Endt 1 Auto Mogollon Water Management, LLC.pdf

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

IL 12 09 08 23

POLICY NUMBER:

© Insurance Services Office, Inc., 2022 Page to IL 12 09 08 23

ARIZONA POLICY CHANGES

Policy Number: Company:

From: 12:01 AM

12:01 AM

Authorized Representative:

Coverage Parts Affected:

Changes

Named Insured's Mailing Address:

Named Insured:

At the named insured's mailing address shown below.

To:

Policy Changes Effective:

Policy Change Number:

T9A6CA0000033-00

T9A6CA0000033-00

11/26/2024

11/26/2025

American Southern Home Insurance Company

1 2

It is understood and agreed that the policy is amended as follows:

The following policy coverages are added:

The following entity is added:

The following forms are added:

Mogollon Water Management, LLC.

PO Box 81 Pinetop, AZ 85935

Allied Public Risk, LLC 4507 North Front Street Suite 200 Harrisburg, PA 17110

Business Auto Coverage Form

Waiver of Subrogation

Waiver of Subrogation/Designated Insured Name: State of Arizona Arizona Department of Environmental Quality 1110 W Washington Street, Phoenix, AZ 85007 *The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees regarding the Award of Contract #CTR074217

CA 20 48 (10-13) Designated Insured For Covered Autos Liability Coverage CA 04 44 (10-13) Waiver of Transfer of Rights of Recovery Against Others to Us (Waiver of Subrogation)

© Insurance Services Office, Inc., 2022 IL 12 09 08 23Page to

The above amendments result in a change in the premium as follows:

NO CHANGES TO BE ADJUSTED

AT AUDIT

RETURN PREMIUMADDITIONAL PREMIUM

REMOVAL PERMIT

If this Policy includes the Commercial Property Coverage Part, the following applies with respect to such Coverage Part(s):

If Covered Property is removed to a new location that is described on this Policy Change, you may extend this insurance to include that Covered Property at each location during the removal. Coverage at each location will apply in the proportion that the value at each location bears to the value of all Covered Property being removed.

This permit applies up to 10 days after the effective date of this Policy Change; after that, this insurance does not apply at the previous location.

Countersignature Of Authorized Representative

Date:

Signature:

Title:

Name:

oo

2 2

X

POLICY NUMBER: COMMERCIAL AUTO

CA 04 44 10 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US (WAIVER OF SUBROGATION)

This endorsement modifies insurance provided under the following:

AUTO DEALERS COVERAGE FORM

BUSINESS AUTO COVERAGE FORM

MOTOR CARRIER COVERAGE FORM

With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.

This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.

Named Insured:

Endorsement Effective Date:

SCHEDULE

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization.

CA 04 44 10 13 Page 1 of 1c Insurance Services Office, Inc., 2011

T9A6CA0000033-00

11/26/2024

Mogollon Water Management, LLC.

Name(s) Of Person(s) Or Organization(s):

State of Arizona Arizona Department of Environmental Quality 1110 W Washington Street, Phoenix, AZ 85007

*The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees regarding the Award of Contract #CTR074217

POLICY NUMBER: COMMERCIAL AUTO

CA 20 48 10 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

DESIGNATED INSURED FOR

COVERED AUTOS LIABILITY COVERAGE

This endorsement modifies insurance provided under the following:

AUTO DEALERS COVERAGE FORM

BUSINESS AUTO COVERAGE FORM

MOTOR CARRIER COVERAGE FORM

With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement.

This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.

This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.

Named Insured:

Endorsement Effective Date:

SCHEDULE

Name Of Person(s) Or Organization(s):

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I Covered Autos Coverages of the Auto Dealers Coverage Form.

CA 20 48 10 13 Page 1 of 1c Insurance Services Office, Inc., 2011

State of Arizona - Arizona Department of Environmental Quality, 1110 W.

Washington Street, Phoenix, AZ 85007 *The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees regarding the Award of Contract #CTR074217 This insurance shall be primary and noncontributory and not in excess of any other valid and collectible insurance of the above named additional insured, except in the event of sale or contributory negligence on the part of the additional insured, and only with respect to the above referenced operations/contract.

Mogollon Water Management, LLC.

11/26/2024

T9A6CA0000033-00