COI_Arizona_Auto_Glass_9-17-25.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

11/5/2024

(623) 215-1300 (623) 215-1333

15350

Arizona Auto Glass Direct, LLC 3414 S Mill Ave Tempe, AZ 85282

A 1,000,000

X X B445251 9/17/2024 9/17/2025 500,000 5,000

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

1,000,000A

X X B445251 9/17/2024 9/17/2025

A X B445265 9/17/2024 9/17/2025 1,000,000

1,000,000 1,000,000

A Garagekeepers B445251 9/17/2024 Actual Loss Sustaine A Comp/Coll Ded's B445251 9/17/2024 9/17/2025 Each Deductible 1,000

General Liability Additional Insured ongoing and completed operations, Waiver of Subrogation and Primary & Noncontributory per written contract, per attached. Auto Additional Insured, Waiver of Subrogation and Primary & Noncontributory per written contract, per attached. Worker’s Compensation Waiver of Subrogation per written contract, per attached.

Arizona Department of Public Safety 2102 West Encanto Blvd.

P.O. Box 6638 Phoenix, AZ 85005-6638

ARIZAUT-05 MWONG

The Mahoney Group - Phoenix 20333 North 19th Avenue, Suite 200 Phoenix, AZ 85027

West Bend Insurance Company

X

9/17/2025

X X

X

X

X X

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

West Bend Mutual Insurance Company West Bend, Wisconsin 53095

Contains material copyrighted by ISO, with its permission.

WB 1890 01 13 © ISO Properties, Inc., 2004 Page 1 of 2

ADDITIONAL INSURED – AUTOMATIC STATUS WHEN

REQUIRED BY WRITTEN CONTRACT WITH YOU

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

A. Section II - Who is An Insured is amended to include as an additional insured any person or organization you are required by a written contract to name as an additional insured.

The written contract must be:

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

2. Signed by all parties to the written contract or written agreement prior to the “bodily injury,” “property damage,” “personal injury and adver-tising injury."

B. The insurance provided to the additional insured is limited as follows:

1. That person or organization is only an addi-tional insured with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused in whole or in part, by:

a. your ongoing operations performed for the insured at the location designated in the written contract; or

b. premises owned or used by you.

However:

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

b. If coverage provided to the additional in-sured is required by a written contract or written 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.

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

This insurance does not apply to:

1. “Bodily injury”, “property damage” or “personal and advertising injury” arising out of the render-ing of, or the failure to render, any professional architectural, engineering or surveying ser-vices, including:

a. The preparing, approving, or failing to pre-pare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifica-tions; and

b. Supervisory, inspection, architectural or engineering activities.

2. “Bodily injury” or “property damage” occurring after:

a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than ser-vice, maintenance or repairs) to be per-formed by or on behalf of the additional in-sured(s) at the location of the covered operations has been completed: or

b. 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 subcon-tractor engaged in performing operations for a principle as a part of the same project.

D. As respects the coverage provided under this endorsement, Paragraph 4.b. Section IV –

COMMERCIAL GENERAL LIABILITY

CONDITIONS is amended with the addition of the following:

4. Other Insurance

b. Excess Insurance

This insurance is excess over:

Any other valid and collectible insurance available, procured by or on behalf of the additional insured whether primary, excess, contingent or on any other basis unless a written contract specifically requires that this insurance be either primary or primary and noncontributing. Where required by written contract, we will consider any other insurance maintained by the additional in-sured for injury or damage covered by this endorsement to be excess and noncontrib-uting with this insurance.

COMMERCIAL GENERAL LIABILITY

CG 24 53 12 19

CG 24 53 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US (WAIVER OF SUBROGATION) –

AUTOMATIC

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

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 any person or organization, because of any payment we make under this Coverage Part, to whom the insured has waived its right of recovery in a written contract or agreement. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person or organization prior to loss.

WB 1135 11 22 West Bend Mutual Insurance Company

PLUS PAK – COMMERCIAL AUTO

BUSINESS AUTO COVERAGE FORM

MOTOR CARRIER COVERAGE FORM

With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi-fied by the endorsement.

