CTR073186 2025.11.15 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

7/9/2025

Titian Cleaning LLC dba OMEX International 537 S 48th St Tempe, AZ 85281

A 1,000,000

X X NPC-1009739-00 11/15/2024 11/15/2025 100,000

10,000

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

E&O Aggregate 2,000,000 1,000,000A

X X NBA-1009759-00 11/15/2024 11/15/2025

4,000,000A

NEC700025600 11/15/2024 11/15/2025 4,000,000

A

X MWC1037886 11/15/2024 11/15/2025 1,000,000

N 1,000,000 1,000,000

A Employee Theft NPC-1009739-00 11/15/2024 Limit 25,000

Where required per written agreement, Certificate holder is Additional Insured subject to all policy terms conditions and exclusions. Waiver of subrogation shall apply.

ARIZONA DEPARTMENT OF TRANSPORTATION

1655 W. Jackson St., MD 100P Phoenix, AZ 85007

TITACLE-01 ARIVERA

Forte Services, LLC dba Mascolino Insurance Services 1201 South Alma School Rd Suite 11750 Mesa, AZ 85210

Rick Mascolino

Greenwich Insurance Company

X

11/15/2025

X X

X

X

X X

22322

Cindy Lewis Accepted

ENDORSEMENT#

This endorsement, effective 12:01 a.m., forms part of

Policy No.NPC-1009739-00 \

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

XL PLUS ENDORSEMENT

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE FORM

GENERAL DESCRIPTION OF COVERAGE - This endorsement broadens coverage. The following listing is a general coverage description only. Limitations and exclusions may apply to these coverages. Read this endorsement carefully to determine rights, duties, and what is and is not covered.

A. Reasonable Force -Bodily Injury or Property Damage

B. Damage To Premises Rented To You Extension

• Perils of fire, lightning, explosion, smoke, aircraft or vehicles, riot or civil commotion, vandalism, leakage from fire extinguishing equipment or water damage

• Limit increased to $300,000

C. Aircraft Chartered with Crew

D. Non-Owned Watercraft

E. Personal and Advertising Injury -Assumed by Insured Contract

F. Increased Supplementary Payments

• Cost for bail bonds increased to $5,000

• Loss of earnings increased to $1,000 per day

G. Resulting Damage to Your Work or Your Product

H. Broadened Named Insured

I. In Rem

J. Additional Insured -Automatic Status When Required in Written Contract or Agreement

K. Blanket Additional Insured -Managers or Lessors of Premises

L. Blanket Additional Insured -Lessor of Leased Equipment

M. Blanket Additional Insured -Controlling Interest

XIL 436 0623 © 2023 X.L. America, Inc. All Rights Reserved.

May not be copied without permission.

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

in rem in personam

Policy number: NPC-1009739-00

XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 1 of 6 May not be copied without permission.

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

Titan Cleaning, LLC XIC 421 1013

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

COVERAGE DESCRIPTION

policy number: NBA-1009759-00

XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 2 of 6

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

is changed by adding the following:

If Physical Damage coverage is provided by this Coverage Form, the following types of vehicles are also covered “autos” for Physical Damage coverage:

Any “auto” you do not own while used with the permission of its owner as a temporary substitute for a covered “auto” you own that is out of service because of its:

Breakdown;

Repair;

Servicing;

“Loss”; or

Destruction.

is changed by adding the following:

For any covered “auto”, any subsidiary, affiliate or organization, other than a partnership or joint venture, as may now exist or hereafter be constituted over which you assume active management or maintain ownership or majority interest, provided that you notify us within ninety (90) days from the date that any such subsidiary or affiliate is acquired or formed and that there is no similar insurance available to that organization. However, coverage does not apply to “bodily injury” or “property damage” that occurred before you acquired or formed the organization.

Any “employee” of yours is an “insured” while using a covered “auto” you don’t own, hire or borrow, in your business or your personal affairs.

Any person or organization with whom you have agreed in writing in a contract, agreement or permit, to provide insurance such as is provided under this policy, provided that the “bodily injury” or “property damage” occurs subsequent to the execution of the written contract, agreement or permit.

