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Last modified
5/3/2021 3:00:58 PM
Creation date
5/3/2021 2:59:20 PM
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Template:
Contracts
Company Name
BURGESS MOVING & STORAGE
Contract #
N-2021-084
Agency
Community Development
Expiration Date
4/26/2022
Insurance Exp Date
7/1/2021
Destruction Year
2027
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INSURED: Inland Moving and Storage Co. <br />® TRANSGUARD, <br />msvwne, cwlrnw w.wtwct,.�r <br />COMMERCIAL AUTO <br />014108 04/18 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED - BLANKET <br />This endorsement modifies insurance provided under the following: <br />MOTOR CARRIER COVERAGE FORM <br />This endorsement changes the policy effective on the inception date of the policy unless another date is indicated <br />below. <br />Endorsement Effective Date: Policy Number: <br />04/01/2021 TCP 0110357 17 <br />A. Additional Insured Coverage <br />1. SECTION II — COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured, is <br />amended to include as an "insured" the person(s) or organization(s) with respect to the ownership, <br />maintenance, or use of a covered "auto', other than: <br />(1) A "van line' that is party to a written agreement with you that appoints you as its agent for <br />purposes of providing moving and relocation services; or <br />(2) A "van line" that is scheduled on any Additional Insured — Van Line endorsement to this <br />policy; <br />and further provided that you have agreed to add such person or organization as an additional <br />"insured" pursuant to an express provision in a written "insured contract' or other written <br />agreement, or in a permit issued to you by a governmental or public authority. <br />Any person or organization is an additional "insured" solely with respect to "bodily injury' or <br />'property damage' caused by an "accident' arising out of: <br />(1) The ownership, maintenance or use of a covered "auto"; and <br />(2) Your operations under the "insured contract', other written agreement, or permit that takes <br />place after: <br />(a) You executed the "insured contract' or written agreement; or <br />(b) The permit has been issued to you; <br />and then only to the limited extent and for no higher limits of insurance required in such "insured <br />contract', other written agreement, or permit. <br />B. Definitions <br />For purposes of this endorsement only, the following definition is added: <br />1. Van Line means a person or organization for which you have been appointed as an agent for <br />purposes of providing moving and relocation services. <br />All other terms and conditions of the policy remain the same. <br />TRANSGUARD INSURANCE COMPANY OF AMERICA, INC. <br />014108 04/18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. <br />Risk Mougemmt DW[m <br />REmeva) & ArvRov® By., <br />F ae 2. V:EL— <br />�Risk lvlanagemen[Mniyst <br />
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