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HomeMy WebLinkAboutPW14-237 - Amendment - #1 - Hayre McElroy & Associates, LLC - Riverview Park - 12/12/2014 r { Recordsanagen� en KENT Document W ASHINGTGN , ,. tv f r 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: Hayre McElroy & Associates LLC Vendor Number: JD Edwards Number Contract Number: 19 j "Z11 This is assigned by City Clerk's Office Project Name: Riverview PArk Description: ❑ Interlocal Agreement ❑ Change Order ® Amendment ❑ Contract ❑ Other: Contract Effective Date: 12/12/14 Termination Date: 12/31/15 Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Chris Wadsworth 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 because construction activities may — ------- continue beyond the completion date. --- -- — —- As of: 08/27/14 � t�ENT AMENDMENT NO. 1 NAME OF CONSULTANT OR VENDOR: Hayre McElroy & Associates, LLC CONTRACT NAME & PROJECT NUMBER: Riverview Park ORIGINAL AGREEMENT DATE: September 9, 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 construction activities may continue beyond the completion date. 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, $5,150.00 including applicable WSST Net Change by Previous Amendments $0 including applicable WSST Current Contract Amount $5,150.00 including all previous amendments Current Amendment Sum $0 Applicable WSST Tax on this $0 Amendment Revised Contract Sum $5,150.00 i AMENDMENT - 1 OF 2 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: g By: ' 1" . Y� (sign lure) Print Name: � tht Y Print Name: Timothy 3. LaPorte, P.E. Its rtt pfi Its Public Works Director (titre) titi DATE:�> I� #�; DATE: s APPROVED AS TO FORM: (applicable if Mayor's signature required) Kent Law Department Hayre McEvoy-FiveMew 2 Amd I/WadswuRh AMENDMENT - 2 OF 2 OP ID:DS CERTIFICATE OF LIABILITY INSURANCE DAT 081011 Y Y) oatolrla 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 "SLOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED !RESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. UwAORTANT: 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 Phone: 206.62UINSURERC:U.S. CT Sprague Israel Giles : 1501 Fourth Avenue,Suite 730 Fax:206-68PHONE o ExD: A/C No): Seattle WA98101-3225 John M.Policar SS: __CER HAYRE-1MER ID# INSURER(S)AFFORDING COVERAGE NAIC# 2757ER A:Oh10 SoI i rify Ine, CO, 24082 Red ond, Ave. 05 ERB:American Fire&Casualty Co 24066 Redmond,WA 98052Rc:U.S.Specialty Insurance Co. INSURER D: INSURERS: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE DR POLICY EFF POLICY E%P POLICY NUMBER MMIDDIYYYY MMIDO/YY9Y LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,00 A X COMMERCIAL GENERAL LIABILITY X BZS56170651 06/27/14 06127115 PREMISES Eaoccurreree $ 2,000,00 CLAIMS-MADE XI OCCUR MED EXP Any one person) $ 15,000 PERSONAL&AOV INJURY $ Included _ GENERAL AGGREGATE $ 4,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO $ 4,000,00 POUCY X PEO7 LOC $ I- -ITOMOBILE LIABILITY X COMBINED SINGLE LIMIT (Ea awldent) $ 1,000,00 _ B .( ANY AUTO BAA56176651 06127114 06/27/15 ALL OWNEDRUTOS BODILY INJURY(Per person) $ X BODILY INJURY(Peraxident) $ SCHEDULEDAUTOS X HIREDAUTOS PROPERTYAGE (Per eocldent) $ tlent) I NON-OWNEDAUTOS $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ EPROPRIETORIPARrNERIEXECUTIVE UCTIBLE $ ',. ENTION $ $ WORKERS COMPENSATION EMPLOYERS'LIABILITY T RY LA ITS X OSH- RIETOR/PARTNER/EXECUTIVE YIN BZS56170651 06/27/14 06/27/15 E.L.EACH ACCIDENT $ 2,000,00 OFFICEry in NH)EXCLUDED4 N/AWA STOP GAP E.L.DISEASE-EA EMPLOYE $ 2,000,00cribe underTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 2,000,00 ional USS1425020 06127114 06/27/15 Ea.Claim 2,000,0Q$35,000 DED EACH CLAIM Aggregate 2,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attecll ACORD 10t,Additional Remarks Ssheduie,If more space is requiretll RE: Geotech engineering study for existing drainage issues at Riverview Park City of Kent is included as Additional Insured with regards to general liability and auto liability as required by written contract or agreement. General liability is primary and non contributory. 30 days notice of cancellation CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Kent ACCORDANCE WITH THE POLICY PROVISIONS. 220 Fourth Avenue Kent,WA 98032 AUTHORIZED REPRESENTATIVE John M.Policar i ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD Coverage Is Provided In: Policy Number: Liberty Ohio Security Insurance Company BZS (15) 5617 06 51 Mutual, Policy Period: INSURANCE From 0 612 7/2 01 4 To 06/27/2015 Policy Change Endorsement Endorsement Period: From 06/27/2014 to 06/27/2015. 