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HomeMy WebLinkAboutPW14-262 - Original - #1 - Buckland & Taylor - Green River Trail Wall Retrofit Construction Observation Services - 12/15/2014 Records Manage +e tL KENT Document WASHINGTON 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: Buckland & Taylor Vendor Number: JD Edwards Number Contract Number: 1 ` V w co 1, ✓`'✓""� This is assigned by City Clerk's Office Project Name: Green River Trail Wall Retrofit Construction Observation Description: ❑ Interlocal Agreement ❑ Change Order M Amendment ❑ Contract ❑ Other: Contract Effective Date: 12/15/14 Termination Date: 4/30/15 Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Mark Madfai 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 April 30, 2015 to meet the construciton schedule. As of: 08/27/14 KETI�" AMENDMENT NO. 1 NAME OF CONSULTANT OR VENDOR: Buckland & Taylor I CONTRACT NAME & PROJECT NUMBER: Green River Trail Wall Retrofit Construction Observation ORIGINAL AGREEMENT DATE: October 29, 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 April 30, 2015 to meet the construction schedule. 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, $8,975.05 including applicable WSST Net Change by Previous Amendments $0 including applicable WSST Current Contract Amount $8,975.05 including all previous amendments i Current Amendment Sum $o Applicable WSST Tax on this $0 Amendment Revised Contract Sum $8,975.05 AMENDMENT - 1 OF 2 i Original Time for Completion 12/31/14 (insert date) Revised Time for Completion under n/a prior Amendments (insert date) Add'I Days Required {f) for this 120 calendar days Amendment Revised Time for Completion 4/30/15 (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 H KENT: (signature) "05ignature) Print Name: S&v 1'r- <Ou7)( Print Name: Timothy ). LaPorte, P.E. Its VP j L- s. Its Pub is Works Director (title) (tit/ ) DATE: 2-0 q `)C I DATE: 2' 4 APPROVED AS TO FORM: (applicable if Mayor's signature required) Kent Law Department Buckland&Taylor-Horseshoe Bend 2 Amd I/Madfai AMENDMENT - 2 OF 2 R M CERTIFICATE OF LIABILITY INSURANCE DATE; 10127J2014 TwIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS I NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($)ND OR ALTER THE COVERAGE ),AUTHORIZED REPRESENTATIVE OR PRODUCER,RDED BY THE POLICIES BELOW.THIS IA DFICATE TURANCE HE _S CERTIFICATE BOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the polieyjIs-)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER GONTADr NAME. Sandy Treleaven Willis of Illinois PHONEFAX 233 South Wacker Drive A!C No EW: 604-605-3672 (A!C,No): 604-6835]46 o,Chica IL E-MAIL g ADDRESS: sertl.IraleavenrAwiilis.corJr ,,, 60606 PRODUCER CUSTOMER IO#; NIA INSURER(S)AFFORDING COVERAGE NAIC+# INSURED INSURERA:Travelers Indemnity Company of America 25666 Buckland&Taylor Inc. INSURER IS: Buckland&Taylor International Inc. INSURER C 220 West Mercer Street INSURER Suite W100 INSURERE: .. .... ... Seattle,WA 98119 INSURER F: i COVERAGES - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW NAVE 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 MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH PsOB ICIES. LIMITS SHOWN MAY HAVE BEE NOREDULICY ECEED BY PAID CLAIMS. INSR ADDL R POLICY NUMBER POLICY EFF (MMIDOMY) LIMITS LTR TYPE OF INSURANCE INSR WVD (MMIDDlYY) EACH OCCURRENCE $1,000,000 A GENERAL LIABILITY Y 680-3D816768 0710112014 07/01/2015 