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PW14-145 - Change Order - #1 - Transportation Systems, Inc. - 101st Ave SE & 256th St Signal Pole Installation - 10/09/2014
s is s �a 0 Records Managernerit KENT wa=„, .o„ Document CONTRACT COVER SHEET i 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. I Vendor Name: Transportation Systems , Inc. Vendor Number: JD Edwards Number Contract Number: VW 14o,146 sPOOL This is assigned by City Clerk's Office Project Name: 101st Ave. SE and S. 256th St. Signal Pole Installation Description: ❑ Interlocal Agreement ® Change Order ❑ Amendment ❑ Contract ❑ Other: Contract Effective Date: Date of the Mayor's signature Termination Date: 12/31/14 Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Ken L.angholz Department: Engineering Contract Amount: $0 time extension only Approval Authority: (CIRCLE ONE) Department Director Mayor City Council Detail. (i.e. address, location, parcel number, tax id, etc.): A change order is necessary Wreisntate the original greement and extend the time of completion to December 31, 2014 due to a delay in the delivery of the signal pole and equipment. As of: 08/27/14 i i KENT CHANGE ORDER NO. 1 NAME OF CONTRACTOR: Transportation Systems, Inc. ("Contractor") CONTRACT NAME & PROJECT NUMBER: 1015t Ave. SE and S. 256th St. Signal Pole Installation ORIGINAL CONTRACT DATE: June 6, 2014 i 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 needed to reinstate the original agreement and extend the time of completion to December 31, 2014 due to a delay in the delivery of the signal pole and equipment, 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, $39,946,00 (including applicable alternates and WSST) Net Change by Previous Change Orders $0 (incl. applicable WSST) Current Contract Amount $39,946.00 (incl. Previous Change Orders) Current Change Order $0 Applicable WSST Tax on this Change $0 Order Revised Contract Sum $39,946.00 The parties acknowledge that the Agreement terminated by its own terms on September 30, 2014. However, the City and Contractor express their mutual intent and desire to reinstate the Agreement; extend its term through December 31, 2014; and amend the work to include additional duties to be performed in accordance with the same provisions set forth in the original Agreement, except as modified within this Change Order. In addition, the parties wish to ratify and affirm any and all acts consistent with the authority of the Agreement and prior to the effective date of this Change Order. CHANGE ORDER - 1 OF 3 i Original Time for Completion 9/30/14 (insert date) Revised Time for Completion under n/a prior Change Orders (insert date) Days Required (f) for this Change 92 calendar days Order Revised Time for Completion 12/31/14 (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:___ By: ByT r nature) , (signature) Print Name: Print Name: Suzette Cooke Its L0 ,r Mayor (ti e) (GGe) DATE S �l DATE: 'c t `��',._ �r r I CHANGE ORDER - 2 OF 3 IIII APPROVED AS TO FORM: (applicab7p if Mayof's signature required) qq II f 3 Kent Law Department i i I Transportatlon Syst-10P'4 256°Signal Pole Repl CO11Langholz i I CHANGE ORDER 3 OF 3 9/20/2314 5:26 Remote ID Remote IDD 2/18 i Accw& CERTIFICATE LIABILITY INSURANCE °0ATE 9/18/2014Y) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS FICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES L . THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,ANDTHE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(ies) 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 endomement(s). PRODUCER WA4712152 1-206-343-2323 CONTACT MC4 Insurance Services, LLC dba PICK NAME_ ' M PHONE FAX C[d Benefits and Insurance services, LLC, CA Lic #OF82099 Ac LN`E.q: (AID N y: 1325 Fourth Avenue, Suite 2100 ADDRESS: Seattle, WA 98103, __INSUREMS)AFFORDING COVERAGE _ NAIC#_ -. ..-. INSURER A: CONTINENTAL WESTERN INS CO 10804 INSURED Transportation Systems Inc. INSURER B -- INSURER C: _ 3218 142nd Ave E INSURER D: Sumner, WA 98390 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 41493425 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 13ELOW 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. ILTft TYPE OFINSURANCE ADDL UB- POLICY NUMBER MMIDI O/YYYY 61MIDD/YYYY LIMITS A GENERAL LIABILNY X X CWP293586125 09/19/1 09/19/15 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENT D 100,000 11-171 PREMISES Eaoaumnce $ CLAIMS-MADE OCCUR MED EXP(An ono person) $ 5,000 rGEN'L d. op 000.00PERSONAL&ADV INJURY $ 1,000,000 Stop Gap GENERALAGGREGATE $ 2,000,000 GREGATE LIMIT APPLIES PER: PRODUCTB-COMPtOP AGG $ 2r000,000 POLICY X PRO' LUC $ A Fri rOMOBILE LIABILITY X CWP293586125 09 19 1 09/19115 COMBINED SINGLE I_RAIT X Ea acoldeni 1,000,000 ANYAUTO BODILY INJURY(Parpemon) $ ALLOWNED SCHEDULED - AUTOS AUTOS BODILY INJURY(Pcrnccldenl) $ HIRED AUTOS NON-OWNED PROPERTY DAM AGE AUTOS Per accident $ X Comp: $1,0 §t Coll: $1,00 P - $ A X UMBRELLALIAB X OCCUR X X CU293586223 Sq/19/1 09/19/15 EACH OCCURRENCE $ 5/000/000 EXCESS DAB CLAIMS-MADE AGGREGATE $ 510001000 DED RETENTION $ A WORKERS COMPENSATION CWP293586125 WC STATU- OT_H- ANDEMPLOYERS'LIABILITY YIN 09/19/1 09/19/15 ggyLIMITS-1 _ ANVPROMEMBERlEXCLUDEEXECUI'IVE E.L EACH ACCIDENT $ 1,000,000 OFFICERtMF_MBER EXCLUDED? NIA -_ (Mandnlory in NH)if if, ET.DISEASE-FA EMPLOYE DECC IPTIOs Order $ 1,000,400 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCArIONS/VEHICLES (Allech ACORD 101,Additional Remarks Schedule,i(more space Is required) RE: 101st Ave BE & S. 256th St. Per the attached the following are additional insured - products completed operations, primary & noncontributory, waiver of subrogation applies: City of Kent CERTIFICATE HOLDER CANCELLATION j LAUTHORIZED Y OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE "_ity of Kent ATION DATE THEREOF, NOTICE WILL BE DELIVERED IN E WITH THE POLICY PROVISIONS. too West Gowe RESENTATIVE Cent, WA 98032 'GSA — ©1988.2010 ACORD CORPORATION. All rights reserved, 4CORD 25(2010/05) The ACORD name and logo are registered marks of ACORD.a..t_l_.