ACCEPTED CTR070670 GL,AL.WC 06.17.23-06.17.24.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

3/21/2024

(480) 830-7400 (480) 830-7404

27987

Power Tech Contracting LLC 380 E Ray Rd Gilbert, AZ 85296

32700 44776 13043

A 1,000,000

X X WH0138062 6/17/2023 6/17/2024 100,000

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

TOTAL AGGREGATE 5,000,000

1,000,000B

X X 5182035100 6/17/2023 6/17/2024

3,000,000C

78538U230ALI 7/12/2023 6/17/2024 3,000,000

D X 1019778 6/18/2023 6/18/2024 1,000,000

1,000,000 1,000,000

B Physical Damage 5182035100 6/17/2023 Comprehensive Ded 1,000 B Physical Damage 5182035100 6/17/2023 6/17/2024 Collision Ded 1,000

Solicitation No: BPM005725

The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are included as Additional Insureds with respect to liability arising out of the activities performed by or on behalf of the Contractor. This insurance is Primary and Non-contributory. A Waiver of Subrogation applies in favor of the Additional Insureds.

Arizona Department of Transportation 205 S. 17th Ave Phoenix, AZ 85007

POWETEC-01 MMORIN

ARNETT INSURANCE SERVICES, LLC

3850 E BASELINE RD #106

MESA, AZ 85206 mmorin@arnettins.com

Northfield Insurance Company Owners Insurance Company StarStone Specialty Insurance Company CopperPoint General Insurance Company

X

6/17/2024

X X

XX

X

X X

X X a8812 Accepted

S2802-CG (3/20) Page 1 of 2© 2020 The Travelers Indemnity Company. All rights reserved.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

BLANKET ADDITIONAL INSURED (CONTRACTORS)

(Includes Products-Completed Operations When Required By Contract)

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PROVISIONS

1. The following is added to SECTION II - WHO IS AN INSURED:

Any person or organization that you agree in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only:

a. With respect to liability for "bodily injury" or "property damage" that occurs subsequent to the signing of that contract or agreement and while that part of the contract or agreement is in effect;

b. If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the written contract or agreement applies. Such person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization; and

c. Subject to the following limitations and conditions on the insurance provided to such additional insured:

(1) If the Limits of Insurance of this Coverage Part shown in the Declarations exceed the minimum limits required by the written contract or agreement, the insurance provided to the additional insured will be limited to such minimum required limits. For the purposes of determining whether this limitation applies, the minimum limits required by the written contract or agreement will be considered to include the minimum limits of any Umbrella or Excess liability coverage required for the additional insured by that written contract or agreement. This provision will not increase the limits of insurance described in SECTION III - LIMITS OF

INSURANCE.

(2) The insurance provided to such additional insured does not apply to "bodily injury" or "property damage" arising out of the providing, or failure to provide, any professional architectural, engineering or surveying services, including:

(a) The preparing, approving or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders or change orders, or the preparing, approving, or failing to prepare or approve, drawings and specifications; and

(b) Supervisory, inspection, architectural or engineering activities.

(3) The insurance provided to such additional insured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products-completed operations hazard" unless the written contract or agreement requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that occurs before the end of the period of time for which the written contract or agreement requires you to provide such coverage or the end of the policy period, whichever is earlier.

(4) The insurance provided to such additional insured is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover. However, if the written contract or agreement requires that the insurance provided under this Coverage Part apply on a primary basis or a primary and non-contributory basis, then this insurance is primary to other insurance available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that other insurance. But, the insurance provided to the additional insured still is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under such other insurance.

S2802-CG (3/20) Page 2 of 2© 2020 The Travelers Indemnity Company. All rights reserved.

(5) The additional insured must comply with the following duties:

(a) Give us written notice as soon as practicable of an "occurrence" which may result in a claim. To the extent possible, such notice should include:

(i) How, when and where the "occurrence" took place;

(ii) The names and addresses of any injured persons and witnesses; and

(iii) The nature and location of any injury or damage arising out of the "occurrence".

(b) If a claim is made or "suit" is brought against the additional insured:

(i) Immediately record the specifics of the claim or "suit" and the date received; and

(ii) Notify us as soon as practicable and see to it that we receive written notice of the claim or "suit" as soon as practicable.

(c) Immediately send us copies of all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and otherwise comply with all policy conditions.

(d) Tender the defense and indemnity of any claim or "suit" to any provider of other insurance which would cover such additional insured for a loss we cover. However, this condition does not affect whether the insurance provided to the additional insured is primary to other insurance available to the additional insured which covers that person or organization as a named insured.

This endorsement modifies insurance under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

S2803-CG (5/11) Page 1 of 2

Total General Aggregate Limit: $

© 2011 The Travelers Indemnity Company. All rights reserved.

A. The Total General Aggregate Limit stated in the Schedule above is the most we will pay for the sum of all:

1. Medical Expenses under COVERAGE C

(SECTION I);

2. Damages under COVERAGE A (SECTION I), except damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard"; and

3. Damages under COVERAGE B (SECTION I) regardless of the number of:

a. Insureds;

b. Claims made or "suits" brought;

c. Persons or organizations making claims or bringing "suits"; or

d. "Projects".

B. For all sums which the insured becomes legally obligated to pay as damages because of "bodily injury" or "property damage" caused by "occurrences" under COVERAGE A (SECTION I), and for all medical expenses for "bodily injury" caused by accidents under COVERAGE C (SECTION I), which can be attributed only to operations at a single "project":

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

TOTAL GENERAL AGGREGATE LIMIT

PER PROJECT(S) - GENERAL AGGREGATE LIMIT

1. A separate Per Project General Aggregate Limit applies to each "project", and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations.

