2025-10-1 Watearth WC.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

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

9/23/2024

Aon Risk Services, Inc. of Florida 4010 W. Boy Scout Boulevard, Suite 200 Tampa, FL 33607

936-521-5753 www.aon.com Key Risk/ Midwest Employers Casualty Company 23612

A KEYMCP00035302 (CA) 10/1/2024 10/1/2025 ✓

A KEYMCP00022902 (NY) 10/1/2024 10/1/2025

1,000,000

A KEYMCP00035402 (PA) 10/1/2024 10/1/2025

1,000,000A KEYPEO00001702 10/1/2024 10/1/2025

A KEYMCP00051702 (AZ) 10/1/2024 10/1/2025 1,000,000

David E. Carothers

Questco Risk Management coirequest@questco.net

Questco Holdings, Inc.

480 Wildwood Forest Drive, Suite 250 The Woodlands TX 77380

82013411

Arizona Department of Environmental Quality (ADEQ) 1110 W Washington St.

Phoenix AZ 85007

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

Project /Job#: Project/Job: -CTR074233 , Client Name/Alt. Employer: Watearth, Inc. Client ID #: 8165 Main Location: 3371 Glendale Blvd., Suite 101, Los Angeles, CA 90039 Addt'l Locations: See Page 2 Workers Compensation coverage is provided for only co-employees of, but not subcontractors to Watearth, Inc..

--See Attached Remarks Schedule--

82013411 | 2024-25_Watearth (8165) Key | Abbey Shoupe | 9/23/2024 4:43:24 PM (EDT) | Page 1 of 3 This certificate cancels and supersedes ALL previously issued certificates.

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:

Workers Compensation policy(s) provides a Blanket Waiver of Subrogation when required by written contract, except as prohibited by law

30 day Notice of Cancellation applies in the event the named insured's Workers Comp.

policy is cancelled prior to the expiration date.

Aon Risk Services, Inc. of Florida Questco Holdings, Inc.

480 Wildwood Forest Drive, Suite 250 The Woodlands TX 77380

25 ACORD 25 (03/16)

ADDENDUM/DOO

HOLDER:

ADDRESS:

Arizona Department of Environmental Quality (ADEQ) 1110 W Washington St. Phoenix AZ 85007

82013411 | 2024-25_Watearth (8165) Key | Abbey Shoupe | 9/23/2024 4:43:24 PM (EDT) | Page 2 of 3

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:

Workers Compensation coverage is provided for only co-employees of, but not subcontractors to Watearth, Inc..

Named Insured: Emergent XIII, LLC L/C/F Watearth, Inc.

Policy #: KEYMCP00035302 Locations:

1050 E. Ramon Rd., Palm Springs, CA 92264 8237 Tevrin Way, Sacramento, CA 95828 602 10th Avenue, San Mateo, CA 94402 738 S New Hampshire Ave., Apt 109, Los Angeles, CA 90005 225 Cahuenga Drive, Oxnard, CA 93035 1200 West Crest Way, Monterey Park, CA 91754 188 W. Saint James St., Unit 11104, San Jose, CA 95110 2401 27th Avenue, San Francisco, CA 94116

Named Insured: Emergent IV, LLC L/C/F Watearth, Inc.

Policy #: KEYMCP00022902 Location:

46 Hampton Rd, Marlboro, NY 12542

Named Insured: Emergent IV, LLC L/C/F Watearth, Inc.

Policy #: KEYMCP00035402 Locations:

405 Blue Heron Circle, Blue Bell, PA 19422 516 Guyasuta Rd, Pittsburgh, PA 15215

Named Insured: Questco Holdings, Inc.

Policy #: KEYPEO00001702 Locations:

9657 Red Oakes Place, Highlands Ranch, CO 80126 3600 Hawthorne Woods Terrace, Manhattan, KS 66503 6909 North Platte Purchase Drive, Kansas City, MO 64118 1721 Greenhouse Rd Apt 424, Houston, TX 77084 904 West Belknap Street, Jacksboro, TX 76458 3225 N GRAPEVINE MILLS BLVD, APT 3301, Grapevine, TX 76051 775 Douglas Ave, Palmer Lake, CO 80133

Named Insured: Transport Tax Consulting, Inc. FWLT Watearth, Inc.

Policy #: KEYMCP00051702 Locations:

500 W, 1st Street #1029, Tempe, AZ 85281 237 N DESERT STREAM DR, Tucson, AZ 85745

Aon Risk Services, Inc. of Florida Questco Holdings, Inc.

480 Wildwood Forest Drive, Suite 250 The Woodlands TX 77380

25 Certificate of Liability (03/16)

ATTACHMENT

HOLDER:

ADDRESS:

Arizona Department of Environmental Quality (ADEQ) 1110 W Washington St. Phoenix AZ 85007

82013411 | 2024-25_Watearth (8165) Key | Abbey Shoupe | 9/23/2024 4:43:24 PM (EDT) | Page 3 of 3

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13

(Ed. 4-84)

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

1983 National Council on Compensation Insurance.

WC 00 03 13

(Ed. 4-84) c

(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.

Endorsement No.Endorsement Effective Date: Policy No.

Carrier Name / Code:

Policy Effective Date: to Premium $

Insured:

DBA:

Countersigned by

Page of

KEYMCP00051702

Midwest Employers Casualty Company

Transport Tax Consulting, Inc FWLT Watearth, Inc.

10/01/2024

10/01/2024 10/01/2025

1 1

Any Party with whom the insured, Watearth, Inc., agrees to waiver of subrogation in a written contract.