An “employee” of yours is an “insured” while operating an “auto” hired or rented under a contract or agreement in that “employee’s” name, with your permission, while performing duties related to the conduct of your business.

XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 3 of 6

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

is replaced with the following:

For Hired Auto Physical Damage Coverage, the following are deemed to be covered “autos” you own:

Any covered “auto” you lease, hire, rent or borrow; and

Any covered “auto” hired or rented by your “employee” under a contract in that individual “employee’s” name, with your permission, while performing duties related to the conduct of your business.

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

is changed as follows:

Item is deleted and replaced by the following:

Up to $3,500 for 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.

Item is deleted and replaced by the following:

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.

does not apply.

The insurance provided under this Provision is excess over any other collectible insurance.

is changed by adding the following:

We will pay for rental reimbursement expenses incurred by you for the rental of an “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”. No deductibles apply to this coverage.

We will pay only for those expenses incurred during the policy period beginning twenty-four

(24) hours after the “loss” and ending, regardless of the policy’s expiration, with the lesser of the following number of days:

XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 4 of 6

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

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.

Thirty (30) days.

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

Necessary and actual expenses incurred.

$50 any one day per private passenger “auto”;

$100 any one day per truck;

$1,500 any one period per private passenger “auto”;

$3,000 any one period per truck; or Higher limits if shown elsewhere in this policy.

This coverage does not apply while there are spare or reserve “autos” available to you for your operations.

If “loss” results from the total theft of a covered “auto” of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided for under the Physical Damage Coverage Extension.

We will pay for the expense of returning a stolen covered “auto” to you.

If you have purchased Comprehensive Coverage on this policy for an “auto” you own and that “auto” is stolen, we will pay, without application of a deductible, up to $500 for “personal effects” stolen from the “auto”.

As used in this endorsement, “personal effects” means tangible property that is worn or carried by an “insured”. “Personal effects” does not include tools, jewelry, money or securities.

In the event of a total “loss” to a covered “auto” shown in the Declarations, we will pay any unpaid amount due on the lease or loan for a covered “auto”, less:

The amount paid under the Physical Damage Coverage Section of the policy; and

Any:

Overdue lease/loan payments at the time of the “loss”;

Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage;

Security deposits not returned by the lessor;

Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchases with the loan or lease; and

Carry-over balances from previous loans or leases.

XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 5 of 6

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

No deductible applies to glass damage if the glass is repaired rather than replaced.

is amended by the following:

and are amended to provide a limit of $50 per day and a maximum limit of $1,000.

The following section is added:

Any “auto” you lease, hire, rent or borrow is deemed to be a covered “auto” for physical damage coverage. The most we will pay for each covered “auto” is the lesser of:

the actual cash value;

the cost for repair or replacement; or

$50,000, or higher limit if shown on the Declarations for Hired Auto Physical Damage Coverage.

For each covered “auto” a deductible of $100 for Comprehensive Coverage and $1,000 for Collision Coverage will apply.

is changed by the following:

is changed by adding the following:

If you report an injury to an “employee” to your workers’ compensation carrier and if it is subsequently determined that the injury is one to which this insurance may apply, any failure to comply with this condition will be waived if you provide us with the required notice as soon thereafter as practicable after you know or reasonably should have known that this insurance may apply.

is changed by adding the following:

However, this Condition does not apply to any person(s) or organization(s) with whom you have a written contract, but only to the extent that subrogation is waived prior to the “accident” or the “loss” under such contract with that person or organization.

XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 6 of 6

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

is changed by the following:

The following condition is added:

Your unintentional failure to disclose all hazards as of the inception date of the policy shall not prejudice any insured with respect to the coverage afforded by this policy.

is changed by adding the following:

For any covered “auto” this insurance shall apply as primary and not contribute with any other insurance where such requirement is agreed in a written contract executed prior to a “loss”.

“Bodily injury” is replaced by the following:

“Bodily injury” means bodily injury, sickness or disease sustained by a person including mental anguish, mental injury, shock, fright or death resulting from any of these at any time.

is replaced by the following:

The greater of sixty (60) days or the time required by any applicable state amendatory endorsement before the effective date of cancellation if we cancel for any other reason.

All other terms and conditions of this policy remain unchanged.

policy number: MWC1037886