COI-_Exp_2024-8-4._CGAUUWPro.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

6/3/2024

Breinholt Anderson Insurance Consultants LLC 4140 E. Baseline Road, Suite 201 Mesa AZ 85206

Heather Glancy 480-935-7000 480-935-7009 certificates@baicins.com

Ameritrust Insurance Corporation 10665 VIKISPE-01 Secura Insurance 22543

Viking Specialty Services LLC 1008A E. Vista Del Cerro Dr Tempe AZ 85281

Guideone National Insurance Company 14167 Star Insurance Company 18023

711531074

A X 1,000,000 X 100,000

5,000

1,000,000

2,000,000 X X

Y Y AIC4009973 1/4/2024 1/4/2025

2,000,000

B 1,000,000

X Y Y A3327931 8/10/2023 8/10/2024

C X 5,000,000 X

UXS565000004-01 1/4/2024 1/4/2025

5,000,000 X 0

D X

N

Y WC 0871130 1/4/2024 1/4/2025

1,000,000

1,000,000

1,000,000 B A

Leased and Rented Equipment Contractors Pollution Liability Consultants Professional Liab

CP3327930

AIC4009973

8/10/2023 1/4/2024

8/10/2024 1/4/2025

Limit/Deductible Limit/Deductible Limit/Deductible

$200,000/$500 $1,000,000/$2,500 $1,000,000/$2,500

The General Liability and Business Auto policies include an automatic Additional Insured endorsement that provides Additional Insured status to the Certificate Holder and any additional entities listed, if any, only when there is a written contract that requires such status, and only with regard to work performed on behalf of the named insured. The General Liability and Business Auto policies contain the endorsement with Primary and Noncontributory wording, when required by written contract. The General Liability, Business Auto and Workers Compensation policies provide a Waiver of Subrogation when required by written contract.

The Excess Liability policy follows form to the General Liability, Professional Liability, Pollution Liability, Business Auto and Employers Liability policies.

RE: RE: Solicitation No. BPM004287 Asbestos and Lead Consultant and Abatement Services.

Additional Insureds include: State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees Contract #: CTR067100

Arizona Department of Environmental Quality 1110 W Washington St Phoenix AZ 85007

CAE 0131 Includes copyrighted material of Insurance Services Offices, Inc., with its permission. Page 1 of 2 1508 © 2015, SECURA INSURANCE, A Mutual Company

THIS ENDORSEMENT CHANGES YOUR POLICY. PLEASE READ IT CAREFULLY.

AUTO ADDITIONAL INSURED WRAP

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

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

A. AUTOMATIC ADDITIONAL INSURED – PRIMARY AND NONCONTRIBUTORY

SECTION II – COVERED AUTOS LIABILITY COVERAGE, subsection A. Coverage, paragraph 1. Who Is An Insured is amended to add:

d. (1) Automatic Additional Insured – Primary And Noncontributory

Any person or organization is an additional insured when you and such person or organization have agreed in writing prior to a loss that such person or organization be added as additional insured on your policy. Such person or organization is an additional insured only with respect to liability for “bodily injury” or “property damage” resulting from the ownership, maintenance or use of a covered “auto”, provided the “bodily injury” or “property damage” is caused, in whole or in part, by you or by those acting on your behalf. This insurance is primary and is not contributing with any other insurance carried by the additional insured.

(2) Blanket Lessor Additional Insured Provisions

If the additional Insured is a lessor of a “leased auto”;

(a) Coverage

i. Any “leased auto” that is a covered “auto” will be considered a covered “auto” you own and not a covered “auto” you hire or borrow.

For a covered “auto” that is a “leased auto” Who Is An Insured is changed to include as an “Insured” the lessor.

ii. The coverages provided under this endorsement apply to any “leased auto” until the policy expiration date, or when the lessor or his or her agent takes possession of the “leased auto”, whichever occurs first.

(b) Loss Payable Clause

i. We will pay, as interest may appear, you and the lessor for “loss” to a “leased auto”.

ii. The insurance covers the interest of the lessor unless the “loss” results from fraudulent acts or omissions on your part.

iii. If we make any payment to the lessor, we will obtain his or her rights against any other party.

(c) The lessor is not liable for payment of your premiums.

(d) Additional Definition

As used in this endorsement:

“Leased auto” means an “auto” leased or rented to you including any substitute, replacement or extra “auto” needed to meet seasonal or other needs, under a leasing or rental agreement that required you to provide direct primary insurance for the lessor.

Policy #A3327931

CAE 0131 Includes copyrighted material of Insurance Services Offices, Inc., with its permission. Page 2 of 2 1508 © 2015, SECURA INSURANCE, A Mutual Company

B. WAIVER -- TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US

SECTION IV – BUSINESS AUTO CONDITIONS, subsection A. Loss Conditions, paragraph 5. Transfer Of Rights Of Recovery Against Others To Us is amended to add:

We waive any right of recovery we may have against any person or organization when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be waived from recovery because of payments we make for injury or damage arising out of an "accident" and resulting from the ownership, maintenance or use of a covered "auto". However, our rights may only be waived prior to the “accident” for which we make payment under this Coverage Part. The insured must do nothing after a loss to impair our rights.

