AAGO16-118345-Insurance_Certs.pdf

ThoughtSpan Technology 14045 Ballantyne Corp. Place, Suite 550, Charlotte, NC 28277 www.thoughtspantech.com | 888.548.5058 (P) | 704.973.9758 (F)

Solicitation No.: AAGO16-00005379

Project # AG16-0003

Insurance Certificates

Please find below our current insurance certificates including Waivers of Subrogation. These are the current certificates on file with the AGO and/or state procurement office.

CERTIFICATE.OF.LIABILITY.INSURANCE

RMB DATE (MM/DD/YYYY)

R001 4/8/2015

THIS CERTIFICATEIS 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 CONTACT

NAME:

METLIFE AUTO & HOME INS AGCY/PHS PHONE

(A/C, No, Ext): (866) 467-8730

FAX

(A/C, No): (888) 443-6112

180001 P:(866) 467-8730 F:(888) 443-6112 E-MAIL

ADDRESS:

301 WOODS PARK DRIVE INSURER(S) AFFORDING COVERAGE NAIC#

CLINTON NY 13323 INSURER A : Hartford Casualty Ins Co 29424

INSURED INSURER B :

INSURER C :

THOUGHTSPAN TECHNOLOGY LLC INSURER D :

14045 BALLANTYNE CORPORATE PL STE 550 INSURER E :

CHARLOTTE NC 28277 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/YYYY)

LIMITS

COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000

CLAIMS-MADE X OCCUR DAMAGE TO RENTED

PREMISES (Ea occurrence) $300,000

A X General Liab X X 47 SBA VA2644 10/01/2014 10/01/2015 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: $

AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT

(Ea accident) $1,000,000

ANY AUTO BODILY INJURY (Per person) $

A ALL OWNED

AUTOS

SCHEDULED

AUTOS 47 SBA VA2644 10/01/2014 10/01/2015 BODILY INJURY (Per accident) $

X HIRED AUTOS X NON-OWNED

AUTOS

PROPERTY DAMAGE

(Per accident) $

X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $1,000,000

A EXCESS LIAB CLAIMS-MADE X 47 SBA VA2644 10/01/2014 10/01/2015 AGGREGATE $1,000,000

DED X RETENTION $ 10,000 $

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

N/ A

PER

STATUTE

OTH-

ER

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH)

Y/N E.L. EACH ACCIDENT $

E.L. DISEASE- EA EMPLOYEE $

If yes, describe under DESCRIPTION OF OPERATIONS below

E.L. DISEASE - POLICY LIMIT

A Technology E&O 47 SBA VA2644 10/01/2014 10/01/2015 1,000,000/2,000,000

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. Please see attached.

CERTIFICATE HOLDER CANCELLATION

State of Arizona

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED

BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE

DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

Arizona Office of the Attorney General

1275 W WASHINGTON ST

PHOENIX, AZ 85007

AUTHORIZED REPRESENTATIVE

© 1988-2014 ACORD CORPORATION. All rights reserved.

ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD

AGENCY CUSTOMER ID:

LOC#:

ADDITIONAL REMARKS SCHEDULE Page of

AGENCY NAMED INSURED

METLIFE AUTO & HOME INS AGCY/PHS

POLICY NUMBER THOUGHTSPAN TECHNOLOGY LLC

SEE ACORD 25 14045 BALLANTYNE CORPORATE PL STE 550

CARRIER NAIC CODE CHARLOTTE NC 28277

SEE ACORD 25 EFFECTIVE DATE: SEE ACORD 25

ADDITIONAL REMARKS

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM

FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE

The State of Arizona for the office of the Attorney General , and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees shall be named as additional insureds per the Business Liability Coverage

Form SS0008 attached to this policy with respect to liability arising out of the activities performed by or on behalf of the Contractor. Waiver of Subrogation applies in favor of the State of Arizona Office of the Attorney General, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees per the Business Liability Coverage Form SS0008 attached to this policy.

Contractual Liability applies per the Business Liability Coverage Form SS0008 attached to this policy

ACORD 101 (2014/01) © 2014 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

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 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

AUTOSAUTOS

NON-OWNED

HIRED AUTOS

SCHEDULEDALL OWNED

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 (2014/01)

© 1988-2014 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

04/15/2015

Automatic Data Processing Insurance Agency, Inc.

1 Adp Boulevard Roseland, NJ 07068

THOUGHTSPAN TECHNOLOGY LLC

PO BOX 77414

Charlotte, NC 28271

Employers Compensation Insurance Company 11512

332422

A Y Y EIG151106202 06/01/2014 06/01/2015

X 1,000,000 1,000,000 1,000,000

This certificate of insurance includes a Waiver of Subrogation in favor of the certificate holder.

Arizona Office of the Attorney General 1275 W Washington Phoenix, AZ 85007