A. Changes In Covered Autos Liability Coverage

1. Paragraph A.1. Who Is An Insured is amend-ed by the addition of the following:

Newly Acquired Organizations Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no other similar in-surance available to that organization. Howev-er:

a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the poli-cy period, whichever is earlier;

b. This coverage does not apply to “bodily injury” or “property damage” that occurred before you acquired or formed the organi-zation;

c. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited lia-bility company that is not shown as a named Insured in the Declarations.

Employees As Insureds 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 af-fairs.

Employee Hired Autos An "employee" of yours is an "insured" 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.

If Employee Hired Autos CA 20 54 is attached to this policy, the Employee Hired Autos cover-age described above does not apply.

Additional Insured By Written Contract Any person or organization for whom you have agreed to add under a written contract or agreement. Such person or organization is an additional "insured" only with respect to your ownership, maintenance or use of a covered "auto".

This coverage is primary to and will not seek contribution from any other insurance available to an "insured" provided that:

a. Such "insured" is a Named Insured under such other insurance; and

b. You have agreed in a written contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured".

2. Increased Supplementary Payments Paragraph A.2.a.(4) is replaced by:

(4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $300 a day because of time off from work.

3. Fellow Employee Paragraph B.5. Fellow Employee does not apply to claims for "bodily injury" resulting from the use of a covered "auto" where the fellow "employee" is not immune from "suit" or civil li-ability for "bodily injury" by reason of Workers Compensation laws or other similar laws.

Coverage is excess over any other collectible insurance.

This amendment is not applicable in Virginia.

See applicable Virginia Changes endorsement.

Page 2 of 4 West Bend Mutual Insurance Company

WB 1135 11 22

B. Changes In Physical Damage Coverage

1. Paragraph A. Coverage is amended by the addition of:

Loan/Lease Gap Coverage In the event of a total “loss” to a covered “au-to”, of the private passenger or "light or medi-um truck" type, to which a loss payee applies under the Commercial Auto Coverage Part, we will pay any unpaid amount due on the lease or loan for a covered “auto” less:

The amount paid under the policy’s Physical Damage Coverage and any:

a. Overdue or any deferred lease/loan pay-ments at the time of the “loss”;

b. Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage;

c. Security deposits not returned by the les-sor;

d. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability In-surance purchased with the loan or lease;

and

e. Carry-over balances from previous loans or leases.

This coverage applies only to “autos”, of the private passenger or "light or medium truck" type, that:

a. Are provided comprehensive and collision coverages by the attached policy and

b. Have not been previously titled under the motor vehicle laws of any state.

The insurance provided is excess over any other collectible insurance including but not limited to any coverage provided by or pur-chased from the lessor or any financial institu-tion.

If Auto Loan/Lease Gap Coverage CA 20 71 is attached to this policy, the Loan/Lease Gap Coverage described above does not apply.

2. Paragraph A.2. Towing and Labor is replaced by:

2. Towing and Labor We will pay up to a maximum of $150 for towing and labor costs incurred each time a covered ”auto”, of the private passenger or "light or medium truck" type, is disabled.

However, the labor must be performed at the place of disablement.

If a limit is shown in the Declarations for towing and labor costs, the Towing and La-bor coverage described above does not apply.

3. Paragraph A.4.a. Transportation Expenses is replaced by:

a. Transportation Expenses We will pay up to $50 per day, to a maxi-mum of $1,500, for temporary transporta-tion expense incurred by you because of the total theft of a covered “auto” of the pri-vate passenger or "light or medium truck" type. We will pay only for those covered ”autos” for which you carry either Compre-hensive or Specified Causes Of Loss Cov-erage. We will pay for temporary transpor-tation expenses incurred during the period beginning 48 hours after the theft and end-ing, regardless of the policy’s expiration, when the covered “auto” is returned to use or we pay for its “loss”.

