INSR ADDL SUBR

LTR INSR WVD

DATE (MM/DD/YYYY)

PRODUCER CONTACT

NAME:

FAXPHONE

(A/C, No):(A/C, No, Ext):

E-MAIL

ADDRESS:

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

POLICY NUMBER

POLICY EFF POLICY EXP

TYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)

COMMERCIAL GENERAL LIABILITY

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

INSURER(S) AFFORDING COVERAGE NAIC #

Y / N

N / A (Mandatory in NH)

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

EACH OCCURRENCE $

DAMAGE TO RENTED

$PREMISES (Ea occurrence)CLAIMS-MADE OCCUR

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER:

PRODUCTS - COMP/OP AGG $

PRO-

OTHER:

LOCJECT

COMBINED SINGLE LIMIT

$(Ea accident)

BODILY INJURY (Per person) $ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS

AUTOS ONLY

HIRED PROPERTY DAMAGE $

AUTOS ONLY (Per accident)

OCCUR EACH OCCURRENCE $

CLAIMS-MADE AGGREGATE $

DED RETENTION $ $

PER OTH-

STATUTE ER

E.L. EACH ACCIDENT $

E.L. DISEASE - EA EMPLOYEE $

If yes, describe under

E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below

POLICY

NON-OWNED

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 any rights to the certificate holder in lieu of such endorsement(s).

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

CERTIFICATE HOLDER CANCELLATION

© 1988-2015 ACORD CORPORATION. All rights reserved.

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

ACORDTM CERTIFICATE OF LIABILITY INSURANCE

Illinois Union Ins.Co.-NON-ADMITTED

CopperPoint General Insurance Company

Philadelphia Indemnity Insurance Co.

12/04/2023

MJ Insurance, Inc.

3900 E. Camelback Road, Suite 225 Phoenix, AZ 85018 602 772-3300 certificate@mjinsurance.com 317 805-7500 3178057515 certificate@mjinsurance.com

Solterra Holdings, LLC 14650 N. 78th Way Bldg B Scottsdale, AZ 85260

27960 13043 18058

A X X

DED: $100K

X

X X HPLG71836745004 11/01/2023 11/01/2024 1,000,000

50,000 5,000 1,000,000 3,000,000 1,000,000

C X

X X

X X PHPK2620646 11/01/2023 11/01/2024 1,000,000

A X X XHLG71836757004 11/01/2023 11/01/2024 5,000,000

5,000,000

B

N

X 1022049 08/03/2023 08/03/2024 X 1,000,000

1,000,000 1,000,000

A A

Professional Liab Abuse & Molestati

HPLG71836745004

HPLG71836745004

11/01/2023 11/01/2023

11/01/2024 11/01/2024

$1M Per Claim/$3Mil Agg $1,000,000 Aggregate

Additional Named Insureds include:

AHP Housing Fund 113, LLC AHP Housing Fund 129, LLC AHP Housing Fund 162, LLC Avondale Van Buren ALF, LLC (See Attached Descriptions)

The State of Arizona and Dept of Economic Security C/O: myCOI 1075 Broad Ripple Ave, Suite 313 Indianapolis, IN 46220

#S1559485/M1552542

SOLTSENClient#: 13723

ERIGA

#S1559485/M1552542

SAGITTA 25.3 (2016/03)

DESCRIPTIONS (Continued from Page 1) Bridgewater Assisted Living Midtown Bridgewater Avondale Operations, LLC Bridgewater Avondale, LLC Bridgewater La Cholla, LLC Bridgewater La Cholla Holdings, LLC Bridgewater La Cholla Operations, LLC Deer Valley Assisted Living Facility, LLC Hesperus Consulting, LLC Indian School Assisted Living Facility, LLC J-Bar Investment, LLC J-Bar Investments, LLC Two Solterra 3rd Indian School Development, LLC Solterra 3rd Indian School Operations, LLC Solterra 3rd Indian, LLC Solterra At White Mountains Two Ops Solterra At White Mountains Two, LLC Solterra Deer Valley Development, LLC Solterra Deer Valley Operations, LLC Solterra Deer Valley, LLC Solterra Holdings, LLC Solterra La Cholla Operations, LLC Solterra La Cholla Re, LLC Solterra Management Group, LLC Solterra of Arizona, LLC Solterra Of Arizona, LLC Dba: Solterra Senior Living Solterra Team Services, LLC Solterra White Mountains, LLC Third Indian, LLC 3rd and Indian School Assisted Living Facility, LLC Affordable Housing Partners, Inc.

