Loading...
PROOF OF INSURANCE (2024 - 2024) CLOSED" DATE (MM/DD/YYYY) ACC)RH CERTIFICATE OF LIABILITY INSURANCE 10/16/2023 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(les) must have ADDITIONAL INSURED provisions or be endorsed. I f SUBROGATION IS WAIVED, subject to the terms and require an endarsemem. A statement as this certificate does not confer rights to the certificate holder In lieu of such endorsemenl(s). conditions of the policy, certain policies may PRODUCER CONTACT NAME: Mi llenot A Specially tmuranca IAX d'ba Founder Shield PHONE (A/C No. Ext): 646-854-1058 FAX (A/C No): 114 E 25th St, Floor New York, New York, 10010 E-MAIL ADDRESS:coi@foundershield.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Continental Casualty Co (CNA) 20443 INSURED INSURER B : Hiscox Insurance Company Inc. 10200 INSURER C : Scottsdale Indemnity Co 15580 SPIDR Tech INSURER D : 1 North Macdonald Mesa, Arizona, 85201 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 INSD SUBR WVD POLICY NUMBER POLICY F.FF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000.00 '4rCLAIMS MADE OCCUR DAMAGE TO RENTED $1,000,000.00 .1. PREMISES (Ea occurrence) MED EXP (Any one person) $10,000.00 A GEN'L AGGREGATE LIMIT APPLIES PER: 6020975247 02/26/2023 02/26/2024 PERSONAL & ADV INJURY $2,000,000.00 ' ',✓maDl.➢CY .. jmuRaD.rEt°�I ;rc,sDe: GENERAL AGGREGATE $4,000,000.00 'PRODUCTS-COMP/OPAGG $4,000,000.00 ,..,., f ' OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000.00 :i ANY AUTO (Ea accident) BODILY INJURY (Per person) ..�............ .......�.................... ..•. A ' OWN E➢D AUTOS ON➢.,'4' ;: SC➢AF.ID0.FIL,ED - ,... 6020975247 02/26/2023 02/26/2024 BODILY INJURY (Per ,r NN(8N-OWNED AUTOS "P;t HIRED AUTOS ONLY ONLY accident) .. PROPERTY DAMAGE (Per accident) UMBRELLA LIA.➢.R ,... EX4,ESsi L➢AB Each oecurenee 4'DC'7(",RIR CLAIMS -MADE ....' ;. � Aggregate WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ; PER STATUTE `. ANYPROPRIETORMARTNER/EXECUTIV Y/N OFFICER/MEMBER EXCLUDED? N OTHER E.L. EACH ACCIDEN (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT B Cyber Liability,Errors &Omissions MPL5048839.23 01/05/2023 01/05/2024 $ 3,000,000 per oce S3,000,000 in agg C Excess E&O/Cyber " EK13463147 01/05/2023 01/05/2024 $ 1,000,000 per oce $1,000,000 in agg A Property 6020975247 02/26/2023 02/26/2024 S959494.00 BPP S500 deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) ''. The Certificate Holder is Included as an Additional Insured on the above referenced policy where required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE City of El Segundo THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 _ AUTHORIZED REPRESENTATIVE © 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ADDITIONAL REMARKS SCHEDULE Intermediary Insured Policy Number Insurer Effective Date. ADDITIONAL REMARKS This Additional Remarks form is a schedule to ACORD form. Form Number: Form Title SPIDR - City of El Segundo COI INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS C 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CNA Connect Endorsement Declaration POLICY NUMBER COVERAGE PROVIDED BY B 6020975247 VALLEY FORGE INSURANCE COMPANY 151 N Franklin CHICAGO, IL 60606 INSURED NAME AND ADDRESS SPIDR Tech 1 N MACDONALD MESA, AZ 85201 AGENCY NUMBER AGENCY NAME AND ADDRESS 0181956 FOUNDER SHIELD 114 E 25TH ST NEW YORK, NY 10010 Phone Number: (646)854-1058 BRANCH NUMBER BRANCH NAME AND ADDRESS 030 NEW YORK CITY 125 BROAD STREET NEW YORK, NY 10004 Phone Number: (000)000-0000 FROM - POLICY PERIOD - TO 02/26/2023 02/26/2024 This policy becomes effective and expires at 12:01 A.M. standard time at your mailing address on the dates shown above. This endorsement changes your policy. Please read it carefully. This Endorsement Results In No Change In Premium. The Named Insured is a Corporation. i---- Audit Period is Not Auditable INSURED Page 1 of 3 POLICY NUMBER INSURED NAME AND ADDRESS B,6020975247 SPIDR Tech 1. N MACDONALD MESA, AZ 85201. SCHEDULE OF LOCATIONS AND COVERAGE LOCATION 2 BUILDING I I N MACDONALD MESA, AZ 85201-7339 Construction: Masonry Non Combustible, Class Description. Software & Internet Design Services Inflation Guard 3% INSURED Page 2 of 3 POLICY ER INSUAED NAME AND ADDRESS B 6020975247 SPIDR 'T'ech 1. N MACDONA1:.D MESA, AZ 85201 ADDITIONAL INTEREST SCHEDULE LOCATION 2 BUILDING 1 The following has been added to your policy effective 10/16/2023 Type: Designated Person or Organization Additional Interest Name and Address: CITY OF EL SEGUNDO 350 MAIN STREET EL SEGUJNDO CA 90245 Countersignature •'�� �Y Chairman of th?5- Secretary SB-146895-A (Ed. 01/06) INSURED Page 3 of 3 Client#: 882656 VERSATERUS '. DATE (MM/DD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 10/25/2023 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 anmADDITIONAL 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME; Ranee K MannlOn Marsh & McLennan Agency LLC "PHONE parc Nq E' Ranee.Mannlort-(arc Ng)L, ... 