2023 04 30 COI GL AL WC.pdf

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

INSR ADDL SUBR

LTR INSD WVD

DATE (MM/DD/YYYY)

PRODUCER CONTACT

NAME:

FAXPHONE

(A/C, No):(A/C, No, Ext):

E-MAIL

ADDRESS:

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

POLICY NUMBER

POLICY EFF POLICY EXP

TYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)

AUTOMOBILE LIABILITY

UMBRELLA LIAB

EXCESS LIAB

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

AUTHORIZED REPRESENTATIVE

EACH OCCURRENCE $

DAMAGE TO RENTED

CLAIMS-MADE OCCUR $PREMISES (Ea occurrence)

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

PRO-

POLICY LOC PRODUCTS - COMP/OP AGG $JECT

OTHER: $

COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $

OWNED SCHEDULED BODILY INJURY (Per accident) $

AUTOS ONLY AUTOS

HIRED NON-OWNED PROPERTY DAMAGE $

AUTOS ONLY AUTOS ONLY (Per accident)

OCCUR EACH OCCURRENCE $

CLAIMS-MADE AGGREGATE $

DED RETENTION $ $

PER OTH-

STATUTE ER

E.L. EACH ACCIDENT $

E.L. DISEASE - EA EMPLOYEE $

If yes, describe under

E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below

INSURER(S) AFFORDING COVERAGE NAIC #

COMMERCIAL GENERAL LIABILITY

Y / N

N / A (Mandatory in NH)

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

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.

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).

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

CERTIFICATE HOLDER CANCELLATION

© 1988-2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03)

CERTIFICATE OF LIABILITY INSURANCE

LOCKTON COMPANIES

3657 BRIARPARK DRIVE, SUITE 700

HOUSTON TX 77042

866-260-3538

Crafco, Inc.

2829 Lakeland Drive Flowood MS 39232

ACE American Insurance Company 22667 National Fire and Marine Insurance Co 20079

X X

1,000,000 1,000,000

XXXXXXX

1,000,000 6,000,000 6,000,000

X 3,000,000

XXXXXXX

XXXXXXX

XXXXXXX

XXXXXXX

X X 10,000,000 10,000,000

XXXXXXX

N

X

1,000,000 1,000,000 1,000,000

A ISA H25564352 4/30/2022 4/30/2023

A XSL G72489056 4/30/2022 4/30/2023

B 42-UMO-302493-07 4/30/2022 4/30/2023

A WLR C68924807 4/30/2022 4/30/2023

4/30/2023

1407257

Y Y

Y Y

Y Y

Y

4/15/2022

18329815

18329815 XXXXXXX

Arizona Department of Transportation, Procurement 1739 W. Jackson St., Ste. A Phoenix AZ 85007-3276

X

See Attachments a8812 Accepted

All policies (except Workers' Compensation/EL) include a blanket automatic Additional Insured endorsement [provision] that confers Additional Insured status to the certificate holder only if there is a written contract between the named insured and the certificate holder that requires the named insured to name the certificate holder as an Additional Insured. In the absence of such a contractual obligation on the part of the named insured, the certificate holder is not an Additional Insured under the policy. The insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.

All policies include a blanket automatic Waiver of Subrogation endorsement [provision] that provides this feature only when there is a written contract between the named insured and the certificate holder that requires it. In the absence of such a contractual obligation on the part of the named insured, the Waiver of Subrogation feature does not apply.

Attachment Code: D547512 Master ID: 1407257, Certificate ID: 18329815

Named Insured Schedule

Ergon, Inc.

Ergon - West Virginia, Inc.

Ergon Refining, Inc.

Ergon BioFuels, LLC Ergon BioSciences, Inc.

Ergon Asphalt & Emulsions, Inc.

Ergon Asphalt Holdings, LLC Crafco, Inc.

Tricor Refining, LLC Paragon Technical Services, Inc.

Paving Maintenance Supply, Inc.

Ergon Terminaling, Inc.

Ergon Oil Purchasing, Inc.

Ergon - Baton Rouge, Inc.

Ergon - Ironton, LLC Ergon - Knoxville, Inc.

