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HomeMy WebLinkAboutPW13-004 - Amendment - #1 - A & M Consulting - Utility Coordination Downey Farmstead Project - 11/25/2013 it Records Management�= KENT Document W ASH IN GTON AM 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 City Clerk's Office. Vendor Name: A & M Consulting Vendor Number: JD Edwards Number Contract Number: �z— C)04 This is assigned by City Clerk's Office Project Name: Downey Farmstead Description: ❑ Interlocal Agreement ❑ Change Order ® Amendment ❑ Contract ❑ Other: Contract Effective Date: 11/25/13Termination Date: 12/31/14 Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Beth Tan Department: Engineering Detail: (i.e. address, location, parcel number, tax id, etc.): An amendment is necessary to extend-the-time for completion to December 31, 2014__ because the project is still in the design phase. 5•Publlc\RecordsManagement\Forms\ContractCover\adcc7B32 1 11/08 KENT WASHINGTON AMENDMENT NO. 1 NAME OF CONSULTANT OR VENDOR: A & M Consultina CONTRACT NAME & PROJECT NUMBER: Downey Farmstead ORIGINAL AGREEMENT DATE: January 8, 2013 This Amendment is made between the City and the above-referenced Consultant or Vendor and amends the original Agreement and all prior Amendments. All other provisions of the original Agreement or prior Amendments not inconsistent with this Amendment shall remain in full force and effect. For valuable consideration and by mutual consent of the parties, Consultant or Vendor's work is modified as follows: 1. Section I of the Agreement, entitled "Description of Work," is hereby modified to add additional work or revise existing work as follows: In addition to work required under the original Agreement and any prior Amendments, the Consultant or Vendor shall: The scope of work remains the same, however an amendment is needed to extend the time of completion to December 31, 2014 because the project is still in the design phase. 2. The contract amount and time for performance provisions of Section II "Time of Completion," and Section III, "Compensation," are modified as follows: Original Contract Sum, $9,240.00 including applicable WSST Net Change by Previous Amendments $0 including applicable WSST Current Contract Amount $9,240.00 including all previous amendments Current Amendment Sum $0 Applicable WSST Tax on this $0 Amendment Revised Contract Sum $9,240.00 AMENDMENT - 1 OF 2 Original Time for Completion 12/31/13 (insert date) Revised Time for Completion under n/a prior Amendments (Insert date) Add'I Days Required (t) for this 365 calendar days Amendment Revised Time for Completion 12/31/14 (Insert date) The Consultant or Vendor accepts all requirements of this Amendment by signing below, by its signature waives any protest or claim it may have regarding this Amendment, and acknowledges and accepts that this Amendment constitutes full payment and final settlement of all claims of any kind or nature arising from or connected with any work either covered or affected by this Amendment, including, without limitation, claims related to contract time, contract acceleration, onsite or home office overhead, or lost profits. This Amendment, unless otherwise provided, does not relieve the Consultant or Vendor from strict compliance with the guarantee and warranty provisions of the original Agreement. All acts consistent with the authority of the Agreement, previous Amendments (if any), and this Amendment, prior to the effective date of this Amendment, are hereby ratified and affirmed, and the terms of the Agreement, previous Amendments (if any), and this Amendment shall be deemed to have applied. The parties whose names appear below swear under penalty of perjury that they are authorized to enter into this Amendment, which is binding on the parties of this contract. IN WITNESS,. the parties below have executed this Amendment, which will become effective on the last date written below. CONSULTANT/VENDOR: CITY OF KENT: By: By: (sign to e) ( gnature) Print Name: ro A I J M Print Name: Timothy J. LaPorte, P.E. Its 61 yL,1 L/v� Its Public Works