Eight_Eleven_-_Certificate_of_Insurance.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

8/19/2025

Marsh & McLennan Agency LLC 20 North Martingale Road Schaumburg IL 60173

Colleen Larson

(312) 625-5674 (847) 440-9126

Colleen.Larson@MarshMMA.com

PHILADELPHIA INDEMNITY INSURAN 18058

EIGHELE-01 QBE INSURANCE CORPORATION 39217

Eight Eleven Group, LLC 6215 N. College Ave Indianapolis IN 46220

Travelers Casualty and Surety 19038

789623317

A X 1,000,000 X 100,000

25,000 X Contractual Li 1,000,000

2,000,000 X X X X Contractual Liab

PHPK2583665003 7/28/2025 7/28/2026

2,000,000

Included A 5,000,000

X X X

PPK2583725002 7/28/2025 7/28/2026

A X X 10,000,000PHUB874892003 7/28/2025 7/28/2026

10,000,000 X 10,000 Prod/Comp Ops 10,000,000

B X

N

202000610 7/28/2025 7/28/2026

1,000,000

1,000,000

1,000,000 C A A

Crime - 3rd Party Employment Practices Liability Professional Liability

107682912

PHPK2583665003

PHPK2583665003

7/28/2025 7/28/2025 7/28/2025

7/28/2026 7/28/2026 7/28/2026

Limit: 5,000,000 Per Occur : 2,000,000 Per Occur: 5,000,000

Ded: 50,000 Agg: 2,000,000 Agg: 5,000,000

The Umbrella Liability Follows Form Over The General Liability, Employers Liability, Scheduled Automobile Liability and The Professional Liability.

Proof of Insurance

Scheduled Automobile Liability 7/28/2025 - 7/28/2026 Philadelphia Insurance Co Policy #: PHPK258366500.

See Attached...

Arizona Department of Administrative State Procurement Office 1802 W. Jackson, #100 Phoenix AZ 85007

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:

EIGHELE-01

1 1

Marsh & McLennan Agency LLC Eight Eleven Group, LLC 6215 N. College Ave Indianapolis IN 46220

25 CERTIFICATE OF LIABILITY INSURANCE

Limits: $1,000,000

Cyber Liability 7/28/2025 - 7/28/2026 Homeland Insurance Co of New York Policy #: 7200021660001 Limits: $10M / $10M

RE: All work performed by the Named Insured on behalf of the Certificate Holder.

The following are additional insured for General Liability and Automobile Liability where required by written contract or agreement per attached form(s) subject to the provisions and limitations of the policy(ies) per policy terms and conditions:

- Arizona Department of Administrative, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees

Primary Non-Contributory coverage applies to General Liability and Automobile Liability where required by written contract or agreement per policy terms and conditions.

Waiver of Subrogation in favor of the following applies to General Liability, Workers Compensation Liability and Automobile Liability where required by written contract or agreement per policy terms and conditions.

30-Day Notice of Cancellation Applies in Favor of the Certificate Holder.