Ergon - St. James, Inc.

Ergon Moda St. James, LLC Ergon - Texas Pipeline, Inc.

Ergon Acquisition Corp.

Ergon Foundation, Inc.

Ergon Securities, Inc.

Big Valley, LLC Ergon Properties, Inc.

ISO Panels, Inc.

Magnolia Marine Transport Company Ergon Marine & Industrial Supply, Inc.

Ergon Trucking, Inc.

LLWR, LLC

M & L Properties, LLC Mirror Lake Building, LLC Mirror Lake Land Company Pearl Street Parking LLC PruGON Properties LLC Crafco (Wuxi) Pavement Preservation Equipment Co., Ltd.

Ergon - Latin America, LLC Ergon - Asia, Inc.

Ergon Asia (Hong Kong) Limited Ergon Mexico S de R.L. de C.V.

Attachment Code: D547513 Master ID: 1407257, Certificate ID: 18329815

Ergon Oil (Singapore) Pte. Ltd Ergon Oil (Indonesia) Ergon International, Inc. (Formerly Ergon Europe, MEA, Inc.)

Bay Harbour Development, LLC Grand Harbour Development, LLC Specialty Process Fabricators, Inc.

Ergon Energy Associates, LLC Ergon Energy Partners, LP Flowood Oil, LLC Ergon Exploration, Inc.

Ergon Production, Inc.

MSLATX Pipeline Company Kearney Park Farms, Inc.

Lampton-Love, Inc.

Lacox Propane Gas Company Blossman L. P. Gas Service, Inc.

Harrell Gas, Inc.

Lacox, Inc.

Lampton-Love Gas Company Lampton-Love of Magee, Inc.

Lampton-Love of Pelahatchie, Inc.

Liquefied Petroleum Gas Management, Inc.

Allgas, Inc.

Allgas, Inc., of Montgomery Allgas, Inc., of TN Magnolia Gas, Inc.

Natchez Butane, Inc.

Petroleum Distributor of Jackson, Inc.

Progas Inc.

Southern Propane, Inc.

Starkville L.P. Gas, Inc.

Process Oils, Inc.

Chemical Marketing Associates DBA Process Oils, Inc.

Ergon Construction Group, Inc.

Ergon Construction Group, Inc. dba Alliant Construction Ergon Construction Group, Inc. dba Ergon Maintenance Services Bryan & Bryan Asphalt, LLC TABB Management Services, LLC Trinity Asphalts, Ltd.

BMR Transport, Inc.

Ergon Construction Group, Inc. dba ISO Panels, Inc.

Bryan & Bryan Trucking, LLC

Ergon Asfaltos México HC, LLC Ergon México HC, LLC Ergon Chemicals, LLC Resinall Corporation Industrial Transport, Inc.

Ergon-Frazier Development I, LLC Diversified Technology, Inc.

Bunge-Ergon Renewable Energy, LLC Ergon Asphalt Products - Coolidge, Inc. (Dissolved 10/8/2010) Ergon Asphalt Products, Inc.

Lampton-Love Trucking, Inc.

Mainstreet Builders, Inc. (Dissolved 6/30/10) Pearl Street Properties, Inc. (Dissolved 08/11/2010) Solquim, C.A. (Sold March 2007) Flowood Properties LLC (Dissolved 01/23/2007) Georgia Emulsions, LLC (Dissolved 10/21/2010) Bunge-Ergon Vicksburg, LLC Ergon Ethanol, Inc.

Telfer Pavement Technologies (Southeast), LLC (Dissolved 2019) Telfer Pavement Technologies, LLC (Dissolved 2019) Telfer Geosynthetics (Dissolved 2019) Telfer Highway Technologies, LLC (Dissolved 2019) Telfer Oil Company (Dissolved 2019) Continental Western Transportation Co., Inc. (Dissolved) Western States Asphalt of Montana, LLC Western States Group, LLC

ALL-47410 (04/16) Page 1 of 2

NOTICE TO OTHERS ENDORSEMENT – SCHEDULE – EMAIL ONLY

NOTICE TO OTHERS ENDORSEMENT – SCHEDULE – EMAIL ONLY

Named Insured Ergon, Inc. Endorsement Number

Policy Symbol

ISA

Policy Number

H25564352 Policy Period

04/30/2022 TO 04/30/2023

Effective Date of Endorsement

Issued By (Name of Insurance Company)

