2025-03-01_COI_Summitt.pdf

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

INSURER(S) AFFORDING COVERAGE

INSURER F :

INSURER E :

INSURER D :

INSURER C :

INSURER B :

INSURER A :

NAIC #

NAME:

CONTACT

(A/C, No):

FAX

E-MAIL

ADDRESS:

PRODUCER

(A/C, No, Ext):

PHONE

INSURED

REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES

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.

OTHER:

(Per accident)

(Ea accident)

N / A

SUBR

WVD

ADDL

INSD

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.

$PROPERTY DAMAGE

BODILY INJURY (Per accident)

BODILY INJURY (Per person)

COMBINED SINGLE LIMIT

AUTOS ONLY

AUTOSAUTOS ONLY

NON-OWNED

SCHEDULEDOWNED

ANY AUTO

AUTOMOBILE LIABILITY

Y / N

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH)

DESCRIPTION OF OPERATIONS below If yes, describe under

ANY PROPRIETOR/PARTNER/EXECUTIVE

E.L. DISEASE - POLICY LIMIT

E.L. DISEASE - EA EMPLOYEE

E.L. EACH ACCIDENT

ER

OTH-

STATUTE

PER

LIMITS(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY)

POLICY EFF

POLICY NUMBERTYPE OF INSURANCELTR

INSR

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

EXCESS LIAB

UMBRELLA LIAB $EACH OCCURRENCE

$AGGREGATE

OCCUR

CLAIMS-MADE

DED RETENTION $

$PRODUCTS - COMP/OP AGG

$GENERAL AGGREGATE

$PERSONAL & ADV INJURY

$MED EXP (Any one person)

$EACH OCCURRENCE

DAMAGE TO RENTED

$PREMISES (Ea occurrence)

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY

PRO-

JECT LOC

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

CANCELLATION

AUTHORIZED REPRESENTATIVE

ACORD 25 (2016/03)

© 1988-2015 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

11/19/2024 k.p.d. Insurance LLC 1111 Gateway Loop Springfield OR 97477

541-741-0550 541-741-1674

License#: PC-1210733 THE CINCINNATI SPECIALTY UNDERWRITER 13037

SUMMFOR02C CONTINENTAL DIVIDE INS CO 35939

Summitt Forests, Inc.

2305 Ashland Street, Suite #104

PMB #432

Ashland OR 97520-3777

LANDMARK AMER INS CO 33138

NATIONAL FIRE & MARINE INS CO 20079

CRUM & FORSTER SPECIALTY INS CO 44520

SAIF Corporation 36196

23441095

A X 1,000,000 X 100,000

X LOGGERS BFPD EXCLUDED

X WA STOP GAP 1,000,000

2,000,000 X

Y Y CSU 0183947 3/1/2024 3/1/2025

2,000,000

B 1,000,000

X X X

Y Y 05APM02876803 3/1/2024 3/1/2025

NO HAPD COVERAGE

C X 2,000,000

X

LHA106877 3/1/2024 3/1/2025

2,000,000

F XY 887885 11/1/2024 11/1/2025

500,000

500,000

500,000 D E

EXCESS AUTOMOBILE LIABILITY

POLLUTION LIABILITY

72XAS009915

PKC-115052

3/1/2024 3/1/2024

3/1/2025 3/1/2025

$4,000,000 LIMIT

$1,000,000/$2,000,000

POLL LIAB RETRO DATE:

$5,000 DEDUCTIBLE

12/31/2021

*2nd Workers Comp policy: Zurich Insurance #1152905, WC Policy has $1Million Employers Liability Limits* **Additional Insured wording does not apply to the Workers Comp/Employers Liability Coverage** ***Excess/Umbrella Liability extends over the Workers Comp/Employers Liability Coverage***

RE: Solicitation #BPM006328: Tree Thinning, Tree Removal and Woody Vegetation Removal The State of Arizona, and its Departments, Agencies, Boards, Commissions, Universities, Officers, Officials, Agents and Employees are included as Additional Insureds, for General Liability, when required by written contract or agreement, per form CSGA4034_0612, which includes Primary and Non-Contributory coverage; and for Automobile Liability, per form M-5876_0516. Products/Completed Operations coverage applies to General Liability, per form CSGA437_1213 See Attached...

