CTR062320 2024.11.01 COI.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

9/3/2024

(480) 834-9315 (480) 844-9866

21415

Vermeer Mountain West Inc.

17019 S Weber Dr.

Chandler, AZ 85226

21407 42376

A 1,000,000

X X 4D83571 11/1/2023 11/1/2024 300,000 5,000

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

1,000,000B

X X 4E83571 11/1/2023 11/1/2024

2,000,000A 4J83571 11/1/2023 11/1/2024 2,000,000

10,000 C

X TWC4369440 1/1/2024 1/1/2025 1,000,000

1,000,000 1,000,000

A Stock 4C83571 11/1/2023 $5,000 Ded 100,000,000

The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees, Arizona Department of Transportation and employees shall be named as additional insured with respect to liability arising out of the activities performed by or on behalf of the contractor. A waiver of subrogation against the State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees for losses arising from work performed by or on behalf of the Contractor applies. Coverage is Primary and non-contributory.

The State of Arizona 1324 N. 22nd Ave Phoenix, AZ 85009

VERMSAL-01 CSCHMELTER

LeBaron & Carroll LLC 1350 E Southern Avenue Mesa, AZ 85204 landc@lebaroncarroll.com

Employers Mutual Casualty Company EMCASCO Insurance Co Technology Insurance Company

X

11/1/2024

X X

X

X

X X

X

X

X

G0171 Accepted

COMMERCIAL AUTO

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

AUTO DEALERS ELITE EXTENSION

CA7475(2-22) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 1 of 4

This endorsement modifies insurance provided under the following:

AUTO DEALERS COVERAGE FORM

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

A. BLANKET ADDITIONAL INSUREDS

Section I – Covered Autos Coverage, Paragraph 2.

and Section II – General Liability Coverages, Paragraph D. Who Is An Insured provision is amended to include the following as an “insured”:

1. Any person or organization whom you have agreed in a written contract or agreement to name as an additional “insured” under your “auto” Policy to provide “bodily injury” or “property damage” coverage, but only with respects to liability arising out of the use of a covered “auto” you own, hire or borrow and resulting from the acts or omissions by you, any of your “employees” or agents. The insurance afforded to such additional “insured” will not be broader than that which you are required to provide for such additional “insured” and applies only to a written contract executed prior to the “bodily injury” or “property damage” and is still in force at the time of the “accident”.

2. With respect to the insurance afforded to the additional “insured” described above, the following is added to Section C. Limit Of Insurance Autos Liability Coverage or General Liability Coverage shown in the Declarations:

a. Required by the written contract or agreement described above.

b. Available under the applicable Limit Of Insurance for Covered Autos or General Liability Coverages shown in the Declarations;

whichever is less.

B. EMPLOYEES HIRED AUTOS

1. Changes In Covered Autos Liability Coverage

The following is added to the Who Is An Insured Provision:

An “employee” of yours in 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.

2. Changes In General Conditions

Paragraph 5.b. of the Other Insurance Condition in the Auto Dealers Coverage Form is amended by the addition of the following:

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

However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto".

C. NEWLY FORMED OR ACQUIRED AUTO

DEALERSHIP

The Who Is An Insured provision under the General Liability Coverages Paragraph D.6.a. is replaced as follows:

a. Coverage under this provision is afforded only until the 180th day after you acquire or form the “auto” dealership or the end of the Policy period, whichever is earlier; and

D. SUBSIDIARIES AS INSUREDS

The Who Is An Insured provision in Section I – Covered Autos Coverages and Section II – General Liability Coverages is amended by adding the following:

Any legally incorporated subsidiary in which you own more than 50% of the voting stock on the effective date of this Policy. However, “insured” does not include any subsidiary that is an “insured” under any other automobile Policy or was an “insured” under such Policy but for the termination of that Policy or the exhaustion of the Policy’s limit of insurance.