12:01 am Standard Time at Insured Mailing Location Named Insured Agent HAYRE MCELROY &ASSOCIATES (206) 623-7035 SPRAGUE, ISRAEL, GILES, INC. #1 SUMMARY OF LOCATION(S) AND PREMIUM(S) 0001 2755-57 152nd Ave NE 57, Redmond, WA 98052-5555 $1,081.00 POLICY FORMS AND ENDORSEMENTS This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE BP 00 03 07 13 Businessowners Coverage Form BP Ol 06 07 13 Washington Changes BP 04 73 Ol 06 Washington Changes -Domestic Abuse *BP 04 97 Ol 06 Waiver Of Transfer Of Rights Of Recovery Against Others To Us BP 05 18 Ol 08 Washington -Amendment of Terrorism Exclusions BP 05 23 Ol 08 Cap On Losses From Certified Acts Of Terrorism BP 05 65 01 07 Conditional Exclusion of Terrorism Involving Nuclear, Biological or Chemical Terrorism (Relating to Disposition of Federal Terrorism Risk Insurance Act) BP 06 69 Ol 06 Washington Fungi Or Bacteria Exclusion (Liability) BP 06 74 07 13 Washington Stop Gap -Employer's Liability Coverage *BP 14 88 07 13 Primary And Noncontributory - Other Insurance Condition BP 79 74 07 13 Amendment of Pollution Exclusion (Premises) BP 79 82 Oi 07 Employee Benefits Liability Coverage Endorsement BP 79 96 07 13 Businessowners Liability Extension Endorsement BP 80 32 Ol 07 Consulting Errors and Omissions Exclusion 13P 80 44 01 07 Inspection and Appraisal Services Exclusion BP 81 15 03 11 Exclusion-Asbestos BP 82 37 01 07 Equipment Breakdown Enhancement Endorsement BP 82 46 06 09 Employment -Related Practices Liability Coverage BP 82 89 Ol 07 Washington Exclusion -Asbestos BP 88 04 03 12 Exclusion -Professional Services BP 88 16 06 09 Business Income Changes - 24 Hour Time Period BP 88 27 02 11 Limited Cyber Liability -Amendment of Personal and Advertising Injury BP 88 77 07 13 Identity Theft Administrative Services and Expense Coverage BP 88 84 07 13 Washington -Businessowners Property Extension Endorsement Servicing Office Western Washington and Issue Date Authorized Representative To report a claim, call your Agent or 1-800-362-0000 DS 70 27 01 08 56170651 N6112864 235 INSURED COPY 002819 PAGE 2 OF 8 BVSNB5S&WNGRS BP799$ o713 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ |TCAREFULLY. BUSINESSOWNERS LIABILITY EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: DUS|NE80OVVNER3 COVERAGE FORM SUBJECT PAGE AGGREGATE LIMITS OF INSURANCE 3 AMENDMENT 0F INSURED CONTRACT DEFINITION 4 BLANKET ADDITIONAL INSURED (OVVNERD. CONTRACTORS ORLESSORS) 7 BODILY INJURY 4 BROADENED COVERAGE FOR DAMAGE T0 PREMISES RENTED T0YOU 2 DUTIES |N THE EVENT OF OCCURRENCE,OFFENSE,CLAIM ORSUIT 4 INCIDENTAL MEDICAL MALPRACTICE 2 ' r� MOBILE EQUIPMENT 2 NEWLY FORMED 0R ACQUIRED ORGANIZATIONS 3 PERSONAL AND ADVERTISING INJURY 4 SUPPLEMENTARY PAYMENTS 2 Bail Bonds Loss Of Earnings 020131-i Mutual AU rights reserved, Section II -Liability is amended as follows: I. SUPPLEMENTARY PAYMENTS Paragraph f.(1)(b) of A Coverages is replaced by the following; (b) Up to $3000 for cost of bail bond required because of accidents or traffic law violations arising out of the use of any vehicle to which Business Liability Coverage for "bodily injury" applies. We do not have to furnish the bonds. Paragraph 1.f.(1)(d) of A Coverages is replaced by the following; (d) All reasonable expenses incurred by the insured at our request to assist us in the Investigation or — defense of the claim or "suit", including actual loss of earnings up to $500 a day because of time off from work. 11. BROADENED COVERAGE FOR DAMAGE TO PREMISES RENTED TO YOU With respect to the coverage provided under this endorsement, Section 11 -Liability is amended as follows: 1. The final paragraph of B.I. Exclusions - Applicable To Business Liability Coverage is deleted and replaced by the fallowing: With respect to the premises which are rented to you or temporarily occupied by you with the permis- sion of the owner, Exclusions c., d., e., g., h., k., I., m., n. and o.do not apply to "property damage". 2. Paragraph D.2. Liability And Medical Expenses Limits Of Insurance is deleted and replaced by the following: The most we will pay under this endorsement for the sum of all damages because of all "property damage" to premises while rented to you or temporarily occupied by you with the permission of the owner is the Limit of Insurance shown in the Declaration. 3. Paragraph D.3. Liability And Medical Expenses Limits Of Insurance is deleted. Ill. INCIDENTAL MEDICAL MALPRACTICE Exclusion 1.j.