ACCEPTED CTR066796 GL,AL,WC 02.04.23-02.04.24 .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)

© 1988-2015 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

7/25/2023

Arthur J. Gallagher Risk Management Services, LLC 6967 South River Gate Dr.

Suite 200 Salt Lake City UT 84047

Aubrie Kemp 801-924-1400 801-924-1441 certrequests@ajg.com

Great Northern Insurance Company 20303 INTESAF-01 Federal Insurance Company 20281

Interwest Safety Supply, LLC Interwest Safety Supply Holdings, LLC PO Box 31 Provo UT 84606

WCF National Insurance Company 40517

108428379

A X 1,000,000 X 100,000

5,000

1,000,000

2,000,000

36058556 2/4/2023 2/4/2024

2,000,000

EBL AGG 2,000,000

A 1,000,000

X

X X

73613513 2/4/2023 2/4/2024

B X X 6,000,00078188506 2/4/2023 2/4/2024

6,000,000 X 10,000

C C

X3408993 3409035

2/4/2023 2/4/2023

2/4/2024 2/4/2024

1,000,000

1,000,000

1,000,000

Verification of insurance subject to the terms and conditions of the policy RE: BPM005460 Impact Crash Barrier Attenuators and Cable Barriers Systems

ARIZONA DEPARTMENT OF TRANSPORTATION

1739 W. Jackson St.

Suite A, MD 100P Phoenix, AZ 85007 a8812 Accepted

�������������./,0�,1��/23� 1+4)/ �+ 5��236/7�,1�6)+8)6)47�) 19,+ ���3/6)�7 �����������.�����������������������������������������

3�#�%�� �

Liability Insurance

Endorsement

Policy Period FEBRUARY 4, 2023 TO FEBRUARY 4, 2024

Effective Date FEBRUARY 4, 2023

Policy Number 3605-85-56 DAL

Insured INTERWEST SAFETY SUPPLY, LLC

Name of Company GREAT NORTHERN INSURANCE COMPANY

Date Issued FEBRUARY 9, 2023

EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE

This Endorsement applies to the following forms:

GENERAL LIABILITY

Designated Person Or Organization

CITY OF GOODYEAR, AZ

190 N LITCHFIELD RD., GOODYEAR, AZ 85338

All other terms and conditions remain unchanged.

Authorized Representative UVWX

EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE

Under Conditions, Transfer Or Waiver Of Rights Of Recovery Against Others, the following provision is added:

Conditions

Transfer Or Waiver Of Rights Of Recovery Against Others

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

Liability Insurance Condition - Waiver Of Transfer Of Rights Of Recovery

Form 80-02-2362 (Rev. 4-01) Endorsement Page 1 last page

Liability Insurance

Endorsement

Policy Period FEBRUARY 4, 2023 TO FEBRUARY 4, 2024

Effective Date FEBRUARY 4, 2023

Policy Number 3605-85-56 DAL

Insured INTERWEST SAFETY SUPPLY, LLC

Name of Company GREAT NORTHERN INSURANCE COMPANY

Date Issued FEBRUARY 9, 2023

EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE

This Endorsement applies to the following forms:

GENERAL LIABILITY

EMPLOYEE BENEFITS ERRORS OR OMISSIONS

All other terms and conditions remain unchanged.

Authorized Representative UVWX

EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE

Under Conditions, the following provision is added to the condition titled Other Insurance.

Conditions

Other Insurance - Primary, Noncontributory Insurance - Scheduled Person Or Organization

If you are obligated, pursuant to a written contract or agreement, to provide the person or organization described in the Schedule (that is also included in the Who Is An Insured section of this contract) with primary insurance such as is afforded by this policy, then this insurance is primary and we will not seek contribution from insurance available to such person or organization.

EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE

Schedule

CITY OF GOODYEAR, AZ

190 N LITCHFIELD RD., GOODYEAR, AZ 85338

Liability Insurance Conditions - Other Insurance - Primary, Noncontributory Insurance - Scheduled Person Or Organization

Form 80-02-2653 (Rev. 7-09) Endorsement Page 1 last page

Additional Insured - Scheduled Person Or Organization continued

80-02-2367 (Rev. 5-07) Endorsement 1

Liability Insurance

Form Page

3605-85-56 DAL

GREAT NORTHERN INSURANCE COMPANY

FEBRUARY 4, 2023 TO FEBRUARY 4, 2024

FEBRUARY 9, 2023

FEBRUARY 4, 2023

INTERWEST SAFETY SUPPLY, LLC

This Endorsement applies to the following forms:

Name of Company

Endorsement

Policy Number

Effective Date

Policy Period

Date Issued

Liability Insurance

Insured

GENERAL LIABILITY

Who Is An Insured the following provision only:

them but they are insuredAdditional Insured - you are

Scheduled Person Or Organization by this policy.

Is An Insured, However, the person or organization is an insured is added withobligated pursuant to a to shown or agreement to are insureds is� if or organizations the extent the person or organ

Persons and then only contract in the Schedule provide

Under Who ization described in the Schedule;

such insurance s only if as is afforded for eement; and did not occur, in whole requires the person or agr act an insured loss, cost or expense for injury or to� status as to damages, or agreement or in part, before the of with respect that contract damage which this insurance applies.

such execution the be affordedto the extent organization to contract orivities person is more specifically identified under this provision:

of the

No section organization is an insured under any other provision Whothat or

(regardless of any limitation applicable thereto).

Is An Insured expense for injury absence of

, to which this insurance person would have in the or contr or agreement. This limitation does not apply cost or with act to any assumption of liability (of another applies, that the respect damage such contract or agreement.

liability for damages organization in to the or organization) by them a person or , loss, Additional Insured - Scheduled Person Or Organization last page

80-02-2367 (Rev. 5-07) Endorsement 2

Liability Insurance

Form Page

Liability Endorsement (continued)

Conditions from insurance available to such

Other Insurance � person Primary, Noncontributory case Insurance � Scheduled Person Or Organization this insurance is primary and we a contract or added to the th shown are obligated, pursuant to will not seek contribution or you

Conditions, the following provision is agreement, afforded by

If organization.

with

Schedule

Schedule

Under in the primary insurance such as is to condition provide titled policy, then in suchthis

Other Insurance.

e person or organization

Persons or organizations that you are obligated, pursuant to a contract or agreement, to provide with such insurance as is afforded by this policy.

UVWX

All other terms and conditions remain unchanged.

Authorized Representative

Additional Insured - Scheduled Person Or Organization continued

80-02-2367 (Rev. 5-07) Endorsement 1

Liability Insurance

Form Page

3605-85-56 DAL

GREAT NORTHERN INSURANCE COMPANY

FEBRUARY 4, 2023 TO FEBRUARY 4, 2024

FEBRUARY 9, 2023

FEBRUARY 4, 2023

INTERWEST SAFETY SUPPLY, LLC

This Endorsement applies to the following forms:

Name of Company

Endorsement

Policy Number

Effective Date

Policy Period

Date Issued

Liability Insurance

Insured

GENERAL LIABILITY

Who Is An Insured the following provision only:

them but they are insuredAdditional Insured - you are

Scheduled Person Or Organization by this policy.

Is An Insured, However, the person or organization is an insured is added withobligated pursuant to a to shown or agreement to are insureds is� if or organizations the extent the person or organ

Persons and then only contract in the Schedule provide

Under Who ization described in the Schedule;

such insurance s only if as is afforded for eement; and did not occur, in whole requires the person or agr act an insured loss, cost or expense for injury or to� status as to damages, or agreement or in part, before the of with respect that contract damage which this insurance applies.

such execution the be affordedto the extent organization to contract orivities person is more specifically identified under this provision:

of the

No section organization is an insured under any other provision Whothat or

(regardless of any limitation applicable thereto).

