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HomeMy WebLinkAboutPD15-183 - Original - Fair and Impartial Policing - Dr. Lori Fridell - Contract - 5/18/15 ecords erne KENT Document WASHINGTO'N 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: Fair and Impartial Policing - Dr. Lori Fridell Vendor Number: JD Edwards Number Contract Number: �7� This is assigned by City Clerk's Office G Project Name: Fair and Impartial Policing Training Description: Interlocal Agreement ❑ Change Order ❑ Amendment 0 Contract p ❑ g 9 ❑ Other: I D May 20 Termination ate ff iv Date. May 18 201 5 e Contract Effective e 2015 f r Contract Renewal Notice (Days): n/a Number of days required .notice for termination or renewal or amendment Contract Manager: Rafael Padilla Department Police Contract Amount: $18,500 Approval Authority: (CIRCLE ONE) Department Director Mayor City Council Detail: ('i.e. address, location, parcel number, tax id, etc.): I As of: 08/27/14 �5 sE!" �C yi 5::ry y 6. 8t �y ^ w-Q gi A $ $ $. At A � r 7s' Q Q as_ $ e s - E � .. o ..,- .. ,>,. r� '.An. � �:�: N; p;�s _ �; ��.�.� ..�. � �..�tB a,� ,s,: � 4 ae. ��� '� ,. � ,�:-'r ����:; Y� � � r., ., ..< ;— s - � .�: e s � 4 ® �p s �, � � . nF 9 i :n V ® y� ' ,.,. ,� ' �, a �" .r� a e ,. ,� �, � j �, '�.r-�;'�. � � �� � r.. �. �' _a � �� ,... .. _ �� A � �;, A d., ,R w - .._..- Q, /M1 � � p, d" 11 iv. � �, a ,I� � .. �� ,►;.� � !!! � 4 �'.''� w. � t a "�` � a 6 ffi ,:... .rE �, .::, Nam. � _ q� �:. A� � '� � I �s W � A. i,, D ��} ji#'" r' ,:�' � �... ,�� e `- ,, ^. -.. � .� -- r A:.i .i � �/P- W � � �. n � P, Q ,. �P �, w: �'� .' �at �� � i ��. ®., .. " � ��` � � ... 11`: � � � a, �`, " °; � , ■ r _ R' P � r 8 arW, s qq s � a s. � Y R . M e,' m: M •-'. s O' � a � •'W.r,.p. i GIs @ Jw s 1 � '•- as� UHF �?fficed '1 - 74- ► 62 Here Office: ( eleha e) IAPPROV €Cent:Lauv ep�rr� rit [Tn this fieid,.yau 6s6y enter the electronic fllepath where the,contract has been saved] i CONSULTANT SE WI�t AMEEMENT - (over '.0,U00) i r 1 and tte laws re rdir e" ua 1 unity, o farm to Fde_a ,p The. City,of Dent �s committed,: g � As such all contr curs, ubcontra. tdr end suppliers w.h`a pe�f®rM t�� w��h rel:atiort tc� this Areement Thal°1 cc reply with the,.:,;r gul- �ti n cif he rs q n� c y ept c p c�rtunity pollcies, The dll vuln uestlons �pec�fically ldentlfy the requirements the Ay e s necessary f ar any Contractor, subc,ntra or or supplier on this specific agreement to adhere t, An affirmaV. e rasp®nee is required n alI of the followingu sti ns fc r this , greernent to be v 1id "rid binding. If any contractor, subcontractor car,suppliervillfu.11y Misrepresents themsely with regard tca the d rectiVeS' outlines, it,`' i11 be o'h'id r� a breach cif co tr ct and it w111 a the lty�s seal determintich regarding suspensioncar eringv lcn tr 1I r park o the Agri ant, i The questions are as felldWs': 1 I here reed the'attached i of lien a mini tra ive pulley number 1.2. 2. Curing,the time of this Agreement I w111 nit discri mil'ate to in arm le omen on the basis of , s r , nene crph s�.cal o or natfonaorlgi e allsesEX, race c g i n disabllky= g Curing the tine bf thts greern nt the prime contractor will provide a written statement tc all nUu ernplbyees aid s�bccrractrs lr�.dcatig �rr�rhtr�ent as a 11 n c �rnit employer. 4. During the;time cf the ;�greem nt I.P the prime co tr ctor, �wi11- activeCy .co si er Kirin and promotion of wdrner� and rninoritiess 5s Before accept ice of this Agreement, an adherence state pent uv�l1=en gned �y me,,,-the Prime orstractor, that the Prime Contractor coMpHed with "the rec t� a� set firth a bovei. By signing be low,,; I agree to f Ulfi1,1 the fire;requirements referenced ��nv yv For. Title: ate E t LIA►NCE DOCUMENTS � lUi i E�: .. EEFEMV [ T . January 3 SUBJECT: MINOR.ITY AND OMEN UPE SE®E Aprll , � ONT CTORS , P G ,ED Jim White, �la�or POLICY:. E coal erloyrentportur�ity requirements f®r City of lnt vifl conforrn to federal and state la . 1 l -ontraCtors, suhcontractor-.s, con:su[te is aid su;p;pllers cif tl pity must ,ua me egaa'I employ�raert opportunity within shear` o.