2025-11-26 Mogollon Water Management GAP .pdf

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Attached to
Master Agreement AZ|CTR074217
Contract number
CTR074217
Issued by
Arizona

About this file

This document is a Certificate of Liability Insurance issued on 11/27/2024 by Hancock-Leavitt Insurance for Mogollon Water Management LLC. The certificate involves two insurance carriers: American Alternative Insurance Corporation and American Southern Home Insurance Company. The primary certificate holder is the State of Arizona, specifically the Arizona Department of Environmental Quality located in Phoenix, AZ.

The insurance certificate covers Contract #CTR074217 and provides multiple liability protections, including Commercial General Liability and Professional Liability. The policies are effective from 11/26/2024 to 11/26/2025, with coverage limits of $1,000,000 per occurrence and $3,000,000 aggregate. The policy includes additional insured status for the State of Arizona and its departments, with insurance being primary and non-contributory, and includes a waiver of subrogation. The Professional Liability coverage specifically includes a 3M Aggregate/$1M Occurrence structure.

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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

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

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

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:

E-MAIL

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)

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