HomeMy WebLinkAboutPK07-100 - Original - Management Valuation Systems, LLC - Clark Lake Park Appraisal - 06/27/2007 Records Marvagement3
KENT ",P' Document
W I�SHINGTON
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, if you have questions, please contact Mary Simmons, City
Clerks Office. I,
Vendor Name: �ar�� L J P �jQ I u ` emed Va'V� a�� 5 Ss- ( 5
Contract Number. �,�07 1 d Q
This is assigned by Mary Simmons
Vendor Number:
Project Name: l0,- lc L A lCp C 0v ✓K 4 Pey'a('5Q J
Contract Effective Date:
Contract Termination Date:
Contract Renewal Notice (Days):
Number of days required notice for termination or renewal or amendment
Contract Manager: 1—( �nm��
Department: ��f �S �G V'� h t
Abstract:
ADCL7832 07/02
KENT
VJPS MINGTON
CONSULTANT SERVICES AGREEMENT
between the City of Kent and
Management Valuation Systems, LLC
THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation
(hereinafter the "City"), and Management Valuation Systems, LLC organized under the laws of the State of
Washington, located and doing business at PO Box 1531 Kent, Washington 98035 1531 (hereinafter the
"Consultant").
I. DESCRIPTION OF WORK.
Consultant shall perform the following services for the City in accordance with the following described
plans and/or specifications
Consultant will prepare appraisals and reports for Parcel Numbers 212059099 and 2122059122
on property near Clark Lake Park in Kent, Washington as described in the consultants proposal
dated May 22, 2007 attached and incorporated as Exhibit A.
Consultant further represents that the services furnished under this Agreement will be performed in
accordance with generally accepted professional practices in effect at the time those services are performed.
II. TIME OF COMPLETION. The parties agree that work will begin on the tasks described in
Section I above immediately upon the effective date of this Agreement Upon the effective date of this
Agreement, Consultant shall complete the work described in Section I ay 31, 2007 e t�_
III. COMPENSATION.
A. The City shall pay the Consultant, based on time and materials, an amount not to exceed One
Thousand One Hundred Dollars and NO/100ths ($1.100.00) for the services described in this
Agreement. This is the maximum amount to be paid under this Agreement for the work
described in Section I above, and shall not be exceeded without the prior written authorization of
the City in the form of a negotiated and executed supplemental agreement. The Consultant
agrees that the hourly or flat rate charged by it for its services contracted for herein shall remain
locked at the negotiated rate(s) for a period of one (1) year from the effective date of this
Agreement. The Consultant's billing rates shall be as delineated in Exhibit A
B. The Consultant shall submit monthly payment invoices to the City for work performed, and a
final bill upon completion of all services described in this Agreement. The City shall provide
payment within forty-five (45) days of receipt of an invoice If the City objects to all or any
portion of an invoice, it shall notify the Consultant and reserves the option to only pay that
portion of the invoice not in dispute. In that event, the parties will immediately make every
effort to settle the disputed portion.
CONSULTANT SERVICES AGREEMENT- 1
(Under$10,000)
IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent Contractor-
Employer Relationship will be created by this Agreement and that the Consultant has the ability to control and
direct the performance and details of its work, the City being interested only in the results obtained under this
Agreement.
V. TERMINATION. Either party may terminate this Agreement, with or without cause, upon
providing the other party thirty (30) days written notice at its address set forth on the signature block of this
Agreement. After termination, the City may take possession of all records and data within the Consultant's
possession pertaining to this project, which may be used by the City without restriction If the City's use of
Consultant's records or data is not related to this project, it shall be without liability or legal exposure to the
Consultant.
VI. DISCRIMINATION. In the hiring of employees for the performance of work under this
Agreement or any subcontract, the Consultant, its subcontractors, or any person acting on behalf of the
Consultant or subcontractor shall not, by reason of race, religion, color, sex, age, sexual orientation, national
origin, or the presence of any sensory. mental, or physical disability, discriminate against any person who is
qualified and available to perform the work to which the employment relates Consultant shall execute the
attached City of Kent Equal Employment Opportunity Policy Declaration, Comply with City Administrative
Policy 1.2, and upon completion of the contract work, file the attached Compliance Statement.
VII. INDEMNIFICATION. Consultant shall defend, indemnify and hold the City, its officers,
officials, employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or suits,
including all legal costs and attorney fees, arising out of or in connection with the Consultant's performance of
this Agreement, except for that portion of the injuries and damages caused by the City's negligence
The City's inspection or acceptance of any of Consultant's work when completed shall not be grounds to
avoid any of these covenants of indemnification.
Should a court of competent jurisdiction determine that this Agreement is subject to RCW 4.24.115,
then, in the event of liability for damages arising out of bodily injury to persons or damages to property caused
by or resulting from the concurrent negligence of the Consultant and the City, its officers, officials, employees,
agents and volunteers, the Consultant's liability hereunder shall be only to the extent of the Consultant's
negligence.
IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE
INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE CONSULTANT'S WAIVER OF
IMMUNITY UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF
THIS INDEMNIFICATION THE PARTIES FURTHER ACKNOWLEDGE THAT THEY HAVE
MUTUALLY NEGOTIATED THIS WAIVER.
The provisions of this section shall survive the expiration or termination of this Agreement.
VIII. INSURANCE. The Consultant shall procure and maintain for the duration of the Agreement,
insurance of the types and in the amounts described in Exhibit B attached and incorporated by this reference.
IX. EXCHANGE OF INFORMATION. The City will provide its best efforts to provide
reasonable accuracy of any information supplied by it to Consultant for the purpose of completion of the work
under this Agreement.
CONSULTANT SERVICES AGREEMENT-2
(Under 510,000)
X. OWNERSHIP AND USE OF RECORDS AND DOCUMENTS. Original documents,
drawings, designs, reports, or any other records developed or created under this Agreement shall belong to and
become the property of the City All records submitted by the City to the Consultant will be safeguarded by the
Consultant Consultant shall make such data, documents, and files available to the City upon the City's request.
The city's use or reuse of any of the documents, data and tiles created by Consultant for this project by anyone
other than Consultant on any other project shall be without liability or legal exposure to Consultant.
XI. CITY'S RIGHT OF INSPECTION. Even though Consultant is an independent contractor
with the authority to control and direct the performance and details of the work authorized under this
Agreement, the work must meet the approval of the City and shall be subject to the City's general right of
inspection to secure satisfactory completion
XIL WORK PERFORMED AT CONSULTANT'S RISK. Consultant shall take all necessary
precautions and shall be responsible for the safety of its employees, agents, and subcontractors in the
performance of the contract work and shall utilize all protection necessary for that purpose All work shall be
done at Consultant's own risk, and Consultant shall be responsible for any loss of or damage to materials, tools,
or other articles used or held for use in connection with the work.
XIII. MISCELLANEOUS PROVISIONS.
A. Recyclable Materials. Pursuant to Chapter 3 80 of the Kent City Code, the City requires its
contractors and consultants to use recycled and recyclable products whenever practicable. A price preference
may be available for any designated recycled product.
B. Non-Waiver of Breach. The failure of the City to insist upon strict performance of any of the
covenants and agreements contained in this Agreement, or to exercise any option conferred by this Agreement
in one or more instances shall not be construed to be a waiver or relinquishment of those covenants, agreements
or options, and the same shall be and remain in full force and effect.
C. Resolution of Disputes and Governing Law. This Agreement shall be governed by and
construed in accordance with the laws of the State of Washington. If the parties are unable to settle any dispute,
difference or claim arising from the parties' performance of this Agreement, the exclusive means of resolving
that dispute, difference or claim, shall only be by filing suit exclusively under the venue, rules and jurisdiction
of the King County Superior Court, King County, Washington, unless the parties agree in writing to an
alternative dispute resolution process In any claim or lawsuit for damages arising from the parties'
performance of this Agreement, each party shall pay all its legal costs and attorney's fees incurred in defending
or bringing such claim or lawsuit, in addition to any other recovery or award provided by law; provided,
however, nothing in this paragraph shall be construed to limit the City's right to indemnification under Section
VII of this Agreement
D. Written Notice All communications regarding this Agreement shall be sent to the parties at the
addresses listed on the signature page of the Agreement, unless notified to the contrary Any written notice
hereunder shall become effective three (3) business days after the date of mailing by registered or certified mail,
and shall be deemed sufficiently given if sent to the addressee at the address stated in this Agreement or such
other address as may be hereafter specified in writing.
E. Assggnment. Any assignment of this Agreement by either party without the written consent of
the non-assigning party shall be void. If the non-assigning party gives its consent to any assignment, the terms
of this Agreement shall continue in full force and effect and no further assignment shall be made without
additional written consent
CONSULTANT SERVICES AGREEMENT-3
(Under$10,000)
F. Modification. No waiver, alteration, or modification of any of the provisions of this Agreement
shall be binding unless in writing and signed by a duly authorized representative of the City and Consultant.
G. Entire Agreement. The written provisions and terms of this Agreement, together with any
Exhibits attached hereto, shall supersede all prior verbal statements of any officer or other representative of the
City, and such statements shall not be effective or be construed as entering into or forming a part of or altering
in any manner this Agreement. All of the above documents are hereby made a part of this Agreement
However, should any language in any of the Exhibits to this Agreement conflict with any language contained in
this Agreement, the terms of this Agreement shall prevail.
H. Compliance with Laws. The Consultant agrees to comply with all federal, state, and municipal
laws, rules, and regulations that are now effective or in the future become applicable to Consultant's business,
equipment, and personnel engaged in operations covered by this Agreement or accruing out of the performance
of those operations.
IN WITNESS, the parties below execute this Agreement, which shall become effective on the last
date entered below.
CONSULTAN . CITY OF KENT:
S �-
By: By:
(signature) (signature)
Print Name arr y L. Stre e Print Name: Jeff Watling
Its: Owner Its: Director
lade) (Tide)
DATE:��z � �7 DATE- (12/a Z r�
NOTICES TO BE SENT TO: NOTICES TO BE SENT TO:
CONSULTANT: CITY OF KENT:
Larry Strege Perry Brooks
Management Valuation Systems, LLC Kent Parks, Recreation & Community Services
PO Box 1531 220 Fourth Avenue South
Kent, WA 98035-1531 Kent, WA 98032-5895
(253) 520-8054 (telephone) (253) 856-5114 (telephone)
(253) 520-8057 (facsimile) (253) 856-6050 (facsimile)
Clark Lake Park Appraisal-Lannoye
CONSULTANT SERVICES AGREEMENT-4
(Under$10,000)
DECLARATION
CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY
The City of Kent is committed to conform to Federal and State laws regarding equal opportunity As such all
contractors, subcontractors and suppliers who perform work with relation to this Agreement shall comply with
the regulations of the City's equal employment opportunity policies
The following questions specifically identify the requirements the City deems necessary for any contractor,
subcontractor or supplier on this specific Agreement to adhere to. An affirmative response is required on all of
the following questions for this Agreement to be valid and binding. If any contractor, subcontractor or supplier
willfully misrepresents themselves with regard to the directives outlines, it will be considered a breach of
contract and it will be at the City's sole determination regarding suspension or termination for all or part of the
Agreement;
The questions are as follows:
1. I have read the attached City of Kent administrative policy number 1.2.
2. During the time of this Agreement I will not discriminate in employment on the basis of sex, race, color,
national origin, age, or the presence of all sensory, mental or physical disability.
3. During the time of this Agreement the prime contractor will provide a written statement to all new
employees and subcontractors indicating commitment as an equal opportunity employer.
4. During the time of the Agreement I, the prime contractor, will actively consider hiring and promotion of
women and minorities.
S. Before acceptance of this Agreement, an adherence statement will be signed by me, the Prime
Contractor, that the Prime Contractor complied with the requirements as set forth above.
By signing below, I agree to fulfill the five requirements referenced above.
Dated this day of 2007.
By:
For:
Title-
Date
EEO COMPLIANCE DOCUMENTS - 1
CITY OF KENT
ADMINISTRATIVE POLICY
NUMBER: 1.2 EFFECTIVE DATE- January 1, 1998
SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996
CONTRACTORS APPROVED BY Jim White, Mayor
POLICY:
Equal employment opportunity requirements for the City of Kent will conform to federal and state laws. All
contractors, subcontractors, consultants and suppliers of the City must guarantee equal employment opportunity
within their organization and, if holding Agreements with the City amounting to $10,000 or more within any
given year, must take the following affirmative steps.
1. Provide a written statement to all new employees and subcontractors indicating commitment as an equal
opportunity employer.
2. Actively consider for promotion and advancement available minorities and women.
Any contractor, subcontractor, consultant or supplier who willfully disregards the City's nondiscrimination and
equal opportunity requirements shall be considered in breach of contract and subject to suspension or
termination for all or part of the Agreement.
Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public Works
Departments to assume the following duties for their respective departments.
1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these regulations are
familiar with the regulations and the City's equal employment opportunity policy.
2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines.
EEO COMPLIANCE DOCUMENTS-2
CITY OF KENT
EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT
This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded the
Agreement.