-.._�.... i 1Rece_iyed Time Sep, 20, 2014 2: 26AM No. 1111 9/20/2014 5:26 Remote ID Remote ID D 8118 I I POLICY NUMBER: CWP293586125 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS SCHEDULE® PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anizatian s : Locations Of Covered Operations City of Kent t Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — Who Is An Insured is amended to B. With respect to the insurance afforded to these Include as an additional insured the person(s) or additional insureds, the following additional exclu- organization(s) shown in the Schedule, but only sions apply: with respect to liability for"bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" caused, in whole or in part, 6y: "property damage"occurring after: 1. Your acts or omissions; or 1. All work, including materials, parts or equip- ment furnished in connection with such work, 2. The acts or omissions of those acting on your on the project (other than service, maintenance behalf; or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the location(s) desig- covered operations has been completed; or nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. I I � i CG 20 10 07 04 O ISO Properties, Inc., 2004 Page 1 of 1 Received Time Sep, 20, 2014 2:26AM No. 1111 D/20/2014 5:26 Remote ID Remote ID 9/18 ................ ............................ ............... ....................................... ....... ........ ........ ...... ........I....... ........ .........COtAMEKOLAL�GJ5NERAL::LIARI-LITY ....... . .........................-..............................;...1.11.....___...111111111.... ..... ... I ............. 11.1....-............. CL,CG 0013 08 13 q: ........ .... ...... .......... ............ ....... .................... . ........ ...... . T fIS ENOORSE llN ijI4ANJG**15S THE P*CiLI*C- PLEA E REAG.IT�64ki2rULLY,-'* G. NERALLIAMLITY.PLATINUM 'END M E NT. C011VIM51RCE A PIEDIcALPAYMENT5.- If 8EOT[09'k'dOVFJOAt d MEbidA0jM Nq r-N PS j6:ri.ot.1 otherwise elwise excluded f I rwi this "IlleMedical:C X co L'p J*�f lj�c Vqjj�d fhotev—* of Sc_r�,Tfa N Itf-: ,L I MIT* 1 9 p& is-pollcy, gw�jeb t� M� P.INSURANCE,.6half betha:gfsater bfi-._, ......... JIMO;tXP05$4614,�SMOKFANP$PRMKL R LEAKAGE DAMAGE TO M RkL� ISES If dsMage to:preen 1Sesrented to'Y*6t']*U'*n*(f'*e'*r"ta'V'O age A. it not-ot-erwigo 1policy, 'd- 1. e 9a.s if parag r krItigidn§Is dolptod:arid replace-d'h Y th,I fbilbWlrig' ....... ... ........... .. n 0 YOU,Of.,0 -Occupied byry' V, -ijas oll of! he whll�.rented*d t �i repC)rafj Y OMP Y. 0 h ding. ex Ou h peril Ownp-r,* N �oparae, limit bf*InOrarr46:applle!i to this -111 0"TON Al - -**UMITS*OF 08014ANCE' ' z. pi), flif :41trAT6 :dF.]Ni6liAN' CE- is,diol6ted" gridpiPi'w' q P _. F r. 5,ahove,f 16 greater'o f! F M. 8bbject ta,loaradr�p� A)'A"ho Qarriag6To.Prdie(i6$Redf6d:T—ty ymi t lmit >frgivn 1n1haJ)eok*ar4ons;.t 15rite most Q&Vll Oa V pbdef:M0VEkX6 for data ages becauso of property damage" to airy one pri&hisda;While Peptod to youtO61OOrbriI9 bacupled by you with the ridneMidri of the 6w er 4-1x,(1)(a7i(0 e tiogfiratic MONI IV -4.tfr3MMEAGIRt &TEMPIUL lbfi5dand fepl�bed'by the foll V, fl)-.T-'h*e* is E, I aposiani :preffils66*kshted toj6u.6e teftiocl-gril caupled With the Permis6lon-Of r Y ner, aragraphq.a,of SEGT1 iiPTINITIO'NSHs deleted aft d r6plaCdd:bytlyb four%11ng: ., , ,-.-t h6f*pbrObn:of ti-16 C so 0..,p emises. 06 wever A confrd-of fora :ea .a by firb;t.I!ghtil. org iog. q x P Osloh,,smokn�L. A sprinkrer . ea nqd .to Premises. VV lid occupied by,qqu IvIffi j36r4*2;f6h6f theovJc6r is rrcf a r"insured contract L Cd 00 13*08 13*..- 4 w P A ;�� :T W, ` , ('�� A- i 9/20/2014 5:26 Remote ID Remote ID D 10/18 ............................... ........_............. .........._ ._..... ......... .. .. ........ .....-_ ....._. .... ...........I.......... . ._... . ..............I.........._.... ...... .................,................................_.... ......._............_........ .._... ..................._.. _...................._........._..............,...._.....,..,.._...._................,_.................,.......,......._..,........._.,.........._.........._._.... C. IMI ED:Fit t3Vt€NED SATRlaE i :::. . .. .. . . . . . . . .. . . . . . . .. . .. . .. . . .. . .. . . .. . . . :. Y .: ._.. ...... ..... ..... .. .. .. 1.. 1atagraph r .( 0.orT€ ! 1, ' tVtAGE A:2 C xclusirrns as rle[ecod atYd:roplat 1 by the .......... ...... . .. .. ... .. ... : - . €�vaatercrait yotr dtxnot'�twn that Is .;' a . .less#€2n 51`fi aktong;a9i1 - b Nbt users to carry porsniYs or j t perty for dl argc I� : t�pRtN1s7 Rt .a" tYt418EJ . SECTIMI. 1 SUP. LEt}€N"PykO OAY*ME'NT 6OVERrx12ES AkAND B.1s:amdndea as Fol€owl;.. - "!_ TiidIlmftofrnsCrra6d6:in:p6raijrnph14t.;tstirhea's4dfrotri $26C1to 2;590;1. nc3 .:...:.. i TNetntl.4i+3i utsut;i9ee fn paragt4rpll'C.#,gS[tarPryasdd fresrrr-g�59 to;59�. - I - E AUTOMATIC AIDD3"CIf3 RLLF�Ti01dSh€t�S.":.: €`bt4.0 1tTt�*OBUT. Ff Y ....: 7€iaoltaGUEti is:tcib to €�araEraph 2 ;off ETtd3N Et b 4V01t3 rd. N t ¢SURR C. Atiy esvo or ovcgan3zatCot7 dostiiand i�eto V,..Wh r you aF :alaltga$ d vletue f a vHtt0h . : : . . .... :cor tract fl'r e reena�ht rttak�uctr i�er4nrt 6 . meted s an:addifto tsl'Insured'rirv.'Our:Pollcy,.. When reguir d"bv vlttu cr a writton vonfracf'"or.ardreement; coverage :provJd0d tc? sriy .. . .. a'dtllhe�iai lnsuted will be'pn:a p'ri'mary no rbrn,thqq adCiit:i'onal " . ,.insurpd'� �raifoy; : :::.-•- �...:..: ': .::".....::'.: ....,..-..,-- ..,.,...,..:......: .,:.:..-..... CJn€y eh fol€awing,�PL rs0115 of trtcoiin z ittdns art ae3ditian�l it sfJeec9s'ur der tF ig�ndr�rscin*rats ,.41p :Nia9'ra �i's, tr mass "ts Qfi € t Ian TJto ittaFia er or lessdr of a pren"tt e Iea� c1 to ,:.. but only wrth'rosraaat to lidbtlity arisiY g frorv:the etunershlp tttain#eatatt ar use o that ad:t Part'vf tno.t riti'tses 1pa'ser yuu'an iorrs ii sublect:ftr;the#olEow ng:ad iitioital o tptu This riisutsncdoes`ictkap (y ti:-''. . .. (a) A ta' rciurrsneca.`�vh Cl"talus pliaee:aiteryou ce' se t be `tenatjt rif:that pretni s tbj Strurtiira[ Itorati ns, ttrw:o3nskruaf€a QY letndlikior p raktpr7s.perform d by:pi:qn - (�j €.�s5�r ti� �.ivas¢d;�gtar(�tt5a€tt Arty�etsan ter orffa[iizait�iFr from Wftor� ycru'.I�a's�: :- "`, " , e uiptt ettEt hui t( '.wteh resj ect tri liab'K(y for:`6odtty injury",.: orbp4Ly 4 a 0a` cr "1oisonol::and hdv rG3irg :inararV" cats'et itt 'ivholu' or-in':part, by your mWiltonurrc oporrifion or use of e uif tnF nt('eased ta'yuu Iay stroll pet<ontsJ;nt rlydan'fzaiioit(sj owdver:thts in trrart e dog ant al�ptyr f©arry' union l toy tell s ttlac3 affi nth : (3} 'lfencEsrs Arty pens an or orgsrnaat on;.t ut l only.Vdlrh rFspcct to 6o irly tttJu j' or plop3ctjr damage"'srisit�g: oUt of °'your,products"'Sho�m ii:`khe clte l€ witioit'are " distribuWd or sold fit thu:ru'ourar 8otirse:af the yonder°s businoss, subjeM to the f6ilowin ' :a Tho ir7suC�ri :�fi`ord�d�tl��:yersdos dues not�apjiiu to - `I "f3oclily Injury' or "prgperty dariia�o' Por'w7iclu the nreneor is;ofllrgufietf 1Cs pa{j' ... .. .., 3e agos':tijr raasori.. 