(4) does not apply to Incidental Medical Malpractice Injury coverage. The following is added to F. LIABILITY AND MEDICAL EXPENSES DEFINITIONS: 23. "Incidental Medical Malpractice Injury" means bodily injury arising out of the rendering of or failure to render, during the policy period, the following services: a, medical, surgical, dental, x-ray or nursing service or treatment or the furnishing of food or bev- erages in connection therewith; or b. the furnishing or dispensing of drugs or medical, dental or surgical supplies or appliances. This coverage does not apply to: 1, expenses incurred by the insured for first- aid to others at the time of an accident and the Duties in the Event of Occurrence, Claim or Suit Condition is amended accordingly; 2. any insured engaged in the business or occupation of providing any of the services described under a. and le. above; 3. injury caused by any indemnitee if such indemnitee is engaged in the business or occupation of providing any of the services described under a. and b. above. IV. MOBILE EQUIPMENT 1. Section C. Who is An Insured is amended to include any person driving "mobile equipment" with your permission. V. BLANKET ADDITIONAL INSURED (OWNERS, CONTRACTORS OR LESSORS) 1. Section C. Who Is An Insured is amended to include as an insured any person or organization whom you are required to name as an additional insured on this policy under a written contract or written agreement. The written contract or agreement must be: a. currently in effect or becoming effective during the term of this policy; and b. executed prior to the "bodily injury", "property damage", "personal and advertising injury". © 2013 Liberty Mutual Insurance.All rights reserved. BP 79 96 07 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 2 of 4 2. The insurance provided the additional insured is limited as follows: a. The person or organization is only an additional insured with respect to liability arising out of (1) Real property, as described in a written contract or written agreement, you own, rent, lease, maintain or occupy; (2) Caused in whole or In part by your ongoing operations performed for that insured. b. The limits of insurance applicable to the additional insured are those specified In the written contract or written agreement or the limits available under this policy, as stated in the Declara- tions, whichever are less. These limits are inclusive of and not in addition to the limits of insurance available under this policy. c. The insurance provided the additional insured does not apply to: (1) Liability arising out of the sole negligence of the additional insured; (2) 'Bodily injury", "property damage", "personal and advertising injury"; or defense coverage under the Supplementary Payments section of the policy arising out of an architect's, en- gineer's or surveyor's rendering of or failure to render any professional services including: (a) The preparing, approving maps, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; and (b) Supervisory, inspection, architectural or engineering activities. (3) Any "occurrence" that takes place after you cease to be a tenant in the premises described in the Declarations; or (4) Structural alterations, new construction or demolition operations performed by or for the person or organization designated in the Declarations. 3. Any coverage provided hereunder shall be excess over any other valid and collectible insurance avail- able to the additional insured whether primary, excess, contingent or on any other basis unless a contract specifically requires that this insurance be primary or you request that it apply on a primary basis. VI. NEWLY FORMED OR ACQUIRED ORGANIZATIONS The following is added to C.Who Is An Insured: 3. Any business entity acquired by you or incorporated or organized by you under the laws of any individual state of the United States of America over which you maintain majority ownership interest exceeding fifty percent. Such acquired or newly formed organization will qualify as a Named Insured if there is no similar insurance available to that entity. However, a. Coverage under this provision is afforded only until the 180th day after the entity was acquired or incorporated or organized by you or the end of the policy period, whichever is earlier; b. Coverages A. Paragraph 1. Business Liability, does not apply to: (1) 'Bodily injury" or "property damage" that occurred before the entity was acquired or incor- porated or organized by you; and (2) "Personal and advertising injury" arising out of an offense committed before the entity was acquired or incorporated or organized by you; and C. Records and descriptions of operations must be maintained by the first Named Insured. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. VII. AGGREGATE LIMITS The following is added to Aggregate Limits Paragraph 4. of D. Liability and Medical Expenses Limits of Insurance: The Aggregate Limits apply separately to each of"locations" owned by or rented to you or temporarily occupied by you with the permission of the owner. The Aggregate Limits also apply separately to each of your projects away from premises owned by or rented to you. For the purpose of this endorsement only, "location" means premises involving the same or connect- ing lots, or premises whose connection is interrupted only by a street, roadway, waterway or right- of-way of a railroad. O 2013Liberty Mutual Insurance.All rights reserved. ) BP 79 96 07 13 Includes copyrighted material of Insurance Services Office,Inc.,with Its permission. Page 3 of 4 Vill. DUTIES IN THE EVENT OF OCCURRENCE, OFFENSE,CLAIM OR SUIT 1. The requirement in E. Liability And Medical Expenses General Conditions paragraph 2.a. that you must see to it that we are notified of an "occurrence" or offense which may result in a claim applies only when the "occurrence" is known to any insured listed in Paragraph C.I. Who Is An Insured or any "employee" authorized by you to give or receive notice of an"occurrence" or claim. 2. The requirements in E. Liability And Medical Expenses General Conditions paragraph 2.b. that you must see to it that we receive notice of a claim or "suit" will not be considered breached unless the breach occurs after such claim or "suit" is known to any insured listed under Paragraph CA. Who Is An Insured or any "employee" authorized by you to give or receive notice of an "occurrence" or claim. IX. BODILY INJURY Paragraph 3. of F. Liability And Medical Expenses Definitions is replaced by the following: 3. "Bodily Injury" means: a. Bodily injury, sickness, disease, or incidental medical malpractice injury sustained by a person, and includes mental anguish resulting from any of these; and including death resulting from any of these at any time. X. AMENDMENT OF INSURED CONTRACT DEFINITION Paragraph 9. of F. Liability And Medical Expenses Definitions is replaced by the following: 9. "Insured contract" means: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; b. A sidetrack agreement; c. Any easement or license agreement, except in connection with construction or demolition oper- ations on or within 50 feet of a railroad; d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to your business (including an indem- nification 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" or "property damage" to a third person or organization, provided the "bodily injury" or "property damage" is caused, in whole or in part, by you or by those acting on your behalf. However, such part of a contract or agreement shall only be considered an "insured contract" to the extent your assumption of the tort liability is permitted by law. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies a railroad for "bodily injury" or "property damage" arising out of construc- tion or demolition operations, within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, road-beds, tunnel, underpass or crossing, (2) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; or (3) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in (2) above and supervisory, inspection, architectural or engineering activities. XI. PERSONAL AND ADVERTISING INJURY Paragraph 14. b. of F.Liability And Medical Expenses Definitions is replaced by the following: b. Malicious prosecution or abuse of process. © 2013 Liberty Mutual Insurance.All rights reserved. BP 79 96 07 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 4 of 4 BUSINESSOWNERS BP 14 88 07 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM The following is added to Paragraph H. Other In- 2. You have agreed in writing in a contract surance of Section III - Common Policy Condi- or agreement that this insurance would tions and supersedes any provision to the con- be primary and would not seek contribu- trary: tion from any other insurance available Primary And Noncontributory Insurance to the additional insured. This insurance is primary to and will not seek contribution from any other insurance avail- able to an additional insured under your poli- cy provided that: 1. The additional insured Is a Named In- sured under such other insurance; and i I I BP 14 88 07 13 o Insurance Services Office, Inc., 2012 Page 1 of 1 Coverage Is Provided In: Policy Number. _ Lib Ohio Security Insurance Company BAS (15) 55960933 Mutual. Policy Period: INSURANCE From 03/01/2014 To 03/01/2015 Common Policy Declarations 12:01 am Standard Time at Insured Mailing Location Named Insured Agent HAYRE MCELROY AND ASSOCIATES, LLC (206) 623-7035 SPRAGUE, ISRAEL, GILES, INC. 41 POLICY FORMS AND ENDORSEMENTS This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CA 00 01 03 06 Business Auto Coverage Form CA Ol 35 Ol 08 Washington Changes CA 21 34 01 08 Washington Underinsued Motorists Coverage CA 23 93 01 06 Washington Exclusion of Terrorism Involving Nuclear, Biological or Chemical Terrorism CA 85 47 12 93 Temporary Substitute Auto -Physical Damage Insurance CA 85 53 12 93 Recreational Trailers and Boat Trailers CA 88 10 01 10 Business Auto Coverage Enhancement Endorsement CA 99 03 03 06 Auto Medical Payments Coverage IL Ol 46 08 10 