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HomeMy WebLinkAboutPW14-087 - Amendment - #1 - Northwest Hydraulic Consultants, Inc. - Horseshoe Bend Levee Milwaukee II Extension - 01/05/2015 Qt ® RE--:-:- cords t �. x , it KEN7" Document W A9HINGTON .-M.x.. F 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: Northwest Hydraulic Consultants Inc. Vendor Number: 3D Edwards Number 5" j s'fc I LJ�Contract Number: �'wrl This is assigned by City Clerk's Office Project Name: Horseshoe Bend Levee Milwaukee II Extension Description: ❑ Interlocal Agreement ❑ Change Order ® Amendment ❑ Contract ❑ Other: , F , Contract Effective Date: Date of the Mayor's signature Termination Date: 12/31/15 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 December 31, 2015 so the consultant can provide additional support necessary for LOMR and CLOMR which is still under review. As of: 08/27/14 I�EI T WASH nGTON AMENDMENT NO. 1 NAME OF CONSULTANT OR VENDOR: Northwest Hydraulic Consultants Inc. CONTRACT NAME & PROJECT NUMBER: Horseshoe Bend Levee Milwaukee II Extension ORIGINAL AGREEMENT DATE: April 15, 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 so the consultant can provide additional support necessary for LOMR and CLOMR which is still under review. 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, $13,534.00 including applicable WSST Net Change by Previous Amendments $0 including applicable WSST Current Contract Amount $13,534.00 including all previous amendments Current Amendment Sum $0 Applicable WSST Tax on this $0 Amendment Revised Contract Sum $13,534.00 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. i 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: rg T By: (signature) 'II' (signature) Print Name: '-J. e,9,4-"T Print(T�4alvfe: Suzette Cooke Its ' 94� k -I M4N ; rn Its Mayor (title) ,e (title,)-...—- DATE: `? 1 DATE: _ f APPROVED AS TO FORM: (applica le if Mayor'sbignature required) Kent Law Department i — NHC-Horseshoe Bend 4 Amd](Mad/ai AMENDMENT - 2 OF 2 —•. NORTH34 OP ID: NN CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 4.� 06127/2014 JS 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 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 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 Mike Griffith Griffith/Rush Drake Insurance PHONE 206-632-1433 A1C New-365-0699 12 Box Lake City AM No E t: _ _. 12354 Lake City Way NE ADDRESS_ Seattle,WA 98125 --- '.. Mike Griffith INSURER(S)AFFORDING COVERAGE NAIC# _ INSURER A:The Hartford Casualty Ins Co 29424 INSURED Northwest Hydraulic INSURERS: Consultants,Inc. --- — -- 16300 Christensen Rd#}360 INSURER C: _ Tukwila,WA 98188 INSURERD: INSURER E: 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, INSR POLICY EFF PO CY EXP LIMITS LTH TYPE OF INSURANCE G POLICY NUMBER MMIOOIYYYY MMIDDNYYY A X COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR 52UUNZD9765 06/30/2094 O6/30/2015 PREMISES ee comn-a_nce 300,000 MED EXP(Any one pemon) $ 10,000 PERSONAL B ADV INJURY_ $ 1,000,000 SENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT D LOC PRODUCTS-COMP(OP AGG 1$ - 2,000,000 $ OTHER: COMBINED SINGLELE LIMIT $ 1,000,000 HX OMOBILE LIABILITY Ea accitlenl A ANYAUTO 52UUNZD9765 06/30/2014 06/30/2015 BODILY INJURY(Per Person) $ ALL OWNED SCHEDULED BODILY INJURY(Per eccitleO) $ AUTO' AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTO$ H AUTOS (Per accident) S X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 5,000,000 A EXCESS LIAR CLAIMS-MADE 192XHUZD8463 06/3012014 0613012015 AGGREGATE $ 5,000,006 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION STATUTE X ORH- ANDEMPLOVERS'uaeiLiTY 52UUNZD9765 06/30/2014 06/30/2015 EL EACH ACCIDENT $ 1,000,D00 A ANY PROPRIETOR/PARTNERrEXECUTIVE Y❑N(A -" ' OFFICERIMEMBER EXCLUDED? WA STOP GAP E.L DISEASE EAEMPLOYE $ 1,000,D90 (Mandatory in Nm _ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) RE: Horseshoe Bend Levee Milwaukee II Extension The City of Kent is listed as primary non-contributory additional insured as '.., pertains to the work and services performed by the named insured only per form HG 00 01 06 05. 30 day notice of cancellation i CERTIFICATE HOLDER CANCELLATION CITYKN2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN .I Y of Kent i ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Nancy Yoshitake 400 W. Gown AUTHORIZED REPRESENTATIVE Kent,WA 98032 ©1988.2014 ACORD CORPORATION. All rights reserved. ADDED 25(2014101) The ACORD name and logo are registered marks of ACORD Policy#:52UUNPXC936 COMMERCIAL GENERAL LIABILITY COVERAGE FORM Various provisions in this policy restrict coverage. Read (2) The "bodily injury" or"property damage" occurs the entire policy carefully to determine rights, duties and during the policy period;and what Is and is not covered. (3) Prior to the policy period, no insured listed Throughout this policy the words"you"and"your"refer to under Paragraph 1. of Section 11 —Who Is An I the Named Insured shown In the Declarations, and any insured and no"employee"authorized by you to other person or organization qualifying as a Named give or receive notice of an "occurrence" or insured under this policy, The words"we", "us" and"our" claim, knew that the "bodily injury" or"properly refer to the stook insurance company member of The damage" had occurred, In whole or In part. If Hartford providing this Insurance, such a listed insured or authorized "employee" The word "insured" means any person or organization knew prior to the policy period,that the"bodily qualifying as such under Section II—Who is An Insured. injury'. or property damage occurred;then any continuation, change or resumption of such Other words and phrases that appear in quotation marks "bodily injury" or "property damage" during or have special meaning. Refer to Section V—Definitions, after the policy period will be deemed to have SECTION I-COVERAGES been known prior to the policy period COVERAGE A BODILY INJURY AND PROPERTY G. "Bodily Injury"or"property damage" will be deemed DAMAGE LIABILITY to have been known to have occurred at the j 1. Insuring Agreement earliest time when any insured listed under Paragraph 1. of Section 11—Who Is An Insured or a. We will pay those sums that the insured becomes any "employee" authorized by you to give or legally obligated to pay as damages because of receive notice of an "occurrence"or claim; i "bodily injury" or "property damage" to which this insurance applies. We will have the right and duty (1) Reports all, or any part, of the "bodily Injury"or to defend the insured against any "suit" seeking "property damage"to us or any ocher Insurer; those damages. However, we will have no duty to (2) Receives a written or verbal demand or claim defend the Insured against any "suit" seeking for damages because of the "bodily injury' or damages for"bodily