1h0 assurnptron 'bf lobiiitt?':ih a:conEract 6r agroofflaht: . .: -:: . ' . ;%hls:ericltisi4t5citlss'rir�trappfy'tolialtrtity:fai°rl�nr��es:tFietttte''vi3titiorwnule9f5n4+s :' Irt'the at5sos7G's.of the ue+ntraot rir a�r�ement . g f by you;. -n)a expfe� warranfy:ur autharizerJ . . . Any,phys ca ot'..et3emioal :changa :an 'tlie.3Xioduof ifiado :aliter#ionat[y':is thy' ' vendor,: . CzL.UG t30 1 0E$':13 (nctu le?q erSRYrighte rt}ti3F.e i!'of lr�cur�rict'.S fvioE's , ... . . : �:' .,.: ,: . . �• brFit�,atia�v��thfts�per"rills=ion .:... � :�� � ages serf� Received Ti.me:-SeP. 20, '.-201d. 2: 26AM hl0 1111 9/20/2014 5:26 Remote ID Remote ID D 11/18 .................-.............................._......_...._.........................._.............._..................._._._........................................_................................ t.......... .:............................._..............._..........._........................................_._......._._....... ......_...____. .......... ................._......._.............................. ........................................._.............,..,................,.....,....,......,,.,.....,............... .."......"..,.. .. .. 4: };epric aging,',,iin[ess .Unpao e salaiy'':fof f[ie.:Purpos�.:.-of nspe-ctiaii. ..:: .: : : .. . . "oeinanstY�t?odi; testing, oe':t[ia subsfrCutioi af;pa'ts uiader:instru'atiors::frriiit tho ::- ._ r al ufactt7't'er ah 4 th h tepackaged irt.the:araginal bohtpiner, - - .... " ,' .AisY fatiur -to inakrs such irispeations arfjustrr eats, tests or serulorrrg es the yan fot has agreed to:riiake or nomially ui d rtalees tciaiiake Iliiila usual etiurs tru5rness,lrt c "cttor Wvrtti ilia aistr[buflon or. alsof the pra ltiets, j r C3etr ons#Cafi[on rns;a[IaCion, sarvratng a'r rapair :OperaCionsi" eXeept sudv j oWatlnns perFoi mad st the venctbr`s premises irr cor6i20trdn cvit[5'tite sale.:df tYSa Praduots Svkiirh,atterdistn[sutio :or Sale by you, holre teen IaboP21 dr retetae[ed or used as"a container hart of (ngradiertt rf an r,thilrq or suffistanue iip or or t�. Thia in ura 3ee,daes:nai 'a I ':to. an insure!' arson b'r''nr' �nizat n,,fYo r :U1t h1 )oa have aoq duii such pry a fa to?:'any riiar>=d entr lair€b'r conCMner enteNEfo. 1h][0 act6ripanying;or cdlitcrnii g such ptonurfis (4 319t¢ agr k�at[t?cab uhdtvrsiaSn tact sks' t Yx€rth�rizead:s RoI'�ttng Ta,Rratxrllsas "dklTy;state:'or pcBCircal'suktd[v[s[e il,fit,bJeGC:tia'thy:-tollGW1 V additional provlsiMi::- ........ "phis insurance npp teS only with i espeetrto fhs t`o'llpWrnQ hazards for Which tha s ata 4r - po[itca[sir s livisi err tIasi s'sugd a Jaermrt;'ih udmhaclibf9 iWi#h pren�ises'ybU .contra(Wio to:tvhicti'thfs ?n'su"ranee -- (ay Th€ ttsJ laa,T ainterrat C: ,ropair for structi r' erottioh',:or remitval tsf advertising ,,. :.. ,.,:srgris' ::ativriiirtgs, cdts€ap[es,:.c,�llar':ant'rances',-:coal ;:Hu[es;;:fr?uecuays;,rrran}i[i[es;:' marquees, hoovaway openlnrus,sideyIfulle vaulds street i sryrfar9;:or daeor�tlons ierrd = .. . .-marquees,, slmf(ar, xt osures, or, {tit Tlio:dprrstrur#ran ''s actianr.orYen�ovai:of olevata s, r (a} Thoiat°dner5ltip,'r tainzeffaobe, 01 use.:bf nny e[etiat zr eoyered#ay thte:i isura c " L[mrts.©f [naUra ce.fprsuch eddit[dnal nsurad ara.ths ?units In this caverayefnr r orthe linvts;you and stiefr.additirsnal dnsured agr t3 to by virtu.,of rcontractoragreement whto Mef" s ?ass 7t ese " lintts are.i clusrye of:and ara nrs iil addii?oii to.the Limits .. 1 isUl2nbe shdwn in th ;Wraticns, : :When required 'by v M6 6f a V rittei7 �oifraoC or acdreement. oavaiage,pravided ta'ai7y 3tidif?tndl _ EhsuretJ Ar?T [�Y TC : AfJCi itt I3 .1t EU 'Et] F t [ptl ;t LAIIr� S ttlP:a C I i i NON��NT I�t�T�.t.�k u,Pil[ ha"dii a.gn[irt tl bes[s grid w II naY:seelt�'oi tr(b'utlan froirt tha�d iit'iairta[ . insuretl's-i5alicy:; "``::"': ' ..,: :- ":.....".......: y $;t Cl f C2 lV nSt�C?7[&�TWK t3 tNL P t ?JIFt i� 16t1 DAY S Pas rjra.ph:I of SECT6 1i'-WHO-M.Afl lWSURE6 is d616t6a and hetlauesri by tha follow fig, Any orcdanization you.naw?y aeq :ovor which you main#ain. ravrnarsl�?Ix:or malanty riterra'st4 inrrra1,han-6.01f4 wmli k'e r i rarndd [r sr7red(P Fhem i .n� zfhsr's(rnil�i insurance avalfobtri*to'that:orgarilzaCi�n::Fi�wever...::: o viagca rider this.przviv?inn I5 afForder['bi[q.tmki[ tt P-18Q#h dayarter yci:tculra c7r'form' " "iho'orgaril�a#idi�de t['tz atYr�(:of thr:policy±aaefort dirhich'ever is earl?ari - Ed EQFfClt49 : Des naT �pfiiy ts:rbodily iri�ui'y" or°prapariy darmge" rY E.oncurred..Ca'efore, yc r:Ertquira�ti'Porrrekte:argrSiraPirzS. .; " e COVE RAG :�dues riot-app[y ter "'parsanal and adver€is[ng injury"_arrsirtg out;of.dn 6 anea" . 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Payl a ril- " I —t . - " .... . , pie* rt�* d ge"-'afl8iii-9 on '-Of your 6ngoiriq;jbpbret!6 I doid.a:. ro '1 ** n YOUrwor, .(dae (in wntriibf h I jerffZation�6M IMAuded :11! the: 1. at person:or b ..Ho'WWer,OUIr rig ts:rilby Qhly bd'�Wved prf6f t64 g ithe "Occurrerice- giving-lise As ti,b.-njury-pr rn*� a i5lc.)rWi0i Part: P.a..rt: 4-hajnSule.d rimi-tie ribihing,aftar.a Iossi*1M--.,- .. ini parr,our ddiirs; g us enforce fl1QSo-HgW;-., V 6 '0*fs :P3 CG 00 308 3 'Received 'Tim*e* SeD, 20. 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P11..,.NP M LABiLjTYflgF_Ftf;l_RY 10 The a ow ffq 15,a 6 jo pam"p Lhadnal :nrwd a Veirtistriq injury` CTI M.-V LIARILITYtOV)P�kArA-176Rkii- Non employment il3aranrinatian -8bi is t 1 11 his I jo a U cb' a.ii.hs, ,tIol'qQi 6 , * th - .on ..Fba pal , A rig s .wi --meper age;. Sexua or Person'$ raM�.oblor,: manta( �tof d I on c P'ne bircmc6i PIIW�061 OrXIOPte' ddn** tl it any Ot her prole cted c dss 5t.chaa16tqIj8tI8:. f-1: a iany federal; state or:IacaT s t'.aIl—iAsI. i-flos Or fodu'la. tiOti.s..�.K:-1d..n.-bmp*lO.:*Y.'m..'_6 n .a lisniv:al,."n*' "IT. n-itlo.d.a-:net nblu tovintaftO'b CNI 110t �rs_g-bur.of past;pies nt orpro8pe,tiVe,erzipIoymoft : - Qjr i5ing..,In ju.Y . c 0 dy meges in q Da cl ba. '�.ern lby�.ne ffl: dliEbrit nination MO �an ri I We �Ql, pay far a The 1W all damages .for non p. aggreg 9e, is covered.. Onml�_qrppqorm acts o 07110 :�Apy Abriftofdy B':d*' It ' p' I* to: -- ffi 4iT dl ppeill ..,.boverage', PR'IMA Y*.