ACE American Insurance Company

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

A. If we cancel or materially change this Policy prior to its expiration date by notice to you or the first Named insured for any reason other than nonpayment of premium, we will endeavor, as set out below, to send written notice of cancellation, via such electronic or other form of notification as we determine, to the persons or organizations listed in the schedule that you or your representative provide or have provided to us (the “Schedule”). You or your representative must provide us with the physical and/or e-mail address of such persons or organizations, and we will utilize such e-mail address or physical address that you or your representative provided to us on such Schedule.

B. The Schedule must be initially provided to us within 15 days after:

i. The beginning of the Policy period, if this endorsement is effective as of such date; or

ii. This endorsement has been added to the Policy, if this endorsement is effective after the Policy period commences.

C. This endorsement must be in an electronic format that is acceptable to us; and must be accurate.

D. Our delivery of the notification as described in Paragraph A. of this endorsement will be based on the most recent Schedule in our records as of the date the notice of cancellation is mailed or delivered to the first Named Insured.

E. We will endeavor to send or deliver such notice to the e-mail address or physical address corresponding to each person or organization indicated in the Schedule at least 30 days prior to the cancellation date applicable to the Policy.

F. The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). Our failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule shall impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy.

G. We are not responsible for verifying any information provided to us in any Schedule, nor are we responsible for any incorrect information that you or your representative provide to us. If you or your representative does not provide us with a Schedule, we have no responsibility for taking any action under this endorsement. In addition, if neither you nor your representative provides us with e-mail and physical address information with respect to a particular person or organization, then we shall have no responsibility for taking action with regard to such person or entity under this endorsement.

H. We may arrange with your representative to send such notice in the event of any such cancellation.

ALL-47410 (04/16) Page 2 of 2

I. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule.

J. This endorsement does not apply in the event that you cancel or materially change the Policy.

All other terms and conditions of this Policy remain unchanged.

Authorized Representative

DA-9U74c (03/16) Page 1 of 1

ADDITIONAL INSURED – DESIGNATED PERSONS OR ORGAN IZAT IONS

ADDITIONAL INSURED –

DESIGNATED PERSONS OR ORGANIZATIONS

Named Insured Ergon, Inc. Endorsement Number

Policy Symbol

ISA

Policy Number

H25564352 Policy Period

04/30/2022 TO 04/30/2023

Effective Date of Endorsement

Issued By (Name of Insurance Company)

ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

AUTO DEALERS COVERAGE FORM

MOTOR CARRIER COVERAGE FORM

EXCESS BUSINESS AUTO COVERAGE FORM

Additional Insured(s): Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss.

A. For a covered “auto,” Who Is Insured is amended to include as an “insured,” the persons or organizations named in this endorsement. However, these persons or organizations are an “insured” only for “bodily injury” or “property damage” resulting from acts or omissions of:

1. You.

2. Any of your “employees” or agents.

3. Any person operating a covered “auto” with permission from you, any of your “employees” or agents.

B. The persons or organizations named in this endorsement are not liable for payment of your premium.

CA 20 70 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1

POLICY NUMBER: ISA H25564352 Endorsement Number: 7

COMMERCIAL AUTO

CA 20 70 10 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

COVERAGE FOR CERTAIN OPERATIONS IN CONNECTION WITH RAILROA DS

COVERAGE FOR CERTAIN OPERATIONS

IN CONNECTION WITH RAILROADS

This endorsement modifies insurance provided under the following:

AUTO DEALERS COVERAGE FORM

BUSINESS AUTO COVERAGE FORM

MOTOR CARRIERS COVERAGE FORM

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

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

Named Insured: Ergon, Inc.

Endorsement Effective Date:

SCHEDULE

Scheduled Railroad Designated Job Site

Any railroad (RR) which you have agreed to indemnify pursuant to a written contract entered into with such RR that was signed prior to loss, in connection with an easement granted by such RR to you.

