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HomeMy WebLinkAboutPW13-003 - Amendment - #2 - A & M Consulting - SE 256th Street Improvements - 12/11/2014 Records Managem it KENT Document W ASMIH6TON # y4i 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. Vendor Name: A & M Consulting Vendor Number: 7D Edwards Number Contract Number: '{f `i ' '`J y r '7, This is assigned by City Clerk's Office Project Name: Green River Natural Resources Area Stormwater Pump Station Description: ❑ Interlocal Agreement ❑ Change Order ® Amendment ❑ Contract ❑ Other: Contract Effective Date: 12/11/14 Termination Date: 12/31/15 Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Alex Murillo Department: Engineering j 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 because project design is continuing. I As of: 08/27/14 i KENT AMENDMENT NO. 2 NAME OF CONSULTANT OR VENDOR: A & M Consulting CONTRACT NAME & PROJECT NUMBER: Green River Natural Resources Area Stormwater Pump Station ORIGINAL AGREEMENT DATE: January 29, 2013 This Amendment is made between the City and the above-referenced Consultant or Vendor and amends the original Agreement and all prior Amendments. All other provisions of the original Agreement or prior Amendments not inconsistent with this Amendment shall remain in full force and effect. For valuable consideration and by mutual consent of the parties, Consultant or Vendor's work is modified as follows: 1. Section I of the Agreement, entitled "Description of Work," is hereby modified to add additional work or revise existing work as follows: In addition to work required under the original Agreement and any prior Amendments, the Consultant or Vendor shall: The scope of work remains the same, however an amendment is needed to extend the time of completion to December 31, 2015 because project design is continuing. 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, $1,980.00 including applicable WSST Net Change by Previous Amendments $0 including applicable WSST Current Contract Amount $1,980,00 including all previous amendments Current Amendment Sum $0 Applicable WSST Tax on this $0 Amendment Revised Contract Sum $1,980.00 AMENDMENT - 1 OF 2 Original Time for Completion 12/31/13 (insert date) _ Revised Time for Completion under 12/31/14 prior Amendments (insert date) Add'I Days Required (f) 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: x r By. By: J ' (slg ature) .wa-- (signature) Print Name: it L�r� ��n '� Print Name: Michael Mactutis P.E. Its /1 i-L 4� 4 Its Environmental Engineering Manager (title) Gtitle) DATE: / _ �" DATE: - f 1 /t`-i APPROVED AS TO FORM: (applicable if Mayor's signature required) Kent Law Department A&MCv WtMg-GRNRA PS Amd 2/Morino I AMENDMENT - 2 OF 2 JRK OATH(MABDDtYYVY) CERTIFICATE OF LIABILITY INSURANCE Raol lotl7tzol� THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS 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 SUBROGATIONIS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT TAX MG AJ GALLAGHER & CO INS BRKRS CA(PHS IC PHONE V tue,Ne,EpJ: (866) 467-8730 [Ate,Na): (877) 905-0957 255202 2; (866) 467-8730 F: (877) 905-0457 RDOR'EES; PO BOX 33015 INSURER(S)AFFORDING COVERAGE NAIGY SAN ANTONIO TX 78265 INSURER A: Hartford Casualty Ins Co 29421 INSURED INSURER 8: INSURERC: ARNOLD TOMAC DBA A & M CONSULTING INSURERD: 18119 NE 30TH ST INSURER E: REDMOND WA 98052 INSURERF: _ COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPEOFLNSURANCE ADDL SUER POLtCYNUALRRR POLICI'EPF POLICYEXP LAID AS MAfNDNYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s2, 000,000 CLAIMS-MADE M OCCUR M TO(E Raw nce S300, DDD A X General Liab X 72 SPIN UK5025 11/01/2014 11/01/2015 NED up V( yoae peCsa) $10, 000 PERSONAL Is ADV INJURY S2, 000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s4, 000,000 POLICY PRO-I X I LOD PRODUCTS-COCHRANAGO ;4, 000,000 OTHER: ECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $2 DDD DOD (Ea aocNent) r r ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED' 72 SBM UY5025 11/01/2014 11/01/2015 BODILY INJURY(Pal allsent) g AUTOS AUTOS X HIRED AUTOS N NON-0WNED PROPERTY DAMAGE $ AUTOS (Per aaGtlent} UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ $ -0ED an.uUNS AND EMPLOIERT'NSAJOu PER OTH- ANO fd1l'GO1'ERS'LtADILfTY STATUTE Eft $ ANY PROPRIETORIPARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT OFFICEFUMEMBER EXCLUDED? ❑ NIA $ (Mandatory In NH) E.L.DISEASE-ER Eh1PLOYEE If yes,describe made, E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below A