Attachment_5_-_Supplementary_Insurance.pdf

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

INSR ADDL SUBR

LTR INSD 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)

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 RENTED

CLAIMS-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 AGG $JECT

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 LIMIT $DESCRIPTION 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.

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

CERTIFICATE OF LIABILITY INSURANCE

LOCKTON COMPANIES

500 West Monroe, Suite 3400

CHICAGO IL 60661

(312) 669-6900

Alert Holding Company, Inc.

DBA Appriss 9901 Linn Station Rd Louisville, KY 40223

Endurance Assurance Corporation 11551

Sompo America Insurance Company 11126 Sompo America Fire & Marine Insurance Company 38997

X X

1,000,000 1,000,000 5,000 1,000,000 2,000,000 2,000,000

X 1,000,000

XXXXXXX

XXXXXXX

XXXXXXX

Comp/Coll Ded. 1,000

X X

X 10,000

15,000,000 15,000,000

XXXXXXX

N

X

1,000,000 1,000,000 1,000,000

Foreign Casualty Employers Liability: $1M General Liability: $1M OCC, $2M Agg Auto Liability: $1M

A ACV41396S0 4/1/2021 4/1/2022

A CPL40389L0 4/1/2021 4/1/2022

A FOM40149X0 4/1/2021 4/1/2022

C TUM30005043400 4/1/2021 4/1/2022

B JWC40145T0 4/1/2021 4/1/2022

4/1/2022

1444585

Y Y

Y Y

N N

Y

6/10/2021

N N

17633980

17633980 XXXXXXX

State of Arizona PO Box 52016 Phoenix AZ 85072-2016

See attachment for E&O and Cyber coverages. State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are included as additional insured if required by written contract with respect to General and Automobile Liability per the terms and conditions of the policy. A waiver of subrogation applies in favor of the additional insured if required by written contract with respect to Workers' Compensation, General and Automobile Liability per the terms and conditions of the policy where permitted by state law.

X

See Attachments

Alert Holding Company, Inc.’s Cyber and E&O

Effective Dates: 4/1/2021 - 4/1/2022 Type of

Coverage Carrier Policy Number Retention Limits of Insurance

Cyber / E&O AWAC 0312-2890 $500,000 $10,000,000 Agg/per claim

Excess Cyber/E&O

QBE 130000174

N/A

$10,000,000 xs $10,000,000 Agg

2nd XS Cyber/E&O

Lloyd's London Crum & Forster

CXS386221

EOL-231759

N/A Each Share $5,000,000 part of $10,000,000 excess of $20,000,000

3rd XS Cyber/E&O

AXA XL

C.N.A.

MTE9039245 02

652132714

N/A Each Share $5,000,000 part of $10,000,000 excess of $30,000,000

4th XS Cyber/E&O Munich Re CYXS61901

N/A $10,000,000 xs $40,000,000

Agg

5th XS Cyber/E&O

RLI

Valdius

CYB0000438

B6044FIP3524897

N/A

Each Share $10,000,000 part of $25,000,000 excess of

$50,000,000

5th XS Cyber/E&O

Evanston MKLV2XEO000058 N/A

$5,000,000 part of $25,000,000 xs $50,000,000

6th XS Cyber/E&O

Arch NPL0065126-01 N/A

$10,000,000 part of $25,000,000 excess of

$75,000,000

6th XS Cyber/E&O

Everest

RSU Landmark

Lloyds

CY5EX00265-211

LQS788481

B1230FC18910A21

N/A Each Share $5,000,000 part of $25,000,000 excess of $75,000,000

Attachment Code: D575123 Master ID: 1444585, Certificate ID: 17633980

Alert Holding Company, Inc.’s Management Lines

Effective Dates: 4/1/2020 - 7/30/2021

Type of Coverage

Carrier Policy Number Retention Limits of Insurance

Primary Directors and

Officers (D&O)

Chubb 8259-6760 $50,000 $5,000,000 Agg

Excess Directors and

Officers (D&O)

One Beacon MMX-01759-20 N/A $3,000,000 Excess of

$5,000,000

Attachment Code: D575123 Master ID: 1444585, Certificate ID: 17633980

State of Arizona

To whom it may concern:

In our continuing effort to provide timely certificate delivery, Lockton Companies is transitioning to paperless delivery of Certificates of Insurance.

To ensure electronic delivery for future renewals of this certificate, we need your email address.

Please contact us via one of the methods below, referencing Certificate ID 17633980.

Email: Chicagoedelivery@lockton.com Phone: 866-297-8023

If you received this certificate through an internet link where the current certificate is viewable, we have your email and no further action is needed.

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Thank you for your cooperation and willingness in reducing our environmental footprint.

Lockton Companies

Lockton Companies 500 W. Monroe Street, Suite 3400

Chicago, IL 60661

Attachment Code: D563661 Master ID: 1444585, Certificate ID: 17633980 mailto:Chicagoedelivery@lockton.com