Arnold_Machinary_Company_-_General-Auto-Umbrella__Exp_10.01.25_.pdf

DATE (MM/DD/YYYY)

CERTIFICATE OF LIABILITY INSURANCE

CONTACTPRODUCER

NAME:

PHONE FAX

(A/C, No, Ext): (A/C, No):

EMAIL

ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

INSR

LTR TYPE OF INSURANCE ADDL

INSR

SUBR

WVD POLICY NUMBER POLICY EFF

(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY) LIMITS

AUTHORIZED REPRESENTATIVE

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY

PRO-

JECT LOC

OTHER:

AUTOMOBILE LIABILITY

ANY AUTO

OWNED

AUTOS ONLY

SCHEDULED

AUTOS

HIRED

AUTOS ONLY

NON-OWNED

AUTOS ONLY

UMBRELLA LIAB

EXCESS LIAB

OCCUR

CLAIMS-MADE

DED RETENTION $

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below

Y / N N / A

EACH OCCURRENCE

DAMAGE TO RENTED

PREMISES (Ea occurrence)

MED EXP (Any one person)

PERSONAL & ADV INJURY

GENERAL AGGREGATE

PRODUCTS - COMP/OP AGG

COMBINED SINGLE LIMIT

(Ea accident)

BODILY INJURY (Per person)

BODILY INJURY (Per accident)

PROPERTY DAMAGE

(Per accident)

EACH OCCURRENCE

AGGREGATE

PER

STATUTE

OTH-

ER

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE

E.L. DISEASE - POLICY LIMIT

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

CERTIFICATE HOLDER CANCELLATION

ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

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).

Arnold Machinery Company PO Box 30020 Salt Lake City, UT 84130-0020

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.

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

09/17/2024

Sentry Customer Service

800-473-6879 800-514-7191 businessproducts_direct@sentry.com

Sentry Select Insurance Company 21180

1277141

Sentry Insurance 1800 North Point Drive Stevens Point, WI 54481

$AGGREGATE LIMIT

$POLLUTION INCIDENT LIMIT

CLEANUP COSTS-COVERED

LOCATION LIMIT

CLAIMS-MADE OCCUR

POLLUTION LIABILITY

N / AXA 2568383009 10/01/2024 10/01/2025

1,000,000

1,000,000

100,000

State of Arizona Dept of Emergency & Military Affairs Dema Procurement Office Building #M5800 5645 E Mcdowell Rd Phoenix, AZ 85008-3423

09/17/20242568383

Sentry Select Insurance Company 00001 0000000000 24262 0 N1 2738c218-8c34-434c-a3ad-bd4317d939ae2738c218-8c34-434c-a3ad-bd4317d939ae 0027020044377402283885008342345

AGENCY CUSTOMER ID:

LOC #:

ADDITIONAL REMARKS SCHEDULE Page of

AGENCY

POLICY NUMBER

CARRIER NAIC CODE

ADDITIONAL REMARKS

NAMED INSURED

EFFECTIVE DATE:

Arnold Machinery Company

XXXXXX2120

2 2

Bruce Johansen

2568383009

Sentry Select Insurance Company 21180 10/01/2024

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: FORM TITLE:ACORD 25 Certificate of Liability Insurance

ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD 09/17/20242568383

CONTACTPRODUCER

NAME:

PHONE FAX

(A/C, No, Ext): (A/C, No):

EMAIL

ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

INSR

LTR TYPE OF INSURANCE ADDL

INSR

SUBR

WVD POLICY NUMBER POLICY EFF

(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY) LIMITS

AUTHORIZED REPRESENTATIVE

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY

PRO-

JECT LOC

OTHER:

AUTOMOBILE LIABILITY

ANY AUTO

OWNED

AUTOS ONLY

SCHEDULED

AUTOS

HIRED

AUTOS ONLY

NON-OWNED

AUTOS ONLY

UMBRELLA LIAB

EXCESS LIAB

OCCUR

CLAIMS-MADE

DED RETENTION $

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below

Y / N N / A

EACH OCCURRENCE

DAMAGE TO RENTED

PREMISES (Ea occurrence)

MED EXP (Any one person)

PERSONAL & ADV INJURY

GENERAL AGGREGATE

PRODUCTS - COMP/OP AGG

COMBINED SINGLE LIMIT

(Ea accident)

BODILY INJURY (Per person)

BODILY INJURY (Per accident)

PROPERTY DAMAGE

(Per accident)

EACH OCCURRENCE

AGGREGATE

PER

STATUTE

OTH-

ER

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE

E.L. DISEASE - POLICY LIMIT

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

CERTIFICATE HOLDER CANCELLATION

ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

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).

