ACCEPTED GL,AL, 05.01.23-05.01.24.pdf
PDF 4 MB Posted
- Attached to
- Master Agreement AZ|CTR066077
- Contract number
- CTR066077
- Issued by
- Arizona
About this file
This document is a set of insurance certificates and endorsements for LZ Delta, LLC and Yam Management LLC, primarily covering commercial general liability, automobile liability, and workers' compensation insurance. The primary insured parties include LZ Delta, LLC, Go AZ Motorcycles, and various affiliated motorcycle dealerships located in Arizona. The certificates name the State of Arizona or ADOT (Arizona Department of Transportation) as the certificate holder, with specific reference to Contract No. CTR06677.
The insurance policies provide coverage for work performed for ADOT, with policy periods from May 1, 2023 to May 1, 2024 for the LZ Delta certificate and October 1, 2022 to October 1, 2023 for the Yam Management certificate. Commercial general liability limits are set at $1,000,000 per occurrence, with a $2,000,000 general aggregate. Automobile liability and workers' compensation policies are also included, with additional insured endorsements specifically naming the State of Arizona. The policies include waivers of subrogation and provisions for additional insureds, indicating these are likely for specific contracted services related to transportation or motorcycle-related operations for the Arizona Department of Transportation.
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Text version
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
INSR ADDL SUBR
LTR INSD WVD
PRODUCER CONTACT
NAME:
FAXPHONE
(A/C, No):(A/C, No, Ext):
ADDRESS:
INSURER A :
INSURED INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)
AUTOMOBILE LIABILITY
UMBRELLA LIAB
EXCESS LIAB
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
EACH OCCURRENCE $
DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence)
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT
OTHER: $
COMBINED SINGLE LIMIT
$(Ea accident) ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED
BODILY INJURY (Per accident) $AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE
$AUTOS ONLY AUTOS ONLY (Per accident)
OCCUR EACH OCCURRENCE
CLAIMS-MADE AGGREGATE $
DED RETENTION $
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below
INSURER(S) AFFORDING COVERAGE NAIC #
COMMERCIAL GENERAL LIABILITY
Y / N N / A
(Mandatory in NH)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
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.
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).
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
CERTIFICATE HOLDER CANCELLATION
© 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03)
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
The ACORD name and logo are registered marks of ACORD
8/7/2023
(602) 992-9750 (602) 992-9775
18988
LZ Delta, LLC., c/o Yam Mng. LLC 15475 N 84th Street Scottsdale, AZ 85260
A 1,000,000
X X 49-973-952-02 5/1/2023 5/1/2024 5,000
1,000,000 2,000,000 2,000,000
1,000,000A X X 49-973-952-02 5/1/2023 5/1/2024
10,000,000A 49-973952-03 5/1/2023 5/1/2024 10,000,000
10,000
A Garagekeepers 49-973-952-02 5/1/2023 Limit 450,000
Additional Named Insureds:
LZ Delta, LLC LZ Flagstaff, LLC BMW Motorcycles of Scottsdale BMW Motorcycles of Peoria GoAZ Motorcycles
SEE ATTACHED ACORD 101
The State of Arizona or ADOT 1324 N. 22nd Ave.
Phoenix, AZ 85009
LZDELTA-01 PJOHNSON
AssuredPartners 14805 N 73rd St Scottsdale, AZ 85260
Auto Owners Insurance Company
5/1/2024
X X
X
X
X
X a8812 Accepted
FORM NUMBER:
EFFECTIVE DATE:
The ACORD name and logo are registered marks of ACORD
ADDITIONAL REMARKS
ADDITIONAL REMARKS SCHEDULE
FORM TITLE:
Page of
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
ACORD 101 (2008/01)
AGENCY CUSTOMER ID:
LOC #:
AGENCY NAMED INSURED
POLICY NUMBER
CARRIER NAIC CODE
© 2008 ACORD CORPORATION. All rights reserved.
AssuredPartners
LZDELTA-01
SEE PAGE 1
SEE PAGE 1
ACORD 25 Certificate of Liability Insurance
SEE P 1
LZ Delta, LLC., c/o Yam Mng. LLC 15475 N 84th Street Scottsdale, AZ 85260
SEE PAGE 1
PJOHNSON
Description of Operations/Locations/Vehicles:
GoAZ Motorcycles Peoria GoAZ Motorcycles Cottonwood GoAZ Motorcycles Flagstaff 15500 N. Hayden, LLC South Union Cottonwood, LLC Arrowhead Fountain Drive, LLC Harley-Davidson of Scottsdale
0311, LLC
126 Tactical, LLC LZ Prescott LLC GoAZ Motorcycles Scottsdale YAM Management LLC 15475 N. 84th Street LLC LZ Payson, LLC dba GO AZ Motorcycles Payson
RE: Any and all work performed for ADOT
Contract No. CTR06677
Additional Insured in regards to Garage Liability with waiver of subrogation as required by written contract .
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ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
INSR ADDL SUBR
LTR INSD WVD
PRODUCER CONTACT
NAME:
FAXPHONE
(A/C, No):(A/C, No, Ext):
ADDRESS:
INSURER A :
INSURED INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)
AUTOMOBILE LIABILITY
UMBRELLA LIAB
EXCESS LIAB
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
EACH OCCURRENCE $
DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence)
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT
OTHER: $
COMBINED SINGLE LIMIT
$(Ea accident)
ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED
BODILY INJURY (Per accident) $AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE
$AUTOS ONLY AUTOS ONLY (Per accident)
OCCUR EACH OCCURRENCE
CLAIMS-MADE AGGREGATE $
DED RETENTION $
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below
INSURER(S) AFFORDING COVERAGE NAIC #
COMMERCIAL GENERAL LIABILITY
Y / N N / A
(Mandatory in NH)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
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.
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).
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
CERTIFICATE HOLDER CANCELLATION
© 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03)
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
The ACORD name and logo are registered marks of ACORD
6/14/2023
(602) 992-9750 (602) 992-9775
12741
Yam Management LLC LZ Delta, LLC Go AZ Motorcycles 15475 N 84th Street Scottsdale, AZ 85260
A X 1021219 10/1/2022 10/1/2023 1,000,000
Y 1,000,000 1,000,000
***Bob Parsons is excluded***
Contract No. CTR06677
The State of Arizona or ADOT 1324 N. 22nd Ave.
Phoenix, AZ 85009
YAMMANA-02 PJOHNSON
AssuredPartners 14805 N 73rd St Scottsdale, AZ 85260
CopperPoint Premier Insurance Company
X
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13
(Ed. 4-84)
WC 00 03 13
(Ed. 4-84)
© 1983 National Council on Compensation Insurance.
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
06/09/2023Endorsement Effective 1021219Policy No. 40Endorsement No.
Yam Management LLCInsured 0.00Premium $
CopperPoint Premier Insurance CompanyInsurance Company Countersigned by
This document may have been uploaded to the CopperPoint Portal.
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us).
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule State Blanket/Schedule/State AZ The State of Arizona or ADOT. 1324 N. 22nd Ave.
Phoenix, AZ 85009
File details come from the government source that posted it. Updated .