*f4ofvt G6MT'R�IEL)T'ORY,* w.timende Include as err edditiohal ansir d ally person F.br argainUtibla:f6r whdrri.�old arb�perf6rinind -,yod..*an9.-dbJ[&tdd bY,'M'r64 CA a'..' vRritten.cantr at. ,r agrPe6ielit that "such person -or orgamia on.: e`adde asAn addifitnai u tubri Your�61fa� So. - � �- - , -- -v i Ing rc� M*osMoo*OrOrqah�Atl6n1sah bilditidthEil B'sUf6d 66IYVAhTe16'P6ct.to milge 0 � . � � &. . . . ... 0 ' - la I or .. 0 1 yi in rfgo in,970 1 p e.1 rationa ,?& the, qdklttloiw leis:*Ur4d,and bhJy,tb`the,.d tt nt1Ah8(.sU*oh "bodily Arty 6 r is ng,, inp ry im Thls� hen i'apply fa InMAd scti dined dii your pa b toy. y-sepa ace , Tff*6*(jr6*d are the (mats inthlt� Cbvbr6gb loran br*.the rnis you Snob'aiddiIfi -' 1 0 f insured acme uY vlf'tIle 0f i I nra- * * 'on 'a L' " 1: or agreement;i�wjuhdvi� less,Jlib-644MIll %'66Mcittsiveor an'a.A,rVy!id In.dddstrun ta the� bmiiilqbf I n'-surah-6 spawn:Jh this:- these .. .... 4 :1 �ur n r adc3itiohl insureds; the f411otJiggddrtiona) [Jr. 'Winia u q p0tskxcl anp a ve npry ar xClus;orls a I?JV u sing t, y plafess'lonul on y6uf'Wft% r 60 following operations, ola.,081 3 mat ril'of incurFl1CQ*..5UrV(I;Q1% .46 'R rAht Tima Can 90 . 9,W tJn I I'l 9/28/2014 5:26 Remote lD Remote [D ' ---�--'r-' - - ---�---�- --'----~ ---. ---- ---.---.---- ' -'-�-- '----' ---' --- --- ---. ----' ---. -' '--------� -- ------------. ---- ---' ---- -' ------ --------� -' ------ ------. ------� -- . ~~~~.~~.~~.~~~~~~—~—~~~~~~~~~.~~.~~~~~.~~~.� ' x. or P61formtki ni'l-OdIdn'lMLh h. W. 4: Ail Or'oil If or IN rid Will rld �§ieo 9/20/2014 5:26 Remote ID Remote ID [j 15/ggI THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTOR GENERAL LIABILITY PLATINUM ENDORSEMENT This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART i A. PROPERTY DAMAGE TO BORROWED EQUIPMENT 1, Paragraph 2.1. of SECTION I e COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY is amended as follows: Paragraphs (3) and (4) of this exclusion do not apply to tools or equipment loaned to you, provided they are not being used to perform operations at the time of loss. 2. SECTION III—LIMITS OF INSURANCE is deleted and replaced by the following: The most we will pay In any one "occurrence" for "property damage" to borrowed equipment is $15,000. This limit of insurance is the most we will pay regardless of the number of: a. Insureds; b. Claims made or"suits"brought; or c. Persons or organizations making claims or bringing "suits". 3. Deductible a. Our obligation to pay damages on behalf of the insured applies only to the amount of damages in excess of $250 as applicable to "property damage" as the result of any one "occurrence", regardless of the number of persons or organizations who sustain damages because of that"occurrence". b. The terms of this insurance, including those with respect to our right and duty to defend the insured against any "suits" seeking those damages; and your duties in the event of an "occurrence", claim,or"suit"apply irrespective of the application of the deductible amount. c. We may pay any part or all of the deductible amount to effect settlement of any claim or suit and, upon notification of the action taken; you shall promptly reimburse us for such part of the deductible amount as we have paid. B. CONSTRUCTION PROJECT GENERAL AGGREGATE LIMIT 1. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under COVERAGE A (SECTION I), and for all medical expenses caused by accidents under COVERAGE C (SECTION 1), which can be attributed only to ongoing operations at a single construction project away from premises awned by or rented to the insured: a. A Single Construction Project General Aggregate Limit applies to each construction project away from premises owned by or rented to the insured, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. Id. The Single Construction Project General Aggregate Limit Is the most we will pay for the sum of all damages under COVERAGE A, except damages because of"bodily injury" or"property damage" included in the "products-completed operations hazard", and for medical expenses under COVERAGE C regardless of the number of: (1) Insureds; (2) Claims made or"suits"brought; or (3) Persons or organizations making claims or bringing"suits". c. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the Single Construction Project General Aggregate Limit for that construction project away from premises owned by or rented to the insured. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Single Construction Project General Aggregate Limit for any other separate construction project away from premises owned by or rented to the insured. CL CG 00 20 01 12 Includes copyrighted material of Insurance Services Page 1 of 4 Office, Inc with its permission R— I,,,,A TIC,,,, Q_ 1)n IWA 0, 9AAtg MI iiii 9/20/2014 5:26 Remote ID Remote ID d 16118 d. The limits shown in the Declarations for Each Occurrence, Fire Damage and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Single Construction Project General Aggregate Limit. 2. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under COVERAGE A (SECTION 1), and for all medical expenses caused by accidents under COVERAGE C (SECTION 1), which cannot be attributed only to ongoing operations at a single designated construction project away from premises owned by or rented to the Insured: i a. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-Completed Operations Aggregate Limit,whichever is applicable; and b. Such payments shall not reduce any Single Construction Project General Aggregate Limit. 3. When coverage for liability at out of the"products-completed operations hazard" Is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard" will reduce the Products-Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit or the Single Construction Project General Aggregate Limit. 4. If the applicable construction project away from premises owned by or rented to the Insured has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. 