DAMAGES TO RENTED x COMMERCIAL GENERAL LIABILITY PREMISES Ee ancurrenra} $3DO,DDO MED EXP IAnq one person] $5,000 CLAIMS-MADE F_X OCCUR PERSONAL&ADV INJURY $1,000,son GENERAL AGGREGATE ROW 000 PRODUCTS-COMPIOP $2A)D000 GEN'LAGGREGATE LIMITAPPLIES PER: AGG X POLICY PRO- LOC JECT COMBINED SINGLE LIMIT A AUTOMOBILE LIABILITY Y BA31381773A 07/01/2014 07101/2015 (Esa Idenq BODILY INJURY(Perpeaon) ANY AUTO BODILY INJURY(Fer ft iWI p ALL OWNED AUTOS PROPERTY DAMAGE SCHEDULEDAUTOS (Per F,ddem $y000000 x HIRED AUTOS $1.000,000 x NON-OWNED AUTOS A x UMBRELLA LIAB X OCCUR CUP-3D817882 07/01/2014 0710112015 EACH OCCURRENCE $s,000,000 AGGREGATE $5,000,000 EXCESS LIAB CLAIMS-MADE $ $ DEDUCTIBLE-71 $ SELF-INSURED RETENTION$1D,000 E.L.EACH ACCIDENT $ E.L.DISEASE—EA $ EMPLOYEE EL DISEASE—POLICY S 'OMIT OTHER '.. The City of Kent is included as an additional Insured,but Solely with respect to liability arising out of the business operations of the Named Insured in relation to the"Green River Trail Wall Retrofit"Consultant Services Agreement.The policies noted above contain cross-liability!s ever ability of Interests clauses. A copy of the Blanket Additional Insured Endorsement/Primary and CANCELLATION Endorsement is attached to this Certificate, CERTIFICATE HOLDER Engineering SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Kent Attention;Nancy eke THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 400 West Gowe Kent,WA 7TH 98032 RIZE�REPRESETATIVE` r - 1 ACORD 25-2010105 ©1988.2010 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered.marks of ACORD W- TRAVELERS J~ One Tower Square, Hartford, Connecticut 06163 RENEWAL CERTIFICATE COMMON POLICY DECLARATIONS POLICY NO.: 680-3D816768-TIA-14 OFFICE PAC ISSUE DATE: 06-04-14 BUSINESS: ENGINEERS INSURING COMPANY: THE TRAVELERS INDEMNITY COMPANY OF AMERICA 1. NAMED INSURED AND MAILING ADDRESS: BUCKLAND & TAYLOR, INC. ; AND AS PER IL F1 18 220 W MERCER ST, STE W100 SEATTLE WA 98119 2. POLICY PERIOD: From 07-01-14 to 07-01-15 12:01 A.M. Standard Time at your mailing address. 3. LOCATIONS: PREM. BLDG. OCCUPANCY ADDRESS (same as Mailing Address NO. NO. unless specified otherwise) 01 01 ENGINEERS 220 W MERCER ST, STE W100 SEATTLE WA 98119 02 01 ENGINEERS 276 5TH AVE, STE 1006 NEW YORK NY 10001 4. COVERAGE PARTS AND SUPPLEMENTS FORMING PART OF THIS POLICY AND INSURING COMPANIES: COVERAGE PARTS AND SUPPLEMENTS INSURING COMPANY Businessowners Coverage Part TIA a 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 _ DIRECT BILL 7. PREMIUM SUMMARY: Provisional Premium $ Due at Inception $ Due at Each $ NAME AND ADDRESS OF AGENT OR BROKER COUNTERSIGNED BY: WILLIS OF ILLINOIS INC CSN36 233 S WACKER DR STE 2000 Authorized Representative CHICAGO IL 60606 DATE: IL TO 25 OB 01 (Page 1 of 02) 000563 Office: SPECIALIST A&E DOWN < .. TRAVELERS One Tower Square, Hartford, Connecticut 06103 BUSINESSOWNERS COVERAGE PART DECLARATIONS OFFICE PAC POLICYNO.: G80-3D81G7G8-TIA-14 ISSUE DATE: OG-04-14 INSURING COMPANY: THE TRAVELERS INDEMNITY COMPANY OF AMERICA POLICY PERIOD: ' From 07-01-14 to 07-01-15 12:01 A.M. Standard Time at your mailing address. FORM OF BUSINESS: CORPORATION 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) $ 2,000,000 Products-Completed Operations Aggregate Limit $ 2,000,000 Personal and Advertising Injury Limit $ 1 ,000,000 Each Occurrence Limit $ 1 ,000,000 Damage to Premises Rented to You $ 300,000 Medical Payments Limit (any one