2. Subject to the Total General Aggregate Limit stated in the Schedule above, the Per Project General Aggregate Limit is the most we will pay for the sum of all damages under COVERAGE A, except damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard", and for medical expenses under COVERAGE C regardless of the number of:

a. Insureds;

b. Claims made or "suits" brought; or

c. Persons or organizations making claims or bringing "suits".

3. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce both the Total General Aggregate Limit stated in the Schedule above, and the Per Project General Aggregate Limit for that "project". Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Per Project General Aggregate Limit for any other "project".

SCHEDULE

*This endorsement is EFFECTIVE *and is part of Policy Number:

*issued to:

*Entry optional if shown in the Policy Declarations. If no entry is shown, the effective date of the endorsement is the same as the effective date of the policy.

5,000,000

06/17/2022 WH013806

Power Tech Contracting LLC

S2803-CG (5/11) Page 2 of 2© 2011 The Travelers Indemnity Company. All rights reserved.

4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to both the Total General Aggregate Limit stated in the Schedule above, and the applicable Per Project General Aggregate Limit.

C. For all sums which the insured becomes legally obligated to pay as damages because of "bodily injury" or "property damage" caused by "occurrences" under COVERAGE A (SECTION I), and for all medical expenses for "bodily injury" caused by accidents under COVERAGE C (SECTION I), which cannot be attributed only to operations at a single "project":

1. Any payments made under COVERAGE A for damages shall reduce both the Total General Aggregate Limit stated in the Schedule above and the General Aggregate Limit, or shall reduce the Products-Completed Operations Aggregate Limit, whichever is applicable.

2. All payments made under COVERAGE C for medical expenses shall reduce both the Total General Aggregate Limit stated in the Schedule above and the General Aggregate Limit; and

3. Such payments shall not reduce the Per Project General Aggregate Limit for any "project".

As respects this Provision C., the limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply.

D. Part 2. of SECTION III - LIMITS OF INSURANCE is deleted and replaced by the following:

2. The General Aggregate Limit is the most we will pay for the sum of:

a. Damages under COVERAGE B; and

b. Damages because of "bodily injury" or "property damage" caused by "occurrences" under COVERAGE A (SECTION I), and for all medical expenses for "bodily injury" caused by accidents under COVERAGE C (SECTION I), which cannot be attributed only to operations at a single project.

E. When coverage for liability arising out of the "products-completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard" will reduce the Products-Completed Operations Aggregate Limit, and not reduce the Total General Aggregate Limit stated in the Schedule above, the General Aggregate Limit, or the Per Project General Aggregate Limit for any "project".

F. For the purposes of this endorsement, the DEFINITIONS Section is amended by the addition of the following definition:

"Project" means an area away from premises owned by or rented to you at which you are performing operations pursuant to a contract or agreement. For the purposes of determining the applicable aggregate limit of insurance, each "project" that includes premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway or waterway, or by a right-of-way of a railroad, shall be considered a single "project".

G. The provisions of LIMITS OF INSURANCE (SECTION III) not otherwise modified by this endorsement shall continue to apply as stipulated.

S2857-CG (1/16) Includes copyrighted material of Insurance Services Office, Inc., with its permission.

© 2016 The Travelers Indemnity Company. All rights reserved.

The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV -

COMMERCIAL GENERAL LIABILITY CONDITIONS:

If the insured has agreed in a written contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of:

a. "Bodily injury" or "property damage" caused by an "occurrence" that takes place; or

b. "Personal and advertising injury" caused by an offense that is committed;

subsequent to the execution of the written contract or agreement.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

BLANKET WAIVER OF SUBROGATION

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

58504 (1-15)

DESIGNATED INSURED FOR COVERED

AUTOS LIABILITY COVERAGE - BLANKET COVERAGE

This endorsement modifies insurance provided under the following:

COMMERCIAL AUTO POLICY

SECTION II - COVERED AUTOS LIABILITY COVER-

AGE is amended. The following provision is added.

Any person or organization is an insured for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an insured under

SECTION II - COVERED AUTOS LIABILITY COVER-

AGE, A. COVERAGE, 1. Who Is An Insured.

All other policy terms and conditions apply.

58504 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1

58583 (1-15)

WAIVER OF OUR RIGHT TO RECOVER PAYMENTS

(WAIVER OF SUBROGATION) - BLANKET

This endorsement modifies insurance provided under the following:

COMMERCIAL AUTO POLICY

SECTION V CONDITIONS, A. LOSS CONDITIONS is amended. 5. Our Right to Recover Payments is de-leted and replaced by the following condition.

5. Our Right to Recover Payments

If we make a payment under this policy and the per-son to or for whom payment is made has a right to recover damages from another, we will be entitled to that right. That person shall do everything neces-sary to transfer that right to us and do nothing to prejudice it.

However, we waive our right to recover payments made for bodily injury or property damage:

a. Covered by the policy; and

b. Arising out of the operation of autos covered by the policy, in accordance with the terms and conditions of a written contract between you and such person or entity only if such rights have been waived by the written con-tract prior to the accident or loss which caused the bodily injury or property damage.

All other policy terms and conditions apply.

58583 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13

(Ed. 4-84)

WC 00 03 13

(Ed. 4-84)

© 1983 National Council on Compensation Insurance.

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

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 anyone not named in the Schedule.

Schedule State Blanket/Schedule/State

AZ BLANKET

Blanket Waiver: Anyone for whom you have agreed to provide this Waiver subject to the terms of this endorsement

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

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

1019778Policy No. 2Endorsement No.Endorsement Effective 06/18/2022 Insured Power Tech Contracting LLC Premium $

CopperPoint Casualty Insurance CompanyInsurance Company Countersigned by