product-completed
operations
hazard".
additional insured under this policy must apply on a
primary basis, or a primary and non-contributory
basis, this insurance is primary to other insurance
that is available to such additional insured which
covers such additional insured as a named insured,
and we will not share with that other insurance,
provided that:
a.
The "bodily injury" or "property damage" for
which coverage is sought occurs after you have
entered into that contract or agreement; or
b.
The "personal and advertising injury" for which
coverage is sought arises out of an offense
committed after you have entered into that
contract or agreement.
2.
The insurance provided to the ;3dditional insured by
this endorsement is limited as follows:
4.
The following is added to SECTION Ill K. 2.
a.
This insurance does not apply on any basis to
any person or organization for which coverage
as an additional insured specifically is added by
another endorsement to this policy.
b.
This insurance does not apply to the rendering
of or failure to render any "professional
services".
c.
This endorsement does not increase any of the
limits of insurance stated in D. Liability And
Medical Expenses Limits of Insurance.
3.
The following is added to SECTION Ill H.2. Other
Insurance - COMMON POLICY CONDITIONS
(BUT APPLICABLE ONLY TO SECTION II -
LIABILITY)
However, if you specifically agree in a contract or
agreement that the insurance provided to an
Transfer of Rights of Recovery Against Others to
Us - COMMON POLICY CONDITIONS (BUT
APPLICABLE TO ONLY TO SECTION II -
LIABILITY)
We waive any rights of recovery we may have
against any person or organization because of
payments we make for "bodily injury", "property
damage" or "personal and advertising injury" arising
out of "your work" performed by you, or on your
behalf, under a contract or agreement with that
person or organization. We waive these rights only
where you have agreed to do so as part of a
contract or agreement with such person or
organization entered into by you before the "bodily
injury" or "property damage" occurs·, or the "personal
and advertising injury" offense is committed.
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED.
PPB 304 0212
Page 1 of 1
b.
All:
(1) "Bodily injury" and "property damage"
except damages because of "bodily in
jury" or "property damage" included in the
"products-completed operations hazard";
(2) Plus medical expenses;
(3) Plus all "personal and advertising injury"
caused by offenses committed;
is twice the Liability and Medical Expenses limit.
Subject to Paragraph a. or b. above, whichever
applies, the Damage To Premises Rented To You
Limit is the most we will pay for damages
because of "property damage" to any one
premises, while rented to you, or in the case of
fire, while rented to you or temporarily occupied
by you with permission of the owner.
The Limits of Insurance of SECTION 11- LIABILITY
apply separately to each consecutive annual period
and to any remaining period of less than twelve (12)
months, starting with the beginning of the policy
period shown in the Declarations, unless the policy
period is extended after issuance for an additional
period of less than twelve (12) months. In that case,
the additional period will be deemed part of the last
preceding period for purposes of determining the
Limits of Insurance.
E.
Liability
And
Medical
Expenses
General
Conditions
1.
Bankruptcy
Bankruptcy or insolvency of the insured or of the
insured's estate will not relieve us of our obligations
under this policy.
2.
Duties In The Event Of Occurrence Offense
Claim Or Suit
'
'
a.
You must see to it that we are notified as
soon as practicable of an "occurrence" or an
offense which may result in a claim. To the
extent possible, notice should include:
(1) How, when and where the "occurrence"
or offense took place;
(2) The names and addresses of any injured
persons and witnesses; and
(3) The nature and location of any injury or
damage arising out of the "occurrence" or
offense.
b.
If a claim is made or "suit" is brought against
any insured, you must:
(1) Immediately record the specifics of the
claim or "suit" and the date received; and
(2) Notify us as soon as practicable.
You must see to it that we receive written notice
of the claim or "suit" as soon as practicable.
c.
You and any other involved insured must:
(1) Immediately send us copies of any de
mands, notices, summonses or legal
papers received in connection with the
claim or "suit";
(2) Authorize us to obtain records and other
information;
{3) Cooperate with us in the investigation or
settlement of the claim or defense against
the "suit"; and
(4) Assist us, upon our request, in the en
forcement of any right against any person
or organization that may be liable to the
insured because of injury or damage to
which this insurance may also apply.
d.
