B1564_ADOT_24-25.pdf

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

INSURER(S) AFFORDING COVERAGE

INSURER F :

INSURER E :

INSURER D :

INSURER C :

INSURER B :

INSURER A :

NAIC #

NAME:

CONTACT

(A/C, No):

FAX

E-MAIL

ADDRESS:

PRODUCER

(A/C, No, Ext):

PHONE

INSURED

REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES

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).

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.

OTHER:

(Per accident)

(Ea accident)

N / A

SUBR

WVD

ADDL

INSD

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.

$PROPERTY DAMAGE

BODILY INJURY (Per accident)

BODILY INJURY (Per person)

COMBINED SINGLE LIMIT

AUTOS ONLY

AUTOSAUTOS ONLY

NON-OWNED

SCHEDULEDOWNED

ANY AUTO

AUTOMOBILE LIABILITY

Y / N

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH)

DESCRIPTION OF OPERATIONS below If yes, describe under

ANY PROPRIETOR/PARTNER/EXECUTIVE

E.L. DISEASE - POLICY LIMIT

E.L. DISEASE - EA EMPLOYEE

E.L. EACH ACCIDENT

ER

OTH-

STATUTE

PER

LIMITS(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY)

POLICY EFF

POLICY NUMBERTYPE OF INSURANCELTR

INSR

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

EXCESS LIAB

UMBRELLA LIAB $EACH OCCURRENCE

$AGGREGATE

OCCUR

CLAIMS-MADE

DED RETENTION $

$PRODUCTS - COMP/OP AGG

$GENERAL AGGREGATE

$PERSONAL & ADV INJURY

$MED EXP (Any one person)

$EACH OCCURRENCE

DAMAGE TO RENTED

$PREMISES (Ea occurrence)

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY

PRO-

JECT LOC

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

CANCELLATION

AUTHORIZED REPRESENTATIVE

ACORD 25 (2016/03)

© 1988-2015 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

11/26/2024

Reseco Insurance Advisors, LLC 7901 N. 16th Street, Suite 100 Phoenix AZ 85020

602-753-4250 602-419-2242 certificates@resecoadvisors.com

Pacific Compensation Insurance Company 11555 5830 Travelers Property Casualty Co of Amer 25674

CS Construction, Inc.

22023 North 20th Avenue Phoenix AZ 85027

Palomar Excess and Surplus Insurance Company 16754 Greenwich Insurance Company 22322

351803169

B X 1,000,000 X 300,000

X $5,000 PD Ded 10,000

1,000,000

2,000,000 X

Y Y DT-CO-3X116500-PHX-23 11/30/2024 11/30/2025

2,000,000

B 1,000,000

X

X X X HA Phys Dam

Y Y 810-3X080492-23-26-G 11/30/2024 11/30/2025

Comp/Coll Deductibles 1,000/$1,000 B X 10,000,000

X

CUP-7S273365-23-NF 11/30/2024 11/30/2025

10,000,000 X 10,000

A X

Y

Y 1019352 11/30/2024 11/30/2025

1,000,000

1,000,000

1,000,000 D C

Professional Liability Pollution Liability Cyber Liability

PEC003929811

2-CIA-AZ-17-S0113837-00

11/30/2024 11/30/2024

11/30/2025 11/30/2025

Aggregate Limit Each Occurrence Occurrence/Aggregate

5,000,000 5,000,000

3MM/3MM

Builders Risk/Installation Floater: Limit: $2,000,000 Carrier/NAIC #: Travelers Casualty Insurance Company of America / 19046 Policy Number: QT-630-4X620984-TIL-23 Policy Term: 11/30/2024-11/30/2025

Technology Errors & Omissions: Limit $5,000,000 Carrier/NAIC #: Greenwich Insurance Company / 22322 Policy Number: PEC003929811 See Attached...

ADOT

1324 N. 22nd Avenue Phoenix AZ 85009

ACORD 101 (2008/01)

The ACORD name and logo are registered marks of ACORD

© 2008 ACORD CORPORATION. All rights reserved.