� .ar�izat�o� arid, if;holding'Ac�r�ern�nts with, the pity amounting to 1 ,�0t or more Sul h n any given year, rr us t l e h ollo�rin a irrrl ti st R 1e Provide a v�r`ttten statement to all new emp yees end sylc,ontractors indicating cot° rnitrnent as an equal opportunity employer. . fictively consider for promotion and, advancement available' mini-ities and women. Any contractor, subcontractor; Cort sultrtt .or supplier ho 'llFull disrega r 's the ity�s non iscrirr in tior and equal o pdr unit requirements shall b� eonsidered in breach o contract and ub. o suspei sit r� car terminatiwn dr ill or -parry o the r erner� . ContractornplinCe Officers Will be app 'tnted by the irectbrsf Planir�q, Parks and Public Wors t3ertrnents to assume the following duties fir.°their, respective :ep��tn�;ents. 1. Ensurin.g that contractors, sucortracors; consultants, and suppliers sub :ect to these ar ulations are familiar, with the regulations an the ,City's qu: l eMP 90 Me opportunity al icy Monitorin§ to assure adherence to federal, -state and local la s, poli aid -guici:eie's. I EEo co PLIANC DOCUMENT - 2 Exhibit A Fair and Impartial Trainings: Lengths and Costs The lengths and costs for each are: (1) Command 1.5 days, $4700 plus travel costs for one Trainer; (2) Mid-level managers 6 hours, $2000 plus travel costs for one trainer; (3) First line supervisors 5 hours, $3200'plus travel for two trainers; (4) patrol officers 6 hours; $3200 plus travel for two trainers; (5) train-the-trainer 2.5 days, $13,500 plus travel for 2 trainers (estimated at$3000 to$5000 depending on location). The TOT is capped at 25 students; all other programs accommodate up to 30 trainees. EXHIBIT B INSURANCE REQUIREMENTS FOR CONSULTANT SERVICES AGREEMENTS Insurance The Consultant shall procure and maintain for the duration of the Agreement, insurance against claims for injuries to persons or damage to property which may arise from or in connection with the performance of the work hereunder by the Consultant, their agents, representatives, employees or subcontractors. A. Minimum Scope of Insurance Consultant shall obtain insurance of the types described below: 1. Automobile Liability insurance covering all owned, non- owned, hired and leased vehicles. Coverage shall be written on Insurance Services Office (ISO) form CA 00 01 or a substitute form providing equivalent liability coverage. If necessary, the policy shall be endorsed to provide contractual liability coverage. 2. Commercial General`Liability insurance shall be written on ISO occurrence form CG 00 01 and shall cover liability arising from premises, operations, independent contractors, products-completed operations, personal injury and advertising injury, and liability assumed under an insured contract. The Commercial General Liability insurance shall be endorsed to provide the Aggregate Per Project Endorsement ISO form CG 25 03 11 85. There shall be no endorsement or modification of the Commercial General Liability insurance for liability arising from explosion, collapse or underground property damage. The City shall be named as an insured under the Consultant's Commercial General Liability insurance policy with respect to the work performed for the City, using ISO additional` insured endorsement CG 20 10 11 85 or a substitute endorsement providing equivalent coverage. B. Minimum Amounts of Insurance Consultant shall maintain the following insurance limits: 1. Automobile Liability insurance with a minimum combined single limit for bodily injury and property damage of `$1000,000 per accident. 2. Commercial General Liability insurance shall be written with Limits no less than $1,000,000 each occurrence, $1,000000 general aggregate and a $1,000,000 products-completed operations aggregate limit. EXHIBIT B (Continued) C. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions for Automobile Liability and Commercial General Liability insurance: 1. The Consultant's insurance coverage shall be primary insurance as respect the City. Any; Insurance, self-insurance, or insurance pool coverage maintained by the City shall be excess of the Consultant's insurance and shall not contribute with it. - 2. The Consultant's insurance shall be endorsed to state that coverage shall not be cancelled by either party, except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City. 3. The City of Kent shall be named as an additional insured on all policies (except Professional Liability) as respects work performed by or on behalf of the Consultant and a copy of the endorsement naming the City as additional insured shall be attached to the Certificate of Insurance. The City reserves the right to receive a certified copy of all required insurance policies. The Consultant's Commercial General Liability insurance shall also contain a clause stating that coverage shall apply separately to each insured against whom claim is made or suit is brought, except with respects to the limits of the insurer's liability. D. Acceptability of'Insurers Insurance is to be placed with insurers with a current A.M. Best rating of not less than ANII. E. Verification of Coverage Consultant shall furnish the City with original certificates and a copy of the amendatory endorsements, including but notnecessarily limited to the additional insured endorsement, evidencing the insurance requirements of the Consultant before commencement of the work. F. Subcontractors Consultant shall include all subcontractors as insureds under its policies or shall furnish separate certificates and endorsements for each subcontractor. All coverages for subcontractors shall be subject to all of the same insurance requirements as stated herein for the Consultant. NFP PROPERTY & CASUALTY-SVCS/PHS PO BOX 33015 SAN ANTONIO TX 78265 City of Kent Washington Attention: AC Padilla 220 FORTH AVE S KENT WA 98032 I ' ACORD 25(2014/01) JLD DATE(lurnvnn/YYYY) '�-�-�- CERTIFICATE OF LIABILITYINSURANCE R001 5/13/2015 THIS'CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A.CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: POTAN:If the certificate of t h lldeADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATIONIS WAIVED,subject to the terms andpolicy,certa n p 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 NAME: NFP PROPERTY & CASUALTY SVCS/PHS JC°,NN,Ext): (866) 467-8730 FAX (888) 443-6112 185869 P: (866) 467-8730 F (888) 443-6112 ADDRESS: PO BOX 33015 INSURER(S)AFFORDING COVERAGE NAIC# SAN ANTONIO TX 78265 wsURERA: Hartford Casualty, Ins Co 29424 INSURED` wsURERa: Hartford Casualty Ins Co 29424 INSURER C LORIE FRIDELL INSURERD: 17409 HEATHER OAKS PL INSUREREi `TAMPA FL 33647 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 1S SUBJECT TO ALL THE TERMS,EXC4USIONS AND CONDITIONS OF SUCH POLICIES:LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS'. INSR TYPE OFINSURANCE ADDL SUBR POLICYNUMBER POZICYEFF < POZICYEXP LIMITS (MMIDD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,0 00, 0 0 0 CLAIMS-MADE I OCCUR DAMAGE TO RENTED $3 0 0 O O O PREMISES(Ea occurrence) A X General Liab X 72 SBM TV7180 01/04/2015 01/04/2016 MEDEXP(Any one person) $10r 000 PER SONAL&ADV INJURY $1 y 0 0 0',O O Q GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s2,000, 000 , POLICY JECT �PRO LOC PRODUCTS-COMP/OP AGG s2,000, 000 Fx OTHER: $ AUTOMOBILE LIABILITY (Ea acc d COMBINED SINGLE LIMIT $11 O O O/ 000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED A 72 SBM TV7180 01/04/2015 01/04/2016 BODILY INJURY(Per accident) $ AUTOS' AUTOS AUTOS X .HIRED AUTOS X NON-OWNED PROPERTY DAMAGE r accident) $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER OTH AND EMPLOYE RS'LLIBILITY STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.'!EACH ACCIDENT 1100,000 OFFICER/MEMBER EXCLUDED? B (MandatorkInNH) ❑ NIA72 WEC GD3509 02/11/2015 02/11/2016 E.L:IDISEASE-EA EMPLOYEE 1100,000 If yes, E:L.DISEASE-POLICY LIMIT describe under $5 O O DESCRIPTION OF OPERATIONS below i 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured's Operations. The City of Kent Washington is an Additional Insured per Additional Insured-Designated Person/Organization IH1200 attached .to this policy,. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED City of Kent Washington BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attention: AC Padilla AUTHORIZED REPRESENTATIVE 220 FORTH AVE S _.. KENT, WA, 98032 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 1 - THE AC HARTFORD Select Customer Insurance Center 3600 WISEMAN BLVD. SAN'ANTONIO - TX 78251 Policyholder,please call us at: (8 6 6) 4 6 7-8 7 3 0 Agent, please.call us at: (866) 467-8730 SERVICE.TX@THEHARTFORD'.COM J INSURANCE ENDORSEMENT ATTACHED PLEASE REVIEW THE CHANGE ** Enclosed is an endorsement for your business insurance policy..'Please review it at your convenience. if you have questions or need to make further changes: Policyholder,please call us at: (8 6 6) 4 6 7-s 7 3 0 'Agent, please callus at: (8 6 6)', 4 6 7-8 7 3 0 between 7 A.M. and 7 P.M. CENTRAL TIME The premium,billing will be mailed to you separately. You can expect to receive it soon. Thank you for allowing us to service your business needs. NFP PROPERTY & CASUALTY SVCS/PHS THE HARTFORD SELECT CUSTOMER INSURANCE CENTER The Hartford I Hartford Fire Insurance Company and its Affiliates One Hartford Plaza,Hartford,Connecticut 06155 I POLICY NUMBER; 72 SBM TV7180 5 THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN RESPONSE TO THE DISCLOSURE REQUIREMENTS OF.THE TERRORISM RISK INSURANCE ACT. DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT SCHEDULE Terrorism Premium: $3.00 J A. Disclosure Of Premium United States or to influence the policy or In accordance` with the federal Terrorism Risk affect the conduct of the United States Insurance Act, as amended (TRIA), we are required Government by coercion to provide you with a notice disclosing the portion of C. Disclosure Of Federal Share Of Terrorism your premium, if any, attributable to coverage for Losses "certified acts of terrorism" under TRIA. The portion The United States Department of the.Treasury will of your premium attributable to such coverage is reimburse insurers for a portion of insured losses, shown in the Schedule of this endorse ment. as indicated in the table below, attributable to B. The following definition is added with respect to the "certified acts of terrorism"under TRIA that exceeds provisions of this endorsement: the applicable insurer deductible: 1. A"certified act of terrorism"means an act that is Calendar Year Federal Share of : certified by the Secretary of.the Treasury, in Terrorism Losses accordance with the provisions of TRIA, to be an act of terrorism under TRIA. The criteria 2015 85% contained in TRIA for a "certified act of 2016 84% terrorism include the following: 2017 83%: a. The act results I in insured losses in excess of$5 million in the aggregate, attributable to 2018 82%° all types of insurance subject to TRIA;and 2019 81 b. The act results in damage within the United 2020 or later 80% States, or outside the United States in the case of certain air carriers or vessels or the However, if aggregate industry insured losses under premises of an United States mission;and TRIA exceed $100 billion in a calendar year, the c. The act is a violent act or an act that is Treasury shall not make ,any payment for any dangerous to human life, property or portion of the amount of such losses that exceeds infrastructure and is committed by an $100 billion. The United States government has not individual or individuals as part of an.effort charged any premium for their participation in to coerce the civilian population .of the covering terrorism losses. Form.SS 83,76 01 15 Pagel of 2 2015,The Hartford (Includes copyrighted material of the Insurance Services Office,Inc., with its permission.) D. Cap On Insurer Liability for Terrorism Losses If aggregate industry insured losses attributable to "certified acts of terrorism"under TRIA exceed$100 billion in a calendar year and we have met, or will meet,-our insurer deductible under TRIA, we shall not be liable for the payment of any portion of the