Loading...
HomeMy WebLinkAboutPW14-090 - Amendment - #1 - Horseshoe Bend Levee - Appraisal Services }Y Records anagemen � KENT Document WP.H NOON Yj I hua¢,55 k� 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: The Eastman Company Vendor Number: 7D Edwards Number Contract Number: I,v' 1 H- 6!' 0, This is assigned by City Clerk's Office Project Name: Horseshoe Bend Levee Description: ❑ Interlocal Agreement ❑ Change Order ® Amendment ❑ Contract ❑ Other: Contract Effective Date: 12/10/14 Termination Date: 12/31/15 i Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Ingrid Willms-Dixon Department: Engineering Contract Amount: Approval Authority: (CIRCLE ONE) Department Director Mayor City Council Detail: (i.e. address, location, parcel number, tax id, etc.): Extend the time of completion to December 31, 2015. As of: 08/27/14 �i All- ICEIdT AMENDMENT NO. 1 NAME OF CONSULTANT OR VENDOR: The Eastman Company CONTRACT NAME & PROJECT NUMBER: Horseshoe Bend Levee ORIGINAL AGREEMENT DATE: April 10, 2014 This Amendment is made between the City and the above-referenced Consultant or Vendor and amends the original Agreement and all prior Amendments. All other provisions of the original Agreement or prior Amendments not inconsistent with this Amendment shall remain in full force and effect. For valuable consideration and by mutual consent of the parties, Consultant or Vendor's work is modified as follows: 1. Section I of the Agreement, entitled "Description of Work," is hereby modified to add additional work or revise existing work as follows: In addition to work required under the original Agreement and any prior Amendments, the Consultant or Vendor shall: The scope of work remains the same, however an amendment is needed to extend the time of completion to December 31, 2015 because the design has not progressed in order to appraise property. 2. The contract amount and time for performance provisions of Section II "Time of Completion," and Section III, "Compensation," are modified as follows: Original Contract Sum, $3,200.00 including applicable WSST Net Change by Previous Amendments $0 including applicable WSST Current Contract Amount $3,200.00 including all previous amendments Current Amendment Sum $0 Applicable WSST Tax on this $0 Amendment Revised Contract Sum $3,200.00 AMENDMENT - 1 OF 2 j Original Time for Completion 12/31/14 (insert date) Revised Time for Completion under n/a prior Amendments (insert date) Add'I Days Required (t) for this 365 calendar days Amendment Revised Time for Completion 12/31/15 (insert date) The Consultant or Vendor accepts all requirements of this Amendment by signing below, by its signature waives any protest or claim it may have regarding this Amendment, and acknowledges and accepts that this Amendment constitutes full payment and final settlement of all claims of any kind or nature arising from or connected with any work either covered or affected by this Amendment, including, without limitation, claims related to contract time, contract acceleration, onsite or home office overhead, or lost profits. This Amendment, unless otherwise provided, does not relieve the Consultant or Vendor from strict compliance with the guarantee and warranty provisions of the original Agreement. All acts consistent with the authority of the Agreement, previous Amendments (if any), and this Amendment, prior to the effective date of this Amendment, are hereby ratified and "! affirmed, and the terms of the Agreement, previous Amendments (if any), and this Amendment shall be deemed to have applied. The parties whose names appear below swear under penalty of perjury that they are authorized to enter into this Amendment, which is binding on the parties of this contract. IN WITNESS, the parties below have executed this Amendment, which will become effective on the last date written below. CONSULTANT/VENDOR(:: CITY OF KENT: By: By. , s fiMv1f' (signature) 7 (signature) Print Name --�-� ,r k Print Name: Mark Howlett Its 6 fir]f t- e l Tl Ea.;]awlLa.N f c _ Its Design Engineering Manager i f(titl(� (title) DATE: f " ? �.ci i DATE: E 1 i" t APPROVED AS TO FORM: (applicable if Mayor's signature required) ',.. Kent Law Department Eastman Co-Horseshoe Rend 2 Amd I/WIlms-Dixon I AMENDMENT - 2 OF 2 CERTIFICATE OF LIABILITY INSURANCE 6/DATE{MMIDDYYYY} 20/2014 THIS 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 P `N. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED F, -cSENTATIVE 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 endorsement(s). PRODUCER CONTANAME: Shari LO£gnist C Don Filer Agency PHONE (206)545-4800I FAX Net:(206)545-4849 4201 Roosevelt Way NE ADDRESS:slofquist@filerinsurance.com INSURERS AFFORDING COVERAGE NAIC 9 Seattle WA 98105-6608 INSURERA:Travelers Cas Ins of America 119046 INSURED INSURER B; G2MZ LLC D13A THE EASTMAN COMPANY msuRERc: 6206 35th Ave NE INSURER D: INSURER E: Seattle WA 98115 INSURERP: COVERAGES CERTIFICATE NUMBER:Travelers Master GL 13-14 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 111 TYPE OF INSURA ADD NCE SUER POLICY EFF POLICY EXP POLICYNUMBER WOE NY MMIDD Y kLIMITS GEN ERAL LIABILITY EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISE uLm,,Mee $ 300,000 A CLAIMS-MADE X OCCUR X 660-7E721300-14-42 /19/2015 MEO EXP(Arty oneperson) $ 5,000 PERSONAL a ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GENT AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPIOP AGO $ 4,000,000 ,-qmY PRO- LOC $ 110811.E LIABILITY COMBINED accident)SINGLE LIMITfEa 1 000 OOO A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 680-7E721300-14-42 6/19/2014 6/19/2015 AUTOS AUTOS X BODILY INJURY(per accident) $ X HIRED AUTOS X NOWOWNEO —PROPERTY—DAMAGE AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ Q Q MP��LOYO R3$l ABI�LTV V{N X WC STATU- DIN Ell ANY PROPRIETOR/PARTNER/EXECUTIVE PLOYERS LIABILITY OFFIC E.L.EACH ACCIDENT $ 1,000,00 ERIMEMBER EXCLUDED? N/A (Mandatory in NH) 680-7E721300-14-42 6/19/2014 6/19/2015 E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 ..SCRIPTION OF OPERATIONS I LOCATIONS l VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) ertificate holder is hereby named additional insured. I ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1. :y of Kent, Dept. of ACCORDANCE WITH THE POLICY PROVISIONS. Engineering Attn: Nancy Ycshitake AUTHORIZED REPRESENTATIVE 220 4th Ave S Kent, WA 98032-3994 Shari Lofquiat/SHARI 'ORD 25(2010106) ©1988-2010 ACORD CORPORATION. All rights reserved, TRAVELERS J� One Tower Square, Hartford,Connecticut 06163 COMMON POLICY DECLARATIONS POLICY NO.: 680-7E721300-14-42 OFFICE PAC ISSUE DATE: 06/19/2014 BUSINESS:REAL ESTATE APR INSURING COMPANY: TRAVELERS CASUALTY INSURANCE COMPANY OF AMERICA 1. NAMED INSURED AND MAILING ADDRESS: 0214Z LLC DEA THE EASTMAN COMPANY 6206 35TH AVE NE SEATTLE WA 98115 2. POLICY PERIOD: From 06/19/2014 to 06/29/2015 12:01 A.M. Standard Time at your mailing address. 3. DESCRIPTION OF PREMISES: ADDRESS PREM, LOC. NO. BLDG. NO. OCCUPANCY (same as Mailing Address unless specified otherwise) 001 001 REAL ESTATE APR 6206 35TH AVE NE SEATTLE WA 98115 4. COVERAGE PARTS AND SUPPLEMENTS FORMING PART OF THIS POLICY AND INSURING COMPANIES COVERAGE PARTS and SUPPLEMENTS INSURING COMPANY Businessowners Coverage Part ACJ S. The COMPLETE POLICY consists of this declarations and all other declarations,and the forms and endorse- ments for which symbol numbers are attached on a separate listing. 6. SUPPLEMENTAL POLICIES: Each of the following is a separate policy containing its complete provisions, POLICY POLICY NUMBER INSURING COMPANY I DIRECT BILL 7. PREMIUM SUMMARY: i Provisional Premium $ 650.00 Due at Inception $ Due at Each $ NAME AND ADDRESS OF AGENT OR BROKER COUNTERSIGNED BY: FILER\C DON\AGCY INC P4287 4201. ROOSEVELT WAY NE Authorized Representative SEATTLE WA 95105 IL TO 19 02 05 (Page 1 of 01) DATE: 06/19/2014 office: SEATTLE WA DOWN i WK TRA Y Ert.ERSA J One Tower square, Hartford,Connecticut 06183 BUSINESSOWNERS COVERAGE PART DECLARATIONS OFFICE PAC POLICY NO.: 680-7E721300-14-42 ISSUE DATE: 06/19/2014 INSURING COMPANY: TRAVELERS