Director (t e) itle) DATE: DATE: « 2S l3 APPROVED AS TO FORM: (applicable If Mayor's signature required) Kent Law Department A&M Consulting-Downey Amd 1/Tan AMENDMENT - 2 OF 2 A�C�RI DATE(MM/DD,YYYY) CERTIFICATE OF LIABILITY INSURANCE 10-18-2013 THIS CERTIFICATEIS 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 CERTIFICATEOF 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 ADDITIONALINSURED,the pollcy(les)must be endorsed If SUBROGATIONIS 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) PRODUCER CONTACT NAME AJ GALLAGHER RSK MGMT SVCS INC/PHS E FAX 812490 P: (866) 467-8730 F: (877) 905-0457 " al"°'E " (866) 467-873o Aic,N°) (877) 9os-o45 PO BOX 33015 ADDRESS SAN ANTONI O TX 78265 INSURER(S)AFFORDING COVERAGE NAIC q INSURER Hartford Casualty Ins CO INSURED INSURER B INSURER C ARNOLD TOMAC DBA A & M CONSULTING INSURER D 18119 NE 30TH ST REDMOND WA 98052 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER REVISION NUMBER 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 INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSR WVL POLICY NUMBER (MMlDDYYVV) IMMIDD/YVVYI GENERAL LIABILITY EACH OCCURRENCE S 2, 000, 000 COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ 300, 000 A CLAIMS-MADE I XI OCCUR I MED EXP(Any one person) $ 10, 000 X General Liab L`J u 52 SBM UK5025 11/01/2013 11/01/2014 1 PERSONAL St ADV INJURY $ 2 , 000, 000 GENERAL AGGREGATE S 4 , 000, 000 GEN'L AGGREGATE LIMIT A�PPLIE�S PER PRODUCTS-COMPIOP AGG � $ 4 , 000, 000 POLICY u P ECT RO X LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 2, 000, ()00 ANYAUTO BODILY INJURY(Per person) $ ' A ALL OWNED I I SCHEDULED u u 52 SBM UK5025 11/01/2013 11/01/2014 BODILY INJURY(Per accident) S AUTOS II AUTOS X PROPERTY DAMAGE HIRED AUTOS �( NON-OWNED u AUTOS (Per accident) $ UMBRELLA LIAB ( OCCUR EACH OCCURRENCE $ EXCESS LIAB a CLAIMS-MADE u u AGGREGATE $ DEDI I RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS LIABILITY YIN TORYLIMITS ER A ONICERMEMS 9REXCRLUDED EXECUTIVE N/A j 52 SBM UK5025 11/01/2013 11/01/2014 EL EACH ACCIDENT $ 1 000 000 (Mandatory In NH) L'� E L DISEASE-EA EMPLDYE $ 1 000 000 If yes,descnbe uncer DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ 1, 000, 000 uu DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101 Additional Remarks Schedule it more space is requeed7 Those usual to the Insured' s Operations . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED The City of Kent BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE Public Works Engineering DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS 222 Fourth Ave . S . AUTHORIZE-9 REPRESENTATIVE Kent WA 98032 aC ��� . ® 1988-2010 ACORD CORPORATION All rights reserved %CORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 6 . IMPORTANT NOTICE TO POLICYHOLDERS To help your insurance keep pace with increasing costs, we have increased your amount of insurance . . . giving you n better protection in case of either a partial,or total loss to your property. Ln If you feel the new amount is not the proper one, please contact your agent or broker. M 14 ,-4 O Ln N O L.(1 N N Ln N O O a-q M �L s 25 This Spectrum Policy consists of the Declarations, Coverage Forms, Common Policy Conditions and any 50 other Forms and Endorsements issued to be a part of the Policy This insurance is provided by the stock UK insurance company of The Hartford Insurance Group shown below SBM INSURER: HARTFORD CASUALTY INSURANCE COMPANY ONE HARTFORD PLAZA, HARTFORD, CT 06155 COMPANY CODE, 3 Policy Number: 52 SBM UK5025 DX THE HARTFORD SPECTRUM POLICY DECLARATIONS ORIGINAL co Named Insured and Mailing Address: ARNOLD TOMAC DBA A & M Ln (No , Street, Town, State, Zip Code) CONSULTING 18119 N.E. 30TH STREET REDMOND WA 98052 m Policy Period: From 11/01/12 To 11/01/13 1 YEAR Ln 12 01 a m , Standard time at your mailing address shown above. Exception: 12 noon in New Hampshire N ,C> Name of Agent/Broker: AJ GALLAGHER RSK MGMT SVCS INC/PHS Code: 812490 N N Previous Policy Number: 52 SBM UK5025 0 0 m Named Insured is: INDIVIDUAL Audit Period: NON-AUDITABLE Type of Property Coverage: NONE