E. ADDITIONAL INSURED – GENERAL LIABILITY

COVERAGES – OWNERS OF LEASED OR

RENTED LAND OR PREMISES

SCHEDULE

Name Of Person Or Organization:

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

1. Paragraph D. Who Is An Insured under Section II – General Liability Coverages is changed to include as an “insured” the person or organization named in a contract or named in the Schedule, but only for liability arising out of the ownership, maintenance and use of that part of the described land or premise which is leased or rented to you.

2. The insurance afforded by this endorsement does not apply to:

a. Any “accident” which occurs after you cease to be a tenant in the premise.

4E83571 & 4D83571

CA7475(2-22) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 2 of 4

b. Structural alterations, new construction or demolition operations performed by or for the designated person or organization.

F. LEASED AUTO SERVICE WORK COVERAGE

Section I – Covered Autos Coverages, Paragraph D.4.g. Leased Autos is replaced with the following:

Any covered “auto” while leased or rented to others.

However, this exclusion does not apply to:

1. Any covered “auto” while leased or rented to others. But this exclusion does not apply to a covered “auto” you rent to one of your customers while their “auto” is left with you for service or repair.

2. Damage to “auto’s” leased to others that results from service or repair “work you perform” including “property damage” to “work you performed” if the “property damage” results from any part of the work itself or from the parts, materials or equipment used in connection with the work or to “property damage” or equipment used in connection with the work or to “property damage” to any of your “products” if caused by a defect existing in your “products” or any part of your “products”, at the time it was transferred to another.

However, coverage for “work you performed” is subject to $15,000 Limit Of Insurance the coverage only applies to that amount of “property damage” to “work you performed” that exceeds $500 for any one “auto”.

G. CUSTOMER’S PERSONAL PROPERTY

Paragraph E. Garagekeepers Coverage is amended by adding the following:

We will pay up to $500 for “loss” to Customer’s Personal Property which is in or on a “customer’s auto” or “customers auto” equipment left in the “insured’s” care while the “insured” is attending, servicing, repairing, parking or storing it in your “auto dealer operations”.

No Deductible applies to this coverage.

H. SUPPLEMENTARY PAYMENTS

Section I – Covered Autos Coverages, Paragraph D.3.a Subparagraphs (2) and (4), E. Garagekeepers Coverage Subparagraph 3.b. and c., Section II – General Liability Coverages, Paragraph E.

Subparagraph 2. and 3., Section III – Acts, Errors Or Omissions Liability Coverages, Paragraph D.

Subparagraph 2. and 3. are changed where applicable as follows:

1. Up to $5,000 for the cost of bail bonds (including bonds for related traffic law violations) required because of an “accident” we cover. We do not have to furnish these bonds.

2. All reasonable expenses incurred by the “insured” at our request, including actual loss of earnings up to $500 a day because of time off from work.

I. FELLOW EMPLOYEE COVERAGE

In those jurisdictions where, by law, fellow employees are not entitled to the protection afforded to the employer by workers compensation exclusivity rule, or similar protection. The following is added:

Section I – Covered Autos Coverages, Subparagraph D.4.e. Fellow Employee Exclusion does not apply.

J. EXPECTED OR INTENDED INJURY

Section I – Covered Autos Coverages, D.4.

Exclusions, Section II – General Liability Coverages, A.2. Exclusions, B.2. Exclusions and C.2. Exclusions, are amended as follows:

Expected Or Intended Injury is replaced with the following:

“Bodily injury” or “property damage” expected or intended from the standpoint of the “insured”. But for “auto dealer operations” this exclusion does not apply to “bodily injury” or “property damage” resulting from the use of reasonable force to protect persons or property.

K. AIRBAG COVERAGE

Section I – Covered Autos Coverages, Paragraph F.

Physical Damage Coverage, is amended as follows:

If you have purchased Comprehensive or Collision Coverage under this Policy, 3. Exclusions Subparagraph f.(1) relating to mechanical breakdown does not apply to the accidental discharge of an airbag.

L. VEHICLE DAMAGE TO PREMISES RENTED TO

YOU

Section I – Covered Autos Coverages, Paragraph F.