Arizona Game and Fish Department 5000 W Carefree Highway Phoenix AZ 85086-5000

THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE

ACORD 101 (2008/01)

The ACORD name and logo are registered marks of ACORD

© 2008 ACORD CORPORATION. All rights reserved.

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: FORM TITLE:

ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE Page of

AGENCY CUSTOMER ID:

LOC #:

AGENCY

CARRIER NAIC CODE

POLICY NUMBER

NAMED INSURED

EFFECTIVE DATE:

SUMMFOR02C

1 1 k.p.d. Insurance LLC Summitt Forests, Inc.

2305 Ashland Street, Suite #104

PMB #432

Ashland OR 97520-3777

25 CERTIFICATE OF LIABILITY INSURANCE

and Waiver of Subrogation applies, per form CSGA4087_1212. Waiver of Subrogation applies to Automobile Liability, per form M-5144a_0607; and to Workers’ Compensation, per form WC000313.

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Includes copyrighted material of Insurance CSGA 4087 12 12 Services Office, Inc., with its permission. Page 1 of 1

COMMERCIAL GENERAL LIABILITY

CSGA 4087 12 12

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US - PER CONTRACT

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

The following is added to Paragraph 8. Transfer of Rights of Recovery Against Others to Us of SECTION

IV - CONDITIONS:

If you have agreed, in a written contract or agreement, to provide a waiver of any right of recovery against a person or organization, we will waive any right of recovery we may have against that person or organization because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard".

This waiver applies only to that person or organization for which you have agreed to in a written contract to provide said waiver.

Includes copyrighted material of ISO CSGA 437 12 13 Properties, Inc., with its permission. Page 1 of 2

COMMERCIAL GENERAL LIABILITY

CSGA 437 12 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED - OWNERS, LESSEES OR

CONTRACTORS - AUTOMATIC STATUS WHEN

REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU -

OPERATIONS AND COMPLETED OPERATIONS

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

A. SECTION II - WHO IS AN INSURED is amended to include as an additional insured any person or organization when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy, but only with respect to "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by:

1. Your acts or omissions in the perform-ance of your ongoing operations for the additional insured;

2. The acts or omissions of those acting on your behalf in the performance of your ongoing operations for the additional in-sured; or

3. "Your work" performed for the additional insured and included in the "products-completed operations hazard".

If not specified otherwise in the written con-tract or agreement, a person's or organiza-tion's status as an additional insured under this endorsement ends one year after your opera-tions for that additional insured are completed.

The written contract or agreement must be currently in effect or become effective during the term of this Coverage Part. The contract or agreement must be executed prior to the "bod-ily injury", "property damage" or "personal and advertising injury" to which this endorsement pertains.

However:

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

2. If coverage provided to the additional in-sured is required by a contract or agree-ment, the insurance afforded to such ad-ditional insured will not be broader than that which you are required by the con-tract or agreement to provide for such ad-ditional linsured.

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

This insurance does not apply to:

1. "Bodily injury", "property damage" or "per-sonal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineer-ing or surveying services, including:

a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or draw-ings and specifications; or

b. Supervisory, inspection, architectural or engineering activities.

2. "Bodily injury" or "property damage" aris-ing out of "your work" for which a consoli-dated (wrap-up) insurance program has been provided by the prime contrac-tor/project manager or owner of the con-struction project in which you are involved.

3. "Bodily injury", "property damage" or "per-sonal and advertising injury" to any em-ployee of you or to any obligation of the additional insured to indemnity another because of damages arising out of such injury.

Includes copyrighted material of ISO CSGA 437 12 13 Properties, Inc., with its permission. Page 2 of 2

4. "Bodily injury", "property damage" or "per-sonal and advertising injury" for which the Named Insured is afforded no coverage under this policy of insurance.

