ACCEPTED_CTR072726_GL_AL_WC_02.17.25-08.25.25.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

2/14/2025

License # 0757776

(916) 770-2918 (951) 231-2572

39993

Graffiti Protective Coatings, Inc.

530 E Mcdowell Rd. #107 Phoenix, AZ 85004

25674 12262

A 1,000,000

X X PACEP4245049 2/17/2025 2/17/2026 100,000

5,000

1,000,000 6,000,000 6,000,000

2,000,000B

X X 810-A3270965-25-26-G 1/1/2025 1/1/2026

5,000,000A

EXC4257701 2/17/2025 2/17/2026 5,000,000

C

X WCAZ000130901 8/25/2024 8/25/2025 1,000,000

Y 1,000,000 1,000,000

A Pollution Liabilty PACEP4245049 2/17/2025 Each Condition 3,000,000

RE: Contract Number: CTR072726 | Project Name: ADOT - Graffiti Removal Services - Phoenix Metro Area - Wide. | Contract #CTR07272. | Solicitation No:

BPM006023.

The State of Arizona/ADOT, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are Additional Insured with regard to the General Liability policy, when required by written contract, per the attached endorsement form EPACE101 07/21. Coverage is Primary & Non –Contributory with regard to the General Liability policy, when required by written contract, per the attached endorsement form EPACE107 07/14. Waiver of Subrogation applies to the General Liability policy, when required by written contract, per the attached endorsement form EPACE113 07/14.

SEE ATTACHED ACORD 101

The State of Arizona/ADOT 1655 W. Jackson Street Phoenix, AZ 85007

GRAFPRO-01 GGOWENS

HUB International Insurance Services Inc.

3000 Executive Parkway Suite 300 San Ramon, CA 94583

Michelle Vargas cal.cpu@hubinternational.com

Colony Insurance Company Travelers Property Casualty Company of America Pennsylvania Manufacturers' Association Insurance Company

X

2/17/2026

X X

X

X

X X

ACCEPTED

ADOT Risk Management

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.

HUB International Insurance Services Inc.

GRAFPRO-01

SEE PAGE 1

SEE PAGE 1

ACORD 25 Certificate of Liability Insurance

License # 0757776

SEE P 1

Graffiti Protective Coatings, Inc.

530 E Mcdowell Rd. #107 Phoenix, AZ 85004

SEE PAGE 1

GGOWENS

Description of Operations/Locations/Vehicles:

Additional Insured applies with regard to the Auto Liability policy, when required by written contract, per the attached endorsement form CAT353 02/15, Waiver of Subrogation included. Primary & Non -Contributory wording applies to the Auto Liability policy, when required by written contract, per the attached endorsement form CAT499 02/16. Waiver of Subrogation with regard to the Workers Compensation policy per attached endorsement form WC000313 04/84.

Policy Number: PACEP4245049

Insured: Graffiti Protective Coatings, Inc.

Policy No.: PACEP4245049 Policy Period: 2/17/2025 to 2/17/2026

Insured: Graffiti Protective Coatings, Inc.

Policy No.: PACEP4245049 Policy Period: 2/17/2025 to 2/17/2026

COMMERCIAL AUTO

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

BUSINESS AUTO EXTENSION ENDORSEMENT

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

GENERAL DESCRIPTION OF COVERAGE – This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover-age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en-dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered.

H. HIRED AUTO PHYSICAL DAMAGE – LOSS OF

USE – INCREASED LIMIT

A. BROAD FORM NAMED INSURED

B. BLANKET ADDITIONAL INSURED

I. PHYSICAL DAMAGE – TRANSPORTATION

EXPENSES – INCREASED LIMITC. EMPLOYEE HIRED AUTO

D. EMPLOYEES AS INSURED J. PERSONAL PROPERTY

E. SUPPLEMENTARY PAYMENTS – INCREASED

LIMITS

K. AIRBAGS

L. NOTICE AND KNOWLEDGE OF ACCIDENT OR

LOSSF. HIRED AUTO – LIMITED WORLDWIDE COV-

ERAGE – INDEMNITY BASIS M. BLANKET WAIVER OF SUBROGATION

G. WAIVER OF DEDUCTIBLE – GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS

PROVISIONS

A. BROAD FORM NAMED INSURED this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II.

The following is added to Paragraph A.1., Who Is

An Insured, of SECTION II – COVERED AUTOS

LIABILITY COVERAGE:

C. EMPLOYEE HIRED AUTOAny organization you newly acquire or form dur-ing the policy period over which you maintain 50% or more ownership interest and that is not separately insured for Business Auto Coverage.

