2023-05-25_COI_GL_AL_U_WC_TEO.pdf

04/03/2023

Stahl & Associates Insurance Inc.

3939 Tampa Road

Oldsmar FL 34677

Maribeth Patino

(813) 818-5300 (813) 818-5396 maribeth.patino@stahlinsurance.com

Geographic Solutions, Inc.

2570 Coral Landings Blvd

Palm Harbor FL 34684

Great Northern Insurance Co 20303 Federal Insurance Company 20281 Phoenix Insurance Company 25623 Endurance American Specialty Ins Co 41718

22-23 Master

A Y Y 35935113 05/25/2022 05/25/2023

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

B Y Y 99486726 05/25/2022 05/25/2023

1,000,000

B Y 79880107 05/25/2022 05/25/2023 5,000,000 5,000,000

C N Y UB-6N916326-22 05/25/2022 05/25/2023

1,000,000 1,000,000 1,000,000

D Tech E&O/Cyber (Primary Layer)

Y Y PRO10011187905 05/25/2022 05/25/2023

Aggregate $5,000,000 Rentention $50,000 Retro Date See Remarks*

ADES Contract Number CTR063562 Arizona Department of Economic Security the State of Arizona, its departments, agencies, boards, commissions, universities, officers, officials, agents and employees are included as Additional Insured on a Primary and Non-Contributory basis as regards the General Liability, Auto Liability and Cyber E&O, as required by written contract. Waiver of Subrogation applies in favor of the General Liability, Auto Liability, Cyber, E&O as required by written contract. A waiver of subrogation as required by the written agreement in favor of the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees for losses arising from work performed by or on behalf of the Contractor applies.

30 day notice of cancellation except 10 days for non-payment of premium will be provided per policy terms and conditions. Umbrella is follow form.

Arizona Department of Economic Security 1789 W Jefferson Street, Mail Drop 1541 Phoenix AZ 85007

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

Geographic Solutions, Inc.Stahl & Associates Insurance Inc.

25 Certificate of Liability Insurance: Notes

*Tech E&O/Cyber (Primary Layer) Retroactive Dates- Tech E&O and Media Liability: 5/25/2008, except 9/21/2015 for limits of liability $3,000,000 excess of $2,000,000 Cyber: Full Prior Acts

G 1st Excess Layer: Tech E&O / Cyber MTE903511205 5/25/2022 - 5/25/2023 Aggregate $5,000,000 - Indian Harbor Inws. Co.. - NAIC #36940

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: