CTD12C_1.PDF
PDF 227 KB Posted
- Attached to
- Master Agreement AZ|CTR078901
- Contract number
- CTR078901
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by Hartford Underwriters Insurance Company for FSOC LLC, located in El Segundo, California. The certificate is addressed to the Arizona Department of Public Safety in Phoenix, Arizona, and provides proof of insurance coverage valid from February 20, 2025 to February 20, 2026. The insurance is managed through Nutmeg Insurance Agency and The Hartford Business Service Center in San Antonio, Texas.
The insurance policy covers commercial general liability, automobile liability, and umbrella liability with significant coverage limits, including $2,000,000 for general liability, $2,000,000 for automobile liability, and $3,000,000 for umbrella liability. Additional coverage includes a $50,000 data breach defense and liability protection. The policy lists the Arizona Department of Public Safety as an additional insured and includes standard business liability protections. The certificate provides comprehensive insurance coverage for FSOC LLC's operations, with policies effective through September 30, 2025.
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Other files
| File | Type | Posted |
|---|---|---|
| BPM007_1.DOC | DOC document | |
| BPM007_1.PDF | ||
| CTR078_4.PDF | ||
| CTR078_3.PDF |
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Text version
WLTR005
THE HARTFORD
BUSINESS SERVICE CENTER
3600 WISEMAN BLVD
SAN ANTONIO TX 78251 September 30, 2025
Arizona Department of Public Safety
2102 W ENCANTO BLVD
PHOENIX AZ 85009
Account Information:
Policy Holder Details : FSOC LLC Contact Us
Need Help?
Chat online or call us at
(866) 467-8730.
We're here Monday - Friday.
Enclosed please find a Certificate Of Insurance for the above referenced Policyholder. Please contact us if you have any questions or concerns.
Sincerely, Your Hartford Service Team
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
09/30/2025 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 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
NUTMEG INS AGENCY INC/PHS
76210775 The Hartford Business Service Center 3600 Wiseman Blvd San Antonio, TX 78251
CONTACT
NAME:
PHONE
(A/C, No, Ext):
(888) 925-3137 FAX
(A/C, No):
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC#
INSURED
FSOC LLC
803 EUCALYPTUS DR
EL SEGUNDO CA 90245-2307
INSURER A : Hartford Underwriters Insurance Company 30104
INSURER B :
INSURER C :
INSURER D :
INSURER E :
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/Y YYY)
LIMITS
A
COMMERCIAL GENERAL LIABILITY
X 76 SBA AZ2YDK 02/20/2025 02/20/2026
EACH OCCURRENCE $2,000,000
CLAIMS-MADE X OCCUR DAMAGE TO RENTED
PREMISES (Ea occurrence) $1,000,000
X General Liability MED EXP (Any one person) $10,000
PERSONAL & ADV INJURY $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000
X POLICY PRO-
JECT
LOC PRODUCTS - COMP/OP AGG $4,000,000
OTHER:
A
AUTOMOBILE LIABILITY
76 SBA AZ2YDK 02/20/2025 02/20/2026
COMBINED SINGLE LIMIT
(Ea accident)
$2,000,000 ANY AUTO BODILY INJURY (Per person)
ALL OWNED
AUTOS
SCHEDULED
AUTOS BODILY INJURY (Per accident)
X HIRED
AUTOS X NON-OWNED
AUTOS
PROPERTY DAMAGE
(Per accident)
A
X UMBRELLA LIAB
EXCESS LIAB
X OCCUR
CLAIMS-
MADE 76 SBA AZ2YDK 02/20/2025 02/20/2026
EACH OCCURRENCE $3,000,000
AGGREGATE $3,000,000
DED RETENTION $ 10,000
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY
PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below
N/ A
PER
STATUTE
OTH-
ER
Y/N E.L. EACH ACCIDENT
E.L. DISEASE -EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
A Data Breach - Defense & Liab Covg
76 SBA AZ2YDK 02/20/2025 02/20/2026 Limit $50,000
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. Certificate holder is an additional insured per the Business Liability Coverage Form SL3032 attached to this policy.
CERTIFICATE HOLDER CANCELLATION
Arizona Department of Public Safety
2102 W ENCANTO BLVD
PHOENIX AZ 85009
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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