Locations: 295 E VAN BUREN ST, AVONDALE, AZ; 2641 W UNION HILLS DR, PHOENIX, AZ; 4000 N 3RD ST, PHOENIX, AZ; 5408 HIGHWAY 250, LAKESIDE, AZ.

Division Name: ADES.

- Contract ID: CTR057909

30 Days Notice of Cancellation, 10 Days Notice for Non-Payment, applies subject to the terms, conditions and exclusions on the policy(s).

Umbrella sits over Auto, Professional Liability, General Liability, Employee Benefits Liability.

The Certificate Holder and others as defined in the written agreement and the General Liability additional insured endorsement are included as additional insured subject to the terms, conditions and exclusions on the policy(ies).

Attn: ETP State Administrator

Additional Insured Names: State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees Waiver of Subrogation applies to: State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees

#S1559485/M1552542

INSR ADDL SUBR

LTR INSR WVD

DATE (MM/DD/YYYY)

PRODUCER CONTACT

NAME:

FAXPHONE

(A/C, No):(A/C, No, Ext):

E-MAIL

ADDRESS:

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

POLICY NUMBER

POLICY EFF POLICY EXP

TYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)

COMMERCIAL GENERAL LIABILITY

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

INSURER(S) AFFORDING COVERAGE NAIC #

Y / N

N / A (Mandatory in NH)

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

EACH OCCURRENCE $

DAMAGE TO RENTED

$PREMISES (Ea occurrence)CLAIMS-MADE OCCUR

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER:

PRODUCTS - COMP/OP AGG $

PRO-

OTHER:

LOCJECT

COMBINED SINGLE LIMIT

$(Ea accident)

BODILY INJURY (Per person) $ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS

AUTOS ONLY

HIRED PROPERTY DAMAGE $

AUTOS ONLY (Per accident)

OCCUR EACH OCCURRENCE $

CLAIMS-MADE AGGREGATE $

DED RETENTION $ $

PER OTH-

STATUTE ER

E.L. EACH ACCIDENT $

E.L. DISEASE - EA EMPLOYEE $

If yes, describe under

E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below

POLICY

NON-OWNED

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 any rights to the certificate holder in lieu of such endorsement(s).

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

CERTIFICATE HOLDER CANCELLATION

© 1988-2015 ACORD CORPORATION. All rights reserved.

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

ACORDTM CERTIFICATE OF LIABILITY INSURANCE

Illinois Union Ins.Co.-NON-ADMITTED

CopperPoint General Insurance Company

Philadelphia Indemnity Insurance Co.

11/29/2023

MJ Insurance, Inc.

3900 E. Camelback Road, Suite 225 Phoenix, AZ 85018 602 772-3300 certificate@mjinsurance.com 317 805-7500 3178057515 certificate@mjinsurance.com

Solterra Holdings, LLC 14650 N. 78th Way Bldg B Scottsdale, AZ 85260

27960 13043 18058

A X X

DED: $100K

X

X X HPLG71836745004 11/01/2023 11/01/2024 1,000,000

50,000 5,000 1,000,000 3,000,000 1,000,000

C X

X X

X X PHPK2620646 11/01/2023 11/01/2024 1,000,000

A X X XHLG71836757004 11/01/2023 11/01/2024 5,000,000

5,000,000

B

N

X 1022049 08/03/2023 08/03/2024 X 1,000,000

1,000,000 1,000,000

A A

Professional Liab Abuse & Molestati

HPLG71836745004

HPLG71836745004

11/01/2023 11/01/2023

11/01/2024 11/01/2024

$1M Per Claim/$3Mil Agg $1,000,000 Aggregate

Additional Named Insureds include:

