Certificate.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

3/1/2024

(520) 467-6091 (520) 571-9667

38733

Spencer Construction LLC 7225 N Mona Lisa Rd.Suite 202 Tucson, AZ 85741

11555 27960

A 1,000,000

X X 24C PS 13229 3/1/2024 3/1/2025 100,000

5,000

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

COMPOSITE RATED

1,000,000A

X X 24C AS 13229 3/1/2024 3/1/2025

5,000,000A

24C LU 13229 3/1/2024 3/1/2025 5,000,000

10,000 B

X 1030075 3/2/2024 3/2/2025 1,000,000 1,000,000 1,000,000

C Pollution Liability X COOG47408398 001 6/1/2023 Ret $10,000 Limit 2,000,000 C Errors & Ommisions COOG47408398 001 6/1/2023 3/1/2025 Ret $25,000 Limit 2,000,000

RE: Solicitation No BPM003283

* Not to Exceed $500,000 Leased/Rented Cranes; **Replacement Cost Valuation applies to Contractors Equipment Leased or Rented from other if required by contract

Equipment Floater Atlantic Specialty Insurance Company Policy Number: IM 0000828-00

SEE ATTACHED ACORD 101

State of Arizona and the Arizona Game and Fish Department 5000 West Carefree Highway Phoenix, AZ 85086

SPENCON-02 BRITTANYKOCIS

NFP Property & Casualty Services, Inc.

6992 East Broadway Boulevard Tucson, AZ 85710

CynDee Graves cyndee.graves@nfp.com

Alaska National Insurance Company Pacific Compensation Insurance Company Illinois Union Insurance Company

X

3/1/2025

X X

X XX

X

X

X

X

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.

NFP Property & Casualty Services, Inc.

SPENCON-02

SEE PAGE 1

SEE PAGE 1

ACORD 25 Certificate of Liability Insurance

SEE P 1

Spencer Construction LLC 7225 N Mona Lisa Rd.Suite 202 Tucson, AZ 85741

SEE PAGE 1

BRITTANYKOCIS

Description of Operations/Locations/Vehicles:

Period: 3/01/24 to 3/01/25 Any One item: $900,000 ACV**/$5,000 Ded - Any One Occurrence: $10,000,000

Employers Liability: TX Argonaunt Insurance Company Policy Number: WC929088810414 Period: 03/01/2024 - 03/01/2025

E.L. EACH ACCIDENT: $1,000,000

E.L. DISEASE - EA EMPLOYEE: $1,000,000

E.L. DISEASE - POLICY LIMIT: $1,000,000

Employers Liability: NM CopperPoint General Insurance Company Policy Number: 1030074 Period: 03/01/2024 - 03/01/2025

E.L. EACH ACCIDENT: $1,000,000

E.L. DISEASE - EA EMPLOYEE: $1,000,000

E.L. DISEASE - POLICY LIMIT: $1,000,000

Excess Liability Policy Number: CXP-030552-00 Period: 03/01/2024 - 03/01/2025 Each Occurrence: $5,000,000 Each Aggregate: $5,000,000 Retained Limit: $10,000 Per Statue

Certificate Holder is Additional Insured with respects to General Liability per endorsement ANIC GL 1187 07-16 attached. Primary and Non-Contributory applies per endorsement ANIC GL 1187 07-16 attached. Waiver of Subrogation applies with respects to General Liability per endorsement GL 1187 07-16 attached.

Certificate Holder is Additional Insured with respects to Auto Liability per endorsement ANIC CA 1264 02-21 attached. Primary and Non-Contributory applies per endorsement ANIC CA 1264 02-21 attached. Waiver of Subrogation applies with respects to Auto Liability per endorsement ANIC CA 1264 02-21 attached.

Waiver of Subrogation applies with respects to Workers Compensation per endorsement WC990410C 10-17, WC000313 04-84, WC4203 04 B 06-14 attached.