Insurance Provided: In return for the payment of the premium and subject to all of the terms of this policy, we o agree with you to provide insurance as stated in this policy TOTAL ANNUAL PREMIUM IS: $425 MP IN RECOGNITION OF THE MULTIPLE COVERAGES INSURED WITH THE HARTFORD, YOUR POLICY PREMIUM INCLUDES AN ACCOUNT CREDIT. Countersigned by 09/17/12 Authorized Representative Date Form SS 00 02 12 06 Page 001 (CONTINUED ON NEXT PAGE) Process Date: 09/17/12 Policy Expiration Date: 11/01/13 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 52 SBM UK5025 BUSINESS LIABILITY LIMITS OF INSURANCE LIABILITY AND MEDICAL EXPENSES $1,000,000 MEDICAL EXPENSES -ANY ONE PERSON $ 10, 000 PERSONAL AND ADVERTISING INJURY $1,000, 000 DAMAGES TO PREMISES RENTED TO YOU $ 300, 000 on ANYONE PREMISES in o AGGREGATE LIMITS PRODUCTS-COMPLETED OPERATIONS $2,000,000 rn 1i GENERAL AGGREGATE $2, 000,000 0 in o EMPLOYMENT PRACTICES LIABILITY m COVERAGE: FORM SS 09 01 N N EACH CLAIM LIMIT $ 51000 0 0 rC" DEDUCTIBLE -EACH CLAIM LIMIT NOT APPLICABLE AGGREGATE LIMIT $ 5, 000 RETROACTIVE DATE: 11012005 This Employment Practices Liability Coverage contains claims made coverage. Except as may be otherwise provided herein, specified coverages of this insurance are limited generally to liability for injuries for which claims are first made against the insured while the insurance is in force. Please read and review the insurance carefully and discuss the coverage with your Hartford Agent or Broker. The L!mits of Insurance stated in this Declarations will be reduced, and may be completely exhausted, by the payment of"defense expense" and, in such event, The Company will not be obligated to pay any further"defense expense" or sums which the insured is or may become legally obligated to pay as "damages" BUSINESS LIABILITY OPTIONAL COVERAGES HIRED/NON-OWNED AUTO LIABILITY $1,000, 000 FORM: SS 01 70 Form SS 00 02 12 06 Page 003 (CONTINUED ON NEXT PAGE) Proress Date: 09/17/12 Policv Fxniration Date: 11/01/13 POLICY DECLARATIONS Continued SPECTRUM ( 1 POLICY NUMBER: 52 5BM UK5025 ADDITIONAL INSUREDS: THE FOLLOWING ARE ADDITIONAL INSUREDS FOR BUSINESS LIABILITY COVERAGE IN THIS POLICY. LOCATION 001 BUILDING 001 TYPE MANAGER LESSOR 0 NAME SEE FORM IX 12 00 C) 0 M o 'r Ln N O Ln Ln N O O Form SS 00 02 12 06 Page 005 (CONTINUED ON NEXT PAGE) Process Date: 09/17/12 Policy Expiration Date: 11/01/13 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 52 SBM UK5025 SUPPLEMENTAL DECLARATIONS: A service fee of$ 0006.00 is charged for each installment when your premium is paid in installments. The service fee is $ 0006.00 per withdrawal when you select an electronic fund transfer payment plan. The service fee will be added to the premium amount shown on your premium billing statement. CD 0 M rA 1', c-1 CD tif r Ln N ry - r4 Ln rl CJ 6'1 R or d' Form SS 00 45 12 06 Process Date: 09/17/12 Policy Expiration Date: 11/01/13 N ci c> O M r-I O Lf) N O U] N CN N O O �-i fh COMMON POLICY CONDITIONS Form SS 00 05 12 06 0 2006. The Hartford COMMON POLICY CONDITIONS All coverages of this policy are subject to the following conditions A. Cancellation (5) Failure to: 1. The first Named Insured shown in the (a) Furnish necessary heat, water, Declarations may cancel this policy by mailing sewer service or electricity for 30 or delivering to us advance written notice of consecutive days or more, except cancellation. during a period of seasonal 2. We may cancel this policy by mailing or unoccupancy, or o delivering to the first Named Insured written (b) Pay property taxes that are owing rn notice of cancellation at least and have been outstanding for a. 5 days before the effective date of more than one year following the o cancellation if any one of the following date due, except that this u, CN o conditions exists at any budding that is provision will not apply where you Ln Covered Property in this policy. are in a bona fide dispute with the taxing authority regarding payment (1) The building teas been vacant or N of such taxes N unoccupied 60 or more consecutive C> days This does not apply to b. 10 