CASUALTY INSURANCE COMPANY OF AMERICA POLICY PERIODt From 06-19-14 to 06-19-15 12:01 A.M. Standard Time at your mailing address FORM OF BUSINESSt LIMITED LIAB CORP COVERAGES AND LIMITS OF INSURANCE: Insurance applies only to an item for which a "limit" or the word "included" is shown. COMMERCIAL GENERAL LIABILITY COVERAGE OCCURRENCE FORM LIMITS OF INSURANCE General Aggregate (except Products-Completed Operations Limit) $ 4,000,000 Products-completed Operations Aggregate Limit $ 4,000,000 Personal and Advertising Injury Limit $ 2,000,000 Each Occurrence Limit $ 2,000,000 j Damage to Premises Rented to You $ 300,000 Medical Payments Limit (any one person) $ 51000 1.. BUSINESSOWNERS PROPERTY COVERAGE '.. DEDUCTIBLE AMOUNT: Busineenowners Property Coverage: $ 2S0 per occurrence. Building Glasst $ 250 per occurrence. BUSINESS INCOME/EXTRA EXPENSE LIMIT: Actual loss for 12 consecutive months Period of Restoration-Time Periods Immediately ADDITIONAL COVERAGE: Fine Arts: $ 25,000 i i Other additional coverages apply and may be changed by an endorsement. Please li read the policy. i SPECIAL PROVISIONS: COMMERCIAL GENERAL LIABILITY COVERAGE IS SUBJECT TO A GENERAL AGGREGATE LIMIT MP TO 0102 05 (Page 1 of 2) BUSINESSOWNERS PROPERTY COVERAGE PREMISES LOCATION NO.: 001 BUILDING NO.: 001 LIMIT OF INFLATION COVERAGE INSURANCE VALUATION COINSURANCE GUARD BUSINESS PERSONAL PROPERTY $ 8,000 RC* N/A 0.0$ *Replacement Coat COVERAGE EXTENSIONSz _ Accounts Receivable $ 25,000 Valuable Papers $ 2S,000 Other coverage extensions apply and may be changed by an endorsement. Please read the policy. I i i I MP TO 0102 05 (Page 2 of 2) POLICY NUMBER: 680-7E721300-14-42 EFFECTIVE DATE; 06/19/2014 ISSUE DATE: 06/19/2014 '.... LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS . IL TO 19 02 05 COMMON POLICY DECLARATIONS MP TO 01 02 05 BUSINESSOWNERS COVERAGE PART DECLARATIONS IL T8 01 01 01 FORMS ENDORSEMENTS AND SCHEDULE NUMBERS IL T3 16 05 12 COMMON POLICY CONDITIONS - WASHINGTON BUSINE850WNERS MP T1 30 02 05 TABLE OF CONTENTS - BUSINESSOWNERS COVERAGE PART DELUXE PLAN ''..... MP T1 02 02 OS BUSINESSOWNERS PROPERTY COVERAGE SPECIAL FORM MP Tl 05 02 05 AMENDATORY PROVISIONS - OFFICES MP T3 06 02 07 SHWER OR DRAIN BACK UP EXTENSION ', MP T3 25 01 08 TERRORISM RISK INSURANCE ACT OF 2002 DISCLOSURE '.. _ MP T3 50 11 06 EQUIPMENT BREAKDOWN - SERVICE INTERRUPTION LIMITATION (..... MP T3 56 02 08 AMENDATORY PROVISIONS - GREEN BUILDING AND BUSINESS _ - - PERSONAL PROP COV ENHANCEMENTS '.. MP T9 70 03 06 POWER PAC ENDORSEMENT CP 01 60 12 98 WASHINGTON CHANGES - DOMESTIC ABUSE MP T4 31 12 09 WASHINGTON CHANGES COMMERCIAL GENERAL LIABILITY i CG TO 34 11 03 TABLE OF CONTENTS - COMMERCIAL GENERAL LIABILITY COVERAGE FORM CG 00 01 SO 01 CG 00 01 10 01 COMMERCIAL GENERAL LIABILITY COVERAGE FORM CG 21 70 01 08 CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM CO 24 04 10 93 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US I CO D2 55 11 03 AMENDMENT OF COVERAGE - POLLUTION CG D3 09 11 03 AMENDATORY ENDR- PRODUCTS-COMPLETED OPERATIONS HAZARD CG D4 71 02 09 AMENDMENT OF COVERAGE 3 - PERSONAL AND ADVERTISING '.. INJURY LIABILITY f GN 01 13 11 03 EMPLOYERS OVERHEAD LIABILITY CG DO 37 04 05 OTHER INSURANCE - ADDITIONAL INSUREDS CG D1 86 11 03 XTEND ENDORSEMENT '.... CG D2 03 12 97 AMEND - NON CUMULATION OF EACH OCC j CG T4 91 11 88 ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION CO D4 13 04 08 AMEND COVG - POLLUTION-EQUIP EXCEPTION MP T1 25 11 03 HIRED AUTO AND NON-OWNED AUTO LIABILITY '.. CG D2 56 11 03 AMENDMENT OF COVERAGE - PROPERTY DAMAGE CG D2 72 11 03 EXCLUSION - INSPECTION, APPRAISAL AND SURVEY COMPANIES CO D3 26 10 11 EXCLUSION - UNSOLICITED COMMUNICATION i IL TO 010101 PAGE: 1 OF 2 CG DI 86 11 03 Page 1 of 5 CG D1 86 11 03 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. The following listing is a general coverage description only. Limitations and exclusions may apply to these coverages. Read all the PROVISIONS of this endorsement carefully to determine rights, duties, and what is and is