2025-03-12 COI GL AL WC CP.pdf

04/30/2024

AssuredPartners of Arizona, LLC 14805 N 73rd Street

Scottsdale AZ 85260

Shannen Mills

Shannen.Mills@assuredpartners.com

Kary Environmental Services Inc.

641 S. Drew St

Mesa AZ 85210

Everest Indemnity Insurance Co 10851 Berkley National Insurance Company 38911

24-25 MASTER CERT

A Poll Liab $1m/$2m Occur Prof Liab $1m/$2m Claims Made Y Y EF4CE00063241 03/12/2024 03/12/2025

1,000,000 50,000 5,000 1,000,000 2,000,000 2,000,000

A Y Y EF4CA00321241 03/12/2024 03/12/2025

1,000,000

A 10,000

EF4XS00059241 03/12/2024 03/12/2025

10,000,000 10,000,000

FOLLOWING FORM

B Y Y BIN151024337 03/01/2024 03/01/2025

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

A Prof Liab - ClaimMade Retro 05/15/98 Transportation Pollution - Occur EF4CE00063241 03/12/2024 03/12/2025

Per Claim/Aggr $1m/$2m Occur/Aggr $1m/$2m

Prj:No. CTR071401 Applies to any and all work performed for or on behalf of the State of Arizona/ADOT

Arizona Department of Transportation/ADOT is continued next page:

Arizona Department of Transportation/ADOT ATTN: Bambi Brenden 206 S 17th Ave Phoenix AZ 85007

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

G0171 Accepted

Kary Environmental

00069468

AssuredPartners of Arizona, LLC

25 Certificate of Liability Insurance: Notes an Additional Insureds for both ongoing and completed operations of the Named Insured on a Primary/non contributory basis including a Waiver of Subrogation including a Per Project aggregate for the General Liability.

An Additional Insured, primary/non contributory including a Waiver of Subrogation applies for the Commercial Auto. The Workers Compensation reflects a Waiver of Subrogation.

Blanket notice of cancelation to third party applies.

Forms:

ECG 00 595 (09/23), ECG 24 671 (02/23), ECG 24 669 (08/18), EIL 00 734 (09/18), CA 20 48 (10/13), ECA 24 503 (02/14), CA 99 48 (10/13), WC 00 03 13 (04/84).

All forms apply where required by written contract.

Third Party Action Over coverage is not excluded under the General Liability policy as evidenced on page one of the 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:

Kary Environmental Services Inc.AssuredPartners of Arizona, LLC

25 Certificate of Liability Insurance: Notes hereby listed as Additional insured on a Primary/non contriburory basis including a Waiver of Subrogation and a Per Project Aggregate for the General Liability and Pollution sections of the policy and as an Additional Insured including a Waiver of Subrogation for the Commercial Auto. A Waiver of Subrogation applies for the Workers Compensation.

FORMS: ECG00595(09/23), ECG24671(08/18), ECG24669(08/18), ECG24673

(08/18), CA2048(10/13), ECA24503(02/14), ECA24509(04/14) and WC000313 (04/84).

Transportation Liability per form CA9948.

Blanket Notice of Cancellation - 30 day per form EIL00734(09/18) Umbrella is following form & extends over all underlying coverage including Pollution and Professional Liability.

All forms apply where required by written contract.

Workers Compensation - Owner Excluded - Jeff Kary.

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:

EF4CE00063-241

POLICY NUMBER: EVEREST .CONTRACTORS ENVIRONMENTAL PLUS

ECG 24 673 08 18

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

PER PROJECT(S)

GENERAL AGGREGATE LIMIT WITH CAP

This endorsement modlfies insurance provided under the following:

EVEREST CONTRACTORS ENVIRONMENTAL PLUS COVERAGE PART

SCHEDULE

Designated Project(s): ALL PROJECTS WHERE REQUIRED BY WRITTEN CONTRACT

Designated Project General Aggregate limit With Cap: $6,000,000 lnfonnation reQuired to complete this Schedule, if not shown above, will be shovm in the Declarations.

A For all sums which the insured becomes legally obligated to pay as damages caused by �occurrences" under Section I - Coverage A, and for all medical expenses caused by accidents under Section I - Coverage C, which can be attributed only to operations at a single designated project shown in the Schedule above:

1. A separate Designated Project General Aggregate Limit applies to each designated project, and that limit Is equal to the amount of the General Aggregate Limit shown In the Declarations. However, the separate Designated Project General Aggregate Llmit(s) are subject to a Designated Project General Aggregate Limit Cap in the amount shown in the above Schedule of this endorsement. The Designated Project General Aggregate Limit Cap Is the most we will pay under the Designated Project General Aggregate Limit for all designated projects combined.

2. The Designated Project General Aggregate Limit ls the mos! 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", and for medical expenses under Coverage C 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 or under Coverage C for medlcal expenses shall reduce the Designated Project General Aggregate Limit for that designated project and the Designated Project General Aggregate Limit Cap. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Projecf General Aggregate Limit for any other designated project shown in the Schedule above. However, such payments for damages and medical expenses included in the Designated Project General Aggregate Limit for all designated projects combined will reduce the Designated Project General Aggregate Limit Gap.

4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, Instead of being subject to the General Aggregate Limit shown In the Declarations, such limits will be subject to the applicable Designated Project General Ag gregate Limit.

ECG 24 673 0818 Copyright, Everest Reinsurance Company, 2018 Includes copyrighted material of Insurance Services Office, Inc.

used with its pennission.

EF4CE00063-241

POLICY NUMBER: EF4CA00321-241 COMMERCIAL AUTO

CA20481013

THIS ENDORSEMENT CHANGES THE POLICY. PL.EASE READ IT CAREFUL!. Y.

DESIGNATED INSURED FOR

COVERED AUTOS LIABILITY COVERAGE

This endorsement modifies Insurance provided under the following:

AUTO DEALERS COVERAGE FORM

BUSINESS AUTO COVERAGE FORM

MOTOR CARRIER COVERAGE FORM

\/v'llh respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement.

This endorsement identifies person(s) or organizalion(s) who are "insureds" for Covered Autos Llabllity Coverage under the VVho I s An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Forrn This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below, Named Insured: Kary Environmental Services

Endorsement Effective Date: 03/12/2024

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

SCHEDULE

ALL PERSONS OR ORGANIZATIONS AS REQUIRED BY WRITTEN CONTRACT WITH THE

NAMED INSURED. THE WRITTEN CONTRACT MUST BE SIGNED PRIOR TO THE DATE

OF THE "ACCIDENT".

Information reauired to comolete this Schedule if not shown above will be shown In the Declarations.

Each person or organization shown In the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An insured provision contained in Paragraph A.1. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form.

CA20481013 @Insurance Services Office, Inc., 2011

INSUReD COPY

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