No insured will, except at that insured's own
cost, voluntarily make a payment, assume
any obligation, or incur any expense, other than
for first aid, without our consent.
3.
Legal Action Against Us
No person or organization has a right under this
policy:
a.
To join us as a party or otherwise bring us
into a "suit" asking for damages from an in
sured; or
b.
To sue us on this policy unless all of its terms
have been fully complied with.
A person or organization may sue us to recover
on an agreed settlement or on a final judgment
against an insured; but we will not be liable for
damages that are not payable under the terms of
this policy or that are in excess of the applicable
Limit of Insurance. An agreed settlement means a
settlement and release of liability signed by us,
the insured and the claimant or the claimant's
legal representative.
4.
Separation Of Insureds
Except with respect to the Limits of Insurance of
SECTION II - LIABILITY, and any rights or duties
specifically assigned in this policy to the first Named
Insured, this insurance applies:
a.
As if each Named Insured were the only
Named Insured; and
b.
Separately to each insured against whom
claim is made or "suit" is brought.
PPB 101 0716
Contains copyrighted material of Insurance Services Office, Inc.
Page 42 of 48
Policy Number: PSE0001219
RU Insurance Company
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
RLIPack® FOR DESIGN PROFESSIONALS
EXCESS LIABILITY ENHANCEMENT
SCHEDULE OF COVERAGES ADDRESSED BY THIS ENDORSEMENT
A.
General Aggregate Limit - Per Project Or Per location
B.
Additional Insured - Primary/Non-contributory
C. Waiver Of Transfer Of Rights Of Recovery Against Others To Us
This endorsement modifies insurance provided under the following:
COMMERCIAL EXCESS LIABILITY COVERAGE FORM
A.
General Aggregate Limit - Per Project Or Per
location
Paragraph 2.a. of C. Limits of Liability of SECTION
I -
INSURING AGREEMENT is deleted and
replaced by the following:
a.
The limit of liability stated in the Declarations as
general aggregate is the most we will pay during
each policy period for all ultimate net loss,
except ultimate net loss because of:
(1)
injury and damage included in the products
completed operations hazard or;
(2)
any coverage included in underlying
insurance to which no underlying aggregate
applies.
The general aggregate applies separately to
each of your "projects" away from premises
owned by or occupied by you or to each of your
locations owned by or occupied by you.
"Projects" mean an area away from premises
owned by or rented to you at which you are
performing operations pursuant to a contract or
agreement. For the purposes of determining the
applicable aggregate limit of insurance, each
"project" at the same "location" shall be
considered a single "project".
For the purposes of this provision, "location"
means
(1) premises involving the same or connecting
lots;
(2) premises where connection is interrupted
only by a street, roadway, waterway or right
of-way of a railroad; or
PPU 304 0610
(3) premises where operations are performed in
sections, stages or phases as a continuation
of the same contract or agreement, even if
the premises do not involve connecting lots.
8. Additional Insured - Primary/Non-contributory
Paragraph K. Other Insurance of SECTION IV -
CONDITIONS is deleted and replaced by the
following:
K.
Other Insurance
If other insurance, whether collectible or not, is
available to the insured covering a loss also
covered by this policy, the insurance afforded by
this policy shall be in excess of, and shall not
contribute with, such other insurance. However,
if the underlying insurance provides coverage
to an additional insured on a primary basis, or a
primary and non-contributory basis, this insur
ance shall be available to such additional
insured on an excess basis over the underlying
insurance. We will not share with other
insurance which covers such additional insured
as a named insured.
C. Waiver Of Transfer Of Rights Of Recovery
Against Others To Us
Paragraph L. Subrogation of SECTION IV -
CONDITIONS
is deleted and replaced by the
following:
Page 1 of2
L. Subrogation
>n the event of any payment under this policy, the
insured must notify us of any of the insured's rights
of recovery against any person or organization. We
?hall be subrogated to all such rights. The
insured shall execute and deliver instruments
and papers and do whatever else is necessary to
secure such rights. The insured shall do nothing
after loss to prejudice such rights. However we
wai@e any rights of recovery we may have
against any person or organization if the
underlying insurance also waives such rights.