Inland Marine/Contractors Equipment Loss Payee and Additional Insured applies per endorsement PIM5101 11-22 & PIM5102 08-22 attached.

Additional Insureds: State of Arizona and the Arizona Game and Fish Department

ANIC GL 1187 07 16 Page 1 of 6

CONTRACTORS’ GENERAL LIABILITY ENHANCEMENT ENDORSEMENT

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

Coverage afforded under this extension of coverage endorsement does not apply to any person or organization covered as an additional insured on any other endorsement now or hereafter attached to this Coverage Part.

SCHEDULE OF COVERAGES ARE SUMMARIZED BELOW

1. Miscellaneous Additional Insureds 8 additional insured extensions.

Primary and Noncontributory Insurance

2. Damage To Premises Rented to You Limit increased to $500,000.

3. Medical Payments Limits increased to $15,000.

Reporting period increased to three years from the date of accident.

4. Non-owned Watercraft Increased to 50 feet.

5. Supplementary Payments Cost of bail bonds increased to $10,000.

Daily loss of earnings increased to $500.

6. Newly Formed Or Acquired Organizations Coverage extended to the end of the policy period or the next anniversary of this policy’s effective date.

7. Liberalization Clause

8. Unintentional Failure To Disclose Hazards

9. Notice of Occurrence

10. Broad Knowledge of Occurrence

11. Bodily Injury - Extension of Coverage

12. Expected Or Intended Injury Reasonable force - bodily injury or property damage.

13. Blanket Waiver of Subrogation Waiver of subrogation where required by written contract or written agreement.

14. In Rem Actions

1. MISCELLANEOUS ADDITIONAL INSUREDS

Section II Who Is An Insured is amended to include as an additional Insured any person or organization described in Paragraphs 2.a.

through 2.h. below whom you are required to add as an additional insured on this policy under a written contract or written agreement. However, the written contract or written agreement must be:

1. Currently in effect or becoming effective during the term of this policy; and

2. Executed prior to the “bodily injury”, “property damage” or “personal injury and advertising injury”, but

Only the following persons or organizations are additional insureds under this endorsement and coverage provided to such additional insureds is limited as provided herein:

a. State or Governmental Agency or

Subdivision or Political Subdivi-sions

Any state or governmental agency or subdivision or political subdivision that has issued a permit in connection with operations performed by you or on your behalf and that you are required by any ordinance, law or building code to include as an additional insured on this coverage part is an additional insured, but only with respect to liability for “bodily injury”, “property damage”, “personal and advertising injury” arising out of such operations.

ANIC GL 1187 07 16 Page 2 of 6

The insurance provided to such state or political subdivision does not apply to any “bodily injury”, “property damage” or “personal and advertising injury” arising out of operations performed for that state or political subdivision.

b. Controlling Interest

Any persons or organizations with a controlling interest in you but only with respect to their liability arising out of:

(1) Their financial control of you, or

(2) Premises they own, maintain or control while you lease or occupy these premises.

This insurance does not apply to structural alterations, new construc-tion and demolition operations performed by or for such additional insured.

c. Managers or Lessors of Premises

A manager or lessor of premises but only with respect to liability arising out of the ownership, maintenance or use of that specific part of the premises leased to you and subject to the following additional exclusions:

This insurance does not apply to:

(1) Any “occurrence” which takes place after you cease to be a tenant in that premises; or

(2) Structural alterations, new con-struction or demolition operations performed by or on behalf of such additional insured.

d. Mortgagee, Assignee or Receiver

A mortgagee, assignee or receiver but only with respect to their liability as mortgagee, assignee, or receiver and arising out of the ownership, maintenance, or use of a premises by you.

