2526_MASTER_-_Arizona_Department_of_Transporation__ADOT_.pdf

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

INSR ADDL SUBR

LTR INSD WVD

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 EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)

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

EACH OCCURRENCE $

DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence)

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT

OTHER: $

COMBINED SINGLE LIMIT

$(Ea accident)

ANY AUTO BODILY INJURY (Per person) $

OWNED SCHEDULED

BODILY INJURY (Per accident) $AUTOS ONLY AUTOS

HIRED NON-OWNED PROPERTY DAMAGE

$AUTOS ONLY 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 LIMITDESCRIPTION OF OPERATIONS below

INSURER(S) AFFORDING COVERAGE NAIC #

COMMERCIAL GENERAL LIABILITY

Y / N N / A

(Mandatory in NH)

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 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.ACORD 25 (2016/03)

CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)

The ACORD name and logo are registered marks of ACORD

4/1/2025

(559) 650-3537 2790

16188

GrassXhopper LLC 203 Sweet Lane Rio Rico, AZ 95648

22322 35378

A 1,000,000

X X NRGDBGGL11963 3/30/2025 3/30/2026 100,000

5,000

1,000,000 2,000,000 2,000,000

1,000,000B

X X NBA100891901 3/30/2025 3/30/2026

B Inland Marine NPC100891801 3/30/2025 C Poll. w/$1mil Occ X X CPLMOL121760 2/2/2024 2/2/2026 Aggregate 2,000,000

RE: Contract: CTR069459 Solicitation #BPM005891 Highway Litter Pick-up and Disposal Services (See attached CG20100413 & CG20010413 & CG24040509 & XIC4211013 & MEEI25100819 & MEEI25890122 & Primary and Non-Contributory per MEEI00070123 & Waiver per MEEI25900819) Arizona Department of Transporation (ADOT), The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees

Arizona Department of Transporation (ADOT) 1655 W. Jackson St.

Phoenix, AZ 85007

GRASLLC-02 AMCCLUNG

World Insurance Associates, LLC 1835 N. Fine Ave Fresno, CA 93727

Rhonda Scow rhondascow@worldinsurance.com

Trisura Insurance Company Greenwich Insurance Company Evanston Insurance Company

3/30/2026

X X

X

X X X

POLICY NUMBER: NRG-DBG-GL05630 COMMERCIAL GENERAL LIABILITY

CG 20 01 0413

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE

CONDITION

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

The following is added to the Other Insurance Condition and supersedes any provision to the contrary:

Primary And Noncontributory Insurance

This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that:

(1) The additional insured is a Named Insured under such other insurance; and

(2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured.

CG 20 010413 © Insurance Services Office, Inc., 2012 Page 1 of 1

MEEI 0007 01 23 Page 14 of 22

With respect to any such counsel, the insured agrees that counsel will:

1. Respond timely and regularly to our request for information regarding the "claim" or "suit"; and

2. Provide regular status reports, budgets, case plans, and updates on significant developments.

Furthermore, the insured may at any time, by the insured's written consent, freely and fully waive these rights to select independent counsel.

E. Legal Action Against Us

No person or organization has a right under this Policy to:

1. Join us as a party or otherwise bring us into a "suit" asking for damages from an insured; or

2. Sue us on this Policy unless all of its terms have been fully complied with.

A person or organization may sue us to recover on an agreed settlement or on a final judgment against an insured obtained after an actual trial, but we will not be liable for "losses" that are not payable under the terms of this Policy or that are in excess of the applicable Limit Of Insurance. An agreed settlement means a settlement and release of liability signed by the insured and the claimant or the claimant's legal representative.

F. Other Insurance

If other valid and collectible insurance is available to the insured for "loss" we cover under this Policy, our obligations are limited as follows:

1. Primary Insurance

This insurance is primary except when Paragraph 2. below applies. If this insurance is primary:

a. This insurance is not contributory with any other insurance available to any third-party liability policy if required by a written contract, signed by both parties, and executed prior to the commencement of operations or "your work".

b. Our obligations are not affected unless any of the other insurance is also primary. In that case, we will share with all such other insurance by the method described in Paragraph 3. below.