Any amount recovered through subrogation or
otherwise shall be apportioned in the inverse order
of payment of the claim or claims involved to the
extent of actual payment thereof by all interests. The
expenses of all such recoveries and proceedings in
connection therewith shall be apportioned in the
ratio of respective recoveries. With respect to
proceedings conducted solely by us, if there is no
recovery, we will bear the expense thereof. If there
is a recovery, we shall be reimbursed in full from
Auch recovery for the amount of all expenses
incurred by us before apportionment of such
recovery as herein provided.
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED.
PPU 304 0610
Page 2 of2
1983 National Council on Compensation Insurance.
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
WC 00 03 13
(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 enforce
our right against the person or organization named in the Schedule.
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule
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.)
Policy No.
Endorsement No.
Insured
Premium
Insurance Company
Countersigned by ___________________________________________
WC 00 03 13
(Ed. 4-84)
10430
Entellus, Inc.
PSW0001258
RLI Insurance Company
(This agreement applies only to the extent that you perform work under a written contract that requires you to obtain
this agreement from us.)
Any person or organization that you have agreed with in a written contract to provide this agreement.
Policy Number: PSA0001072
Named Insured: Entellus, Inc.
RLI Insurance Company
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
RLIPack® BUSINESS AUTO ENHANCEMENT
SCHEDULE OF COVERAGES ADDRESSED BY THIS ENDORSEMENT
A.
Broad Form Named Insured
B. Employees As Insureds
C.
Blanket Additional Insured
D. Blanket Waiver Of Subrogation
E.
Employee Hired Autos
F.
Fellow Employee Coverage
G. Auto Loan Lease Gap Coverage
H. Glass Repair - Waiver Of Deductible
I.
Personal Effects Coverage
J.
Hired Auto Physical Damage Coverage
K Hired Auto Physical Damage - Loss Of Use
L.
Hired Car -Worldwide Coverage
M. Temporary Transportation Expenses
N. Amended Bodily Injury Definition - Mental Anguish
0. Airbag Coverage
P.
Amended Insured Contract Definition - Railroad Easement
Q. Coverage Extensions - Audio, Visual And Data Electronic Equipment Not Designed Solely For The
Production Of Sound
R. Notice Of And Knowledge Of Occurrence
S.
Unintentional Errors Or Omissions
T.
Towing Coverage
PPA 300 0313
Page 1 of 5
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
A.
Broad Form Named Insured
The following is added to the SECTION II -
COVERED AUTOS LIABILITY COVERAGE, Para
graph A.1. Who Is An Insured Provision:
Any business entity newly acquired or formed by you
during the policy period, provided you own fifty
percent (50%) or more of the business entity and the
bus·iness entity is not separately insured for Bus-iness
Auto Coverage. Coverage is extended up to a
maximum of one hundred eighty (180) days following
the acquisition or formation of the business entity.
This provision does not apply to any person or
organization for which coverage is excluded by
endorsement.
B. Employees As Insureds
The following is added to the SECTION II -
COVERED AUTOS LIABILITY COVERAGE, Para
graph A.1. Who Is An Insured Provision:
Any "employee" of yours is an "insured" while using a
covered "auto" you don't own, hire or borrow in your
business or your personal affairs.
C. Blanket Additional Insured
The following is added to the SECTION II -
COVERED AUTOS LIABILITY COVERAGE, Para
graph A.1. Who Is An Insured Provision:
Any person or organization that you are required to
include as an additional insured on this coverage form
in a contract or agreement that is executed by you
before the "bodily injury" or "property damage" occurs
is an "insured" for liability coverage, but only for
damages to which this insurance applies and only to
the extent that person or organization qualifies as an
"insured" under the Who Is An Insured provision
contained in SECTION II - COVERED AUTOS
LIABILITY COVERAGE.
The insurance provided to the additional insured will
be on a primary and non-contributory basis to the
additional insured's own business auto coverage if
you are required to do so in a contract or agreement
that is executed by you before the "bodily injury" or
"property damage" occurs.
D. Blanket Waiver Of Subrogation
The following is added to the SECTION IV - BUSI
NESS AUTO CONDITIONS, A. Loss Conditions, 5.