This insurance does not apply to structural alterations, new construc-tion or demolition operations performed by or for such additional insured.

e. Owners or Other Interests From Whom Land Has Been Leased

An owner or other interest from whom land has been leased by you but only with respect to liability arising out of the ownership, maintenance or use of that specific part of the land leased to you and subject to the following additional exclusions:

This insurance does not apply to:

(1) Any “occurrence” which takes place after you cease to lease that land; or

(2) Structural alterations, new con-struction or demolition operations performed by or on behalf of such additional insured.

f. Co-owner of Insured Premises

A co-owner of a premises co-owned by you and covered under this insurance but only with respect to the co-owners liability as co-owner of such premises.

g. Lessor of Equipment

Any person or organization from whom you lease equipment. Such person or organization is an additional insured only with respect to their liability for “bodily injury”, “property damage” or “personal and Advertising injury” caused, in whole or in part, by your maintenance, oper-ation or use of equipment leased to you by such person or organization.

A person’s or organization’s status as an additional insured under this endorsement ends when their written contract or written agreement with you for such leased equipment ends.

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

This insurance does not apply:

(1) To any “occurrence” which takes place after the equipment lease expires; or

ANIC GL 1187 07 16 Page 3 of 6

(2) To “bodily injury”, “property damage”, or “personal and advertising injury” arising out of the sole negligence of such additional insured.

h. Owners, Lessees or Contractors

(1) Such person or organization is an additional insured for “bodily injury”, “property damage” and “personal and advertising injury” if, and only to the extent that, the injury or damage is caused by negligent acts or omissions of you or your subcontractor in the performance of “your work” to which the written contract applies. This person or organization does not qualify as an additional insured with respect to injury or damage caused in whole or in part by independent negligent acts or omissions of such person or organization.

(2) However, this insurance does not apply to “bodily injury”, “property damage” or “personal and advertising injury” arising out of an architect’s, engineer’s, or surveyor’s rendering of or failure to render any professional services including:

i. the preparing, approving, or failing to prepare or approve maps, drawings, opinions, reports, surveys, change orders, design or specifications; and

ii. supervisory, inspection, or engineering services.

(3) The insurance provided to this additional insured, does not cover "bodily injury" or "property damage” caused by your negligent acts and omissions in the performance of "your work" that occurs within the "products-completed operations hazard", unless the written contract contains a specific requirement that you procure completed operations coverage or coverage within the "products-completed operations hazard" for the additional insured. However, even if coverage within the "products-completed operations hazard" is required by the written contract, such coverage is available to the additional insured only if the "bodily injury" or "property damage" occurs prior to the end of the time period during which you are required by the written contract to provide such coverage or the expiration date of the policy, whichever comes first.

Any insurance provided to an additional insured designated under Paragraphs 2.a.

through 2.g. above does not apply to “bodily injury” or “property damage” included within the products-completed operations hazard.”

Primary And Noncontributory Insurance

The following is added to the Other Insurance Condition and supersedes any provision to the contrary:

This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that:

(1) The additional insured is a Named Insured under such other insurance; and

(2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured.

Section III - Limits of Insurance, the following is added:

With respect to the insurance afforded to the additional insureds described in Paragraphs a.

through h. above, the most we will pay on behalf of such additional insured is the amount of insurance:

(1) Required by the contract or agreement; or

(2) Available under the applicable Limits of Insurance shown in the Declarations;

whichever is less.

ANIC GL 1187 07 16 Page 4 of 6

This provision shall not increase the applicable Limits of Insurance shown in the Declaration.

2. Damage To Premises Rented to You

SECTION III – LIMITS OF INSURANCE,

Paragraph 6. is replaced by the following:

6. Subject to Paragraph 5. above, the

Damage to Premises Rented to You Limit is the most we will pay under Coverage A for damages because of “property damage” to any one premises, while rented to you, or in the case of damage by fire, while rented to you or temporarily occupied by you with permission of the owner.

If a limit is shown for Damage to Premises Rented to You the most we will pay under Coverage A for damages because or “property damage” to any one premises is the Limit shown in the Declarations or $500,000, whichever is greater.

