CTR075379 2025.08.01 COI.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

1/22/2025

Aon Risk Services Central Inc.

200 E Randolph St.

Chicago, IL 60601

317-841-6004 317-841-6006

Swiss Re Corporate Solutions Elite Ins 29700

Old Republic Insurance Company 24147

A 5,000,000CGP0000001-02 8/1/2024 8/1/2025

5,000,000

10,000

5,000,000 5,000,000

5,000,000

B MWTB 317015 24 8/1/2024 8/1/2025 2,000,000

PHYSICAL DAMAGE SELF-INSURED

A CGU0000001-02 8/1/2024 8/1/2025 20,000,000✓✓

20,000,000

B MWC 314311-24 8/1/2024 8/1/2025 ✓

2,000,000 N

2,000,000 2,000,000

B Excess Auto Liability MWZX 317016 24 8/1/2024 8/1/2025 Limit 3,000,000

Al King

A. I. King Insurance Agency, Inc. (CMI) cummins@aikinginsurance.com

Cummins Inc.

500 Jackson Street Columbus IN 47201-6258

83643145

General Liability, Auto Liability and Umbrella Policies are primary & non-contributory.

The State of Arizona/ADOT 206 S. 17th Ave Phoenix, AZ 85007

The State of Arizona/ADOT is listed as additional insured with a waiver of subrogation as required by written contract.

83643145 | 24/25 GL AU UMB WC (Custom Merged) | Shelly Pence | 1/22/2025 2:44:03 PM (EST) | Page 1 of 10 This certificate cancels and supersedes ALL previously issued certificates.

Cindy Lewis Accepted

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED – OWNERS, LESSEES OR

Swiss Re Corporate Solutions Elite Insurance Company Endorsement No. 3

CONTRACTORS – SCHEDULED PERSON OR

ORGANIZATION

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE

Name Of Additional Insured Person(s) Or Organization(s)

Location(s) Of Covered Operations

All persons or organizations as required by written contract or agreement

All locations on file with the Company

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", "property damage" or "personal and advertising injury" caused, in whole or in part, by:

1.Your acts or omissions; or 2.The acts or omissions of those acting on your behalf;

in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above.

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 additional exclusions apply:

This insurance does not apply to "bodily injury" or "property damage" occurring after:

1.All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or

2.That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project.

Insured Copy

CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2

83643145 | 24/25 GL AU UMB WC (Custom Merged) | Shelly Pence | 1/22/2025 2:44:03 PM (EST) | Page 4 of 10 This certificate cancels and supersedes ALL previously issued certificates.

C. 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.

All other terms and conditions of this policy shall remain unchanged.

This endorsement forms a part of the policy to which attached, effective on the inception date of the policy unless otherwise stated herein.

Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 10 12 19

(The information below is required only when this endorsement is issued subsequent to the preparation of the policy.)

Policy Number:

Endorsement Effective Date:

Named Insured: Cummins Inc.

CGP0000001-02

08/01/2024

83643145 | 24/25 GL AU UMB WC (Custom Merged) | Shelly Pence | 1/22/2025 2:44:03 PM (EST) | Page 5 of 10

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED – OWNERS, LESSEES OR

Swiss Re Corporate Solutions Elite Insurance Company Endorsement No. 4

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) All persons or organizations as required by written contract or agreement

Location And Description Of Completed Operations All locations on file with the Company

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.

CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2

83643145 | 24/25 GL AU UMB WC (Custom Merged) | Shelly Pence | 1/22/2025 2:44:03 PM (EST) | Page 2 of 10

All other terms and conditions of this policy shall remain unchanged.

This endorsement forms a part of the policy to which attached, effective on the inception date of the policy unless otherwise stated herein.

CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 2 of 2

(The information below is required only when this endorsement is issued subsequent to the preparation of the policy.)

Policy Number:

Endorsement Effective Date:

Named Insured: Cummins Inc.

