ACCEPTED ANY_ALL GL,AL,WC,PROFESSIONAL LIAB 09.01.24-09.01.25.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

8/29/2024

(703) 726-0700 (703) 726-0753

30104

High Street Consulting Group 6937 Blenheim Ct.

Pittsburgh, PA 15208

29424 19038

A 2,000,000

X X 42SBAAK8YF6 9/1/2024 9/1/2025 300,000

10,000

2,000,000 4,000,000 4,000,000

2,000,000A

X 42SBAAK8YF6 9/1/2024 9/1/2025

1,000,000A

42SBAAK8YF6 9/1/2024 9/1/2025 1,000,000

10,000 B

X 42WECLG9429 9/1/2024 9/1/2025 1,000,000

N 1,000,000

1,000,000 C Prof. Errors & Omiss 107673147 9/1/2024 $2M occ/$3M agg 2,000,000 D Cyber Liability C-4LQT-083222 9/1/2024 9/1/2025 Occurrence 1,000,000

Travelers Policy #107265279 Crime coverage $1,000,000

The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employeesare named as an additional insured with respect to General Liability on a primary and noncontributory and Auto Liability basis where required by a written contract or agreement. The checked Policies shall contain a waiver of subrogation endorsement, as required by this written agreement, in favor of the State of Arizona, and its departments, agencies, bo ards, commissions, universities, officers, officials, agents, and employees for losses arising from work performed by or on behalf of the Contractor where required by a written contract or agreement for any and all work performed for or on behalf of the State of Arizona/ADOT.

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

HIGHSTR-01 LTERAN

Integrated Insurance Solutions 44675 Cape Ct. Suite 100 Ashburn, VA 20147

Hartford Underwriters Ins Co Hartford Insurance Co.

Travelers Casualty & Surety Coalition Insurance Services

X

9/1/2025

X X

X

X X

X

X

X

G0171 Accepted

Policy Change:

Business Owner’s Policy

Form SC 00 06 10 18 Page 2 of 2 Process Date: 05/09/2022 © 2018, The Hartford Policy Expiration Date: 09/01/2022

(May include copyrighted material of Insurance Services Office, Inc., with its permission)

The following Additional Insured has been added as an Additional Insured - Designated Person or Organization.

Additional Insured Name

State of Arizona Department of Transportation , 1324 N 22 Ave.,, PHOENIX, AZ 85009

Policy is amended to add the following Endorsement Forms reflecting the changes made to your policy.

FORM NUMBER FORM NAME COVERAGE PART

SL 30 42 10 18

ADDITIONAL INSURED -

DESIGNATED PERSON OR

ORGANIZATION

Liability

Policy is amended to revise the following Endorsement Forms reflecting the changes made to your policy.

FORM NUMBER FORM NAME COVERAGE PART

SC 00 06 10 18 POLICY CHANGE Common

Premium associated with this Policy Change has pro rata factor 0.315.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

Form SL 30 42 10 18 Page 1 of 1 © 2018, The Hartford

(May include copyrighted material of Insurance Services Office, Inc., with its permission)

ADDITIONAL INSURED – DESIGNATED PERSON OR ORGANIZATION

This endorsement modifies insurance provided under the following:

BUSINESS LIABILITY COVERAGE FORM

Except as otherwise stated in this endorsement, the terms and conditions of the Policy apply.

A. The following is added to Section C. WHO IS AN INSURED:

Designated Person Or Organization

a. The person(s) or organization(s) shown in the Declarations as Additional Insured – Designated Person Or Organization 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 your acts or omissions or the acts or omissions of those acting on your behalf:

(1) In the performance of your ongoing operations; or

(2) In connection with your premises owned by or rented to you.

b. If coverage provided to these additional insureds is required by a written contract or written agreement, or when required by a written permit issued by a state or governmental agency or subdivision or political subdivision, the insurance afforded to these additional insureds will not be broader than that which you are required by the contract, agreement, or permit to provide for these additional insureds.

c. The insurance afforded to these additional insureds only applies to the extent permitted by law.

B. With respect to the insurance afforded such additional insured(s) by this endorsement, the following additional exclusion is added to Section B. EXCLUSIONS:

This insurance does not apply to “bodily injury” or “property damage” included within the “products-completed operations hazard”.