ACCEPTED ANY_ALL GL 07.31.24-07.01.25.pdf

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

06/12/2025

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).

CONTACT

NAME: Lucas Shafer

PHONE FAX

(A/C, No, Ext): (602) 788-5359 (A/C, No):

E-MAIL

ADDRESS: lshafe1@amfam.com

INSURER(S) AFFORDING COVERAGE NAIC #

PRODUCER

Lucas Shafer

1717 E BELL RD STE 7

PHOENIX AZ 85022

INSURER A : Midvale Indemnity Company 27138

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURED

Prime Collision LLC 801 S Arizona Ave Chandler AZ 85225

INSURER F :

COVERAGES CERTIFICATE NUMBER: 89227044467733 REVISION NUMBER:

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.

INSR ADDL SUBR POLICY EFF POLICY EXP

TYPE OF INSURANCE POLICY NUMBERLTR INSR WVD (MM/DD/YYYY) (MM/DD/YYYY)

LIMITS

A COMMERCIAL GENERAL LIABILITY Y Y BP00040970 07/31/2024 07/31/2025 EACH OCCURRENCE $2,000,000

DAMAGE TO RENTED $50,000

CLAIMS-MADE

X

OCCUR

PREMISES (Ea occurrence)

MED EXP (Any one person) $10,000

PERSONAL & ADV INJURY $2,000,000

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000

PRO- PRODUCTS - COMP/OP AGG $4,000,000

X

POLICY

JECT

LOC

OTHER:

AUTOMOBILE LIABILITY

COMBINED SINGLE LIMIT (Ea accident)

ANY AUTO BODILY INJURY (Per person)

OWNED SCHEDULED BODILY INJURY

AUTOS ONLY AUTOS (Per accident)

HIRED NON-OWNED PROPERTY DAMAGE

AUTOS ONLY AUTOS ONLY (Per accident)

UMBRELLA LIAB OCCUR EACH OCCURRENCE

EXCESS LIAB CLAIMS-MADE AGGREGATE

DED RETENTION $

WORKERS COMPENSATION PER OTH-

AND EMPLOYERS' LIABILITY Y/N STATUTE ER

ANY PROPRIETOR/PARTNER/EXECU

-TIVE OFFICER/MEMBER EXCLUDED? N/A E.L. EACH ACCIDENT

(Mandatory in NH) E.L. DISEASE - EA

EMPLOYEE

If yes, describe under DESCRIPTION OF OPERATIONS below

E.L. DISEASE - POLICY LIMIT

PROFESSIONAL LIABILITY OCCURRENCE

AGGREGATE

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

*Please refer Additional Remarks Schedule Attached below for since the permissible character limit has been exceeded.*

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED

BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE

State of Arizona Arizona Department of Transportation 1655 W. Jackson St. MD 100P Phoenix, AZ 85007

BLANKET WHEN REQUIRED BY WRITTEN CONTRACT

© 1988-2015 ACORD CORPORATION. All rights reserved.

ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD

Cindy Lewis GL Only

BID BP 1001 07 17 Page 1 of 4

American Family Insurance - Business Insurance Underwritten by: Midvale Indemnity Company A Wisconsin Stock Company

Lucas Shafer

1717 E BELL RD STE 7

PHOENIX, AZ 85022

(602) 788-5359

Information as of: 06/10/2025

POLICY DECLARATIONS

This document and your policy contract define our insuring agreement. In return for payment of premium and subject to all the terms of this policy, we agree to provide you insurance as stated in the policy.

Policy Information

Location Information

Location Number: 1 Building Number: 1

Address: 801 S Arizona Ave Chandler, AZ 85225

Coverage Information (applies to Location Number: 1, Building Number: 1) Building Limit: $712,566 Business Personal Property Limit: $200,000 Deductible (applies per location, per occurrence): $5,000 Windstorm or Hail Percentage Deductible (applies per location, per occurrence):

N/A

Building Limit – Automatic Annual Increase: 4%

Limit of Insurance Deductible Other Coverage

Accounts Receivable (On Premises / Off Premises) $10,000/$5,000 None Valuable Papers and Records (On Premises / Off Premises) $10,000/$5,000 None Outdoor Property $2,500 None Business Income from Dependent Properties $5,000 None Damage To Premises - Rented To You $50,000 None Business Income & Extra Expense 12 months actual loss sustained None