Coverage under this provision is afforded only un-til the 180th day after you acquire or form the or-ganization or the end of the policy period, which-ever is earlier.

1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION II – COV-

ERED AUTOS LIABILITY COVERAGE:

An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your busi-ness.B. BLANKET ADDITIONAL INSURED

The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II – COVERED

AUTOS LIABILITY COVERAGE:

2. The following replaces Paragraph b. in B.5., Other Insurance, of SECTION IV – BUSI-

NESS AUTO CONDITIONS:

b. For Hired Auto Physical Damage Cover-age, the following are deemed to be cov-ered "autos" you own:

Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi-tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which

(1) Any covered "auto" you lease, hire, rent or borrow; and

(2) Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your

CA T3 53 02 15 ú 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission.

Insured name: Graffiti Protective Coatings, Inc.

Policy Number: 810-A3270965-25-26-G Policy Term: 1/1/2025 to 1/1/2026 permission, while performing duties related to the conduct of your busi-ness.

(a) With respect to any claim made or "suit" brought outside the United States of America, the territories and possessions of the United States of America, Puerto Rico and Canada:

However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". (i) You must arrange to defend the "in-sured" against, and investigate or set-tle any such claim or "suit" and keep us advised of all proceedings and ac-tions.

D. EMPLOYEES AS INSURED

The following is added to Paragraph A.1., Who Is

An Insured, of SECTION II – COVERED AUTOS

LIABILITY COVERAGE:

(ii) Neither you nor any other involved

"insured" will make any settlement without our consent.

Any "employee" of yours is an "insured" while us-ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs.

(iii) We may, at our discretion, participate in defending the "insured" against, or in the settlement of, any claim or "suit".

E. SUPPLEMENTARY PAYMENTS – INCREASED

LIMITS

1. The following replaces Paragraph A.2.a.(2), of SECTION II – COVERED AUTOS LIABIL-

ITY COVERAGE:

(iv) We will reimburse the "insured" for sums that the "insured" legally must pay as damages because of "bodily injury" or "property damage" to which this insurance applies, that the "in-sured" pays with our consent, but only up to the limit described in Para-graph C., Limits Of Insurance, of

SECTION II – COVERED AUTOS

LIABILITY COVERAGE.

(2) Up to $3,000 for cost of bail bonds (in-cluding bonds for related traffic law viola-tions) required because of an "accident" we cover. We do not have to furnish these bonds.

2. The following replaces Paragraph A.2.a.(4), of SECTION II – COVERED AUTOS LIABIL-

ITY COVERAGE:

(v) We will reimburse the "insured" for the reasonable expenses incurred with our consent for your investiga-tion of such claims and your defense of the "insured" against any such "suit", but only up to and included within the limit described in Para-graph C., Limits Of Insurance, of

SECTION II – COVERED AUTOS

LIABILITY COVERAGE, and not in addition to such limit. Our duty to make such payments ends when we have used up the applicable limit of insurance in payments for damages, settlements or defense expenses.

(4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day be-cause of time off from work.

F. HIRED AUTO – LIMITED WORLDWIDE COV-

ERAGE – INDEMNITY BASIS

The following replaces Subparagraph (5) in Para-graph B.7., Policy Period, Coverage Territory, of SECTION IV – BUSINESS AUTO CONDI-

TIONS:

(5) Anywhere in the world, except any country or jurisdiction while any trade sanction, em-bargo, or similar regulation imposed by the United States of America applies to and pro-hibits the transaction of business with or within such country or jurisdiction, for Cov-ered Autos Liability Coverage for any covered "auto" that you lease, hire, rent or borrow without a driver for a period of 30 days or less and that is not an "auto" you lease, hire, rent or borrow from any of your "employees", partners (if you are a partnership), members (if you are a limited liability company) or members of their households.

(b) This insurance is excess over any valid and collectible other insurance available to the "insured" whether primary, excess, contingent or on any other basis.

(c) This insurance is not a substitute for re-quired or compulsory insurance in any country outside the United States, its ter-ritories and possessions, Puerto Rico and Canada.

Page 2 of 4 ú 2015 The Travelers Indemnity Company. All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc. with its permission.