5. The provisions of Limits Of Insurance (SECTION III) hot otherwise modified by this endorsement shall continue to apply as stipulated. C. LIMITED JOB SITE POLLUTION 1. Exclusion f, under Section I—Coverage A is replaced by the following: 2. Exclusions This insurance does not apply to: f. Pollution (1) "Bodily injury" or "property damage" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of"pollutants": (a) At or from any premises, site or location on which any insured or any contractors or subcontractors working directly or indirectly on any insured's behalf are performing operations if the operations are to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants"; or (b) At or from a storage tank or other container, ducts or piping which is below or partially below the surface of the ground or water or which, at any time, has been buried under the surface of the ground or water and then subsequently exposed by erosion, excavation or any other means if the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of"pollutants" arises at or from any premises, site or location which any insured or any contractors or subcontractors working directly or indirectly on any insured's behalf are j performing operations if the "pollutants" are brought on or to the prerrrises,site or location in connection with such operations by such insured, contractor or subcontractor. Subparagraph (b) does not apply to "bodily injury" or "property damage" arising out of heat, smoke or fumes from a "hostile fire". (2) Any loss,cost or expense arising out of any: (a) Request, demand, order or statutory or regulatory requirement issued or made pursuant to any environmental protection or environmental liability statutes or regulations that any insured test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants"; or CL CIS 00 20 01 12 Includes copyrighted material of Insurance Services Page 2 of 4 Office, Inc with its permission Received Time Sep. 20. 2014 2: 26AM No. 1111 9/20/2014 5:26 Remote ID Remote ID 17/1d I (b) Claim or suit by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, or neutralizing or in any way responding to or assessing the effects of, "pollutants". However, this paragraph does not apply to liability for those sums the insured becomes legally obligated to pay as damages because of"property damage" that the insured would have in the absence of such request, demand order or statutory or regulatory requirement, or such claim or "suit' by or on behalf of a governmental authority. 2. With respect to "bodily Injury" or "property damage" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of"pollutants": a. The "Each Occurrence Limit"shown in the Declarations does not apply. b. Paragraph 7.of Limits Of Insurance(Section III) does not apply. c. Paragraph 1.of Section III—Limits of Insurance is replaced by the following: The Limits Of Insurance shown in this endorsement, or in the Declarations and the rules below fix the most we will pay regardless of the number of: (1) Insureds; (2) Claims made or"suits"brought;or (3) Persons or organizations making claims or bringing "suits". d. The following are added to Section III—Limits Of Insurance: 9. Subject to 2,or 3.above, whichever applies, the most we will pay for the sum of: a. Damages under Coverage A; and b. Medical expenses under Coverage C because of "bodily injury" or "property damage" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of"pollutants" is $100,000 aggregate. 9. Subject to S.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 arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of"pollutants". D. VOLUNTARY PROPERTY DAMAGE 1. The following is added to Section 9 —COVERAGES: We will pay, at your request for"property damage'to that part of any property: a. Which you or any subcontractors working directly or indirectly on your behalf are performing operations; or b. That must be restored, repaired or replaced because "your work" was incorrectly performed on it. This insurance applies only to "property damage" to property of others while in your care, custody, er control, and arising out of operations away from your insured premises and incidental to your business. Exclusions j.(3),(4),(5)and(6) do not apply to this coverage. This insurance does not apply to "property damage" included within the "explosion hazard", the "collapse hazard" or the"underground property damage hazard". 2. For the purposes of the coverage provided by D. VOLUNTARY PROPERTY DAMAGE, SECTION III—LIMITS OF INSURANCE is replaced by the following: A. Limits of Insurance 1. Unless a higher limit is shown in the Declarations, the most we will pay in any one "occurrence"for"property damage" under this endorsement is $15,000. 2. Unless a higher limit is shown in the Declarations, the most we will pay for all covered "occurrences"during any one policy period Is$15,000 Aggregate Limit of Insurance. I CL CG 00 20 01 12 Includes copyrighted material of Insurance services Page 3 of 4 Office, Inc with its permission RP.CA. Iviid Time San U 901d 7- %A10 NA 1111 9/20/2014 5:26 Remote ID Remote ID 1e'71e I The Limits of Insurance of this endorsement apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. 3. Deductible a. Our obligation to pay damages on behalf of the insured applies only to the amount of damages in excess of $250 as the result of any one "occurrence", regardless of the number of persons or organizations who sustain damages because of that"occurrence". b. The terms of this insurance, including those with respect to our right and duty to defend the insured against any"suits" seeking those damages; and your duties in the event of an "occurrence", claim, or "suit" apply irrespective of the application of the deductible amount. c. We may pay any part or all of the deductible amount to effect settlement of any claim or suit and, upon notification of the action taken; you shall promptly reimburse us for such part of the deductible amount as we have paid. 4. For the purposes of the coverage provided by D. VOLUNTARY PROPERTY DAMAGE, SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: a. The following is added to paragraph 2. Duties In The Event Of Occurrence, Offense, Claim or Suit: In the event of loss covered by this endorsement, the insured shall, if requested by us, replace the property or furnish the labor and materials necessary for repairs at actual cost to the insured, excluding prospective profit or overhead charges of any nature. Any property so paid for or replaced shall, at our option, become our property. Any payment made by us shall not constitute an admission of liability by an insured, or by us. b. Paragraph 4. Other Insurance is amended as follows: (1) Paragraph 4.a. Primary Insurance is deleted. (2) Subparagraphs (1) and (2) of paragraph 4.b. Excess Insurance are deleted and replaced with the following: This insurance Is excess over any of the other insurance, whether primary, excess, contingent or on any other basis. All other provisions that apply to paragraph 4. Other Insurance contained In the Commercial General Liability Coverage Form are applicable. 