Physical Damage Coverage is amended to add the following coverage:

1. “Property damage” to buildings leased by the insured caused by a “customer’s auto” to premises while rented to you, but only for such liability which is assumed by you under a written lease of premise.

2. The most we will pay for all “property damage” caused by a “customer’s auto”, resulting from any one “occurrence” is $5,000.

3. The insurance afforded by this provision is excess over any valid collectible property insurance;

including any deductible available to the insured.

4. This coverage does not apply to “loss” caused by fire.

M. TOWING AND LABOR

Section I – Covered Autos Coverages, Paragraph F.

Physical Damage Coverage is amended to add the following coverage:

1. Coverage A. is amended by adding the following:

We will pay for Towing And Labor cost incurred subject to the following:

a. Up to $100 each time a covered “auto” of the private passenger type is disabled; or

b. Up to $500 each time a covered “auto” other than the private passenger type is disabled.

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

N. TRANSPORTATION EXPENSES

Section I – Covered Autos Coverages, Paragraph F.

Physical Damage Coverage is amended to add the following coverage:

1. We will pay up to $75 per day to a maximum of $1,000 for transportation expense incurred by you because of the total theft of a covered “auto” of the private passenger type. We will pay only for those covered “autos” for which you carry either Comprehensive or Specified Cause of Loss

CA7475(2-22) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 3 of 4

Coverage. We will pay for transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the Policy’s expiration, when the covered “auto” is returned to use or we pay for its “loss”.

2. If the temporary transportation expenses you incur arise from your rental of an “auto” of the private passenger type, the most we will pay is the amount it costs to rent an “auto” of the private passenger type which is of like kind and quality as the stolen covered “auto” or $75 per day, whichever is less, subject to the $1,000 maximum.

O. ELECTRONIC EQUIPMENT COVERAGE ADDED

LIMITS

Section I – Covered Autos Coverage, Paragraph F.

Physical Damage Coverage 4. Limits Of Insurance is amended as follows:

All electronic equipment that reproduces, receives or transmits audio, visual or data signals in any one “loss” is $5,000 in addition to the $1,000 in any one “loss” under Paragraph 4.a.(2).

P. HIRED AUTO PHYSICAL DAMAGE

Section I – Covered Autos Coverages, Paragraph F.

Physical Damage Coverage is amended to add the following coverage:

If hired “auto” are covered “auto” for Liability Coverage, and if Comprehensive, Specified Causes of Loss or Collision Coverage is provided for any “auto” you own, then the physical damage coverages provided are extended to any “auto” you lease, hire, rent or borrow is deemed to be a covered “auto” you own subject to the following:

(1) The most we will pay for “loss” to any hired “auto” is the lesser of $100,000 or Actual Cash Value or Cost of Repair, minus the deductible.

(2) The deductible will be equal to the largest deductible applicable to any owned “auto” for that coverage.

(3) Subject to the above deductible, we will provide the broadest coverage applicable to any covered “auto” you own.

We will pay up to $1,000 for Loss Of Use of a hired “auto” to a leasing or rental concern for a monetary “loss” sustained, provided it results from an “accident” for which you are legally liable.

However, coverage does not apply to any “auto” leased, hired, rented or borrowed in your Motor Carrier operations and any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto".

Q. RENTAL REIMBURSEMENT

Section I – Covered Autos Coverages, Paragraph F.

Physical Damage Coverage is amended to add the following:

1. This coverage applies only to a covered “auto” that is of the private passenger type or light truck for which Physical Damage Coverage is provided on this Policy.

2. We will pay for Rental Reimbursement Expenses incurred by you for the rental of any “auto” because of “loss” to a covered “auto”.

Payment applies in addition to the otherwise applicable amount of each coverage you have on a covered “auto”. A deductible of $500 applies for this coverage.

3. We will pay only for those expenses incurred during the Policy period beginning 24 hours after the “loss” and ending, regardless of the policies expiration, while 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 return it to you; or

b. 30 days.

4. Our payment is limited to the lesser of the following amounts:

a. Necessary and actual expenses incurred; or

b. $75 per day, subject to a $2,250 limit.

