State_of_Arizona.pdf

INSR ADDL SUBR

LTR INSR WVD

DATE (MM/DD/YYYY)

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)

COMMERCIAL GENERAL LIABILITY

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

INSURER(S) AFFORDING COVERAGE NAIC #

Y / N

N / A (Mandatory in NH)

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

EACH OCCURRENCE $

DAMAGE TO RENTED

$PREMISES (Ea occurrence)CLAIMS-MADE OCCUR

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER:

PRODUCTS - COMP/OP AGG $

PRO-

OTHER:

LOCJECT

COMBINED SINGLE LIMIT

$(Ea accident)

BODILY INJURY (Per person) $ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS

AUTOS ONLY

HIRED PROPERTY DAMAGE $

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 LIMIT $DESCRIPTION OF OPERATIONS below

POLICY

NON-OWNED

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 any 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.

The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03)

ACORDTM CERTIFICATE OF LIABILITY INSURANCE

Hartford Fire Insurance Company

Hartford Casualty Insurance Co.

Various- see below

State Automobile Mutual Insurance Co

07/15/2025

Harmon Dennis Bradshaw, Inc.

334-273-7277 P.O. Box 241667 Montgomery, AL 36124

Stephanie Henderson 334 273-7277 334-273-9197 shenderson@hdbinsurance.com

Beasley Allen Crow Methvin Portis & Miles, P.C.

P. O. Box 4160 Montgomery, AL 36103

19682 29424 35289 25135

A X X

21UUNBC5FCY 06/29/2025 06/29/2026 1,000,000

300,000 10,000 1,000,000 2,000,000 2,000,000

D

X X X

10138308CA 06/29/2025 06/29/2026 2,000,000

C X X

X 10,000

See Below 06/29/2025 06/29/2026 50,000,000 50,000,000

B

N

21WBNV8537 06/29/2025 06/29/2026 X

500,000

500,000 500,000

C Hire Phys Damage $100 Comp Ded $1,000 Coll Ded

10138308CA 06/29/2025 06/29/2026 Actual Cash Value or the cost to repair the auto (smallest cost)

Umbrella/Excess Limits:

$10,000,000 primary limit #21XHUBE3GBP- Hartford Casualty Insurance- NAIC #29424 $15,000,000 xs $10,000,000 limit #7034193277- Continental Insurance- NAIC #35289 $10,000,000 xs $25,000,000 limit #EXB583043025NF- Travelers Casualty Property-NAIC #25674 $10,000,000 xs $35,000,000 limit #MKLV5EUE104218- Evanston Insurance Company- NAIC #35378 (See Attached Descriptions)

State of Arizona Office of the Attorney General 2005 N Central Ave Phoenix, AZ 85004

#S895313/M895273

BEAALClient#: 55

SDH

SAGITTA 25.3 (2016/03)

DESCRIPTIONS (Continued from Page 1) $5,000,000 xs $45,000,000 limit #CSX00528934Q00- Starstone Specialty Insurance- NAIC #25496 Project#: AG24-0016

State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are named as Additional Insured on the General Liability and Automobile Liability policies on a Primary and Non-Contributory basis as their interest may appear regarding work performed or services provided by the named insured where required by written contract and subject to the policy terms and conditions. Waiver of subrogation applies to the Additional insured with respect to the General Liability and Auto Liability Policies where required by written contract. 30 day Notice of Cancellation is provided per policy terms, conditions, and exclusions.

#S895313/M895273

Job 40: State of Arizona