2025-07-24_Emergency Environmental_CTR059035_GAUWP.pdf
PDF 942 KB Posted
- Attached to
- Master Agreement AZ|CTR059035
- Contract number
- CTR059035
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for Emergency Environmental Services, LLC, located in Mesa, Arizona, with coverage provided by multiple insurance carriers including Westchester Surplus Lines Insurance Company, Midwest Family Mutual Insurance Company, Carolina Casualty Insurance Company, and Hanover Insurance Company. The certificate holder is the Arizona Department of Environmental Quality, and the insurance policies cover the period from 7/24/2024 to 7/24/2025.
The insurance package includes comprehensive coverage such as commercial general liability ($1,000,000 per occurrence), automobile liability ($1,000,000), umbrella liability ($7,000,000), workers' compensation ($1,000,000), pollution liability ($1M occurrence/$2M aggregate), and equipment floater coverage for leased/rented equipment ($750,000). The policies include additional insured provisions for the State of Arizona and its departments, with waivers of subrogation and primary and non-contributory insurance clauses. Specific officers (Nicklaus Christofferson, Dave Buttrum, Brad Preston) are excluded from workers' compensation coverage. The endorsements ensure that the insurance will respond according to written contract requirements, providing protection for ongoing and completed operations.
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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
11/22/2024
(480) 834-9315
10172
Emergency Environmental Services, LLC 3064 N Norfolk Mesa, AZ 85215
23574 10510 22292
A 1,000,000
X X G71545805006 7/24/2024 7/24/2025 50,000 Professional Liabili 5,000
1,000,000 2,000,000 2,000,000
1,000,000B
X X CPAZ0560125682 7/24/2024 7/24/2025
7,000,000A G71545817006 7/24/2024 7/24/2025
0 7,000,000 C
X CCWC393402 7/24/2024 7/24/2025 1,000,000
Y 1,000,000
1,000,000 D Equipment Floater IH4H31639104 7/24/2024 Leased/Rented Equip 750,000 A Pollution Liability X X G71545805006 7/24/2024 7/24/2025 Occ $1M / Agg $2M 1,000,000
Officers Excluded from Work Comp: Nicklaus Christofferson, Dave Buttrum, Brad Preston.
State of Arizona, and its departments, agencies, boards, commisions, universities, officers, officials agents, and employees are included as additional insured with respects to the general liability, auto liability and polluation liability where required by written contract, per attached endorsement. Waiver of subrogation applies in favor of the general liability, auto liability, pollution liability and work comp where required by written contract, per attached endorsement. 30 Day NOC included
Arizona Department of Environmental Quality 1110 W Washington Street Phoenix, AZ 85007
EESLLC0-01 HBERANEK
LeBaron & Carroll LLC 1350 E Southern Avenue Mesa, AZ 85204
Haylie Beranek haylie@lebaroncarroll.com
Westchester Surplus Lines Ins Midwest Family Mutual Insurance Company Carolina Casualty Ins Co Hanover Insurance Company
Aggregate X
7/24/2025
X X
X
X
X
X X
X
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13
(Ed. 4-84)
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
The following statement only applies to policies or exposure in Missouri: Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual.
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.)
Endorsement Effective Policy No. Endorsement No.
Insured Premium $
Insurance Company
WC 00 03 13
(Ed. 4-84)
1983 National Council on Compensation Insurance.
CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1
POLICY NUMBER: G71545805
COMMERCIAL GENERAL LIABILITY
CG 20 37 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – COMPLETED OPERATIONS
ADDITIONAL INSURED – OWNERS, LESSEES OR
CONTRACTORS – COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations
As required by written contract, prior to a loss to which this insurance applies.
As required by written contract, prior to a loss to which this insurance applies.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard".
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
ENV-3143 (03-05) Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 1 of 1
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US
Named Insured Emergency Environmental Services LLC
Endorsement Number
Policy Symbol
GLW
Policy Number G71545805
Policy Period 07/24/2024 to 07/24/2025
Effective Date of Endorsement 07/24/2024
Issued By (Name of Insurance Company) Westchester Surplus Lines Insurance Company
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
CONTRACTORS POLLUTION LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
As required by written contract, prior to a loss to which this insurance applies.
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.)
The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition is amended by the addition of the following:
We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or your work done under a contract with that person or organization and included in the products-completed operations hazard. This waiver applies only to the person or organization shown in the Schedule above.
All other terms and conditions remain the same.
CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1
POLICY NUMBER: G71545805 COMMERCIAL GENERAL LIABILITY
CG 20 10 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – SCHEDULED PERSON OR ORGANIZATION
ADDITIONAL INSURED – OWNERS, LESSEES OR
CONTRACTORS – SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations
As required by written contract, prior to a loss to which this insurance applies.
As required by written contract, prior to a loss to which this insurance applies.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf;
in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above.
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:
This insurance does not apply to "bodily injury" or "property damage" occurring after:
1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or
2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project.
C. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
ENV-3252 (12-18)
(266562.1)
Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 1 of 1
PRIMARY AND NONCONTRIBUTORY – OTHER INSURANCE CONDITION
Named Insured
Emergency Environmental Services LLC Endorsement Number
Policy Symbol
GLW
Policy Number
G71545805 Policy Period
07/24/2024 TO 07/24/2025
Effective Date of Endorsement
07/24/2024 Issued By (Name of Insurance Company)
Westchester Surplus Lines Insurance Company
Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
CONTRACTOR’S POLLUTION LIABILITY COVERAGE PART
The following is added to the Other Insurance Condition and supersedes any provision to the contrary:
Primary and Noncontributory Insurance
This policy is primary to, and will not seek contribution from, any other insurance available to an additional insured under this policy, provided that:
a. The additional insured is a named insured under such other insurance; and
b. You have agreed in a written contract or agreement that this insurance would:
(1) act as primary insurance; and
(2) would not seek contribution from any other insurance available to the additional insured.
All other terms and conditions of this policy remain unchanged.
ENV-3250 (12/18)
(221012.1)
Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 1 of 2
ADDITIONAL INSURED ENDORSEMENT – ONGOING WORK OR OPERATIONS
Named Insured
Emergency Environmental Services LLC Endorsement Number
Policy Symbol
GLW
Policy Number
G71545805 Policy Period
07/24/2024 TO 07/24/2025
Effective Date of Endorsement
07/24/2024 Issued By (Name of Insurance Company)
Westchester Surplus Lines Insurance Company
Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING:
CONTRACTORS POLLUTION LIABILITY COVERAGE PART
SCHEDULE:
Name of Person(s) or Organization(s):
As required by written contract, prior to a loss to which this insurance applies.
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.)
A. SECTION II - WHO IS AN INSURED is amended to include as an additional insured the persons or organizations shown in the Schedule, but only with respect to liability for injury or damage, to which this insurance applies, caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf;
in the performance of your ongoing operations for the additional insureds.
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following exclusion is added:
Exclusions
This insurance does not apply to injury or damage occurring after:
a. All work or operations, including materials, parts or equipment furnished in connection with such work or operations, on the project (other than service, maintenance or repairs) to be performed by you or on your behalf at the site of the covered operations has been completed; or
ENV-3250 (12/18)
(221012.1)
Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 2 of 2
b. That portion of your work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for the additional insured as a part of the same project.
C. With respect to the insurance afforded to these additional insureds, the following is added to SECTION
III – LIMITS OF INSURANCE:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
All other terms and conditions of this policy remain unchanged.
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