All job sites where you are operating under an easement granted by a scheduled RR, and where you have agreed to indemnify such RR for your operations pursuant to such easement under a written contract entered into with such RR prior to loss

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

With respect to the use of a covered "auto" in operations for or affecting a railroad designated in the Schedule at a Designated Job Site, the two exceptions contained in the definition of "insured contract" relating to construction or demolition operations performed within 50 feet of a railroad do not apply.

DA-13115a (06/14) Page 1 of 1

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS

Named Insured Ergon, Inc. Endorsement Number

Policy Symbol

ISA

Policy Number

H25564352 Policy Period

04/30/2022 TO 04/30/2023

Effective Date of Endorsement

Issued By (Name of Insurance Company)

ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This Endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

MOTOR CARRIERS COVERAGE FORM

AUTO DEALERS COVERAGE FORM

We waive any right of recovery we may have against the person or organization shown in the Schedule below because of payments we make for injury or damage arising out of the use of a covered auto. The waiver applies only to the person or organization shown in the SCHEDULE.

SCHEDULE

Any person or organization against whom you have agreed to waive your right of recovery in a written contract, provided such contract was executed prior to the date of loss.

ALL-47410 (04/16) Page 1 of 2

NOTICE TO OTHERS ENDORSEMENT – SCHEDULE – EMAIL ONLY

NOTICE TO OTHERS ENDORSEMENT – SCHEDULE – EMAIL ONLY

Named Insured Ergon, Inc. Endorsement Number

Policy Symbol

XSL

Policy Number

G72489056 Policy Period

04/30/2022 TO 04/30/2023

Effective Date of Endorsement

Issued By (Name of Insurance Company)

ACE American Insurance Company

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

A. If we cancel or materially change this Policy prior to its expiration date by notice to you or the first Named insured for any reason other than nonpayment of premium, we will endeavor, as set out below, to send written notice of cancellation, via such electronic or other form of notification as we determine, to the persons or organizations listed in the schedule that you or your representative provide or have provided to us (the “Schedule”). You or your representative must provide us with the physical and/or e-mail address of such persons or organizations, and we will utilize such e-mail address or physical address that you or your representative provided to us on such Schedule.

B. The Schedule must be initially provided to us within 15 days after:

i. The beginning of the Policy period, if this endorsement is effective as of such date; or

ii. This endorsement has been added to the Policy, if this endorsement is effective after the Policy period commences.

C. This endorsement must be in an electronic format that is acceptable to us; and must be accurate.

D. Our delivery of the notification as described in Paragraph A. of this endorsement will be based on the most recent Schedule in our records as of the date the notice of cancellation is mailed or delivered to the first Named Insured.

E. We will endeavor to send or deliver such notice to the e-mail address or physical address corresponding to each person or organization indicated in the Schedule at least 30 days prior to the cancellation date applicable to the Policy.

F. The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). Our failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule shall impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy.

G. We are not responsible for verifying any information provided to us in any Schedule, nor are we responsible for any incorrect information that you or your representative provide to us. If you or your representative does not provide us with a Schedule, we have no responsibility for taking any action under this endorsement. In addition, if neither you nor your representative provides us with e-mail and physical address information with respect to a particular person or organization, then we shall have no responsibility for taking action with regard to such person or entity under this endorsement.

H. We may arrange with your representative to send such notice in the event of any such cancellation.

ALL-47410 (04/16) Page 2 of 2

I. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule.

J. This endorsement does not apply in the event that you cancel or materially change the Policy.

All other terms and conditions of this Policy remain unchanged.

XS-21164a (04/13) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1

ADDIT IONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – COMPLETED OPERATIONS

ADDITIONAL INSURED – OWNERS, LESSEES OR

CONTRACTORS – COMPLETED OPERATIONS

Named Insured

Ergon, Inc.

Endorsement Number

Policy Symbol

XSL

Policy Number

G72489056 Policy Period

04/30/2022 to 04/30/2023 Effective Date of Endorsement

Issued By (Name of Insurance Company)

ACE American Insurance Company

Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This Endorsement modifies insurance provided under the following:

EXCESS COMMERCIAL GENERAL LIABILITY POLICY

SCHEDULE

Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations

Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss.

