Enertech_Certificate_of_Insurance_Valid_Thru_2-28-21.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 EXP

TYPE 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

12/9/2020

(830) 387-7019 (830) 387-7022

20699

TAC Enertech Resources Holdings, LLC 1820 Watson Lane East New Braunfels, TX 78130

42307

22945

00000

A 1,000,000

G46608288 004 2/28/2020 2/28/2021 300,000

10,000

1,000,000

2,000,000

2,000,000

1,000,000A

PMU H08467973 2/28/2020 2/28/2021

5,000,000B

HO20EXCZ01EJAIV 2/28/2020 2/28/2021 5,000,000

1,000

C 0001302345 2/28/2020 2/28/2021 1,000,000

N 1,000,000

1,000,000

D Pollution Liability B0621PENER008020 2/28/2020 Each Poll/Agg 2,000,000

-Umbrella and Excess Liability: Umbrella Policy #HO20EXCZ01EJAIV (2/28/2020-2/28/2021) is with Navigators Insurance Company and has a $5,000,000 limit/aggregate. The Excess Liability Policy # NHA89158 (2/28/2020-2/28/2021) is with RSUI Indemnity Company and has an excess limit/aggregate of $5,000,000 over the Navigators policy. These policies together provide $10,000,000 in coverage. Both the Umbrella and Excess Liability policies are follow form over the underlying policies.

-Architects & Engineers Professional Liability; Error & Omissions & Pollution: Lloyds of London (2/28/2020-2/28/2021) Policy # B0621PENER008020: Limits of Liability $2,000,000 each claim; $2,000,000 Aggregate with $25,000 deductible AND The Excess Professional & Pollution policy is with Lloyds of London Policy

SEE ATTACHED ACORD 101

Arizona Dept. of Public Safety* 2102 W. Encanto Blvd.

Phoenix, AZ 85009

TACENER-01 MZENKNER

Alliant Insurance Services, Inc.

1421 Hanz Dr New Braunfels, TX 78130

Maria Zenkner maria.zenkner@alliant.com

ACE Property & Casualty Insurance Company

Navigators Insurance Company

Texas Mutual Insurance Company

Lloyd's Syndicate 2488

X

2/28/2021

X

X

X

X

X

X

X

FORM NUMBER:

EFFECTIVE DATE:

The ACORD name and logo are registered marks of ACORD

ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE

FORM TITLE:

Page of

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

ACORD 101 (2008/01)

AGENCY CUSTOMER ID:

LOC #:

AGENCY NAMED INSURED

POLICY NUMBER

CARRIER NAIC CODE

© 2008 ACORD CORPORATION. All rights reserved.

Alliant Insurance Services, Inc.

TACENER-01

SEE PAGE 1

SEE PAGE 1

ACORD 25 Certificate of Liability Insurance

SEE P 1

TAC Enertech Resources Holdings, LLC 1820 Watson Lane East New Braunfels, TX 78130

SEE PAGE 1

MZENKNER

Description of Operations/Locations/Vehicles:

#B0621PENER009820 (2/28/2020-2/28/2021) and has an excess limit/aggregate of $3,000,000 over the $2M Lloyds policy. These policies together provide $5,000,000 in coverage. They are Claims made and reported coverage form.

- Cyber Liability: Lloyds of London (2/28/2020-2/28/2021) Policy #ESI0014137894; Limits of Liability $10,000,000 Deductible $25,000;

Includes Liability, Cyber Crime and Media Liability.

-Other States Workers Compensation Coverage: Argonaut Midwest Insurance Company (2/28/2020-2/28/2021) Policy #WC92-859-845142-4: Limits of Employers Liability $1,000,000 Each accident, policy limit and each employee. Argonaut policy covers AZ, NM, AL, MS, OK, CA, CO, AR, GA, LA, ID, IA, PA, FL, NE, TN, KS, KY, MO, IL and MT. Other States coverage covers all states including those listed previously except NY, IL, ND, OH, TX, WA and WY.

-Inland Marine/Contractors Equipment: (2/28/2020-2/28/2021) Policy #0670-46-95, written with Federal Insurance Co., Scheduled Contractors Equipment Limit $1,126,250; Leased, Rented or Borrowed Equipment from Others Limit $100,000; $2,500 deductible.

Project Works/Open Installation (Installation Floater): $1,500,000 limit not to exceed $300,000 per job site. $100,000 in transit;

$100,000 temporary locations. $2,500 deductible.

-The General Liability policy includes a blanket automatic additional insured endorsement that provides additional insured status to the certificate holder when there is an agreement requiring the insured to require such status to the certificate holder per coverage form CG 2010 0413 & CG 2037 0413.

-The Commercial Auto policy includes a blanket automatic additional insured endorsement that provides additional insured status to the certificate holder when there is an agreement requiring the insured to require such status to the certificate holder per coverage form DA-9U74c (03/16).

-The Pollution policy (claims made and reported coverage form) includes a blanket automatic additional insured endorsement that provides additional insured status to the certificate holder when there is an agreement requiring the insured to require such status to the certificate holder per coverage form MEEI 0001 0612.

-The General Liability (CG 2404 0509), Commercial Auto (DA13115a0614), Workers Compensation and Pollution (MEEI 2211 0516) policies include a blanket waiver of subrogation endorsement that provides this feature only when there is a written contract between the named insured and the certificate holder that requires it.

-Policies contain a special provision with "Primary and NonContributory" wording.

-30 Days Notice of Cancellation applies to the General Liability, Auto and Workers Compensation policies.

-Property policy #3605-43-58 WCE, written with Federal Insurance Co., effective 2/28/2020 to 2/28/2021. Blanket Building limit $1,300,000, blanket personal property limit $2,980,910, EDP Property on Premises $175,000. $2,500 deductible.

Extended Named Insured Schedule: DAS Purchaser 1 Corp.; DAS Purchaser 2 Corp.; EasTex Tower, Inc.; EasTex Tower, LLC;

Enertech Resources, LLC; Integrated Wireless Solutions, LLC; JCET Holdings, LLC; Legacy Telecommnications, LLC; Legacy Telecommunications, Inc.; LH Consulting LLC; Ontivity, LLC; RiggingCalc, LLC; TAC Enertech Resources Holdings LLC; CMS Wireless, LLC; NexLevel Safety Training, LLC

*Certificate holder continued: State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees -Inland Marine/Contractors Equipment: (2/28/2020-2/28/2021) Policy #0670-46-95, written with Federal Insurance Co. includes a $5,000,000 Riggers Liability Limit. The Inland Marine policy is All Risk, replacement cost and includes Flood and Earth Movement.

Bid Number BPM002972 for CTR - Tower Services: Construction; Maintenance & Repair; Site Engineering