Loading...
HomeMy WebLinkAboutPW04-402 - Change Order - #3 - KCM, Inc - Upper Meridian Valley Creek Improvements - Extend Time & Increase Contract Amount Records Main. "d-. ements� KENT Y �� Document CONTRACT COVER SHEET This is to be completed by the Contract Manager prior to submission to City Clerks Office. All portions are to be completed, it you have questions, please contact Mary Simmons, City Clerks Office. Vendor Name: e ) 9rxl d,ba. L�W_ • - Contract Number: Thisis assigned by Mary Simmons Vendor Number. Project Name: " 'I�f d.�an� r (2raQA- P o2 ��s Contract Effective Date: at. �'�•a�s S•on .r8 Contract Termination Date: _ 'y3-f 4 Contract Renewal Notice(Days): Number of days required notice for termination or renewal or amendment Contract Manager: Department: q,4Q Abstract: AOCL7832 07102 I's KENT W ASMINOTON CHANGE ORDER NO. 3 NAME OF CONTRACTOR, CONSULTANT, OR VENDOR: KCM Inc. d.b.a. Tetra Tech/KCM, Inc. ("Contractor") CONTRACT NAME &PROJECT NUMBER:Uvver Meridian Valley Creek Improvements ORIGINAL CONTRACT DATE:December 16, 1999 This Change Order amends the above-referenced contract; all other provisions of the contract that are not inconsistent with this Change Order shall remain in effect. For valuable consideration and by mutual consent of the parties, the project contract is modified as follows: 1. Section I of the Agreement, entitled"Description of Work," is hereby modified as follows: Provide all labor, materials, and equipment necessary to: The Consultant shall be providing requested modifications to contract drawings, specification review, and structural engineering review of the precast concrete culvert box sections. See Exhibit A for a detailed description of the Scope of Work. 2. The contract amount and time for performance provisions of Section II "Compensation," and Section III, "Time for Completion,"are hereby modified as follows: Original Contract Sum, $72,310.00 including applicable alternates and WSST. Net Change by Previous Change Orders $409835.00 (incl. applicable WSST) Current Contract Amount $1139145.00 (incl. Previous Change Orders) Current Change Order $129882.00 Applicable WSST Tax on this Change Order $0.00 Revised Contract Sum $1269027.00 Original Time for Completion September 21, 2000 (280 days) (insert date) Days Required ± for this Change Order approximately 345 calendar days Revised Time for Completion September 30, 2004 (insert date) Pursuant to Section XX., entitled "Changes," of the Contract executed by the parties, the Contractor accepts all requirements of this Change Order by signing below. Also, pursuant to the above-referenced contract, Contractor agrees to waive any protest it may have regarding this Change Order and acknowledges and accepts that this Change Order constitutes final settlement of all claims of any kind or nature arising from or connected with any work either covered or affected by this Change Order, including, without limitation, claims related to contract time, contract acceleration, onsite or home office overhead, or lost profits. The parties whose names appear below swear under penalty of perjury that they are authorized to enter into this contract modification, which is binding on the parties of this contract. 3. The Contractor will adjust the amount of its performance bond (if any) for this project to be consistent with the revised contract sum shown in section 2, above. IN WITNESS,the parties below have executed this Agreement,which will become effective on the last date written below. CONTRACTOR: CITY O NT: By: By: �jy7 Wnlu� eZ 0AI -1-1 •+�fie Print Name: Print N e: �1ti GlJ Q.{ Its VlTe f' 7lE�l Its :rt DATE: /a DATE: APPROVED AS TO FORM: Kent qity Attorney �sr KCM Inc -CM3-Upper Mendian Valley/Fielding CONTRACT MODIFICATION-2 OF 2 EXHIBIT A SCOPE OF WORK UPPER MERIDIAN VALLEY CREEK IMPROVEMENTS ADDENDUM NO. 3 Drawing Modifications and Contract Extension INTRODUCTION This scope of work reflects modifications requested to the contract drawings, specification review, and providing a structural engineer review of the precast concrete culvert box sections subsequent to the previous 100-percent submittal. In addition, the contract duration is extended to include the period January 2003 through September 2004, an additional 21 months. DURATION The project budgeting and fee estimate are based upon following the previous work effort described in the original contract and addendum 1 and 2 (City project number 01-3016). This addendum is scheduled for termination on September 30, 