Analytical_Intelligence_-_COI_Part_2.pdf

PDF 296 KB Posted

Attached to
Master Agreement AZ|CTR078074
Contract number
CTR078074
Issued by
Arizona

About this file

This document is a Certificate of Liability Insurance issued by Tom Gorski Insurance Agency Inc. for Analytical Intelligence International LLC, with State Farm Mutual Automobile Insurance Company and State Farm Fire and Casualty Company as insurers. The certificate is specifically issued for the State of Arizona, with the Arizona Department of Administration listed as the certificate holder, located in Phoenix, AZ.

The insurance policy provides Commercial General Liability coverage with policy number 92-A0-C773-2, effective from 06/01/2025 to 06/01/2026. The policy includes $1,000,000 per occurrence, $2,000,000 general aggregate, and $2,000,000 for products-completed operations. Additionally, the policy includes a $2,000,000 Cyber/Privacy Liability coverage. The State of Arizona is included as an additional insured as required by written contract, with a waiver of subrogation and coverage applied on a primary and non-contributory basis. The certificate includes a 30-day notice of cancellation provision for the certificate holder.

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Text version

1001486 132849.14 04-13-2022

INSR

LTR TYPE OF INSURANCE

ADD

INSD

SUB

WVD POLICY NUMBER

POLICY EFF

(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY) LIMITS

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY

PRO-

JECT LOC

OTHER:

EACH OCCURRENCE $

DAMAGE TO RENTED

PREMISES (Ea occurrence) $

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $

PRODUCTS - COMP/OP AGG $

AUTOMOBILE LIABILITY

ANY AUTO

OWNED

AUTOS ONLY

SCHEDULED

AUTOS

HIRED

AUTOS ONLY

NON-OWNED

AUTOS ONLY

COMBINED SINGLE LIMIT

(Ea accident) $

BODILY INJURY (Per person) $

BODILY INJURY (Per accident) $

PROPERTY DAMAGE

(Per accident) $

UMBRELLA LIAB OCCUR

EXCESS LIAB CLAIMS-MADE

DED RETENTION $

EACH OCCURRENCE $

AGGREGATE $

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

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

Y / N

N / A

PER

STATUTE

OTH-

ER $

E.L. EACH ACCIDENT $

E.L. DISEASE - EA EMPLOYEE $

E.L. DISEASE - POLICY LIMIT $

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

CANCELLATION

E-MAIL

ADDRESS:

CONTACT

NAME:

PHONE

(A/C, No, Ext):

FAX

(A/C, No):

INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

PRODUCER

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.

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.

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

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

ACORD 25 (2016/03)

© 1988-2015 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

AUTHORIZED REPRESENTATIVE

B Y Y 92-A0-C773-2 06/01/2025 06/01/2026

1,000,000

300,000

5,000

1,000,000

2,000,000

2,000,000 Cyber / Privacy Liability 2,000,000

SERVICE@TOMGORSKI.NET

Camilo Moreira

949-831-9090 949-831-0532

State Farm Mutual Automobile Insurance Company 25178

State Farm Fire and Casualty Company 25143

TOM GORSKI INS AGENCY INC.

26800 ALISO VIEJO PKWY STE 125

ALISO VIEJO, CA 92656

ANALYTICAL INTELLIGENCE INTERNATIONAL LLC

325 E CONCORD WAY

PLACENTIA, CA 92870-5052

08/26/2025

State of Arizona c/o Arizona Department of Administration

100 N. 15th Ave, Suite 201

Phoenix, AZ 85007

The State of Arizona are included as additional insured as required by written contract. A Waiver of subrogation is included with respect all policies where required by written contract. Coverage applied on a Primary and Non-Contributory basis. 30 Days Notice of Cancellation to the Certificate Holder.

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