AZ_DoH_COI.pdf

PDF 92 KB Posted

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

About this file

This document is an ACORD Certificate of Liability Insurance for ImageTrend, LLC, located in Eagan, Minnesota, with the Arizona Department of Health Services as the certificate holder. The insurance is provided by multiple insurers, 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 covers the period from 6/15/2025 to 6/15/2026.

The insurance provides comprehensive coverage including Commercial General Liability ($1,000,000 per occurrence), Automobile Liability ($1,000,000 combined single limit), Umbrella Liability ($5,000,000 each occurrence), Workers Compensation, and specialized Cyber and Tech E&O coverage ($5,000,000 each claim/aggregate). The policy includes additional insured provisions for the Arizona Department of Health Services on a primary and non-contributory basis, with a waiver of subrogation where required by written contract. The coverage extends to various operational risks, with specific protections for general liability, auto liability, and workers compensation related to work performed by the named insured.

View the file

Other files

File Type Posted
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
CTR053289 A1.pdf PDF
CTR053289 A4.pdf PDF
CTR053289 A5.pdf PDF
CTR053289 A6 Pricing.pdf PDF
CTR053289 A3.pdf PDF
CTR053289 Original Pricing.pdf PDF
CTR053289_CI_Determination_executed_6.8.2021.pdf PDF
2023-06-15 COI.pdf PDF
2024-06-15 COI.pdf PDF
2025-06-15 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
Show all 21

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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

6/16/2025

CAC Specialty 416 W 13th Street, Suite 303 New York, NY 10014

205-414-8100 www.cacspecialty.com

Grantland Rice IV

Helen Dillen helen.dillen@cacspecialty.com

ImageTrend, LLC 1305 Corporate Center Drive, Suite 500 Eagan MN 55121

85788539 conditions in policy. A Waiver of subrogation is granted to the additional insureds where required by written contract, as per terms and conditions in 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

Certificate Holder is included as additional insured, on a primary and non-contributory basis, where required by written contract, as per terms and policy.

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

A 1,000,00021UUNAY1CP8 6/15/2025 6/15/2026

300,000

10,000

1,000,000 2,000,000 2,000,000✓

B 21UENBM5WY9 6/15/2025 6/15/2026 1,000,000

C 21XHUAY1E24 6/15/2025 6/15/2026 5,000,000✓✓

5,000,000

✓ 10,000

D 21WEAY1F1N 6/15/2025 6/15/2026 ✓

1,000,000N 1,000,000 1,000,000

E Cyber and Tech E&O MTP904334804 6/15/2025 6/15/2026 Each Claim/Aggregate 5,000,000 F Excess Cyber and Tech E&O $5MX$5M LHZ867746 6/15/2025 6/15/2026 Each Claim/Aggregate 5,000,000

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

85788539 | IMAGLLC-01 | 25-26 GL, AU, Umb, WC, Cyber, Tech E&O | Helen Dillen | 6/16/2025 9:11:13 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 .