days before the effective date of 1 cancellation if we cancel for nonpayment M (a) Seasonal unoccupancy, or of premium ic imam (b) Buildings in the course of c. 30 days before the effective date of construction; renovation or cancellation if we cancel for any other addition reason Buildings with 65% or more of the rental 3. We will mad or deliver our notice to the first units or floor area vacant or unoccupied Named Insured's last marling address known —' are considered unoccupied under this to us provision (2) After damage by a Covered Cause of 4. Notice of cancellation will state the effective date of cancellation The policy period will end Loss, permanent repairs to the on that date. budding 5. If this policy is canceled, we will send the first (a) Have not started; and Named Insured any premium refund due o (b) Have not been contracted for, Such refund will be pro rata The cancellation within 30 days of initial payment of will be effective even if we have not made or loss offered a refund (3) The building has. 6. If notice is mailed, proof of mailing will be sufficient proof of notice (a) An outstanding order to vacate; T. If the first Named Insured cancels this policy, (b) An outstanding demolition order; we will retain -no less than $100 of the or premium. (c) Been declared unsafe by B. Changes governmental authority This policy contains all the agreements between you (4) Fixed and salvageable items have and us concerning the insurance afforded The first been or are being removed from the Named Insured shown in the Declarations is budding and are not being replaced authorized to make changes in the terms of this policy This does not apply to such removal with our consent This policy's terms can be that is necessary or incidental to any amended or waived only by endorsement issued renovation or remodeling by us and made a part of this policy Form SS 00 05 12 06 Page 1 of 3 © 2006. The Hartford COMMON POLICY CONDITIONS c. Yourtenant. L. Premium Audit You may also accept the usual bills of lading or a. We will compute all premiums for this policy in shipping receipts limiting the liability of carriers accordance with our rules and rates This will not restrict your insurance b. The premium amount shown in the K. Transfer Of Your Rights And Duties Under This Declarations is a deposit premium only At the Policy close of each audit period we will compute the Your rights and duties under this policy may not be earned premium for that period Any transferred without our written consent except in additional premium found the case of death of an individual Named Insured the the audit are due and payab to le ble due as a result the first Named Insured If the notice t e deposit If you die, your rights and duties will be transferred premium paid for the policy term is greater to your legal representative but only while acting than the earned premium, we will return the within the scope of duties as your legal excess to the first Named Insured o representative Until your legal representative is c. The first Named Insured must maintain all appointed, anyone having proper temporary records related to the coverage provided by custody of your property will have your rights and this policy and necessary to finalize the CD but only with respect to that property. premium audit, and send us copies of the N same upon our request 0 Ln N L N O Our President and Secretary have signed this policy Where required by law, the Declarations page has also been countersigned by our duly authorized representative Terence Shields Secretaryv It Andre A.Napoli,President Form SS 00 05 12 06 Panu 4 of Z THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM This endorsement modifies insurance provided under the following. M BUSINESS LIABILITY COVERAGE FORM ro OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM SPECIAL PROPERTY COVERAGE FORM STANDARD PROPERTY COVERAGE FORM UMBRELLA LIABILTY PROVISIONS 0 Ln N 0 x A. Disclosure Of Federal Share Of Terrorism 3. The act is a violent act or an act that is N Losses dangerous to human life, property or N The United States