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HomeMy WebLinkAboutPW13-191 - Change Order - #1 - PumpTech, Inc. - Green River Natural Resources Area Pump - 10/29/2013 x yE x I Records M a"J ia",-2 e t KENT Document k j6 £ 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: PumpTech Inc. Vendor Number: JD Edwards Number Contract Number: This is assigned by City Clerk's Office Project Name: Green River Natural Resources Area Pump Maintenance Description: ❑ Interlocal Agreement Chan e Order ❑ Amendment ® Contract Other: Mime MC)P))c"t !-ab Contract Effective Date: Date or Mayor's signatureTermination Date: 3/31/14 Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Matt Knox Department: Engineering Detail: (i.e. address, location, parcel number, tax id, etc.): Extend the time of completion to March 31, 2014 due to pump part availability problems and difficulties reinstalling the pump at the site. S:Puellc\RecordsManagement\Forms\ContractCover\adcc7832 1 11/08 i 00 KE KENT CHANGE ORDER NO. 1 NAME OF CONTRACTOR: PumpTech Inc. ("Contractor") CONTRACT NAME & PROJECT NUMBER: Green River Natural Resources Area Pump Maintenance ORIGINAL CONTRACT DATE: July 3, 2013 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 to add additional work or revise existing work as follows: In addition to work required under the original,Agreement and any prior Amendments, Contractor shall provide all labor, materials, and equipment necessary to: The scope of work remains the same, however a change order is necessary to extend the time of completion to March 31, 2014 due to pump part availability problems and difficulties reinstalling the pump at the site. 2. The contract amount and time for performance provisions of Section II "Time of Completion," and Section III, "Compensation," are hereby modified as follows: Original Contract Sum, $20,830.99 (including applicable alternates and WSST) Net Change by Previous Change Orders $0 (incl. applicable WSST) Current Contract Amount $20,830.99 (incl. Previous Change Orders) Current Change Order $0 Applicable WSST Tax on this Change $0 Order Revised Contract Sum $20,830.99 CHANGE ORDER - 1 OF 3 Original Time for Completion 10/31/13 (insert date) Revised Time for Completion under n/a prior Change Orders (insert date) Days Required (t) for this Change 151 calendar days Order I Revised Time for Completion 3/31/14 (insert date) In accordance with Sections 1-04.4 and 1-04.5 of the Kent and WSDOT Standard Specifications, and Section VII of the Agreement, 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. This Change Order, unless otherwise provided, does not relieve the Contractor from strict compliance with the guarantee and warranty provisions of the original contract, particularly those pertaining to substantial completion date. All acts consistent with the authority of the Agreement, previous Change Orders (if any), and this Change Order, prior to the effective date of this Change Order, are hereby ratified and affirmed, and the terms of the Agreement, previous Change Orders (if any), and this Change Order 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 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 OF KENT. �sr ature ,y� /" (signature) Znt Name: Print Names Suzette Cooke Its '4ts — ' Mayor (tit! ) DATE: DATE:_'°':�? i CHANGE ORDER - 2 OF APPROVED AS TO FOM: (applicable if Mayor's signature r quired� - ,Jj Kent Law Department _- Ali NmpTech-GRNM M VKnox i CHANGE ORDER 3 OF 3 PUMPT-1 OP ID: DL CERTIFICATE OF LIABILITY INSURANCE D06/271201ATE YY) 06127/2013 (HIS 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(les) must 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 endorsements). PRODUCER Phone:425-268-2300 CONTACT NAME: Whitfield's United Insurance Fax:425.258-9363 INC,NN FAx PO Box 112713426 Broadway c No Ext: - (AID,Na Everett WA 98206 E-MAIL Ted Sc�latter-Assigned ADDRESS: INSURERISI AFFORDING COVERAGE NAIL INSURERA:Travelers Prop Cas'Ins Co 25674 INSURED Pumptech Inc INSURERB:The Travelers Indemnity Go. 25658 12020 SE 32nd StSuite 2 Bellevue,WA 98005 INSURERC: INSURER D: 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. THAT ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICI4 THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY*THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TL=RMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INBR ADDLSUBR POLICY EFF POLICI'E%P LTft TYPE OF IN POLICY NUMBER NIFUDD/YYYY MMIDDIYYYY LIMITS- GENERALLIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X X 630532D6517 02/0112013 02101/2014 DA AGE TORENTEO PREMISES(Ea occurrence $ 100,000 CLAIMS-MADE IIOCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY 3 1,000.000 GENERAL AGGREGATE $ 2,000,000 ENT AGGREGATE LIMIT APPLIES PER; PRODUCTS_-COMPIOP AGO $ 2,000,000 r Rp- LOC $ Y COMEa acddenl S * X X 810532DG517 02101/2013 02101/2014 BODILY INJURY(Per person)SCHEDULEDBODILY INJURY Per aWdenl $ AUTOS ( )}( NON-OWNED PROPERTY DAMAGE $ AUTOS fferrawidenl X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 4,000,000 /-� EXCESS LU CLAIMS-MADE CUP532D6517I 02101/2013 02/01/2014 AGGREGATE $ 4,000,000 DED X RETENTIONS 0 $ !NORKERS COMPENSATION WCSTATU- OTH- MIT EMPLOYERS'LIABILITY 'TORY NUTS X ER V11J J_HtIOM ANY PROPRIETORIPARTNER ECUTIVE 030532D6517 02l01l7-013 02/01/20'14 F.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMSER EXCLUDED4 MIA (Mzndatoryln HH) ASTOP GAP E.L.DISEASE-EAEMPLOYEES "1,000,000 if desribe under DESCRIPTION OF OPERATIONS belor, FL.DISEASE-POLICY LIMIT S 2,000,000 quipment G30532D6517 02/09/2013 02/0112014 FIRL 100,000 obsite poll IT.630532065'17 OS12912.013 05/2.9120.14 pollution 'I,000,000 DESCRIPTION OF OPERATIOIJS l LOCATIONS 1 VEIIICLES (Attasd ACORD 101,Additional Rernadrs Schedule,If mare spnea Ls re.ga0edl ?xojact; GRNRA Hump rSaintenance 804105188 :ity of Rent-Public Works Department, its officers, officials, employees, ,.gents and volunteers are additional instIxeds as per terms and conditions of `oxms CGD037 04 05, CGD144 01 93, COD459 10 08 , CAT353 06 09. Ci per project aggregate, CGD211 01 04 and cancellation per SLT320 09 97 n XL0146 08 10 CERTIFICATE HOLDER CANCEILLATimi c - - cIIYI(GN --- -- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE MILL BE DELIVERED IN City of Icook ACCORDANCE WITH THE POLICY PROVISIONS, PLII)IiC VIloiks Dept. -- --- I`IaIICyYOShItalCe=COn tl'BCtu hUTt10RIZED REPRESENTATIVE AGO WestGovve J<ent INA 98032 ©1988-2010 ACORD CORPORATION. All rights reserved. Cr1Rn 9 S rgain70.1 'I'h,o 4C 1PPI —0—of Arnon ! COMMERCIAL GENERAL LIABILITY 630532D6517 THIS ENDORSEMENT C1 ANGES THE POLICY. PLEASE READ.IT CAREFULLY. THE INSURANCE - ADDITI NAL INSUREDS This endorsement modifies insurance provided under the following:. COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS b. The"personal injury"or"advertising injury"for COMMERCIAL GENERAL LIABILITY CONDITIONS which coverage is sought arises out of an af- (Section IV), Paragraph 4. (Other Insurance), is tense committed amended as follows: subsequent to the signing and execution of that 1. The following is added to Paragraph a. Primary contract or agreement by you, lnsuranee: 2. The first subparagraph (7) of Paragraph D. Ex- However, if you specifically agree in a written con- cess Insurance regarding any other primary In- tract or written agreement that the Insurance pro- surance available to you is deleted. vlded to an additional insured under this 3. The following is added to Paragraph b. Excess Coverage Part must apply on a primary basis, or Insurance, as an.additional subparagraph under a primary and non-contributory basis, this incur- Subparagraph (1), ance is primary to other Insurance that is avail- That is available to the insured when the insured able to such additional Insured which covers such is added as an additional insured under any other additional insured as a named insured, and we policy, including any umbrella or excess policy. will not share with that other Insurance, provided 'that: a. The "bodily injury" or "property damage" for which coverage is sought occurs; and o� o o ate^ GO 00 37 04 ll"a .C:opynght 2gd5 Tile St. Paul Travelers Companies, Inc.All rights reserv.od.. Pago 'i of :I COMMERCIAL GENERAL LIABILITY 630532D6517 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. li OTHER ADDITIONAL INSUREDS This endorsement modifies Insurance provided underthe following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS 3. This insurance is excess over any valid and col- 1. WHO IS AN INSURED (SECTION It) is amended lectible Insurance unless you have agreed in a to Include as an insured any person or organiaa- written contract for this insurance to apply on a tion (called hereafter "additional insured") with primary or contributory basis. whom you have agreed In a written contract, 4. This insurance does not apply on any basis: executed prior to loss, to name as an additional a. To any person or organization forwhom you Insured, but; have purchased an Owners and Contractors a. Only with respect to liability because of Protective policy. "bodily injury' or "property damage" arlsing b. To any person or organization who dis- out of"your work" for that additional Insured tributes or sells"your products" in the regular performed by you or for you; and course of Its business. b. Subject to any limitations In the written con- c. To any person or organization from whom tract regarding the scope of the additional you have acquired any products, or any In- Insured status. gredient, part or container, entering into, ac- This insurance does not apply to "bodily Injury" companying or containing such products. or "property damage" arising out of "your work" d. To any manager or. lessor of premises with included In the "products-completed operations respect to liability"arlsing out of the owner- hazard" unless you are required to provide such ship, maintenance, or use of that part of any coverage by written contract and then only for premises leased to you. the period of time required by the contract, but In no event beyond the expiration date,of the e• ro any lessor of leased equipment. polloy f. To any architect, engineer or surveyor for 2. The Limits of Insurance provided to such addl- Injury or damage arising out of: tional Insured shall be: ('1) The preparing, approving or failing to a. The limits which you have agreed to provide; prepare or approve maps, drawings, or opinions, reports, surreys, change or- dero, designs or specifications; and b. The limits shown on the Declarations (2) Supolvisory, inspection or engineering whichever is less. serriees, i , r o ri 1 01 9ns Copyright, rho Travelers IndemoRy Conmany, 19C'6. Pago'I of 1 CG D4 58 10 08 Page 1 of 10 CG D4 58 10 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 630532D6517 INTERNATIONAL XTEND ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIAr3ILITY COVERAGE PART GENERAL DrSCRIPTION OF COVERAGE—This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described In any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is.excluded or limited by such an endorsement.The following listing is a general coverage description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights,duties, and what is and is not covered. A. Broadened Named Insured B. Blanket Additional Insured—Broad Form Vendors C. Limited Worldwide Liability Coverage—Indemnity Basis D. Damage To Premises Rented To You Perils of fire, explosion, lightning, smoke,water Limit increased to$300,000 a Blanket Waiver of Subrogation F. Blanket Additional Insured—Owners, Managers or Lessors of Premises G. Blanket'Additlonal Insured—Lessors of Leased Equipment H. Incidental Medical Malpractice I. Personal Injury—Assumed by Contract J. Amended Bodily Injury Definition It, Bodily Injury to Co-Employees and Co-Volunteer Workers 1— Afrcraft Chartered with Crew M. Non-Owned Watercraft—Increased from 25 feet to 50 feet N. Increased Supplementary Payments Cost of bail bonds increased to$2.501) Loss of earnings increased to$500 per day 0. Medical Payments—Limit increased to$1D,000perpoison P, Knowledge and Notice of Occurrence or Offense Q. Unintentional Omission R. Reasonable Force—Bodily Injury or Property Damage S. Transportation Expenses For Repatriation or Relocation of Injured Or Sick Employees PROVISIONS A. BROADENED NAMED INSURED 1. The following is added to SE CTION ll WI-10 IS AM INGUREID: Any organization, other than a partnership or joint venture, over which you maintain ownership or majority interest on the effective date of the policy qualifies as a Named Insured. However, coverage for any such organization will cease as of the date during the policy pei ind that you no longer maintain ownership of, or CG D4 58 10 08 Page 2 of 10 majority interest in, such organization. 2. The following replaces Paragraph 4.a. of SECTION II —WHO IS AN INSURED: a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier, unless reported in writing to us within 180 days. B. BLANKET ADDITIONAL INSURED-BROAD FORM VENDORS The following is added to SECTION II—WHO IS AN INSURED: Any person or organization that is a vendor and that you have agreed in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury"or"property damage"that: a. Is caused by an "occurrence" that takes place after you have signed and executed that contract or agreement;and b. Arises out of"your products"which are distributed or sold in the regular course of such vendor's business. The insurance provided to such vendor is subject to the following provisions: a. The limits of insurance provided to such vendor will be the limits which you agreed to provide in the written contract or agreement, or the limits shown in the Declarations of this Coverage Part, whichever are less. b. The insurance provided to such vendor does not apply to: (1) "Bodily injury" or"property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (2) Any express warranty unauthorized by you; (3) Any physical or chemical change in"your products" made intentionally by such vendor; (4) Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (6) Any failure to make such inspections, adjustments, tests or servicing as vendors agree to perform or normally undertake to perform in the regular course of business, in connection with the distribution or sale of'your products"; (6) Demonstration, installation, servicing or repair operations, except such operations performed at such vendor's premises in connection with the sale of"your products"; or (7) "Your products"which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for such vendor. Coverage under this provision does not apply to: a. Any person or organization from whom you have acquired "your products", or any Ingredlent, part or container entering into, accompanying or containing such products; or h. Any vendor for which coverage as an additional insured specifically is scheduled by endorsement. G. LIPflITE1J 4ll012LUWI0E LIl1t31L1T'(GOVEF�\OE�-IPIDEA4N1"i^f AA:il:i I. The following replaces the definition of"coverage territory" in the DEFINITIONS Section: "Coverage territory" means: a. The United States of America (including its territories and possessions), Puerto Rico and Canada; b. International waters or airspace, but only if: (1) The"bodily injury'or"property damage"is caused by an"occurrence"that takes place, or (2) The "personal injury"or"advertising injury"is caused by an offense committed; in the course of travel or transportation between any places included in Paragraph a. above; or c. All other parts of the world exceptthe"prohibited area", but only if the injury or damage arises out of: (`I) Goods or products made, sold, handled or dist0burted by you, or services provided by you to your CG D4 58 10 08, Page 3 of 10 customers or clients, in the territory described in Paragraph a. above; (2) The activities of a person whose home is in the territory described in Paragraph a. above, but is away for a shorttime on your business;or (3) "Personal injury" or "advertising injury" offenses committed through the Internet or similar electronic means of communication; provided that the insured's responsibility to pay damages is determined in a "suit" on the merits brought anywhere in the world except the"prohibited area", or in a settlement we agree to. With respect to "occurrences" that take place, or "personal injury" or "advertising Injury" offenses committed within the territory described In Paragraph c.above,the following conditions apply: (1) This Insurance is excess over any valid and collectible other insurance available to the insured, whether primary, excess, contingent or on any other basis. (!I) This insurance is not a substitute for "compulsory admitted insurance" in any country or jurisdiction included In Paragraph c, above, regardless of whether this insurance would qualify as "compulsory admitted insurance" in such country or jurisdiction or Is accepted by the appropriate authorities as proof of"compulsory admitted insurance". You agree to maintain "compulsory admitted insurance" at the limits required by law. Your failure to do so will not invalidate the coverage provided for such "occurrences"or offenses, but we will only be liable to the same extent we would have been liable had you maintained "compulsory admitted insurance". For purposes of this Paragraph(H), "compulsory admitted Insurance"means insurance that is: (1) Required to be in-force to satisfy the legal requirements of a specific country or jurisdiction; and, (2) Issued by an insurance fund administered by.such country or jurisdiction or Issued by an insurer licensed or permitted by law to do business in such country or jurisdiction. (ill)With respect to defending the insured against; or the investigation or settlement of, any clairii or"suit" brought against the insured, the following will apply: (1) The phrase "We vdIl pay.....' in the first sentence of Paragraph I.R. of `-F-GVON I - COVER! GES e COVERAGE A BODILY INJURY AND PROPERTY DAMAW—: L IAt11Dl Y and Paragraph 1.a. of SECTION I ® C®VE11AGES - COVERAGE D PERSONAL AND ADVERTISING INJURY LIABILITY is replaced by the phrase We will indemnify the insured for....". (2) You must arrange to defend the insured against, and investigate or settle, any claim or"suit". (3) Neither you nor any other,involved insured will make any settlement without our consent. (4) We will pay expenses incurred with our consent for your defense of the insured against any"suit" seeking damages for "bodily injury", "property damage'.', "personal Injury"or "advertising injury"to which this insurance applies. (b) We may, at our discretion, participate In defending the insured against, or in the settlement of, any claim or"suit". 2. The following Is added to the DLhINITION5 Section: "Prohibited area" means any country or jurisdiction while any trade sanction, embargo, or similar regulation imposed by the United States of America applies to and prohibits the transaction of business with or within such country.orjurisdiction. FJ. DlUVUkGE TO PREMISES REN` ED TO YOU '1: The following replaces the last paragraph of Paragraph 2., f'xclusions, of SECTION I -GOVERAG 'a •- GOVERAGE A BODILY INJURY AND PROPPt:TY Dr11UAGE LIABILITY: Exclusions c. through n. do not apply to damage to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: a, Fire; b. Explosion; c, Lightning; CG D4 58 10 08 Page 4 of 10 d. Smoke resulting from such fire, explosion, or lightning; or e. Water. A separate limit of insurance applies to such damage to premises as described in Paragraph 6. of Section III—Limits Of Insurance. This insurance does not apply to damage to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: a. Rupture, bursting, or operation of pressure relief devices; b. Rupture or bursting due to expansion or swelling of the contents of any building or structure, caused by or resulting fromwater c. Explosion of steam boilers, steam pipes, steam engines, or steam turbines. 2.. The following replaces Paragraph 6. of SECTION III.—LIMITS OF INSURANCE: Subject to S. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of"property damage" to any one premises while rented to you, or temporarily occupied by you with permission of the owner, caused by fire; explosion; lightning smoke resulting from such fire, explosion, or lightning; or water. The Damage To Premises Rented To You Limit will apply to all damage proximately caused by the same"occurrence", whether such damage results from fire;F: S k slon; lightning; smoke resulting from such fire, explosion, or lightning; vdator; or any combination of any of these. Thc, fiamage To Premises Rented To You Limit will be the higher of: a. $300,000; or ri Fhe amount shown on the Declarations of this Coverage Part for Damage To Premises Rented To You Limit. 4. Thc=f Anwing replaces Paragraph a. of the clef nitlon of"insured contract"In the DEFINITIONS Section: a. A oonfact for a lease of premises. However, that portion of the contract for a lease of premises that Indemnifies any person or organization for damage to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: (1) Fire; (2) Explosion; (3) Lightning; (4) Smoke resulting from such fire, explosion, or lightning; or (5). Water, is not an"insured contract; 5. The following replaces Paragraph 4.b.(1)(b) of SFCTION IV � COMMERCIAL GFNFRAL LIABILITY CONDITIONS: (b) That is insurance for premises rented to you, or temporarily occupied by you with the permission of the owner; rZ BLANKET WAIVER OF' SUBROGATI©N The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV--COMMERCIAL GENERAL LIABILITY GOMITIONS: We waive any right of recovery we may have against any person or organizatlon because of payments we male for injury of damage arising out of premises owned or occupied by or rented or loaned to you; ongoing operations performed by you or on your behalf,clone under a contract with that person or organization; "your work'; or 'your products", We waive this right where you have agreed to do so as part of a written contract, executed byyou prior to loss. RI,ANKt1'PADorriONAI_ INSURED -OWN 17.11i, MAMAG Ie12S©R LE SORS OF PRLMISI The following is added to srec'noN II -WI 10 IS AN IN:31LIRI=11 Any person or organization that is a premises owner, manager or lessor and that you have agreed in a written contract or agreement 'to name as an additional insured on this Coverage Pan', is an insured, but only with CG D4 58 10 08 Page 5 of 10 respect to liability for"bodily injury", "property damage", "personal Injury"or"advertising injury"that: kes a advvertising s "bodily injury" causedyby an offense caused t that is committed, after that you haveplace, sighed and"personal exec executed that contractor agreement; and b.. Arises out of the ownership, maintenance or use of that part of any premises leased to you. The insurance provided to such premises owner, manager or lessor Is subject to the following provislons a. The limits of insurance provided to such premises owner, manager or lessor will be the limits which you agreed to provide In the written contract or agreement, or the limits shown on the Declarations of this Coverage Part,whichever are less. b. The insurance provided to such premises owner, manager or lessor does not apply to: (1) "Bodily injury" or"property damage"caused by an "occurrence" that takes place, or"personal injury" or "advertising injury" caused by an offense that Is committed, after you cease to be a fenant in that premises:or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such premises owner, manager or lessor. c. The insurance provided.to such premises owner, manager or lessor is excess over any valid and collectible other