Transfer Of Rights Of Recovery Against Others
To Us:
We waive any right of recovery we may have against
any person or organization to the extent required of
you by a contract executed prior to any ·accident" or
"loss", provided that the "accident" or "loss" arises out
PPA300 0313
of the operations contemplated by such contract. The
waiver applies only to the person or organization
designated in such contract.
E.
Employee Hired Autos
1. The following is added to the SECTION II
COVERED AUTOS LIABILITY COVERAGE,
Paragraph A.1. Who Is An Insured Provision:
An "employee" of yours is an "insured" while
operating an "auto" hired or rented under a
contract or agreement in that "employee's" name,
with your permission, while performing duties
related to the conduct of your business.
2.
Changes In General Conditions:
Paragraph 5.b. of the Other Insurance Con
dition in the BUSINESS AUTO CONDITIONS is
deleted and replaced with the following:
b.
For Hired Auto Physical Damage Coverage,
the following are deemed to be covered
"autos" you own:
(1) Any covered "auto" you lease, hire, rent
or borrow; and
(2) Any covered "auto" hired or rented by
your "employee• under a contract in that
individual "employee's" name, with your
permission,
while performing duties
related to the conduct of your business.
However, any "auto" that is leased, hired,
rented or borrowed with a driver is not a
covered "auto".
F.
Fellow Employee Coverage
SECTION II -
COVERED AUTOS LIABILITY
COVERAGE, Exclusion B.5. does not apply if you
have workers compensation insurance in-force
covering all of your employees.
G. Auto Loan Lease Gap Coverage
SECTION Ill - PHYSICAL DAMAGE COVERAGE,
C. Limit Of Insurance, is amended by the addition of
the following:
In the event of a total "loss" to a covered "auto" shown
in the Schedule of Declarations, we will pay any
unpaid amount due on the lease or loan for a covered
"auto", less:
1.
The amount paid under the
PHYSICAL
DAMAGE COVERAGE section of the policy; and
2.
Any:
a.
Overdue lease/loan payments at the time of
the "loss";
Page 2 of5
b.
Financial penalties imposed under a lease for
excessive use, abnormal wear and tear or
high mileage.
c.
Security deposits not returned by the lessor;
d.
Costs for extended warranties, Credit Life
Insurance, Health, Accident or Disability
Insurance purchased with the loan or lease;
and
e.
Carry-over balances from previous loans or
leases.
H.
Glass Repair - Waiver Of Deductible
SECTION Ill - PHYSICAL DAMAGE COVERAGE,
D. Deductible is amended by adding the following:
No deductible for a covered "auto" will apply to glass
damage if the glass is repaired rather than replaced.
I.
Personal Effects Coverage
The following is added to SECTION Ill - PHYSICAL
DAMAGE COVERAGE, A. Coverage, 4. Coverage
Extensions:
c.
Personal Effects Coverage
In the event of a total theft loss of your covered
"auto" we will pay up to $400 for "loss" to wearing
apparel and other personal effects which are:
(1) Owned by an "insured"; and
(2) In or on your covered "auto";
No deductible applies to Personal Effects
Coverage ..
J.
Hired Auto Physical Damage Coverage
The following is added to SECTION Ill - PHYSICAL
DAMAGE COVERAGE, A. Coverage, 4. Coverage
Extensions:
d.
Hired Auto Physical Damage Coverage
If hired "autos" are covered "autos" for Liability
Coverage and this policy also provides Physical
Damage Coverage for an owned "auto", then the
Physical Damage Coverage is extended to
"autos" that you hire, rent or borrow subject to the
following:
(1) The most we will pay for "loss" in any one
"accident" to a hired, rented or borrowed
"auto" is the lesser of:
(a) $60,000
(b) The actual cash value of the damaged or
stolen property as of the time of the
"loss"; or
(c) The cost of repairing or replacing the
damaged or stolen property with other
property of like kind and quality.
PPA 300 0313
(2) An adjustment for depreciation and physical
condition will be made in the event of a total
"loss".
(3) If a repair or replacement results in better
than like kind or quality, we will not pay for the
betterment.
(4) A deductible equal to the highest Physical
Damage deductible applicable to any owned
auto will apply.
