ࡱ> FHEy 5bjbj -6{{3>>>>>RRR8$TR$x>>>v>>p5%^s0*!*!*!>xL)6_,$p*! :  Michigan Department of Environmental Quality - Resource Management DivisionHAZARDOUS WASTE MANAGEMENT FACILITY AMENDATORY ENDORSEMENT POLLUTION LEGAL LIABILITY - SUDDEN AND ACCIDENTAL This endorsement (Endorsement) changes the Pollution Legal Liability Policy (Policy) effective on the inception date of the Policy. This Endorsement is attached to the Policy to fulfill the insurance requirements of Section 11123 of the State of Michigan Natural Resources and Environmental Protection Act, 1994 PA 451, as amended, and R299.9710 of the Michigan Administrative Code (MAC). INSURER:INSURED:INSURERS ADDRESS:INSUREDS ADDRESS:CITY:STATE:ZIP CODE:CITY:STATE:ZIP CODE:POLICY NUMBER: POLICY PERIOD: FROM:  TO: COVERED FACILITY: (Attach additional page if necessary to list multiple Facilities covered)FACILITY NAME:FACILITY ADDRESS:CITY:STATE:ZIP CODE:EPA ID NUMBER: DEFINITIONS As used in this Endorsement: The term Contaminant means any hazardous waste defined in MAC R299.9203, and any hazardous waste or hazardous constituent listed in Appendix VIII of Part 261 or Appendix IX of Part 264 of Title 40 of the Code of Federal Regulations; and The term Sudden and Accidental Occurrence means the unintentional and unexpected discharge, dispersal, release, or escape of a contaminant in a noncontinuous and nonrepetitive manner, into or upon the land, the atmosphere, or any watercourse or body of water, which results in bodily injury or property damage. DECLARATIONS The insurance afforded with respect to Sudden and Accidental Occurrences is subject to all of the terms and conditions of the Policy provided however that any provisions of the Policy inconsistent with Sections A through F of this Endorsement are hereby amended to conform to Sections A through F. The limits of liability as respects bodily injury and property damage are provided in an amount not less than $1,000,000 per occurrence with an annual aggregate of not less than $2,000,000 exclusive of legal defense costs. The Insurer is liable for the payment of amounts within any deductible applicable to the Policy, with a right of reimbursement by the Insured for any such payment made by the Insurer. A Notice of Violation or Order issued by the DEQ or other environmental agency shall not be deemed in and of itself sufficient evidence of an insureds intentional, knowing, willful, or deliberate noncompliance with a legal requirement so as to preclude coverage under this Policy. The Insurer will provide the Resource Management Division at the address below with at least 30 days advance written notice of cancellation, termination, or material change to the Policy which affects the coverage required by MAC R299.9710. Such notices shall be provided no matter which party initiates the cancellation, termination, or material change, and whether or not nonpayment of premium is involved. The following are the only specific pre-existing soil and groundwater conditions (defined in the referenced assessments or reports) that are excluded from coverage under the Policy (Attach additional pages if necessary):____________________________________________________ No condition, provision, stipulation, limitation, or exclusion contained in the Policy, or any other endorsement thereon, or any violation thereof, shall relieve the insurer from liability or from the payment of any claim, within the stated limits of liability in this Endorsement, for bodily injury and property damage to a third party