(2) In or on your covered "auto".You agree to maintain all required or compulsory insurance in any such coun-try up to the minimum limits required by local law. Your failure to comply with compulsory insurance requirements will not invalidate the coverage afforded by this policy, but we will only be liable to the same extent we would have been liable had you complied with the compulsory in-surance requirements.

This coverage applies only in the event of a total theft of your covered "auto".

No deductibles apply to this Personal Property coverage.

K. AIRBAGS

The following is added to Paragraph B.3., Exclu-sions, of SECTION III – PHYSICAL DAMAGE

COVERAGE:

Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered "auto" you own that in-flate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A.1.c., but only:

(d) It is understood that we are not an admit-ted or authorized insurer outside the United States of America, its territories and possessions, Puerto Rico and Can-ada. We assume no responsibility for the furnishing of certificates of insurance, or for compliance in any way with the laws of other countries relating to insurance.

a. If that "auto" is a covered "auto" for Compre-hensive Coverage under this policy;

b. The airbags are not covered under any war-ranty; andG. WAIVER OF DEDUCTIBLE – GLASS

c. The airbags were not intentionally inflated.The following is added to Paragraph D., Deducti-ble, of SECTION III – PHYSICAL DAMAGE

COVERAGE:

We will pay up to a maximum of $1,000 for any one "loss".

No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced.

L. NOTICE AND KNOWLEDGE OF ACCIDENT OR

LOSS

The following is added to Paragraph A.2.a., of

SECTION IV – BUSINESS AUTO CONDITIONS:H. HIRED AUTO PHYSICAL DAMAGE – LOSS OF

USE – INCREASED LIMIT Your duty to give us or our authorized representa-tive prompt notice of the "accident" or "loss" ap-plies only when the "accident" or "loss" is known to:

The following replaces the last sentence of Para-graph A.4.b., Loss Of Use Expenses, of SEC-

TION III – PHYSICAL DAMAGE COVERAGE:

(a) You (if you are an individual);However, the most we will pay for any expenses for loss of use is $65 per day, to a maximum of $750 for any one "accident".

(b) A partner (if you are a partnership);

(c) A member (if you are a limited liability com-pany);I. PHYSICAL DAMAGE – TRANSPORTATION

EXPENSES – INCREASED LIMIT (d) An executive officer, director or insurance manager (if you are a corporation or other or-ganization); or

The following replaces the first sentence in Para-graph A.4.a., Transportation Expenses, of

SECTION III – PHYSICAL DAMAGE COVER-

AGE:

(e) Any "employee" authorized by you to give no-tice of the "accident" or "loss".

We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in-curred by you because of the total theft of a cov-ered "auto" of the private passenger type.

M. BLANKET WAIVER OF SUBROGATION

The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV – BUSINESS AUTO CONDI-

TIONS:J. PERSONAL PROPERTY

5. Transfer Of Rights Of Recovery Against Others To Us

The following is added to Paragraph A.4., Cover-age Extensions, of SECTION III – PHYSICAL

DAMAGE COVERAGE: We waive any right of recovery we may have against any person or organization to the ex-tent required of you by a written contract signed and executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by

Personal Property

We will pay up to $400 for "loss" to wearing ap-parel and other personal property which is:

(1) Owned by an "insured"; and

CA T3 53 02 15 ú 2015 The Travelers Indemnity Company. All rights reserved. Page 3 of 4 such contract. The waiver applies only to the person or organization designated in such contract.

The unintentional omission of, or unintentional error in, any information given by you shall not prejudice your rights under this insurance. How-ever this provision does not affect our right to col-lect additional premium or exercise our right of cancellation or non-renewal.

N. UNINTENTIONAL ERRORS OR OMISSIONS

The following is added to Paragraph B.2., Con-cealment, Misrepresentation, Or Fraud, of

SECTION IV – BUSINESS AUTO CONDITIONS:

Page 4 of 4 ú 2015 The Travelers Indemnity Company. All rights reserved. CA T3 53 02 15

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

00708-25-24 WCAZ000130901

GRAFFITI PROTECTIVE COATINGS INC INCL.

PENNSYLVANIA MANUFACTURERS' ASSOCIATION

AZ WCIP Assigned Carrier:

1983 National Council on Compensation Insurance.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

STATE OF ARIZONA

ARIZONA DEPARTMENT OF TRANSPORTATION (ADOT)

1655 W JACKSON ST, MD 100P

PHOENIX, AZ 85007

CONTRACT # CRT072726