3. MEDICAL PAYMENTS

A. Section lll – Limits of Insurance, Paragraph

7. is replaced by the following:

7. Subject to Paragraph 5. above the

Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of “bodily injury” sustained by any one person.

If a limit is shown for Medical Expense in the Declarations the most we will pay under Coverage C for all medical expenses because of “bodily injury” sustained by any one person is the Limit shown in the Declarations or $15,000, whichever is greater.

B. This provision 5. (Medical Payments) does not apply if Section I - Coverage C Medical Payments is excluded either by the provisions of the Coverage Part or by endorsement.

C. Paragraph 1.a.(3)(b) of Section I - Coverage

C - Medical Payments, is replaced by the following:

(b) The expenses are incurred and reported to us within three years of the date of the accident; and

4. NON-OWNED WATERCRAFT

A. If endorsement CG 21 09, CG 21 10, CG 24

50, or CG 24 51 is attached to the policy, Paragraph A. 2. g. (2) (b) is replaced by the

(b) A watercraft that you do not own that is:

(i) Less than 50 feet long:

and

(ii) Not being used to carry persons or property for a charge.

B. If Paragraph A. does not apply, Paragraph g.

(2) of 2. EXCLUSION under SECTION l –

COVERAGES, COVERAGE A – BODILY

INJURY AND PROPERTY DAMAGE

LIABILITY is replaced by the following:

(2) A watercraft that you do not own that is:

(a) Less than 50 feet long; and

(b) Not being used to carry persons or property for a charge.

5. SUPPLEMENTARY PAYMENTS

A. Under Section I - Supplementary Payments

- Coverage A and B, Paragraph 1.b., the limit of $250 shown for the cost of bail bonds is replaced by $10,000;

B. In Paragraph 1.d., the limit of $250 shown for daily loss of earnings is replaced by $500.

6. NEWLY FORMED OR ACQUIRED

ORGANIZATIONS

Paragraph 3.a. of Section II - Who Is An Insured is deleted and replaced by the following:

Coverage under this provision is afforded only until the end of the policy period or the next anniversary of this policy’s effective date after you acquire or form the organization, whichever is earlier.

ANIC GL 1187 07 16 Page 5 of 6

7. LIBERALIZATION CLAUSE

If we adopt a change in our forms or rules which would broaden coverage for contractors under this endorsement without an additional premium charge, your policy will automatically provide the additional coverages as of the date the revision is effective in your state.

8. UNINTENTIONAL FAILURE TO DISCLOSE

HAZARDS

SECTION IV – COMMERCIAL GENERAL

LIABILITY CONDITIONS – Paragraph 6. – Representations is replaced by the following:

6. Representations

By accepting this policy, you agree:

a. The statements in the Declarations are accurate and complete;

b. Those statements are based upon representations you made to us; and

c. We have issued this policy in reliance upon your representations.

The unintentional omission of, or unintentional error in, any information you provided to us which we relied upon in issuing this policy will not prejudice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable laws and regulations.

9. NOTICE OF OCCURRENCE

The following is added to Paragraph 2. of Section

IV - Commercial General Liability Conditions - Duties In The Event of Occurrence, Offense, Claim or Suit:

Your rights under this Coverage Part will not be prejudiced if you fail to give us notice of an “occurrence”, offense, claim or “suit” and that failure is solely due to your reasonable belief that the “bodily injury” or “property damage” is not covered under this Coverage Part. However, you shall give written notice of this “occurrence”, offense, claim or “suit” to us as soon as you are aware that this insurance may apply to such “occurrence”, offense, claim or “suit.”

10. BROAD KNOWLEDGE OF OCCURRENCE

The following is added to Paragraph 2. of Section

IV - Commercial General Liability Conditions - Duties in The Event of Occurrence, Offense, Claim or Suit:

You must give us or our authorized representative notice of an “occurrence”, offense, claim, or “suit” only when the “occurrence”, offense, claim or “suit’ is known to:

(1) You, if you are an individual;

(2) A partner, if you are a partnership;

(3) An executive officer or the employee designated by you to give such notice, if you are a corporation; or

(4) A manager, if you are a limited liability company.