EMP STOP GAP 72 HEM UK5025 11/01/2014 11/01/2015 $1,000,000/1,000,000/1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,AddiHanal Remarks Schedule,maybe attached If more space ie required) Those usual to the Insured's Operations. Certificate Holder is an Additional Insured per the Business Liability Coverage Form SS0008 attached to this policy. I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE The City of Kent DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, Public Works Engineering AUTHORIZED REPRESENTATIVE 222 4TH AVE S 7A'r._- KENT, WA 98032 ©1988.2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ' III II I IMPORTANT NOTICE TO POLICYHOLDERS i To help your insurance keep pace with Increasing costs, we have increased your amount of insurance . . . giving you I r better protection in case of either a partial, or total loss to your property. If you feel the new amount is not the proper one, please contact your agent or broker. r, a 0 uO N O lfl N In N O O m �e 0 o i i I 25 This Spectrum Policy consists of the Declarations, Coverage Forms, Common Policy Conditions and any 50 other Forms and Endorsements issued to be a part of the Policy. This insurance is provided by the stock UK insurance company of The Hartford Insurance Group shown below. SBM INSURER: HARTFORD CASUALTY INSURANCE COMPANY ONE HARTFORD PLAZA, HARTFORD, CT 06155 COMPANY CODE: 3 Policy Number: 52 SBM UK5025 DX THE HARTFORD SPECTRUM POLICY DECLARATIONS ORIGINAL i co Named Insured and Mailing Address: ARNOLD TOMAC DBA A & M � (No., Street, Town, State, Zip Code) CONSULTING o 18119 N.E. 30TH STREET REDMOND WA 98052 M Policy Period: From 11/01/12 To 11/01/13 1 YEAR n 12:01 a.m., Standard time at your mailing address shown above. Exception: 12 noon in New Hampshire. N Name of Agent/Broker: AJ GALLAGHER RSK MGMT SVCS INCIPHS Code: 812490 N N Previous Policy Number: 52 SBM UK5025 0 0 Named Insured is: INDIVIDUAL Audit Period: NON-AUDITABLE Type of Property Coverage: NONE Insurance Provided: In return for the payment of the premium and subject to all of the terms of this policy, we agree with you to provide insurance as stated in this policy. TOTAL ANNUAL PREMIUM IS: $425 MP IN RECOGNITION OF THE MULTIPLE COVERAGES INSURED WITH THE HARTFORD, YOUR POLICY PREMIUM INCLUDES AN ACCOUNT CREDIT. I li e , _ Countersigned by 09/17/12 Authorized Representative Date j Form SS 00 02 12 06 Page 001 (CONTINUED ON NEXT PAGE) - . ,,,. — ,,., 9 t MI 111 i SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 52 SBM UK5025 I BUSINESS LIABILITY LIMITS OF INSURANCE i LIABILITY AND MEDICAL EXPENSES $1, 000,000 MEDICAL EXPENSES -ANYONE PERSON $ 10, 000 PERSONAL AND ADVERTISING INJURY $1, 000, 000 DAMAGES TO PREMISES RENTED TO YOU $ 300, 000 u, ANY ONE PREMISES o AGGREGATE LIMITS PRODUCTS-COMPLETED OPERATIONS $2,000,000 M i GENERAL AGGREGATE $2, 000,000 LO o EMPLOYMENT PRACTICES LIABILITY COVERAGE: FORM SS 09 01 N N EACH CLAIM LIMIT $ 5,000 0 0 m DEDUCTIBLE-EACH CLAIM LIMIT NOT APPLICABLE AGGREGATE LIMIT $ 5,000 RETROACTIVE DATE: 11012005 -= This Employment Practices Liability Coverage contains claims made coverage. Except as may be otherwise provided herein, specified coverages of this insurance are limited generally to liability for injuries for which claims are first made against the insured while the insurance is in force. Please read and review the insurance carefully and discuss the coverage with your Hartford Agent or Broker. The Limits of Insurance stated in this Declarations will be reduced, and may be completely exhausted, by the payment of"defense expense" and, in such event, The Company will not be obligated to pay any further"defense expense" or sums which the insured is or may become legally obligated to pay as "damages". BUSINESS LIABILITY OPTIONAL COVERAGES HIRED/NON-OWNED AUTO LIABILITY $1, 000, 000 FORM: SS 01 70 r....,, cc nn nq a,) na Pnop 003 (CONTINUED ON NEXT PAGE) SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 52 SBM UK5025 i i I ADDITIONAL INSUREDS: THE FOLLOWING ARE ADDITIONAL INSUREDS FOR BUSINESS LIABILITY COVERAGE IN THIS POLICY. i I LOCATION 001 BUILDING 001 TYPE MANAGER LESSOR 0 NAME SEE FORM IS 12 00 0 m a - ci 0 N O N N 0 O ri m I Fnrm cc nn n? 19 nF Pale 005 (CONTINUED ON NEXT PAGE) i SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 52 SBM UK5025 i SUPPLEMENTAL DECLARATIONS: I A service fee of$ 0006.00 is charged for each installment when your premium is paid in installments. The service fee is $ 0006 .00 per withdrawal when you select an electronic fund transfer payment plan. The service fee will be added to the premium amount shown on your premium billing statement. 