Certificate_4_.pdf
PDF 148 KB Posted
- Attached to
- Master Agreement AZ|CTR078722
- Contract number
- CTR078722
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by Higginbotham Insurance Agency, Inc. for Lango Holdings, Inc.; Lango, Inc.; and Translation & Interpretation Network LLC, located in Fort Worth, TX. The certificate is issued for the Arizona Department of Administration in Phoenix, AZ, and covers multiple insurance policies from insurers including The Hanover Insurance Company, Massachusetts Bay Insurance Company, and Endurance Assurance Corporation, with coverage effective from 9/8/2024 to 9/8/2025.
The insurance certificate provides comprehensive coverage including Commercial General Liability ($2,000,000 each occurrence), Automobile Liability, Umbrella Liability ($3,000,000 aggregate), Workers' Compensation, Professional Liability, and Cyber Liability. Notably, the Cyber & Data Breach policy includes Privacy & Security Liability with $2,000,000 coverage per claim and a $15,000 retention. The policy includes additional provisions such as a blanket automatic additional insured endorsement, a waiver of subrogation, and a Primary & Non-Contributory endorsement, all contingent on a written contract between the named insured and the certificate holder.
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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
12/17/2024
Higginbotham Insurance Agency, Inc.
500 W. 13th Street Fort Worth TX 76102
Sherry Harris 817-350-6468 817-347-6981
SHarris@higginbotham.com
License#: 2081754 The Hanover Insurance Company 22292 LANGHOL-02 Massachusetts Bay Insurance Company 22306
Lango Holdings, Inc; Lango, Inc;
Translation & Interpretation Network LLC;
249 W Thornhill Dr Fort Worth TX 76115
Endurance Assurance Corportion 11551
328455419
A X 2,000,000 X 100,000
10,000
2,000,000
4,000,000 X
ZZDJ231671 9/8/2024 9/8/2025
Incl in Gen Agg
A 1,000,000
X X X Hired P/D
ZZDJ231671 9/8/2024 9/8/2025
A X X 3,000,000UHDJ232082 9/8/2024 9/8/2025
3,000,000
B XWDDJ230908 9/8/2024 9/8/2025
1,000,000
1,000,000
1,000,000 C C
Professional Liability Cyber Liability
PRO30044425901
PRO30044425901
9/8/2024 9/8/2024
9/8/2025 9/8/2025
Aggregate Aggregate
2,000,000 2,000,000
Cyber & Data Breach - Policy #PRO3004425901 - 9/8/2024 - 9/8/2025 - INCLUDES PRIVACY & SECURITY LIABILITY $2,000,000 each claim $15,000 retention
The General Liability policy include a blanket automatic additional insured endorsement that provides additional insured status to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status.
The General Liability and Workers' Compensation policies include a blanket waiver of subrogation endorsement to the certificate holder only when there is a See Attached...
Arizona Department of Administration 100 N. 15th Ave., Ste 302 Phoenix AZ 85007
ACORD 101 (2008/01)
The ACORD name and logo are registered marks of ACORD
© 2008 ACORD CORPORATION. All rights reserved.
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: FORM TITLE:
ADDITIONAL REMARKS
ADDITIONAL REMARKS SCHEDULE Page of
AGENCY CUSTOMER ID:
LOC #:
AGENCY
CARRIER NAIC CODE
POLICY NUMBER
NAMED INSURED
EFFECTIVE DATE:
LANGHOL-02
1 1
Higginbotham Insurance Agency, Inc. Lango Holdings, Inc; Lango, Inc;
Translation & Interpretation Network LLC;
249 W Thornhill Dr Fort Worth TX 76115
25 CERTIFICATE OF LIABILITY INSURANCE
written contract between the named insured and the certificate holder that requires such status.
The General Liability policy has a blanket Primary & Non Contributory endorsement that affords that coverage to certificate holders only where there is a written contract between the Named Insured and the certificate holder that requires such status
The General Liability policy includes an endorsement providing that 30 days notice of cancellation will be furnished to the certificate holder.
File details come from the government source that posted it. Updated .