CTR077218_CGL_AL_WC_COI_Exp_04_27_2026_EOP_Exp_5_27_2026.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

7/2/2025

Canyon Lands Insurance

1655 West Drake Drive

Tempe AZ 85263

Andrea Gonzales

(480) 288-5900 x 1003 (480) 288-5906 andrea@canyonlandsinsurance.com

Independence Home Remodeling Inc

6031 W Grovers Ave

Glendale AZ 85308

ACUITY A MUT INS CO 14184

LLOYDS OF LONDON 122000

A

Y Y ZQ9011 04/12/2025 04/12/2026

1,000,000

300,000

10,000

1,000,000

3,000,000

3,000,000

Tenants Liability 10,000

A

✘ COMP $1,000

✘ COLL $1,000

Y Y ZQ9011 04/12/2025 04/12/2026

1,000,000

A Y Y ZQ9011 04/12/2025 04/12/2026

1,000,000

1,000,000

1,000,000

B

ERRORS AND OMISSIONS

POLLUTION

ANE555080925 05/27/2025 05/27/2026

PER OCCURENCE 2,000,000

GENERAL AGGREGATE 2,000,000

See ACORD 101

The State of Arizona and Dept of Economic Security c/o myCOI

PO Box 501970, 8710 Bash Street

Indianapolis IN 46256

EFFECTIVE DATE:

NAMED INSURED

POLICY NUMBER

NAIC CODECARRIER

AGENCY

LOC #:

AGENCY CUSTOMER ID:

ofPageADDITIONAL REMARKS SCHEDULE

ADDITIONAL REMARKS

FORM TITLE:FORM NUMBER:

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

© 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

ACORD 101 (2008/01)

1 1

Canyon Lands Insurance

ZQ9011, ANE555080925

ACUITY A MUT INS CO 14184, 122000

Independence Home Remodeling Inc

25 Certificate Of Liability Insurance

RE: Contract ID: CTR077218

(GL Additional Insured) 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. Primary and Non-Contributory Wording is included in the policy language. Waiver of Subrogation applies as permitted by policy language. 30-day Notice of Cancellation is included.

(Auto Additional Insured) 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.

(GL and Auto Waiver Wording) 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.

Sexual Abuse and Molestation coverage is not excluded.

The owner, Michael Ryan, is the only excluded individual from the Workers Compensation Coverage.

This endorsement modifies insurance provided under the following:

BIS-PAK® COMMON POLICY CONDITIONS

The following is added to paragraph H Other Insur-ance of the Bis-Pak® Common Policy Conditions and supersedes any provision to the contrary:

This insurance is primary to and will not seek con-tribution from any other insurance available to an additional insured under your policy provided that:

The additional insured is a Named Insured un-der such other insurance; and

You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured.

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

POLICY NUMBER: ZQ9011

CB-7331(7-13) Page 1 of 1

ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -

SCHEDULED PERSON OR ORGANIZATION

CB-7331(7-13)

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

This endorsement modifies insurance provided under the following:

BIS-PAK® BUSINESS LIABILITY AND MEDICAL

EXPENSES COVERAGE FORM

1. The following is added to Who Is An Insured:

Any 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:

a. Your acts or omissions; or

b. 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 below.

However:

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

b. 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.

2. 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:

a. 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

b. 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.

3. With respect to the insurance afforded to these additional insureds, the following is added to the Liability And Medical Expenses Limits Of Insurance section:

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:

a. Required by the contract or agreement; or

b. Available under the applicable Limits of Insurance shown in the Declarations;

whichever is less.

This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.

SCHEDULE

Name of Additional Insured Person(s) or Organization(s)

(Name and Address) Location(s) of Covered Operations

STATE OF ARIZONA

1789 W JEFFERSON M/D 2HC3

PO BOX 6123

PHOENIX AZ 85005

HOME MODIFICATIONS FOR

THE DISABLED WHO QUALIFY

CB-7333(10-01) Page 1 of 1

ADDITIONAL INSURED - COMPLETED OPERATIONS SCHEDULED (OWNERS,

LESSEES OR CONTRACTORS)

CB-7333(10-01)

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

This endorsement modifies insurance provided under the following:

BIS-PAK® BUSINESS LIABILITY AND MEDICAL

EXPENSES COVERAGE FORM

The following is added to Who Is An Insured:

Any person or organization shown in the Schedule is also an insured, but only with respect to liability arising out of your work at the location designated and described in the schedule of this endorsement performed for that insured and included in the products-completed operations hazard.

SCHEDULE

Person or Organization (Name and Address)

Location and Description of Completed Operations

STATE OF ARIZONA

1789 W JEFFERSON M/D 2HC3

PO BOX 6123

PHOENIX AZ 85005

HOME MODIFICATIONS FOR

THE DISABLED WHO QUALIFY

IL-8000(1-90) Page 1 of 1

MANUSCRIPT ENDORSEMENT IL-8000(1-90)

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

Acuity, A Mutual Insurance Company

This endorsement modifies insurance provided under the following:

ANYWHERE "STATE OF ARIZONA" IS LISTED ON THIS POLICY IT

MEANS: "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"

WC 00 03 13(4-84) Page 1 of 1

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

Acuity, A Mutual Insurance Company

WC 00 03 13(4-84)

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 any one not named in the Schedule.

SCHEDULE

We will not enforce our right against any person or organization with whom you have a written contract or agreement which you are required to waive rights of recovery under this policy. We will not enforce our right against any other person or organization named in these contracts or agreements which you are also required to waive rights of recovery. Such a contract or agreement must have been executed prior to the occurrence causing injury or damage. An entity meeting these requirements does not have to be named in the Schedule for the waiver to apply.

This waiver also applies to the following person(s) or organization(s):

THE STATE OF ARIZONA & DEPT OF ECONOMIC

SECURITY

C/O: MYCOI P.O. BOX #501970

8710 BASH STREET

INDIANAPOLIS, IN 46256