Washington Common Policy Conditions IL 01 98 09 08 Nuclear Energy Liability Exclusion Endorsement (Broad Form) In witness whereof, we have caused this policy to be signed by our authorized officers. DvA 9. kjj Dexter Legg Paul Condrin Secretary President To report a claim, call your Agent or 1-800-362-0000 DS 70 21 01 08 02/17/14 55960933 N0112864 235 NCXFPPNO INSURED COPY 0004% PAGE 10 OF 54 COMMERCIAL AUTO C8O810D1 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ |TCAREFULLY. / BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: ` BUSINESS AUTO COVERAGE FORM With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. COVGRAGG |NVEX SUBJECT PROVISION NUMBER ADDITIONAL INSURED RY CONTRACT, AGREEMENT ORPERMIT 0 ACCIDENTAL AIRBAG DEPLOYMENT 12 AMENDED DUTIES |N THE EVENT 0F ACCIDENT, CLAIM, SUIT 0RLOSS 18 AMENDED FELLOW EMPLOYEE EXCLUSION 5 /\UD|D. VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE 10 BROAD FORM INSURED i BODILY INJURY REDEFINED 21 EMPLOYEES A8 INSUREDS (including employee hired auto) 2 EXTENDED CANCELLATION CONDITION 22 EXTRA EXPENSE^BROADENED COVERAGE 10 GLASS REPAIR-WAIVER 0FDEDUCTIBLE 15 H|RFDAUTO PHY8|SALDAM/\GE(indudinO employee hired auto) 0 HIRED AUTO COVERAGE TERRITORY 20 14 LOAN / LEASE GAP � PARKED AUTO COLLISION COVERAGE(WAIVER DFDEDUCTIBLE) 10 PERGONALEFFECTOCVVERAGE 11 PHYSICAL DAMAGE -ADDITIONAL TRANSPORTATION EXPENSE COVERAGE D RENTAL REIMBURSEMENT 9 SUPPLEMENTARY PAYMENTS 4 TOWING AND LABOR 7 UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS 17 WAIVER OF TRANSFER OF RIGHTS OFREC0VERYAGA|N8T OTHERS TOUG 19 SECTION || ~LIABILITY COVERAGE in amended asfollows: 1. BROAD FORM INSURED SECTION 11 - LIABILITY COVERAGE, paragraph A.1. -WHO IS AN INSURED is amended to include the following noaninsured: d. Any legally incorporated entity vf which you own more than 5O percent uf the voting stock during the policy period. However, "insured" does not include any organization that: (1) |sa partnership nr joint venture; nr (2) |oan insured under any other automobile policy; or (3) Has exhausted its Limit of Insurance under any other automobile policy. Paragraph d. (2) of this provision does not apply to a policy written to apply specifically in excess of this policy. o. Any organization you newly acquire or form, other than a partnership or joint venture, of which you own more than 50 percent of the voting stock. This automatic coverage is afforded only for 18O days from the date of acquisition orformation. However, coverage under this provision does not apply: / (1) If there is similar insurance or a self-insured retention plan available to that organization; @2010 Liberty Mutual Insurance Company.All rights reserved. CA 88100110 Includes copyrighted material of Insurance ServicesOffice Inc.,with its Permission. Page Inf7 (2) If the Limits of Insurance of any other insurance policy have been exhausted; or (3) To "bodily injury" or "property damage" that occurred before you acquired or formed the organization. 2. EMPLOYEES AS INSUREDS SECTION II - LIABILITY COVERAGE, paragraph A.I. -WHO IS AN INSURED is amended to include the following as an insured: f. Any "employee" of yours while using a covered "auto" you do not own, hire or borrow but only for acts within the scope of their employment by you. Insurance provided by this endorse- ment is excess over any other insurance available to any "employee". g. An "employee" of yours while operating an "auto" hired or borrowed under a written contract or agreement in that "employee's" name, with your permission, while performing duties re- lated to the conduct of your business and within the scope of their employment. Insurance provided by this endorsement is excess over any other insurance available to the "employee". 3. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT SECTION 11 - LIABILITY COVERAGE, paragraph A.I. -WHO IS AN INSURED is amended to include the following as an insured: h. Any person or organization with respect to the operation, maintenance or use of a covered "auto", provided that you and such person or organization have agreed in a written contract, agreement, or permit issued to you by governmental or public authority, to add such person, or organization, or governmental or public authority to this policy as an "insured". However, such person or organization is an "insured": (1) Only with respect to the operation, maintenance or use of a covered "auto"; (2) Only for "bodily injury" or "property damage" caused by an "accident" which takes place after you executed the written contract or agreement, or the permit has been issued to you; and (3) Only for the duration of that contract, agreement or permit 4. SUPPLEMENTARY PAYMENTS SECTION 11 - LIABILITY COVERAGE, Coverage Extensions, 2.a. Supplementary