11. EXPANDED BODILY INJURY

Section V - Definitions, the definition of “bodily injury” is changed to read:

“Bodily injury” means bodily injury, sickness or disease sustained by a person, including death, humiliation, shock, mental anguish or mental injury by that person at any time which results as a consequence of the bodily injury, sickness or disease.

12. EXPECTED OR INTENDED INJURY

Exclusion a. of Section I - Coverage A - Bodily

Injury and Property Damage Liability is replaced by the following:

a. “Bodily injury” or “property damage” expected or intended from the standpoint of the insured. This exclusion does not apply to “bodily injury” or “property damage” resulting from the use of reasonable force to protect persons or property.

This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective on the date issued at 12:01 A.M. standard time at your mailing address shown in the policy. The information below is required only when this endorsement is issued subsequent to commencement of the policy.

Endorsement Effective Policy No.

Insured Endorsement No.

Countersigned By

Includes copyrighted material of Insurance Services Office, Inc., with its permission

ANIC GL 1187 07 16 Page 6 of 6

13. BLANKET WAIVER OF SUBROGATION

The Transfer Of Rights Of Recovery Against

Others To Us Condition (Section IV - Commercial General Liability Conditions) is amended by the addition of the following:

We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of:

1. Your ongoing operations; or

2. “Your work” included in the “products-completed operations hazard.”

However, this waiver applies only when you have agreed in writing to waive such rights of recovery in a contract or agreement, and only if the contract or agreement:

1. Is in effect or becomes effective during the term of this policy; and

2. Was executed prior to loss.

14. IN REM ACTIONS

Any action in rem against any vessel owned, operated by or for, or chartered by or for you will be treated in the same manner as though the action were in personam against you.

vla Typewriter Marc Schmittlein wconkle Typewriter 03/01/2024 wconkle_1 Typewriter

24C PS 13229

wconkle_2 Typewriter Spencer Construction LLC.

wconkle_3 Typewriter

ANIC CA 1264 02 21 Page 1 of 5

BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT - ARIZONA

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

Various provisions in this endorsement restrict coverage. Read the entire policy carefully to determine rights, duties, and what is and is not covered.

Throughout this policy, the words “you” and “your” refer to the Named Insured shown in the Declarations. The words “we”, “us”, and “our” refer to the company providing this insurance.

Other words and phrases that appear in quotation marks have special meaning. Refer to SECTION V – DEFINITIONS in the Business Auto Coverage Form.

The coverages provided by this endorsement apply per “accident” and, unless otherwise specified, are subject to all of the terms, conditions, exclusions and deductible provisions of the policy, to which it is attached.

SECTION II – COVERED AUTO LIABILITY

COVERAGE, Paragraph A.1. Who Is An Insured is amended to include:

d. Any “employee” of yours 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 business.

e. Any person or organization for whom you have agreed in writing to provide insurance such as is afforded by this Coverage Form, but only with respect to liability arising out of the ownership, maintenance or use of “autos" covered by this policy. If such person or organization has other insurance then this insurance is primary to and we will not seek contribution from the other insurance.

f. Any organization you newly acquire or form during 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 until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier.

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

SECTION II – COVERED AUTO LIABILITY

COVERAGE, Paragraph A.2.a. (2) – Supplementary Payments is replaced by the following:

(2) Up to $10,000 for cost of bail bonds

(including bonds for related traffic law violations) required because of an “accident” we cover. We do not have to furnish these bonds.

COVERAGE, Paragraph A.2.a. (4) – Supplementary Payments is replaced by the following:

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

COVERAGE, Paragraph A.2.c. – Voluntary Prop-erty Damage is added as follows:

c. Voluntary Property Damage

At your written request, we may make a voluntary payment for Property Damage caused by an “insured”, but without liability to a third party, up to $25,000. We will not make a Voluntary Property Damage payment to anyone who is an “insured” under this policy.

