Pure_Storage_Inc_-_State_of_AZ_-_COI.pdf

H o ld e r Id e n ti fi e r

77777

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60006 06006

C e rt if ic a te N o

CERTIFICATE OF LIABILITY INSURANCE

DATE(MM/DD/YYYY)

04/08/2024

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.

PRODUCER

Aon Risk Insurance Services West, Inc.

San Francisco CA Office 425 Market Street Suite 2800 San Francisco CA 94105 USA

PHONE

(A/C. No. Ext):

E-MAIL

ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC #

(866) 283-7122

INSURED 19682Hartford Fire Insurance Co.INSURER A:

27120Trumbull Insurance CompanyINSURER B:

11000Sentinel Insurance Company, LtdINSURER C:

INSURER D:

INSURER E:

INSURER F:

FAX

(A/C. No.): (800) 363-0105

CONTACT

NAME:

Pure Storage, Inc.

Treasury Department 2555 Augustine Drive Santa Clara CA 95054 USA

COVERAGES CERTIFICATE NUMBER: 570105017127 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, Limits shown are as requested

POLICY EXP

(MM/DD/YYYY)

POLICY EFF

(MM/DD/YYYY)

SUBR

WVD

INSR

LTR

ADDL

INSD POLICY NUMBER TYPE OF INSURANCE LIMITS

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

POLICY LOC

EACH OCCURRENCE

DAMAGE TO RENTED

PREMISES (Ea occurrence)

MED EXP (Any one person)

PERSONAL & ADV INJURY

GENERAL AGGREGATE

PRODUCTS - COMP/OP AGG

X

X

X

GEN'L AGGREGATE LIMIT APPLIES PER:

$1,000,000

$1,000,000

$15,000

$1,000,000

$2,000,000

$2,000,000

A 01/31/2024 01/31/202557UUNBE3301

PRO-

JECT

OTHER:

AUTOMOBILE LIABILITY

ANY AUTO

OWNED

AUTOS ONLY

SCHEDULED

AUTOS

HIRED AUTOS

ONLY

NON-OWNED

AUTOS ONLY

BODILY INJURY ( Per person)

PROPERTY DAMAGE

(Per accident)X X

BODILY INJURY (Per accident)

$1,000,000B 01/31/2024 01/31/2025

$1,000

COMBINED SINGLE LIMIT

(Ea accident)

57 UEN BE3209

Comp./Coll. Ded.

EXCESS LIAB

OCCUR

CLAIMS-MADE AGGREGATE

EACH OCCURRENCE

DED

UMBRELLA LIAB

RETENTION

E.L. DISEASE-EA EMPLOYEE

E.L. DISEASE-POLICY LIMIT

E.L. EACH ACCIDENT $1,000,000

X OTH-

ER

PER STATUTEC 01/31/2024 01/31/2025

$1,000,000

Y / N

(Mandatory in NH)

ANY PROPRIETOR / PARTNER /

EXECUTIVE OFFICER/MEMBER N / AN

WORKERS COMPENSATION AND

EMPLOYERS' LIABILITY

If yes, describe under DESCRIPTION OF OPERATIONS below

$1,000,000

57WBGB6152

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

Contractual Liability is included in General Liability. RE: State of AZ NASPO Contract No. CTR071001. State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees are included as Additional Insured in accordance with the policy provisions of the General Liability and Automobile Liability policies. General Liability and Automobile Liability policies evidenced herein are Primary and Non-Contributory to other insurance available to an Additional Insured, but only in accordance with the policy's provisions. A Waiver of Subrogation is granted in favor of State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees in accordance with the policy provisions of the General Liability, Automobile Liability and Workers' Compensation policies.

CANCELLATIONCERTIFICATE HOLDER

AUTHORIZED REPRESENTATIVEState of AZ 1802 West Jackson Street Number 100 Phoenix AZ 85007 USA

ACORD 25 (2016/03)

©1988-2015 ACORD CORPORATION. All rights reserved

The ACORD name and logo are registered marks of ACO

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION

DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

ADDITIONAL REMARKS SCHEDULE

AGENCY CUSTOMER ID:

LOC #:

ADDITIONAL REMARKS

EFFECTIVE DATE:

CARRIER NAIC CODE

NAMED INSUREDAGENCY

See Certificate Numbe

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance

570000073117

Aon Risk Insurance Services West, Inc.

570105017127

570105017127

See Certificate Numbe

POLICY NUMBER

Companies Affording coverage

COMPANYLINE OF BUSINESS DESCRIPTION POLICY NUMBER NAICPOLICY

EFFECTIVE DATE

(MM/DD/YYYY)

POLICY

EXPIRATION

DATE

(MM/DD/YYYY)

PRIMARY

(Y/N)

FLAG

PERCENTAGE

OF

RISK

Page _ of _

Pure Storage, Inc.

57 UEN BE3209Business Auto Coverage

Trumbull Insurance Company 27120

57UUNBE3301General Liability Coverage

Hartford Fire Insurance Co. 19682 100

57WBGB6152Workers Compensation Sentinel Insurance Company, Ltd

11000 90

57WBGB6152Workers Compensation Hartford Insurance Co Of The Southeast

38261 1

57WBGB6152Workers Compensation Twin City Fire Insurance Company

29459 1

57WBGB6152Workers Compensation Hartford Underwriters Insurance Company

30104 1

57WBGB6152Workers Compensation Nutmeg Insurance Co 39608 1

57WBGB6152Workers Compensation Property & Casualty Ins Co of Hartford

34690 1

57WBGB6152Workers Compensation Trumbull Insurance Company 27120 1

57WBGB6152Workers Compensation Hartford Ins Co of the Midwest

37478 1

57WBGB6152Workers Compensation Hartford Casualty Insurance Co

29424 1

57WBGB6152Workers Compensation Hartford Accident & Indemnity Company

22357 1

Y

Y

Y

N

N

N

N

N

N

N

N

N

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1/31/2025

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The Subscribing insurers' obligations under contracts of insurance to which they subscribe are several and not joint and are limited solely to the extent of their individual subscriptions. The subscribing insurers are not responsible for the subscription of any co-subscribing insurer who for any reason does not satisfy all or part of its obligations.

ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

ADDITIONAL REMARKS SCHEDULE

AGENCY CUSTOMER ID:

LOC #:

ADDITIONAL REMARKS

EFFECTIVE DATE:

CARRIER NAIC CODE

NAMED INSUREDAGENCY

See Certificate Numbe

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance

570000073117

Aon Risk Insurance Services West, Inc.

570105017127

570105017127

See Certificate Numbe

POLICY NUMBER

Companies Affording coverage

COMPANYLINE OF BUSINESS DESCRIPTION POLICY NUMBER NAICPOLICY

EFFECTIVE DATE

(MM/DD/YYYY)

POLICY

EXPIRATION

DATE

(MM/DD/YYYY)

PRIMARY

(Y/N)

FLAG

PERCENTAGE

OF

RISK

Page _ of _

Pure Storage, Inc.

57WBGB6152Workers Compensation Hartford Insurance Company of Illinois

38288 N1/31/2024 1/31/2025 1

The Subscribing insurers' obligations under contracts of insurance to which they subscribe are several and not joint and are limited solely to the extent of their individual subscriptions. The subscribing insurers are not responsible for the subscription of any co-subscribing insurer who for any reason does not satisfy all or part of its obligations.

ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD