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

3/21/2025

Arthur J. Gallagher Risk Management Services, LLC 101 S Main St Ste 200 Decatur IL 62523

Christina Larson 217-233-3315 217-428-0865 christina_larson@ajg.com

License#: 0D69293 Ironshore Specialty Insurance Co 25445 SILVBIR-03 Selective Insurance Company of SC 19259

3rd and Indian School Assisted Living Facility, LLC Solterra 3rd Indian School Operations, LLC 4000 N 3rd Ave.

Phoenix AZ 85013

United Wisconsin Insurance Company 29157

1382942612

A X 1,000,000 X 100,000

100,000

1,000,000

3,000,000 X

Y Y HC7CACKG5B003 8/1/2024 8/1/2025

1,000,000

B 1,000,000

X

X X

Y Y S 2546678 8/1/2024 8/1/2025

A X 5,000,000 X

HC7CACKG5K003 8/1/2024 8/1/2025

C XY 100084926 11/1/2024 11/1/2025

1,000,000

1,000,000

1,000,000 A Professional Liability Y HC7CACKG5B003 8/1/2024 8/1/2025 Per Claim

Aggregate 1,000,000 3,000,000

RE: Contract #: CTR057909 | Description: Assisted Living Facility

The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees as additional insureds with respect to liability arising out of the activities performed by or on behalf of the Contractor are listed as Additional Insured with respects to General Liability, Automobile Liability and Professional Liability. A waiver of subrogation applies to the General Liability, Automobile Liability and Workers Compensation. Sexual Abuse and Molestation coverage is not excluded.

Both General Liability and Professional Liability are written on a claims-made basis. Contractor warrants that any retroactive date under both the General See Attached...

The State of Arizona Department of Economic Security c/o myCOI P.O. Box 501970 8710 Bash Street Indianapolis, IN 46256

ACORD 101 (2008/01)

The ACORD name and logo are registered marks of ACORD

© 2008 ACORD CORPORATION. All rights reserved.

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: FORM TITLE:

ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE Page of

AGENCY CUSTOMER ID:

LOC #:

AGENCY

CARRIER NAIC CODE

POLICY NUMBER

NAMED INSURED

EFFECTIVE DATE:

SILVBIR-03

1 1

Arthur J. Gallagher Risk Management Services, LLC 3rd and Indian School Assisted Living Facility, LLC Solterra 3rd Indian School Operations, LLC 4000 N 3rd Ave.

Phoenix AZ 85013

25 CERTIFICATE OF LIABILITY INSURANCE

Liability and Professional Liability policy shall precede the effective date of this Contract; and that either continuous coverage will be maintained or an extended discovery period will be exercised for a period of two (2) years beginning at the time work under this Contract is completed.

LTC.P.019 (5.08 ed.) Page: 1 of 1

IRONSHORE SPECIALTY INSURANCE COMPANY

175 Berkeley Street Boston, MA 02116

Toll Free: (877) IRON411

Endorsement # 29

Policy Number: HC7CACKG5B003 Effective Date of Endorsement: February 01, 2025 Insured Name: Silver Birch Living, LLC

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED ENDORSEMENT

In consideration of the premium charged:

1. The term “Insured,” as defined in the Policy, shall be deemed to include each person or entity listed below (each an “Additional Insured”), but only with respect to liability of any such Additional Insured that is based on or arises out of a Claim for which coverage would otherwise be afforded to the original Insured under this Policy.

Additional Insured(s):

The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees

2. It is understood and agreed that each Additional Insured listed above is being afforded coverage under this Policy for any liability incurred solely as a result of the acts, errors or omissions of the original Insured. No coverage will be available under this Policy for any Claim based on or arising out of any actual or alleged independent or direct liability of any Additional Insured.

3. The Insurer will provide the Additional Insured(s) identified above with at least ten (10) days’ written notice of cancellation or non-renewal of this Policy if such cancellation or non-renewal is for non-payment of premium, or sixty (60) days’ written notice of cancellation or non-renewal if such cancellation or non-renewal is for any other reason.

ALL OTHER TERMS, CONDITIONS AND EXCLUSIONS OF THIS POLICY REMAIN UNCHANGED.

LTC.P.068 (03/09 Ed.) Page 1 of 1

175 Berkeley Street Boston, MA 02116

Toll Free: (877) IRON411

Endorsement # 30

Policy Number: HC7CACKG5B003 Effective Date of Endorsement: February 01, 2025 Insured Name: Silver Birch Living, LLC

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

WAIVER OF SUBROGATION RIGHTS FOR GENERAL LIABILITY PAYMENTS

In consideration of the premium charged, the Ins agrees to waive its right to be subrogated to the extent of any payment s under INSURING AGREEMENT (B) of this Policy to rights of recovery of the Insured against the following third party(ies):

Third Party(ies):

State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees

GENERAL CONDITION (K) will be deemed amended to effect the purpose and intent of this endorsement.

ALL OTHER TERMS, CONDITIONS AND EXCLUSIONS OF THIS POLICY REMAIN UNCHANGED.

LTC.P.012 (03/09 Ed.) Page 1 of 1

175 Berkeley Street Boston, MA 02116

Toll Free: (877) IRON411

Endorsement # 32

Policy Number: HC7CACKG5B003 Effective Date of Endorsement: March 01, 2025 Insured Name: Silver Birch Living, LLC

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

AMEND DEFINITION OF “NAMED INSURED” TO INCLUDE ADDITIONAL

ENTITIES

In consideration of the premium charged, the term “Named Insured,” as defined in Section II DEFINITIONS of the Policy, is amended to include each of the following entities, but solely with respect to Wrongful Acts committed or allegedly committed, or Occurrences happening, on or after the Retroactive Date:

Additional Named Insured(s)

Silver Birch Midtown Manager, LLC Silver Birch Midtown GP, LLC 3rd and Indian School Assisted Living Facility, LLC

All other terms, conditions and limitations of this Policy shall remain unchanged.