5. This coverage does not apply:

a. While there are spare or reserve “autos” available to you for your operations; or

b. While ”autos” are rented, leased or borrowed to others under contract.

6. If “loss” results from a total theft of a covered “auto” of the private passenger type, we will pay under this coverage only that amount your Rental Reimbursement Expenses which is not already provided for under the Physical Damage – Transportation Expense Coverage Extension included in this endorsement.

7. Coverage provided by this extension is excess over any other collectible insurance and/or endorsement to this Policy.

R. FULL GLASS COVERAGE

Section I – Covered Autos Coverages, Paragraph F.5. Deductible is amended by the addition of the following:

If the Comprehensive Coverage applies to the covered “autos”, no Comprehensive Coverage Deductible applies to the cost of repairing or replacing damaged glass on the covered “auto(s)”.

However, this does not apply to the Dealers Open Lot Inventory or Garagekeepers Coverages

S. TWO OR MORE COVERED AUTOS FROM ONE

ACCIDENT

Section I – Covered Autos Coverages, Paragraph F.

Physical Damage Coverage, Subparagraph 5.

Deductible, is amended as follows:

(2) The maximum deductible applicable to “autos” not held for sale for all “loss” in any one event caused by:

(a) Theft or Mischief or Vandalism; or

(b) All Perils

Will be equal to two times the highest deductible applicable to any one covered “auto” on the Policy for Comprehensive or Specified Causes of Loss Coverage or Collision Coverages. The application of the highest deductible used to calculate the maximum deductible will be made regardless of which covered “autos” were damaged or stolen in the “loss”.

However, this does not apply to the Dealers Open Lot Inventory or Garagekeepers Coverages.

CA7475(2-22) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 4 of 4

T. WATERCRAFT EXTENSION

Section II – General Liability Coverages, Paragraph 2.g. Aircraft, Auto Or Watercraft is amended by adding the following:

This exclusion does not apply to:

1. A watercraft while ashore on premises where you conduct “auto dealer operations”; or

2. A watercraft you do not own that is:

a. Less than 51 feet long; and

b. Not being used to carry persons or property for a charge.

If there is other applicable collectible insurance covering damages payable under Non-Owned Watercraft Coverage, we will not make any payments under this coverage.

U. DEFECTIVE PRODUCTS COVERAGE

Paragraph A. Bodily Injury And Property Damage Liability of Section II – General Liability Coverages is amended as follows:

1. Exclusion A.2.h. Defective Products does not apply. However, coverage for Defective Products is subject to Paragraph F. Limits Of Insurance – General Liability Coverages, the coverage only applies to that amount of “property damage” to your “products” that exceeds $500 for any one “auto”.

2. This coverage applies to “property damage” to any of your “products”, if caused by a defect existing in your “products”, or any part of your “products”, at the time it was transferred to another.

V. WORK YOU PERFORMED COVERAGE

Paragraph A. Bodily Injury and Property Damage of Section II – General Liability Coverages is amended as follows:

1. Exclusion A.2.i. Work You Performed does not apply, when actual “property damages” occur that was caused by “work you performed” within the last 90 days. However, coverage for “work you performed” is subject to $15,000 Limit Of Insurance the coverage only applies to that amount of “property damage” to “work you performed” that exceeds $500 for any one “auto”.

2. This coverage applies to “work you performed” if the “property damage” results from any part of the work itself or from the parts of the work itself or from the parts, materials or equipment used in connection with the work.

W. PER LOCATION AGGREGATE

Section II – General Liability Coverages is amended as follows:

Paragraph F. Limits Of Insurance – General Liability Coverages applies separately to each location owned by or rented to you for your “auto dealers operations”.

X. LOSS CONDITIONS

Section IV – Conditions, Paragraph A. 2. Duties In The Event Of Accident, Claim, Offense, Suit Loss Or Acts, Errors Or Omissions is amended by adding the following:

Your obligation to notify us promptly of an “accident”, claim, “suit” or “loss” is satisfied if you send us the required notice as soon as practicable after your

Insurance Administrator or anyone else designated by you to be responsible for insurance matters is notified, or in any manner made aware, of an “accident”, claim, “suit” or “loss”.

