CTR067054_GL_AL_WC_05.30.25-03.20.26.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

6/5/2025

Crest Insurance Group, LLC 100 S Mill Avenue, Suite 930 Tempe AZ 85281

Michelle Reif 888-881-5765 mreif@crestins.com

Westchester Surplus Lines Ins. 10172 TROOUSA-01 WCF Select Insurance Company 21865

Villa 13, LLC dba: Trooper USA, LLC 3707 E Southern Ave Ste 2003 Mesa AZ 85206

Middlesex Insurance Company 23434

1432160232

C X 1,000,000 X 500,000

5,000

X $500 PD DED/CLM 1,000,000

2,000,000 X

Y Y A0273052 5/30/2025 5/30/2026

2,000,000

C 1,000,000

X X X

Y Y A0273052 5/30/2025 5/30/2026

C X X 1,000,000A0273052 5/30/2025 5/30/2026

1,000,000 X 0

B X

Y

Y 4083989 3/20/2025 3/20/2026

1,000,000

1,000,000

1,000,000

A POLLUTION LIABILITY

AZDOT Contracts Only

Y Y G71671203 001 8/2/2024 8/2/2025 EA CONDITION

AGGREGATE

DEDUCTIBLE

1,000,000 1,000,000 2,500

Certificate holder and others when required in a written contract or agreement are Additional Insured (General Liability & Automobile Liability) for ongoing and completed operations. Coverage is Primary and Non-Contributory when required in a written contract or agreement (General Liability). Waiver of Subrogation applies when required in a written contract or agreement (General Liability, Automobile Liability, Workers Compensation). Workers Compensation Excluded officers; SUSIE VILLARREAL & JESSE VILLAREAL. Umbrella/Excess Liability is follow form of General Liability, Auto Liability and Employer’s Liability. Hired Auto Physical Damage$500 Comprehensive, $500 Collision Deductibles; Middlesex Insurance Co Policy No. A0273052; 05/30/2025 to 05/30/2026. This form is subject to all policy forms, terms, endorsements, conditions definitions & exclusions. Forms: CG7125 06/22, CG2010 12/19, CG2037 12/19, CA7013 10/13, CA7616 06/18, WC000313 04/84, WC420304B 06/14.

REFERENCE: ADOT19-214720; CTR067054 I-10 Deck Park Tunnel Cleaning See Attached...

The State of Arizona (ADOT) 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:

TROOUSA-01

1 1

Crest Insurance Group, LLC Villa 13, LLC dba: Trooper USA, LLC 3707 E Southern Ave Ste 2003 Mesa AZ 85206

25 CERTIFICATE OF LIABILITY INSURANCE

Additional Form: CA2048 10 13 Automobile Liability Additional Insured Endorsement The State of Arizona (ADOT) included, when required in written contract, as Additional Insured and coverage applies per above and attached endorsements.

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¾§ mreif Typewritten text Any person or organization you are required to add as an additional insured under a written contract or written agreement in effect prior to any loss or damage mreif_1 Typewritten text Jobsites and Operations as described in written contracts with the named insured mreif_2 Typewritten text A0273052 mreif_3 Typewritten text Villa 13, LLC dba: Trooper USA LLC

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POLICY NUMBER:

© Insurance Services Office, Inc., 2018

COMMERCIAL GENERAL LIABILITY

CG 20 37 12 19

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED - OWNERS, LESSEES OR

CONTRACTORS - COMPLETED OPERATIONS

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

SCHEDULE

Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations

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

A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard".

However:

1. The insurance afforded to such additional insured only applies to the extent permitted by law; and

2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.

B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance:

If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:

1. Required by the contract or agreement; or

2. Available under the applicable limits of insurance;

whichever is less.

This endorsement shall not increase the applicable limits of insurance.

Page 1 of 1CG 20 37 12 19 mreif_4

Any person or organization you are required to add as an additional insured under a written contract or written agreement in effect prior to any loss or damage mreif_5 Typewritten text Jobsites as described in written contracts with the named insured mreif_6

A0273052

POLICY NUMBER:

SCHEDULE

COMMERCIAL AUTO

CA 70 13 10 13

AUTO ADDITIONAL INSURED

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

AUTO DEALERS COVERAGE FORM

MOTOR CARRIER COVERAGE FORM

Insurance Company

Limit of Liability Insurance $ Each "Accident"

Policy Expiration Date

Name And Address Of Person Or Organization

Relationship Or Capacity

Description Of Auto

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

A. Who is an insured is changed to include as an "insured" the person or organization named in the schedule, but only with respect to liability arising out of the stated relationship or capacity and the described "auto".

B. Cancellation

1. If we cancel the policy, we will mail notice to the named person or organization in accordance with the cancellation common policy condition.

2. If you cancel the policy, we will mail notice to the named person or organization.

3. Cancellation ends this agreement.

Page 1 of 1CA 70 13 10 13

SPECIMEN COPY

mreif_7 Typewritten text Any person or organization you are required to add as an additional insured under a written contract or written agreement in effect prior to any loss or damage mreif_8 Typewritten text On file with the insured mreif_9 Typewritten text On file with the insured mreif_10 Typewritten text A0273052 mreif_11 Typewritten text 05/30/2026 mreif_12

1,000,000

COMMERCIAL AUTO

CA 76 16 06 18

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

BLANKET 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.

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

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

Named Insured:

Endorsement Effective Date:

Page 1 of 1CA 76 16 06 18 mreif_13

Villa 13, LLC dba: Trooper USA, LLC mreif_14 Typewritten text 05/30/2025 mreif_15

Policy No. A0273052