Payments, para- graphs (2) and (4) are replaced by the following: (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic violations ) required because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the insured at our request, including actual loss of earn- ings up to $500 a day because of time off from work. 5. AMENDED FELLOW EMPLOYEE EXCLUSION In those jurisdictions where, by law, fellow employees are not entitled to the protection afforded to the employer by the workers compensation exclusivity rule, or similar protection, the following provision is added: SECTION II - LIABILITY, exclusion B.5. FELLOW EMPLOYEE does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire. SECTION III -PHYSICAL DAMAGE COVERAGE is amended as follows: 6. HIRED AUTO PHYSICAL DAMAGE Paragraph AA. Coverage Extensions of SECTION III - PHYSICAL DAMAGE COVERAGE,is amended by adding the following: If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of Loss or Collision coverage are provided under the Business Auto Coverage Form for any "auto" you own, then the Physical Damage coverages provided are extended to "autos": a. You hire, rent or borrow; or @2010Liberty Mutual Insurance Company.All rights reserved. CA 88 10 01 10 Includes copyrighted material of Insurance Services Office Inc.,with its Permission. Page 2 of 7 Is. Your "employee" hires or rents under a written contract or agreement in that "employee's" name, but only if the damage occurs while the vehicle is being used in the conduct of your business, subject to the following limit and deductible: A. The most we will pay for "loss" in any one "accident" or "loss" is the smallest of: (1) $50,000; or (2) The actual cash value of the damaged or stolen property as of the time of the "loss"; or (3) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality, minus a deductible. B. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. C. Subject to the limit, deductible and excess provisions described in this provision, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own. D. Subject to a maximum of $750 per "accident", we will also cover the actual loss of use of the hired "auto" if it results from an "accident', you are legally liable and the lessor incurs an actual financial loss. E. This coverage extension does not apply to: (1) Any "auto" that is hired, rented or borrowed with a driver; or (2) Any "auto" that is hired, rented or borrowed from your "employee". For the purposes of this provision, SECTION V-DEFINITIONS is amended by adding the following: "Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash value. 7. TOWING AND LABOR SECTION III - PHYSICAL DAMAGE COVERAGE,paragraph A.2. Towing, is amended by the addition of the following: We will pay towing and labor costs incurred, up to the limits shown below, each time a covered "auto" classified and rated as a private passenger type, "light truck" or "medium truck" is dis- abled: a. For private passenger type vehicles, we will pay up to $50 per disablement. b. For "light trucks", we will pay up to $50 per disablement. "Light trucks" are trucks that have a gross vehicle weight (GVW) of 10,000 pounds or less. C. For "medium trucks" ,we will pay up to $150 per disablement. "Medium trucks" are trucks that have a gross vehicle weight (GVW) of 10,001 -20,000 pounds. However, the labor must be performed at the place of disablement. 8. PHYSICAL DAMAGE- ADDITIONAL TRANSPORTATION EXPENSE COVERAGE Paragraph AA.a., Coverage Extension of SECTION III - PHYSICAL DAMAGE COVERAGE, is amend- ed to provide a limit of$50 per day and a maximum limit of $1,500 I i m2010 Liberty Mutual Insurance Company.All rights reserved. ' CA 88 10 01 10 Includes copyrighted material of Insurance Services Office Inc.,with its Permission. Page 3 of 7 9. RENTAL REIMBURSEMENT SECTION III -PHYSICAL DAMAGE COVERAGE,A. COVERAGE,is amended by adding the following: a. We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of an "auto' because of "accident' or 'loss", to an "auto' for which we also pay a 'loss" under Comprehensive, Specified Causes of Loss or Collision Coverages. We will pay only for those expenses incurred after the first 24 hours following the "accident' or 'loss" to the covered "auto." b. Rental Reimbursement will be based on the rental of a comparable vehicle, which in many cases may be substantially less than $75 per day, and will only be allowed for the period of time it should take to repair or replace the vehicle with reasonable speed and similar quality, up to a maximum of 30 days. c. We will also pay up to $500 for reasonable and necessary expenses incurred by you to remove and replace your tools and equipment from the covered "auto". d. This coverage does not apply unless you have a business necessity that other "autos" avail- able for your use and operation cannot fill. e. If 'loss" results from the total theft of a covered "auto' of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided under Paragraph 4. Coverage Extension. f. No deductible applies to this coverage. For the purposes of this endorsement provision, materials and equipment do not include "personal effects" as defined in provision 11. 