I, the undersigned, a duly represented agent of Management Valuation Systems, LLC Company,
hereby acknowledge and declare that the before-mentioned company was the prime contractor for the
Agreement known as Clark Lake Park Appraisal Lannoye Property that was entered into on the_
(date) ,between the firm I represent and the City of Kent.
I declare that I complied fully with all of the requirements and obligations as outlined in the City of Kent
Administrative Policy 12 and the Declaration City of Kent Equal Employment Opportunity Policy that was part
of the before-mentioned Agreement.
Dated this day of 2007.
By-
For:
Title:
Date.
EEO COMPLIANCE DOCUMENTS-3
Larry L Strege
Management Valuation Systems LLC
PO Box 1531
Kent,WA 980351531
Phone 253 520.8054
Fax 253 520.8057
LStrege@mrktusa com
May 22, 2007
Perry Brooks
City of Kent
Parks, Recreation & Community Services
220 41"Avenue S
Kent, WA 98032
RE Parcel #2122059099
12436 SE 2481"ST
Kent, WA 98030
Parcel#2122059122
Vacant Land
No Site Address
Perry,
i
Pursuant to your request, an interior inspection f or the purpose of an appraisal using
FNMA URAR 1004 (6-93) will be performed on parcel #2122059099 for a fee of$500
Regarding the vacant land par cel #2122059122, you are quoted a fee of$600 for a Land
Appraisal Report
Both reports will be delivered to you on or before May 31, 2007
Thank you for this opportunity to be of service
Sincerely,
Larry L Strege, MA/ABS GAA
Real Estate Appraiser
EXHIBIT B
INSURANCE REQUIREMENTS FOR
CONSULTANT SERVICES AGREEMENTS
Insurance
The Contractor shall procure and maintain for the duration of the Agreement, insurance against claims for
injuries to persons or damage to pi operty which may arise from or in connection with the performance of
the work hereunder by the Contractor, their agents, representatives, employees or subcontractors
A. Minimum Scope of Insurance
Contractor shall obtain insurance of the types described below
1. Professional Liability insurance appropriate to the Consultant's profession.
B. Minimum Amounts of Insurance
Contractor shall maintain the following insurance limits:
1. Professional Liability insurance shall be written with limits no less than$1,000,000
per claim and $1,000,000 policy aggregate limit
C. Other Insurance Provisions
The insurance policies are to contain, or be endorsed to contain,the following provisions for Automobile
Liability and Commercial General Liability insurance
1. The Contractor's insurance coverage shall be primary insurance as respect the City. Any Insurance,
self-insurance, or insurance pool coverage maintained by the City shall be excess of the Contractor's
insurance and shall not contribute with it.
2. The Contractor's insurance shall be endorsed to state that coverage shall not be cancelled by either
party,except after thirty(30) days prior written notice by certified mail,return receipt requested,has
been given to the City
3. The City of Kent shall be named as an additional insured on all policies(except Professional
Liability) as respects work performed by or on behalf of the contractor and a copy of the endorsement
naming the City as additional insured shall be attached to the Certificate of Insurance The City
reserves the right to receive a certified copy of all required insurance policies The Contractor's
Commercial General Liability insurance shall also contain a clause stating that coverage shall apply
separately to each insured against whom claim is made or suit is brought, except with respects to the
limits of the insurer's liability
D. Acceptability of Insurers
Insurance is to be placed with insurers with a current A M Best rating of not less than A.VII.
E. Verification of Coverage
Contractor shall furnish the City with original certificates and a copy of the amendatory endorsements,
including but not necessarily limited to the additional insured endorsement, evidencing the insurance
requirements of the Contractor before commencement of the work
F. Subcontractors
Contractor shall include all subcontractors as insureds under its policies or shall furnish separate
certificates and endorsements for each subcontractor All coverages for subcontractors shall be subject to
all of the same insurance requirements as stated herein for the Contractor
ACORD CERTIFICATE OF LIABILITY INSURANCE D0 18i/00A'YW)
,,, 6/ 8l20D7
i PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Intercorp,Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1438-F West Main St HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Ephrata PA 1 7 522-1 34 5 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
(717)721-3500
INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURERA Lexington
Management Valuation Systems,LLC and
Larry L Strege INSURER 8
PO Box 1531 INSURERC
Kent WA 98035- INSURER D
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATEO 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
INSR ADD TI
POLICY NUMBER POLICYEFFECTIVE POLICY EXPIRAOM LIMI
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISE $
CLAIMS MADE F1 OCCUR MED EXP(Any one erwn
PERSONAL&AOV INJURY It
GENERAL AGGREGATE S
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGO S
POLICY I I PRO LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANYAUTO (Ea axident) $
ALL OWNED AUTOS BODILY INJURY S
SCHEDULED AUTOS
(Per person)
HIRED AUTOS
BODILY INJURY S
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE S
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO EAACC S
OTHER THAN
AUTO ONLY AGG $
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE $
S
DEDUCTIBLE
RETENTION
WORKERS COMPENSATION AND VPC STATU- OTH-
F.
EMPLOYERS UASWTY 5
ANY PROPRIETOR/PARTNERlEXECUTIYE
E L EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED
E L DISEASE-EA EMPLOYEE $
If Yee, PR r SPECIAL iAL PROVISIONS 1 -P LI Y I IMI7
A OTHER D0893425 05/21/2007 05/21/2008 Each Claim 1,000.000
Real Estate Appraisers Errors&Omissions Aggregate 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS[VEHICLES I EXCLUSIONS ADDED BY ENDORSEM ENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION At 000128
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Kent DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
Park,Recreation&Community Services NOTICE TO THE CERTIFICATE HOLDER NAMEOTO THE LEFT,BUT FAILURE TO DO SO SHALL
220 4th Avenue S IMPOSE NOO IGATI IN OR LIA ILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
Kent WA 98035- REPRESEN TIVE
AUTHORIZED kEPRELENVTIVE
L
ACORD 26(2001108) UC ACORD CORPORATION 1988
LEXINGTON INSURANCE COMPANY
W ILMINGTON,DELAWARE
Administrative Offices—100 Summer Street,Boston,Massachusetts 02110
Certificate Number: D0893425
This Certificate forms a part of Master Policy Number: 5120607
Renewal of Master Policy Number: 5113872
YOUR RISK PURCHASING GROUP MASTER POLICY IS A CLAIMS MADE POLICY.
READ THE ATTACHED MASTER POLICY CAREFULLY.
THE AMERICAN ACADEMY OF STATE CERTIFIED APPRAISERS
CERTIFICATE DECLARATIONS
1. Name and Address of Insured: Management Valuation Systems, LLC and
Larry L Strege
PO Box 1531
Kent,WA 98035
2. Certificate Period: Effective Date: 05/21/07 to Expiration Date: 05/21108
12:01 a.m. Local Time at the Address of the Insured.
2a. Retroactive Date: 05/21/05
12.01 a.m. Local Time at the Address of the Insured.
3 Limit of Liability: $1,000,000 each claim
$1,000,000 aggregate limit
4. Deductible: $5,000 each claim
5. Professional Covered Services insured by this policy are: REAL ESTATE APPRAISAL SERVICES
6. Advance Certificate Holder Premium: $507
7. Minimum Earned Premium: 25% or $127
Forms and Endorsements:
PRG 3150 10/05 Real Estate Appraisers Professional Liability Declarations, PRG 3149 10/05 Real Estate Appraisers
Professional Liability Form, MPL022 12/02 Fungus Mold Exclusion, LX 9346 09199 Employment-Related Practices
Exclusion, 81227 11/02 Terrorism Exclusion,AASCARPGNS 08/03 Non Stacking Endorsement, PRG 3151 10/05
Disciplinary Proceedings Extension Endorsement
Agency Name and Address: INTERCORP, INC.
1438-F West Main Street
Ephrata, PA 17522-1345
IT IS HEREBY UNDERSTOOD AND AGREED THAT THE CERTIFICATE HOLDER AGREES TO ALL TERMS AND
CONDITIONS AS SET FORTH IN THE ATTACHED MASTER POLICY.
THIS POLICY IS ISSUED BY YOUR RISK PURCHASING GROUP YOUR RISK PURCHASING GROUP MAY NOT BE
SUBJECT TO ALL OF THE INSURANCE LAWS AND REGULATIONS OF YOUR STATE STATE INSURANCE
INSOLVENCY GUARANTY FUNDS ARE NOT AVAILABLE FOR YOUR RISK PURCHASING GROUP
talf*j 5-
Authorized Representative OR
Countersignature (in states where applicable) Date- May 9, 2007
PRG 3152(10105)
i
I
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s)
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 ofsuch endorsement(s)
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing msurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon
ACORD 26(2001108)