All locations where you perform work for such additional insured pursuant to any such written contract.

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organiza-tion(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorse-ment performed for that additional insured and included in the "products-completed operations hazard".

However:

1. The insurance afforded to such additional insured only applies to the extent permitted by law; and

2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.

B. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance And Retained Limit:

If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:

1. Required by the contract or agreement; or

2. Available under the applicable Limits of Insurance shown in the Declarations;

whichever is less.

This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.

XS-6W25b (04/13) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1

ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION

ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION

Named Insured

Ergon, Inc.

Endorsement Number

Policy Symbol

XSL

Policy Number

G72489056 Policy Period

04/30/2022 to 04/30/2023 Effective Date of Endorsement

Issued By (Name of Insurance Company)

ACE American Insurance Company

Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This endorsement modifies insurance provided under the following:

EXCESS COMMERCIAL GENERAL LIABILITY POLICY

SCHEDULE

Name of Person or Organization: Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss.

A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability 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 acting on your behalf:

1. In the performance of your ongoing operations; or

2. In connection with your premises owned by or rented to you.

However:

1. The insurance afforded to such additional insured only applies to the extent permitted by law; and

2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.

B. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance And Retained Limit:

If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:

1. Required by the contract or agreement; or

2. Available under the applicable Limits of Insurance shown in the Declarations;

whichever is less.

XS-21168a (04/13) Copyright, Insurance Services Office, Inc., 2012 Page 1 of 2

A DDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – SCHEDULED PERSON OR ORGANIZATION

ADDITIONAL INSURED – OWNERS, LESSEES OR

CONTRACTORS – SCHEDULED PERSON OR ORGANIZATION

Named Insured

Ergon, Inc.

Endorsement Number

Policy Symbol

XSL

Policy Number

G72489056 Policy Period

04/30/2022 to 04/30/2023 Effective Date of Endorsement

Issued By (Name of Insurance Company)

ACE American Insurance Company

Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This Endorsement modifies insurance provided under the following:

EXCESS COMMERCIAL GENERAL LIABILITY POLICY

SCHEDULE

Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations

Any Owner, Lessee or Contractor whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss.

All locations where you are performing ongoing operations for such additional insured pursuant to any such written contract.

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organiza-tion(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by:

1. Your acts or omissions; or

2. The acts or omissions of those acting on your behalf;

in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above.

However:

1. The insurance afforded to such additional insured only applies to the extent permitted by law; and

2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.

B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:

This insurance does not apply to "bodily injury" or "property damage" occurring after:

1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or

XS-21168a (04/13) Copyright, Insurance Services Office, Inc., 2012 Page 2 of 2

2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project.

C. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance And Retained Limit:

If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:

1. Required by the contract or agreement; or

2. Available under the applicable Limits of Insurance shown in the Declarations;

whichever is less.

XS-29893 (05/10)

Includes copyrighted material of Insurance Services Office, Inc. with its permission

DESIGNATED PROJECT(S) GENERAL AGGREGATE LIMIT

DESIGNATED PROJECT(S) GENERAL AGGREGATE LIMIT

Named Insured

Ergon, Inc.

Endorsement Number

Policy Symbol

XSL

Policy Number

G72489056 Policy Period

04/30/2022 to 04/30/2023

Effective Date of Endorsement

Issued By (Name of Insurance Company)

ACE American Insurance Company

Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This endorsement modifies all insurance provided under the following:

EXCESS GENERAL LIABILITY POLICY

SCHEDULE:

Designated Project(s): Each project for which the Insured has agreed, pursuant to a written contract signed prior to the date loss, to provide a separate Designated Project Aggregate Limit under this policy.

Designated Project General Aggregate Limit: $2,000,000

A. Subject to and eroding the General Aggregate Limit shown in the Declarations, for all sums which the insured becomes legally obligated to pay as damages caused by “occurrences” under COVERAGE A (SECTION I) which can be attributed only to ongoing operations at the Designated Project(s) shown in the Schedule above:

1. A separate Designated Project General Aggregate Limit applies to each Designated Project shown in the Schedule, and that limit is equal to the amount of the Designated Project General Aggregate Limit shown in the Schedule above.

