3-Attachment_-_Supplement_Insurance.pdf

07/01/2024

Reliable Risk Management, LLC 42104 N Venture Dr Suite D122 Anthem AZ 85086

Kurtis Haynes

(480) 813-3415

Kurtis@reliableriskmanagement.com

310 Dust Control LLC 515 E. Carefree Highway #868

Phoenix AZ 85085

Benchmark Specialty Insurance Company 17180 Alaska National Insurance Co. 38733 CopperPoint Indemnity Insurance Co. 13928

24/25 Master

A Professional Liability Contractor's Pollution Liability Y Y MNGR-P-2000511-02 07/01/2024 07/01/2025

1,000,000 50,000 10,000 1,000,000 2,000,000 2,000,000

Prof-Polu Limits/Agg $1M / $2M

B Y Y 24G-13362 07/01/2024 07/01/2025

1,000,000

Comp/Coll Deductible: 5,000

A

MNGR-X-2000298-02 07/01/2024 07/01/2025

5,000,000 5,000,000

C N Y 1031967 07/01/2024 07/01/2025 1,000,000 1,000,000 1,000,000

B IM - Leased & Rented Equipment

24G-13362 07/01/2024 07/01/2025 Each Item: $200,000 Maximum: $200,000 Deductible: $1,000

RE: Verification of insurance for any & all jobs;

The Certificate Holder and Project Owner are named additional insureds on a blanket basis per written contract with respects to General Liability. Coverage is on a Primary & Non-Contributory basis. Blanket Additional Insured endorsement also applies with respects to Auto Liability per written agreement.

Blanket Waivers of Subrogation apply with respects to the General Liability, Auto Liability, and Employers Liability coverages as required by a written contract. The Excess Liability follows form and is overlying the General Liability, Professional Liability & Pollution Liability; attached forms.

**For Verification of Insurance**

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

310 Dust Control, LLC

310 Fluids, LLC

310 Liquids, LLC

310 Mechanics, LLC

310 UTV, LLC

310 Works, LLC

310 WT, LLC

3R, LLC

46234, LLC

48126, LLC

Bunkhouse 48014, LLC

Cool Stuff and Things, LLC

Estrella/2606 LLC

Flippant, LLC

JKS Adventures LLLP

King Green Holdings, LLC

Kwanza, LLC

Flippant II, LLC

National Emergency Water, LLC

New River Equipment, LLC

Additional Named Insureds

Other Named Insureds

OFAPPINF (02/2007) COPYRIGHT 2007, AMS SERVICES INC

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY

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 07/01/2024 Policy No. 1031967 Endorsement No.

Insured 310 Dust Control LLC Premium $ 1,147.00

Insurance Company CopperPoint Indemnity Insurance Company Countersigned by

Authorized Representative

WC 00 03 13

(Ed. 04-1984)

© Copyright 1983 National Council on Compensation Insurance, Inc. All Rights Reserved.

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

Anyone for whom you have agreed to provide this Waiver subject to the terms of the endorsement.