2022.06.15 COI.pdf

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

INSURER(S) AFFORDING COVERAGE

INSURER F :

INSURER E :

INSURER D :

INSURER C :

INSURER B :

INSURER A :

NAIC #

NAME:

CONTACT

(A/C, No):

FAX

E-MAIL

ADDRESS:

PRODUCER

(A/C, No, Ext):

PHONE

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.

OTHER:

(Per accident)

(Ea accident)

N / A

SUBR

WVD

ADDL

INSD

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.

$PROPERTY DAMAGE

BODILY INJURY (Per accident)

BODILY INJURY (Per person)

COMBINED SINGLE LIMIT

AUTOS ONLY

AUTOSAUTOS ONLY

NON-OWNED

SCHEDULEDOWNED

ANY AUTO

AUTOMOBILE LIABILITY

Y / N

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH)

DESCRIPTION OF OPERATIONS below If yes, describe under

ANY PROPRIETOR/PARTNER/EXECUTIVE

E.L. DISEASE - POLICY LIMIT

E.L. DISEASE - EA EMPLOYEE

E.L. EACH ACCIDENT

ER

OTH-

STATUTE

PER

LIMITS(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY)

POLICY EFF

POLICY NUMBERTYPE OF INSURANCELTR

INSR

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

EXCESS LIAB

UMBRELLA LIAB $EACH OCCURRENCE

$AGGREGATE

OCCUR

CLAIMS-MADE

DED RETENTION $

$PRODUCTS - COMP/OP AGG

$GENERAL AGGREGATE

$PERSONAL & ADV INJURY

$MED EXP (Any one person)

$EACH OCCURRENCE

DAMAGE TO RENTED

$PREMISES (Ea occurrence)

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY

PRO-

JECT LOC

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

CANCELLATION

AUTHORIZED REPRESENTATIVE

ACORD 25 (2016/03)

© 1988-2015 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

7/30/2021

Marsh & McLennan Agency LLC 6160 Golden Hills Drive Minneapolis MN 55416

Jessica Rayman

Jessica.Rayman@marshmma.com

Hartford Fire Insurance Company 19682 IMAGEINC4 Hartford Casualty Insurance Company 29424

ImageTrend, Inc.

20855 Kensington Blvd Lakeville MN 55044

Travelers Cas & Surety Co of America 31194 Indian Harbor Insurance Company 36940 Steadfast Insurance Company 26387

2035744274

A X 1,000,000 X 1,000,000

10,000

1,000,000

2,000,000 X X

Y Y 41UUNZT8493 6/15/2021 6/15/2022

2,000,000

A 1,000,000

X

Y Y 41UUNZT8493 6/15/2021 6/15/2022

B X X 5,000,000Y 41HUZT7339 6/15/2021Y 6/15/2022

5,000,000 X 10,000

B X

N

Y 41WEAB6LMI 6/15/2021 6/15/2022

1,000,000

1,000,000

1,000,000 D E C

Tech E&O and Cyber Liability Third Party Crime

Y Y Y

Y MTP904334800

EOC414934700

107170808

6/15/2021 6/15/2021 6/15/2021

6/15/2022 6/15/2022 6/15/2022

Per Claim/Aggregate Per Claim/Aggregate Per Claim/Aggregate

3,000,000 3,000,000 1,000,000

Continued Coverages:

XS Tech E&O/Cyber Liability; Policy #661012301; HSB Specialty Insurance Company, NAIC #11452; Per Claim/Aggregate $3,000,000 XS Tech E&O/Cyber Liability; Policy #LHZ789811; Landmark American Insurance Company, NAIC #0012; Per Claim/Aggregate $1,000,000

This insurance is issued pursuant to the Minnesota surplus lines insurance act. The insurer is an eligible surplus lines insurer but is not otherwise licensed by the State of Minnesota. In case of insolvency, payment of claims is not guaranteed. Company B, C, D & E is subject to the statutes and regulations of surplus lines carriers.

RE: Contract No. CTR053289 See Attached...

Arizona Department of Health Services State of Arizona 150 N. 18th Avenue, Suite 530 Phoenix AZ 85007

ACORD 101 (2008/01)

The ACORD name and logo are registered marks of ACORD

© 2008 ACORD CORPORATION. All rights reserved.

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: FORM TITLE:

ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE Page of

AGENCY CUSTOMER ID:

LOC #:

AGENCY

CARRIER NAIC CODE

POLICY NUMBER

NAMED INSURED

EFFECTIVE DATE:

IMAGEINC4

1 1

Marsh & McLennan Agency LLC ImageTrend, Inc.

20855 Kensington Blvd Lakeville MN 55044

25 CERTIFICATE OF LIABILITY INSURANCE

Arizona Department of Health Services, State of Arizona, its Department, agencies, boards, commissions, universities, officers, officials, agents, and employees are Additional Insured on a primary and non-contributory basis as required by written contract or agreement limited to the General Liability and Automobile Liability coverages. A Waiver of Subrogation applies in favor of the certificate holder for General Liability and Automobile Liability, and Workers Compensation with respect to work performed by the named insured for specifically referenced jobs or as required by written contract or agreement.