insurance available to such premises owner, manager or lessor, unless you have agreed in a written contract for this insurance to apply on a primary or contributory basis. G', BLANKET AULATIONAL'INSt REL)—LESSORS OF WASB9 EQUIPMENT The following is added to SECTION 11 m WHO IS AN INSURED: Any person or organization that Is an equipment lessor and that you have agreed in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to llabllity for"bodily injury", "property damage", "personal injury"or"advertising Injury"that: a. Is "bodily injury" or"property damage" caused by an "occurrence"that takes place; or"personal injury"or "advertising injury" caused by an offense that is committed, after you have signed and executed that contract or agreement;and b. le caused, in whole or in part, by your acts or omissions in the maintenance, operation or use by you of equipment leased to you by such equipment lessor. The Insurance provided to.such equipment lessor is subject to the following provisions: a. The limits of insurance provided to such equipment lessor will be to limits which you agreed to provide in the written contract or agreement, or the limits shown on the Declarations of this Coverage Part, whichever are less. b. The insurance provided to such equipment lessor does not apply to any "bodily injury" or "property damage" caused by an "occurrence" that takes place, or"personal injury" or "advertising injury"caused by an offense that is committed, after the equipment lease expires. c, The insurance provided to such equipment lessor is excess over any valid and collectible other insurance available to such equipment lessor, unless you have agreed in a written contract for this insurance to apply on a primary or contributory basis. 1•I. INCICDD- ITA1, 1VIOW1CA! MAL_F I ACT(GB 1. The following is added to the definition of"occurrence" in the DEFINITIONS Section: Unless you are in the business or occupation of providing professional health care services, "occurrence" also means an act or omission committed in providing or failing to provide "incidental medical services"to a person. 2. The following is added to the or rINITIONS Section: "Incidental medical services"means: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; 1). The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances; CG D4 58 10 08 Page 6 of 10 c. First aid; or d. "Good Samaritan services". "Good Samaritan services" means any emergency medical services for which no compensation is demanded or received. 3. The following is added to Paragraph 2.a.(1)of SECTION II—WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to any "bodily injury" arising out of any providing or failing to provide "incidental medical services" by any of your "employees", other than an employed doctor. Any such "employees" providing or falling to provide "incidental medical services"during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. 4. The following exclusion is added to Paragraph 2., Exclusions, of SECTION 1 — COVERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury" or "properly damage" arising out of the willful violation of a penal statute or ordinance relating to the sale of pharmaceuticals committed by, or with the knowledge or consent of, the insured. 5. The following is added to Paragraph'6. of SECTION III--LIMITS OFF INSURANCE: For the purposes of determining the applicable Each Occurrence Limit, all related acts or omissions committed in the providing of failing to provide "incidental medical services" to any one person will be considered one "occurrence" 6. The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS` This insurance is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to any of your"employees"for"bodily injury"that arises out of providing or failing to provide "incidental medical services"to any person to the extent riot subject to Paragraph 2.a.(1)of SECTION II —WHO IS AN IN.suRED. 1. PERSONAL INJURY—ASSUMEU BY CONTRACT 1. The following replaces Exclusion e., Contractual Liability, in Paragraph 2. of SECTION I COVERAGES COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY: e. Contractual Liability "Personal injury"or"advertising injury"for which the insured is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to: (1) Liability for damages that the insured would have in the absence of the contract or agreement; or (2) Liability for damages because of"personal injury" assumed in a contract or agreement that is an "insured contract", provided that the "personal injury" Is caused by an offense committed subsequent to the execution of the contract or agreement. Solely For the purposes of liability assumed in an "insured contract", reasonable attorneys fees and necessary litigation expenses Incurred by or for a party other than an insured will be deemed to be damages because of "personal Injury", at that: (a) Liability to such party for, or for the cost of, that parly's defense has also been assumed in the same "insured contract'; and (b) Such attorney fees and litigation expenses are for defense of that party against a civil or alternative dispute resolution proceeding in which damages to which this insurance applies are alleged. 2. The following replaces the third sentence of Paragraph 2. of 23UPpf.1'MI NTARY PAYmr'.NTS — COVERAGES A AND B: Notwithstanding the provisions of Paragraph 2.17.(2) of Section I — Coverage A — Bodily Injury And Property Damage Liability or Paragraph 2.e. of Section I —Coverage 6 —Personal and Advertising Injury Liability, such payments will not be deemed to be darna5es because of"bodily injury", "property damage" CQ D4 58 10 08 Page 7 of 10 or"personal injury", and will not reduce the limits of insurance. 3. The following replaces Paragraph 2.d.of SUPPLEMENTARY PAYMENTS—COVERAGES A AND 13: d. The allegations In the "suit"and the information we know about the "occurrence" or offense are such that no conflict appears to exist between the interests of the insured and the interests of the indemnitee; 4. The following replaces the first subparagraph of Paragraph f:of the definition of"insured contract" in the DEFINITIONS Section: f. That part*of any other contract or agreement pertaining to your business (including an Indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for"bodily Injury,""property damage"or"personal injury"to a third person or organization. Tort liability means a liability that would be imposed by law In the absence of any contract or agreement. J. EXTENSION OF COVERAGE—BODILY INJURY The following replaces the definition of"bodily injury"In the DEFINITIONS Section: "Bodily injury"means bodily injury, mental anguish, mental injury, shock, fright, disability, humiliation, sickness or disease sustained by a person, including death resulting from any of these at any time. K. 1100ILY INJURY TO CO-EMPLOYEES AND CO-VOLUNTEER WORKERS The following is added to Paragraph 2.a.(1)of SECTION II—WHO IS AN INSURED: Paragraph (1)(a) above does not apply to.."bodily injury" to a cc-"employee" in the course of the cc- "employee's" employment by you or performing duties related to the conduct of your business, or to "bodily injury"to your other"volunteer workers"while performing duties related to the conduct of your business. L. AIRCRAFT CHARTERED WITH CREW The following is added to Exclusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION I — COVERAGES—COVERAGPA BODILY INJURY AND PROPERTY DAMAGE LIABILITY: This exclusion does not apply to an airciaft that is: (a) Chartered with crew to any insured; (b) Not owned by any insured;and (c) Not being used to carry any person or property for a charge. M. NON-OWNED WA 1URCRAF> 1. The following replaces Paragraph (2) of Exclusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of ,SECTION I-cove/ zAGf=s COVERAGU A BODILY INJURY AND PROPER-17(DAMAGE LIABILITY: (2) A watercraft you do not own that is: (a) Fifty feet long or less;and (b) Not being used to carry any person or property for a charge. 