5-SecureOne State-of-Arizona_insurance.pdf

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

Phoenix AZ 85007

100 North 15th Avenue

The State of Arizona

See ACORD 101

7,500Retention per claim

2,000,000Combined Aggregate

2,000,000Per claim

06/30/202306/30/2022652243750Y

Professional Liability

Cyber Liability

Media Liability

D

1,000,000

1,000,000

1,000,000

06/30/202306/30/202259WBCAG6XDZYYC

5,000,000

5,000,000

04/21/202304/21/20227015274251Y

10,000✘

A

1,000,000

06/30/202306/30/202210030568CAYY

B

4,000,000

4,000,000

2,000,000

10,000

1,000,000

2,000,000

04/21/202304/21/20227012748297YY

A

35289CONTINENTAL INS CO

00914THE HARTFORD

25135STATE AUTOMOBILE MUT INS CO

20443CONTINENTAL CAS CO

85009-1445AZPhoenix

2801 N 33rd Ave Ste 1

Secure One Outsource Solutions

Michelle@insuranceproaz.com

(480) 981-6339(480) 981-6338

Michelle Jaramillo

85213AZMesa

3521 E Brown Rd. Ste 101

Insurance Professionals of Arizona

7/13/2022

EFFECTIVE DATE:

NAMED INSURED

POLICY NUMBER

NAIC CODECARRIER

AGENCY

LOC #:

AGENCY CUSTOMER ID:

ofPageADDITIONAL REMARKS SCHEDULE

ADDITIONAL REMARKS

FORM TITLE:FORM NUMBER:

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

© 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

ACORD 101 (2008/01)

REFERENCE: #ADSPO18-00007454 - Document Management Services

The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are additional insured and coverage applies per above and attached endorsements. Waiver of subrogation in favor of State of Arizona, its departments, agencies, boards, commissions, universities, officers, officials, agents and employees, where required by written contract.

Professional Liability / Cyber Liability - Contenental Casualty Company $2M Limit Policy No. GLS12049X effective 06/30/2020 to 06/30/2021.

CA Work Comp: National Fire Insurance Company of Hartford Policy No. 59SB3514EU, effective 06/30/2020 to 06/30/2021, $1M/$1M/$1M

Certificate holder and others when required in a written contract or agreement are Additional Insured (General Liability & Automobile Liability). Coverage is

Primary & Non-Contributory when required in a written contract or agreement (General Liability & Automobile L

Certificate Of Liability Insurance25

Secure One Outsource Solutions

20443, 20443, 25135, 00914, 35289CNA

7015274251, 7012748297, 10030568CA, 59WBCAG6XDZ, 652243750

Insurance Professionals of Arizona