Adashi_COI_-_Expires_5-31-2024.pdf

INSR ADDL SUBR

LTR INSR WVD

DATE (MM/DD/YYYY)

PRODUCER CONTACT

NAME:

FAXPHONE

(A/C, No):(A/C, No, Ext):

E-MAIL

ADDRESS:

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

POLICY NUMBER

POLICY EFF POLICY EXP

TYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)

COMMERCIAL GENERAL LIABILITY

AUTOMOBILE LIABILITY

UMBRELLA LIAB

EXCESS LIAB

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

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

AUTHORIZED REPRESENTATIVE

INSURER(S) AFFORDING COVERAGE NAIC #

Y / N

N / A (Mandatory in NH)

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

EACH OCCURRENCE $

DAMAGE TO RENTED

$PREMISES (Ea occurrence)CLAIMS-MADE OCCUR

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER:

PRODUCTS - COMP/OP AGG $

PRO-

OTHER:

LOCJECT

COMBINED SINGLE LIMIT

$(Ea accident)

BODILY INJURY (Per person) $ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS

AUTOS ONLY

HIRED PROPERTY DAMAGE $

AUTOS ONLY (Per accident)

OCCUR EACH OCCURRENCE $

CLAIMS-MADE AGGREGATE $

DED RETENTION $ $

PER OTH-

STATUTE ER

E.L. EACH ACCIDENT $

E.L. DISEASE - EA EMPLOYEE $

If yes, describe under

E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below

POLICY

NON-OWNED

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

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.

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 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 any rights to the certificate holder in lieu of such endorsement(s).

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

CERTIFICATE HOLDER CANCELLATION

© 1988-2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03)

ACORDTM CERTIFICATE OF LIABILITY INSURANCE

Westchester Fire Insurance Company

Scottsdale Indemnity Company

Federal Insurance Company

5/31/2023

Marsh & McLennan Agency LLC 11330 Lakefield Drive Suite 100 Johns Creek, GA 30097-1508

Ranee K Mannion 770-295-1008

Ranee.Mannion@MarshMMA.com

Adashi Systems, Inc.

3700 O'Donnell Street, Suite 200 Baltimore, MD 21224

10030 15580 20281

A X X

D01728611 05/31/2023 05/31/2024 1,000,000 1,000,000 15,000 1,000,000 2,000,000 2,000,000

C

X X

73633936 05/31/2023 05/31/2024 1,000,000

B TechE&O/Cyber EKI3480480 05/31/2023 05/31/2024 2,000,000 each claim 2,000,000 aggregate

Additional Insured continued: State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees.

Certificate Holder is included as Additional Insured with regard to the Technology Errors & Omissions and Cyber Security liability policies of the Named Insured, when required by written contract or agreement, and (See Attached Descriptions)

Arizona Department of Administration State Procurement Office 100 N 15th Avenue Phoenix, AZ 85007

#S12846955/M12846940

ADASHISYSTClient#: 868852

JJRKM

#S12846955/M12846940

SAGITTA 25.3 (2016/03)

DESCRIPTIONS (Continued from Page 1) subject to the provisions and limitations of the policy.

Technology Errors & Omissions and Cyber Security liability insurance is Primary and non-contributory, when required by written contract or agreement, and subject to the provisions and limitations of the policy.

Waiver of subrogation applies to the Technology Errors & Omissions and Cyber Security liability when required by written contract or agreement, and subject to the provisions and limitations of the policy.

Certificate holder is included as Additional Insured, when required by written contract or agreement, but only with respect to the General Liability and Auto Liability insurance and subject to the provisions and limitations of the policy.

Waiver of subrogation applies to the General Liability and Auto Liability when required by written contract or agreement, and subject to the provisions and limitations of the policy.

General Liability and Auto Liability insurance is Primary and non-contributory, when required by written contract or agreement and subject to the provisions and limitations of the policy.

#S12846955/M12846940

Job 1: Arizona Department of