2024_State_of_Arizona_COI_Hartford.pdf

WLTR005

THE HARTFORD

BUSINESS SERVICE CENTER

3600 WISEMAN BLVD

SAN ANTONIO TX 78251 May 28, 2024

State of Arizona Arizona Department of Administration

1802 W JACKSON ST STE 100

PHOENIX AZ 85007

Account Information:

Policy Holder Details : JS Reporting Inc Contact Us

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(866) 467-8730.

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Enclosed please find a Certificate Of Insurance for the above referenced Policyholder. Please contact us if you have any questions or concerns.

Sincerely, Your Hartford Service Team

CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)

05/28/2024 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 be endorsed. If SUBROGATIONIS 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).

PRODUCER

USI INSURANCE SERVICES LLC/PHS

41715776 The Hartford Business Service Center 3600 Wiseman Blvd San Antonio, TX 78251

CONTACT

NAME:

PHONE

(A/C, No, Ext):

(877) 532-3486 FAX

(A/C, No):

E-MAIL

ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC#

INSURED

JS Reporting Inc 20701 N Scottsdale Road Suite Scottsdale AZ 85255

INSURER A : Hartford Casualty Insurance Company 29424

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

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.

INSR

LTR

TYPE OF INSURANCE ADDL

INSR

SUBR

WVD

POLICY NUMBER POLICY EFF

(MM/DD/YYYY)

POLICY EXP

(MM/DD/Y YYY)

LIMITS

A

COMMERCIAL GENERAL LIABILITY

X X 41 SBA BX4567 08/03/2023 08/03/2024

EACH OCCURRENCE $1,000,000

CLAIMS-MADE X OCCUR DAMAGE TO RENTED

PREMISES (Ea occurrence) $300,000

X General Liability MED EXP (Any one person) $10,000

PERSONAL & ADV INJURY $1,000,000

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000

POLICY PRO-

JECT X LOC PRODUCTS - COMP/OP AGG $2,000,000

OTHER:

A

AUTOMOBILE LIABILITY

41 SBA BX4567 08/03/2023 08/03/2024

COMBINED SINGLE LIMIT

(Ea accident)

$1,000,000 ANY AUTO BODILY INJURY (Per person)

ALL OWNED

AUTOS

SCHEDULED

AUTOS BODILY INJURY (Per accident)

X HIRED

AUTOS X NON-OWNED

AUTOS

PROPERTY DAMAGE

(Per accident)

UMBRELLA LIAB

EXCESS LIAB

OCCUR

CLAIMS-

MADE

EACH OCCURRENCE

AGGREGATE

DED RETENTION $

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

ANY

PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below

N/ A

PER

STATUTE

OTH-

ER

Y/N E.L. EACH ACCIDENT

E.L. DISEASE -EA EMPLOYEE

E.L. DISEASE - POLICY LIMIT

A EMPLOYMENT PRACTICES

LIABILITY

41 SBA BX4567 08/03/2023 08/03/2024 Each Claim Limit Aggregate Limit

$5,000 $5,000

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

Those usual to the Insured's Operations. Certificate holder is an additional insured per the Business Liability Coverage Form SS0008 attached to this policy. Waiver of Subrogation applies in favor of the Certificate Holder per the Business Liability Coverage Form SS0008, attached to this policy.

CERTIFICATE HOLDER CANCELLATION

State of Arizona Arizona Department of Administration

1802 W JACKSON ST STE 100

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.

AUTHORIZED REPRESENTATIVE

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