CGP0000001-02

08/01/2024

83643145 | 24/25 GL AU UMB WC (Custom Merged) | Shelly Pence | 1/22/2025 2:44:03 PM (EST) | Page 3 of 10

Cummins Inc.

CGP0000001-02

08/01/2024 08/01/2025

83643145 | 24/25 GL AU UMB WC (Custom Merged) | Shelly Pence | 1/22/2025 2:44:03 PM (EST) | Page 7 of 10

CGP0000001-02

08/01/2024 08/01/2025

83643145 | 24/25 GL AU UMB WC (Custom Merged) | Shelly Pence | 1/22/2025 2:44:03 PM (EST) | Page 6 of 10

IL 10 �12/06) OLD REPUBLIC INSURANCE COMPANY

n-ns ENDORSEMENT CS-{ANGES TH= PCl.lCY. PLEASE READ IT CAREFULLY ..

ADDIT�ONAL INSURBD AND PRIMARY AND

NON-CONllRIBUfTORY ENDORSEMENT

This endorsement mocr es insurance provided under iale .. oOa,Ying:

BUSINESS AUTO COVERAGE IFORM

MOTOR CARRIER COVERAGE FORM

SCHEDULE

Designated Person ls) or Organizalion(s,:

.AJI persOC",s or organiza:icns where required by wriiten oon,rao, A SECTIOJlil □ - COVERED AUTOS UABIUTY OOVERAG E, paragraph 1 .. Who Is An Insured is amended :o indude :he per'SO.n(s} or organiza:i!Jlj (s) sho-1. in the .al::ove Schedu[e .as an m:ltiition.3.1 " i nsured·. but on[y \vith rrespem to "accidents" arising out of your 'liOrK 11,hrle being per.onned for such person(-s) ororganiz.a:ion(s}.

B.. The follo-1.mg is added to me other Insurance Condition in the Business Auto Coverage Form

.and 1he otn"E!r Insuran ce - Primary And Ex�s Insur ance Provisions in 1he Mo:or Carner Cover.::;ge Form and supersedes Gn)' provision :o the coriir,::uy:

This polfcy's Covered Au-�os Liabil y Co•.-erage is primary to and ,,.;11 not secek contribution from

.any o:her insurance available �o me ·insr..llJ1edr per'SO.n(s} or organiza1io.n(s) shown in 1t.e ebave Sdhedule provided th.er

1. Suc'h ·insured1· is a Named Insured under such other insuranoe; and

2. Yoo have .agreed in ,Yriting c.n .a oomracl or 3greement chat this insriance would be pcimary and ,,.ould not seek oon:ributioo horn any ott-.er insurance .3.1,•.mable to s1Jdh "insured•.

PCA 048, 09 1fl Page 1 • 1 ln.clu:des ooi:yr1�E<I l'Tli1tel1i1l rJ 11"1:'Sunn.ce ser.1ces Ci'llce. mnr.., WO! ltti p=-:mssm

Cummins Inc.

MWTB 317015 24

08/01/2024 08/01/2025

83643145 | 24/25 GL AU UMB WC (Custom Merged) | Shelly Pence | 1/22/2025 2:44:03 PM (EST) | Page 8 of 10

MWTB 317015 24

08/01/2024 08/01/2025

83643145 | 24/25 GL AU UMB WC (Custom Merged) | Shelly Pence | 1/22/2025 2:44:03 PM (EST) | Page 9 of 10

WC 00 03 13

(Ed. 4-84)

1983 National Council on Compensation Insurance.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13

(Ed. 4-84)

POLICY NUMBER:

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.

Schedule

ALL PERSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN

CONTRACT.

NOT APPLICABLE IN CA, TX AND UT

DATE OF ISSUE:

MWC 314311-24

08/01/2024

83643145 | 24/25 GL AU UMB WC (Custom Merged) | Shelly Pence | 1/22/2025 2:44:03 PM (EST) | Page 10 of 10