2024-07-01_COI.pdf

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E H

J O

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Id e n ti fi e r

77777 77707 07070 00777 61616 04557 11107 74737 02632 65552 07662 20575 25073 00070 67377 52653 22210 75073 77572 57676 20721 50463 06622 13107 66570 66050 25554 07175 14763 31640 10076 25154 42036 45520 76727 24203 57720 00777 77770 70007 07007

77777 77707 07070 00735 25677 11545 60007 67040 50357 70020 07675 51446 16204 74070 22367 30653 31500 70333 27243 16200 00703 32373 52173 11107 12332 62520 73110 07022 23734 20630 11070 23336 25316 31110 77756 16335 17655 40777 77770 70007 07007

C e rt if ic a te

N o

CERTIFICATE OF LIABILITY INSURANCE

DATE(MM/DD/YYYY)

08/05/2024

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).

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.

PRODUCER

Aon Risk Insurance Services West, Inc.

Los Angeles CA Office 707 Wilshire Boulevard Suite 2600 Los Angeles CA 90017-0460 USA

PHONE

(A/C. No. Ext):

E-MAIL

ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC #

(866) 283-7122

INSURED 19682Hartford Fire Insurance Co.INSURER A:

INSURER B:

INSURER C:

INSURER D:

INSURER E:

INSURER F:

FAX

(A/C. No.):

(800) 363-0105

CONTACT

NAME:

West Coast Arborists, Inc.

2200 E Via Burton Anaheim CA 92806 USA

COVERAGES CERTIFICATE NUMBER: 570107494595 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. Limits shown are as requested

POLICY EXP

(MM/DD/YYYY)

POLICY EFF

(MM/DD/YYYY)

SUBR

WVD

INSR

LTR

ADDL

INSD POLICY NUMBER TYPE OF INSURANCE LIMITS

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

POLICY LOC

EACH OCCURRENCE

DAMAGE TO RENTED

PREMISES (Ea occurrence)

MED EXP (Any one person)

PERSONAL & ADV INJURY

GENERAL AGGREGATE

PRODUCTS - COMP/OP AGG

X

X

X X

GEN'L AGGREGATE LIMIT APPLIES PER:

$2,000,000

$1,000,000

$2,000,000

$4,000,000

$4,000,000

A 07/01/2024 07/01/2025

SIR applies per policy terms & conditions

72ECSS89301

PRO-

JECT

OTHER:

AUTOMOBILE LIABILITY

ANY AUTO

OWNED

AUTOS ONLY

SCHEDULED

AUTOS

HIRED AUTOS

ONLY

NON-OWNED

AUTOS ONLY

BODILY INJURY ( Per person)

PROPERTY DAMAGE

(Per accident)

X

BODILY INJURY (Per accident)

$2,000,000A 07/01/2024 07/01/2025 COMBINED SINGLE LIMIT

(Ea accident)

72 CSE S89302

EXCESS LIAB

OCCUR

CLAIMS-MADE AGGREGATE

EACH OCCURRENCE

DED

UMBRELLA LIAB

RETENTION

E.L. DISEASE-EA EMPLOYEE

E.L. DISEASE-POLICY LIMIT

E.L. EACH ACCIDENT $1,000,000

X OTH-

ER

PER STATUTEA 07/01/2024 07/01/2025

Workers Comp AZ CA

$1,000,000

Y / N

(Mandatory in NH)

ANY PROPRIETOR / PARTNER / EXECUTIVE

OFFICER/MEMBER EXCLUDED? N / AN

WORKERS COMPENSATION AND

EMPLOYERS' LIABILITY

If yes, describe under DESCRIPTION OF OPERATIONS below

$1,000,000

72WNS89300

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

RE: Subject: Award of Contract No. CTR072956 and all work performed for or on behalf of the State of Arizona/ADOT, Project No.

240001, Vons #3280 Catalina 240 Sumner Ave. Avalon, CA 90704. A.J. Padelford & Son, Inc., it's owners, officers, directors, agents, employees, owners and associates and Vons #3280 are included as Additional Insured in accordance with the policy provisions of the General Liability policy. General Liability policy evidenced herein is Primary and Non-Contributory to other insurance available to an Additional Insured, but only in accordance with the policy's provisions. A Waiver of Subrogation is granted in favor of Vons #3280 Catalina 240 Sumner Ave. Avalon, CA 90704 A.J. Padelford & Son, Inc.: it's owners, officers, directors, agents, employees, owners and associates and Vons #3280 in accordance with the policy provisions of the General

CANCELLATIONCERTIFICATE HOLDER

AUTHORIZED REPRESENTATIVEThe State of Arizona/ADOT 206 S. 17th Ave.

Phoenix AZ 85007 USA

ACORD 25 (2016/03)

©1988-2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE

EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE

POLICY PROVISIONS.

G0171 Accepted

Liability, Automobile Liability and Workers' Compensation policies.

FORM TITLE:FORM NUMBER:

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

ADDITIONAL REMARKS

EFFECTIVE DATE:

CARRIER NAIC CODE

POLICY NUMBER

Aon Risk Insurance Services West, Inc.