0 m 0 CN N 0 N N N Ln N 0 0 .-i n it o I Form SS 00 45 12 06 Pmr.P_RJi natP: 09/17/12 Policy Expiration Date: 11/01/13 i I N ' � I r 0 m `-1 0 N O Llt cq N L(1 N 0 O .-I m COMMON POLICY CONDITIONS I r_.._, cc nn nr 41 ne i I COMMON POLICY CONDITIONS All coverages of this policy are subject to the following conditions. I A. Cancellation (5) Failure to: i 1. The first Named Insured shown in the (a) Furnish necessary heat, water, Declarations may cancel this policy by mailing sewer service or electricity for 30 or delivering to us advance written notice of consecutive days or more, except n cancellation. during a period of seasonal unoccupancy; or 2. We may cancel this policy by mailing or delivering to the first Named Insured written (b) Pay property taxes that are owing notice of cancellation at least: and have been outstanding for a. 5 days before the effective date of more than one year following the LO cancellation if any one of the following date due, except that this N conditions exists at any building that is provision will not apply where you Ln Covered Property in this policy: are in a bona fide dispute with the 1 The building has been vacant or taxing authority regarding payment O g of such taxes, ounoccupied 60 or more consecutive b. 10 days before the effective date of o days.This does not apply to: cancellation if we cancel for nonpayment (a) Seasonal unoccupancy; or of premium. (b) Buildings in the course of c. 30 days before the effective date of construction; renovation or cancellation if we cancel for any other addition. reason. Buildings,with 65% or more of the rental 3. We will mail or deliver our notice to the first units or floor area vacant or unoccupied Named Insured's last mailing address known are considered unoccupied under this to us. provision. 4. Notice of cancellation will state the effective (2) After damage by a Covered Cause of date of cancellation. The policy period will end Loss, permanent repairs to the on that date. building: 5. If this policy is canceled, we will send the first (a) Have not started; and Named Insured any premium refund due. (b) Have not been contracted for, Such refund will be pro rata. The cancellation within 30 days of initial payment of will be effective even if we have not made or loss. offered a refund. (3) The building has: 6. If notice is mailed, proof of mailing will be sufficient proof of notice. (a) An outstanding order to vacate; 7. If the first Named Insured cancels this policy, (b) An outstanding demolition order; we will retain -no less than $100 of the or premium. (c) Been declared unsafe by B. Changes governmental authority. This policy contains all the agreements between you (4) Fixed and salvageable items have and us concerning the insurance afforded. The first been or are being removed from the Named Insured shown in the Declarations is building and are not being replaced, authorized to make changes in the terms of this policy This does not apply to such removal with our consent. This policy's terms can be that is necessary or incidental to any amended or waived only by endorsement issued renovation or remodeling. by us and made a part of this policy. C c.,..,. cc nn na no na pane 1 of 3 i COMMON POLICY CONDITIONS c. Yourtenant. L. Premium Audit You may also accept the usual bills of lading or a, We will compute all premiums for this policy in shipping receipts limiting the liability of carriers, accordance with our rules and rates. This will not restrict your insurance. b. The premium amount shown in the K. Transfer Of Your Rights And Duties Under This Declarations is a deposit premium only. At the Policy close of each audit period we will compute the earned premium for that period. Any Your rights and duties under this policy may not be additional premium found to be due as a result transferred without our written consent except in of the audit are due and payable on notice to the case of death of an individual Named Insured. the first Named Insured. If the deposit If you die, your rights and duties will be transferred premium paid for the policy term is greater w to your legal representative but only while acting than the earned premium, we will return the within the scope of duties as your legal excess to the first Named Insured. representative. Until your legal representative is c, The first Named Insured must maintain all appointed, anyone having