2025-11-26 Mogollon Water Magn GAWP.pdf
PDF 21 KB Posted
- Attached to
- Master Agreement AZ|CTR074217
- Contract number
- CTR074217
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance for Mogollon Water Management LLC, issued by Hancock-Leavitt Insurance on 11/27/2024. The certificate involves multiple insurers, including American Alternative Insurance Corporation, American Southern Home Insurance Company, and WCF National Insurance Company. The certificate holder is the State of Arizona, specifically the Arizona Department of Environmental Quality located in Phoenix, AZ.
The insurance certificate covers multiple types of liability, including Commercial General Liability, Professional Liability, Automobile Liability, and Inland Marine, with various policy limits. The policies are effective from 11/26/2024 to 11/26/2025, with a contract number CTR074217. Key coverage details include $1,000,000 per occurrence for general and professional liability, $1,000,000 for automobile liability, and $75,000 for rented/leased equipment with a $1,000 deductible. The State of Arizona and its departments are listed as additional insureds, with the insurance being primary and non-contributory, and including a waiver of subrogation.
View the file
Other files
Show all 28
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
11/27/2024
Hancock-Leavitt Insurance PO Box 830
Taylor AZ 85939
Monti Hancock (928)536-4237 (866)821-4287 monti-hancock@leavitt.com
Mogollon Water Management LLC PO Box 81
Pinetop AZ 85935
American Alternative Insurance Corporation19720 American Southern Home Insurance Company41998 WCF National Insurance Company
CL24112707625
A
X
X X Professional Liability
X
X Y T9A2CP0000918-00 11/26/2024 11/26/2025
1,000,000
1,000,000
10,000
1,000,000
3,000,000
3,000,000
Professional Liability 3M Agg/$1M Occ
B X
X X
X Y T9A6CA0000033-00 11/26/2024 11/26/2025
1,000,000
C 4123833 7/15/2025 7/15/2026 X X
1,000,000
1,000,000
1,000,000
A Inland Marine T9A2CP0000918-00 11/26/2024 11/26/2025 Rented/Leased Equipment $75,000
Deductible $1,000
Contract #CTR074217 All coverages and limits are subject to the terms, conditions, insuring agreement and exclusions provided in the policy. The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees as additional insureds with respect to liability arising out of the activities performed by or on behalf of the Mogollon Water Management LLC. Insurance is Primary & Non-Contributory. Waiver of Subrogation applies.
State of Arizona Arizona Dept of Environmental Quality 1110 W. Washington Street Phoenix, AZ 85007
Monti Hancock/TAMATT
Y
The ACORD name and logo are registered marks of ACORD
CERTIFICATE HOLDER
© 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01)
AUTHORIZED REPRESENTATIVE
CANCELLATION
DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE
LOCJECT
PRO-
POLICY
GEN'L AGGREGATE LIMIT APPLIES PER:
OCCURCLAIMS-MADE
COMMERCIAL GENERAL LIABILITY
PREMISES (Ea occurrence) $
DAMAGE TO RENTED
EACH OCCURRENCE $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
$RETENTIONDED
CLAIMS-MADE
OCCUR
AGGREGATE $
EACH OCCURRENCE $UMBRELLA LIAB
EXCESS LIAB
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
INSR
LTR TYPE OF INSURANCE POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY) LIMITS
PER
STATUTE
OTH-
ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
ANY PROPRIETOR/PARTNER/EXECUTIVE
If yes, describe under DESCRIPTION OF OPERATIONS below
(Mandatory in NH)
OFFICER/MEMBER EXCLUDED?
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
HIRED AUTOS
NON-OWNED
AUTOS AUTOS
AUTOS
COMBINED SINGLE LIMIT
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE $
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.
INSD
ADDL
WVD
SUBR
N / A
(Ea accident)
(Per accident)
OTHER:
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 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).
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
INSURED
PHONE
(A/C, No, Ext):
PRODUCER
ADDRESS:
FAX
(A/C, No):
CONTACT
NAME:
NAIC #
INSURER A :
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
INSURER(S) AFFORDING COVERAGE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
INS025 (201401)
File details come from the government source that posted it. Updated .