5. For the purposes of the coverage provided by D. VOLUNTARY PROPERTY DAMAGE, the following definitions are added to SECTION V—DEFINITIONS: a. "Collapse hazard" includes "structural property damage" and any resulting "property damage"to any other property at any time. b. "Explosion hazard" includes "property damage" arising out of blasting or explosion. The "explosion hazard" does not include"property damage" arising out of the explosion of air or steam vessels, piping under pressure, prime movers, machinery or power transmitting equipment. c. "Structural property damage" means the collapse of or structural injury to any building or structure due to: I (1) Grading of land, excavating, borrowing, filling, back-filling, tunneling, pile driving, cofferdam work or caisson work;or (2) Moving, shoring, underpinning, raising or demolition of any building or structure or removal or rebuilding of any structural support of that building or structure. d, "Underground property damage hazard" includes "underground property damage' and any resulting"property damage"to any other property at any time. e. "Underground property damage" means "property damage" to wires, conduits, pipes, mains, sewers, tanks, tunnels, any similar property, and any apparatus used with them beneath the surface of the ground or water, caused by and occurring during the use of mechanical equipment for the purpose of grading land, paving, excavating, drilling, borrowing, filling, back-filling or pile driving. CL CG 00 20 01 12 Includes copyrighted material of Insurance services Page 4 of 4 Office, Inc with its permission Received Time Sep, 20. 2014 2:26AM No. 1111 9/20/2014 5:26 Remote ID Remote ID D 3!1g THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY COMMERCIAL AUTOMOBILE EXPANSION ENDORSEMENT m PLATINUM This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM The following provides a broad range of coverage in addition to that provided by the basic policy. In some instances, a higher limit or broader coverage is available. Should the policy indicate broader coverage or higher limits than provided by this endorsement,the higher limits or broader coverage shall apply. A. BROADENED NAMED INSURED (2) A person's or organization's status The Named Insured shown in the Declarations is as an additional insured exists only amended to include: while you are performing operations for that additional insured. Any organization,other than a joint venture, over (3) Section Ii, Paragraph C. Limits of which you maintain ownership or majority Inter- Insurance for person organization est of more than 50%, unless that organization added as additional insured are is an 'Insured" under any other automobile pol- those specified I the written con- icy or would be an "insured" under such a policy tract or agreement, or in this cover- but for the exhaustion of its Limit at insurance, age form,whichever Is less. These however; limits of insurance are Inclusive of 1. Coverage under this provision is afforded and are not in addition to the Limits only until the 180th day after you acquire or of Insurance shown In the Declare- form the organization or the and of the policy tions. period,whichever Is earlier, (4) Thls insurance applies on a primary 2. Coverage does not apply to"bodily Injury"or and non-contributory basis If that is "property damage" that occurred before you required by the written contract or acquired or formed the organization. agreement, B. ADDITIONAL INSURED BY CONTRACT OR (5) This insurance does not apply AGREEMENT unless the written contract or The following is added to Section II - Liabillty agreement has been executed prior Coverage, Paragraph A.1.: to the "bodily Injury" or "property damage". d. Any person or organization for whom you C. ADDITIONAL INSURED-EMPLOYEES are performing operations if you and such person or organization have agreed in writ- The following is added to the Section II—Liability ing in a contract or agreement that such Coverage, Paragraph A.I. Who Is An Insured person or organization be added as an addl- Provision: tional insured on your pulley, Any"employed' of yours is an "insured" while us- (1) Such person or organization is an ing a covered "auto"you don't own, hire or borrow additional insured only with respect in your business or your personal affairs. to liability for°bodily injury'or"prop- D. EXTENDED COVERAGE-BAILL BONDS erty damage", Section II — Liability Coverage, Paragraph (a) Caused by an"accident", and A.2.a.(2). is deleted and replaced by the follow- (b) Resulting from the ownership, Inc): maintenance or use of a cov- (2) Up to $5,000 for cost of bail bonds ered"auto". (including bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. CW 34 68 01 12 Includes Copyrighted material of Insurance Services Page 1 of 5 Office,Inc.,with Its permission i Received Time Sec. 20. 2014 9: 26AM No. 1111 9/20/2014 5:26 Remote ID Remote ID 6 4/1g I E. EXTENDED COVERAGE - LOSS OF EARN- J. LEASED OR FINANCED "AUTOS" - PHYSI- ING CAL DAMAGE COVERAGE Section II — Liability Coverage, Paragraph The following is added to Section III— Physical A.2.a.(4) is deleted and replaced by the follow- Damage Coverage, Paragraph C. ng' 4. In the event of a total "loss" to a covered (4) All reasonable expenses incurred by "auto", we will pay any unpaid amount due the "insured" at our request, includ- on the lease or loan for a covered "auto", ing actual loss of earning up to $500 less: a day because of time off from work, a. The amount under the Physlcaf Damage F. FELLOW EMPLOYEE COVERAGE Coverage section of the policy; and The Fellow Employee Exclusion contained in b. Any: Section II —Liability Coverage does not apply. (q} Overdue lease/lawn payments at the This coverage Is excess over any other collect- time of the"loss"; able insurance, G. AUTO MEDICAL. PAYMENTS COVERAGE - (2) Financial penalties imposed under a INCREASED LIMIT lease for excessive use, abnormal wear and tear or high mileage; If the"insured"is wearing a seat belt at the time (3} Security deposits not returned by an "accident" occurs, the LIMIT OF INSUR- the lessor; ANCE for AUTOMOBILE MEDICAL PAYMENTS COVERAGE shown in the Declarations will be (4) Costs for extended warranties, double the limit shown. All other terms and con- Credit Life Insurance, Health, Acci- ditions applicable to MEDICAL PAYMENTS re- dent or Disability Insurance pur- maln unchanged, chased with the loan or lease;and H. COVERAGE EXTENSION AS A CONS& (5) Carry-over balances from previous QUENCE OF THEFT OF AN "AUTO" loans or leases. 