2. The Designated Project General Aggregate Limit is the most we will pay for the sum of all damages under COVERAGE A, except damages because of “bodily injury” or “property damage” included in the “products-completed operations hazard”, which damages can be attributed only to ongoing operations at a single Designated Project, regardless of the number of:

a. Insureds;

b. Claims made or “suits” brought; or

c. Persons or organizations making claims or bringing “suits”.

3. Any payments made under COVERAGE A for damages shall reduce the Designated Project General Aggregate Limit for that Designated Project and shall also reduce and erode the General Aggregate Limit shown in the Declarations.

XS-29893 (05/10)

Includes copyrighted material of Insurance Services Office, Inc. with its permission

4. The limits shown in the Declarations for Each Occurrence and Damage to Premises Rented to You continue to apply. However, such limits will be subject to the Designated Project General Aggregate Limit, as well as the General Aggregate Limit shown in the Declarations.

B. For all sums which the insured becomes legally obligated to pay as damages caused by “occurrences” under COVERAGE A (SECTION I) which cannot be attributed to ongoing operations at a Designated Project:

1. Any payments made under COVERAGE A for damages shall reduce the amount available under the General Aggregate Limit or the Products-Completed Operations Aggregate Limit, whichever is applicable; and

2. Such payments shall not reduce the Designated Project General Aggregate Limit.

C. When coverage for liability arising out of the “products-completed operations hazard” is provided, any payments for damages because of “bodily injury” or “property damage” included in the “products-completed operations hazard” will reduce the Products-Completed Operations Aggregate Limit, and will not reduce the General Aggregate Limit nor the Designated Project General Aggregate Limit.

D. If any one or more of your Designated Projects has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same Designated Project.

E. The provisions of Limits Of Insurance (SECTION III) not otherwise modified by this endorsement shall continue to apply as stipulated.

XS-20288a (05/14) ©Chubb. 2016. All rights reserved. Page 1 of 1

NON-CONT RIBUTORY END ORSEMENT FOR ADDITIONAL INSUREDS

NON-CONTRIBUTORY ENDORSEMENT FOR ADDITIONAL INSUREDS

Named Insured

Ergon, Inc.

Endorsement Number

Policy Symbol

XSL

Policy Number

G72489056 Policy Period

04/30/2022 to 04/30/2023 Effective Date of Endorsement

Issued By (Name of Insurance Company)

ACE American Insurance Company

Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This endorsement modifies insurance provided under the following:

EXCESS COMMERCIAL GENERAL LIABILITY POLICY

Schedule

Organization Additional Insured Endorsement

Any additional insured with whom you have agreed to provide such non-contributory insurance, pursuant to and as required under a written contract executed prior to the date of loss.

(If no information is filled in, the schedule shall read: “All persons or entities added as additional insureds through an endorsement with the term “Additional Insured” in the title)

For organizations that are listed in the Schedule above that are also an Additional Insured under an endorsement attached to this policy, the following is added to Section IV.4:

If other insurance is available to an insured we cover under any of the endorsements listed or described above (the “Additional Insured”) for a loss we cover under this policy, this insurance will apply to such loss and is primary (subject to satisfaction of the “retained limit”), meaning that we will not seek contribution from the other insurance available to the Additional Insured. Your “retained limit” still applies to such loss, and we will only pay the Additional Insured for the “ultimate net loss” in excess of the “retained limit” shown in the Declarations of this policy.

XS-6W34a (02/20) Page 1 of 1

W AIVER OF T RANSFER O F RIGHT S OF RECOVERY AGAINST OTHERS TO US

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US

Named Insured

Ergon, Inc.

Endorsement Number

Policy Symbol

XSL

Policy Number

G72489056 Policy Period

04/30/2022 to 04/30/2023 Effective Date of Endorsement

Issued By (Name of Insurance Company)

ACE American Insurance Company

Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This endorsement modifies insurance provided under the following:

EXCESS COMMERCIAL GENERAL LIABILITY POLICY

SCHEDULE

Name ofof Person oror Organization: Any person oror organization against whom you have agreed toto waive your right of recovery in a written contract, provided such contract was executed prior to the date of loss.