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

b. Loss of Use Expenses For Hired Auto Physical Damage, we will pay expenses for which an "insured" be-comes legally responsible to pay for loss of use of a vehicle rented or hired without a driver under a written rental contract or agreement. We will pay for loss of use ex-penses caused by:

(1) Other than collision only if the Declara-tions indicates that Comprehensive Coverage is provided for any covered "auto";

(2) Specified Causes Of Loss only if the Declarations indicates that Specified Causes Of Loss Coverage is provided for any covered "auto"; or

(3) Collision only if the Declarations indi-cates that Collision Coverage is provid-ed for any covered "auto".

However, the most we will pay for any ex-penses for loss of use is $50 per day, to a maximum of $1,500.

If Optional Limits – Loss of Use Expenses Endorsement CA 99 90 is attached to this policy, the Loss of Use Expenses described above does not apply.

5. Paragraph A.4. Coverage Extensions is amended by the addition of:

Electronic Logging Devices We will also pay, with respect to a covered "loss”, up to $5,000 in any one occurrence for the actual loss sustained to all electronic on-board recorder permanently installed in the “auto” but only with respect to a covered “auto”.

WB 1135 11 22 West Bend Mutual Insurance Company

A deductible of $250 applies to any one occur-rence.

In the event that there is more than one appli-cable deductible, only the highest deductible will apply.

Personal Property If we pay for a “loss” to a covered “auto” caused by:

a. Fire,

b. Lightning,

c. Theft or attempted theft if there are visible signs of someone breaking into the covered “auto” or the entire “auto” is stolen or

d. Collision, we will extend coverage to pay for “loss” to personal property contained in or on the “auto” at the time of the “loss” to the “auto”.

Under this extension:

(1) The personal property must be owned by you, your family member or your em-ployee.

(2) We will pay up to $500 in any one “loss”.

(3) This Personal Property coverage is excess over any other insurance availa-ble for the same ”loss”.

(4) Personal Property does not include tools, jewelry, money or securities.

Rental Reimbursement We will pay for rental reimbursement expenses incurred by you for the rental of an “auto” be-cause of a covered “loss” to a covered “auto” of the private passenger or truck type. Payment applies in addition to the otherwise applicable amount of each coverage you have on a cov-ered “auto”. No deductibles apply to this cover-age.

We will pay only for those expenses incurred during the policy period beginning 24 hours af-ter the “loss” and ending, regardless of the pol-icy’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”. If “loss” is caused by theft, this number of days is added to the number of days it takes to locate the covered “auto” and re-turn it to you.

b. 30 days.

Our payment is limited to the lesser of the fol-lowing amounts:

a. Necessary and actual expenses incurred.

b. $100 per day.

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

If “loss” results from the total theft of a covered “auto” of the private passenger or truck type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided for under – Phys-ical Damage Coverage Extension.

If Rental Reimbursement Coverage CA 99 23, is attached to this policy, the Rental Reim-bursement described above does not apply.

Hired Auto Physical Damage If hired “autos” are covered “autos” for Liability Coverage and Comprehensive, Specified Causes Of Loss or Collision Coverages are provided for any “auto” you own, then the Physical Damage Coverages provided are ex-tended to “autos” you hire of the private pas-senger or "light or medium truck" type.

The most we will pay for “loss” to any hired “auto” is the lesser of:

a. $75,000

b. The actual cash value of the damaged hired

“auto” or

c. The cost of repairing or replacing the dam-aged or stolen hired “auto”.

Our obligation to pay for repair, return or re-placement of a stolen hired “auto”, will be re-duced by a deductible. The deductible will be equal to the largest deductible applicable to any owned “auto” of the private passenger or "light or medium truck" type for the applicable coverage.

Hired Auto Physical Damage Coverage is ex-cess over any other collectible insurance. Sub-ject to the above limit, deductible and excess provisions, we will provide coverage equal to the broadest coverage applicable to any cov-ered “auto” you own of the private passenger or "light or medium truck" type.

If symbol 08 or 68 is listed in the Covered Au-tos section of the Declarations as applying to any Physical Damage Coverages, the Hired Auto Physical Damage described above does not apply.

