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
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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