injury"or"property damage"to "property,damage";or which this Insurance does not apply. We may, at (3) Becomes aware by any other means that our discretion, investigate any "occurrence" and "bodily injury" or "property damage" has settle any claim or"suit"that may result,But; occurred or has begun to occur. (1) The amount we will pay for damages Is limited d, Damages because .of "bodily injury" include as described in Section [if — L Its Of damages claimed by any person or organization for Insurance;and care, loss of services or death resulting at any time (2) Our right and duty to defend ends when we from the"bodily injury", have used up the applicable limit of insurance in e. incidental Medical Malpractice the payment of judgments or settlements under Coverages A'or B or medical expenses under (1) "Bodily injury" arising out of the rendering of or Coverage C, failure to render professional health care No other obligation or liability to pay sums or services as a physician, dentist, nurse, perform acts or services is covered unless explicitly emergency medical technician or paramedic P P Y shall be deemed to he caused by an provided for under Supplementary Payments "occurrence", but only if: Coverages A and B. b: This insurance applies to "bodily injury" and (a) The physician, dentist, nurse, emergency medical" property damage"only if: employed technician youto rovide su h services (1) The "bodily injury" or "property damage" is and y y y p caused by an "occurrence" that takes place in (b) You are not engaged in the business or the "coverage territory"; occupation of providing such services, i I ' HG 00 01 06 05 Page 1 of 18 02005 The Hartford ' (includes copyrighted material of Insurance Services Office, Inc, with its permission.) I Policy 9:52UUNPX0936 (M) 'Bodily injury" or "property damage" (a) At or from any premises, site or location on arising out of heat, smoke or fumes from which any insured or any contractors or a"hostile fire"; subcontractors working directly or indirectly (b) At or from any premises, site or location on any insured's behalf are performing which is or was at any time used by or for operations if the operations are to test for, any insured or others r for the handling, monitor, clean up, remove, contain, treat, storage,disposal, processing or treatment of detoxify or neutralize, or in any way respond waste; to,or assess the effects of,"pollutants", (c) Which are or were at any time transported, (2) Any loss,cost or expense arising out of any: handled, stored, treated, disposed of, or (a) Request, demand, order or statutory or processed as waste by or for: regulatory requirement that any insured or (i) Any insured;or others test for, monitor, clean up, remove, (it) Any person or organization for whom you contain, treat, detoxify or neutralize, or in may be legally responsible; any way respond to,or assess the effects of, pollutants,or (d) At or from any premises, site or location on (b) Claim or suit by or on behalf of a which any insured or any contractors or governmental authority for damages subcontractors working directly or indirectly because of testing for, monitoring, cleaning on any insureds behalf are performing up, removing, containing, treating, operations if the pollutants' are brought on detoxifying or neutralizing, or in any way or to the premises, site or location in responding to, or assessing the effects of, connection with such operations by such "pollutants", insured, contractor or subcontractor. However, thisparagraph does. not apply However, this subparagraph does not apply liability for damages ecause o ppl"property to: tiY 9 "prc e , (1) "Bodily injury" or "property damage" damage" that the Insured would have In the arising out of the escape of fuels, absence of such request, demand, order or lubricants or other operating fluids which tatutory or regulatory requiremenf or such are needed to perform the nonnal claim or"suit"by or on behalf of a governmental electrical, hydraulic or mechanical authority. functions necessary for the operation of g• Aircraft Auto Or Watercraft mobile equipment" or its parts, if such "Bodily injury" or "property damage" arising out of fuels, lubricants or other operating fluids the ownership, maintenance, use or entrustment to escape from a vehicle part designed to others of any aircraft, "auto"or watercraft owned or hold, store or receive them. This operated by or rented or loaned to any Insured. Use exception does not apply if the 'bodily Includes operation and"loading or unloading". Injury"or"property damage"arises out of This exclusion applies even if the claims against the intentional discharge; dispersal or any Insured allege negligence or other wrongdoing release of the fuels, lubricants or other In the supervision, hiring, employment, training or operating fluids, or if such fuels. monitoring of others by that insured, if the lubricants or other operating fluids are "occurrence" which caused the "bodily injury" or brought on or to the premises, site or "property damage" involved the ownership, location with the intent that they be maintenance, use or entrustment to others of any discharged,dispersed or released as part aircraft, "auto" or watercraft that is owned or of the operations being performed by operated by or rented or loaned to any insured. such insured, contractor or subcontractor; This exclusion does not apply to: (it) "Bodily injury" or "property damage" (1) A watercraft while ashore on premises you oven sustained within a building and caused or rent; by the release of gases,fumes or vapors (.2) A watercraft you do not own that is: from materials brought into that building (a) Less than 51 feet long;and In connection with operations being {h} Not losing used to camp parsons for a performed by you or on your behalf by a contractor or subcontractor;or charge; (111) "Bodily injury" or "property damage" (3) Parking an "auto" on, or on the ways next to, arising out of heat, smoke or fumes from premises you own or rent, provided the "auto"is a"hostile fire';or not owned by or rented or loaned to you or the Insured; HG 00 01 06 OS Page 3 of 19 Policy#:52UUNPX0936 n. Recall Of Products, Work Or impaired kind to persons or property which would not Property I have occurred in whole or In part but for the Damages claimed for any loss, cost or expense "asbestos hazard"; Incurred by you or others for the loss of use, (b) Arise out of any request, demand, order or withdrawal, recall, inspection, repair, replacement, statutory or regulatory requirement that any adjustment, removal or disposal of: insured or others test for, monitor, clean up, (1) "Your product"; remove, encapsulate, contain, treat, detoxify (2), "Your work";or or neutralize or in any way respond to or assess the effects of an asbestos hazard"; {3) "Impaired property'; or If