2004. This termination date represents an extension from Addendum 2 by 21 months. SERVICES The time estimates for the tasks discussed below represent the new tasks described in this scope of work only. The fee estimate reflects a reduction in fee by incorporating unused funds from the original Contract and Addendum 1 and 2. Consequently, no further work described in the original Contract and Addendums 1 and 2 will be performed. Tt/KCM shall perform services and furnish material necessary to accomplish the following work items: 1. Project Administration: This task includes administration of the contract between Tt/KCM and the City of Kent, preparation of City of Kent format specified status reports with each monthly invoice, and quality control. This task includes all administration efforts needed to coordinate with the City and to complete the project on time and within budget. 1.1 Prepare the special project status report with each monthly invoice. 1.2 Provide ongoing coordination and project management. 1.3 Provide Quality Assurance review by a senior engineer. 2. Drawing Revisions: Revise construction drawings to address City comments and mark- ups. The City will provide a traffic control plan to be included in the drawing set. The City is responsible for signing and stamping this drawing. 2.1 Revise construction drawings to reflect City comments.Submit to the City for review. Scope-Addendum 3-v2.doc 10/21/03 1 Addendum 3. 2.2 Revise drawings to reflect final comments. Submit stamped and signed Tt/KCM developed drawings to the City. 3. Specification Review: Review the current construction specifications provided by the City. These specifications reflect the City's standard components and Tt/KCM special provisions which were previously submitted. In addition to the construction specifications, a procurement specification has been prepared by the City that Tt/KCM will review. As with previous specification submittals, Tt/KCM will provide any comments and suggested revisions to the City and the City will compile this information into the specification document for bidding and construction use. I 3.1 Review the City provided construction specifications and provide comments and suggestions to the City for incorporation into the specifications. "Track Changes" will be used to document the suggested changes. 3.2 Review the City provided procurement specifications for the precast concrete box culverts and provide comments and suggestions to the City for incorporation into the specifications. "Track Changes" will be used to document the suggested changes. 4. Quantity/Cost Estimate Revisions: Revisions to the quantities and cost estimates are developed under this task. 4.1 Quantities will be revised to reflect the current project design. 5. Structural Review: A Tt/KCM staff structural engineer will review the Contractor submittals pertaining to the precast concrete culverts. In addition, two site visits to the procurement site will be made to ensure conformance to previously approved submittal details. Also, time is provided for the structural engineer to visit the construction site to respond to a City request to verify an installation in conformance with the design. Responding to Contractor questions on the box culvert is also included. 5.1 The structural engineer will review Contractor submittals pertaining to the precast concrete box culverts. Three submittal reviews are budgeted. All other submittals shall be reviewed by the City. 5.2 The structural engineer will make two visits to the fabrication site of the precast concrete box culverts to assess conformance with the approved Contractor submittals. One visit is scheduled to occur early in the fabrication process so the rebar size and placement can be observed and documented. The second visit will occur following the initial casting to confirm correct culvert geometry. The fabrication site is budgeted to be within a 40 mile radius of Seattle and is accessible by car. A brief report will be written by the structural engineer to document his observations. 5.3 A single construction site visit is budgeted for the structural engineer. This visit is in anticipation of a construction related issue that emerges during construction. A brief report will be written by the structural engineer to document his observations. 