CTR076404 2025.08.16 COI.pdf
PDF 1 MB Posted
- Attached to
- Master Agreement AZ|CTR076404
- Contract number
- CTR076404
- Issued by
- Arizona
About this file
This document is a comprehensive insurance certificate issued by Smith-Berclair Insurance for LB Technology, Inc., with multiple insurance policies covering various liability types. The primary certificate holder is the State of Arizona/Arizona Department of Transportation (ADOT), located in Phoenix, Arizona. The insurance is provided through multiple insurers, including Tri-State Insurance Company of Minnesota, Progressive Hawaii Ins Co, Firemen's Ins Co of Washington DC, Employers Preferred Insurance Company, and Lloyds.
The insurance coverage includes Commercial General Liability, Automobile Liability, Umbrella Liability, Workers Compensation, Employers Liability, and Errors and Omissions Professional Liability. The policies are effective from various dates in 2024 and 2025, with coverage limits ranging from $1,000,000 to $5,000,000 depending on the specific type of insurance. The policies explicitly state that the insurance applies to any and all work performed for or on behalf of the State of Arizona/ADOT, with a specific notation about installing telematics. The total premium for the Workers Compensation policy is $2,767, and the policies provide comprehensive protection for LB Technology, Inc.'s operations and potential liabilities.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 3.13.2025 LB Technology.Inc_Response_Summary of Negotiation for BPM006461.pdf | ||
| CTR076404_Pricing.xls | XLS spreadsheet | |
| CTR076404_Contract_Documents.pdf | ||
| 3.13.2025 PRICESHEET LB Technology.xls | XLS spreadsheet | |
| Post Award Meeting Sign-In Sheet .pdf |
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Text version
04/09/2025
Smith-Berclair Insurance 5118 Park Avenue Suite 400 Memphis TN 38117
Lelania McCown
(901) 753-4323 (901) 753-4365
Lelania.McCown@SmithBerclair.com
LB Technology, Inc.
6991 Appling Farms Parkway Suite 101 Memphis TN 38133
Tri-State Insurance Company of Minnesota 31003 Progressive Hawaii Ins Co 10067 Firemen's Ins Co of Washington DC 21784 Employers Preferred Insurance Company 10346 Lloyds
CL252443183
A ADV4290443-50 01/20/2025 01/20/2026
1,000,000 500,000 10,000 1,000,000 2,000,000 2,000,000
B 985391583 08/16/2024 08/16/2025
1,000,000
C CNA4294048-51 01/20/2025 01/20/2026
5,000,000 5,000,000
D EIG219266010 01/20/2025 01/20/2026
1,000,000 1,000,000 1,000,000
E Errors and Omissions
ESN0540150084 11/25/2024 11/25/2025
Professional Liability $2,000,000 Products/Completed Ops Aggregate
$2,000,000 Breach of Contract $2,000,000
Insurance applies to any and all work performed for or on behalf of the State of Arizona/ADOT
The State of Arizona/ADOT 206 S 17th Ave
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.
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
Cindy Lewis Accepted
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