such product, work, or property is withdrawn or (a) Arise out of any claim or suit for damages recalled from the market or from use by any person because of testing for, monitoring, cleaning or organization because of a known or suspected up, removing, encapsulating, containing, defect, deficiency, inadequacy or dangerous treating, detoxifying or neutralizing or In any condition In it, way responding to or assessing the effects o. Personal And Advertising injury of an"asbestos hazard "Bodily Injury" arising out of "personal and Damage To Premises Rented To You — Exception advertising injury". For Damage By Fire,Lightning Or Explosion p. Electronic Data Exclusions G.through h.and j,through n.do not apply Damages arising'out of the loss of, loss of use of, to damage by fire, lightning or explosion to promises damage to, corruption of, inability to access, or while rented to you or temporarily occupied byyou with inability to manipulate electronic data, permission of the owner, A separate limit of insurance applies to this coverage as described in Section iII — As used In this exclusion, electronic data means Limits Of Insurance. Information, facts or programs stored as or on, created or used on, or transmitted to or from INJURY LIABILITY 3 PERSONAL AND ADVERTISING I computer software, Including systems and NJURB(LiTY applications. software, hard'or floppy disks, CD- 1. Insuring Agreement ROMS, tapes, drives, cells, data processing a. We will pay those sums that the insured becomes devices or any other media which are used with legally obligated to pay as damages because of electronically controlled equipment. "personal and advertising injury" to which this ; q. Employment-Related Practices Insurance applies. We will have the right and duly "Bodily injury"tot to defend the insured against any "suit" seeking those damages. However, we will have no duty to (1),A person .arising out of any "employment— defend the insured against any "suit" seeking related practices";or damages for "personal and advertising injury" to (2) The spouse, child, parent, brother or sister of which this Insurance does riot apply. We may, at that person as a consequence off"bodily Injury" our discretion, investigate any offense and settle to that person at whom any "employment- any claim or"suit"that may result,But: related practices"are directed, (1) The amount we will pay for damages is limited This exclusion applies: as described In Section III — Uralic Of (1) Whether the insured may be liable as an Insurance;and employer or In any other capacity;and (2) Our right and duty to defend end when we have (2) To any obligation to share damages with or used up the applicable limit of Insurance in the repay someone also who must pay damages payment of judgments or settlements under because of the injury, Coverages A or B or medical expenses under Coverage C. V. Asbestos No other obligation or liability to pay sums or (1) "Bodily injury" or"property damage" arising out perform acts or services is covered unless explicitly of the"asbestos hazard", provided for under Supplementary Payments — (2) Any damages, judgments, settlements, loss, Coverages A and B. costs or expenses that: la. This insurance applies to "personal and advertising (a) May be awarded or Incurred by reason of Injury" caused by an offense arising out of your any claim or suit alleging actual or business but only if the offense was committed in threatened injury or damage of any nature or the"coverage territory"during the policy period, Ha 00 0106 05 Pages of 18 Policy#:52UUNPX0936 9. War (2) The spouse, child, parent, brother or sister of "Personal and advertising injury", however caused, that personas a consequence of"personal and arising,directly or indirectly,out of: advertising injury"to that person at whom any (1) War,including undeclared or civil war; °employment-related practices"are directed. (2) Warlike action by a military force, including This exclusion applies: action in hindering or defending against an (1) Whether .the insured may be liable as an actual or expected attack, by any government, employer or in any other capacity;and sovereign or other authority using military (2) To any obligation to share damages with or personnel or other agents;or repay someone else who must pay damages (3) Insurrection, rebellion, revolution, usurped power, because of the injury, or action taken by governmental authority in v. Asbestos hindering or defending against any of these. (1) "Personal and advertising Injury" arising out of p. Internet Advertisements And Content Of Others the"asbestos hazard". "Personal and advertising injury"arising out of: (2) Any damages, judgments, settlements, loss, (1) An"advertisement"for others on your Web site; costs or expenses that: (2) Placing a link to a web site of others on your (a) May be awarded or Incurred by reason of web site; any claim or suit alleging actual or (3) Content, Including Information, sounds, text, threatened injury or damage of any nature or graphics, or images from a web site of others kind to persons or properly which would not have stoccurred In whole or in part but for the displayed within a frame or border on your web "asbestos hazard"; site;or (4) Computer code, software or programming used (b) Arise out of any request, demand, order or to enable: statutory or regulatory requirement that any insured or others test for, monitor, dean up, i (a) Your web site;or remove, encapsulate, contain,treat, detoxtfy (b) The presentation or functionality of an or neutralize or in any way respond to or t "advertisement" or other content on your assess the effects of an "asbestos hazard"; web site. or q. Right Of Privacy Created By Statute (a) Arise out of any claim or suit for damages "Personal and advertising injury"arising out of the because of testing for, monitoring, cleaning violation of a person's right of privacy created by up, removing, encapsulating, containing, any state or federal act. treating, detoxifying or no or in any way responding to or assessing the effects However, this exclusion does not apply to liability of an"asbestos hazard". for damages that the insured would have in the COVERAGE C MEDICAL PAYMENTS absence of such state or federal act, r. Violation Of Anti-Trust taw 1. insuring Agreement "Personal and advertising injury" arising out of a a. We will pay medical expenses as described below violation of any anti-trust law, for bodily.injury' caused by an accident: s. Securities (1) On premises you own or rent; "Personal and advertising injury" arising out of the (2) On ways next to premises you own or rent; or fluctuation in price or value of any stocks, bonds or (3) Because of your operations; other securities. provided that: t. Discrimination Or Humiliation (1) The accident takes place in the 'coverage "Personal and advertising Injury" arising out of territory"and during the policy period; discrimination or humiliation committed by or at the (2) The expenses are incurred and reported to us direction of any "executive officer", director, within three years of the dale of the accident; stockholder, partner or member of the insured, and u. Employment-Related Practices (3) The injured person submits to examination, at "Personal and advertising injury"to: our expense, by physicians of our choice as (1) A person arising out of any "employment— often as we reasonably require, related practices";or HG co 01 06 os Page 7 of 18 Pr M 52UUNPX0936 necessary litigation expenses incurred by us and However, none of these "employees" or "volunteer necessary litigation expenses incurred by the workers"are insureds for: Indemnitee at our request will be paid as (1) "Bodily injury" or "personal and advertising Supplementary Payments, Notwithstanding the injury": provisions of Paragraph 2.b.