Department of the Treasury will infrastructure and is committed by an individual o reimburse insurers for 85% of that portion of insured or individuals acting as part of an effort to losses attributable to "certified acts of terrorism"that coerce the civilian population of the United exceeds the applicable insurer deductible. States or to influence the policy or affect the However, if aggregate industry insured losses under conduct of the United States Government by the federal Terrorism Risk Insurance Act, as coercion amended ("TRIA") exceed $100 billion in a Program If aggregate industry insured losses attributable to Year (January 1 through December 31), the "certified acts of terrorism" under TRIA exceed $100 Treasury shall not make any payment for any billion in a Program Year (January 1 through _ portion of the amount of such losses that exceeds December 31), and we have met, or will meet, our $100 billion The United States government has not insurer deductible under TRIA, we shall not be liable charged any premium for their participation in for the payment of any portion of the amount of such covering terrorism losses. losses that exceed $100 billion In such case, your B. Cap On Insurer Liability for Terrorism Losses coverage for terrorism losses may be reduced on a pro-rata basis in accordance with procedures A "certified act of terrorism" means an act that is established by the Treasury, based on its estimates certified by the Secretary of the Treasury, in of aggregate industry losses and our estimate that concurrence with the Secretary of State and the we will exceed our insurer deductible In Attorney General of the United States to be an act accordance with the Treasury's procedures, of terrorism under TRIA The criteria contained in amounts paid for losses may be subject to further TRIA for a "certified act of terrorism" include the adjustments based on differences between actual following losses and estimates 1. The act results in insured losses in excess of$5 C. Application Of Exclusions million in the aggregate, attributable to all types The terms and limitations of any terrorism exclusion, of insurance subject to TRIA, and the inapplicability or omission of a terrorism 2 The act results in damage within the United exclusion, or the inclusion of terrorism coverage, do States, or outside the United States in the case not serve to create coverage for any loss which of certain air carriers or vessels or the premises would otherwise be excluded under this Coverage of an United States mission, and Form or Policy, such as losses excluded by the Nuclear Hazard Exclusion or the War And Military Action Exclusion Form SS 50 19 03 12 Page 1 of 1 © 2012, The Hartford ____ (Includes coovnahted material of Insurance Services Office Inc_ with its nermission) POLICY NUMBER: 52 SBM UK5025 AL THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGER/LESSOR THE CITY OF KENT PUBLIC WORKS ENGINEERING 0 222 FOURTH AVE. SO. KENT WA 98032 M r-I OC) N O Ln N L1 (V O O f7 Form IH 12 0011 85 T SEQ. NO. 002 Printed in U.S.A. Page 001 Process Date: 09/17/12 Expiration Date: 11/01/13 INSURED COPY THE HARRTFORD Named Insured: ARNOLD TOMAC DBA A & M Policy Number- 52 SBM UK5025 Effective Date. 11/01/12 Expiration Date: 11/01/13 Company Name: AJ GALLAGHER RSK MGMT SVCS INC/PHS r 0 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY. Ln TRADE OR ECONOMIC SANCTIONS ENDORSEMENT LnLn N N o This insurance does not apply to the extent that trade or economic sanctions or other laws or regulations prohibit us from providing insurance, including, but not limited to,the payment of claims. All other terms and conditions remain unchanged Form IH 99 41 04 09 Page 1 of 1 POLICY NUMBER: 52 SBM UK5025 ` THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK INSURANCE ACT. DISCLOSURE PURSUANT TO TERRORISM RISK Ln INSURANCE ACT 0 M � SCHEDULE 0 En N O Ln CM Terrorism Premium (Certified Acts): t-n CD $ $5.00 0 1-4 �c A. Disclosure Of Premium C. Cap On Insurer Liability for Terrorism Losses _ In accordance with the federal Terrorism Risk If aggregate industry