6. Paragraphs B.3.a. in the Business Auto Cov-erage Form and B.4.a. in the Motor Carrier Coverage Form are amended by the addition of the following:

Accidental Airbag Inflation This exclusion does not apply to the accidental inflation of an airbag.

Page 4 of 4 West Bend Mutual Insurance Company

WB 1135 11 22

7. Paragraph C. Limits of Insurance is amended by the addition of the following:

Waiver of Depreciation – Private Passenger Vehicle If we deem a covered “auto”, of the private passenger type, to be a total loss, within 180 days of your purchase of the “auto”, and it has not been previously titled under the motor ve-hicle laws of any state, at our option, we may:

a. Replace the covered “auto” with a new "auto" of like make, model and year or

b. Pay you an amount equal to the cost of the covered “auto” new, including taxes.

This coverage does not apply to a leased "au-to".

No one will be entitled to receive duplicate payments for the same elements of “loss” un-der this endorsement and this Coverage Form’s Physical Damage Coverage If Replacement Cost Coverage - Private Pas-senger Types CA 04 41 is attached to this poli-cy, the waiver described above does not apply.

8. Paragraph D. Deductible is amended by the addition of the following:

Attached Autos If you have a loss to more than one covered “auto” when such covered “autos” are attached to one another at the time of “loss”, then our obligation to pay will be reduced by the single highest applicable deductible.

Auto and Other Property Loss If you have a covered “loss” to Covered Prop-erty under a Commercial Property or Inland Marine Coverage Part under this policy and a covered “loss” to a covered “auto” or more than one covered “autos” that are attached to one another at the time of “loss”, then our obligation to pay will be reduced by the single highest applicable deductible.

Glass Repair – Waiver Of Deductible If the Declarations indicates that Comprehen-sive Coverage applies, no Comprehensive Coverage deductible applies to the cost of re-pairing damaged glass on the covered "au-to(s)".

C. Changes in Business Auto Conditions and Motor Carrier Conditions

1. Paragraph A.2.a. Duties In The Event Of Accident, Claim, Suit Or Loss is amended by the addition of the following:

This duty applies only when the “accident” or “loss” is known to:

(1) You, if you are an individual,

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

(3) A member or manager, if you are a limited liability company or

(4) An executive officer or insurance man-ager, if you are a corporation.

2. Paragraph A.5. Transfer of Rights of Recov-ery Against Others To Us is amended by the addition of the following:

This condition does not apply to any person(s) or organization(s) for whom you are required to waive subrogation with respect to the coverage provided under this Coverage Form, but only to the extent that subrogation is waived:

a. Under a written contact or agreement with such person(s) or organization(s); and

b. Prior to the "accident" or the "loss."

3. Paragraphs B.5.b. in the Business Auto Cov-erage Form and B.5.f. in the Motor Carrier Coverage Form are deleted.

If symbol 08 or 68 is listed in the Covered Au-tos section of the Declarations as applying to any Physical Damage Coverages, this item does not apply.

4. Paragraph B.5 is amended by the addition of the following:

Employee Hired Autos For Hired Auto Physical Damage Coverage, any covered "auto" hired or rented by your "employee" under a contract in an "employ-ee's" name, with your permission, while per-forming duties related to the conduct of your business is deemed to be a covered "auto" you own.

If Employee Hired Autos Endorsement CA 20 54 is attached to this policy, the Employee Hired Autos coverage described above does not apply.

D. Changes in Definitions

1. Paragraph C. is replaced by the following:

C. “Bodily injury” means bodily injury, sick-ness or disease sustained by a person in-cluding mental anguish or death resulting from any of these.

2. The following definition is added:

"Light or medium truck" means a truck of 20,000 lbs. or less gross vehicle weight.

1983 National Council on Compensation Insurance.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13

(Ed. 4-84)

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

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.)

Endorsement Effective Policy No. Endorsement No.

Insured Premium

Insurance Company Countersigned by ___________________________________________

WC 00 03 13

(Ed. 4-84)

Any party with whom the insured agrees to waive subrogation in a written contract

Included Arizona Auto Glass Direct, LLC

B445265 09-17-2024

West Bend Insurance Company