ACCEPTED ANY_ALL GL,AL,WC,PROF LIAB 01.01.25-01.01.26.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

2/12/2025

(703) 827-2277 (703) 827-2279

25615

Ardurra Group, Inc.

1000 N.W. 57th Court, Suite 800 Miami, FL 33126

25623 25674 20079

A 1,000,000

630-5X487435 1/1/2025 1/1/2026 1,000,000 Contractual Liab. 15,000

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

1,000,000B 810-5X558309 1/1/2025 1/1/2026

C

UB-5X489557 1/1/2025 1/1/2026 1,000,000

N 1,000,000 1,000,000

D Professional Liab. 42-EPP-306878-07 1/1/2025 Per Claim/Aggregate 2,000,000

RE: Any and All Projects/Operations

The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees are included as additional insured with respect to General Liability, Automobile Liability, and Umbrella Liability when required by written contract. General Liability includes Additional Insured coverage for On-Going & Completed Operations as required by written contract. General Liability, Automobile Liability, and Umbrella Liability are primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured and when required by written contract. General Liability, Automobile Liability, Workers Compensation, and Umbrella Liability policies include a waiver of subrogation in favor of the

SEE ATTACHED ACORD 101

The State of Arizona / ADOT 206 S 17th Avenue Phoenix, AZ 85007

ARDURRA-01 RJONES

Ames & Gough 8300 Greensboro Drive Suite 980 McLean, VA 22102 admin@amesgough.com

Charter Oak Fire Insurance Company A++ (XV) Phoenix Insurance Company A++, XV Travelers Property Casualty Company of America, A++, XV

National Fire & Marine Insurance Company A++ X

X

1/1/2026

X X

X

XX

X

Cindy Lewis Accepted

FORM NUMBER:

EFFECTIVE DATE:

The ACORD name and logo are registered marks of ACORD

ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE

FORM TITLE:

Page of

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

ACORD 101 (2008/01)

AGENCY CUSTOMER ID:

LOC #:

AGENCY NAMED INSURED

POLICY NUMBER

CARRIER NAIC CODE

© 2008 ACORD CORPORATION. All rights reserved.

Ames & Gough

ARDURRA-01

SEE PAGE 1

SEE PAGE 1

ACORD 25 Certificate of Liability Insurance

SEE P 1

Ardurra Group, Inc.

1000 N.W. 57th Court, Suite 800 Miami, FL 33126

SEE PAGE 1

RJONES

Description of Operations/Locations/Vehicles:

additional insureds where permissible by state law and when required by written contract. Umbrella Liability coverage sits excess over General Liability, Automobile Liability and Employers’ Liability coverage. A 30-day Notice of Cancellation will be issued for the General Liability, Automobile Liability, Umbrella Liability, Workers Compensation and Professional Liability policies in accordance with policy terms and conditions.

Policy#630-5X487435

Highlight

Highlight

Policy#630-5X487435

Policy # 630-5X487435

Policy Number: 810-5X558309

ENDORSEMENT WC 00 03 13 (00) -

POLICY NUMBER:

EMPLOYERS LIABILITY POLICY

AND

WORKERS COMPENSATION

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

ONE TOWER SQUARE

HARTFORD CT 06183

UB-5X489557

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 any one not named in the Schedule.

SCHEDULE

DESIGNATED ORGANIZATION:

DESIGNATED PERSON:

ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED

BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS

WAIVER.

DATE OF ISSUE: PAGEST ASSIGN: OF

Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual.

01-1-25 1 1

Endorsement Effective

Countersigned by

Policy No.

Premium $Insured

Insurance Company

Endorsement No.

All other terms and conditions of this policy remain unchanged.

(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.

TO DESIGNATED PERSONS OR ORGANIZATIONS

NOTICE OF CANCELLATION

POLICY NUMBER:

ENDORSEMENT WC 99 06 R3 (00) -

EMPLOYERS LIABILITY POLICY

AND

WORKERS COMPENSATION

Notice Of Cancellation To Designated Persons Or Organizations

Name and Address of Designated Persons or Organizations: Number of Days Notice

The following is added to PART SIX – CONDITIONS :

SCHEDULE

If we cancel this policy for any reason other than non-payment of premium by you, we will provide notice of such cancellation to each person or organization designated in the Schedule below. We will mail or deliver such notice to each person or organization at its listed address at least the number of days shown for that person or organiza-tion before the cancellation is to take effect.

You are responsible for providing us with the information necessary to accurately complete the Schedule below.

If we cannot mail or deliver a notice of cancellation to a designated person or organization because the name or address of such designated person or organization provided to us is not accurate or complete, we have no responsibility to mail, deliver or otherwise notify such designated person or organization of the cancellation.

ONE TOWER SQUARE

UB-5X489557-25-43-G

HARTFORD CT 06183 001

CONTRACT THAT NOTICE OF CANCELLATION OF THIS POLICY WILL BE GIVEN

, BUT ONLY IF:

1. YOU SEE TO IT THAT WE RECEIVE A WRITTEN REQUEST

TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PE

RSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTI

CE FROM US OF THE CANCELLATION OF THIS POLICY; AND

2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BE

GINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS ENDORSEMEN

T.

ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZATION INCLUDED

IN SUCH WRITTEN REQUEST FROM YOU TO US.

ANY PERSON OR ORGANIZATION WITH WHOM YOU HAVE AGREED IN A WRITTEN

Page ofDATE OF ISSUE: ST ASSIGN:

© 2013 The Travelers Indemnity Company. All rights reserved.

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