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: FORM TITLE:

ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE Page of

AGENCY CUSTOMER ID:

LOC #:

AGENCY

CARRIER NAIC CODE

POLICY NUMBER

NAMED INSURED

EFFECTIVE DATE:

1 1

Reseco Insurance Advisors, LLC CS Construction, Inc.

22023 North 20th Avenue Phoenix AZ 85027

25 CERTIFICATE OF LIABILITY INSURANCE

Policy Term: 11/30/2024-11/30/2025

Certificate holders and those parties, required by written contract, are included as Additional Insured with respects to the General Liability, Automobile Liability and Excess/Umbrella Liability on a primary and non-contributory basis, subject to all provisions and limitations of the policy. Waiver of Subrogation in favor of Certificate Holder and those parties required, by written contract, applies to the General Liability, Automobile Liability and Employers Liability/Workers Compensation, subject to all provisions and limitations of the policy.

Excluded officers Zachary Teegarden and Ross Genebacher CS Job #: B1564 Job Name: ITS Installation, Repair and Replacement Services – Solicitation #BPM005010 – Contract #CTR064363

COMMERCIAL AUTO

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

BLANKET ADDITIONAL INSURED – PRIMARY AND

NON-CONTRIBUTORY WITH OTHER INSURANCE –

CONTRACTORS

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

PROVISIONS 2. The following is added to Paragraph B.5., Other

Insurance of SECTION IV – BUSINESS AUTO

1. The following is added to Paragraph c. in A.1., CONDITIONS:

Who Is An Insured, of SECTION Il – COVERED

AUTOS LIABILITY COVERAGE: Regardless of the provisions of paragraph a. and paragraph d. of this part 5. Other Insurance, thisThis includes any person or organization who you insurance is primary to and non-contributory withare required under a written contract or applicable other insurance under which anagreement, that is signed by you before the additional insured person or organization is a"bodily injury" or "property damage" occurs and named insured when a written contract orthat is in effect during the policy period, to name agreement with you, that is signed by you beforeas an additional insured for Covered Autos the "bodily injury" or "property damage" occursLiability Coverage, but only for damages to which and that is in effect during the policy period,this insurance applies and only to the extent of requires this insurance to be primary and non-that person's or organization's liability for the contributory.conduct of another "insured".

CA T4 99 02 16 ú 2016 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission.

POLICY NUMBER: 810-3X080492-23-26-G

Policy Number: DT-CO-3X116500-PHX-23

Policy No. DT-CO-3X116500-PHX-23

COMMERCIAL GENERAL LIABILITY

XTEND ENDORSEMENT FOR CONTRACTORS

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

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 this 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 coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered.

A. Who Is An Insured – Unnamed Subsidiaries C. Incidental Medical Malpractice

B. Blanket Additional Insured – Governmental D. Blanket Waiver Of Subrogation Entities – Permits Or Authorizations Relating To

E. Contractual Liability – Railroads Operations

F. Damage To Premises Rented To You

PROVISIONS a. An organization other than a partnership, joint venture or limited liability company; or

A. WHO IS AN INSURED – UNNAMED

b. A trust;SUBSIDIARIES

The following is added to SECTION II – WHO IS as indicated in its name or the documents that AN INSURED: govern its structure.

Any of your subsidiaries, other than a partnership, B. BLANKET ADDITIONAL INSURED – joint venture or limited liability company, that is GOVERNMENTAL ENTITIES – PERMITS OR not shown as a Named Insured in the AUTHORIZATIONS RELATING TO OPERATIONS Declarations is a Named Insured if:

The following is added to SECTION II – WHO IS

a. You are the sole owner of, or maintain an

AN INSURED:

ownership interest of more than 50% in, such

Any governmental entity that has issued a permitsubsidiary on the first day of the policy period;

or authorization with respect to operationsand performed by you or on your behalf and that you

b. Such subsidiary is not an insured under are required by any ordinance, law, building code similar other insurance.