10. EXTRA EXPENSE-BROADENED COVERAGE Under SECTION III -PHYSICAL DAMAGE COVERAGE,A. COVERAGE,we will pay for the expense of returning a stolen covered "auto' to you. The maximum amount we will pay is $1,000. 11. PERSONAL EFFECTS COVERAGE A. SECTION III - PHYSICAL DAMAGE COVERAGE, A. COVERAGE, is amended by adding the following:If you have purchased Comprehensive Coverage on this policy for an "auto' you own and that "auto" is stolen, we will pay, without application of a deductible, up to $600 for "personal effects" stolen with the "auto." The insurance provided under this provision is excess over any other collectible insurance. B. SECTION V-DEFINITIONS is amended by adding the following: For the purposes of this provision, "personal effects" mean tangible property that is worn or carried by an insured." 'Personal effects" does not include tools, equipment, jewelry, money or securities. 12. ACCIDENTAL AIRBAG DEPLOYMENT SECTION III - PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS is amended by adding the follow- ing: If you have purchased Comprehensive or Collision Coverage under this policy, the exclusion for "loss" relating to mechanical breakdown does not apply to the accidental discharge of an airbag. Any insurance we provide shall be excess over any other collectible insurance or reimbursement by manufacturer's warranty. However, we agree to pay any deductible applicable to the other cov- erage or warranty. 13. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE SECTION III - PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS, exception paragraph a. to exclu- sions 4.c. and 4.d. is deleted and replaced with the following: @2010Liberty Mutual Insurance Company.All rights reserved. CA 88 10 01 10 Includes copyrighted material of Insurance Services Office Inc.,with its Permission. Page 4 of 7 Exclusion 4.c. and 4.d. do not apply to: a. Electronic equipment that receives or transmits audio, visual or data signals, whether or not designed solely for the reproduction of sound, if the equipment is permanently installed in the covered "auto" at the time of the "loss" and such equipment is designed to be solely operated by use of the power from the "auto's" electrical system, in or upon the covered "auto" and physical damage coverages are provided for the covered "auto"; or If the 'loss" occurs solely to audio, visual or data electronic equipment or accessories used with this equipment, then our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by a$100 deductible. 14. LOAN /LEASE GAP COVERAGE A. Paragraph C., LIMIT OF INSURANCE of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by adding the following: The most we will pay for a "total loss" to a covered "auto" owned by or leased to you in any one "accident' is the greater of the: 1. Balance due under the terms of the loan or lease to which the damaged covered "auto" is subject at the time of the 'loss" less the amount of: a. Overdue payments and financial penalties associated with those payments as of the date of the 'loss", b. Financial penalties imposed under a lease due to high mileage, excessive use or ab- normal wear and tear, c. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease, d. Transfer or rollover balances from previous loans or leases, e. Final payment due under a"Balloon Loan", f. The dollar amount of any unrepaired damage which occurred prior to the 'total loss" of a covered "auto"', g. Security deposits not refunded by a lessor, In. All refunds payable or paid to you as a result of the early termination of a lease agreement or as a result of the early termination of any warranty or extended service agreement on a covered "auto", I. Any amount representing taxes, j. Loan or lease termination fees; or 2. The actual cash value of the damage or stolen property as of the time of the 'loss". An adjustment for depreciation and physical condition will be made in determining the actual cash value at the time of the 'loss". This adjustment is not applicable in Texas. B. ADDITIONAL CONDITIONS This coverage applies only to the original loan for which the covered "auto" that incurred the loss serves as collateral, or lease written on the covered "auto" that incurred the loss. C. SECTION V-DEFINTIONS is changed by adding the following: As used in this endorsement provision, the following definitions apply: "Total loss" means a 'loss" in which the cost of repairs plus the salvage value exceeds the actual cash value. A "balloon loan" is one with periodic payments that are insufficient to repay the balance over the term of the loan, thereby requiring a large final payment. i I ®2010Liberty Mutual Insurance Company.All rights reserved. CA 88 10 01 10 Includes copyrighted material of Insurance Services Office Inc.,with its Permission. Page 5 of 7 15. GLASS REPAIR-WAIVER OF DEDUCTIBLE Paragraph D. Deductible of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: No deductible applies to glass damage if the glass is repaired rather than replaced. 