Arnold Machinery Company PO Box 30020 Salt Lake City, UT 84130-0020

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.

Refer to attached

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

09/17/2024

Sentry Customer Service

800-473-6879 800-514-7191 businessproducts_direct@sentry.com

Sentry Select Insurance Company 21180

Sentry Insurance Company 24988

1277141

B 2568383010 10/01/2024 10/01/2025

X

1,000,000

1,000,000

1,000,000

A

X

X

X

2568383006 10/01/2024 10/01/2025

25,000,000

75,000,000

PRODUCTS - COMP/OP AGG 75,000,000

Y

Sentry Insurance 1800 North Point Drive Stevens Point, WI 54481

COMMERCIAL GENERAL LIABILITY

A

X

X

X

X X 2568383004 10/01/2024 10/01/2025

1,000,000

500,000

5,000

1,000,000

3,000,000

2,000,000

A

X

X X 2568383005 10/01/2024 10/01/2025

1,000,000

ERRORS & OMISSIONS

Employee Benefits Errors & Omissions

Occurrence Limit Annual Aggregate Limit Deductible

All Other Errors & Omissions

Occurrence Limit Annual Aggregate Limit Deductible

A 2568383008 10/01/2024 10/01/2025

500,000 1,000,000 1,000

250,000 500,000 10,000

State of Arizona Dept of Emergency & Military Affairs Dema Procurement Office Building #M5800 5645 E Mcdowell Rd Phoenix, AZ 85008-3423

09/17/20242568383

00001 0000000000 24262 0 N1 9b7f1071-a8db-4fd6-b9c5-a1051377b0969b7f1071-a8db-4fd6-b9c5-a1051377b096 0027020044377402282685008342345

ADDITIONAL REMARKS SCHEDULE Page of

AGENCY

POLICY NUMBER

CARRIER NAIC CODE

ADDITIONAL REMARKS

NAMED INSURED

EFFECTIVE DATE:

Arnold Machinery Company

XXXXXX2120

2 2

Bruce Johansen

2568383004

Sentry Select Insurance Company 21180 10/01/2024

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: FORM TITLE:ACORD 25 Certificate of Liability Insurance

General Liability

THE STATE OF ARIZONA, & ITS DEPARTMENTS, AGENCIES, BOARDS, COMMISIONS UNIVERSITIES, OFFICERS, OFFICALS, AGENTS, & EMPLOYEES ARE ADDITIONAL INSURED WITH RESPECT TO LIABILITY ARISING OUT OF THE ACTIVITIES PREFORMED BY OR ON BEHALF OF THE CONTACTOR. COVERAGE IS

PRIMARY & NON-CONTRIBUTORY.

ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.

CONTACTPRODUCER

NAME:

PHONE FAX

(A/C, No, Ext): (A/C, No):

EMAIL

ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

INSR

LTR TYPE OF INSURANCE ADDL

INSR

SUBR

WVD POLICY NUMBER POLICY EFF

(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY) LIMITS

AUTHORIZED REPRESENTATIVE

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY

PRO-

JECT LOC

OTHER:

AUTOMOBILE LIABILITY

ANY AUTO

OWNED

AUTOS ONLY

SCHEDULED

AUTOS

HIRED

AUTOS ONLY

NON-OWNED

AUTOS ONLY

UMBRELLA LIAB

EXCESS LIAB

OCCUR

CLAIMS-MADE

DED RETENTION $

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below

Y / N N / A

EACH OCCURRENCE

DAMAGE TO RENTED

PREMISES (Ea occurrence)

MED EXP (Any one person)

PERSONAL & ADV INJURY

GENERAL AGGREGATE

PRODUCTS - COMP/OP AGG

COMBINED SINGLE LIMIT

(Ea accident)

BODILY INJURY (Per person)

BODILY INJURY (Per accident)

PROPERTY DAMAGE

(Per accident)

EACH OCCURRENCE

AGGREGATE

PER

STATUTE

OTH-

ER

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE

E.L. DISEASE - POLICY LIMIT

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

CERTIFICATE HOLDER CANCELLATION

ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

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).

Arnold Machinery Company PO Box 30020 Salt Lake City, UT 84130-0020

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.

