INSR ADDL SUBR

LTR INSR WVD

DATE (MM/DD/YYYY)

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 EXP

TYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)

COMMERCIAL GENERAL LIABILITY

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

INSURER(S) AFFORDING COVERAGE NAIC #

Y / N

N / A (Mandatory in NH)

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

EACH OCCURRENCE $

DAMAGE TO RENTED

$PREMISES (Ea occurrence)CLAIMS-MADE OCCUR

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER:

PRODUCTS - COMP/OP AGG $

PRO-

OTHER:

LOCJECT

COMBINED SINGLE LIMIT

$(Ea accident)

BODILY INJURY (Per person) $ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS

AUTOS ONLY

HIRED PROPERTY DAMAGE $

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 LIMIT $DESCRIPTION OF OPERATIONS below

POLICY

NON-OWNED

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 any 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.

The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03)

ACORDTM CERTIFICATE OF LIABILITY INSURANCE

Scottsdale Insurance Company

Bridgeway Insurance Company

Great American Insurance Company

Lloyds of London

At-Bay Specialty Insurance Company

Philadelphia Indemnity Ins Company

10/29/2025

Propel Insurance 805 SW Broadway; Suite 2300 COM Middle Market Portland, OR 97205-3363

Celeste Brooks 800 499-0933 866 577-1326 celeste.brooks@propelinsurance.com

Rite of Passage Inc.

2560 Business Parkway Ste A Minden, NV 89423

41297 12489 16691

19607 18058

A X

X BI/PD Ded: 25,000 X PROF Ded: 250,000

X X OPS1586853 07/01/2025 07/01/2026 1,000,000

300,000 5,000 1,000,000 3,000,000 3,000,000 1M/3MPROF Liab

F X

X X PHPK2691771001 07/01/2025 07/01/2026 1,000,000

B A X

X

X 25000

X X 9HA7PX000200802

XLS1229413

07/01/2025

07/01/2025

07/01/2026

07/01/2026

3,000,000 3,000,000 2,000,000

C

N

X WCF13728101 12/31/2024 12/31/2025 X

1,000,000

1,000,000 1,000,000

A D E

Sexual Misconduct Excess SAM Cyber Liability X

OPS1586853

MR25AA09

AB661029905

07/01/2025 07/01/2025 07/01/2025

07/01/2026 07/01/2026 07/01/2026

1M/2M 2M/2M 2M

Excess Liability is Follow Form Crime Coverage Policy # 105765798 Effective 7/1/2025-2028 Travelers Casualty and Surety Company of America Employee Theft of Clients Property $100,000 with $1,000 retention. Third party coverage applies.

Re: Falcon Ridge Ranch and Lava Heights Academy Arizona Department of Child Safety is included as additional insured, and waiver of subrogation applies, as respects general liability, per attached endorsements, if required by written contract.

Arizona Department of Child Safety 3003 N. Central , Suite 2000 Site Code CH010-20 Phoenix, AZ 85012-0000

#S7655557/M7614731

RITPASClient#: 189018

CXB03

#S7655557/M7614731

This page has been left blank intentionally.

Underwritten by Scottsdale Insurance Company ENDORSEMENT

NO.

ATTACHED TO AND

FORMING A PART OF

POLICY NUMBER

ENDORSEMENT EFFECTIVE DATE

(12:01 A.M. STANDARD TIME)

NAMED INSURED AGENT NO.

XLS1229413 7/1/2025

Rite of Passage, Inc.

29511

XLS-245-NEG (08-25) Page 1 of 1

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED FOLLOW FORM ENDORSEMENT

This endorsement modifies insurance provided under the following:

EXCESS LIABILITY COVERAGE FORM

A. Notwithstanding anything to the contrary, it is agreed this Policy shall follow form with respect to the

Additional Insured provisions contained in the “Underlying Insurance.”

Coverage afforded to any Additional Insured under this policy shall not be broader than that which the

“Named Insured” is required by written contract or agreement to provide for such Additional Insured.

B. The following is added to Section I. COVERAGE, subsection D.:

However, with respect to Additional Insured status, primary and noncontributory wording, waiver of subrogation, or notice of cancellation, the terms of the “Underlying Insurance” shall apply.

C. The following is added to Section V. CONDITIONS, subsection B.:

However, with respect to any Additional Insured, this Policy shall follow the notice of cancellation pro-visions of the “Underlying Insurance,” provided such notice is required by written contract or agreement.

D. The following is added to Section V. CONDITIONS, subsection I.:

However, this Policy shall follow the “Underlying Insurance” with respect to any requirement that cov-erage provided to any Additional Insured be primary and noncontributory and required by a written contract or agreement.

E. The following is added to Section V. CONDITIONS, paragraph K.:

However, with respect to any Additional Insured, we waive any right of recovery we may have against any Additional Insured because of payments we make for injury or damage arising out of your acts or omissions or the acts or omissions of those acting on your behalf in the performance of your ongoing operations for the Additional Insured. This waiver only applies only to an Additional Insured when re-quired by a written contract or agreement.

All other terms and conditions of this policy remain unchanged.

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.)

Insured Rite of Passage, Inc

Policy No.

WC F137281 01

Company Great American Alliance Insurance Company

Effective Date Premium

Endorsement No.

Authorized Representative Propel Insurance

TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page.

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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us.

This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule.

The premium for this endorsement is shown in the Schedule.

Schedule

1. ( ) Specific Waiver

Name of person or organization

( X )

Blanket Waiver

Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver.

2. Operations:

All Texas Operations

3. Premium:

The premium charge for this endorsement shall be 2 percent of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described.

4. Advance Premium:

Included

Copyright 2014 National Council on Compensation Insurance, Inc. All Rights Reserved.

WC 42 03 04B (Ed. 06-14)

WC 42 03 04B (Ed. 06-14)

(Page 1 of 1)

R * SW * 12/24/2024 * WC F137281 01 00 Great American Alliance Insurance Company

*D/B* 458498777 384087

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.)

Insured Rite of Passage, Inc

Policy No.

WC F137283 01

Company Great American Alliance Insurance Company

Effective Date Premium

Endorsement No.

Authorized Representative Propel 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

Any Person or Organization for whom the insured has agreed by written contract to furnish this waiver for all states listed in Item 3A of the Information Page.

1983 National Council on Compensation Insurance.

WC 00 03 13 (Ed. 04-84)

WC 00 03 13 (Ed. 04-84)

(Page 1 of 1)

R * SW * 12/24/2024 * WC F137283 01 00 Great American Alliance Insurance Company

*D/B* 458498777 384087

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.)

Insured Rite of Passage Adolescent Treatment Centers and Schools, Inc.

Policy No.

WC F137275 01

Company Great American Alliance Insurance Company

Effective Date Premium

Endorsement No.

Authorized Representative Propel Insurance

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA

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.)

You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule.

The additional premium for this endorsement shall be 2 % of the California workers' compensation premium otherwise due on such remuneration.

Schedule

Person or Organization Job Description

Any Person or Organization for whom the named insured has agreed by written contract to furnish this waiver

Any job for which the named insured has agreed by written contract to furnish this waiver

WC 04 03 06 (Ed. 04-84)

WC 04 03 06 (Ed. 04-84)

(Page 1 of 1)

R * SW * 12/24/2024 * WC F137275 01 00 Great American Alliance Insurance Company

*D/B* 345103999 384087

Job 1: Arizona Department of Child