E_O_AZDHS_TSSW.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

1/19/2021

Hall & Company A/E Insurance Services 19660 10th Ave NE Poulsbo WA 98370

John Dewing 360-626-2011 360-626-2011 john.dewing@assuredpartners.com

Underwriters at Lloyd's, London/Rivington

TERRSOU-01

TerraSystems Southwest Inc 2761 N. Country Club Rd, Suite 202 Tucson AZ 85716

1740752026

A Professional Liab; Claims Made Contractors Pollution Liab; Occur

ENP 0003020-03 1/15/2021 1/15/2022 $2,000,000 Per Claim $2,000,000 Per Claim

$2,000,000 Aggr $2,000,000 Aggr

The certificate holder is an additional insured per the attached.

Contract No.: CTR043289 The state of Arizona, its departments, agencies, boards, commissions, universities, and its officers, officials, agents, and employees are additional insured per the attached. A waiver of subrogation applies to the Professional Liability and Contractors Pollution Liability in favor of the Additional Insured.

Arizona Department of Health Services 150 N 18th Ave, Suite 260 Phoenix AZ 85007

Page 1CPL271 12/2016

Certain Underwriters at Lloyds

Unique Market Reference B0868PFDBA1804040 effective date of this endorsement: policy number: ENP 0003020‐01

01/15/2019 Endorsement Number: 02

ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – SCHEDULED PERSON OR

ORGANIZATION

This endorsement modifies insurance provided under the following:

CONTRACTORS POLLUTION LIABILITY COVERAGE PART

All other terms and conditions of this Policy remain unchanged.

SCHEDULE

Name of Additional Insured Person(s) Or Organization(s):

Location(s) of Covered Operations

Any person(s) or organization(s) where this endorsement is required by contract.

All project locations where this endorsement is required by contract.

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

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 Damages and Claims Expenses 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.

Page 2CPL271 12/2016

B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:

This insurance does not apply to Damages or Claims Expenses 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.

Page 1CPL275 12/2016

Unique Market Reference B0868PFDBA1804040 effective date of this endorsement: policy number: ENP 0003020‐01

01/15/2019 Endorsement Number: 03

ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – COMPLETED OPERATIONS

This endorsement modifies insurance provided under the following:

All other terms and conditions of this Policy remain unchanged.

CONTRACTORS POLLUTION LIABILITY COVERAGE PART

SCHEDULE

Name Of Additional Insured Person(s) Or

Organization(s):

Location And Description Of Completed

Operations

Any person(s) or organization(s) where this endorsement is required by contract.

All project locations where this endorsement is required by contract.

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

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 Damages and Claims Expenses 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.

Page 1CPP208 12/2016

Unique Market Reference B0868PFDBA1804040 effective date of this endorsement: policy number: ENP 0003020‐01

01/15/2019 Endorsement Number: 04

OTHER INSURANCE – PRIMARY WITHOUT RIGHT OF CONTRIBUTION

This endorsement modifies insurance provided under all coverages applicable to this policy.

All other terms and conditions of this Policy remain unchanged.

In consideration of the premium charged for the Policy, it is hereby understood and agreed that Clause XIV. OTHER INSURANCE is deleted in its entirety and replaced with the following:

XIV. OTHER INSURANCE

Subject to Clause VII. and VIII., where other valid and collectible insurance is available to the Insured for any Pollution Condition or Claim , this insurance shall apply as primary insurance versus any other valid and collectable insurance, and the Underwriters will have no right of contribution against any other insurance company providing insurance for a Pollution Condition or a Claim on a primary basis.

Page 1CPP279 12/2016

Unique Market Reference B0868PFDBA1804040 effective date of this endorsement: policy number: ENP 0003020‐01

01/15/2019 Endorsement Number: 07

WAIVER OF SUBROGATION – CONTRACTORS POLLUTION LIABILITY AND PROFESSIONAL

LIABILITY

This endorsement mo difies insurance to all coverages applicable to this policy and applies specifically for the entity scheduled below.

All other terms and conditions of this Policy remain unchanged.

SCHEDULE

Name of Additional Insured Person(s) Or Organization(s):

All person(s) or organization(s) where this endorsement is required by contract.

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

In consideration of the premium charged for the Policy, it is hereby understood and agreed that Clause XX. SUBROGATION is deleted in its entirety and replaced with the following:

XX. SUBROGATION

In the event of any payment under this Insurance, the Underwriters shall be subrogated to all the Insureds’ rights of recovery therefore against any person or organization, and the Insured shall execute and deliver instruments and papers and do whatever else is necessary to secure such rights. The Insured shall do nothing to prejudice such rights.

The Underwriters agree to waive its rights of recovery against any person or entity for a Claim which is covered pursuant to this Policy, but only where indemnity or contractual obligation has been provided by the Named Insured pursuant to a written contract. Any recoveries shall be applied first to subrogation expenses, second to the Named Insured to the extent of any payments in excess of the Limit of Liability, third to Damages , Cleanup Costs and Claims Expenses paid by the Underwriters, and fourth to the Deductible. Any additional amounts recovered shall be paid to the Named Insured.

Page 1CPL262 12/2016

Unique Market Reference B0868PFDBA1804040 effective date of this endorsement: policy number: ENP 0003020‐01

01/15/2019 Endorsement Number: 01

ADDITIONAL CLAIMS EXPENSE LIMIT

This endorsement modifies insurance provided under the Contractors Pollution Liability Coverage applicable to this policy.

All other terms and conditions of this Policy remain unchanged.

In consideration of the premium charged for the Policy, it is hereby understood and agreed that:

1. Item 3. of the Declarations is amended to include the following:

(c) $1,000,000 Additional Claims Expense Limit – Each Pollution Condition

(d) $1,000,000 Additional Claims Expense Limit – Aggregate for the Policy Period

2. Subject to Item 3(d), the amount shown in Item 3(c) shall be the Additional Claims Expense Limit for each Pollution Condition which shall be separate and in addition to the Limit shown in Item 3(a) of the Declarations.

3. Payment of Claims Expenses shall erode the Additional Claims Expense Limits first and will not erode the limits in Item 3(a) and 3(b) until limits in Item 3(c) and 3(d) are exhausted, respectively, Page 1CPP263 12/2016

Unique Market Reference B0868PFDBA1804040 effective date of this endorsement: policy number: ENP 0003020‐01

01/15/2019 Endorsement Number: 06

ADDITIONAL CLAIMS EXPENSE LIMIT – PROFESSIONAL LIABILITY

This endorsement modifies insurance provided under the Professional Liability Coverage applicable to this policy.

All other terms and conditions of this Policy remain unchanged.

In consideration of the premium charged for the Policy, it is hereby understood and agreed that:

1. Item 3. of the Declarations is amended to include the following:

(c) $1,000,000 Additional Claims Expense Limit – Each Claim

(d) $1,000,000 Additional Claims Expense Aggregate for the Policy Period

2. Subject to Item 3(d), the amount shown in Item 3(c) shall be the Additional Claims Expense Limit for each Claim which shall be separate and in addition to the Limit shown in Item 3(a) of the Declarations.

3. Payment of Claims Expenses shall erode the Additional Claims Expense Limits first and will not erode the limits in Item 3(a) and 3(b) until limits in Item 3(c) and 3(d) are exhausted, respectively,