proper temporary records related to the coverage provided by a custody of your property will have your rights and this policy and necessary to finalize the o duties but only with respect to that property. premium audit, and send us copies of the Ln same upon our request. CN O CC7 N CN N O H Our President and Secretary have signed this policy, Where required by law,the Declarations page has also been countersigned by our duly authorized representative. Terence Shields,Secretary Andr6 A.Napoli,President i I i i i THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. i CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM This endorsement modifies insurance provided under the following: in a BUSINESS LIABILITY COVERAGE FORM o OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM SPECIAL PROPERTY COVERAGE FORM STANDARD PROPERTY COVERAGE FORM UMBRELLA LIABILTY PROVISIONS 0 N A. Disclosure Of Federal Share Of Terrorism 3. The act is a violent act or an act that is N Losses dangerous to human life, property or N The United States Department of the Treasury will infrastructure and is committed by an individual o . reimburse insurers for 85% of that portion of insured or Individuals acting as part of an effort to losses attributable to certified acts of terrorism that coerce the civilian population of the United * exceeds the applicable insurer deductible. States or to influence the policy, or affect the However, if aggregate industry insured losses under conduct of the United States Government by — coercion. the federal Terrorism Risk Insurance Act, as amended ("TRIA") exceed $1D0 billion in a Program If aggregate industry insured losses attributable to Year (January 1 through December 31), the "certified acts of terrorism" under TRIA exceed $100 Treasury shall not make any payment for any billion in a Program Year (January 1 through portion of the amount of such losses that exceeds December 31), and we have met, or will meet, our $100 billion. The United States government has not insurer deductible under TRIA,we shall not be liable _= charged any premium for their participation in for the payment of any portion of the amount of such covering terrorism losses, losses that exceed $100 billion. In such case, your B. coverage for terrorism losses may be reduced on a . Cap On Insurer Liability for Terrorism Losses pro-rata basis in accordance with procedures A "certified act of terrorism" means an act that is established by the Treasury, based on its estimates certified by the Secretary of the Treasury, in of aggregate industry losses and our estimate that concurrence with the Secretary of State and the we will exceed our insurer deductible. In Attorney General of the United States to be an act accordance with the Treasury's procedures, of terrorism under TRIA. The criteria contained in amounts paid for losses may be subject to further TRIA for a "certified act of terrorism" Include the adjustments based on differences between actual following: losses and estimates. 1. The act results in insured losses in excess of$5 C. Application Of Exclusions million in the aggregate, attributable to all types The terms and limitations of any terrorism exclusion, of insurance subject to TRIA; and the inapplicability or omission of a terrorism 2. The act results in damage within the United exclusion, or the inclusion of terrorism coverage, do States, or outside the United States in the case not serve to create coverage for any loss which of certain air carriers or vessels or the premises would otherwise be excluded under this Coverage of an United States mission; and Form or Policy, such as losses excluded by the Nuclear Hazard Exclusion or the War And Military Action Exclusion. I Form SS 50 19 03 12 Page 1 of 1 Gi W10 Th. Warifnrrr POLICY NUMBER: 52 SBM UK5025 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. I ADDITIONAL INSURED - MANAGER/LESSOR i i I, THE CITY OF KENT n PUBLIC WORKS ENGINEERING 222 FOURTH AVE. SO. KENT WA 98032 Ln LO a 0 N 0 to N N O O m k Form IH 12 00 11 85 T SEQ.NO. 002 Printed in U.S.A. Page 001 Process Date: 09/17/12 Expiration Date: 11/01/13 II I I i I THE j HARTFORD Named Insured: ARNOLD TOMAC DBA A & M Policy Number: 52 SBM UK5025 Effective Date: 11/01/12 Expiration Date: 11/01/13 h Company Name: AJ GALLAGHER RSK MGMT SVCS INC/PHS h 0 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 0 TRADE OR ECONOMIC SANCTIONS ENDORSEMENT LO N o This insurance does not apply to the extent that trade or economic sanctions or other laws or regulations x prohibit us from providing insurance, including, but not limited to,the payment of claims. All other terms and conditions remain unchanged. Form IH 99 4104 09 Page 1 of 1 POLICY NUMBER: 52 SBM UK5025 j THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK INSURANCE ACT. DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT 0 m SCHEDULE 0 v� cv 0 Terrorism Premium(Certified Acts): o $ $5.00 0 .