person) $ 5,000 r BUSINESSOWNERS PROPERTY COVERAGE DEDUCTIBLE AMOUNT: Businessowners Property Coverage: $ 500 per occurrence. Building Glass: $ 500 per occurrence. ; a_ BUSINESS INCOMEfEXTRA EXPENSE LIMIT: Actual loss subject to a maximum limit of '— Period of Restoration-Time Period; 72 Hours > ADDITIONAL COVERAGE : Fine Arts: $ >_ Other additional coverages apply and may be changed by an endorsement . Please read the policy. >= j SPECIAL PROVISIONS: COMMERCIAL GENERAL LIABILITY COVERAGE IS SUBJECT TO A GENERAL AGGREGATE LIMIT MP TO 01 02 05 (Page 1 of 02) z, w lf1M Pd BUSINESSOWNERS PROPERTY COVERAGE PREMISES LOCATION NO. : 01 BUILDING NO. : 01 LIMIT OF INFLATION COVERAGE INSURANCE VALUATION- COINSURANCE GUARD BUSINESS PERSONAL PROPERTY $ RC* N/A 3.0% *Replacement Cost COVERAGE EXTENSIONS: Accounts Receivable $ Valuable Papers $ PREMISES LOCATION NO. : 02 BUILDING NO, : 01 LIMIT OF INFLATION COVERAGE INSURANCE VALUATION COINSURANCE GUARD BUSINESS PERSONAL PROPERTY $ *Replacement Cost COVERAGE EXTENSIONS: ., Accounts Receivable $ Valuable Papers $ Other coverage extensions apply and may be changed by an endorsement . Please read the policy. n= o� o o ou a MP TO 01 02 05 (Page 2 of 02) 000565 POLICYNUMBER: G80-3D8167G8-TIA-14 EFFECTIVE DATE: 07-01-14 ISSUE DATE: 06-04-14 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS 'I THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS. * IL TO 25 08 01 RENEWAL CERTIFICATE * MP TO 01 02 05 SUSINESSOWNERS COVERAGE PART DECS * IL T8 01 01 01 FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS IL T3 16 05 12 COMMON POLICY CONDITIONS - WASHINGTON j * IL Fi 18 10 13 AMENDMENT OF NAMED INSURED - WASHINGTON BUSINESSOWNERS * MP T1 30 02 05 TEL OF CONT-BUSINESSOWNERS COV-DELUXE MP T1 02 02 05 BUSINESSOWNERS PROPERTY COV-SPEC FORM AMENDATORYMP Ti 05 02 05 * MP T1 75 03 06 WINDSTORM ORR HAIL IPERCENTAGE SDED * MP T5 30 109 07 ARCHITECTS,112 FUNGUS, WET/DRYNROTSCHGSSURVEYORS END NY * MP T3 07 03 97 PROTECTIVE SAFEGUARDS-SPRINK&RESTAURANT MP T3 25 01 08 TERRORISM RISK INS ACT OF 2002 NOTICE * MP T3 29 02 05 ERISA COVERAGE MP T3 49 to 06 BUS INC & EXTRA EXP POL LEVEL DOLLAR LMT MP T3 50 it 06 EQUIP BREAKDOWN SERV INTERRUPTION LIM MP T3 56 02 08 AMENDATORY PROVISIONS-GREEN BLD * MP Ti 55 02 05 AMEND EMPLOYEE DISHONESTY LIMIT m^ CP 01 60 12 98 WASHINGTON CHANG85 - DOMESTIC ABUSE '—' MP T5 45 11 10 NEW YORK CHANGES ME MP T4 31 12 09 WA CHANGES _ COMMERCIAL GENERAL LIABILITY L.. o �= CG D3 15 it 03 BLANKET DESIG LOCATIDN(S) GENL AGGR LMT CG TO 34 it 03 TABLE OF CONTENTS CG OD 01 10 01 COMMERCIAL GENERAL LIABILITY COV FORM CG D2 55 it 03 AMENDMENT OF COVERAGE - POLLUTION CG D3 09 11 03 AMEND ENDT-PRODUCTS-COMPLETED OPR HAZARD "= CG D3 81 09 07 AODT INSURED ARCHITECT,ENGI NEER,SURVEYOR —' CG D4 71 02 09 AMEND COVERAGE B - PERS & ADV INJURY ..-- CG 21 70 O1 08 CAP ON LOSSES-CERTIFIED ACTS-TERRORISM o- * GN 01 13 11 03 EMPLOYERS OVERHEAD LIABILITY CG DO 37 04 05 OTHER INSURANCE-ADDITIONAL INSUREDS �'— CG D2 03 12 97 AMEND-NON CUMULATION OF EACH OCC CG D3 79 09 07 ARCHITECT,ENGINEER,SURVEYOR XTEND ENDORS CG D4 13 04 08 AMENDMENT OF COVERAGE-COOLING-POLLUTION '.. CG D3 26 10 it EXCLUSION - UNSOLICITED COMMUNICATION Co D3 56 05 14 MOBILE EQUIP REDEFINED-EXCL OF VEHICLES CG D3 80 10 it EXCL-ENGIN ARCHITECT OR SURVEY PROF LIAB CG D4 21 07 08 AMEND CONTRAC LIAB EXCL-EXC TO NAMED INS * TEXT IN THIS FORM HAS CHANGED, OR THE FORM WAS NOT ON POLICY