CTR074456_BRINC_-_Certificate_of_Insurance_Part_2_-_Expires_4-1-2025.pdf

NAME:

(A/C, No):

ADDRESS:

COVERAGE

S

CERTIFICATE

NUMBER:

REVISION

NUMBER:

JECT

Other

CERTIFICATE HOLDER CANCELLATION

© 1988-2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

ACORD 25

(2016/03)

Arizona Department of Administration: State Procurement Office 1802 West Jackson Street

Number 100 Phoenix, AZ 85007

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

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

INSD

SUBR

WVD POLICY NUMBER

POLICY EFF

(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY) LIMITS

COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $

DAMAGE TO RENTED

PREMISES (Each occurrence) $ CLAIMS-MADE OCCUR

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER:

PRODUCTS - COMP/OP AGG $ POLICY

PRO-

LOC

OTHER: $

AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT

(Each accident) $

ANY AUTO BODILY INJURY (Per person) $

OWNED

AUTOS ONLY

HIRED

AUTOS ONLY

SCHEDULED

AUTOS

NON-OWNED

AUTOS ONLY

BODILY INJURY (Per accident) $

PROPERTY DAMAGE (Per accident) $

UMBRELLA LIAB

EXCESS LIAB

OCCUR

CLAIMS-MADE

EACH OCCURRENCE $

AGGREGATE $

DED RETENTION $ $

A

WOR K E R S COMPENSATION

AND EMPL O Y E R S ' LIABILITY

Y / N

ANYPROPRIETOR/PA RT NE R/EX ECUTIV E

OFFICER/MEMBER EXCLUDED? N

(Mandatory in NH) If yes, describe under

DESCRIPTION OF OPERATIONS below

N / A

042857617

4/1/2024

4/1/2025 x PER

STATUTE

E.L. EACH ACCIDENT $ 2,000,000

E.L. DISEASE - EA EMPLOYEE $ 2,000,000

E.L. DISEASE - POLICY LIMIT $ 2,000,000

Client Coverage Effective Date:

4/1/2024

4/1/2025

Client # 964-AZ

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

11-08-2024

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 sta tement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

PRODUCER

CAC Specialty, LLC

250 Filmore Street, Suite 450

Denver, CO 80206

CONTACT

PHONE

(A/C, No, Ext)

FAX

E-MAIL

INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A: AIU INSURANCE COMPANY 19399

INSURED

Sequoia One PEO, LLC., Labor Contractor for co-employees of: Brinc Drones Inc

350 W. Washington Street, Suite 301

Tempe, AZ 85288

INSURER B:

INSURER C:

INSURER D:

INSURER E:

INSURER F:

S1Risk@sequoia.com

Coverage is provided for only those co-employees of, but not subcontractors to:

Brinc Drones Inc 3668 Albion Pl N

Seattle, WA 98103

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