-i A. Disclosure Of Premium C. Cap On Insurer Liability for Terrorism Losses In accordance with the federal Terrorism Risk If aggregate industry insured losses attributable to Insurance Act, as amended ("TRIA"), we are "certified acts of terrorism" under TRIA exceed $100 required to provide you with a notice disclosing the billion in a Program Year (January 1 through portion of your premium, if any, attributable to December 31) and we have met, or will meet, our coverage for certified acts of terrorism under TRIA. insurer deductible under TRIA, we shall not be liable The portion of your premium attributable to such for the payment of any portion of the amount of such coverage is shown in the Schedule of this losses that exceed $100 billion. In such case, your endorsement. coverage for terrorism losses may be reduced on a ts. Disclosure Of Federal Share Of Terrorism pro-rota basis in accordance with procedures Losses established by the Treasury, based on its estimates of aggregate industry losses and our estimate that The United States Department of the Treasury will we will exceed our insurer deductible. In accordance reimburse insurers for 85% of that portion of insured with the Treasury's procedures, amounts paid for losses attributable to "certified acts of terrorism" losses may be subject to further adjustments based under TRIA that exceeds the applicable insurer on differences between actual losses and estimates. deductible. D. All other terms and conditions remain the same. However, if aggregate industry insured losses under TRIA exceed $100 billion in a Program Year (January 1 through December 31), the Treasury shall not make any payment for any portion of the amount of such losses that exceeds $100 billion. The United States government has not charged any premium for their participation in covering terrorism losses. Form SS 83 76 03 12 Page 1 of 1 n ondo TLn Llnr+fnM i Policy Number: 52 SBM UK5025 I I IMPORTANT NOTICE TO POLICYHOLDERS DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT 0 SCHEDULE M -1 O U7 o Terrorism Premium (Certified Acts): m $ $5.00 LO N O O ri m �e A. Disclosure Of Premium C. Cap On Insurer Liability for Terrorism Losses In accordance with the federal Terrorism Risk If aggregate industry insured losses attributable to Insurance Act, as amended ("TRIA"), we are "certified acts of terrorism" under TRIA exceed $100 required to provide you with a notice disclosing the billion in a Program Year (January 1 through portion of your premium, if any, attributable to December 31) and we have met, or will meet, our coverage for certified acts of terrorism under TRIA. insurer deductible under TRIA, we shall not be liable The portion of your premium attributable to such for the payment of any portion of the amount of such coverage is shown in the Schedule of this losses that exceed $100 billion. In such case, your endorsement. coverage for terrorism losses may be reduced on a B. Disclosure Of Federal Share Of Terrorism pro-rota basis in accordance with procedures — established by the Treasury, based on its estimates Losses of aggregate industry losses and our estimate that The United States Department of the Treasury will we will exceed our insurer deductible. In accordance reimburse insurers for 85% of that portion of insured with the Treasury's procedures, amounts paid for losses attributable to "certified acts of terrorism" losses may be subject to further adjustments based under TRIA that exceeds the applicable insurer on differences between actual losses and estimates. deductible. D. All other terms and conditions remain the same. However, if aggregate industry insured losses under TRIA exceed $100 billion in a Program Year (January 1 through December 31), the Treasury shall not make any payment for any portion of the amount of such losses that exceeds $100 billion. The United States government has not charged any premium for their participation in covering terrorism losses. Form SS 83 80 03 12 Page 1 of 1 © 2012,The Hartford nn..h,riec nnrnrrinhtorl mnfnrinl nfthp Ineurnnna cLpniiraa nffine Inn with ifs nermission.)