Named Insured: Prime Collision LLC

E-mail Address: primecollisionaz@gmail.com

Phone: 6026259860

Policy Number: BP00040970

Policy Type: Business Owner’s Policy (BOP)

Policy Period: 07/31/2024 to 07/31/2025 12:01AM Standard Time at Primary Location

BID BP 1001 07 17 Page 2 of 4

Additional Coverage (applies to Location Number: 1)

Other Coverage Limit of Insurance Deductible

Businessowners Policy Enhancement (coverage summary attached)

None None

Equipment Breakdown See policy form See policy form Garagekeepers Legal Liability $250,000 $1,000

BID BP 1001 07 17 Page 3 of 4

Policy Coverage (limits & deductibles shown are non-stackable across locations)

Limit of Insurance Deductible

Liability Coverage

Business Liability (per-occurrence limit/annual aggregate limit):

$2,000,000/$4,000,000 None

Medical Expenses (per person) $10,000 None

Property Coverage

Business Income - Extended Period of Indemnity 60 days None Business Income - Payroll Expense 60 days None

Other Coverages

Electronic Data $10,000 None Interruption of Computer Operations $10,000 None Forgery or Alteration $5,000 $500 Cyber Suite Without Business Income $25,000 / $25,000 $1,000 Employee Dishonesty $5,000 $500

Classification Information

Location Class Code Class Description Exposure Basis Exposure Amount

1 88801 Auto Body and Paint Shop SALES $650,000

Policy Premium $19,119

Premium Taxes, Surcharges and Fees (note: included in Policy Premium above)

Cyber Claim Support and Risk Management Fee $7

Discounts Applied to This Policy

Loss-Free Marketing Source

Policy Forms and Endorsements

ACORD 25 0316 CERTIFICATE OF LIABILITY INSURANCE

BP 00 03 07 13 BUSINESSOWNERS COVERAGE FORM

BP 01 38 04 21 ARIZONA CHANGES

BP 04 17 01 10 EMPLOYMENT-RELATED PRACTICES EXCLUSION

BID BP 1001 07 17 Page 4 of 4

BP 04 50 07 13 ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED

PERSON OR ORGANIZATION

BP 04 83 01 10 REMOVAL OF INSURANCE-TO-VALUE PROVISION

BP 04 92 07 02 TOTAL POLLUTION EXCLUSION

BP 04 97 01 06 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US

BP 05 01 07 02 CALCULATION OF PREMIUM

BP 05 15 01 15 DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT

BP 05 17 01 06 EXCLUSION - SILICA OR SILICA-RELATED DUST

BP 05 23 01 15 CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM

BP 05 77 01 06 FUNGI OR BACTERIA EXCLUSION (LIABILITY)

