2023-01-01 GLEC 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

1/27/2022

(231) 271-3623 (231) 271-6189

18988

Great Lakes Environmental Center, Inc.

739 Hastings St Traverse City, MI 49686-3458

12304 42471

A 1,000,000

X X 33743713 1/1/2022 1/1/2023 300,000 10,000

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

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

X X 9536734000 1/1/2022 1/1/2023

10,000,000A 9536734001 1/1/2022 1/1/2023 10,000,000

10,000 B

WCV6202388 1/1/2022 1/1/2023 1,000,000

1,000,000 1,000,000

C Professional Liabili PKC112419 1/1/2022 Each Occurence 3,000,000 C Pollution Liability PKC112419 1/1/2022 1/1/2023 Each Occurence 3,000,000

Contract #CTR056543. State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are additional insured 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 No: CTR056543 1110 W Washington St.

Phoenix, AZ 85007

GREALAK147 KSCHAUB

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

1/1/2023

X X

X

X

X

X

X

Agency Code 01-001 5-00 PolicyNumber 95-367-340-00 s8s04 ( l -1s)

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

DESIGNATED INSURED FOR COVERED

AUTOS LIABILITY COVERAGE . BLANKET COVERAGE

This endorsement modifies insurance provided under the following:

COMIVlERCIAL AUTO POLICY

SECTION II - COVERED AUTOS LIABILIry COVER.

AGE is amended. The following provision is added.

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

All other policy terms and conditions apply

58504 (1-15) lncludes copyrighted material of lnsurance Services Office, lnc., with its permission. Page 1 of 'l

Auto-Owners lnsurance Company s8s83 (1-1s)

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

WAIVER OF OUR RIGHT TO RECOVER PAYMENTS

(wArvER oF SUBRoGATION) - BLANKET

This endorsement modifies insurance provided under the following:

COI\iIMERCIAL AUTO POLICY person or organization qualifies as an insured under SECTION II - COVERED AUTOS LIABILIry COVER- AGE, A. COVERAGE, 1. Who ls An lnsured.

sEcTloN V CONDITIONS. A. LOSS CONDITIoNS is amended. 5. Our Right to Recover Payments is de-leted and replaced by the following condition.

5. our Rightto 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 everything neces-sary to transfer that right to us and do nothing to preJudice it.

However, we waive our right to recover payments made ior 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.

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

Auto-Owners lnsurance Company