insured losses attributable to Insurance Act, as amended ("TRIA"), we are "certified acts of terrorism" under TRIA exceed $100 =_ required to provide you with a notice disclosing the billion in a Program Year (January 1 through portion of your premium, if any, attributable to December 31) and we have met, or will meet, our coverage for certified acts of terrorism under TRIA insurer deductible under TRIA, we shall not be liable The portion of your premium attributable to such for the payment of any portion of the amount of such coverage is shown in the Schedule of this losses that exceed $100 billion In such case, your endorsement. coverage for terrorism losses may be reduced on a B. Disclosure Of Federal Share Of Terrorism pro-rata basis in accordance with procedures Losses established by the Treasury, based on its estimates T of aggregate industry losses and our estimate that The United States Department of the Treasury will we will exceed our insurer deductible In accordance reimburse insurers for 85% of that portion of insured with the Treasury's procedures, amounts paid for losses attributable to "certified acts of terrorism" losses may be subject to further adjustments based under TRIA that exceeds the applicable insurer on differences between actual losses and estimates deductible D. All other terms and conditions remain the same. However, if aggregate industry insured losses under TRIA exceed $100 billion in a Program Year (January 1 through December 31), the Treasury shall not make any payment for any portion of the amount of such losses that exceeds $100 billion. The United States government has not charged any premium for their participation in covering terrorism losses Form SS 83 76 03 12 Page 1 of 1 © 2012, The Hartford (Includes coovnohted material of the Insurance Services Office Inc with its nermission 1 Policy Number: 52 SBM UK5025 IMPORTANT NOTICE TO POLICYHOLDERS DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT Ln 0 SCHEDULE M c-I -I O Ln o Terrorism Premium (Certified Acts): Ln $ $5.00 N Ln N O O M -k A. Disclosure Of Premium C. Cap On Insurer Liability for Terrorism Losses In accordance with the federal Terrorism Risk If aggregate industry insured losses attributable to Insurance Act, as amended ("TRIA"), we are "certified acts of terrorism" under TRIA exceed $100 required to provide you with a notice disclosing the billion in a Program Year (January 1 through portion of your premium, if any, attributable to December 31), and we have met, or will meet, our coverage for certified acts of terrorism under TRIA insurer deductible under TRIA, we shall not be liable The portion of your premium attributable to such for the payment of any portion of the amount of such coverage is shown in the Schedule of this losses that exceed $100 billion In such case, your endorsement. coverage for terrorism losses may be reduced on a B. Disclosure Of Federal Share Of Terrorism pro-rata basis in accordance with procedures Losses established by the Treasury, based on its estimates The United States Department of the Treasury will of aggregate industry losses and our estimate that reimburse insurers for 85% of that portion of insured we will exceed our insurer deductible In accordance with the Treasury's procedures, amounts paid for losses attributable to "certified acts of terrorism" losses may be subject to further adjustments based under TRIA that exceeds the applicable insurer on differences between actual losses and estimates deductible D. All other terms and conditions remain the same. However, if aggregate industry insured losses under TRIA exceed $100 billion in a Program Year _ (January 1 through December 31), the Treasury shall not make any payment for any portion of the amount of such losses that exceeds $100 billion The United States government has not charged any premium for their participation in covering terrorism losses Form SS 83 80 03 12 Page 1 of 1 © 2012, The Hartford (Includes copyrighted material of the Insurance Services Office, Inc , with its permission ) Process Date: 09/17/12 Policy Expiration Date: 11/01/13