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ANIC CA 1264 02 21 Page 2 of 5

SECTION III - PHYSICAL DAMAGE COVERAGE

Paragraph A.5 is added as follows:

5. If hired “autos” are covered “autos” for

Liability Coverage, then the Physical Damage Coverage provided under this Coverage Form for any “auto” you own are extended to “autos” of the private passenger or “light truck” type which you lease, hire, rent or borrow without a driver for a period of 30 days or less, subject to the following limit.

The most we will pay for physical damage for an “auto” under this extension is the lesser of the actual cash value, the cost of repair or $50,000, minus a deductible unless an additional limit is purchased. The deductible will be equal to the largest deductible applicable to any owned “auto” of the private passenger or “light truck” type for that coverage. Subject to the above limit, deductible and excess provisions, we will provide coverage equal to the broadest coverage applicable to any covered “auto” you own of the private passenger or “light truck” type. Coverage is excess over any other valid and collectible insurance.

“Light trucks” are defined as trucks with a gross vehicle weight of 10,000 pounds or less.

The most we will pay is the amount shown in the Declarations.

SECTION III – PHYSICAL DAMAGE COVERAGE –

Paragraph A.2. – Towing is replaced by the

Towing

We will pay up to $500 for towing and labor costs incurred each time a covered “auto” that is a:

a. Private passenger;

b. Truck;

c. Pick-up truck;

d. Panel ; or

e. Van type vehicle under 20,000 lbs. of Gross Vehicle Weight is disabled. However, the labor must be performed at place of disablement.

SECTION III – PHYSICAL DAMAGE COVERAGE,

Paragraph A.3. – Glass Breakage – Hitting a Bird or Animal – Falling Objects or Missiles is replaced by the following:

Glass Breakage – Hitting a Bird or Animal

– Falling Objects or Missiles

If you carry Comprehensive Coverage for the damaged covered “auto”, we will pay the following under Comprehensive Coverage:

a. Glass Breakage;

b. “Loss” caused by hitting a bird or animal;

and

c. “Loss” caused by falling objects or missiles.

However, you have the option of having glass breakage caused by a covered “auto’s” collision or overturn considered a “loss” under Collision Coverage.

SECTION III – PHYSICAL DAMAGE COVERAGE –

Paragraph A.4.a. – Transportation Expenses is replaced by the following:

Transportation Expenses

We will pay up to $200 per day to a maximum of $1,500 for temporary transportation expense incurred by you because of the total theft of a covered “auto” that is a:

(1) Private passenger;

(2) Truck;

(3) Pick-up truck;

(4) Panel; or

(5) Van

ANIC CA 1264 02 21 Page 3 of 5

Vehicle Weight. We will pay only for those covered “autos” for which you carry either Comprehensive or Specified Causes of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy’s expiration, when the covered “auto” is returned to use or we pay for its “loss”.

Personal Effects We will pay up to $400 for "loss" to wearing apparel and other personal effects which are:

(1) Owned by an "insured"; and

(2) In or on your covered "auto".

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

No deductibles apply to this Personal Effects coverage.

Paragraph A.4.b. – Loss of Use Expenses is replaced by the following:

b. Loss of Use Expenses – Hired, Rented, or Borrowed Automobiles

We will pay expenses for which an

“insured” becomes legally responsible to pay for loss of use of a vehicle hired, rented or borrowed without a driver under a written rental contract or agreement.

We will pay for loss of use expenses, if caused by:

(1) Other than Collision, only if the

Declarations indicate that Comprehensive Coverage is provided for the vehicle withdrawn from service.

(2) Specified Causes of Loss only if the

Declarations indicate that Specified Causes of Loss Coverage is provided for the vehicle withdrawn from service.