not covered. A. Broadened Named Insured I. Injury to Co-Employees B. Damage To Premises Rented To You Extension J. Aircraft Chartered with Crew • Perils of fire, explosion, lightning,smoke, water K. Non-Owned Watercraft—Increased • Limit increased to$300,000 from 25 feet to 50 feet C. Blanket Waiver of Subrogation L. Increased Supplementary Payments D. Blanket Additional Insured—Managers or • Cost for bail bonds increased to$2,500 Lessors of Premises • Loss of earnings increased to$500 per day E. Blanket Additional Insured—Lessor of M. Knowledge and Notice of Occurrence Leased Equipment or Offense i F. Incidental Medical Malpractice N. Unintentional Omission G. Personal Injury—Assumed by Contract O. Reasonable Force—Bodily Injury or H. Extension of Coverage—Bodily Injury Property Damage PROVISIONS A. BROADENED NAMED INSURED 1. The Named Insured in Item 1. of the Declarations is as follows: The person or organization named in Item 1. of the Declarations and any organization, other than a partnership or joint venture, over which you maintain ownership or majority interest on the effective date of the policy. However, coverage for any such organization will cease, as of the date, during the policy period, that you no longer maintain ownership of, or majority interest in, such organization. 2. WHO IS AN INSURED (Section II) Item 4.a.is deleted and replaced by the following: 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. 3. This Provision A. does not apply to any person or organization for which coverage is excluded by endorsement. B. DAMAGE TO PREMISES RENTED TO YOU EXTENSION 1. The last paragraph of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY (Section I —Coverages) is deleted and replaced by the following 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; d. Smoke resulting from such fire, explosion, or lightning; or All W­4.. I 441 I n11,f In»7/1m`J CG D1 86 1103 Page 2 of 5 e. Water. A separate limit of insurance applies to this coverage as described in LIMITS OF INSURANCE (Section III). 2. 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 from water; c. Explosion of steam boilers, steam pipes, steam engines, or steam turbines. 3. Part 6. of LIMITS OF INSURANCE(Section 111) is deleted and replaced by the following: Subject to 5. 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, explosion, lightning, smoke resulting from such fire, explosion, or lightning, or water, or any combination of any of these. The Damage To Premises Rented To You Limit will be the higher of: a. $300,000; or b. The amount shown on the Declarations for Damage To Premises Rented To You Limit. 4. Under DEFINITIONS (Section V), Paragraph a. of the definition of"insured contract" is amended so that it does not include 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: a. Fire; b. Explosion; c. Lightning; d. Smoke resulting from such fire, explosion, or lightning; or e. Water. 5. This Provision B. does not apply if coverage for Damage To Premises Rented To You of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY (Section I — Coverages) is excluded by endorsement. C. BLANKET WAIVER OF SUBROGATION We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of premises owned or occupied by or rented or loaned to you; ongoing operations performed by you or on your behalf, done 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 by you prior to loss. D. BLANKET ADDITIONAL INSURED—MANAGERS OR LESSORS OF PREMISES WHO IS AN INSURED (Section 11) is amended to include as an insured any person or organization (referred to below as "additional insured") with whom you have agreed in a written contract, executed prior to loss, to name as an additional insured, but only with respect to liability arising out of the ownership, maintenance or use of that part of any premises leased to you, subject to the following provisions: 1. Limits of Insurance. The limits of insurance afforded to the additional insured shall be the limits which you agreed to provide,or the limits shown on the Declarations, whichever is less. 2. The insurance afforded to the additional insured does not apply to: a. Any"occurrence"that takes place after you cease to be a tenant in that premises; b. Any premises for which coverage is excluded by endorsement; or I i CG D 1 86 1103 Page 3 of 5 c. Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. 3. The insurance afforded to the additional insured is excess over any valid and collectible insurance available to such additional insured, unless you have agreed in a written contract for this insurance to apply on a primary or contributory basis. E. BLANKET ADDITIONAL INSURED—LESSOR OF LEASED EQUIPMENT WHO IS AN INSURED (Section II) is amended to include as an insured any person or organization (referred to below as "additional insured") with whom you have agreed in a written contract, executed prior to loss, to name as an additional insured, but only with respect to their liability arising out of the maintenance, operation or use by you of equipment leased to you by such additional insured, subject to the following provisions: 1. Limits of Insurance. The limits of insurance afforded to the additional insured shall be the limits which you agreed to provide, or the limits shown on the Declarations, whichever is less. 2. The insurance afforded to the additional insured does not apply to: , a. Any"occurrence"that takes place after the equipment lease expires; or b. 'Bodily injury"or"property damage'arising out of the sole negligence of such additional insured. 3. The insurance afforded to the additional insured is excess over any valid and collectible insurance available to such additional insured, unless you have agreed in a written contract for this insurance to apply on a primary or contributory basis. F. INCIDENTAL MEDICAL MALPRACTICE 1. The definition of "bodily injury" in DEFINITIONS (Section V) is amended to include 'Incidental Medical Malpractice Injury". 2. The following definition is added to DEFINITIONS(Section V): "Incidental medical malpractice injury"means bodily injury, mental anguish, sickness or disease sustained by a person, including death resulting from any of these at any time, arising out of the rendering of, or failure to render, the following services: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances;or c. First aid. d. "Good Samaritan services'. As used in this Provision F., "Good Samaritan services" are those medical services rendered or provided in an emergency and for which no remuneration is demanded or received. 3. Paragraph 2.a.(1)(d) of WHO IS AN INSURED (Section II) does not apply to any registered nurse, licensed practical nurse, emergency medical technician or paramedic employed by you, but only while performing the services described in paragraph 2, above and while acting within the scope of their employment by you. Any "employees' rendering "Good Samaritan services' will be deemed to be acting within the scope of their employment by you. 4. The following exclusion is added to paragraph 2. Exclusions of COVERAGE A. —BODILY INJURY AND PROPERTY DAMAGE LIABILITY(Section I—Coverages): (This insurance does not apply to:) Liability arising out of the willful violation of a penal statute or ordinance relating to the sale of pharmaceuticals by or with the knowledge or consent of the insured. 5. For the purposes of determining the applicable limits of insurance, any act or omission, together with all related acts or omissions in the furnishing of the services described in paragraph 2. above to any one person, will be considered one"occurrence". 6. This Provision F. does not apply if you are in the business or occupation of providing any of the services described in paragraph 2.above. 