or written contract or agreement to include as an

No such subsidiary is an insured for "bodily injury" additional insured on this Coverage Part is an or "property damage" that occurred, or "personal insured, but only with respect to liability for "bodily injury", "property damage" or "personal andand advertising injury" caused by an offense advertising injury" arising out of such operations.committed:

The insurance provided to such governmentala. Before you maintained an ownership interest entity does not apply to:of more than 50% in such subsidiary; or

a. Any "bodily injury", "property damage" orb. After the date, if any, during the policy period "personal and advertising injury" arising out ofthat you no longer maintain an ownership operations performed for the governmentalinterest of more than 50% in such subsidiary.

entity; or

For purposes of Paragraph 1. of Section II – Who

b. Any "bodily injury" or "property damage"Is An Insured, each such subsidiary will be included in the "products-completed deemed to be designated in the Declarations as:

operations hazard".

CG D3 16 02 19 ú 2017 The Travelers Indemnity Company. All rights reserved. Page 1 of 3 Includes copyrighted material of Insurance Services Office, Inc., with its permission.

Policy Number: DT-CO-3X116500-PHX-23

C. INCIDENTAL MEDICAL MALPRACTICE pharmaceuticals committed by, or with the knowledge or consent of, the insured.1. The following replaces Paragraph b. of the definition of "occurrence" in the 5. The following is added to the DEFINITIONS DEFINITIONS Section: Section:

b. An act or omission committed in providing "Incidental medical services" means:

or failing to provide "incidental medical

a. Medical, surgical, dental, laboratory, x-ray services", first aid or "Good Samaritan or nursing service or treatment, advice orservices" to a person, unless you are in instruction, or the related furnishing ofthe business or occupation of providing food or beverages; orprofessional health care services.

b. The furnishing or dispensing of drugs or2. The following replaces the last paragraph of medical, dental, or surgical supplies orParagraph 2.a.(1) of SECTION II – WHO IS appliances.AN INSURED:

6. The following is added to Paragraph 4.b.,Unless you are in the business or occupation Excess Insurance, of SECTION IV –of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do COMMERCIAL GENERAL LIABILITY not apply to "bodily injury" arising out of CONDITIONS:

providing or failing to provide:

This insurance is excess over any valid and

(a) "Incidental medical services" by any of collectible other insurance, whether primary, your "employees" who is a nurse, nurse excess, contingent or on any other basis, that assistant, emergency medical technician is available to any of your "employees" for or paramedic; or "bodily injury" that arises out of providing or failing to provide "incidental medical services"(b) First aid or "Good Samaritan services" by to any person to the extent not subject toany of your "employees" or "volunteer workers", other than an employed or Paragraph 2.a.(1) of Section II – Who Is An volunteer doctor. Any such "employees" Insured.

or "volunteer workers" providing or failing

D. BLANKET WAIVER OF SUBROGATION

to provide first aid or "Good Samaritan

The following is added to Paragraph 8., Transferservices" during their work hours for you Of Rights Of Recovery Against Others To Us,will be deemed to be acting within the of SECTION IV – COMMERCIAL GENERALscope of their employment by you or performing duties related to the conduct LIABILITY CONDITIONS:

of your business. If the insured has agreed in a contract or

3. The following replaces the last sentence of agreement to waive that insured's right of

Paragraph 5. of SECTION III – LIMITS OF recovery against any person or organization, we INSURANCE: waive our right of recovery against such person or organization, but only for payments we makeFor the purposes of determining the because of:applicable Each Occurrence Limit, all related acts or omissions committed in providing or a. "Bodily injury" or "property damage" that failing to provide "incidental medical occurs; or services", first aid or "Good Samaritan

b. "Personal and advertising injury" caused byservices" to any one person will be deemed to an offense that is committed;be one "occurrence".