(5) This Coverage Extension will not apply to:
(a) Any "auto" that is hired, rented or
borrowed with a driver; or
(b) Any "auto" that is hired, rented or
borrowed from your "employee".
K. Hired Auto Physical Damage - Loss Of Use
The following is added to SECTION Ill - PHYSICAL
DAMAGE COVERAGE, A. Coverage, 4. Coverage
Extensions:
e. We will pay sums which you legally must pay to
the lessor of a covered "auto" which you have
leased without a driver for thirty (30) days or less
for the lessor's loss of use of the covered "auto",
provided:
, (1) This insurance provides comprehensive,
specified causes of loss or collision covered
on the covered "auto";
(2) The loss of use results from the covered
"auto" being damaged in an "accident" while
you are leasing it.
We will pay up to a maximum limit of $1,500 for
this covered extension.
L.
Hired Car - Worldwide Coverage
The following is added to SECTION II - COVERED
AUTOS LIABILITY COVERAGE, A.2. Coverage
Extensions:
f.
Hired Car - Worldwide Coverage
(1) We will pay all sums an "insured" legally must
pay as damages because of "bodily injury" or
"property damage" to which this insurance
applies, caused by an "accident" which
occurs outside of the United States of
America, the territories and possessions of
the United States of America, Puerto Rico
and Canada resulting from the maintenance,
or use of any covered "auto" of the private
passenger type you lease, hire, rent or
borrow without a driver for thirty (30) days or
less.
(2) With respect to any claim made or "suit"
instituted outside the United States of
America, the territories and possessions of
the United States of America, Puerto Rico,
and Canada:
Page 3 of 5
(a) You shall undertake the investigation,
settlement and defense of such claims
and "suits" and keep us advised of all
proceedings and actions.
(b) You will not make any settlement without
our consent.
(c} We will reimburse you:
(i)
For the amount of damages be
cause of liability imposed upon you
by law on account of "bodily injury" or
"property damage" to which this
insurance applies, and
(ii)
For all reasonable expenses incurred
with our consent in connection with
the investigation,
settlement or
defense of such claims or "suits".
Reimbursement for expenses will be
part of the Limit of Insurance for
liability coverage shown in the
Business
Auto
Coverage
Declarations, and not in addition to
such limits.
(3) The limit of Insurance for Liability Coverage
shown in the Business Auto Coverage
Declarations is the most we will reimburse
you for the sum of all damages imposed on
you, as set forth in paragraph 2.c. above, and
all expenses incurred by you arising out of
any single "accident" or "loss".
(4) You must maintain the greater of the follow
ing primary auto liability insurance limits:
(a) Compulsory admitted insurance with
limits required to be in force to satisfy the
legal requirements of the jurisdiction
where the accident occurs; or
(b} Insurance limits required by law and
issued by a government entity or by an
insurer licensed or permitted by law to do
business in the jurisdiction where the
"accident" occurs; or
(c) Auto liability insurance limits of at least
$300,000
combined single limit or
$100,000 per person/$300,000 per acci
dent Bodily Injury, $100,000 Property
Damage.
If you fail to comply with the above, this
insurance is not invalidated. However, in the
event of a "loss", we will pay only to the extent
that we would have been liable had you so
complied.
(5) The insurance provided by this coverage
extension is excess over any other collec
tible insurance available to you whether on a
primary, excess contingent or any other
basis.
PPA300 03 13
M. Temporary Transportation Expenses
SECTION Ill - PHYSICAL DAMAGE COVERAGE,
A.4. Coverage Extensions, subparagraph a.
Transportation Expenses is deleted and replaced
by the following:
a.
Transportation Expenses
(1) We will pay up to a maximum of $1,500 for
temporary transportation expense incurred
by you because of Physical Damage to a
covered "auto".
(2) We will pay only for those covered "autos" for
which you carry Comprehensive, Colli-sion or
Specified Case of Loss Coverage.
(3) We will pay only for those expenses incurred
by you during the period of time that begins
twenty-four (24) hours after the covered
"loss" and ends at the time when the covered
"auto" can be reasonable repaired or
replaced.
(4) This coverage does not apply while there are
spare or reserve "autos" available to you for
your operations.