(2)' of Section I — (a) To you,to your partners or members (if you Coverage A — Bodily Injury And Property Damage are a partnership or joint venture), to your Liability, such payments will not be deemed to be members (if you are a limited liability damages for"bodily injury"and"property damage"and company), to a co!'employea" while in the will not reduce the limits of insurance. course of his or her employment or Our obligation to defend an insured's indemniteo and performing duties related to the conduct of to pay for attorneys' fees and necessary litigation your business, or to your other "volunteer expenses as Supplementary Payments ends when: workers" while performing duties related to a,. We have used up the applicable limit of insurance the conduct of your business; in the payment of judgments or settlements;or (b) Tothe spouse,child, parent,brother or sister b. The conditions set forth above, or the terms of the of that co-"employee" or that "volunteer agreement described in Paragraph f.above, are no worker" as a consequence of Paragraph longer met. (1)(a)above; SECTION II—WHO IS AN INSURED (c) For which there is any obligation to share t. If you are designated in the Declarations as; damages with or repay someone else who must pay damages because of the Injury a. An Individual, you and your spouse are insureds, described in Paragraphs (1)(9)or(b) above; but only with respect to the conduct of a business or of which you are the sole owner. (d) Arising out of his or her providing or failing to b. A partnership or joint venture, you are an insured. provide professional health care services. Your members, your partners, and their spouses if you are not in the business of providing are also insureds, but only with respect to the professional healthcare services, Paragraph (d) conduct of your business. does not apply to any nurse, emergency c, A limited liability company, you are an insured. medical technician or paramedic employed by Your members are also insureds, but only with you to provide such services. respect to the conduct of your business, Your (g) "Propsrtydamage"topropedy: manage are Insureds, but only with respect to Owned, or used b their duties as your managers, (a) ,occupied y' d. An organization other than a partnership, joint (b) Rented to, in the care, custody or control of, venture or limited liability company, you are an or over which physical control Is being Insured.Your"executive officers"and directors are exercisedfor any purpose by insureds, but only with respect to their duties as you, any of your "employees", "volunteer your officers or directors, Your stockholders are workers", any partner or member (if you are a also Insureds, but only with respect to their liability partnership or oint venture), or any member (if as stockholders, you are a limited liability company). e. A trust, you are an insured. Your trustees are also b. Real Estate Manager insureds, but only with respect to their duties as Any person (other than your "employee" or trustees. "volunteer worker"), or any organization while 2. Each of the following is also an insured: acting as your real estate manager. a. Employees and Volunteer workers c. Temporary Custodlans of Your Property Your "volunteer workers" only while performing Any person or organization having proper duties related to the conduct of your business, or temporary custody of your property if you die, but your"employees',ether than either your "executive only: officers" (if you are an organization other than a (1) With respect to liability arising out of the partnership, joint venture or limited liability maintenance or use of that property;and company) or your managers (If you are a limited liability company), but only for sots within the scope (2) Until your legal representative has been of their employment by you or while performing appointed. duties related to the conduct of your business, d, Legal Representative if You Die Your legal representative if you die, but only with respect to duties as such. That representative will Page 9 of 18 HG 00 01 06 05 Policy d:52UUNPX0936 (b) Any express warranty unauthorized by you; c. Lessors of Land or Premises (c) Any physical or chemical change in t Any person or organization from whom you lease product made intentionally bythe vendor; land or premises, but only with respect to liability (d) Repackaging, except when unpacked solely arising out of the ownership, maintenance or use of for the purpose of inspection, demonstration, that part of the land or premises leased to you. testing, or the substitution of Paris under With respect to the insurance afforded these instructions from the manufacturer, and then additional 'insureds the following additional repackaged in the original container; exclusions apply: (a) Any failure to make such inspections, This insurance does not apply to: adjustments,tests or servicing as the vendor 1, Any "occurrence" which takes place aiier you has agreed to make or normally undertakes cease to lease that land;or to make in the usual course of business, in connection with the distribution or sale of the 2. Structural alterations, for coy or on b if products; demolition operations performed by or on behalf of such person or organization. (f) Demonstration, lnstallaiion, servicing or repair operations, except such operations d. Archffects,EngineerscarSurveyors perform ed at the vendor's premises in Any architect, engineer, or surveyor, but only with connectionwiththe sale of the product; respect to liability for "bodily injury", "prop" (g) Products which, after distribution or sale by damage" or. "personal and advertising injury" you, have been labeled or.relabe(ed or used caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting as a container, part or ingredient of any other thing or substance by or for the gn your behalf: vendor;or (1) inconnectionwith your premises;or (h) "Bodily injury" or "property damage" arising (2) In the performance of your ongoing operations out of the sole negligence of the vendor for performed by you or on your behalf, its own acts or omissions or those of its With respect to the insurance afforded these employees or anyone else acting on its additional insureds, the following additional behalf, However, this exclusion does not exclusion applies: apply to: This Insurance does not apply to "bodily injury, (I)The exceptions contained in Bob- "properly damage" or "personal and advertising paragraphs(d)or(t];or injury"arising out of the rendering of.or the failure (if) Such inspections, adjustments, tests or to render any professional services by or for you, servicing as the vendor has agreed to including: make or normally undertakes to make in 1. The preparing, approving, or failing to prepare the usual course of business, in or approve, maps, shop drawings, opinions, connection with the distribution or sale of reports, surveys, field orders, change orders or the products. drawings and specifications;or (2) This insurance does not apply to any insured 2. Supervisory, inspection, architectural or person or organization,.from whom you have engineering activities. acquired such products, or any ingredient, part e. Permits Issued By State Or Political or container, entering into, accompanying or Subdivisions containing such products, b, Lessors of Equipment Any state or politico(performed by but only with respect to operations performed by you or on your (1) Any person or organization from whom you behalf for which the state or political subdivision lease equipment; but only with respect to their has issued a permit. liability for "bodily injury", "property damage" or With respect to the insurance afforded these "personal and advertising injury" caused, in additional insureds, this Insurance does not apply whole or in part,by your maintenance,operation to: or use of equipment leased to you by such person ororganizatlom (1) "Bodily injury", "property damage" or "personal (2) With respect to the Insurance aforded to these and advertising injury" arising out of operations additional insureds this insurance does not performed for the stale or municipality;or apply to any 'occurrence" which takes place (2) "Bodily injury" or "property damage" included after the equipment lease expires, within the "products-completed operations hazard". HIG 00 01 06 05 Page 11 of 18 p #:52UUNPX0936 added as an additional insured on your policy, the (3) Cooperate with us in the investigation or most we will pay on behalf of such additional insured is settlement of the claim or defense against the the lesser of: "suit";and ! a. The limits of insurance specified in the written (4) Assist us,upon our request,in the enforcement of contractor written agreement;or any right against any person ororganizatlon which b. The Units of Insurance shown in the Declarations, may be liable to the insured because of Injury or damage to which this lnsurance'may also apply. Such amount shall be a part of and not in addition to d. Obligations At The Insureds Own Cost Limits of insurance shown in the Declarations and described in this Section, No insured will, except at that insured's awn cost, The Limits of Insurance of this Coverage Part apply voluntarily matte a payment, assume any j separately to each consecutive annual period and to any obligation, or incur any expense,other than for first remaining period of less than 12 months, starting with the aid,without our consent, beginning of the policy period shown in the Declarations, e. Additional Insureds Other Insurance unless the policy period is extended after issuance for an if we cover a claim or "suit" under this Coverage additional period of less than 12 months. in that case,the Part that may also be covered by other insurance additional period will be deemed part of the last preceding available to an additional insured, such additional ' period for purposes of determining the Limits of Insurance, insured muss submit such,claim or "suit' to the SECTION IV — COMMER61AL GENERAL LIABILITY other insurer for defense and indemnify, CONDITIONS However, this provision does not apply to the 1. Bankruptcy, extent that you have agreed in a written contract or Bankruptcy or Insolvency of the insured or of the written agreement that this Insurance Is primary insured's estate will not relieve us of our obligations and non-contributory with the additional insured's under this Coverage Part, own insurance, 2. Duties in The Event Of Occurrence,Offense,Claim f. Knowledge Of An Occurrence, Offense, Claim Or Stilt Or Suit ! Paragraphs a. and b. apply to you or to any a. Notice OfOccuronacesuredmuse additional insured only when such "occurrence", You or any additional Insured must see to It that we offense,claim or"suit"Is known to: are notified as soon as practicable of an (1) You or any additional Insured that is an occurrence or an offense which may result Ina Individual; clalin,To the extent possible,notfoe should Include: (1) How, when and where the "occurrence" or (2) Any partner, if you or an additional insured Is a offense took place; partnership; (2) The names and addresses of any injured (3) Any manager,If you or an additional insured is a persons and witnesses;and limited liability company; (3) The nature and location of any injury or damage (4) you or"executive e utiveadditiofficer"or Insured s a corporation;er, if arising out of the occurrence or offense. b, Notice Of Claim (6) Any trustee, if you or an additional Insured is a trust;or if a claim is made or "suit" is brought against any (G) Any elected or appointed official, if you or an insured,you or any additional Insured must; additional insured is a political subdivision or (1) Immediately record the specifies of the claim or public entity, "suit"and the date received;and 2 Notify us as soon as practicable, This duty applies separately to you and any additional ( } fy P insured. You or any additlonal insured must see to it that we g, Legal Action Against Us receive written notice of the claim or "stilt"as soon No person or organization has a right under this as practicable. Coverage Part: c. Assistance And Cooperation Of The Insured a. To join us as a party or otherwise bring us into a You and'any oilier involved insured must: "suit'asking for damages from an insured;or (1) Immediately send us copies of any demands, b. To sue us on this Coverage Part unless all of its notices, summonses or legal papers received in terms have been fully complied with. connection with the claim or"suit"; 2 Authorize us to obtain records and other A person or organization may sue us to ntrecover gai st an ( } agreed settlement or on a final judgment against an information; insured; but we will not be