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Qualifications & Experience <br /> A.7.B. / INSURANCE 66 <br /> AC�® DATE(Mi <br /> lCERTIFICATE OF LIABILITY INSURANCE 9/26/2025 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> NAME: <br /> Arthur J.Gallagher Risk Management Services,LLC PHONE FAx <br /> Mail Stop:072102-CHA we No Ext:864-239-2409 A/c No):704-362-1997 <br /> PO Box 4146 ADDRESS: BW2.BSD.Certs@ajg.com <br /> Clinton IA 52733-4146 INSURER(SLAFFORMNG COVERAGE NAIC# <br /> INSURER A:Travelers Property Casualty Cc of America 25674 <br /> INSURED SAMECOR-01 INSURER B:Pacific Insurance Company,Limited 10046 <br /> Samet Corporation <br /> 309 Gallimore Dairy Rd,Suite 102 INSURER C:Travelers Indemnity Company 25658 <br /> Greensboro NC 27409 INSURER D:Berkley Regional Insurance Company 29580 <br /> INSURER E: Indian Harbor Insurance Company 36940 <br /> INSURERF:Travelers Casualty and Surety Company 19038 <br /> COVERAGES CERTIFICATE NUMBER:1848333196 REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSRPOLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE INSD WVD SUER POLICY NUMBER MM DD/YYYY MM/DD/YYYY LIMITS <br /> C X COMMERCIAL GENERAL LIABILITY Y Y VTC2K-CO-7W348030-IND-25 10/1/2025 10/1/2026 EACH OCCURRENCE $2,000,000 <br /> DAMAGE ToRENTED <br /> CLAIMS-MADE "- OCCUR PREMISES(E.occurrence) $1,000,000 <br /> MED EXP(Any one person) $10,000 <br /> PERSONAL&ADV INJURY $2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 <br /> POLICY[X]JjECT D LOC PRODUCTS-COMP/OP AGG $4,000,000 <br /> OTHER: $ <br /> A AUTOMOBILE LIABILITY Y Y VTJ-CAP-7W348029-TIL-25 10/1/202510/1/2026 COMBINED SINGLE LIMIT $2,000,000 <br /> Ea accident <br /> IX ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> X HIRED X NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> A X UMBRELLALIAB X OCCUR Y Y CUP-7W348042-25-25 10/1/2025 10/1/2026 EACH OCCURRENCE $25,000,000 <br /> D BCS 8800458-30 10/1/2025 10/1/2026 <br /> E X EXCESSLIAB CLAIMS-MADE SXS005764205 10/1/2025 10/1/2026 AGGREGATE $25,000,000 <br /> DED X RETENTION$1 n nnn I I I $ <br /> F WORKERS COMPENSATION Y UB-1X658735-25-25-K 10/1/2025 10/1/2026 X PER ETH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANYPROPRIETOR/PARTNER/EXECUTIVEN/A E.L.EACH ACCIDENT $1,000,000 <br /> OFFICER/MEMBEREXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 <br /> B Pollution Liablity 30CPIBD5684 10/1/2025 10/1/2026 Professional Limit 10,000,000 <br /> Professional Liability Pollution Limit 10,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Umbrella/Excess Includes: <br /> Fair American Select Insurance Company-Policy#CSX-8000609-01-Effective 10/1/25-10/1/26 <br /> Westchester Surplus Lines Insurance Company-Policy#G71744097-007-Effective 10/1/25-10/1/26 <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Proof of Insurance AUTHORIZED REPRESENTATIVE <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br /> IN <br /> RFQ 367-005466 /The Renovation& Construction of Sheriff's Office Facilities <br />