2. The following is added to Paragraph 2. of SECTIOPI 11—WHO IS AN IN—SURED: Any person or organization that, with your express or implied consent, either uses or is responsible for the use of a watercraft that you do not own that is: (1) Fifty feet long or less;and , (2) Not being used to carry any person or property for a charge. N. INCREASED SUPPLEMENTARY PAYMENTS 1. -fhe following replaces Paragraph 'Lh. of SUPNLEIVIENTA.W( PAYP1IE1,1rS —COVERAGE'S A AND B of SECT ION I—GOVORAGES: fa. Up to`h2,500 for cost of ball bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Budily Injury Liability Coverage applies. VVe do not have to furnish these bonds. 2. The following replaces Paragraph-'Ld. of SUPE'L1:MENTARY PAYMl1VITS— COVi"RAGt_S A ANIJ 13 of SI:C'I'ION 1—COVERAGES: CG D4 58 10 08 Page 8 of 10 d. All reasonable expenses incurred by the insured at our request to assist us In the investigation or defense of the claim or"suit", including actual loss of earnings up to $500 a day because of time off from work. O. MEDICAL PAYMENTS—INCREASED LIMITS The following replaces Paragraph 7.of SECTION III—LIMITS OF INSURANCE: 7. Subject to 5. above, the Medical Expense Limit is the most we will pay under Coverage C. for all medical expenses because of"bodily injury"sustained by any one person, and will be the higher'of: (a) $10,000; or (b) The amount shown on the Declarations of this Coverage Part for Medical Expense Limit. P. KNOWLEDGE AND NOTICE OF OCCURRENCE OR OFFENSE The following is added to Paragraph 2., Duties In The Event of Occurrence, Offense, claim or Suit, of SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS: e. The following provisions apply to Paragraph a. above, but only for the purposes of the insurance provided under this Coverage Part to you or any insured listed in Paragraph 1. or 2. of Section II — Who Is An Insured: (1) Notice to us of such "occurrence" or offense must be given as soon as practicable only after the "occurrence" or offense is known to you (if you are an individual), any of your partners or members who is an individual (if you are a partnership or joint venture), any of your managers who is an individual (if you are a limited liability company), any of your trustees who is an individual (if you are a trust), any of your"executive officers"or directors (if you are an organization other than a partnership, joint venture, limited liability company or trust) or any"employee" authorized by you to give notice of an"occurrence"or offense. (2) If you are,a partnership, joint venture, limited liability company or trust, and none of your partners, joint venture members, managers or trustees are individuals, notice to us of such "occurrence" or offense must be given as soon as practicable only after the "occurrence"or offense is known by: (a) Any Individual who is: (I) A partner or member of any partnership or joint venture; (ii) A manager of any limited liability company; (it!)A trustee of any trust;or (iv) An executive officer or director of any other organization; that is your partner,joint venture member, manager or trustee; or (b) Any "employee" authorized by such partnership, joint venture, limited liability company, trust or other organization to give notice of an"occurrence" or offense. (3) Notice to us of such "occurrence"or of`iense will be deemed to be given as soon as practicable if it is given in good faith as soon as practicable to your workers' compensation insurer. This applies only if You subsequently give notice to us of the "occurrence" or offense as soon as practicable after any of the persons described in Paragraphs e.(1) or (2) above discovers that the "occurrence" or offense may result in sums to which the insurance provided under this Coverage Part may apply. However, if this policy includes an endorsement that provides limited coverage for "bodily injury" at, "property damage" or pollution costs arising out of a discharge, release or escape of "pollutants' which contains a requirement that the discharge, release or escape of"pollutants" must be reported to us within El specific number of days after its abrupt commencement, this Paragraph e. does not affect that requirement cl. uimirruwriONAL OMISSION The following is added to Paragraph 5., Representations, of SECTION IV --- COMMERCIAL ORINIIAL LIAUILrr( r ONDITIOW. The unintentional omission of, or unintentional error in, any Information provided by you which we relied upon in issuing this policy will not prejudice your rights under this Insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance CO D4 58 10 08 Page 9 of 10 with applicable insurance laws or regulations. R. REASONABLE FORCE—BODILY INJURY OR PROPERTY DAMAGE The following replaces Exclusion a., Expected Or Intended Injury, in Paragraph 2. of SECTION I — COVERAGES—COVERAGEA BODILY INJURYAND PROPERTY DAMAGE LIABILITY: a. Expected or Intended Injury or Damage "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to"bodily injury"or"property damage"resulting from the use of reasonable force to protect any person or property. S. TRANSPORTATION EXPENSES FOR REPATRIATION OR RELOCATION OF INJURED OR SICK EMPLOYEES I 1. The following is added to SUPPLEMENTARY PAYMENTS — COVERAGE A AND B of SECTION I — COVERAGES: We will reimburse you for the reasonable "transportation expenses" that you incur, over and above "normal transportation costs", for the repatriation or relocation of any of your Injured, diseased, sick or deceased"employees". But only if: a. The injury, disease, sickness, or death occurred during the policy period and while such "employee" was employed or assigned to work by you anywhere in the world other than: (1) The United States of America (including its territories and possessions), Puerto Rico and Canada; and (2) Any country or jurisdiction in the "prohibited area'; b. The relocation or repatriation Is necessary In the opinion of competent medical authorities; and c. The relocation or repatriation is from the country where the Injury, disease; sickness, or death occurred to a.destination in another country. The most we will pay as reasonable "transportation expenses"for the repatriation or relocation of any one of your "employees" is $25,000. The most we will pay as reasonable "transportation expenses'for the repatriation or relocation of all of your"employees" is$50,000. These payments will not reduce the limits of insurance. 2. The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — COMMERCIAL GI'Nrn AL LIABILITY CONDITIONS: This insurance is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available for the reasonable "transportation expenses" that you incur, over and above "normal transportation costs", for the repatriation or relocation of any of your injured, diseased, sick or deceased"employees". 3. The following is added to the DEFINITIONS section: "Normal transportation costs" means the costs of transporting your "employee" in good health, and in conformance With your business travel policy, from the country of injury, disease, sickness, or death to tho country of relocation or repatriation. "Transportation expenses"Includes the following expenses: a. Costs of embalming to meet United States standards; and b. All reasonable expenses of transportation to return the remains of the deceased to the country' of burial ornaneral. 1 CO D4 58 10 08 Page 10 of 10 CG D4 58 10 08 Privacy Legal Notices R12008 The Travelers Companies,Inc, COMMERCIAL AUTO 8105321DB517 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE. (READ IT CAREFULLY. BUSINESS AUTO EXTENSION N ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless mod!