BEFORE. PAGE : 1 OF 2 � IL T8 0101 01 POLICY NUMBER: 680-3D81 6768-TIA-1 4 EFFECTIVE DATE: 07-01-14 ISSUE DATE: 06-04-1 4 COMMERCIAL GENERAL LIABILITY (CONTINUED) CG DG 18 10 11 EXCL-VIOLATION OF CONSUMER FIN PROT LAWS CG DO 76 06 93 EXCLUSION-LEAD CG D1 42 01 99 EXCLUSION-DISCRIMINATION CG F2 45 07 02 EXCLUSION - WAR - WASHINGTON CG T4 78 02 90 EXCLUSION-ASBESTOS CG F2 63 OB i1 NEW YORK CHGS-CGL COVERAGE FORM CG F2 66 11 03 WA CHANGES EMPLOY RELATED PRACTICES EXCL CG F4 66 01 08 WASHINGTON CHANGES-WHO IS AN INSURED CG 26 21 10 91 NY CHANGES-TRANSFER OF DUTIES CG FO 94 09 95 EXCLUSION-LEAD-NEW YORK LIMIT WHEN TWO OR MORE POLICIES APPLY CG 01 04 12 04 NEW Y YORK CHANGES-PREMIUM AUDIT INTERLINE ENDORSEMENTS IL FO 63 05 13 NY-EXCL OF LOSS DUE TO VIRUS OR BACTERIA IL T3 82 05 13 EXCL OF LOSS DUE TO VIRUS OR BACTERIA IL 3 23 111 113 WASHINGTONSCHANGES SES M-C DEFENSE ERT S OF ERROR 79 01 OB CAPS ON COSTS IL 01 IL 01 57 07 02 WA CHANGES - ACTUAL CASH VALUE s- IL Ot 73 07 02 WA CHANGES-EXCLUDED CAUSES OF LOSS IL 01 83 08 08 NEW YORK CHANGES - FRAUD IL 01 9B 09 08 NUCLEAR ENERGY LIABILITY EXCLUSION * TEXT IN THIS FORM HAS CHANGED, OR THE FORM WAS NOT ON POLICY BEFORE . PAGE: 2 OF 2 IL T8 01 01 01 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to WHO IS AN INSURED INSURANCE (Section 111) for this Coverage (Section Ii): Part. Any person or organization that you agree in a B. The following Is added to Paragraph a. of 4, "contract or agreement requiring Insurance' to in- other Insurance In COMMERCIAL GENERAL LIABILITY CONDITIONS (Section iV): elude as an additional insured on this Coverage However,if you specifically agree in a"contractor Part,but only with respect to liability for"bodily In- jury", "property damage" or "personal Injury" agreement requiring insurance"that the insurance caused,In whole or In part, by your acts or orals- provided to an additional insured under this Cov- sions or the acts or omissions of those acting on Braga Part must apply on a primary basis, or a your behalf: primary and non-contributory basis,this insurance a. In the performance of your ongoing opera- is primary to other Insurance that is available to ons; such additional Insured which covers such addi- d b. connection with premises owned by or tional Insured as a named Insured,and we will not share with the other Insurance, provided that: rented to you;or O which coverage is sought occurs;and c. in connection with "your work" and included 1 The "bodily injury" or sought perty damage' for within the "products-completed operations (2) The "personal injury" for which coverage is hazard". sought arises out of an offense committed; Such person or organization does not qualify as an additional insured for"bodily injury", "property after you have entered Into that "contract or Incur- damage" or "personal injury" for which that per- agreement requiring insurance". But this insur- son or organization has assumed liability in a con- Insuranoeisexcels over valid and whether primary, excess,collectible of er tract or agreement, on any other basis,that is available to the insured The insurance provided to such additional Insured when the insured Is an additional insured under Is limited as follows: any other insurance. it, This insurance does not apply on any basis to G. The following is added to Paragraph 8. Transfer any person or organization for which cover- Of Rights Of Recovery Against Others To Us age as an