5.4 Questions from the Contractor concerning the box culvert will be addressed in this task. A limited amount of time is allocated to respond to these questions. Scope-Addendum 3-v2.doc 10/2V03 2 . Scope of Work UPPER MERIDIAN VALLEY CREEK IMPROVEMENTS ADDENDUM 3 SUPPLEMENTAL DRAWING LIST The following is a list of supplemental drawings. No new drawings are created by Tt/KCM. Sheet No. Title Responsible Part 10 Traffic Control Plan City of Kent Scope-Addendum 3-v2.doc 10/21/03 3 Addendum 3. . . UPPER MERIDIAN VALLEY CREEK IMPROVEMENTS ADDENDUM 3 ITEMS TO BE FURNISHED TO KCM BY THE CITY The City will furnish to KCM copies of documents that are available to the City that will facilitate the preparation of the review responses, plans, specifications, and estimates as noted below: 1. Review comments on the construction drawings from the City. 2. Construction Specification. 3. Procurement Specification. 4. Sheet 10 (Traffic Control Plan),current cover sheet and title block. 5. Contractor submittals pertaining to the precast concrete box culverts. Scope-Addendum 3-v2.doc 10/21/03 4 . Scope of Work UPPER MERIDIAN VALLEY CREEK IMPROVEMENTS ADDENDUM 3 ITEMS TO BE FURNISHED TO THE CITY BY KCM The following documents, exhibits, or other presentations for the work covered by this agreement will be furnished by KCM to the City upon completion of the various phases of the work. 1. Administration 1.1 City of Kent format progress report with each monthly invoice. 2. Construction Drawings 2.1 AutoCAD version 2000 drawing files and KCM's"CTB" file on CD-1 copy. 2.2 Camera-ready full size stamped and signed set of final drawings -1copy,bond paper. 3. Specification Review 3.1 Electronic copy of City provided construction specifications with"Track Changes" -1 copy. 3.2 Electronic copy of City provided procurement specifications with"Track Changes" -1 copy. 4. Cost Estimate 4.1 Updated construction cost estimate-1 copy. 5. Structural Review 5.1 Reviewed submittals pertaining to the precast concrete box culverts-1 copy each,up to three total. 5.2 Observation report of fabrication site visits- 1 copy each,two total. 5.3 Construction site visit observation report-1 copy,one total. Scope-Addendum 3-v2.doc 10/21/03 5 Addendum 3. . UPPER MERIDIAN VALLEY CREEK IMPROVEMENTS ADDENDUM 3 FEE ESTIMATE The professional fee estimate to perform the services described in this scope of work is attached. Also attached are the associated billing definitions. S\Active\2940126-Kent UMVC\mgmt\scope\Scope-Addendum 3-v2 doc Scope-Addendum 3-v2.doc 10/21/03 6 KCM, Inc. ESTIMATE OF PROFESSIONAL SERVICES 1917 First Avenue Seattle,WA 98101 CLIENT : City of Kent Tel(206)443-5300 Fax(206)443-5372 PROJECT: Upper Meridian Valley Creek Improvements Addendum 3 P.D.No. : 9940126 Proj.No.: 2940126 Date: 10/21/2003 LEVEL OF EFFORT—STAFF HOURS PHASE/TASK DESCRIPTION Project Project Prof. Tech. Clerical M mt. Leader Staff Staff Staff 1.0 Project Administration 1.1 Progress reports and invoice review(21 months) 16 8 12 Coordination and project management(21 1 16 2 months) 13 Quality Assurance Review 8 2 1 2.0 Drawing Revisions 21 Initial drawing revisions for City comments 16 24 2.2 Final drawing revisions 4 4 3.0 Specification Review 3 1 Construction specification review 12 32 Procurement specification review 4 4.0 Quantity/Cost Estimate Revision 4.1 Revise quantities/cost estimate 4 1 5.0 Structural Review 5.1 Contractor submittal review(3) 1 10 1 5.2 Fabrication site visits&documentation(2) 10 1 5.3 Construction site visit&documentation(1) 4 5.4 Respond to Contractor questions 8 TOTAL HOURS 10 1 106 1 1 28 13 HOURLY RATE(DJW`) $52 1 $42 $36 $25 $20 SUBTOTAL $520 1 $4,452 $36 $700 $260 TOTAL DIRECT JOB WAGES $5,968 OVERHEAD COST(Total DJW x 2.10) $12,533 TRAVEL AND PER DIEM (100 x 1.10) $110 PRINTING,PUBLICATIONS,COMMUNICATIONS (50 x 1.10) $55 OTHER Computers CAD @$14/hr (28 x 14.00 x 1.10) $431 Other @$3/hr (130 x 3.00 x 1.10) $429 Subconsultants (none) x 1.15)1 $0 SUBTOTAL $19,526 Deduction of remaining contract balance(as of September 5,2003) $6,644 TOTAL COST-THIS ADDENDUM 3 $12,882 Page 1 of 2 KCM, Inc. ESTIMATE OF PROFESSIONAL SERVICES 1917 First Avenue Seattle,WA 98101 CLIENT: City of Kent Tel(206)443-5300 Fax(206)443-5372 PROJECT: Upper Meridian Valley Creek Improvements Addendum 3 P.D.No. : 9940126 Proj.No.: 2940126 Date: 10/21/2003 LEVEL OF EFFORT—STAFF HOURS PHASE/TASK DESCRIPTION Project Project Prof. Tech. Clerical M mt. I Leader Staff Staff Staff CONTRACT HISTORY Original Contract $72,310 Addendum 1(Addition of north culvert) $23,612 Addendum 2(Responding to Agency comments,etc.) $17,223 Addendum 3(Final drawing modifications,specification review,etc.,this addendum) $19,526 Deduction of remaining contract balance(Original contract,Add.1&2,as of September 5,2003) -$6,644 TOTAL,original contract and all addendums $126,027 ..i■.. in�nwwwwww�s wwwwwanw. Notes. 