Y. CONDITIONS

Section IV – Conditions, is amended as follows:

1. Concealment, Misrepresentation Or Fraud Paragraph B.2. Concealment, Misrepresentation Or Fraud is amended by adding the following:

If you unintentionally fail to disclose any exposures existing at the inception date of your Policy, we will not deny coverage under this coverage form solely because of such failure to disclose. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or nonrenewal.

2. Liberalization

Paragraph B.3. Liberalization is amended by adding the following:

If we revise this endorsement to provide more coverage without additional premium charge, we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your state.

Z. DEFINITIONS

Section V – Definitions is amended as follows:

1. Bodily Injury

Paragraph F. is replaced with the following:

“Bodily Injury” includes bodily injury, sickness or disease sustained by a person, including mental anguish or death resulting from bodily injury, sickness or disease.

2. Customers’ Auto

Paragraph H. is amended to read as follows:

“Customer’s auto” means a land motor vehicle, “trailer”, semitrailer, agricultural equipment, all-terrain vehicles, snowmobiles, watercraft and other mobile equipment similar to the equipment sold or serviced by the named insured lawfully within your possession for service, repair, storage or safekeeping, with or without the vehicle owner’s knowledge or consent. A “customer’s auto” also includes any such vehicle left in your care by your “employees”. And members of their households, who pay for services performed.

BLANKET WAIVER OF SUBROGATION WHEN REQUIRED

IN A WRITTEN CONTRACT OR AGREEMENT

CA7392(11-15) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 1 of 1

This endorsement modifies insurance provided under the following:

AUTO DEALERS COVERAGE FORM

BUSINESS AUTO COVERAGE FORM

MOTOR CARRIER COVERAGE FORM

The TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US Condition Section is added to and replaced by the following:

We waive any right of recovery we may have against any person or organization against whom you have agreed to waive such right of recovery in a written agreement or written contract because of payments we make for injury or damage arising out of your ongoing operations or “work you performed” under a written contract or written agreement with that person or organization and included in the “Auto Dealers Operations”.

A. The following definitions are added to the Definition Section of this endorsement only:

1. “Auto Dealers Operations” means the ownership, maintenance or use of locations for an “auto” dealership and that portion of the roads or other accesses that adjoin these locations. “Auto dealers operations” includes all operations necessary or incidental to an “auto” dealership.

2. “Work you performed” includes:

a. Work that someone performed on your behalf; and

b. The providing of or failure to provide warnings or instructions.

4E83571 & 4D83571

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.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13

(Ed. 04-84)

Schedule

Any person or organization as required by written contract

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 1/1/2024 Policy No. TWC4369440 Endorsement No. 0 Insured Vermeer Mountain West, Inc. Premium $ 119,078 Insurance Company Technology Insurance Company, Inc.

Countersigned by

WC 00 03 13

(Ed. 04-84)

DESIGNATED INSURED – PRIMARY AND NONCONTRIBUTORY

CA7266 (2-22) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 1 of 1

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 this endorsement.

This endorsement identifies person(s) or organization(s) who are “insureds” under the Who Is An Insured provision of the coverage form. This endorsement does not alter coverage provided in the coverage form.

SCHEDULE

Name of Person(s) or Organization(s)

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

Each person or organization indicated above is an ”insured” for Liability Coverage, but only to the extent that person or organization qualifies as an “insured” under the Who Is An Insured provision under the Covered Autos Liability Coverage form and;

The insurance provided to the person(s) or organization(s) shown in the Schedule is Primary Insurance and we will not seek contribution from any other insurance available to that “insured”.

This provision applies to “autos” owned by the insured and covered by this policy.

The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees, Arizona Department of Transportation and employees 1324 N. 22nd Ave Phoenix, AZ 85009

Policy Number: 4E83571 & 4D83571