additional Insured specifically is in COMMERCIAL GENERAL LIABILITY CON- added by another endorsement to this Cover- DITIONS(Section IV): age Part. e, This insurance does not apply to the render- We waive any rights of recovery we may have ing of or failure to render any "professional paymentsny person or organizaon we make for bodily injury",because"Property perttyf services". damage" or "personal Injury" arising out of"your f. The limits of insurance afforded to the addi- work" performed by you, or on your behalf, under tional insured shall be the limits which you a"contract or agreement requiring insurance"with agreed in that "contract or agreement requir- that person or organization. We waive these ing insurance' to provide for that additional Insured, or the limits shown in the a rights only where you have agreed to do so as dons for this Coverage Park, whichever arree part art of the"contract or agreement requiring Insur- less.This endorsement dons not increase the once" with such person or organization entered limits of insurance stated in the LIMITS OF into by you before, and In effect when,the"bodily CO 03 8109 07 2007 The Travelers Companies,Ina, Page 1 of 2 Includes the copyrighted materiel of Insurance Services Office,Inc,,with Its permission COMMERCIAL GENERAL LIABILITY injury" or"property damage"occurs, or the "per- erage Part, provided that the "bodily injury" and sonal injury"offense is committed. "property damage" occurs, and the 'personal In- wi jury"is caused by an offense committed: D. The follo ng definition Is added to DEFINITIONS a. After you have entered into that contract or (Section V): agreement; "Contract or agreement requiring Insurance" b. While that part of the contract or agreement is means that part of any contract or agreement un- der which you are required to Include a person or organization as an additional insured on this Gov- c. Before the end of the policy period. I Page 2 of 2 ®2007 The Travelers companies,Ina CG D$ 8109 07 Includes the copyrighted material of Insurance Services Office,Inc.,with Its permission r. Willis CERTIFICATE OF LIABILITY INSURANCE This certificate Is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does Telephone: (504 663-6331 9 P Fax: (604)669-5746 not amend, extend or alter the coverage afforded by the policies Website: waay.wilfis.conr below. DATE: October 27, 2014 ISSUED TO: City of Kent Engineering Attention: Nancy Yoshitake 400 West Gowe Kent, WA 98032 Re: Green River Trail Wall Retrofit Consultant Services Agreement NAMED INSURED: Buckland and Taylor Inc. Suite W100, 220 W. Mercer Street Seattle, WA 98119 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 •ra subject to all the terms, exclusions and conditions of such policies. Limits may have been reduced by paid claims. EFFECTIVE DATE: July 1, 2014 EXPIRY DATE: July 1, 2015 (12:01 Standard Time) COVERAGE: Professional Liability Insurance LIMITS: $5,000,000. each occurrence and aggregate COVERAGE TERRITORY: Worldwide INSURER: AIG Insurance Company POLICY NO.: 260 06817 The undersigned hereby certifies that the above policy is now in force and it is hereby agreed that the insurer shall endeavor to provide the certificate holder with 30 days notice of cancellation but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives. WILLIS CANADA INC. PER. Authorized Representative Willis Canada Inc. 1600-1095 West Pender Street ,•�'�'"` Vancouver,BC V6E 2M6