C. With respect to the insurance afforded to these additional insureds, SECTION III - LIM- ITS OF INSURANCE is amended to include:

The limits applicable to the additional insured are those specified in the written contract or agreement or in the Declarations of this Cov-erage Part, whichever is less. If no limits are specified in the written contract or agreement, the limits applicable to the additional insured are those specified in the Declarations of this Coverage Part. The limits of insurance are in-clusive of and not in addition to the limits of in-surance shown in the Declarations.

D. With respect to the insurance afforded to these additional insureds, SECTION IV -

COMMERCIAL GENERAL LIABILITY CON-

DITIONS, 4. Other Insurance is amended to include:

Any coverage provided herein will be excess over any other valid and collectible insurance available to the additional insured whether primary, excess, contingent or on any other basis unless you have agreed in a written con-tract or written agreement executed prior to any loss that this insurance will be primary.

This insurance will be noncontributory only if you have so agreed in a written contract or written agreement executed prior to any loss and this coverage is determined to be primary.

SUMMITT FORESTS INC; SUMMITT ENTERPRISES INC

10/29/2024 5:32 PM

ARIZONA GAME AND FISH DEPARTMENT

ATTN: PURCHASING

SCHEDULE

(Authorized Representative)

Countersigned By:

Named Insured:

Endorsement Effective:

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

M-5144a (06/2007)

WAIVER OF TRANSFER OF RIGHTS OF

RECOVERY AGAINST OTHERS TO US

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM

GARAGE COVERAGE FORM

MOTOR CARRIER COVERAGE FORM

TRUCKERS COVERAGE FORM

With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi-fied by the endorsement.

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

POLICY NUMBER 05 APM 028768 - 03

5000 W CAREFREE HIGHWAY

PHOENIX, AZ 85086-5000

34$Additional Premium

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

(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.)

The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply to the person (s) or organiza-tion(s) shown in the Schedule. We will retain the additional premium shown above, regardless of any early termi-nation of this endorsement or the policy.

M-5144a (06/2007)

M-5876 (05/2016)

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

BLANKET ADDITIONAL INSURED ENDORSEMENT

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

GARAGE COVERAGE FORM

TRUCKERS COVERAGE FORM

In consideration of payment of the additional premium listed below, LIABILITY COVERAGE is extended to any person or organization you are required to add to this policy as an additional insured in a written agreement between you and the additional insured that is executed prior to the "accident" provided that:

1) such insurance applies only to the ownership, maintenance or use of a covered auto; and

2) such insurance applies only to acts or omissions by you, your agents or your “employees” while such covered auto is being used in your business; and

3) such insurance does not apply to the acts or omissions of the additional insured or any of the additional insured’s agents or "employees" other than you; and

4) such insurance does not apply if the additional insured is subject to motor carrier insurance requirements and is not insured for hired "autos" under an "auto" liability insurance form that insures on a primary basis the owners of the "autos" and their agents and "employees" while the "autos" are being used exclusively in the additional insured’s business and pursuant to operating rights granted to the additional insured by a public authority; and

5) such inclusion of additional insured shall not increase our limit of liability under this policy.

All other terms, conditions and agreements remain unchanged.

M-5876 (05/2016)

Company Name Policy Number

Endorsement Effective

Named Insured Countersigned by

(Authorized Representative)

(The Attaching Clause need be completed only when this endorsement is issued subsequent to preparation of the policy .)

Additional Premium: $

03/31/2022

05 APM 028768 - 01

Continental Divide Insurance Company

SUMMITT FORESTS INC

03/11/2022 11:22 AM

2,433

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13

(Ed. 04-84)

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 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 anyone not named in the Schedule.

Schedule

ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE

PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND/OR

ORGANIZATION IN AZ, CA, CO, ID, MT, TX.

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.)

Endorsement Effective Policy No. Endorsement No.

Insured Premium $

Insurance Company Countersigned by______________________________Zurich American Insurance Company

11/01/2024 WC 1152905 - 06

SUMMITT FORESTS INC

Copyright 1983 National Council on Compensation Insurance, Inc.WC124 (4-84)

WC 00 03 13