2022-01-01 GLEC CTR056543 GAUWP.pdf

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

INSR ADDL SUBR

LTR INSD WVD

PRODUCER CONTACT

NAME:

FAXPHONE

(A/C, No):(A/C, No, Ext):

E-MAIL

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

8/6/2021

(231) 271-3623

18988

Great Lakes Environmental Center, Inc.

739 Hastings St Traverse City, MI 49686-3458

12304 42471

A 1,000,000

X X 33743713 1/1/2021 1/1/2022 300,000 10,000

1,000,000 2,000,000 2,000,000

X Watercraft Liabilty Crime Insurance 1,000,000 1,000,000A

X X 9536734000 1/1/2021 1/1/2022

10,000,000A 9536734001 1/1/2021 1/1/2022 10,000,000

10,000 B

WCV6202388 1/1/2021 1/1/2022 1,000,000

1,000,000 1,000,000

C Professional Liabili PKC110716 1/1/2021 Each Occurence 3,000,000 C Pollution Liability PKC110716 1/1/2021 1/1/2022 Each Occurence 3,000,000

Contract # CTR056543

State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are additional insureds with respect to General Liability and Auto Liability arising out of the activities performed by, or on behalf of, the Contractor.

General Liability and Auto Liability contain a waiver of subrogation endorsement, as required by this written agreement, in favor of the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees for losses arising from work performed by or on behalf of the Contractor.

Arizona Department of Environmental Quality Contract # CTR056543 1110 W Washington Street Phoenix, AZ 85007

GREALAK147 JSOMMERFIELD

Bonek Insurance Agency PO Box 278 Suttons Bay, MI 49682

Jessica Sommerfield jessica@bonek.com

Auto-Owners Insurance Company Accident Fund General Insurance Company Crum and Forster Insurance Company

X

1/1/2022

X X

X

X X X

X

X

X

Agency Code Ol{015{0 PolrcyNumber 934670-33743713

BLANKET ADDITIONAL INSURED

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILIry COVERAGE PART

A. Under SECTION ll - WHO lS AN INSURED is amended. The following provision is added.

A person or organization is an Additional lnsured, only with respect to liability caused, in whole or in part, by "your work" for that Additional lnsured by or for you:

1. lf required in a written contract or agreement; or

2. lf required by an oral contract or agreement only if a Certificate of lnsurance was issued prior to the loss indicating that the person or organiza-tion was an Additional lnsured.

B. SECTION lll - LIMITS OF INSURANCE is amended. The following provision is added.

The limits of liability for the Additional lnsured are those specified in the written contract or agreement between the insured and the owner, lessee or con-tractor or those specified in the Certificate of lnsur-ance, if an oral contract or agreement, not to exceed the limits provided in this policy. These limits are inclusive of and not in addition to the limits of insurance shown in the Declarations.

C. SECTION IV - COMMERCIAL GENERAL

LlABlLlry CONDITIONS is amended.

1. The following condition is added to 4. Other lnsurance.

This insurance is primary for the Additional lnsured, but only with respect to liability caused, Auto-Owners lnsurance Company

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

55373 (sl7) in whole or in part, by "your work" for that Addi-tional lnsured by or for you. Other insurance available to the Additional lnsured will apply as excess ansurance and not contribute as primary insurance to the insurance provided by this endorsement.

2. The following condition is added.

Other Additional lnsured Coverage lssued By Us lf this policy provides coverage for the same loss to any Additional lnsured specifically shown as an Additional lnsured in another endorsement to this policy, our maximum limit of insurance under this endorsement and any other endorse-ment shall not exceed the limit of insurance in the written contract or agreement between the insured and the owner, lessee or contractor, or the limits provided in this policy, whichever is less. Our maximum limit of insurance arisinq out of an "occunence", shall not exceed the limit of insurance shown in the Declarations, regard-less of the number of insureds or Additional lnsureds.

All other poliqy terms and conditions apply.

!r,c v^,)e L'tr,bility n,Q T4^5tr,w a tc b+ntur,cl

A zlzt,'ti .

55373 (5-17) lncludes copyrighted material of lnsurance Services Office, lnc., with its permission. Page 1 of 1

Agency Code O'l{015-00 ownership or majority interest, will qualify as a Named lnsured if there is no other similar insur-ance available to that organization. However:

a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the pol-icy period, whichever is earlier;

b. Coverage A does not apply to "bodily injury" or "property damage" that occuned before you acquired or formed the organization;

and

c. Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization.

No person or organization is an insured with respect to the conduct of any cunent or past partnership, joint venture or limited liability com-pany that is not shown as a Named lnsured in the Declarations.

PolicyNumber 934670-3374371-

11. BLANKET WAIVER OF SUBROGATION

SECTION IV. COMMERCIAL GENERAL LIABIL.

ITY CONDITIONS is amended. The following provi-sion is added to 8. Transfer Of Rights of Recov-ery Against Others To Us.

When you have agreed to waive your right of subro-gation in a written contract, executed prior to loss, with any person or organization, we waive any right to recoveD/ we may have against such person or organization because of payments we make for in-jury or damage arising out of your ongoing opera-tions or "your work" done under a contract with that person or organization and included in the "productsrompleted operations hazard".

All other policy terms and conditions apply.

55091 (5-17) lncludes copyrighted material of lnsurance Services Office, lnc., with its permission. Page 6 of 6

CctlzY'l.C l-,. r'rZ

[0 r,,tve r 'r-o{ Snt, rcyLtlr)/, Agency Code 01-0015-00 PolicyNumber 95-367-340-00

0tmr,rv,..ir^-l 4,49 P.

DESIGNATED INSURED FOR COVERED

AUTOS LIABILITY COVERAGE . BLANKET COVERAGE

This endorsement modifies insurance provided under the following:

COMMERCIAL AUTO POLICY

SECTION II . COVERED AUTOS LIABILITY COVER.

AGE is amended. The following provision is added.

Any person or organization is an insured for Covered Autos Laability Coverage, but only to the extent that

Auto-Owners lnsurance Company

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

s8s04 (1-1 s) person or organization qualifies as an insured under

SECTION II - COVERED AUTOS LIABILITY COVER.

AGE, A. COVERAGE, 1. Who ls An lnsured.

All other policy terms and conditions apply.

58504 (1-1 5) lncludes copyrighted material of lnsurance Services Office, lnc., with its permission. Page I of 1

Auto-Owners lnsurance Company

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

s8s83 (1-1s)

However, we waive our right to recover payments made for bodily injury or property damage:

a. Covered by the policy; and b, Arising out of the operation of autos covered by the policy, in accordance with the terms and conditions of a written contract between you and such person or entity only if such rights have been waived by the written con-tract prior to the accident or loss which caused the bodily injury or property damage.

All other policy terms and conditions apply.

WAIVER OF OUR RIGHT TO RECOVER PAYMENTS

(wAtvER oF suBRocATtON) - BLANKET

This endorsement modifies insurance provided under the following:

COMMERCIAL AUTO POLICY

SECTION V CONDITIONS, A. LOSS CONDITIONS iS amended. 5. Our Right to Recover paymenG is de- Ieted and replaced by the following condition.

5. Our Right to Recover Payments lf we make a payment under this policy and the per-son to or for whom payment is made has a right to recover damages from another, we will be entitled to that right. That person shall do eveMhing neces-sary to transfer that right to us and do nothing to prejudice it.

58583 (1-15) lncludes copyrighted material of lnsurance Services Office, lnc., with its permission. Page 1 of 1