7. The insurance provided by this Provision F. shall be excess over any other valid and collectible insurance available to the insured,whether primary, excess, contingent or on any other basis, except for insurance purchased specifically by you to be excess of this policy. h+t„•/iPF,•,,,� r«• ..AtP,• ,..,,.,t„w�n�rA.xr".,.tttif�r r.,,O1 1 utit 1(11 k+ tnInoionrn CG DI 86 1103 Page 4 of 5 G. PERSONAL INJURY—ASSUMED BY CONTRACT 1. The Contractual Liability Exclusion in Part 2., Exclusions of COVERAGE B. PERSONAL AND ADVERTISING INJURY LIABILITY(Section I—Coverages) is deleted and replaced by the following: (This insurance does not apply to:) Contractual Liability "Advertising injury"for which the insured has assumed liability in a contract or agreement. This exclusion does not apply to liability for damages that the insured would have in the absence of the contract of agreement. 2. Subparagraph f. of the definition of"insured contract" (DEFINITIONS—Section V) is deleted and replaced by the following: 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 party or organization. Tart liability means a liability that would be imposed by law in the absence of any contract or agreement. 3. This Provision G. does not apply if COVERAGE B. PERSONAL AND ADVERTISING INJURY LIABILITY is excluded by endorsement. H. EXTENSION OF COVERAGE—BODILY INJURY The definition of"bodily injury"(DEFINITIONS—Section V)is deleted and replaced by the following: "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. I. INJURY TO CO-EMPLOYEES 1. It is agreed that your"employees" are insureds with respect to "bodily injury" to a cc-"employee" in the course of the co-"employee's"employment by you, provided that this coverage for your"employees"does not apply to acts outside the scope of their employment by you or while performing duties unrelated to the conduct of your business. 2. Subparagraphs 2.a.(1)(a), (b) and (c) and 3.a. of WHO IS AN INSURED (Section II) do not apply to "bodily injury"for which insurance is provided by paragraph 1,above. J. AIRCRAFT CHARTERED WITH CREW 1. The following is added to the exceptions contained in the Aircraft,Auto Or Watercraft Exclusion in Part 2., Exclusions of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY (Section I — Coverages): (This exclusion does not apply to:)Aircraft chartered with crew to any insured. 2. This Provision J.does not apply if the chartered aircraft is owned by any insured. 3. The insurance provided by this Provision J.shall be excess over any other valid and collectible insurance available to the insured, whether primary, excess, contingent or on any other basis, except for insurance purchased specifically by you to be excess of this policy. K. NON-OWNED WATERCRAFT 1. The exception contained in Subparagraph (2) of the Aircraft, Auto Or Watercraft Exclusion in Part 2., Exclusions of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY (Section I — Coverages) is deleted and replaced by the following: (2) A watercraft you do not own that is: (a) Fifty feet long or less;and (b) Not being used to carry persons or property for a charge; 2. This Provision K. applies to any person who, with your expressed or implied consent, either uses or is responsible for the use of a watercraft. 3. The insurance provided by this Provision K.shall be excess over any other valid and collectible insurance available to the insured,whether primary, excess, contingent or on any other basis, except for insurance CG DI 86 1103 Page 5 of 5 purchased specifically by you to be excess of this policy. L. INCREASED SUPPLEMENTARY PAYMENTS Parts b. and d. of SUPPLEMENTARY PAYMENTS — COVERAGES A AND B (Section I — Coverages) are amended as follows: 1. In Part b. the amount we will pay for the cost of bail bonds is increased to$2500. 2. In Part d. the amount we will pay for loss of earnings is increased to$500 a day. M. KNOWLEDGE AND NOTICE OF OCCURRENCE OR OFFENSE 1. The following is added to COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV), paragraph 2. (Duties In The Event of Occurrence, Offense, Claim or Suit): Notice of an "occurrence"or of an offense which may result in a claim under this insurance shall be given as soon as practicable after knowledge of the "occurrence" or offense has been reported to any insured listed under Paragraph 1. of Section II—Who Is An Insured or an "employee" (such as an insurance, loss control or risk manager or administrator)designated by you to give such notice. Knowledge by other"employee(s)" of an "occurrence" or of an offense does not imply that you also have such knowledge. 