(3) Collision only if the Declarations indicate that Collision Coverage is provided for the vehicle withdrawn from service.

However, the most we will pay for any expenses for loss of use is $200 per day, to a maximum of $1,500.

If CA 99 90 is attached to this policy, the higher of the limits shown here or in CA 99 90 are applicable.

Paragraph A.4.c. – Non-Transportation Loss of Use Expenses is added as follows:

c. Non-Transportation Loss of Use

Expenses

We will pay up to $2,000 for non-transportation expense incurred by you, because of “loss” to a covered “auto”, if caused by:

(1) Other than Collision, only if the

Declarations indicate that Comprehensive Coverage is provided for the “auto” withdrawn from service;

(2) Specified Causes of Loss only if the Declarations indicate that Specified Causes of Loss Coverage is provided for the “auto” withdrawn from service;

or

(3) Collision only if the Declarations indicate that Collision Coverage is provided for the “auto” withdrawn from service.

Paragraph A.4.d. – Airbag Coverage is added as follows:

d. Airbag Coverage

We will pay for the cost to repair, replace, or reset an airbag that inflates for any reason other than as a result of a collision, if the Declarations indicate that the covered “auto” has Comprehensive Coverage or Specified Causes of Loss Coverage.

ANIC CA 1264 02 21 Page 4 of 5

Paragraph A.4.e. – Rental Reimbursement Coverage is added as follows:

e. Rental Reimbursement Coverage

We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of an “auto” because of “loss” to a covered “auto” that is a:

(1) Private Passenger;

(2) Truck;

(3) Pick-up truck;

(4) Panel; or

(5) Van

Vehicle Weight. Payment applies in addition to the otherwise applicable amount of each coverage you have on a covered “auto”. No deductibles apply to this coverage.

(1) We will pay only for those expenses incurred during the policy period beginning 24 hours after the “loss” and ending, regardless of the policy’s expiration, with the lesser of the following number of days:

(a) The number of days reasonably required to repair or replace the covered “auto”.

(b) 30 days.

(2) This coverage does not apply while there are spare or reserve “autos” available to you for your operations.

(3) The Rental Reimbursement

Coverage described above does not apply to a covered “auto” that is described or designated as a covered “auto” on Rental Reimbursement Coverage Form CA 99 23.

SECTION III - PHYSICAL DAMAGE COVERAGE,

the following is added to Paragraph D. Deductible:

Physical Damage Coverage for a covered "auto" of the private passenger type is changed as follows:

1. No deductible applies to "loss" to:

a. Glass used in the windshield, doors and windows of the covered "auto"; or

b. Glass, plastic or other material used in the lights of the covered "auto".

2. All other Physical Damage Coverage provisions apply.

SECTION IV — BUSINESS AUTO CONDITIONS –

Paragraph A.2.d. is added as follows:

Your duty to give us or our authorized representative prompt notice of the “accident” or “loss” applies only when the “accident” or “loss” is known to:

(a) You (if you are an individual);

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

(c) A member (if you are a limited liability company);

(d) An executive officer, director or insurance manager (if you are a corporation or other organization); or

(e) Any “employee” authorized by you to give notice of the “accident” or “loss”.

This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective on the date issued at 12:01 A.M. standard time at your mailing address shown in the policy. The information below is required only when this endorsement is issued subsequent to commencement of the policy.

Endorsement Effective March 1, 2024 Policy No. 24C AS 13229

Insured Spencer Construction LLC Endorsement No.

Countersigned By Marc Schmittlein NFP-Koty

© Insurance Services Office, Inc., 2009

ANIC CA 1264 02 21 Page 5 of 5

SECTION IV – BUSINESS AUTO CONDITIONS –

Paragraph A. 5. – Transfer of Rights of Recovery Against Others To Us is amended to include:

5. Transfer of Rights of Recovery Against

Others to Us

This condition does not apply to any person(s) or organization(s) to the extent that subrogation against that person or organization is waived prior to the “accident” or the “loss” under a contract with that person or organization

SECTION IV – BUSINESS AUTO CONDITIONS –

Paragraph B.2. – Concealment, Misrepresentation Or Fraud is amended by adding Unintentional Failure to Disclose Hazards at the end of Paragraph B.2. as follows:

Unintentional Failure to Disclose Hazards

If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure.

