2025-06-15 COI.pdf

PDF 20 KB Posted

Attached to
Master Agreement AZ|CTR053289
Contract number
CTR053289
Issued by
Arizona

About this file

This document is a Certificate of Liability Insurance for ImageTrend LLC, issued by CAC Specialty on 6/14/2024. The certificate involves multiple insurance providers, including Hartford Fire Insurance Company, Trumbull Insurance Company, Hartford Casualty Insurance Company, Twin City Fire Insurance Company, Indian Harbor Insurance Company, and Landmark American Insurance Company. The certificate is specifically related to a contract (Contract No. CTR053289) with the Arizona Department of Health Services, State of Arizona, covering various liability and insurance provisions.

The insurance coverage includes Commercial General Liability, Automobile Liability, Umbrella Liability, Workers Compensation, Cyber and Tech E&O, and Excess Cyber and Tech E&O. The policies are effective from 6/15/2024 to 6/15/2025, with coverage limits ranging from $1,000,000 to $5,000,000 depending on the specific type of insurance. The Arizona Department of Health Services is listed as an Additional Insured on a primary and non-contributory basis for General Liability and Automobile Liability coverages. A Waiver of Subrogation applies for General Liability, Auto Liability, and Workers Compensation in relation to work performed by ImageTrend LLC.

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Other files

File Type Posted
AZ_DoH_COI.pdf PDF
CTR053289 A3.pdf PDF
CTR053289 Original Pricing.pdf PDF
CTR053289_CI_Determination_executed_6.8.2021.pdf PDF
CTR053289 A1.pdf PDF
CTR053289 A4.pdf PDF
CTR053289 A5.pdf PDF
CTR053289 A6 Pricing.pdf PDF
2022.06.15 COI.pdf PDF
CTR053289 - Second Supplemental CI - Executed.pdf PDF
CTR053289 A2.pdf PDF
CTR053289 Supplemental CI.pdf PDF
CTR053289_Final_CI_Contract_Executed.pdf PDF
Procurement Requests - Assigned Officers.pdf PDF
2023-06-15 COI.pdf PDF
2024-06-15 COI.pdf PDF
CTR053289 A4 Pricing.pdf PDF
CTR053289 A6.pdf PDF
CTR053289 A7.pdf PDF
CTR053289 Pricing from A2.pdf PDF
CTR053289_Contract_Amendment_Summary_No._1.pdf PDF
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Text version

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

6/14/2024

CAC Specialty 3414 Peachtree Road NE, Suite 1000 Atlanta, GA 30326 www.cacspecialty.com

Helen Dillen

Helen Dillen

Helen.Dillen@cacspecialty.com

IMAGETREND LLC

20855 Kensington Blvd.

Lakeville MN 55101

80498673

Arizona Department of Health Services, State of Arizona, its Department, agencies, boards, commissions, universities, officers, officials, agents, and and Automobile Liability coverages. A Waiver of Subrogation applies in favor of the certificate holder for General Liability and Auto Liability, and

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

RE: Contract No. CTR053289 employees are Additional Insured on a primary and non-contributory basis as required by written contract or agreement limited to the General Liability

Workers Compensation with respect to work performed by the named insured for specifically referenced jobs or as required by written contract.

1,000,000

300,000

10,000

1,000,000 2,000,000

2,000,000

1,000,000

5,000,000

5,000,000

1,000,000

1,000,000 1,000,000 5,000,000Each Claim/Aggregate 5,000,000Each Claim/Aggregate

A 21UUNAY1CP8 6/15/2024 6/15/2025✓

B 21UENDQ8431 6/15/2024 6/15/2025

C 21XHUAY1E24 6/15/2024 6/15/2025✓✓

✓ 10,000

D 21WEAY1F1N 6/15/2024 6/15/2025 ✓

N

E Cyber and Tech E&O MTP904334803 6/15/2024 6/15/2025 F Excess Cyber and Tech E&O $5MX$5M LHZ858718 6/15/2024 6/15/2025

Hartford Fire Insurance Company 19682

Trumbull Insurance Company 27120

Hartford Casualty Insurance Company 29424

Twin City Fire Insurance Company 29459

Indian Harbor Insurance Company 36940

Landmark American Insurance Company 33138

80498673 | IMAGLLC-01 | 24-25 GL, AU, Umb, WC, Cyber, Tech E&O | Helen Dillen | 6/14/2024 10:46:03 AM (PDT) | Page 1 of 1 This certificate cancels and supersedes ALL previously issued certificates.

File details come from the government source that posted it. Updated .