AHP Housing Fund 113, LLC AHP Housing Fund 129, LLC AHP Housing Fund 162, LLC Avondale Van Buren ALF, LLC (See Attached Descriptions)

The State of Arizona and Dept of Economic Security C/O: myCOI 1075 Broad Ripple Ave, Suite 313 Indianapolis, IN 46220

#S1559032/M1552542

SOLTSENClient#: 13723

ERIGA

#S1559032/M1552542

SAGITTA 25.3 (2016/03)

DESCRIPTIONS (Continued from Page 1) Bridgewater Assisted Living Midtown Bridgewater Avondale Operations, LLC Bridgewater Avondale, LLC Bridgewater La Cholla, LLC Bridgewater La Cholla Holdings, LLC Bridgewater La Cholla Operations, LLC Deer Valley Assisted Living Facility, LLC Hesperus Consulting, LLC Indian School Assisted Living Facility, LLC J-Bar Investment, LLC J-Bar Investments, LLC Two Solterra 3rd Indian School Development, LLC Solterra 3rd Indian School Operations, LLC Solterra 3rd Indian, LLC Solterra At White Mountains Two Ops Solterra At White Mountains Two, LLC Solterra Deer Valley Development, LLC Solterra Deer Valley Operations, LLC Solterra Deer Valley, LLC Solterra Holdings, LLC Solterra La Cholla Operations, LLC Solterra La Cholla Re, LLC Solterra Management Group, LLC Solterra of Arizona, LLC Solterra Of Arizona, LLC Dba: Solterra Senior Living Solterra Team Services, LLC Solterra White Mountains, LLC Third Indian, LLC 3rd and Indian School Assisted Living Facility, LLC Affordable Housing Partners, Inc.

Locations: 295 E VAN BUREN ST, AVONDALE, AZ; 2641 W UNION HILLS DR, PHOENIX, AZ; 4000 N 3RD ST, PHOENIX, AZ; 5408 HIGHWAY 250, LAKESIDE, AZ.

Division Name: ADES.

- Contract ID: CTR057909

30 Days Notice of Cancellation, 10 Days Notice for Non-Payment, applies subject to the terms, conditions and exclusions on the policy(s).

Umbrella sits over Auto, Professional Liability, General Liability, Employee Benefits Liability.

The Certificate Holder and others as defined in the written agreement and the General Liability additional insured endorsement are included as additional insured subject to the terms, conditions and exclusions on the policy(ies).

Attn: ETP State Administrator

#S1559032/M1552542

Note:

This endorsement may be used to extend the information page by listing additional endorsements and schedules that are part of the policy.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 60

(Ed. 05/22)

WC 99 06 60

(Ed. 05/22)

© 1991 National Council on Compensation Insurance.

EXTENSION OF INFORMATION PAGE

Schedule of Forms

ITEM 3D

1022049POLICY NO:

Form Numbers Form Name Applicable States WC 99 06 18 Notification of Dividend AZ

WC 99 04 19 Premium When Due Endorsement AZ

WC 00 00 00 C Workers Compensation and Employers Liability Insurance Policy

AZ

P-504.1 Out of State Coverage Advisory AZ

P-531 Installment Plan Schedule AZ

WC 99 06 17 Dividend Endorsement AZ

WC 00 00 01 D Information Page Notes AZ

P-799 Policy Renewal Statement Letter AZ

P-503 Independent Contractor Premium Advisory AZ

WC 00 04 21 F Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement

AZ

WC 00 04 22 C Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement

AZ

WC 00 99 03 22 Limited Other States Insurance Endorsement AZ

WC 00 99 06 23 Membership Endorsement AZ

WC 00 99 06 25 Schedule of Fees AZ

WC 02 06 03 Arizona Amendatory Endorsement AZ

WC 02 04 01 C Arizona Alcohol & Drug Free Workplace Premium Credit Endorsement

AZ

WC 99 06 60 Extension of Information Page Item 3D Endorsement

AZ

WC 00 03 08 Partners, Officers And Others Exclusion Endorsement

AZ

WC 00 04 04 Pending Rate Change Endorsement AZ

WC 00 04 14 A 90-Day Reporting Requirement—Notification of Change in Ownership Endorsement

AZ

WC 00 04 25 Experience Rating Modification Factor Revision Endorsement

AZ

Note:

This endorsement may be used to extend the information page by listing additional endorsements and schedules that are part of the policy.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 60

(Ed. 05/22)

WC 99 06 60

(Ed. 05/22)

© 1991 National Council on Compensation Insurance.