However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal.

SECTION IV – BUSINESS AUTO CONDITIONS –

Paragraph B.5.b. – Other Insurance is replaced by the following:

b. For Hired Auto Physical Damage

Coverage, the following are deemed to be covered “autos” you own:

(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 that individual “employee’s” name, with your permission, while performing duties related to the conduct of your business.

However, any “auto” that is leased, hired, rented or borrowed with a driver is not a covered “auto”.

SECTION V – DEFINITIONS – Paragraph C. – “Bodily injury” is replaced by the following:

C. “Bodily injury” means bodily injury, sickness or disease sustained by a person including death or mental anguish resulting from any of these.

Mental anguish means any type of mental or emotional illness or disease.

wconkle_5 Highlight

1 of 1WC 99 03 15 | Doc Type: SFCOR 10|17

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-BLANKET

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).

The additional premium for this endorsement shall be of the California workers' compensation premium otherwise due

(minimum $250).

2.00%

Schedule

Person or Organization Job Description

RE All California Operations Any person or organization for whom the named insured is required under written contract to furnish this waiver

This endorsement changes the policy to which it is attached and is effective on the policy effective date unless otherwise stated.

This endorsement, at 12:01 A.M. standard time, forms a part of03/02/2024effective on

1030075Policy Number Pacific Compensation Insurance Company of the

03/02/2024Policy Effective Date 03/02/2025to 11555NCCI Carrier Code

Spencer Construction LLCInsured Name 4Endorsement No.

221,887 Premium $

Phoenix ,Counter Signed at AZ by

Authorized Representative

02/29/2024on

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.)

03/02/2024Endorsement Effective 1030075Policy No. 7Endorsement No.

Spencer Construction LLCInsured 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

AZ BLANKET

BLANKET LOSS PAYABLE ENDORSEMENT

PIM 51 02 08 22 – Blanket Loss Payable Endorsement Page 1 of 1

THIS ENDORSEMENT CHANGES COVERAGE PROVIDED BY THE POLICY.

PLEASE READ THIS CAREFULLY.

This endorsement modifies insurance provided under the following:

INLAND MARINE COVERAGE

COMMMERCIAL OUTPUT PROGRAM

For Covered Property for which there is a Loss Payee with an insurable interest, we will:

1. Adjust losses with “you”; and

2. Pay any claims for a covered loss or damage jointly to you and the Loss Payee, as interest may appear.

The Loss Payee must have either a certificate of insurance or proof of insurance issued by “your” agent and kept on file with “us”.

WITH THE EXCEPTION OF THE CHANGES MADE BY THIS ENDORSEMENT, THE POLICY

REMAINS UNCHANGED.

BLANKET ADDITIONAL INSURED ENDORSEMENT

PIM 51 01 11 22 – Blanket Additional Insured Endorsement Page 1 of 1

THIS ENDORSEMENT CHANGES COVERAGE PROVIDED THE POLICY.

PLEASE READ THIS CAREFULLY.

This endorsement modifies insurance provided under the following:

INLAND MARINE COVERAGE

COMMMERCIAL OUTPUT PROGRAM

It is agreed the word “you” is amended to include as an insured any person or organization where “you” are required to add as an additional insured on this policy under a written contract or agreement.

The written contract or agreement must be currently in effect or become effective during the term of this policy and executed prior to loss.

This endorsement does not increase the limits of insurance shown in the Declarations.

WITH THE EXCEPTION OF THE CHANGES MADE BY THIS ENDORSEMENT, THE POLICY

REMAINS UNCHANGED.