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.
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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
6/16/2025
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.
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