Policy #AIC4009973

Policy # AIC4009973

EAI 1816b 0622

EAI 1816b 0622 Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., used with its permission.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS –

SCHEDULED PERSON OR ORGANIZATION,

PRIMARY AND NON-CONTRIBUTORY

This endorsement modifies insurance provided under the following:

ENVIRONMENTAL SERVICES LIABILITY COVERAGE FORM

SCHEDULE

Name of Additional Insured Person(s) or Organization Location(s) of Covered Operations

Any person or organization whom you are required to add as an additional insured pursuant to a written contract or agreement.

Various locations where you are performing work for the additional insured whom you are required to add as an additional insured pursuant to a written contract or agreement.

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

1. Your acts or omissions; or

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

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

However:

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

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

B. This endorsement shall not apply to and shall afford no coverage to additional insureds shown in the Schedule above under the following coverages:

1. Coverage E – Consultants’ Professional Liability; or

2. Coverage F – Scheduled Property Pollution Liability; or

3. Coverage G – Non-Owned Disposal Site Pollution Liability.

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

This insurance does not apply to “bodily injury”, “property damage”, “personal and advertising injury” or “environmental damage” occurring after:

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

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

EAI 1816b 0622

EAI 1816b 0622 Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., used with its permission.

D. The insurance provided for the benefit of the above scheduled additional insured(s) shall be primary and non-contributory, but only with respect to liability for “bodily injury”, “property damage”, “personal and advertising injury” or “environmental damage” caused in whole or in part, by:

1. Your acts or omissions; or

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

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

E. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits of Insurance and Deductible:

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

1. Required by the contract or agreement; or

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

whichever is less.

This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.

All other terms and conditions of this policy remain unchanged.

'(�����) *��+��'�,(-�.���'(��% /�,0"��%/�-���*�-)��'�,-*�12//0"�

3-���*� 1�'*-��1�*� 1�*�.('�� 1�*�, ��*0�-.-���'� '(�*���

456789:;<=79>9:?8><;6@69786:7A=B:C98D=<E6;9;8A:;9=8?598@<FF<G6:HI8

JKLMNOKPJK4QR8SJNLMTJS8RMQUMRM4V8TOLJNQWJ8XONP8

JKLMNOKPJK4QR8SJNLMTJS8UYSMKJSSOZKJNS8TOLJNQWJ8XONP[8\QN48MM8]8RMQUMRM4V8

�,(�)2/��

_̂̀abcdef_afdafdgh_ijhkif_ahghi_ekalmfnàfoahdcadcpoidcqrabodeoh_kakfahaldikkc_asf_kdhskafdahgdccnc_krakfalhitcah_̀a digmkafuadcsftcd̀ra vwxyz{|}w~��w�x�{������z|{y�|}y�{�

M:8C<:76;9=B?6<:8<@8?598D=9>6A>8DB6;[86?867859=9��8BH=99;8?5B?8?598C<:;6?6<:[84=B:7@9=8O@8N6H5?78O@8N9C<E9=�8QHB6:7?

O?59=784<8Y7[86:8S9C?6<:8����8T<:;6?6<:7[8678B>9:;9;8��8?598B;;6?6<:8<@8?598@<FF<G6:HI8

Z988GB6E988B:�88=6H5?88<@88=9C<E9=�88G988>B�885BE988BHB6:7?88?5988D9=7<:88<=88<=HB:6�B?6<:8875<G:886:88?5988SC59;AF988B�<E98 �9CBA798<@8DB�>9:?78G98>B�98@<=8B:86:�A=�8<=8;B>BH9[8B=676:H8<A?8<@8�<A=8<:H<6:H8<D9=B?6<:78<=8��<A=8G<=��8;<:9 A:;9=8B8C<:?=BC?8G6?58?5B?8D9=7<:8<=8<=HB:6�B?6<:8B:;86:CFA;9;86:8?598�D=<;AC?7]C<>DF9?9;8<D9=B?6<:785B�B=;��884567

GB6E9=8BDDF6978<:F�8?<8?598D9=7<:8<=8<=HB:6�B?6<:875<G:86:8?598SC59;AF98B�<E9�8

QFF8<?59=8?9=>78B:;8C<:;6?6<:78<@8?5678D<F6C�8=9>B6:8A:C5B:H9;�8

"#$%&'()*+,-.'*(&/%0*1&'2&+%34'+%5&*(06&1$%(&.$'2&%(5*+2%,%(.&'2&'224%5&24/2%34%(.&.*&7+%7-+-.'*(&*)&.$%&7*0'869:

AB&CC&CD&ED

F;�������G ?���

AJKLMKN&BJOPMQNR#SJQ&RQT&MOPUJVMKN&USRWSUS#V&SQNXKRQBM&PJUSBV AB&CC&CD&ED

F;�������G

ARSYMK&JZ&JXK&KS[\#&#J&KMBJYMK&ZKJO&J#\MKN&MQTJKNMOMQ#&

a����� �b��

������G�

cdefghijekjlhmnolhpjcqjrloiihfjstfilesi eu

WC 0871130Viking Specialty Services LLC

1/4/2024