liable for damages that are not payable under the terms of this Coverage Part or HG 00 01 06 05 Page 13 of 1B Policy##:52UUNPX0936 insured will bring"suit"or transfer those rights to us c any of the other insurance does not permit and help us enforce them, contribution by equal shares,we will contribute by limits. Under this method, each insurer's share is b. Waiver Of Rights Of Recovery (Waiver Of based on the ratio of Its applicable limit of Subrogation) insurance to the total applicable limits of insurance If the insured has waived any rights of recovery of all insurers. against any person or organization for all or part of 5. Premium Audit any payment, including Supplementary Payments, a. We will compute all premiums for this Coverage we have waive that right de under this p provided theverage InsurredPart, we also waived their Part in accordance with our rules and rates. rights of recovery against such person or b. Premium shown in this Coverage Part as advance organization in a contract, agreement or permit that premium is a deposit premium only.At the close of was executed priorto the Injury or damage. each audit period we will compute the earned an Wepremium for that period and send notice to the first 9. Wh Named Insured. The due date for audit and decideo to RenewNot renew this coverage Pad, we will retrospective premiums is the date shown as the mail or deliver to the first Named Insured shown in the due date on the bill. If the sum of the advance and Declarations written notice of the nonrenewal not less audit premiums paid for the policy period is greater than So days before the expiration date. than the earned premium,we will return the excess If notice is mailed, proof of mailing will be sufficient to the first Named Insured. proof of notice. a. The first Named Insured must keep records of the SECTION V—DEFINITIONS information we need for premium computation, and send us copies at such times as we may request. 1. "Advertisement' iss ernination tof information hor images that ha.the 6. Representations purpose of inducing the sale of goods, products or % When You Accept This Policy services through: By accepting this policy,you agree: a. (1) Radio; (1) The statements In the Declarations are accurate (2) Television; and complete; (3) Billboard; (2) Those statements are based upon (4) Magazine; representations you made to us;and (5) Newspaper,or (3) We have issued this policy In reliance upon your G Any other publication that is given widespread representations. public distribution. b. Unintentional Failure To Disclose Hazards However, "advertisement"does not include: if unintentionally you should fail to disclose ail a The design,printed material, information or images hazards relating to the conduct of your business contained in, on or upon the packaging or labeling that exist at the inception date of this Coverage of an goods or products;or Part, we shall not deny coverage under this y 000 . p coverage Part because of such failure. b. An interactive conversation between or among persons through a computer network. 7. Separation Of Insureds any 2. "Advertising idea" Except with respect to the Limits of Insurance,and means any Idea for an rights or duties specifically assigned in this Coverage "advert[sement". Part to the first Named Insured,this insurance applies: S. "Asbestos hazard' means an exposure or threat of a. As if each Named Insured were the only Named exposure 10 the asbestos and includes lthe mere presenceuel or alleged r operties of In asbestos Insured;and in any form. b. Separately to each insured against whom claim is ' 4. "Auto"meat is a land motor vehicle,trailer or semitrailer made or"suit"is brought designed for travel on public roads, including any 8. Transfer Of Rights Of Recovery Against Others To attached machinery or equipment But "auto" does not Us include"mobile equipment". a. Transfer of Rights Of Recovery 5. "Bodily injury"means physical: If the insured has rights to recover all or part of any a Injury; payment, including Supplementary Payments, we b Sickness;or have made under this Coverage Part, those rights are transferred to us.The insured must do nothing c. Disease after loss to impair them. At our request, the sustained by a person and, if arising out of the above, mental anguish or death at any time. Page 15 of 19 HG 00 01 06 05 i P #:52UUNPX0936 b. While it is in or on an aircraft, watercraft or"auto"; 16."Occurrence"means an accident, Including continuous or or repeated exposure to substantially the same general ' a. While it is being moved from an aircraft, watercraft harmful conditions. or"auto"to the place where it is finally delivered; 17."Personal and advertising injury" means injury, but "loading or unloading" does not include the including consequential "bodily injury", arising out of movement of property by means of a mechanical one or more of the following offenses: ' device, other than a hand truck, that is not attached to a. False arrest,detention or imprisonment; the aircraft,watercraft or"auto". b. Malicious prosecution; 15."Mobile equipment" means any of the following types c. Tho wrongful eviction from, wrongful entry into, or '... of land vehicles, including any attached machinery or invasion of the right of private occupancy of a room, equipment: dwelling or premises that a person occupies, i a. Bulldozers, farm machinery, forklifts and other committed'by or on behalf of its owner, landlord or vehicles designed for use principally off public lessor; roads; d. oral, written or electronic publication of material b. Vehicles maintained for use solely on or next to that slanders or libels a person or organization or premises you own or rent; disparages a person's or organization's goods, c. Vehicleathat travel on crawler treads; products or services; d. Vehicles,whether self-propelled or not, maintained e. Oral, written or electronic publication of material primarily to provide moblllty to permanently that violates a person's right of privacy; mounted; f. Copying, In your "advertisement", a person's or (1) Power cranes, shovels loaders, diggers or organization's "advertising idea" or style of drills;or "advertisement"; (2) Road construction or resurfacing equipment g• Infringement of copyright; slogan, or title of any such as graders,scrapers or rollers; literary or artistic work,in your"advertisement";or e. Vehicles not described in a., b., o,or d,above that h• Discrimination or humiliation that results in injury to th are not self-propelled and are maintained primarily e feelings or reputation of a natural person, to provide mobility to permanently attached 18."Pollutants"mean any solid, liquid,gaseous or thermal equipment of the following types: irritant or contaminant, Including smoke, vapor, soot, (1) Air compressors, pumps and generators, fumes, acids, alkalis, chemicals