- fed by the endorsement. GENERAL DESCRIPTION OF COVERAGE-This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Pad, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following lisfing is a general cover- age description only. Limitations and exclusions mayapply to these coverages, Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and s�not covered.. A. BROAD FORM NAMED INSURED K HIRED AUTO PHYSICAL DAMAGE - LOSS OF USE-INCREAs'Eb"LIIM 8. BLANKET AODI T IONAL INSURE® I. PHYSICAL DAMAO ANSPOPTAYION ExPENSES-INCREA6�. LIMIT C. EMPLOYEE HIRED AUTO , J. PERSONAL EFFECTS D. EMPLOYEES AS INSURE© K. AIRBAGS F. SUPPLEMENTARY PAYMENTS - INCREASF11 L. NOTICE AND KNOWLEDG-E OF ACCIDENT LIMITS OR LOSS F. HIRED AUTO LIMITED WORLDWIDE M, BLANKET iMA1V EPA Or-PPBRGOATION COVERAGE-INDEMNITY BASIS m O. WAIVER QF DEDUCTiSLIF-GLAS 8 N. UNINTENTIONAL ERRORS OR OMISSIONS PROVISIONS ® A. BROAD FORM NAME© INSURED executed by you before the "bodily Injury" or I he following is added to Paragraph A.9., Who Is "property damage" occurs and that is in effect An InSUr`ed, of SECTION it - LIASILil f CfiV- during the policy period, to be named as an add[- ERAGE: tfonal insured is an "insured" for Liability Cover- age, but only for damages to which this Insuranco inn the policy period over which you maintain applies and only to the extent that person or or- 50% or more ownership interest and that is not Whogani I Ali qualifies as an "fintaine under the Who Is An Insured provision contained in Section separately insured for Business Auto Coverage. Coverage under this provision is afforded only un- r EA�PLrS`f E FIIIIED AUTO _— tit the '180th day after you acquire or form the or- ganizatton or the end of the policy period, which 1. The following is added to Paragraph A.'1„ ever is earlier. rPlho is Ali Insured, of SEC11[ON 11 ­ 1,1- ='" 0. BLANICL'-T AODITIMIAL IN5UREO AWLITY COVERAGE: The following is added to Paragraph c. in A.1., An "employee" of ymos I$ an "insumd" while Who Is An Insured, of SECTION 11 -LIABILITY operating an "auto" hired or rented under a COVERAGE: contract or agreement in that "employee's" name, with your pennission, while palionmhng Any person or organization who is required under duties relater) to the conduct of your bush• a written contract or agreement between you and Hess. that person or organization, that is signed and CA `lit 53 06 09 02009 T ne Travelers Conipanles,Inc. Page 1 of 4 COMMERCIAL AUTO 2. The following replaces Paragraph b. in B.S., United States of America applies to and pro- other Insurance, of SECTION IV — BUSI- hibits the transaction of business with or NESS AUTO CONDITIONS: within such country or jurisdiction, for Liability b. For Hired Auto Physical Damage Cover- Coverage for any covered. "auto" that you age, the following are deemed to be cov- lease, hire, rent or borrow without a driver for ered "autos"you own: a period of 30 days or less and that is not an 1 Any covered "auto" you lease, hire, "auto" you lease, hire, rent or borrow from ( ) Y any of your"employees", partners (if you are rent or borrow; and a partnership), members (if you are a limited (2) Any covered "auto" hired or rented by liability company) or members of their house- your "employee" under a contract In holds. that individual "employee's" name, (1) With respect to any claim made or "suit" with your penrnlsslon, while perform- brought outside the United States of ing duties related to the conduct of America, the territories and possessions your business. of the United States of America, Puerto However, any"auto"that is leased, hired Rico and Canada: rented or borrowed with a driver is not a (a) You must arrange to defend the covered "auto'. "Insured" against, and investigate D. EMPLOYEES AS INSURED or settle any such claim or "suit" The following is added to Paragraph A.1., Wh01a and keep us advised of all pro- An Insured, of SECTION II — LIABILITY COV,r.:r, rr ceedings and actions. ERAOt . (b) Neither you nor any other in- An "employee" of ours is an insured' while us volved "insured" will make any YY ing a covered"auto"you don't own, hire or borrow , settlement without our consent. in your business or your personal affairs. (r.) We may, at our discretion, par- ticipate in defending the "insured" E. SUPPLEMENTARY PAYMENTS - INCREASED against,against, or in the settlement of, LIMITS any claim or"suit". i. The following replaces Paragraph A.2.a.(2), (d) We will reimburse the"Insured"; of SECTION II —LIABILITY COVERAGE: (i) For sums that the "Insured" (2) Up to $3,000 for cost of ball bonds (in, legally must pay as damages eluding bonds for related traffic law viola- because, of "bodily injury" or tions) required because of an "accident" "property damage" to which we. cover. We do not have to furnish this insurance applies, that these bonds, the "insured" pays with our 2. The following replaces Paragraph A,2,aa(4), consent, but only up to the of SECTION II — LIABILITY COVERAGE: limit described in Paragraph C., Limit Of Insurance, of (4) All reasonable expenses Incurred by the SECTION II . LIABILITY "instlred" at our request, including actual COVERAGE; loss of earnings up to $500 a day be- cause of time off frorn work. (II) For the reasonable expenses Incurred with ourconserd for r. 1-1111ED AUTO — I_IMITFD WORLDWIDE 00V- your Investigation of such ERAGE— INDEMNITY BASIS claims and your defense of The following replaces subparagraph ('I. in Para- the "insured" against any graph 03., Policy Tenm, coverage Territory, of such "suit", but only up to and SECTION IV---BUSINESS AUTO CONDITIONS: included within the limit do- e. Anywhere In the wo scribed in Paragraph c., Limit except any country or Of Insurance, of SECTION 11 jurisdiction while any trade sanction, LIABILITY COVERAGE, f ,f bargo, or similar the regulation imposed by the Page 2 of 4 02009'1[10 Travelsrs Companies,Inc, GA TJ 53 08 00 l COMMERCIAL AUTO and not in addition to such 1. PHYSICAL DAMAGE -- TRANSPORTATION limit. Our duty to make such EXPENSES--INCREASED LIMIT payments ends when we The following replaces the first sentence in Para- have used up,the applicable graph AAa., Transportation Expenses, of SEC- limit of Insurance in payments TION III—PHYSICAL DAMAGE. COVERAGE: for damages, settlements or defense expenses. We v,411 pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- (2) This insurance is excess over any valid curred by you because of the total theft of a cov- and collectible other insurance available Bred"auto"of the private passenger type. - to the "insured" whether primary, excess d PERSONAL 5FFr-CTS contingent or on any other basis. 3 The following is added to Paragraph'A.4„ O This insurance is eat a substitute for re- Cover- age Extensions; of SECTION III — PHYSICAL Tutted compulsory insurance i f any DAMAGE C®V�RAGE: country outside the United States, Its ter- dtodes and possessions, Puerto Rico and Personal Fffects Canada. We will pay up to $400 for "Loss" to wearing Up- You agree to nalntaln all required or pares and other personal effects which are: compulsory insurance In any such coun- (1) Owned by an "insured"; and try up to the minimum I[mits required by (2) In or on your covered"auto". local law. Your failure to comply with' compulsory insurance requirements will This coverage applies only in the event of a total not Invalidate the coverago afforded :by theft of your covered "auto". this policy, but we will only be liable to the No deductibles apply to this Personal Effects some extent We would have been liable coverage. had ycu complied with the conipulso'ry in. lC AIRBAG.