2. Notice shall be deemed prompt if given in good faith as soon as practicable to your workers' compensation insurer. This applies only if you subsequently give notice to us as soon as practicable after any insured listed under Paragraph 1. of Section II —Who Is An Insured or an "employee" (such as an insurance, loss control or risk manager or administrator) designated by you to give such notice discovers that the"occurrence", offense or claim may involve this policy. 3. However, this Provision M. does not apply as respects the specific number of days within which you are required to notify us in writing of the abrupt commencement of a discharge, release or escape of "pollutants"which causes"bodily injury"or"property damage"which may otherwise be covered under this i policy. N. UNINTENTIONAL OMISSION The following is added to COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV), paragraph 6. (Representations): The unintentional omission of, or unintentional error in, any information provided by you shall not prejudice your rights under this insurance. However, this Provision N. does not affect our right to collect additional premium or to exercise our right of cancellation or nonrenewal in accordance with applicable state insurance laws, codes or regulations. O. REASONABLE FORCE—BODILY INJURY OR PROPERTY DAMAGE The Expected Or Intended Injury Exclusion in Part 2., Exclusions of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY(Section I—Coverages) is deleted and replaced by the following: (This insurance dose not apply to:) 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 persons or property. CG D1 86 11 03 Privacy I Legal Notices 02008 The Travelers Companies,Inc. i http://eforms.travelers.com/nx6gateway.dll/fssforms 1/general%201iability/egdl861103.ht... 10/22/2012 ACC CERTIFICATE OF LIABILITY INSURANCE DATE(MMtDDIYYYY) �,/ 9/16/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 2TIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES .OW. 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(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 endorsement(s). PRODUCER CONTACT NA ME Shari Lofquist _ : C Don Filer Agency PHONE _EX , (206)545-4800 +NC No,,(406)545-4849 4201 Roosevelt Way NE o RIEss:slofquistQfilerinsurance.com _ INSURERS AFFORDING COVERAGE NAICN Seattle WA 98105-6608 INSURER A:Cont inental Casualty Company INSURED INSURER B G2MZ LLC, DBA: The Eastman Company InsuRERc: �', 6026 35th Ave NE INSURER INSURER E: Seattle WA 98115 INSURER F: COVERAGES CERTIFICATE NUMBER Professional 2014 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADOL SUER POLICY NUMBER MMIDOfIVVY MMfDOnYYP1' LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RE COMMERCIAL GENERAL LIABILITY PRE ISEB Ea occurrence $ CLAMS-MADE ❑OCCUR MED EXP(Any one Person) $ PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ / POLICY PRO- LOC $ ('. UTOMOBILE LIABILITY Ee eaad.nt) NGLE LI IT ANY AUTO BODILY INJURY(Par person) $ ALL OWNED SCHEDULED BODILY INJURY(Peracddent) $ AUTOS NON-0WNED OE PROPERTY DAMAGE $ cci HIRED AUTOS AUTOS Per a dent)H r — — — $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEC RETENTION$ $ li WORKERS COMPENSATION WCSTATU- OTH AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOWPARTNER/EXECUTIVE❑ NIA E.L.EACH ACCIDENT $ OFFICEWMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE$ If yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS bd. A Professional Liability FB-133241088-13 9/15/2014 1/1/2015 g1,000,00011,000,000 dalms made DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) it CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ', For Information Purposes Only AUTHORIZED REPRESENTATIVE Shari Lofquist/SHARI ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS0251>mnnslnl The ACr1Rn name rind Innn aro rcni.f.rnrl mark.of ACf1Rfl