16. PARKED AUTO COLLISION COVERAGE(WAIVER OF DEDUCTIBLE) Paragraph D. Deductible of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: The deductible does not apply to 'loss" caused by collision to such covered "auto' of the private passenger type or light weight truck with a gross vehicle weight of 10,000 lbs. or less as defined by the manufacturer as maximum loaded weight the "auto' is designed to carry while it is: a. In the charge of an "insured"; b. Legally parked; and c. Unoccupied. The 'loss" must be reported to the police authorities within 24 hours of known damage. The total amount of the damage to the covered "auto' must exceed the deductible shown in the Declarations. This provision does not apply to any 'loss" if the covered "auto' is in the charge of any person or organization engaged in the automobile business. SECTION IV -BUSINESS AUTO CONDITIONS is amended as follows: 17. UNINTENTIONAL FAILURETO DISCLOSE HAZARDS SECTION IV-BUSINESS AUTO CONDITIONS, Paragraph B.2. is amended by adding the following: If you unintentionally fail to disclose any hazards, exposures or material facts existing as of the inception date or renewal date of the Business Auto Coverage Form, the coverage afforded by this policy will not be prejudiced. However, you must report the undisclosed hazard of exposure as soon as practicable after its discovery, and we have the right to collect additional premium for any such hazard or exposure. 18. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT, OR LOSS SECTION IV - BUSINESS AUTO CONDITIONS, paragraph A.2.a. is replaced in its entirety by the following: a. In the event of "accident', claim, "suit' or 'loss", you must promptly notify us when it is known to: 1. You, if you are an individual; 2. A partner, if you are a partnership; 3. Member, if you are a limited liability company; 4. An executive officer or the "employee" designated by the Named Insured to give such notice, if you are a corporation. To the extent possible, notice to us should include: (1) How, when and where the "accident' or "loss" took place; (2) The "insureds" name and address; and (3) The names and addresses of any injured persons and witnesses. 19. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION IV - BUSINESS AUTO CONDITIONS, paragraph A.S., Transfer of Rights of Recovery Against Others to Us, is amended by the addition of the following: If the person or organization has waived those rights before an "accident' or 'loss", our rights are waived also. d2010Liberty Mutual Insurance Company.All rights reserved. CA 88 10 01 10 Includes copyrighted material of Insurance Services Office Inc.,with its Permission. Page 6 of 7 20. HIRED AUTO COVERAGE TERRITORY SECTION IV- BUSINESS AUTO CONDITIONS, paragraph B.7., Policy Period, Coverage Territory, is amended by the addition of the following: f. For "autos" hired 30 days or less, the coverage territory is anywhere in the world, provided that the insured's responsibility to pay for damages is determined in a"suit", on the merits, in the United States, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to. This extension of coverage does not apply to an "auto" hired, leased, rented or borrowed with a driver. SECTION V -DEFINITIONS is amended as follows: 21. BODILY INJURY REDEFINED Under SECTION V-DEFINTIONS, definition C. is replaced by the following: "Bodily injury" means physical injury, sickness or disease sustained by a person, including mental anguish, mental injury, shock, fright or death resulting from any of these at any time. COMMMON POLICY CONDITIONS 22. EXTENDED CANCELLATION CONDITION COMMON POLICY CONDITIONS, paragraph A. - CANCELLATION condition applies except as fol- lows: If we cancel for any reason other than nonpayment of premium, we will mail to the first Named Insured written notice of cancellation at least 60 days before the effective date of cancellation. This provision does not apply in those states which require more than 60 days prior notice of cancella- tion. i II 020101-iberty Mutual Insurance Company.All rights reserved. CA 88 10 01 10 Includes copyrighted material of Insurance Services Office Inc.,with its Permission. Page 7 of 7 ',....... i