- surance requirements. The following is added to Paragraph 13.1, Exelu- (4) It is understood that we are not an admit- sio:ns, of SECTION III — PHYSICAL DAMAGE ted or authorized insurer outside the r AVERAGE: Unitcd States of America, its tcrrstortes and possessions, Puerto Rico and Can- Exclusion oicn gs i does net apply to "loss' none or ada. We assume no responsibility for the more airbags in a covered "auto' you own that^n- furnishing of certificates of Insurance, or Hate due to a3cause other than o cause of loss' for compliance in any way with the laws set forth in Paragraphs A.1.b. and A.1.e„ but _ only: of other countries relating to insurance. a. If that "auto" is a covered "auto" for Compre- G. WAIVER OF DEDUCTIBLP:--r3LASS hensive Coverage under this policy; The following is added to Paragraph D., Deducts- b. The airbags arer not covered under any war- life, of SECTION III — PHYSICAL DAMAGk ranty; and r:OVERAOE: c, The aibags were not intentionally inflated. No deductible for a covered "auto" will apply to We will pay up to a maximum of $1,000 for any glass darnago if the glass Is repaired rather than one "loss". ~— replaced. J_ NOTICE ANO KNOWLI-JIGS OF ACGIDFiNT OR a I.I. HIRED AUTO PHYSICAL DAMAGI.— LOSS Or LOSS USE INCREASED LIMIT The following is added to Paragraph A.2.a., of The following replaces the last sentence of Para- SE%TIOPI IV—BUSINESS AUTO COr,101TIOlkIS: graph A.4.b., Loss Of Use Expenses, or tSEC- RON III— PHYSICAL DAMAGE COVFRAGr: Your duty to give us or our authorized represents- five prompt notice of the "accident" or "loss" all- However, the most we will pay for any expenses plies only when the "accident" or "105.' is known 1, for loss of use is $lilt per day, to a maximum of to: :fi750 fm',any one"accident" (a) You (if you are an individual); GA T3 63 06 09 0A00 Ilia Travelers Companies,Inc• P89a 3 of`I COMMERCIAL AUTO (b) A partner(if you are a partnership); tent required of you by a written contract (c) A member (if you are a limited liability eom- signed and executed prior to any "accident" Perry);. or"loss"% provided that the"accident"or"loss" arises out of operations contemplated by (d) An executive officer, director or insurance such contract. The waiver applies only to the manager(if you are a corporation or other or- person or organization designated in such ganization); or contract. (e) Any "employee" authorized by you to give no- N. UNINTENTIONAL ERRORS OR OMISSIONS tioe of the "accident" or"loss". M. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph E.2., Con- cealment, Misrepresentation, Or Fraud, of The following replaces Paragraph A.S., Transfer SECTION IV—BUSINESS AUTO CONDITIONS: Of Rights Of Recovery Against Others To Us, The unintentional omission of, or unintentional of SECTION IV — BUSINESS AUTO CONDI- error in, any information given by you shall not TIONS: prejudice your rights under this insurance. How- 5. Transfer Of !,'Ights Of Recovery Against over this provision does not affect our right to col= Others To trs lest additional premium or exercise our right of We waive soy right of recovery we may have cancellation or non-renewal. against ars, person or organization to the ex- is Page40i r°A'rl fi3 Of 09 POLICY NUMBER: 630532D6517 ISSUE DATE: THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CARErLILLY. EARLIER NOTICE OF CANCELLATIONMONRENEWAL PROVIDED Y U This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCIIFDULE CANCELLATION: Number of pays Notice: 30 Nuncber of days Notice: 30 �Ut-IEN WE t?eJ Nt3T,RlPfia&1P(NosBr'eraewap: Y PROVISIONS. U. For any statutorily permitted reason other than nonpayment of premium, the number of days re- A. For any statutorily Permitted reason other than quired for notice of When We Flo Not Renew nonpayment of premium, the number of days re" (Nonrenewal), as provided in the CONDITIONS quired for notice of cancellation, as provided In Section of this Insurance, or as amended by any the CONDITIONS Section of this Insurance, or as applicable state When We Do Not Renew amended by any applicable state cancellation (Nonrenewal) endorsement applicable to this in- endorsement applicable to this insurance, Is in- suranco, Is increased to the number of days creased to the number of days shown in the shown in the SCHEDULE above. SCHEDULE above. D s•n 70 IN 57 Coovri9ht, Tlie Travelers Indemnity Co piny, 1997 gage 'I of 1 i IL01460810 i WASHINGTON COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. i The conditions in this endorsement replace any 3. We may cancel the Commercial Property similar conditions in the policy that are less Coverage Part and the Capital Assets favorable to the insured. Program (Output Policy) Coverage Part, if A. Cancellation made a part of this policy, by mailing or . delivering to the first Named Insured and 1. The first Named Insured shown in the the first Named Insured's agent or broker Declarations may cancel this policy by written notice of cancellation at least five notifying us or the insurance producer in days before the effective date of can- one of the following ways: collation for any structure where two or a. Written notice by mail, fax or e-mail; more of the following conditions exist: b. Surrender of the policy or binder; or a. Without reasonable explanation, the c. Verbal notice. structure is unoccupied for more th^n 60 consecutive days, or at least Go',.4. Upon receipt of such notice, we will cancel of the rental units are unoccupied for this policy or any binder issued as evidence more than 120 consecutive days, un- of coverage, effective on the later of the less the structure is maintalned for sea- following: sonal occupancy or is under construc- a. The date on which notice is received or tion or repair; the policy or binder is surrendered; or b. Without reasonable explanation, prog- b. The date of cancellation requested by ress toward completion of permanent the first Named Insured. repairs to the structure has not occur- red within 60 days after receipt of 2. We may cancel this policy by mailing or funds fallowing satisfactory adjustment delivering to the first Named Insured and or adjudication of loss resulting from a the first Named Insured's agent or broker fire; written notice of cancellation, including the Because of its physical condition, the actual reason for the cancellation, to the c. Because is In danger of collapse; last mailing address known to us, at least: a. 10 days before the effective data of d. Because of its physical condition, a cancellation if we cancel for non- vacation or demolition order has been payment of premium; or Issued for the structure, or it has been declared unsafe in accordance with b. 45 days before the effective date of applicable law; cancellation if we cancel for any other reason; e. Fixed and salvageable items have been emoved from the structure, indicating except as provided in Paragraphs 3. and 4. an intent to vacate the structure; below. f. Without reasonable explanation, heat, water, sewer and electricity are not fur- nished for the structure for 60 con- secutive days; or g. The structure is not maintained in substantial compliance with fire, safety and building codes, It n.i ,,T ns III (o nsurance Services Office, Inc., 2010 Page 'I of 4 4. If: 7. If this policy is cancelled, we will send the a. You are an Individual; first Named Insured any premium refund due. If we cancel, the refund will be pro b. A covered auto you own is of the rats. If the first Named Insured cancels, the " f the pro rate private passenger type"; and refund will be at least 90% o c. The policy does not cover garage, auto- refund unless the following applies: mobile sales agency, repair shop, a. For Division Two — Equipment Break- service station or public parking place down, if the first Named Insured can- operations hazards; cels, the refund will be at least 75% of we may cancel the Commercial Automobile the pro rata refund. Coverage Part by mailing or delivering to b. If: the first Named Insured and the first (1) You are an individual; Named Insured's agent or broker written 2 A covered auto you own is of the O notice of cancellation, including the actual private passenger type"; reason for cancellation, to the last mailing p p address known to us: (3) The policy does not cover garage, a. At least 10"days before the effective automobile sales agency, repair date of cancellation if we cancel