1. Direct Job Wages rates and number of hours are averages for estimating purposes Invoices will be based on actual hourly rates and hours of staff assigned to the project. 2. Direct Job Wages are subject to change to reflect periodic adjustments in Tt/KCM salary levels. 3. This Estimate of Professional Services is based on labor and the attached"Definitions". Page 2 of 2 Tt/KCM DEFINITIONS "Reimbursable Expenses"include but are not hmrted to 1. Air Fare Expenses—Cost of ticket and travel to and from airport by public conveyances 2. Auto Lease Expenses—Basic charge,gas,oil,repairs,and insurance 3. Tt/KCM Auto Expenses — Cost of using Tt/KCM-owned vehicles at the current IRS mileage rate 4. Boat Expenses—Cost of using rental or leased boats at a fair commercial rate/hour 5. Meal Expenses—"Out-of-pocket"cost to employees while away from office on business 6. Lodging Expenses — "Out-of-pocket" cost to employees while away from office on business 7. Equipment Expenses — Cost of Tt/KCM-owned, rental, or lease of special equipment required to perform work S. Lab Fee Expenses—Cost of consumable laboratory supplies and lab use 9. Computer Expenses — Cost for the use of outside computer hardware or software as invoiced to Tt/KCM for specific project Internal computer rates are based on disc storage, CPU, and terminal connect time used in conjunction with technical programs and word processing Tt/KCM rates are established as- - Outside computer hardware and software at invoiced cost to Tt/KCM — Internal rates • CADD and technical computers — $14 00/hour All Other PC's — $ 3 00/hour • Printing. Charges for printing of black and white smgle-copy output are included in the above processing charges Plotting and color printing are charged separately Multiple-copy printing is$0 10 per additional page These time charges for equipment will be documented on Tt/KCM time sheets to the nearest 0 25 hour in the appropriate category 10. Production Expenses— Commercial and "in-office" printing,binding, and reproduction of reports and contract documents at invoice amount or a fair commercial rate 11. Miscellaneous Expenses — Direct job expenses and costs not defined in categories 1 through 12 such as special licenses,additional"out-of-pocket"employee traveling costs, etc "3ubconsultant Expenses" represent the cost of outside subconsultant technical services and expenses. They include but are not limited to. — Foundation and geological consultants — Technical consultants(electrical) — Other special technical engineers working outside of the engineer's office except those engineers paid directly by the owner — Foundation borings and testing — Laboratory tests — Property,location,or base map surveys — Aerial photography and preparation of topographic maps "Reimbursable Expense Factor" is an amount which takes into account Tt/KCM activities related to specific reimbursable expenses, e g, excise tax, liability insurance, and special added administrative costs and fees not related to Tt/KCM wages, and as indicated in the Professional Services Agreement and/or Estimate of Professional Services 7VKCM-6103 ACORD,. CERTIFICATE OF LIABILITY INSURANCE 1OPID L DATE tMM/DD YYYY) -KCMIN 09 16 03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Lyons Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Powdermill Square HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 3844 Kennett Pike, Suite 210 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. WI.- ngton DE 19807 Ph e: 302-658-5508 Fax:302-658-1253 INSURERS AFFORDING COVERAGE NAIC# Y INSURED * jr:" t;' INSURER A. Hartford Fire Insurance Co. 19682 fr(� rf INSURER Twin CityFire Insurance Co. KCM Inc. dba Tetra JLfU t INSURER American Intl. Specialty Lines Tecf1,3KCM Inc. ra� �p C 1917 First Avenue EIYG I N EL E`�t`"t�e� , ,; INSURER Seattle WA 98101 INSURER E COVERAGES 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 1MTH 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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS LTR INSR POLICY EFFECTIVE POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER DATE(MMIDD/YY) DATE MM/DDIY1' LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X X COMMERCIAL GENERAL LIABILITY 44UUNFU3205 10/01/03 10/O1/04 PREMISES(Ea occurence) s 300000 CLAIMS MADE FK OCCUR MED EXP tiny one poi son) $10000 PERSONAL B ADV INJURY $ 1000000 GENERAL AGGREGATE s 2000000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG s2000000 17 POLICY X JECOT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A X ANY AUTO 44UENFU3301 10/01/03 10/01/04 (Ea accident) $ 1000000 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIREDAUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTYDAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG I$ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $4000000 A X X OCCUR CLAIMSMADE 44XHUFU0785 10/01/03 10/01/04 AGGREGATE s 4000000 s DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND X TORY LIMITS I ER B EMPLOYERS'LIABILITY 44WBRMP3350 10/01/03 10/01/04 EL EACH ACCIDENT $ 1000000 ANY PROPRIETORIPARTNER/EXECUTWE — B OFFICERWEMBER EXCLUDED'+ 44WNMP3351 NA STOP GAP 10/01/03 10/01/04 EL DISEASE-EA EMPLOYEE $1000000 If yes,describe under SPECIAL PROVISIONS below EL DISEASE-POLICY LIMIT $1000000 OTHER C Profess./Pollution 1952583 10/01/03 10/01/04 See Below For Limits E&O Legal Liab. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS Limits: $5,000,000 Ea.Cl./$5,000,000 Agg. and $250,000 Retention Ea. Cl. CLAIMS MADE FORM: Maximum for all claims during the policy year.The Certificate Holder is included as an Additional Insured per the attached CG 20 10 11 85. RE: Upper Meridian Valley Creek Improvements #97-3002 (#2940126) CERTIFICATE HOLDER CANCELLATION CITY OF SHOULDANYOF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN City of Kent NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Dept. of Public Works IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Teresa M. Baim 220 Fourth Ave. South REPRESENTATIVES Kent WA 98032 AUTHO REPRESENTATIV c ACORD 25(2001/08) 0 ACORD CORPORATION 1988 ACORD CERTIFICATE OF LIABILITY INSURANCE OF ID L DATE9/17Y 1-TETR3 09 17 03 PRODUCER r +'�H)$„CBRTIFICATE IS ISSUED AS A MATTER OF INFORMATION Lyons Insurance Agency, Inc, y�e°aa ^��Ll (jF z-ONlIBh�'+A�NND CONFERS NO RIGHTS UPON THE CERTIFICATE Powdermill Square � HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 3844 Kennett Pike, Suite 210 SEA' 2 .;ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Wilmington DE 19807 J ter T te: 302-658-5508 Fax:302-658-12 3; s I gti��,•IN1SU OkSAFFORDINGCOVERAGE NAIC# IN,._ sD INSURERA American Intl. Specialty Lines INSURER B Tetra Tech Inc. INSURERC 3475 E Foothill Blvd, #300 NSURERD Pasadena CA 91107 INSURER E COVERAGES 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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS N*K Wu N - POLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPEOFINSURANCE POLICY NUMBER DATE MMIDO DATE(MMIDDIYVI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurenoe) $ CLAIMS MADE DOCCUR MED EXP(Any one person) S PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG $ POLICY PROJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT E ANY AUTO (Ea aaident) ALL OWNED AUTOS BODILY INJURY E SCHEDULED AUTOS (Per person) MIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ E DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS I ER EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUTNE E L EACH ACCDDENT $ OFFICER/MEMBER EXCLUDEM E L DISEASE-EA EMPLOYEE E If yea,descnbe under SPECIAL PROVISIONS below E L DISEASE-POLICY LIMIT E OTHER A Profess,/Pollution 1952583 10/01/03 10/01/04 See Below For Limits E60 Legal Liao DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS LIMITS: $5,000,000 Ea. Cl./$5,000,000 Agg. and $250,000 Retention Ea. Cl. CLAIMS MADE FORM: Maximum for all claims during the policy year. CERTIFICATE HOLDER CANCELLATION CITY OF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN City of Kent NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Dept. of Public Works IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Teresa M. Bain 220 Fourth Ave. South REPRESENTATIVES Kent WA 98032 AUTHO REPRESENTATI e ACORD 25(2001/08) ©ACORD CORPORATION 1988 POLICY NUMBER; 44UUNFU3205 COMMERCIAL GENERAL LIABILITY THE HARTFORD THIS ENDORSEMENT CHANGES'THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED--OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Persons or Organization: City of Kent Dept.of Public Works 220 Fourth Ave. South Kent,WA 98032 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section 11)is amended to include as an inured the person or organization shown in the Schedule,but only with respects to liability arising out of "your work"for that insured by or for you. CG 20 10 11 85 Copyright, Insurance Service Office, Inc. 19B4