The following isis added toto Paragraph 8.8. Transfer OfOf Rights OfOf Recovery Against Others ToTo UsUs ofof Section IVIV - Conditions:

WeWe waive any right ofof recovery against the person(s) oror organization(s) shown inin the Schedule above because ofof payments wewe make under this policy. Such waiver byby usus applies only toto the extent that the insured has waived its right ofof recovery against such person(s) oror organization(s) prior toto loss. This endorsement applies only toto the person(s) or organization(s) shown in the Schedule above.

All Other Terms And Conditions Remain Unchanged.

Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number

Policy Number Symbol: Number:

Policy Period

TO

Effective Date of Endorsement

Issued By (Name of Insurance Company)

Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.

This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule.

Schedule

For the states of CA, UT, TX, refer to state specific endorsements.

This endorsement is not applicable in KY, NH, and NJ.

The endorsement does not apply to policies in Missouri where the employer is in the construction group of code classifications. According to Section 287.150(6) of the Missouri statutes, a contractual provision purporting to waive subrogation rights against public policy and void where one party to the contract is an employer in the construction group of code classifications.

For Kansas, use of this endorsement is limited by the Kansas Fairness in Private Construction Contract Act(K.S.A..

16-1801 through 16-1807 and any amendments thereto) and the Kansas Fairness in Public Construction Contract Act(K.S.A 16-1901 through 16-1908 and any amendments thereto). According to the Acts a provision in a contract for private or public construction purporting to waive subrogation rights for losses or claims covered or paid by liability or workers compensation insurance shall be against public policy and shall be void and unenforceable except that, subject to the Acts, a contract may require waiver of subrogation for losses or claims paid by a consolidated or wrap-up insurance program.

Authorized Representative

WC 00 03 13 (11/05) Ptd. U.S.A. Copyright 1982-83, National Council on Compensation

ERGON, INC.

2829 LAKELAND DRIVE

FLOWOOD MS 39232-7611

WLR C68924807

04-30-2022 04-30-2023 04-30-2022

ACE AMERICAN INSURANCE COMPANY

ANY PERSON OR ORGANIZATION AGAINST WHOM YOU HAVE AGREED TO WAIVE YOUR RIGHT OF RECOVERY IN A WRITTEN CONTRACT, PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO THE DATE OF LOSS.

Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number

Policy Number Symbol: Number:

Policy Period

TO

Effective Date of Endorsement

Issued By (Name of Insurance Company)

Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.

This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule.

Schedule

For the states of CA, UT, TX, refer to state specific endorsements.

This endorsement is not applicable in KY, NH, and NJ.

The endorsement does not apply to policies in Missouri where the employer is in the construction group of code classifications. According to Section 287.150(6) of the Missouri statutes, a contractual provision purporting to waive subrogation rights against public policy and void where one party to the contract is an employer in the construction group of code classifications.

For Kansas, use of this endorsement is limited by the Kansas Fairness in Private Construction Contract Act(K.S.A..

16-1801 through 16-1807 and any amendments thereto) and the Kansas Fairness in Public Construction Contract Act(K.S.A 16-1901 through 16-1908 and any amendments thereto). According to the Acts a provision in a contract for private or public construction purporting to waive subrogation rights for losses or claims covered or paid by liability or workers compensation insurance shall be against public policy and shall be void and unenforceable except that, subject to the Acts, a contract may require waiver of subrogation for losses or claims paid by a consolidated or wrap-up insurance program.

Authorized Representative

WC 00 03 13 (11/05) Ptd. U.S.A. Copyright 1982-83, National Council on Compensation

CRAFCO, INC.

2829 LAKELAND DRIVE

FLOWOOD MS 39232-7611

WLR C68924807

04-30-2022 04-30-2023 04-30-2022

ACE AMERICAN INSURANCE COMPANY

ANY PERSON OR ORGANIZATION AGAINST WHOM YOU HAVE AGREED TO WAIVE YOUR RIGHT OF RECOVERY IN A WRITTEN CONTRACT, PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO THE DATE OF LOSS.