N. Amended Bodily Injury Definition -
Mental
Anguish
The following is added to
SECTION V -
DEFINITIONS, Definition C.:
"Bodily injury" also includes mental anguish, but only
when the mental anguish arises from other bodily
injury, sickness or disease.
O. Airbag Coverage
The following is added to SECTION Ill - PHYSICAL
DAMAGE COVERAGE B. Exclusions 3.a.:
However, this exclusion will not apply to accidental
discharge of an airbag due to mechanical or electrical
breakdown:
P.
Amended Insured Contract Definition - Railroad
Easement
SECTION V - DEFINITIONS paragraph H. "Insured
contact" is modified as follows:
1.
Paragraph H.3. is replaced by the following:
3.
Any easement or license agreement.
2.
Paragraph H.6.a. is deleted.
Q. Coverage Extensions - Audio, Visual And Data
Electronic Equipment Not Designed Solely For
The Production Of Sound
SECTION Ill - PHYSICAL DAMAGE COVERAGE B.
Exclusions, exception paragraph a. to exclusion 4.c.
and 4.d. is deleted and replaced with the following:
Page 4 of 5
a. Equipment and accessories used wit such
equipment, except for tapes, records, discs or
other electronic media device, provided such
equipment is permanently installed in the covered
"auto• at the time of the "loss" or is removable
from the housing unit which is permanently
installed in the covered "auto• at the time of the
"loss", and such equipment is designed to be
solely operated by use of the power from the
"autos" electrical system, in or upon the covered
"autos"; or
R. Notice Of And Knowledge Of Occurrence
SECTION IV - BUSINESS AUTO CONDITIONS,
A.2. Duties In The Event Of Accident, Claim Suit
Or Loss, subparagraph a. is deleted and replaced
with the following:
a.
In the event of "accident", claim, "suit' or "loss",
you must give us or our authorized repre
sentative prompt notice of the "accident" or "loss"
including:
(1) How, when and where the "accident" or "loss"
occurred;
(2) The "insured's" name and address; and
(3) To the extent possible, the names and
addresses of any injured person and
witnesses.
Your duty to give us or our authorized
representative prompt notice of the "accident' or
"loss" applies only when the "accident" or "loss" is
known to:
(1) You, if you are an individual;
(2) A partner if you are a partnership; or
(3) An executive officer or insurance manager, if
you are a corporation.
s.
Unintentional Errors Or Omissions
SECTION IV - BUSINESS AUTO CONDITIONS, B.
General Conditions; 2. Concealment Misrepre
sentation Or Fraud is amended by adding the
following:
The unintentional omission of, or unintentional error
in, any information given by you shall not prjudice
your rights under this insurnce. However th1. pro
vision does not affect our right to collect add1t1onal
premium or exercise our right of cancellation or
non renewal.
T .. Towing Coverage
SECTION m - PHYSICAL DAMAGE COVERAGE,
A.2. Towing, is deleted and replaced by the
following:
2.
We will pay up to $750 for towing and labor costs
incurred each time a covered "auto" is disabled
due to a covered cause of loss. However:
a.
All labor must be performed at the place of
disablement; and
b.
c.
If the covered auto is a private passenger
type no ded.uctible applies; and
If the covered auto is not of the private
passenger type our obligation to pay will be
reduced by
a $250 deductible
per
disablement.
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED.
PPA 300 0313
Page 5 of 5
07/19/2022
Marsh Affinity
a division of Marsh USA Inc.
PO Box 14404
Des Moines, IA 50306-9686
Marsh Affinity
800-743-8130
ADPTotalSource@marsh.com
New Hampshire Insurance Co.
23841
A
07/01/2022
07/01/2023
2,000,000
2,000,000
2,000,000
ADP TotalSource FL XVIII, Inc.
5800 Windward Parkway
Alpharetta, GA 30005
L/C/F:
Entellus, Inc.
3033 N 44th St Suite 250
Phoenix, AZ 85018
WC 053416131 AZ
All worksite employees working for Entellus, Inc. paid under ADP TOTALSOURCE, INC.'s payroll,
are covered under the above stated policy.
City of Chandler
215 E Buffalo Street
Chandler, AZ 85225
X