1. Transportation Expense K. GLASS DEDUCTIBLE Section III — Physical Damage Coverage, Section lit — Physical Damage Coverage, Para- Paragraph A.4.a, Is deleted and replaced by graph D. is deleted and replaced by the follow- the following: ng: a. We will also pay up to $75 per day to a D. DEDUCTIBLE maximum of $2,500 for temporary For each covered "auto' our obligation to transportation expense incurred by you because of the total theft of a covered pay for,repair, return or replace damaged or "auto" of the 'private passenger type". stolen property will be reduced by the app1- We will pay only for those covered cable deductible shown In the Declarations. "autos" for which you carry either Com- Any Comprehensive Coverage deductible prehensive or Specified Causes of Loss shown In the Declarations does not apply to: Coverage. We will pay for temporary 1. "Loss" caused by fire or lightning;or transportation expenses incurred during the period beginning 48 hours after the 2. "Loss"when you elect to patch or repair theft and ending, regardless of the pol- glass rather than replace, icy's expiration,when the covered"auto" L. EXTENDED COVERAGE - ELECTRONIC is returned to use or we pay for its EQUIPMENT "loss". Paragraph C.2.a. Limits of Insurance of Section We will also pay reasonable and neces- II1—Physical Damage Coverage Is deleted.: sary expenses to facilitate the return of the stolen "auto"to you. We will pay with respects to a covered "auto"for "loss" to antennas and other accessories neces- 1. EXTENDED COVERAGE-AIRBAGS sary for use of the electronic equipment. How- Section III — Physical Damage Coverage, Para- ever, this does not include tapes, records or graph 6.3.a. does not apply to the unintended discs. discharge of an airbag. Coverage is excess over any other collectible insurance or warranty specifically designed to provide coverage. CW 34 68 0112 Includes Copyrighted material of Insurance Services Page 2 of 5 Office,Inc.,with its permission ; Received Time Sep, 20, 2014 2:26AM k 1111 9/20/2014 5:26 Remote ID Remote ID p 5/18 i i M. EXTENDED COVERAGE - PERSONAL EF- P. PHYSICAL DAMAGE COVERAGE - HIRED FECTS "AUTOS The following is added to Section III — Physical You may extend the Comprehensive, Specified Damage Coverage,Paragraph AA.: Causes of Loss and Collision coverages pro- d. Physical Damage Coverage on a cov- vided on your owned "autos" to any "auto" you ered "auto"maybe extended to"loss"to lease, rent, hire or borrow from someone other your personal property or, if you are an than your employees or partners or members of individual the property their households subject to the following: personalof a i family member, that Is in the covered 1. The most we will pay in any one"loss"is the "auto"at the time of"loss". least of $100,000, the actual cash value of The most we will pay for any one"loss" the"auto"or the cast to repair or replace the under this coverage extension is$500. "auto", except that such amount will be re- duced by a deductible to be determined as N. TOWING AND LABOR COVERAGE follows: Section III— Physical Damage Coverage, Para- a. The deductible shall be equal to the graph A.2,is deleted and replaced by the follow- amount of the highest deductible shown Ing: for any owned"auto" of the same classi- If a private passenger fication for that coverage. In the event p p g type "auto" ro light truck there is no owned "auto" of the same "auto" (hens000 Lbs. GVW) is provided both classification, the highest deductible for Comprehensive and Collision Coverage, we will any owned "auto"will apply for that cov- pay up to $150 for towing and labor costs in- erage. curred each time such "auto" is disabled. If a medium, heavy or extra-heavy truck or extra- b. No deductible will apply to "loss"caused heavy Truck-tractor"auto" (greater than 10,ODO by fire or lightning. Lbs.GVW)Is provided both Comprehensive and 2. Coverage provided under this extension will: Collision Coverage, we will pay up to $250 for towing and labor costs incurred each time such a. Be excess over any other collectible "auto" is disabled, However, the labor must be insurance; performed at the place of disablement. b. Pay, in addition to the limit set forth in O. EXTENDED COVERAGE - CUSTOMIZED P.I. above, up to $500 per day, not to FURNISHINGS exceed$3,500 per"loss"for: The following is added to Section III — Physical (1) Any costs or fees associated with Damage Coverage,Paragraph A.4.: the"loss"to a hired "auto": and e. Physical Damage Covernge on a cov- (2) Loss of use, provided it is tha con- ered "auto"may be extended to"loss"to sequence of an "accident"for which custom furnishings Including, but not you are legally liable, and as a result limited to special carpeting and insula- of which a monetary loss is sus- tion, height-extending roofs, and custom tained by the leasing or rental con. murals, paintings, or other decals or cern. graphics, custom signage and custom Q, RENTAL REIMBURSEMENT COVERAGE non-factory paint. Our limit of liability for loss to custom We will pay for rental reimbursement expenses furnishings shall be the least of: incurred by you for flee rental of an "auto" be- cause of"loss"to a covered"auto". (1) Actual cash value of the stolen or damaged property; 1. Payment applies in addition to the otherwise applicable amount of each coverage you (2) Amount necessary to repair or re- have on the covered"auto". place the property;or 2. No deductible applies to this coverage. (3) $1,000 3. We will pay only for those expenses incurred This coverage extension does not apply during the policy period beginning 24 hours to electronic equipment. after the"loss"and ending, regardless of the expiration date of the policy, with the lesser of the following: i CW 34 68 0112 Includes Copyrighted material of Insurance Services Page 3 of 5 Office,Inc„wth Its permission Received Time Ren. 90. M d 9,9hAM tiln 1111 9/20/2014 5:26 Remote ID Remote ID p 6/18 a. When the covered "auto" has been re- (b) Any"solo"used by that Individual paired or replaced, or or his or her spouse while working b. When the total amount paid under this in a business of selling, servicing, repairing or parking"autos". coverage extension reaches$2,600. 