for shop, service station or public nonpayment of premium; or parking place operations hazards; and b. At least 10 days before the effective The fir t Named Insured cancels; date of cancellation for any other O reason if the policy is in effect less than the refund will be not less than 90% of 30 days; or any unearned portion not exceeding c. At least 20 days before the effective $100, p $ butplus5% o y unearned po- date of cancellation for other than non- on and not less than t exc e any payment if the policy is in effect 30 $ ys or more; or unearned portion In excess of$500, da d. da least or days before the effective The cancellation will be effective even if we date of cancellation if the policy is in have not made or offered a refund. effect for 60 days or more or Is a S. If notice is mailed, proof of mailing will be renewal or continuation policy, and the sufficient proof of notice. reason for cancellation is that your B. Changes driver's license or that of any driver who customarily uses a covered "auto" The policy contains all the agreements between has been suspended or revoked during you and us concerning the insurance afforded. policy period. The first Named Insured shown in the Declara J. We will also mail or deliver to any tions is authorized to make changes in the mortgage holder, pledgee or other person terms of this policy with our consent. This shown in this policy to have an interest in policy's terms can be amended or'waived only any loss which may occur under this by endorsement Issued by us and made a part policy, at (heir last mailing address known of this policy. to us, written notice of cancellation, prior C. rxaminatlen Of You" F eoks.4nd Records to the effective date of cancellation. If can- Wo may examine and audit your books and collation Is for reasons other' than those records as they relate to this policy at any time contained in Paragraph A.3. above, this during the policy period and up to three years a notice will be the same as that mailed or fterward. delivered to the first Named Insured. If D. Inspection And purveys cancellation is for a reason contained In Paragraph A.3. above, we will mail or 'l. We have the right to: deliver this notice at least 20 days prior to sr, Make inspections and surveys at any the effective date of cancellatien. time; 3. Notice of cancellation will state the effect b. Give you reports on the conditions we tive date of cancellation. The policy period find; and will end on that date. c. Recommend changes. _ nnan !? 01 %16 08 'I0 2. We are not obligated to make any inspec- G. Nonrenewal tions, surveys, reports or recommen- 1. We may elect not to renew this policy by dations, and any such actions we do mailing or delivering written notice of non- undertake relate only to insurability and the renewal, stating the reasons for non- premiums to be charged. We do not make renewal, to the first Named Insured and the safety Inspections. We do not undertake to first Named Insured's agent or broker, at perform the duty of any person or organ- their last mailing addresses known to us. ization to provide for the health or safety of We will also mail to any mortgage holder, workers or the public. And we do not pledgee or other person shown in this warrant that conditions: policy to have an interest in any loss which a. Are safe or healthful; or may occur under this policy, at their last mailing address known to us, written b. Comply with laws, regulations, codes notice of nonrenewal. We will mail or or standards. deliver these notices at least 45 days 3. Paragraphs I. and 2. of this condition before the: apply not only to us, but also to any rating, a. Expiration of the policy; or advisory, rate service or similar organiza- tion which makes insurance inspections, b. Anniversary date this policy if this surveys, reports or recommendations. policy has been written for a term of more than one year. 4. Paragraph 2. of this condition does not apply to any inspections, surveys, reports Otherwise, we`Will renew this policy' un- or recommendations we may make relative less: to certification, under state or municipal a. The first Named Insured falls to pay the statutes, ordinances or regulations, of renewal premium after we have ex- boilers, pressure vessels or elevators. pressed our willingness to renew, in- E. Premiums cluding .a .statement of the renewal premium, to the first Named Insured The first Named Insured shown in the Declara and the first Named Insured's insurance tions: agent or broker,at least 20 days before 1. Is responsible for the payment of all pre- the expiration.date; miums; and b. Other coverage acceptable to the in- 2. Will be the payee for any return premiums sured has'been procured prior to the we pay. expiration date of the policy; or P. Transfer of Your Rights And Duties Under This c. The policy clearly states that it Is not Policy renewable and is for a specific line, Your rights and duties under this policy may sub- classification, or type of coverage not be transferred without our written consent that is not offered on a renewable except in. the case of death of an individual basis. Named Insured, 2. If: If you die, your rights and duties will be trans- a, You are an individual; ferred to your legal representative but only h. A covered auto you own is of the while acting within the scope of duties as your "private passenger type"; and legal representative. Until your legal represen- c. The policy does not cover garage, auto- tative is appointed, anyone having proper tem- p Y porary custody of your property will have your mobile sales agency, repair shop, serve rights and duties but only with respect to that ice station or public parking place property. operations hazards; Page 3 or<I, .. , , .,. „„ .,,, n1n�„rannr Aervires Office. Inc., 20'10 g i I the following applies to nonrenewal of the b.' We will not refuse to renew Liability Commercial Automobile Coverage Part in Coverage or Collision Coverage solely place of G.1.: because an "insured" has submitted a. We may elect not to renew or continue claims under Comprehensive Coverage or Towing And Labor Coverage. this,policy by mailing or delivering to you and your agent or broker written C. If we fail to mail or deliver proper notice at least 20 days before the end notice of nonrenewal and you obtain of the policy period, including the other insurance, this of policy hat u anced on actual reason for nonrenewal. If the effective policy period is more than one year, we will have the right not to renew or con- tinue it only at an anniversary of its original effective date. If we offer to renew or continue and you do not accept, this policy will terminate at the end of the current policy period, failure to pay the required renewal or continu- ation premium when due shall mean that you have not accepted our offer. ._ n L.�i v�nra .4Pniiras nffice. Inc.. 2010 IL 01 40 08 '10 REQUEST FOR MAYOR'S SIGNATURE K� I T. Please Fill in All Applicable Boxes � —Reviewed by Director Originator's Name: Matt Knox Dept/Div. Engineering/Environmental Extension: 5551 Date Sent: Date Required: / 3i r3 Return to: Nancy Yoshitake CONTRACT TERMINATION DATE: 3/31/14 VENDOR:_PumpTech Inc. ATE OF COUNCIL APPROVAL. N/A ATTACH THE COUNCIL MOTION SHEET FOR THE MAYOR if applicable Brief Explanation of Document: The attached Change Order No. 1 is necessary to extend the time of completion to March 31, 2014 due to pump part availability problems and difficulties reinstalling the pump at the site. All Contracts Must Be Routed Through The Law Department �— (This area to be completed by the Law Department) Received: i, Approval of Law Dept,: Law Dept. Comments: fit. hi i Date Forwarded to Mayor: ,t { t ,` € �'ir t ; Shaded Areas To Be Completed By Administration Staff R. ��`'' , i. m -.� Ll Received: Recommendations and Comments: RECEIVED Disposition: ` OOF Date Returned: C171f�LEIiK