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

09/17/2024

Sentry Customer Service

800-473-6879 800-514-7191 businessproducts_direct@sentry.com

Sentry Select Insurance Company 21180

1277141

Sentry Insurance 1800 North Point Drive Stevens Point, WI 54481

Policy Aggregate Limit of Liability $

Retention $

N / ACyber Liability and Data Breach Response A

2568383011 10/01/2024 10/01/2025 100,000

2,500

State of Arizona Dept of Emergency & Military Affairs Dema Procurement Office Building #M5800 5645 E Mcdowell Rd Phoenix, AZ 85008-3423

09/17/20242568383

00001 0000000000 24262 0 N1 b12b5799-56d1-4e84-80e9-d1a0c6c28cc9b12b5799-56d1-4e84-80e9-d1a0c6c28cc9 0027020044377402284485008342345

ADDITIONAL REMARKS SCHEDULE Page of

AGENCY

POLICY NUMBER

CARRIER NAIC CODE

ADDITIONAL REMARKS

NAMED INSURED

EFFECTIVE DATE:

Arnold Machinery Company

XXXXXX2120

2 2

Bruce Johansen

2568383011

Sentry Select Insurance Company 21180 10/01/2024

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: FORM TITLE:ACORD 25 Certificate of Liability Insurance

ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.

Named Insured:

Endorsement Effective Date:

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

POLICY NUMBER: 2568383005 COMMERCIAL AUTO

CA 04 44 10 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

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.

SCHEDULE

State of Arizona Dept of Emergency & Military Affairs Dema Procurement Office Building #M5800

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.

© Insurance Services Office, Inc., 2011

Arnold Machinery Company

10/01/2024

Page 1 of 1CA 04 44 10 13 09/17/20242568383

00001 0000000000 24262 0 N1 c18fcb26-fb69-41b5-80f7-9db78ba2ff69c18fcb26-fb69-41b5-80f7-9db78ba2ff69

POLICY NUMBER:

Named Insured:

Endorsement Effective Date:

SCHEDULE

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

© Insurance Services Office, Inc., 2011

COMMERCIAL AUTO

CA 20 48 10 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

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.

Arnold Machinery Company

State of Arizona Dept of Emergency & Military Affairs Dema Procurement Office Building #M5800

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.

2568383005

10/01/2024

Page 1 of 1CA 20 48 10 13 09/17/20242568383

00001 0000000000 24262 0 N1 39d44c25-dd00-49c4-abfd-7abfa8c1777f39d44c25-dd00-49c4-abfd-7abfa8c1777f

Page 1 of 2CG 20 10 12 19 09/17/20242568383

Sentry Select Insurance Company

POLICY NUMBER:

© Insurance Services Office, Inc., 2018

COMMERCIAL GENERAL LIABILITY

CG 20 10 12 19

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED - OWNERS, LESSEES OR

CONTRACTORS - SCHEDULED PERSON OR

ORGANIZATION

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE

Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations

State of Arizona Dept of Emergency & Military Affairs Dema Procurement Office Building #M5800

All Locations Description:

State of Arizona Dept of Emergency & Military Affairs Dema Procurement Office Building #M5800

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

A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by:

1. Your acts or omissions; or

2. The acts or omissions of those acting on your behalf;

in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above.

However:

1. The insurance afforded to such additional insured only applies to the extent permitted by law; and

2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.

B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:

This insurance does not apply to "bodily injury" or "property damage" occurring after:

1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or

2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project.

2568383004

00001 0000000000 24262 0 N1 d6825649-adaa-4aea-b122-8716e4a20a6ed6825649-adaa-4aea-b122-8716e4a20a6e

C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance:

If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:

1. Required by the contract or agreement; or

2. Available under the applicable limits of insurance;

whichever is less.

This endorsement shall not increase the applicable limits of insurance.

© Insurance Services Office, Inc., 2018 CG 20 10 12 19Page 2 of 2 09/17/20242568383

POLICY NUMBER:

© Insurance Services Office, Inc., 2018

COMMERCIAL GENERAL LIABILITY

CG 24 04 12 19

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US (WAIVER OF SUBROGATION)

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

ELECTRONIC DATA LIABILITY COVERAGE PART

LIQUOR LIABILITY COVERAGE PART

POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES

POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

RAILROAD PROTECTIVE LIABILITY COVERAGE PART

UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS

SCHEDULE

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

The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions:

We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss.

This endorsement applies only to the person(s) or organization(s) shown in the Schedule above.

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

State of Arizona Dept of Emergency & Military Affairs Dema Procurement Office Building #M5800

2568383004

Page 1 of 1CG 24 04 12 19 09/17/20242568383

00001 0000000000 24262 0 N1 a8fe3deb-0c6c-40a5-befe-529cdf87747ba8fe3deb-0c6c-40a5-befe-529cdf87747b