Modlogics_AZ_State_COI_2022.pdf

2/16/2022

Powers-Leavitt Insurance Agency, Inc.

111 E Monroe Ave, Suite 200 PO Box 125 Buckeye AZ 85326

Jose Padilla (623)386-4452 (866)836-5280

PowersCerts@leavitt.com

Modlogics, LLC 402 N. 37th Drive, Suite #102

Phoenix AZ 85009

Selective Way Insurance Company 26301 Wesco Insurance Company 25011

22/23

A

X

X

X

X Y S 2302839 2/23/2022 2/23/2023

1,000,000

500,000

15,000

1,000,000

3,000,000

3,000,000

A X

X Y S 2302839 2/23/2022 2/23/2023

1,000,000

A

X X

X 0 X Y S 2302839 2/23/2022 2/23/2023

1,000,000

1,000,000

B X

WWC3570410 2/23/2022 2/23/2023

X

1,000,000

1,000,000

1,000,000

A Business Prop incl nonowned S 2302839 2/23/2022 2/23/2023 $1,000 Deductible $750,000 Limit

Installation Floater & Transit $1,000 Deductible $50,000 Limit

Solicitation No. BPM002979 moving and relocation services.

*** See Notes ***

Coverage is subject to policy terms, conditions, limitations, and exclusions.

The State of Arizona Arizona Department of Administration State Procurement Office 100 N 15th Ave Ste 402 Phoenix, AZ 85007

April Tuzon/APTUZO

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:

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)

Solicitation No. BPM002979 moving and relocation services.

The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are included as Additional Insureds on a Primary and Non-Contributory basis including Waiver of Subrogation, if a written contract is in effect for each, as required by form CG7300 0119 with regard to General Liability.

The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are included as Additional Insureds including Waiver of Subrogation, if a written contract is in effect for each, as required by form CA7809 1117 with regard to Auto Liability.

The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees have Waiver of Subrogation if a written contract is in effect for each, as required by form WC000313 0484 with regard to Workers Compensation.

Umbrella Liability follows form

COMMENTS/REMARKS

COPYRIGHT 2000, AMS SERVICES INC.OFREMARK

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