Form Numbers Form Name Applicable States WC 02 06 01 C Arizona Cancellation and NonRenewal

Endorsement

AZ

WC 99 06 22 Extension of Information Page Schedule of Named Insured

AZ

WC 00 03 13 Waiver of Our Right to Recover from Others Endorsement

AZ

WC 89 06 00 B Policy Information Page Endorsement AZ

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 08

(Ed. 1-00)

PARTNERS, OFFICERS AND OTHERS EXCLUSION ENDORSEMENT

The policy does not cover bodily injury to any person described in the Schedule.

The premium basis for the policy does not include the remuneration of such persons.

You will reimburse us for any payment we must make because of bodily injury to such persons.

Schedule

Partners Officers Others

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.)

08/03/2023Endorsement Effective 1022049Policy No. 18Endorsement No.

Solterra Team Services, LLCInsured Premium $

CopperPoint Indemnity Insurance CompanyInsurance Company Countersigned by

This document may have been uploaded to the CopperPoint Portal.

WC 00 03 08

(Ed. 1-00)

© 1996–1999 National Council on Compensation Insurance, Inc.

Jorgenson, Steve

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.)

08/03/2023Endorsement Effective 1022049Policy No. 15Endorsement No.

Solterra Team Services, LLCInsured 100 Premium $

CopperPoint Indemnity Insurance CompanyInsurance Company Countersigned by

This document may have been uploaded to the CopperPoint Portal.

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 Arizona Department of Economic Security. Office of Procurement, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees for losses arising from work performed by or on behalf of the Contractor.

1789 W Jefferson St, Mail drop 1541, Phoenix, AZ 85007

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 89 06 00 B

(Version 7/01)

WC 89 06 00 B

(Version 7/01)

© Copyright 2009 National Council on Compensation Insurance, Inc. All Rights Reserved.

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.)

08/03/2023Endorsement Effective 1022049Policy No. 17Endorsement No.

Solterra Team Services, LLCInsured 111,704 Premium $

CopperPoint Indemnity Insurance CompanyInsurance Company Countersigned by

This document may have been uploaded to the CopperPoint Portal.

POLICY INFORMATION PAGE ENDORSEMENT

The following item(s)

Insured’s Name (WC 89 06 01) Expiration Date (WC 89 06 04) Insured’s Mailing Address (WC 89 06 05) Experience Modification (WC 89 04 06) Producer’s Name (WC 89 06 07) Change in Workplace of Insured (WC 89 06 08) Insured’s Legal Status (WC 89 06 10) Item 3.A. States (WC 89 06 11)

Item 3.B. Limits (WC 89 06 12) Item 3 .C. States (WC 89 06 13)

✔ Item 3.D. Endorsement Numbers (WC 89 06 14) Item 4.* Class, Rate, Other (WC 89 04 15)

✔ Interim Adjustment of Premium (WC 89 04 16) Interstate/Intrastate Risk ID Number (WC 89 06 18) Issuing Agency/Producer Office Address (WC 89 06 25)

Is changed to read:

Total Estimated Annual Premium: $111,704

POLICY NUMBER: COMMERCIAL AUTO

CA 04 44 10 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page of

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US (WAIVER OF SUBROGATION)

This endorsement modifies insurance provided under the following:

AUTO DEALERS COVERAGE FORM

BUSINESS AUTO COVERAGE FORM

MOTOR CARRIER COVERAGE FORM

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

This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.

Named Insured:

Endorsement Effective Date:

SCHEDULE

Name(s) Of Person(s) Or Organization(s):

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization.

PI-AI-SCH (08/20)

PI-AI-SCH (08/20)

Page of

Additional Insured Schedule

Policy Number:

Philadelphia Indemnity Insurance Company