4. The following exclusion is added to subsequent to the execution of the contract or

Paragraph 2., Exclusions, of SECTION I – agreement.

COVERAGES – COVERAGE A – BODILY

E. CONTRACTUAL LIABILITY – RAILROADSINJURY AND PROPERTY DAMAGE

LIABILITY: 1. The following replaces Paragraph c. of the definition of "insured contract" in theSale Of Pharmaceuticals DEFINITIONS Section:

"Bodily injury" or "property damage" arising out of the violation of a penal statute or c. Any easement or license agreement;

ordinance relating to the sale of

Page 2 of 3 ú 2017 The Travelers Indemnity Company. All rights reserved. CG D3 16 02 19

2. Paragraph f.(1) of the definition of "insured a. Any premises while rented to you or contract" in the DEFINITIONS Section is temporarily occupied by you with permission deleted. of the owner; or

F. DAMAGE TO PREMISES RENTED TO YOU b. The contents of any premises while such premises is rented to you, if you rent suchThe following replaces the definition of "premises premises for a period of seven or fewerdamage" in the DEFINITIONS Section:

consecutive days.

"Premises damage" means "property damage" to:

CG D3 16 02 19 ú 2017 The Travelers Indemnity Company. All rights reserved. Page 3 of 3

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.

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.)

1019352Policy No. 22Endorsement No.Endorsement Effective 11/30/2024 Insured CS Construction Inc Premium $

Pacific Compensation Insurance CompanyInsurance Company Countersigned by

This document may have been uploaded to the CopperPoint Portal.

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

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

CO BLANKET

(Ed. 4-84)

© 1983 National Council on Compensation Insurance.

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.)

11/30/2023Endorsement Effective 1019352Policy No. 22Endorsement No.

CS Construction IncInsured Premium $

Pacific Compensation Insurance CompanyInsurance Company Countersigned by

This document may have been uploaded to the CopperPoint Portal.

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

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

AZ BLANKET

(Ed. 4-84)

© 1983 National Council on Compensation Insurance.

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.)

11/30/2023Endorsement Effective 1019352Policy No. 22Endorsement No.

CS Construction IncInsured Premium $

Pacific Compensation Insurance CompanyInsurance Company Countersigned by

This document may have been uploaded to the CopperPoint Portal.

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

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

NV BLANKET

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

CO BLANKET

NV BLANKET

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.)

1019352Policy No. 11Endorsement No.Endorsement Effective 11/30/2024 Insured CS Construction Inc Premium $

CopperPoint Indemnity Insurance CompanyInsurance Company Countersigned by

Policy Number: 810-3X080492-23-26-G

Policy Number: 810-3X080492-23-26-G

COMMERCIAL AUTO

BLANKET ADDITIONAL INSURED – PRIMARY AND

NON-CONTRIBUTORY WITH OTHER INSURANCE –

CONTRACTORS

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

PROVISIONS 2. The following is added to Paragraph B.5., Other

Insurance of SECTION IV – BUSINESS AUTO

1. The following is added to Paragraph c. in A.1., CONDITIONS:

Who Is An Insured, of SECTION Il – COVERED

AUTOS LIABILITY COVERAGE: Regardless of the provisions of paragraph a. and paragraph d. of this part 5. Other Insurance, thisThis includes any person or organization who you insurance is primary to and non-contributory withare required under a written contract or applicable other insurance under which anagreement, that is signed by you before the additional insured person or organization is a"bodily injury" or "property damage" occurs and named insured when a written contract orthat is in effect during the policy period, to name agreement with you, that is signed by you beforeas an additional insured for Covered Autos the "bodily injury" or "property damage" occursLiability Coverage, but only for damages to which and that is in effect during the policy period,this insurance applies and only to the extent of requires this insurance to be primary and non-that person's or organization's liability for the contributory.conduct of another "insured".

CA T4 99 02 16 ú 2016 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission.

POLICY NUMBER: 810-3X080492-23-26-G

Policy No. DT-CO-3X116500-PHX-23