11330 Lakefield Drive._. EMATL DRE Suite 100 ADpRb�9s, _..._ arS COVERAGE INSURERS) AFFORDING COm Hartford Accident & Indemnity __.._. NAIC p Johns Creek, GA 30097-1508 Hertf22357 INSURER A: y _ INSURED SPIDR Tech, Inc. 1 N MacDonald Drive Mesa, AZ 85201 INSURER B : INSURER C : INSURER D : r()VFROGFS 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, .......................LCYNUMBER TYPE OF INSURANCE POLL,,,,,, - COMMERCIAL GENERAL LIABILITY __1 CLAIMS -MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: JR POLICY OTHER: � E O ❑ LOC AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY, AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS -MADE A WORKERS COMPENSATION 20WEBA3VHJ AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE❑ OFFICER/MEMBER EXCLUDED? N N / A (Mandatory in NH) If Ves, describe under 0/01/20231 LIMITS EACH OCCURRENCE $ DAMAGE TO RENTED $ PREMISES-(Eaaccurrencel. MED EXP (Any one person) $ PERSONAL & ADV INJURY GENERAL AGGREGATE $ PROD..............................m, UCTS COMP/OP AGG $ WaNN'CO SINGLE GM'fT. a az6de_nt) _.............. ..$_ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ RPETY DAMAGE PROPERTY ........................,$..... RENCE AGGREGATE $ PER OTH- X E1. EACH ACCIDENT $1 DISEASE - EA EMPLOYEE $1 E.L. DISEASE - POLICY LIMIT j $1 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) (WC)Waiver of Subrogation per form: WC000313 Waiver of Right to Recover From Others (per written contract or agreement) City of El Segundo 350 Main Street El Segundo, CA 90245 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 { ' 4 045 i ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S13373959/M13344865 JJBXR (Policy Provisions: WCOOOOOOC) INFORMATION PAGE WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY INSURER: SEE ATTACHED ENDORSEMENT THE NCCI Company Number: 21261 ffiCi. FORD Company Code: 9 Twin City Fire Insurance Company is required by law to provide its policyholders with certain accident prevention services at no additional cost as required by ARK. Code Ann. §11-9-409(D) and Rule 32. If you would like more information, call The Hartford's Risk Engineering Department, One Hartford Plaza, T-7, Hartford, CT 06155 at 1- 866-586-0467. If you have any questions about this requirement, call the Health and Safety Division, Arkansas Workers' Compensation Commission at 1-800-622-4472. Suffix LARS RENEWAL POLICY NUMBER: 20 WE BA3VHJ Previous Policy Number: New 1. Named Insured and Mailing Address: JUSTICETRAX, INC. (No., Street, Town, State, Zip Code) 1 W MAIN ST MESA AZ 85201 FEIN Number: 86-0960454 State Identification Number(s): UIN : OR 36000000 Refer to the EXTENSION OF THE INFORMATION PAGE — WC990365. The Named Insured is: Corporation Business of Named Insured: Data Processing, Hosting, and Related Services Other workplaces not shown above: See Endorsement - WC990366 2. Policy Period: From 10/01/23 To 10/01/24 ANNUAL 12:01 a.m., Standard time at the insured's mailing address. Producer's Name: MARSH & MCLENNAN AGENCY LLC PO BOX 70 WEST POINT GA 31833 Producer's Code: 20260251 Issuing Office: THE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD SAN ANTONIO TX 78251 (877)853-2582 Total Estimated Annual Premium: Deposit Premium: Policy Minimum Premium: Audit Period: ANNUAL Installment Term: Four Pay (50%Down+3@16.6%) The policy is not binding unless countersigned by our authorized representative. Countersigned by 1--F111 If 10/12/23 Authorized Representative Date Form WC 00 00 01 A (1) Printed in U.S.A. Page 1 (Continued on next page) Process Date: 10/12/23 Policy Expiration Date: 10/01/24 INFORMATION PAGE (Continued) Policy Number: 20 WE BA3VHJ 3. A. Workers Compensation Insurance: Part one of the policy applies to the Workers Compensation Law of the states listed here: FL SEE ENDORSEMENT - WC 99 03 67 B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Two are: Bodily injury by Accident $1,000,000 each accident Bodily injury by Disease $1,000,000 policy limit Bodily injury by Disease $1,000,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any , listed here: ALL STATES EXCEPT NORTH DAKOTA, OHIO, WASHINGTON, WYOMING, U.S.TERRITORIES AND STATES DESIGNATED IN ITEM 3.A. OF THE INFORMATION PAGE. D. This policy includes these endorsements and schedule: SEE ENDORSEMENT -WC 99 03 68 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium Total Standard Premium Premium Discount Expense Constant Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement Catastrophe (Other Than Certified Acts Of Terrorism) Other Miscellaneous State Premiums Estimated Annual Premium (before Surcharges) Total Estimated Surcharges "See the attached Schedule(s) of Operations for Location and State Level Premium Information Total Estimated Annual Premium: Deposit Premium: Policy Minimum Premium: Interstate/Intrastate Identification Number: Refer to Schedule of Operations NAICS: 518210 Labor Contractors Policy Number: SIC: 7374 Form WC 00 00 01 A (1) Printed in U.S.A. Page 2 Process Date: 10/12/23 Policy Expiration Date: 10/01/24