2. Changes in Auto Medical Payments And 4. Our payment Is limited to the lesser of the Uninsured And Underinsured Motorists following amounts: Coverages a. Necessary and ,actual expenses In- The following is added to Who Is An Insured; curved. Any individual named in R.1.a and his or her b. Not more than$75 per day. "family members" are "insured" while "occupy- ' 5. We will pay up to an additional $300 for the ing" or while a pedestrian when being struck by any"auto"you don't own except: reasonable and necessary expenses you in- cur to remove your materials and equipment Any "auto" owned by that individual or by any from the covered "auto" and replace such "family member". materials and equipment on the rental 3. Changes In Physical Damage Coverage "auto". Any private passenger type "auto" you don't 6. This coverage does not apply while there own,hire or borrow is a covered"auto"while In are spare or reserve"autos"available to you the care, custody or control of any individual for your operations, named in R.1.a or his or her spouse while a 7. If"loss" results from the total theft of a cov- resident of the some household except: ered "auto" of the "private passenger type", a. Any "auto" owned by that Individual or by we will pay under this coverage only that any memberof his or her household. amount of your rental reimbursement ex- penses which is not already provided for un- b.Any"auto" used that individual or his or her spouse while working in a business of der the Physical Damage Coverage Exten- selling, servicing, repairing or parking sion. "autos". R. DRIVE OTHER CAR COVERAGE 4. 1 he most we will pay for the total of all dam- 1. Changes In Liability Coverage ages under LIABILITY COVERAGE, AUTO MEDICAL PAYMENTS, UNINSURED MO- a, Any"auto" you don't own,hire or borrow is TORISTS COVERAGE and UNDERIN- a covered "auto" for Liability Coverage SURED MOTORISTS COVERAGE is the while being used by: LIMIT OF INSURANCE shown In the Decla- (1) You, if you are designated in the rations as applicable to owned"autos". Declarations as an individual; 5. Our obligation to pay for, repair, return or (2) Your partners or members, if you replace damaged or stolen property under are designated in the Declarations PHYSICAL DAMAGE COVERAGE, will be as a partnership orjoint venture; reduced by a deductible equal to the amount of the largest deductible shown for any (3) Your members or managers, if you owned private passenger type "auto" appli- are designated In the Declarations cable to that coverage. If there are no as a limited IiabiIlly company; owned private passenger type "autos", the (4) Your "executive officers", If you are deductible shall be $50 for Comprehensive designed in the Declarations as an Coverage and $100 for Collision Coverage. organization other than an individ- No deductible will apply to "loss" caused by ual, partnership, joint venture or lim- fire or lightning, ited liability company; and E. Additional Definition (5) The spouse of any person named In As used in this section; R. DRIVE OTHER R.1.a.1. through R.1,a.(4) while a CAR COVERAGE: resident of the same household. "Family member" means a person related to except: the individual named in R.t.a by blood, mar- j (a) Any"auto" owned by that individ- riage or adoption who is a resident of the indl- ual or by any member of his or vldual's household, including a ward or foster her household. child. I CW 34 68 01 12 Includes Copyrighted material of Insurance Services Page 4 of 5 Office,Ina,with Its permission Received Time Sep, 20. 2014 2:26AM No. 1111 9/20/2014 5:26 Remote ID Remote ID 7/18 i S. KNOWLEDGE OF OCCURRENCE T. WAIVER OF SUBROGATION BY CONTRACT The following is added to Section IV— Business OR AGREEMENT Auto Conditions, Paragraph A.2,: The following is added to Section IV- Business d. Notice of an "accident" or "loss" will be Auto Conditions, Paragraph A.S.: considered knowledge of yours only If We waive any right of recovery we may have reported to you, if you are an individual, against any "insured" provided coverage under a partner, an executive officer or an em- this endorsement under B., ADDITIONAL IN- ployee designated by you to give us SURED BY CONTRACT OR AGREEMENT, but such notice, only as respects "loss" arising out of the opera- tion, maintenance or use of a covered "auto" , Notice of an "accident" or"loss" to your e pursuant to the provisions or conditions of the Workers Compensation insurer, for written contract or agreement event which later develops Into a claim for which there Is coverage under this U. UNINTENTIONAL OMISSIONS policy, shall be considered notice to us, The following is added Section IV - Business but only if we are notified as soon as Auto Conditions, Paragraph B.2.: you know that the claim should be ad- dressed by this policy, rather than your We will not deny coverage under this policy if Workers Compensation policy. you fail to disclose all hazards existing as of the f. Your rights under this policy shall not be inception date of the policy, provided such fall- prejudiced if you fail to give us notice of ure is not intentional. an "accident" or "loss", solely due to V LIBERALIZATION your reasonable and documented belief f we revise this endorsement to provide greater that the event is not covered by this pot- coverage without additional premium charge,we toy' will automatically provide the additional cover- The following is added to Section IV—Busi- age to all endorsement holders as of the day the ness Auto Conditions, Paragraph 2.b.: revision is effective in your state. (6) Knowledge of the receipt of docu- ments concerning a claim or "suit" will be considered knowledge of yours only if receipt of such docu- ments is known to you, if you are an Individual, a partner, an executive officer or an employee designated by you to forward such documents to us. i I i i CW 34 68 01 12 Includes Copyrighted material of Insurance Services Page 5 of 5 Office,Ina,Win its permission I i Received Time Sep, 20, 2014 2: 26AM No, 1111