D_Smith_Technology_and_Consulting_-_COI.pdf
PDF 232 KB Posted
- Attached to
- Master Agreement AZ|CTR078084
- Contract number
- CTR078084
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by The Hartford on August 18, 2025, for D. Smith Technology and Consulting, LLC (DBA DSTC, LLC), with the State of Arizona's Department of Administration and State Procurement Office as the certificate holder. The insurance is provided through multiple insurers, including Hartford Underwriters Insurance Company, Hartford Fire Insurance Company, and Twin City Fire Insurance Company, and was produced by Nutmeg Insurance Agency.
The insurance covers commercial general liability, automobile liability, workers' compensation, and technology errors and omissions with policy periods from 08/10/2025 to 08/10/2026. The policy is associated with contract number CTR078084 for Data Management Services. Coverage limits include $1,000,000 for each occurrence in general liability, with an aggregate limit of $2,000,000, and similar structured limits for other policy types. The policy specifically references services to be performed at 643 Tory Pines Dr, Red Oak, TX, and includes provisions for additional insured status and waiver of subrogation in favor of the certificate holder.
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Text version
WLTR005
THE HARTFORD
BUSINESS SERVICE CENTER
3600 WISEMAN BLVD
SAN ANTONIO TX 78251 August 18, 2025
State of Arizona Arizona Department of Administration State Procurement Office
1802 W JACKSON ST # 100
PHOENIX AZ 85007-3221
Account Information:
Policy Holder Details : D. Smith Technology and Consulting, LLC DBA DSTC, LLC
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)
08/18/2025 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
NUTMEG INS AGENCY INC/PHS
76210775 The Hartford Business Service Center 3600 Wiseman Blvd San Antonio, TX 78251
CONTACT
NAME:
PHONE
(A/C, No, Ext):
(888) 925-3137 FAX
(A/C, No):
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC#
INSURED
D. Smith Technology and Consulting, LLC DBA DSTC, LLC
643 TORY PINES DR
RED OAK TX 75154-2748
INSURER A : Hartford Underwriters Insurance Company 30104 INSURER B : Hartford Fire Insurance Company 19682 INSURER C : Twin City Fire Insurance Company 29459
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
A
COMMERCIAL GENERAL LIABILITY
X X 76 SBW AZ4FXH 08/10/2025 08/10/2026
EACH OCCURRENCE $1,000,000
CLAIMS-MADE X OCCUR DAMAGE TO RENTED
PREMISES (Ea occurrence) $1,000,000
X General Liability MED EXP (Any one person) $10,000
PERSONAL & ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
X POLICY PRO-
JECT
LOC PRODUCTS - COMP/OP AGG $2,000,000
OTHER:
A
AUTOMOBILE LIABILITY
76 SBW AZ4FXH 08/10/2025 08/10/2026
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000 ANY AUTO BODILY INJURY (Per person)
ALL OWNED
AUTOS
SCHEDULED
AUTOS BODILY INJURY (Per accident)
X HIRED
AUTOS X NON-OWNED
AUTOS
PROPERTY DAMAGE
(Per accident)
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS-
MADE
EACH OCCURRENCE
AGGREGATE
DED RETENTION $
C
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 AZ4FXJ 08/10/2025 08/10/2026
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
B FailSafe Technology Errors or Omissions Liability
76 SBW AZ4FXH 08/10/2025 08/10/2026 Each Wrongful Act Aggregate Limit
$1,000,000 $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. RE: Job Description/Contract Number: CTR078084 - Data Mgmt. Services - 643 TORY PINES DR, RED OAK, TX 75154-2748 .
CERTIFICATE HOLDER CANCELLATION
State of Arizona Arizona Department of Administration State Procurement Office
1802 W JACKSON ST # 100
PHOENIX AZ 85007-3221
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
NUTMEG INS AGENCY INC/PHS
NAMED INSURED
D. SMITH TECHNOLOGY AND CONSULTING, LLC DBA DSTC,
LLC
643 TORY PINES DR
RED OAK TX 75154-2748
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
Waiver of Subrogation applies in favor of the Certificate Holder per the Business Liability Coverage Form SL 00 00, attached to this policy. The Business Liability Coverage Part includes a Blanket Additional Insured By Contract Endorsement, Form SL 30
32. Blanket Waiver of Subrogation applies in favor of the Certificate Holder per the Waiver of Our Right to Recover from Others Endorsement WC420304B, attached to this policy.
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