Carahsoft_Technology_Corp-_COI_Part_2.pdf
PDF 232 KB Posted
- Attached to
- Master Agreement AZ|CTR078078
- Contract number
- CTR078078
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by The Hartford Business Service Center on August 21, 2025, for Carahsoft Technology Corp. The certificate is addressed to the Arizona Department of Administration's State Procurement Office in Phoenix, Arizona. The insurance is produced by Auto Data Processing Insurance Agency, Inc., located in Florham Park, New Jersey, with Hartford Fire and Its P&C Affiliates listed as the primary insurer.
The certificate covers workers' compensation and employers' liability for Carahsoft Technology Corp, with a policy effective from 04/19/2025 to 04/19/2026. The policy includes statutory coverage with limits of $1,000,000 for each accident, each employee, and policy limit. The document includes a waiver of subrogation in favor of the certificate holder and provides notice that cancellation will be delivered in accordance with specific policy provisions. The description of operations is noted as "Those usual to the Insured's Operations," suggesting standard business activities for the technology corporation.
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Text version
WLTR005
THE HARTFORD
BUSINESS SERVICE CENTER
3600 WISEMAN BLVD
SAN ANTONIO TX 78251 August 21, 2025
Arizona Department of Administration State Procurement Office
1802 W JACKSON ST # 100
PHOENIX AZ 85007
Account Information:
Policy Holder Details : CARAHSOFT TECHNOLOGY CORP Contact Us
Need Help?
Chat online or call us at
(866) 467-8730.
We're here Monday - Friday.
Enclosed please find a Certificate Of Insurance for the above referenced Policyholder. Please contact us if you have any questions or concerns.
Sincerely, Your Hartford Service Team
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
08/21/2025 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.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS 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).
PRODUCER
AUTO DATA PROCESSING INS AGCYINC
76250717
71 HANOVER ROAD
FLORHAM PARK NJ 07932
CONTACT NAME:
PHONE
(A/C, No, Ext):
(800) 524-7024 FAX
(A/C, No):
(800) 524-4013
E-MAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC#
INSURER A : Hartford Fire and Its P&C Affiliates 00914
INSURED
CARAHSOFT TECHNOLOGY CORP
11493 SUNSET HILLS RD STE 100
RESTON VA 20190-5230
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
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.
INSR
LTR
TYPE OF INSURANCE ADDL
INSR
SUBR
WVD
POLICY NUMBER POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/Y YYY)
LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE
CLAIMS-MADE OCCUR DAMAGE TO RENTED
PREMISES (Ea occurrence) MED EXP (Any one person)
PERSONAL & ADV INJURY
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE
POLICY PRO-
JECT
LOC PRODUCTS - COMP/OP AGG
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
(Ea accident)
ANY AUTO BODILY INJURY (Per person)
ALL OWNED
AUTOS
SCHEDULED
AUTOS BODILY INJURY (Per accident)
HIRED
AUTOS
NON-OWNED
AUTOS
PROPERTY DAMAGE
(Per accident)
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS-
MADE
EACH OCCURRENCE
AGGREGATE
DED RETENTION $
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY
PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below
N/ A X 76 WEG ZJ6798 04/19/2025 04/19/2026
X PER
STATUTE
OTH-
ER
Y/N E.L. EACH ACCIDENT $1,000,000
E.L. DISEASE -EA EMPLOYEE $1,000,000
E.L. DISEASE - POLICY LIMIT $1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Those usual to the Insured's Operations.
CERTIFICATE HOLDER CANCELLATION
Arizona Department of Administration State Procurement Office
1802 W JACKSON ST # 100
PHOENIX AZ 85007
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
ACORD 101 (2014/01) © 2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID:
LOC# :
ADDITIONAL REMARKS SCHEDULE Page 2 of 2
AGENCY
AUTO DATA PROCESSING INS AGCYINC
NAMED INSURED
CARAHSOFT TECHNOLOGY CORP
11493 SUNSET HILLS RD STE 100
RESTON VA 20190-5230
POLICY NUMBER
SEE ACORD 25
CARRIER
SEE ACORD 25
NAIC CODE
EFFECTIVE DATE: SEE ACORD 25
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM
FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
Notice of Cancellation will be provided in accordance with Form WC990394, attached to this policy. Notice of Cancellation will be provided in accordance with Form WC990531, attached to this policy. Waiver of Subrogation applies in favor of the Certificate Holder per Waiver of our Right to Recover from Others Endorsement WC000313 attached to this policy.
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