CTR073448_COI.pdf

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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.

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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):

E-MAIL

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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