2. Excess Insurance

a. This insurance is excess over:

(1) Any other insurance, whether primary, excess, contingent, or on any other basis if you are an insured on an insurance policy that applies to "your work" performed at a specific job site and that insurance policy applies to a specific job site;

(2) Any other valid and collectible insurance available to you covering liability for "losses" arising out of "your work", including that work for which you have been added as an additional insured by an endorsement, by definition in a contract or agreement, or by combination thereof;

(3) Any other valid and collectible insurance available to any person or entity performing functions for others on your behalf as defined in "your work" in this Policy;

(4) Any valid and collectible project- -controlled insurance policy, contractor-controlled insurance policy, wrap-up policy, or similar insurance program under which an insured is covered; or

(5) Any other valid and collectible insurance, whether primary, excess, contingent, or on any other basis, covering a:

(a) "Transportation pollution condition", if Insuring Agreement A.2. Transportation Pollution Liability is shown as purchased in the Declarations;

(b) "Pollution condition" on a "non-owned disposal site", if Insuring Agreement A.3. Non-Owned Disposal Site Liability is shown as purchased in the Declarations; or

(c) "Pollution condition" resulting from "your work" if you are an insured on an insurance policy that applies to "your work" performed at a specific job site or if you are added as an additional insured on another insurance policy.

MEEI 2510 08 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission.

ENVIRONMENTAL

POLICY NUMBER: CPLMOL121760

EVANSTON INSURANCE COMPANY

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED SPECIFIED PERSON(S) OR ORGANIZATION(S)

This endorsement modifies insurance provided under the following:

CONTRACTOR S POLLUTION LIABILITY COVERAGE FORM

SCHEDULE

Person(s) Or Organization(s): State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees

Arizona Department of Transportation

1655 W. Jackson Street

Phoenix, AZ 85007

With respect to coverage provided under this endorsement only, Paragraph 4. under Section III Who Is An Insured is replaced by the following:

4. The Person(s) Or Organization(s) shown in the Schedule of this endorsement is an insured under this policy, provided you have agreed to provide additional insured status in a written contract or agreement that was executed prior to the:

a.

b.

The Person(s) Or Organization(s) shown in the Schedule of this endorsement is an insured only with respect to "bodily injury", "property damage" for which such Persons(s) Or Organization(s) is liable because of "your work" of the sole negligence of such Person(s) Or Organization(s).

However, the insurance afforded to such additional insured:

(1) Only applies to the extent permitted by law; and

(2) Will not be broader than that which you are required by the contract or agreement to provide for such additional insured; and

(3) Is limited to the lesser of the Limits Of Insurance shown in the Declarations or the amount required by the written contract or agreement.

All other terms and conditions remain unchanged.

MEEI 2589 01 22 Page 1 of 1

ENVIRONMENTAL

POLICY NUMBER: CPLMOL121760

EVANSTON INSURANCE COMPANY

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED FOR SPECIFIED PERSON(S) OR ORGANIZATION(S)

This endorsement modifies insurance provided under the following:

CONTRACTOR S POLLUTION LIABILITY COVERAGE FORM

SCHEDULE

Person(s) Or Organization(s): State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees

Arizona Department Of Transportation 1655 W. Jackson Street Phoenix, AZ 85007

With respect to coverage provided under this endorsement only, Paragraph F. under Section III Who Is An Insured is replaced by the following:

Each of the following is an insured under all Insuring Agreements and Supplementary Payments:

F. The Person(s) Or Organization(s) shown in the Schedule of this endorsement, provided you have agreed to provide additional insured status in a written contract or agreement that was executed prior to the:

1.

2.

The Person(s) Or Organization(s) shown in the Schedule of this endorsement is an insured only with respect to liability for "bodily injury", "property damage" caused, in whole or in part, by "your work".

However, the insurance afforded to such additional insured:

a. Only applies to the extent permitted by law;

b. Will not be broader than that which you are required by the written contract or agreement to provide for such additional insured; and

c. Is limited to the lesser of the Limits Of Insurance shown in the Declarations or the amount required by the written contract or agreement.

All other terms and conditions remain unchanged.