CTR065209_Certificate_of_Insurance_Exp_2023.5.29.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

AUTOSAUTOS

NON-OWNED

HIRED AUTOS

SCHEDULEDALL OWNED

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 MTTU

Hiscox Inc.

520 Madison Avenue 32nd Floor New York, New York 10022

(888) 202-3007 contact@hiscox.com

Hiscox Insurance Company Inc 10200

Pinnacle Prevention 250 S Arizona Ave Ste 6 Chandler, AZ 85225

05/29/202305/29/2022P100.293.740.8

Y

X

A

X

X

1,000,000

100,000

5,000

2,000,000

2,000,000

2,000,000

04/21/2023

X

Y

Y

Y

P100.293.740.8 05/29/2022 05/29/2023

2,000,000

AUTOMOBILE LIABILITY WAIVER OF SUBROGATION IN FAVOR OF THE STATE OF ARIZONA, AND ITS DEPARTMENTS, AGENCIES, BOARDS, COMMISSIONS, UNIVERSITIES, OFFICERS, OFFICIALS, AGENTS AND EMPLOYEES FOR LOSSES ARISING FROM WORK PERFORMED BY OR ON BEHALF OF PINNACLE

PREVENTION.

CONTRACT #CTR042019 AND CTR049396 AND CTR065209

ARIZONA DEPARTMENT OF ECONOMIC SECURITY

DIVISION OF AGING AND ADULT SERVICES, MAIL DROP 6271

1789 WEST JEFFERSON STREET PHOENIX, AZ 85007

THE STATE OF ARIZONA, 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.

Hiscox Insurance Company Inc.

Policy Number:

Named Insured:

Endorsement Effective:

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

Includes copyrighted material of Insurance Services Office, Inc., with its permission.

ADDITIONAL INSURED ENDORSEMENT

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY AND AUTOMOBILE LIABILITY COVERAGE

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

INVOLVING AUTOMOBILES OWNED, HIRED, AND/OR NON-OWNED BY THE CONTRACTOR.

CONTRACT #CTR042019 AND #CTR049396 AND #CTR065209

P100.293.740.8 Pinnacle Prevention April 21, 2023

Hiscox Insurance Company Inc.

Policy Number:

Named Insured:

Endorsement Number:

Endorsement Effective:

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CGL E5402 CW (03/10) Page 1 of 1

Includes copyrighted material of Insurance Services Office, Inc., with its permission.

MODIFIED WAIVER OF TRANSFER OF RIGHTS OF

RECOVERY AGAINST OTHERS TO US

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY AND AUTOMOBILE LIABILITY COVERAGE PART

ADDITIONAL INSURED AND WAIVER OF SUBROGATION ENDORSEMENT IN FAVOR OF THE STATE OF ARIZONA, AND ITS DEPARTMENTS, AGENCIES, BOARDS, COMMISSIONS, UNIVERSITIES, OFFICERS, OFFICIALS, AGENTS AND EMPLOYEES FOR LOSSES ARISING FROM WORK PERFORMED BY OR ON

BEHALF OF PINNACLE PREVENTION.

CONTRACT # CTR042019 AND CONTRACT # CTR049396 AND CONTRACT # CTR065209

To Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Conditions:

You may waive your rights against another party so long as you do so in writing prior to: (i) an offense arising out of your business that caused a “personal and advertising injury”; or (ii) an “occurrence” that caused “bodily injury” or “property damage”.

UDC-1587200-CGL-18

Pinnacle Prevention April 21, 2023

CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)

04/21/2023 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 be endorsed. If SUBROGATIONIS 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).

PRODUCER

THE ARIZONA GROUP/PHS

59302624 The Hartford Business Service Center 3600 Wiseman Blvd San Antonio, TX 78251

CONTACT

NAME:

PHONE

(A/C, No, Ext):

(800) 417-6635 FAX

(A/C, No):

E-MAIL

ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC#

INSURED

PINNACLE PREVENTION CORP

484 W CHANDLER BLVD

CHANDLER AZ 85225

INSURER A : Hartford Insurance Company of Illinois 38288

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

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.

INSR

LTR

TYPE OF INSURANCE ADDL

INSR

SUBR

WVD

POLICY NUMBER POLICY EFF

(MM/DD/YYYY)

POLICY EXP

(MM/DD/Y YYY)

LIMITS

COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE

CLAIMS-MADE OCCUR DAMAGE TO RENTED

PREMISES (Ea occurrence) MED EXP (Any one person)

PERSONAL & ADV INJURY

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE

POLICY PRO-

JECT

LOC PRODUCTS - COMP/OP AGG

OTHER:

AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT

(Ea accident)

ANY AUTO BODILY INJURY (Per person)

ALL OWNED

AUTOS

SCHEDULED

AUTOS

BODILY INJURY (Per accident)

HIRED

AUTOS

NON-OWNED

AUTOS

PROPERTY DAMAGE

(Per accident)

UMBRELLA LIAB

EXCESS LIAB

OCCUR

CLAIMS-

MADE

EACH OCCURRENCE

AGGREGATE

DED RETENTION $

A

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

ANY

PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below

N/ A 59 WEC KZ6793 05/28/2022 05/28/2023

X PER

STATUTE

OTH-

ER

Y/N E.L. EACH ACCIDENT $1,000,000

E.L. DISEASE -EA EMPLOYEE $1,000,000

E.L. DISEASE - POLICY LIMIT $1,000,000

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

WAIVER OF SUBROGATION IN FAVOR OF THE STATE OF ARIZONA, AND ITS DEPARTMENTS, AGENCIES, BOARDS, COMMISSIONS, UNIVERSITIES, OFFICERS, OFFICIALS, AGENTS AND EMPLOYEES FOR LOSSES ARISING FROM WORK PERFORMED BY OR ON BEHALF OF PINNACLE PREVENTION. CONTRACT #CTR042019 AND #CTR049396 AND #CTR065209

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED

BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED

IN ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE

© 1988-2015 ACORD CORPORATION. All rights reserved.

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

ARIZONA DEPARTMENT OF ECONOMIC SECURITY

DIVISION OF AGING AND ADULT SERVICES, MAIL DROP 6271

1789 WEST JEFFERSON STREET PHOENIX, AZ 85007

THE STATE OF ARIZONA, 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.

Countersigned by

Authorized Representative

Process Date: 05/28/22 (1) Printed in U.S.A. Page 1 Policy Expiration Date: 05/28/23

ENDORSEMENT OF ADDITIONAL INSURED AND WAIVER OF SUBROGATION

Audit Period: ANNUAL Policy Expiration Date: 05/28/23

INSURER: Property & Casualty Ins Co. of Hartford NCCI Company Number: 30147 Policy Effective Date: 05/28/22 Policy Number: 59 WEC KZ6793 Effective Date: 05/28/22 Named Insured and Address:

Endorsement Number: 2 Effective hour is the same as stated on the Information Page of the policy.

PINNACLE PREVENTION CORP

250 S ARIZONA AVE STE 6

CHANDLER AZ 85225

FEIN Number: 52-1371419 Producer Name: THE ARIZONA GROUP/PHS Producer Code: 59302624 It is agreed that the policy is amended as follows:

Waiver of subrogation endorsement, as required by this written agreement, in favor of the State of Arizona, 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.