2026-06-01 Intera GAUWPP.pdf

INSR ADDL SUBR

LTR INSR 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)

COMMERCIAL GENERAL LIABILITY

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

INSURER(S) AFFORDING COVERAGE NAIC #

Y / N

N / A (Mandatory in NH)

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

EACH OCCURRENCE $

DAMAGE TO RENTED

$PREMISES (Ea occurrence)CLAIMS-MADE OCCUR

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER:

PRODUCTS - COMP/OP AGG $

PRO-

OTHER:

LOCJECT

COMBINED SINGLE LIMIT

$(Ea accident)

BODILY INJURY (Per person) $ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS

AUTOS ONLY

HIRED PROPERTY DAMAGE $

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

POLICY

NON-OWNED

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 any 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)

ACORDTM CERTIFICATE OF LIABILITY INSURANCE

Lloyd's of London

Hartford - WC Multiple Issuing Cos

Sentinel Insurance Company Ltd.

6/03/2025

USI Southwest 7600-C N. Capital of TX Hwy #200 Austin, TX 78731 512 451-7555

Danelle Touchstone 210-524-2094 610-537-1904 danelle.touchstone@usi.com

INTERA Incorporated 9600 Great Hills Trl Suite 300W Austin, TX 78759

SURPLU

00914 11000

A X X

X GL Ded: $10,000 X Poll Ded: $25,000

X X

ENVP000025425 06/01/2025 06/01/2026 1,000,000

300,000 25,000 1,000,000 2,000,000 2,000,000 1,000,000Poll Liab

C X

X X

65UECZR3402 06/01/2025 06/01/2026 1,000,000

A X

X ENVX000020625 06/01/2025 06/01/2026 6,000,000

6,000,000

B

N

65WBOL6H7Y 06/01/2025 06/01/2026 X

1,000,000

1,000,000 1,000,000

A Professional LIab ENVP000025425

Retroactive Date

06/01/2025

01/10/2002

06/01/2026 $2,000,000 Aggregate $1,000,000 Per Claim $100,000 Deductible

RE: Contract #CTR074225 Capacity Development/Technical Assistance to Small Public Drinking Water Systems

The Excess Liability Policy sits over and follows form of the General Liability, Automobile Liability and Professional Liability limits. Professional Liability is on a claims-made basis.

(See Attached Descriptions)

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

#S49495689/M49427165

INTERINC22Client#: 914933

SAPZR

SAGITTA 25.3 (2016/03)

DESCRIPTIONS (Continued from Page 1)

The General Liability and Automobile Liability policies include a blanket Additional Insured endorsement that provides Additional Insured status to State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees when there is a written contract that requires such status and only with regard to work performed on behalf of the named insured.

The General Liability and Automobile Liability policies contain a special endorsement with Primary and Noncontributory wording when required by written contract.

The General Liability, Automobile Liability, and Workers Compensation policies provide a blanket Waiver of Subrogation in favor of State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees when required by written contract.

A thirty (30) days prior written notice of cancellation to certificate holder applies when required by written contract.

#S49495689/M49427165