CTR059067_ACCEPTED_ANY_ALL_GL_AL_WC_01.01.25-01.01.26.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

12/17/2024

Hub International Great Plains, LLC dba Horizon Agency, Inc.

6500 City West Parkway, Suite 100 Eden Prairie MN 55344

Kim Anderson 952-914-7145 952-956-3357 kim.anderson@hubinternational.com

Hartford Fire Insurance Company 19682 WUNDENG-01 Charter Oak Fire Insurance Company 25615

Wunderlich-Malec Engineering Inc, Wunderlich-Malec Services, Inc., Wunderlich-Malec Systems, Inc.

6101 Blue Circle Drive Eden Prairie MN 55344

The Travelers Indemnity Company of America 25666 Travelers Property Casualty Company of America 25674 Travelers Casualty & Surety Company of America 31194

893036547

C X 1,000,000 X 300,000

10,000

1,000,000

2,000,000 X X

Y Y P630-1N669205-TIA-25 1/1/2025 1/1/2026

2,000,000

D 1,000,000

X

X X

Y Y BA1N651564-24-43-G 1/1/2025 1/1/2026

D X X 20,000,000Y CUP-1N707158-25-43 1/1/2025Y 1/1/2026

20,000,000 X 10,000

B XY UB-1N673083-25-43-G 1/1/2025 1/1/2026

1,000,000

1,000,000

1,000,000 E A D

Crime Inland Marine Automobile

105877082

41MSRC0983

BA1N651564-24-43-G

1/1/2025 1/1/2025 1/1/2025

1/1/2026 1/1/2026 1/1/2026

Employee Dishonesty Equipment Hired/Physical Damage

1,000,000 395,000 50,000

Blanket Additional Insured, Blanket Primary & Non-Contributory, Blanket Waiver of Subrogation applies to the general liability, Automobile Liability and Umbrella. Auto: Comprehensive Ded $1000 and Collision Ded $1,000. General Liability - No Deductible; Excess/Umbrella Follow Form; Blanket Waiver of Subrogation applies to the Workers Compensation: Monopolistic Stop Gap included for OH, WA, WY, ND: All coverages are per the forms and endorsements on the policies listed above. Should any of the above described policies be cancelled before the expiration date 60 days notice will be sent in accordance with the policy provisions. 10 Days notice of cancellation due to non-payment of premium in accordance with the policy provisions Regarding Contract number CTR059067, The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents and employees shall be named as additional insureds with respect to liability arising out of the activities performed by or on behalf of the contractor. Waiver of Subrogation applies against the State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents and employees See Attached...

ADOT Risk Management Insurance and Indemnification Unit 1324 N. 22nd Avenue Phoenix AZ 85009

Cindy Lewis Accepted

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:

WUNDENG-01

1 1

Hub International Great Plains, LLC dba Horizon Agency, Inc. Wunderlich-Malec Engineering Inc, Wunderlich-Malec Services, Inc., Wunderlich-Malec Systems, Inc.

6101 Blue Circle Drive Eden Prairie MN 55344

25 CERTIFICATE OF LIABILITY INSURANCE

for losses arising from work performed by or on behalf of the Contractor and involving automobiles owned, leased, hired or borrowed by the contractor. General Liability insurance is primary. Forms CGD414, CGD415 and WC000313 apply.

Cindy Lewis Highlight