NAMED INSUREDAGENCY

LOC #:

570000083713AGENCY CUSTOMER ID:

© 2008 ACORD CORPORATION. All rights reserved.

See Certificate Number:

See Certificate Number:

The ACORD name and logo are registered marks of ACORD

570107494595

570107494595

ACORD 25 Certificate of Liability Insurance Additional Description of Operations / Locations / Vehicles:

ACORD 101 (2008/01)

ADDITIONAL REMARKS SCHEDULE Page _ of _

West Coast Arborists, Inc.

POLICY NUMBER: COMMERCIAL GENERAL LIABILITY

CG 24 04 12 19

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US (WAIVER OF SUBROGATION)

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

ELECTRONIC DATA LIABILITY COVERAGE PART

LIQUOR LIABILITY COVERAGE PART

POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES

POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

RAILROAD PROTECTIVE LIABILITY COVERAGE PART

UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS

SCHEDULE

Name Of Person(s) Or Organization(s):

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

The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Conditions:

We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above.

POLICY NUMBER:

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

Form EH 24 08 03 14 Page 1 of 1 © 2014, The Hartford

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

ABCDEFGHIJ

AMENDMENT OF OTHER INSURANCE CONDITION -

PRIMARY OR PRIMARY AND NON-CONTRIBUTORY WHEN

REQUIRED BY CONTRACT

This endorsement modifies insurance provided under the following:

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART (EXCESS)

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART (EXCESS – BROAD FORM)

With respect to other insurance available to any person or organization who is an additional insured under this Coverage Part, the following replaces Paragraph 4., Other Insurance of Section IV –

PRODUCTS/COMPLETED OPERATIONS LIABILITY

CONDITIONS:

4. Other Insurance

If other valid and collectible insurance is available to the insured for a loss we cover under Coverages A or B of this Coverage Part, our obligations are limited as follows:

a. Primary Insurance When Required By Contract

If you have agreed in a written contract, written agreement or permit that this insurance be primary, then subject to the "self-insured retention", this insurance is primary . If other insurance is also primary, we will share with all that other insurance by the method described in Paragraph c. below.

b. Primary And Non-Contributory To Other Insurance When Required By Contract

If you have agreed in a written contract, written agreement, or permit that this insurance is primary and non-contributory with the additional insured's own insurance, then subject to the "self-insured retention", this insurance is primary, and we will not seek contribution from that other insurance.

Paragraphs a. and b. do not apply to other insurance to which the additional insured has been added as an additional insured.

c. Method Of Sharing

If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first.

If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer’s share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers.

This SPECIAL MULTI-FLEX POLICY is provided by the stock insurance company(s) of The Hartford Insurance Group, shown below.

12:01 a.m. Standard Time at your mailing address shown above.

In return for the payment of the premium, and subject to all of the terms of this policy, we agree with you to provide insurance as stated in this policy. The Coverage Parts that are of this policy are listed below. The Advance Premium shown may be subject to adjustment.

Countersigned by Authorized Representative Date(Where required by law)

COMMERCIAL GENERAL LIABILITY (EXCESS)

COVERAGE PART - DECLARATIONS

DECLARATIONS

POLICY NO.

Previous Policy No.

This COMMERCIAL GENERAL LIABILITY (EXCESS) COVERAGE PART consists of:

A. This Declarations;

B. Commercial Liability Schedule, if applicable;

C. Commercial General Liability (Excess) Coverage Form; and

D. Any Endorsements issued to be part of this Coverage Part and listed below.

1. Audit Period is the Policy Period unless otherwise herein stated: Semi-Annual Quarterly Monthly

Annual Not subject to Audit

2. Advance Premium ,which is A Flat Charge Per Each Policy Period

Adjustable at the end of each Audit Period, Per Premium Computation Endorsement

Minimum Retained Audit Premium

Minimum Retained Premium , not subject to adjustment in the event of cancellation by you.

REFER TO SCHEDULE HC1210Applicable State Surcharges:

Note: charges, if any, are included in item 2. above

3. Limits of Insurance

The Limits of Insurance, subject to all the terms of this policy that apply, are:

Each Occurrence Personal and Advertising Injury Limit General Aggregate Limit (Other than Products-Completed Operations) Products-Completed Operations Aggregate Limit

4. Self-Insured Retentions Your self-insured retentions, subject to all the terms of this policy that apply, are:

Each Occurrence Retention Personal and Advertising Injury Retention General Aggregate Retention (Other than Products-Completed Operations) Products-Completed Operations Aggregate Retention All coverages (including Products-Completed Operations) Aggregate Retention

5. Classification, if any:

REFER TO EXTENSION SCHEDULE.

6. Business Description

7. Form Numbers of Coverage Forms and Endorsements forming a part of this policy:

SEE LISTING OF POLICY PROVISIONS AND ENDORSEMENTS FORMING A PART OF THE POLICY AT ISSUE.

Form EH 00 22 06 05

(c) 2005, The Hartford

G0171 General Liability Only

ACCEPTED SIR GL 09.09.24-09.09.25.pdf