CTR073448_COI.pdf
PDF 19 KB Posted
- Attached to
- Master Agreement AZ|CTR073448
- Contract number
- CTR073448
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by Automatic Data Processing Insurance Agency Inc. on behalf of The Travelers Indemnity Company for Digital Apex LLC. The certificate is addressed to the Arizona State Procurement Office, specifically for a contract with the State of Arizona.
The insurance policy (number UB-9M453706-24) provides workers' compensation coverage with policy effective dates from 04/15/2024 to 04/15/2025. The certificate references Contract Number CTR073448 and Solicitation Number BPM005390, which pertains to "Auditory, Low Vision, Technological and Other Assistive Devices". The policy includes standard workers' compensation limits of $1,000,000 for each accident, each employee disease, and policy disease limit. The certificate holder is the Arizona Department of Administration (ADOA) State Procurement Office located in Phoenix, Arizona.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| CTR073448_Amendment_2_Digital_Apex_LLC.pdf | ||
| Digital_Apex_COI1.pdf | ||
| 6-BAFO_BPM005390_Pricing_Document.xlsx | XLSX spreadsheet | |
| CTR073448_-_Amend_1-Correction_Cover_Page.pdf | ||
| Cert_of_Liability_Ins.pdf | ||
| CTR073448_Contract_Documents_-_signed.pdf |
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Text version
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
INSURER(S) AFFORDING COVERAGE NAIC #
PRODUCER
INSURED
INSURER A :
INSURER B :
INSURER C :
INSURER D :
INSURER E :
COVERAGES
TYPE OF INSURANCE POLICY NUMBER LIMITS
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
LOCPOLICY
OTHER:
EACH OCCURRENCE
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
AUTOMOBILE LIABILITY
ANY AUTO
OCCUR
CLAIMS-MADE
DED RETENTION $
EACH OCCURRENCE
AGGREGATE
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
Y/N
CONTACT
NAME:
PHONE
(A/C, No, Ext):
ADDRESS:
FAX
(A/C, No):
CERTIFICATE NUMBER: REVISION NUMBER:
UMBRELLA LIAB
EXCESS LIAB
AUTHORIZED REPRESENTATIVE
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
INSURER F :
N/A
SCHEDULED
AUTOS
NON-OWNED
AUTOS ONLY
OWNED
AUTOS ONLY
HIRED
AUTOS ONLY
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
ADDL
INSD
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
PRO-
JECT
DAMAGE TO RENTED
PREMISES (Ea occurrence)
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE
(Per accident)
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below
PER
STATUTE
OTH-
ER
SUBR
WVD
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 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).
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
08/29/2024
AUTOMATIC DATA PROCESSING INSURANCE AGCY INC
1 ADP BLVD MS 625
ROSELAND, NJ 07068
(877) 677-0428
(877) 677-0428 (877) 677-0430 spcbicadp@travelers.com
DIGITAL APEX LLC
837 E SPANISH MOSS LN
PHOENIX, AZ 85022
THE TRAVELERS INDEMNITY COMPANY
943870537061242
A UB-9M453706-24 04/15/2024 04/15/2025 X
1,000,000 1,000,000 1,000,000
RE: CONTRACT NUMBER CTR073448
RE: SOLICITATION NO. BPM005390: AUDITORY, LOW VISION, TECHNOLOGICAL AND OTHER ASSISTIVE DEVICES
ADOA - STATE PROCUREMENT OFFICE
STATE OF ARIZONA
1802 W JACKSON ST #100
PHOENIX, AZ 85007
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