ACCEPTED_ANY_ALL_GL_AL_WC_07.01.23-07.01.24.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

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)

© 1988-2016 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

except Heavy Trucks and Tractors

B 07/01/2023

X

Ennis of Marsh USA LLC

X

B

5,000,000

90-04319-002 (HI,ND,WI,WY)

24988

90-04319-007 (OH, WA)

07/01/2024

A

Statutory/$1MM

07/01/2024 X

N/A

X

SPECIFIC EXCESS WORKERS COMP.

CN102240308-PPG-GAWUW-23-24

1,000,000

28460

Leslie A. Kress

07/01/2024

CLE-007181475-05

07/01/2023

X

5,000,000

02/22/2024

07/01/2024 arising out of the operations of the named insured subject to policy terms and conditions. Waiver of Subrogation is included in favor of the Additional Insured where permitted

07/01/2023

5,000,000

(412) 552-5999

07/01/2024

300,000

& EMPLOYERS LIABILITY

5,000,000

Self-Insured Retention

1,000,000 1,000,000

A

Leslie.A.Kress@marsh.com

07/01/2024

07/01/2023

07/01/2023

N/A

90-04319-004 (AOS)

W.C./E.L.

10,000

07/01/2023

90-04319-001 (AOS)

90-04319-010 (CA,DE,FL,IA,NC,PA)

1,000,000

State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees is/are included as Additional Insured (except worker's compensation) where required by written contract or agreement. This insurance is primary and non-contributory over any existing insurance and limited to liability

RE: All work performed for or on behalf of the State of Arizona/ADOT

A subsidiary of PPG Industries, Inc.

Ennis-Flint Inc.

Pittsburgh, PA 15272 One PPG Place, 9th Floor

1,000,000

CA and OH liability self-insured

Sentry Insurance Company

X

Six PPG Place, Suite 400

MARSH USA LLC.

(412) 552-5249

Pittsburgh, PA 15222-5499

A

90-04319-006

Sentry Casualty Company

N

Phoenix, AZ 85007

The State of Arizona/ADOT

206 S. 17th Ave

07/01/2023

90-04319-005 (MA)

A

1,000,000

PERSONAL USE

(412) 552-5249 by law and required by written contract.

X

A

07/01/2024

F0950 Accepted