caused by a sudden and accidental occurrence. The Insurer hereby certifies that it has issued the Insured the Policy to provide financial assurance and responsibility for bodily injury and property damage caused by Sudden and Accidental Occurrences arising from operation of the covered facility(ies), and that the Insurer is licensed to transact the business of insurance, or is eligible to provide insurance as an excess or surplus lines insurer, in the State of Michigan. Filing of this Endorsement is required by Law (MAC R299.9710)Name of Authorized AgentSubmit one original signed Endorsement to:Street Address or PO Box HAZARDOUS WASTE SECTION RESOURCE MANAGEMENT DIVISION DEPARTMENT OF ENVIRONMENTAL QUALITY PO BOX 30241 LANSING MI 48909-7741City, State and Zip CodeSignature of Authorized AgentDate     DEQ(E) 5103-1b (R2 1/2012) %/2EOP H I > Ƿ䌂xhXhXhNxNxNxChoF5CJOJQJhoFCJOJQJhPDjhN6CJOJQJaJhPDjhoF6CJOJQJaJhoFCJOJQJhoFCJOJQJhoF5CJOJQJh|OhPDj5CJOJQJaJh|Oho\5CJOJQJaJh|OhF5CJOJQJaJh|OhoF5CJOJQJaJh|O5CJOJQJaJhoF5CJOJQJ jhGhlm6CJ UaJ OPH I R [ $If$a$Mkd $$Ifl0*t#4 laytPDj "$Ifgd|O $$Ifa$gdPDj [ \ o iGkdY $$Ifl 0*r4 la$IfGkd $$Ifl 0*r4 la keeeeeeeeee$Ifkd $$Ifl ֈD  $* " 4 la ? @ O a i4kd $$Ifl**4 laZkdS $$Ifl F 8*RRR    4 la$Ifa b h o y C>$a$mkd $$Ifl \2 * |4 la$IfGkd7 $$Ifl 0*r4 la> euZaqr#|m["hPDjhoF56CJOJQJaJhPDjhoFCJOJQJaJhPDj5CJOJQJaJhPDjhoF5CJOJQJaJho\CJOJQJhFCJOJQJhyCJOJQJh:MCJOJQJhoFCJOJQJhNCJOJQJhoF5CJOJQJhoF5CJOJQJhoF5CJOJQJhoFCJOJQJ# ar$If $$Ifa$ & F & Fxx]$a$$=>Xv7Okd $$Ifl 0`*<4 laytPDj$Ifrkd $$Ifl F `*vV<      4 lap ytPDj#$<=>   &'(*+,ƶƶƶƶƶvvjv^vjh8CJ OJQJaJ h0CJ OJQJaJ hm#h8CJ OJQJaJ hHCJ OJQJaJ h8hJtSjhJtSUhoFCJOJQJhPDj5CJOJQJhPDjhPDj5CJOJQJaJhPDjhPDjCJOJQJaJhoF5CJOJQJhPDjhoFCJOJQJaJhPDjhoF5CJOJQJaJ$vQkd8$$Ifl4 0`*<4 laytPDj $Ifgd~CY$If    dkd$$Ifl40F`$*0      4 laytPDj./012345$a$,.345hoFCJOJQJhJtSh8hm#h8CJ OJQJaJ +0/ =!"#$%   Dd G7p  c >A?deq logo tif"`b.4Ua|L@Y >ȺDn.4Ua|L@Y >ȺPNG  IHDR83sRGBgAMA a cHRMz&u0`:pQ<PLTEٟ pHYs.#.#x?v!tEXtSoftwareOi/GFS, writer v00.06.02RvIDATxA$`R2Kf;҅U9K.%Uī0 xܰĿtz/t'Eٛٛٛٛ1~=2&f'bVlw- 3v,\ZK!ubD >1P;`7D@V , ʂ3'#dZ6 .;v0ACY~Pc}tGlQ,$F!{l,6MˊeEV,\pm[L(ȎΣ)q ˬ`"Wcr i6 :/&F;bc jx01NcAY eSqx2 oњGI`A .Sv(6@X,UA6 㤰fiCO`A*HS$1HaV<Чl[fE}Lax M(w{ʬi3g 6~*|N ,[.;KY]] ؕYK.,v9vLXͺ38gX 4.],˰Szevm2aMoV]Y=ˮѳaÒ]F},Y͒m9aYzH̶6N1vmDX};,-lM'ˮ)hWF|k<XwA CYv%rS-ˋ,]oԛ ۅ`IVP*V˶e_>\mʬX%JְlhD?k%ۗ34CV*٦NMY vO;mY1qtpM>)\ -֏UTv*E\cSDruĪ0"HGkJ,|S0e*s5Xf VdЬ~ N?b 8N A6dذcŞߺdر|#t4+(Bp՟kˬҬ}9;e3Al-졂Ve/'|mdnN!|1v6"ى ֲ^5a5umN eVaK9Ƕgf/mVw/a ^XefK=ardO¶YYcYYW+.$;agƲS_S]OJbVXg? 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Attachment of the Endorsement to the Policy will fulfill the insurance requirements of Section 11123 of the StChristine HolmesLeiter, Lindacarol (DEQ) Oh+'0 , L X d p|This endorsement (the Endorsement) changes the Pollution Legal Liability Policy (the Policy) effective on the inception date of the Policy. Attachment of the Endorsement to the Policy will fulfill the insurance requirements of Section 11123 of the StChristine Holmes Normal.dotmLeiter, Lindacarol (DEQ)4Microsoft Office Word@@lE@*@x՜.+,0 px   MDEQ - WMD This endorsement (the Endorsement) changes the Pollution Legal Liability Policy (the Policy) effective on the inception date of the Policy. Attachment of the Endorsement to the Policy will fulfill the insurance requirements of Section 11123 of the St Title  !"#%&'()*+,-./012346789:;<>?@ABCDGRoot Entry F@fIData 1Table$:!WordDocument-6SummaryInformation(5DocumentSummaryInformation8=CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q