and waste. Waste I including spraying, welding, building cleaning, includes materials to be recycled, reconditioned or geophysical exploration, lighting and well reclaimed, servicing equipment;or f 9,"Products-completed operations hazard": (2) Cherry pickers and similar devices used to raise a, includes all "bodily injury" and "property damage" or lower workers; occurring away from premises you own or rent and f. Vehicles not described In a„ b., c, or d, above arising out of"your product"or"your work"except: maintained primarily for purposes other than the (1) Products that are still in your physical transportation of persons or cargo, possession;or However, self-propelled vehicles with the following (2) Work that has not yet been completed or types of permanently attached equipment are.not abandoned, However, "your work" will be "mobile equipment"but will be considered"aulos": deemed completed at the earliest of the (1) Equipment, of at least 1,000 pounds gross following times: vehicle weight,designed primarily for; (a) When all of the work called for in your (a) Snow removal; contract has been completed. (b) Road maintenance, but not construction or (5) When all of the work to be done at the job . resurfacing;or site has been completed if your contract calls for work at more than one job site. (c) Street cleaning; (c) When that part of the work done at a job site (2) Cherry pickers and similar devices mounted on has been put to its intended use by any automobile or truck chassis and used to raise or person or organization other than another lower workers;and contractor or subcontractor working on the (3) Air compressors, pumps and generators, same project,. including spraying, welding, building cleaning, Work that may need service, maintenance, geophysical exploration, lighting and well correction, repair or replacement, but which is servicing equipment. otherwise . complete, will be treated as completed. HG 00 01 06 05 Page 17 of 18 I Policy#:52UUNPX0936 COMMERCIAL AUTOMOBILE HA 9916 0910 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT" This endorsement modifies Insurance provided under the following: BUSINESS AUTO COVERAGE FORM To the extent that the provisions of this endorsement provide broader benefits to the "Insured" than other provisions of the Coverage Form,the provisions of this endorsement apply. 1. BROAD FORM INSURED d. Any "employee" of yours while using a A. Subsidiaries and Newly Acquired or covered "auto" you don't own, hire or Formed Organizations borrow in your business or your personal The Named Insured shown in the affairs. Declarations is amended to include: C. Lessors as Insureds (1) Any legally incorporated subsidiary in Paragraph A.1.-WHO IS AN INSURED-of which you own more than 50% of the Section II -Liability Coverage Is amended to voting stock on the effective date of the add' Coverage Form. However, the Named e. The lessor of a covered "auto"while the Insured does not Include any subsidiary "auto" Is leased to you under a written that Is an "insured" under any other agreementff., automobile policy or would be an provide direct primary Insurance"insured" under such a policy but for its (1) p agreement requires you for you to termination or the exhaustion of its Limit pro of Insurance. the lessor and (2) Any organization that is acquired or (2) The"auto"Is leased without a driver. formed by you and over which you Such a leased "auto" will be considered a maintain majority ownership. However, covered "auto" you own and not a covered the Named Insured does not include any "auto"you hire. newly formed or acquired organization: D. Additional Insured If Required by Contract (a) That is a partnership, joint venture (1) Paragraph A.I. -WHO IS AN INSURED or limited liability company - of Section If - Liability Coverage Is (b) That Is an "insured" under any other amended to add: policy, f. When you have agreed, in a written (c) That has exhausted Its Limit of contract or written agreement,that a Insurance under any other policy,or person or organization be added as (d) 180 days or more after its an additional insured on your acquisition or formation by you, business auto policy,such person or unless you have given us notice of organization is an"insured", but only the acquisition or formation, to the extent such person or Coverage does not apply to "bodily organization is liable for "bodily injury"or "property damage" that results injury"or "property damage" caused from an "accident" that occurred before by the conduct of an "insured"under you formed or acquired the organization. paragraphs a. or b, of Who Is An B. Employees as Insureds Insured with regard to the ' A.1. -WHO IS AN INSURED-of ownership, maintenance or use of a Paragraph covered auto. SECTION 11 - LIABILITY COVERAGE is amended to add: 2010,The Hartford(includes copyrighted material Farm HA q9 16 (19In of 190 Prnnsrtles. Inr,..with its oarmisslon.) Pace 1 of 5 Poflev#:52UUNPX0936 If an "employee's" personal insurance also 5, PHYSICAL DAMAGE ADDITIONAL applies on an excess basis to a covered "auto" TEMPORARY TRANSPORTATION EXPENSE hired or rented by your "employee" on your COVERAGE behalf and at your direction, this insurance will Paragraph A.4.a. of SECTION III - PHYSICAL be primary to the "employee's" personal DAMAGE COVERAGE is amended to provide a Insurance. limit of $60 per day and a maximum limit of 3. AMENDED FELLOW EMPLOYEE EXCLUSION $1,000, EXCLUSION 5. - FELLOW EMPLOYEE - of 6. LOAN/LEASE GAP COVERAGE SECTION 11 - LIABILITY COVERAGE does not Under SECTION III - PHYSICAL DAMAGE apply If you have workers' compensation COVERAGE, in the event of a total "loss" to a insurance in-force covering all of your covered "auto", we will pay your additional legal "employees". obligation for any difference between the actual Coverage is excess over any other collectible cash value of the"auto"at the time of the "loss" Insurance. and the"outstanding balance"of the loan/tease. 