State_of_Arizona_and_Arizona_Game_and_Fish_Department_WC_Certificate.pdf

Certificate of Insurance Certificate No. 147716

Rev. Date: 1/3/2024

This is to certify that the policy(ies) of insurance as described below have been issued to the Insured for whom this Certificate is executed and is/are in force at this time. This Certificate is issued for information only and confers no rights upon the holder. This Certificate neither affirmatively nor negatively amends, extends or alters the coverage afforded by such policy(ies) or binder(s) stated herein. This certificate cancels and supersedes all previously issued certificates.

Certificate Holder: Arizona Game and Fish Department Purchasing Office 5000 W. Carefree Highway Phoenix, AZ 85086

Named Insured: Papillon Group 1265 Airport Road

Boulder City, NV 89005

Policy Type: Workers' Compensation & Employers' Liability Policy

Policy Period: January 01, 2024 to January 01, 2025 both days at 12:01am Local Standard Time at the address of the Named Insured shown above

Insurer(s): Company Policy No(s).

Starr Indemnity & Liability Company through Starr Aviation 1000003127

Contract No.: CTR060178, Helicopter Flight Services

Workers' Compensation Insurance Coverage Limit State of AZ & NV Statutory

Other States Coverage Coverage Limit All States except ND, OH, WA, WY and states listed under Workers Compensation Insurance above

Statutory

Workers Compensation and Employers' Liability Coverage Limit Workers Compensation Employers' Liability Statutory Limits E.L. Each Accident: $1,000,000. E.L. Disease-

Each Employee: $1,000,000. E.L. Disease-Policy Limit:

$1,000,000.

Coverage & Limits

Waiver of Subrogation With respect to Workers Compensation coverage provided by this policy the Company hereby waives its rights of Subrogation against the State of Arizona, the Arizona Game and Fish Department, and its departments, agencies, boards, commission, universities, officer, officials, agents and employees, excluding gross negligence and/or willful misconduct by the State of Arizona, the Arizona Game and Fish Department, and its departments, agencies, boards, commission, universities, officer, officials, agents and employees.

Certificate Provisions

3535 Factoria Blvd SE, Suite 510, Bellevue, WA 98006 Phone: (206) 232-9870 - Fax: (206) 232-9515

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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY

(Ed. 04-84)

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Schedule

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.

Any person or organization to whom you become obligated to waive your rights of recovery against, under any contract or agreement you enter into prior to the occurrence of loss.

Endorsement Effective: Policy No.: Endorsement No.:

Insured: Premium:

Insurance Company: Countersigned by:

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.

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

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(Ed. 04-84) Page 1 of 1