BP 14 07 01 10 BUSINESS INCOME AND EXTRA EXPENSE - REVISED PERIOD OF INDEMNITY

BP 14 86 07 13 COMMUNICABLE DISEASE EXCLUSION

BP 15 04 05 14 EXCLUSION - ACCESS OR DISCLOSURE OF CONFIDENTIAL OR PERSONAL

INFORMATION AND DATA-RELATED LIABILITY - WITH LIMITED BODILY INJURY

EXCEPTION

BP 15 31 09 19 CANNABIS PROPERTY EXCLUSION WITH HEMP EXCEPTION

BP 15 33 09 19 CANNABIS LIABILITY EXCLUSION WITH HEMP EXCEPTION

BP 77 01 07 16 EQUIPMENT BREAKDOWN COVERAGE

BP 80 00 07 22 BUSINESSOWNERS COVERAGE EXTENSION ENDORSEMENT

BP 88 10 03 21 PUNITIVE DAMAGES EXCLUSION

BP 88 20 03 21 ASBESTOS EXCLUSION

BP 88 30 05 22 EXCLUSION - BIOMETRIC DATA, IDENTIFIERS OR INFORMATION

BP 88 40 03 21 ADDITIONAL INSURED - BLANKET

BP 88 70 07 16 GARAGE EXTENSION ENDORSEMENT

BP 88 71 07 16 GARAGEKEEPERS COVERAGE

BP 90 00 07 22 BUSINESSOWNERS POLICY ENHANCEMENT ENDORSEMENT

BP 90 00 S 07 22 BUSINESSOWNERS POLICY ENHANCEMENT ENDORSEMENT SUMMARY

BP IN 01 07 13 BUSINESSOWNERS COVERAGE FORM INDEX

CYB 00 01 05 22 CYBER COVERAGE INSURANCE

IL N 014 09 03 ARIZONA FRAUD STATEMENT

In witness whereof, we have caused this policy to be signed by our authorized officers.

Home Office

MIDVALE INDEMNITY COMPANY

6000 American Parkway Madison, WI 53783

Tony Desantis , Jr. Lauren K. Powell President Secretary

ADDITIONAL REMARKS SCHEDULE

AGENCY:

Lucas Shafer

POLICY NUMBER:

BP00040970

NAMED INSURED:

Prime Collision LLC

CARRIER:

Midvale Indemnity Company

NAIC CODE

27138

EFFECTIVE DATE:

07/31/2024

ADDITIONAL REMARKS

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE

Auto Body and Paint Shop The general liability policy includes a blanket automatic additional insured endorsement that provides additional insured status to any person or organization who has a written contract with the named insured. A Waiver of Subrogation applies. / Loc-1 801 S Arizona Ave, Chandler, AZ 85225

ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

POLICY NUMBER: BP00040970 BUSINESSOWNERS

BP 04 50 07 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

BP 04 50 07 13 © Insurance Services Office, Inc., 2012 Page 1 of 2

ADDITIONAL INSURED – OWNERS, LESSEES

OR CONTRACTORS – SCHEDULED PERSON

OR ORGANIZATION

This endorsement modifies insurance provided under the following:

BUSINESSOWNERS COVERAGE FORM

SCHEDULE

Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations

BLANKET WHEN REQUIRED BY WRITTEN

CONTRACT

All locations where work is performed or services are provided for the Additional

Insured(s) listed

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

Section II – Liability is amended as follows:

A. The following is added to Paragraph C. Who Is An Insured:

3. Any person(s) or organization(s) shown in the Schedule is also an additional insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by:

a. Your acts or omissions; or

b. The acts or omissions of those acting on your behalf;

in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above.

However:

a. The insurance afforded to such additional insured only applies to the extent permitted by law; and

b. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.

B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:

This insurance does not apply to "bodily injury" or "property damage" occurring after:

1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or

2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project.

Page 2 of 2 © Insurance Services Office, Inc., 2012 BP 04 50 07 13

C. With respect to the insurance afforded to these additional insureds, the following is added to Paragraph D. Liability And Medical Expenses Limits Of Insurance:

If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:

1. Required by the contract or agreement; or

2. Available under the applicable Limits Of Insurance shown in the Declarations;

whichever is less.

This endorsement shall not increase the applicable Limits Of Insurance shown in the Declarations.

POLICY NUMBER: BP00040970 BUSINESSOWNERS

BP 04 97 01 06

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

BP 04 97 01 06 © ISO Properties, Inc., 2004 Page 1 of 1

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US

This endorsement modifies insurance provided under the following:

BUSINESSOWNERS COVERAGE FORM

SCHEDULE

Name Of Person Or Organization:

BLANKET WHEN REQUIRED BY WRITTEN CONTRACT

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

Paragraph K. Transfer Of Rights Of Recovery Against Others To Us in – Section III Common Policy Conditions is amended by the addition of the following:

We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above.

BUSINESSOWNERS

BP 14 88 07 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

BP 14 88 07 13 © Insurance Services Office, Inc., 2012 Page 1 of 1

PRIMARY AND NONCONTRIBUTORY –

OTHER INSURANCE CONDITION

This endorsement modifies insurance provided under the following:

BUSINESSOWNERS COVERAGE FORM

The following is added to Paragraph H. Other Insurance of Section III – Common Policy Conditions 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.