4. HIRED AUTO PHYSICAL DAMAGE COVERAGE "Outstanding balance" means the amount you i if hired "autos" are covered "autos" for Liability owe on the loan/tease at the time of"toss" less Coverage and if Comprehensive, Specif ed any amounts representing taxes; overdue Causes or Loss, .or Collision coverages are payments; penalties, Interest or charges provided under this Coverage Form for any resulting from overdue payments; additional "auto" you awn, then the Physical Damage mileage charges; excess wear and fear charges; Coverages provided are extended to"autos"you lease termination fees; security deposits not hire or borrow,subject to the following limit, returned by the lessor; costs for extended The most we will pay for "loss" to any hired warranties, credit life insurance,health, accident or disability insurance purchased with the loan or I "auto"is: lease; and carry-over balances from previous (1) $100,000; loans or teases. (2) The actual cash value of the damaged or 7. AIRBAG COVERAGE stolen property at the time of the"loss";or Under Paragraph B. EXCLUSIONS - of (3) The cost of repairing or replacing the SECTION IIi - PHYSICAL DAMAGE damaged or stolen property, COVERAGE,the following is added: whichever to smallest, minus a deductible. The The exclusion relating to mechanical breakdown deductible will be equal to the largest deductible does not apply to the accidental discharge of an applicable to any owned"auto"for that coverage, alrbag. No deductible applies to "loss" caused by fire or 3 ELECTRONIC EQUIPMENT - BROADENED lightning. Hired Auto Physical Damage coverage COVERAGE Is excess over any other collectible Insurance. Subject to the above limit, deductible and excess The exceptions to Paragraphs BA - provisions,we will provide coverage equal to the EXCLUSIONS - of SECTION III - PHYSICAL broadest coverage applicable to any covered DAMAGE COVERAGE are replaced by the "auto"you own, following: We will also cover loss of use of the hired"sutd' a.Excluslons 4.c, and 4.d. do not apply to if it results from an "accident", you are legally equipment designed to be operated solely by liable and the lessor Incurs an actual financial use of the power from the "autos" electrical loss, subject to a maximum of $1000 per system that,at the time of"loss",is: "accident", (1) Permanently installed in or upon the This extension of coverage does not apply to any covered"auto'; "auto" you hire or borrow from any of your (2) Removable from a housing unit which Is "employees", partners (if you are a partnership), permanently installed in or upon the members (if you are a limited liability company), covered"auto"; or members of thou households. (3) An integral part of the same unit housing any electronic equipment described in Paragraphs a.and b,above;or (4) Necessary for the normal operation of the covered "auto" or the monitoring of the covered"auto's"operating system. O 2010,The Hartford(includes copyrighted material pnrm "A as an no An of lPr) PrnnarKnq Inn wtfh tic narmrcctnn 1 parSP_3 of R � Policy#: 52UUNPX0936 If we cancel for any reason other than c.Regardless of the number of autos damaged nonpayment of premium, we will mail or deliver in any one 'loss", the most we will pay under to the first Named Insured written notice of this Hybrid Payment Coverage provision for cancellation at least 60 days before the effective anyone loss"Is$10,000. date of cancellation. For the purposes of the coverage provision, 13. HYBRID PAYMENT COVERAGE a.A "non-hybrid" auto Is defined as an auto that In the event of a total loss to a"non-hybrid"auto uses only an internal combustion engine to for which Comprehensive, Specified Causes of move the auto. Loss, or Collision coverages are provided under b.A "hybrid" auto is defined as an auto with an this Coverage Form, then such Physical internal combustion engine and one or more Damage Coverages are amended as follows: electric motors; and that uses the internal a.If the auto is replaced with a"hybrid"auto,we combustion engine and one or more electric Will pay an additional 10%, to a maximum of motors to move the auto, or the internal $2,500, of the "non-hybrid"auto's actual cash combustion engine to charge one or more . value or replacement cost,whichever Is less, electric motors,which move the auto. b.The auto must be replaced and a copy of a bill of sale or new lease agreement received by us within 60 calendar days of the date of`loss," i I I i i i I O 2010,The Hartford(Includes copyrighted material Form HA 99 16 09 10 of ISO Properties, Inc.,with Its permission.) Page 5 of 5 NORTH34 OP ID:NN A` DATE V CERTIFICATE OF LIABILITY INSURANCE o3111/2014f1u2o14 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 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(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). CONTACT PRODUCER NAME: - Griffith/Rush Drake Insurance PHONE PD BOX 27167 AAI.CNo,Ext: lAID Nc1• 12354 Lake CitAL y/Way NE n ogess: Seattle,WA 96I 25 Mike Griffith INSUREP(S)AFFORDING COVERAGE NAIC It.. INSURER A•Evanston Insurance Company INSURED Northwest Hydraulic wsuREaa: Consultants,Inc. INSURER C: 16300 Christensen Rd#350 Tukwila,WA 98188 INSURER D: .— INSURER E;_ 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. bL UBRI PODCYEFF POLICYEXP ILTp TYPE OF INSURANCE POLICY NUMEER M DIMYYY MMIDOIYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ _ DAMA COMMERCIAL GENERAL LIABILIIY PREMISES Ea occurrence $ CLAIMS-MADE ❑OCCUR MEO EXP(An ane person} $ PERSONAL 6ADV INJURY $ GENERAL AGGREGATE It GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPlOP AGG It POLICY PRO- LOU $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident ANYAUTO BODILY INJURY(Per Person) $ JDEDRETENTION$ SCHEDULED BODILY INJURY(Per accident) $ NON-OWNED OS PROPERTY DAMAGE $ AUTOS PER ACCIDENT OCCUR EACH OCCURRENCE $ _ CLAIMS-MACE AGGREGATE $ ON$ S WC LC C RI- WORKERS COMPENSATION TORV LIM AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNEREXECUTIVE❑ NIA E.L.EACH ACCIDENT $ OFFICERfMEMS1 EXCLUDEO4 (Mandatory in NkL F E.L.DISEASE-EA EMPLOYE $ If yes,describe under I EL DISEASE-POLICY LIMIT It DESCRIP rION OF OPERATIONS below '.. A Professional Lia AES23513 03N 212014 03/12/2015 Occurance 2,000,000 DEDUCTIBLE-$50,000 Aggregate 3,000,000 DESCRIPTION OF OPERATIONS)LOCATIONS!VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Those usual to the insured-s operations. CERTIFICATE HOLDER CANCELLATION CITYKNT 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. Attn: Nancy Yoshitake 220 4th Ave S AUTHORIZED REPRESENTATIVE Kent,WA 98032 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD REQUESTFOR MAYOR'S IGNAT E Please Fill in All Applicable Boxes „ a � "' „ eviewed by Director Or inator's Name: Mark Madfai Dept/Div. Engineering Extension: 5521 Date Sent: /o/3i b.1. Date Re wired. Return to: Nancy Yoshitake CONTRACT TERMINATION ATE: 12/31/15' VENDOR: Northwest Hydraulic DATE OF COUNCIL APPROVAL: N/A' Consultants Inc. ATTACH THE COUNCIL MOTION SHEET FOR THE MAYOR - if applicable Brief Explanation of Document: The attached Amendment No. 1 is necessary to extend the time of completion to December 31, 2015 so the consultant can provide additional support necessary for LOMR and CLOMR for the Horseshoe Bend Levee Milwaukee II Extension project which is still under review. All Contracts Must Be Routed Through The Law Department �� ,a � fi s ts •.. This area to be completed by the Law Department): Received: [ Approval of Law Dept.: [ pP p { i f "✓`4�a tt4 x .• r Law Dept:. Comments: wA Date Forwarded to Mayor: t , Shaded Areas To Be Completed By Administration Staff 77 Received: Recommendations and Comments: Disposition: ,'ram ff df ' tit Date Returned: