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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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
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.
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