Is An Insured expense for injury absence of

, to which this insurance person would have in the or contr or agreement. This limitation does not apply cost or with act to any assumption of liability (of another applies, that the respect damage such contract or agreement.

liability for damages organization in to the or organization) by them a person or , loss, POLICY NUMBER: COMMERCIAL AUTO

CA 04 44 10 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CA 04 44 10 13 Insurance Services Office, Inc., 2011 Page 1 of 1

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US (WAIVER OF SUBROGATION)

This endorsement modifies insurance provided under the following:

AUTO DEALERS COVERAGE FORM

BUSINESS AUTO COVERAGE FORM

MOTOR CARRIER COVERAGE FORM

With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.

This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.

Named Insured:

Endorsement Effective Date:

SCHEDULE

Name(s) Of Person(s) Or Organization(s):

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

The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the ‘‘accident’’ or the ‘‘loss’’ under a contract with that person or organization.

(23)7361-35-13

THE STATE OF ARIZONA OR ADOT

1324 N. 22ND AVE.

PHOENIX AZ 85009

POLICY NUMBER: COMMERCIAL AUTO

CA 20 48 10 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CA 20 48 10 13 Insurance Services Office, Inc., 2011 Page 1 of 1

DESIGNATED INSURED FOR

COVERED AUTOS LIABILITY COVERAGE

This endorsement modifies insurance provided under the following:

AUTO DEALERS COVERAGE FORM

BUSINESS AUTO COVERAGE FORM

MOTOR CARRIER COVERAGE FORM

With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement.

This endorsement identifies person(s) or organization(s) who are ‘‘insureds’’ for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.

This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.

Named Insured:

Endorsement Effective Date:

SCHEDULE

Name Of Person(s) Or Organization(s):

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

Each person or organization shown in the Schedule is an ‘‘insured’’ for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an ‘‘insured’’ under the Who Is An Insured provision contained in Paragraph A.1. of Section II ---- Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I ---- Covered Autos Coverages of the Auto Dealers Coverage Form.

(23)7361-35-13

THE STATE OF ARIZONA OR ADOT

1324 N. 22ND AVE.

PHOENIX AZ 85009

16-02-0316 Ed. 10 14 Page 1 of 1

POLICY NUMBER: (23)7361-35-13 COMMERCIAL AUTO

16-02-0316 Ed. 10 14

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

PRIMARY AND NON-CONTRIBUTORY LIABILITY

INSURANCE

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.

This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.

Named Insured: INTERWEST SAFETY SUPPLY, LLC

Endorsement Effective Date: 02/04/2023

SCHEDULE

Name(s) Of Person(s) Or Organization(s):

THE STATE OF ARIZONA OR ADOT

1324 N. 22ND AVE.

PHOENIX AZ 85009

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

The following is added to Item 5. – “Other Insurance” of Item B. – “General Conditions” under Section IV – “Business Auto Conditions”:

e. Regardless of the provisions of Paragraph 5.a.

through d. above, for any liability arising out of the ownership, maintenance, use, rental, lease, loan, hire or borrowing by an ”insured” of a covered “auto” for which an “insured” is contractually obligated to provide primary insurance coverage to a client, this Coverage Form will be primary and non-contributory with respect to the Persons or Organizations in the schedule, regardless of the availability or existence of other collectible insurance under any other Coverage Form or policy that applies on a primary basis.

Additional Insured - Scheduled Person Or Organization last page

80-02-2367 (Rev. 5-07) Endorsement 2

Liability Insurance

Form Page

Liability Endorsement (continued)

Conditions from insurance available to such

Other Insurance � person Primary, Noncontributory case Insurance � Scheduled Person Or Organization this insurance is primary and we a contract or added to the th shown are obligated, pursuant to will not seek contribution or you

Conditions, the following provision is agreement, afforded by

If organization.

with

Schedule

Schedule

Under in the primary insurance such as is to condition provide titled policy, then in suchthis

Other Insurance.

e person or organization

CITY OF GOODYEAR, AZ

190 N LITCHFIELD RD., GOODYEAR, AZ 85338

UVWX

All other terms and conditions remain unchanged.

Authorized Representative