amount of such losses that exceed $100 billion. In such case, your coverage for terrorism losses may be reduced on a pro-rata basis in accordance with procedures established by the Treasury, based on its estimates of aggregate industry losses and our estimate that we will exceed our insurer deductible. In accordance with the `Treasury's procedures, amounts paid for losses may be subject to further adjustments based on differences between actual losses and estimates. E. Application of Other Exclusions The terms and limitations of any terrorism exclusion, the inapplicability or omission of a terrorism exclusion, or the inclusion of terrorism coverage, do not serve to create coverage for any loss which would otherwise be excluded under this Coverage Form, Coverage Part or Policy. F. All other terms and conditions remain the same. II .: Form SS 83 76 0115 Page 2 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGE This endorsement changes the policy effective on the Inception Date of the policy unless another date is indicated below: Policy Number: 72 SBM TV7180 DX Named Insured and Mailing Address; LORIE FRIDELL 17409 HEATHER OAKS PL. TAMPA FL 33647 Policy Change Effective Date: 05/05/15 Effective hour is the same as stated in the Declarations Page of the Policy. Policy Change Number: 002 Agent.Name: NFP PROPERTY & CASUALTY 'SVCS/PHS Code 185869 POLICY CHANGES: HARTFORD CASUALTY INSURANCE COMPANY ANY CHANGES IN YOUR PREMIUM WILL BE REFLECTED >IN YOUR NEXT BILLING STATEMENT.IF YOU ARE ENROLLED IN REPETITIVE EFT DRAWS FROM YOUR BANK ACCOUNT, CHANGES IN PREMIUM WILL CHANGE FUTURE DRAW AMOUNTS. THIS IS NOT A BILL. ` NO PREMIUM DUE AS OF POLICY CHANGE EFFECTIVE DATE FORM NUMBERS OF ENDORSEMENTS DELETED AT. ENDORSEMENT ISSUE: SS 50 19, 03 12 SS 83 76 03 12 FORM NUMBERS OF ENDORSEMENTS REVISED AT ENDORSEMENT ISSUE IH12001185 ADDITIONAL INSURED PERSON-ORGANIZATION FORM .NUMBERS OF ENDORSEMENTS_ ADDED AT ENDORSEMENT ISSUE: SS 50 19. 01' 15 SS 83' 76 01 15 PRO RATA FACTOR: 1.000 THIS 'ENDORSEMENT -DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN. Form SS 12 1104 05 T Page on, l Process Date: 0 5/06115 Policy Effective Date: 01/04/15 Policy Expiration Date: 01/04/16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM SPECIAL PROPERTY COVERAGE FORM STANDARD PROPERTY COVERAGE FORM UMBRELLA LIABILTY PROVISIONS A. Disclosure Of Federal Share Of Terrorism Losses 2. The act results in damage within the United The United States Department of the Treasury will States, or outside the United States in the case reimburse insurers for a portion of such insured of certain air carriers or vessels or the premises losses, as indicated in the table below that exceeds of an United States mission;and the applicable insurer deductible:.. 3. The act is a violent act or an act that is Calendar Year Federal Share of dangerous to human life, property or Terrorism Losses infrastructure and is committed by an individual or 2015 g5% individuals acting as part of an effort to coerce the civilian population of the United States or to 2016 84%11influence the policy or affect the conduct of the 2017 83% United States Government by coercion. 2018 82% if aggregate industry insured losses attributable to 2019 81 "certified acts of terrorism"under TRIA exceed$100 billion in a;calendar year, and we,have met, or will 2020 or later 80% meet, our insurer deductible under TRIA, we shall not be liable for the payment of any portion of the However, if aggregate industry insured losses, amount of such losses that exceed $100 billion. In attributable to "certified acts of terrorism" under the such case, your coverage for terrorism losses may federal Terrorism Risk Insurance Act, as amended be reduced on a pro-rata basis in accordance with (TRIA), exceed $100 billion in a calendar year, the procedures' established by the Treasury, based on Treasury shall not make any 'payment for any its estimates of aggregate industry losses and our portion of the amount of such losses that exceeds estimate that we will exceed our insurer deductible. $100 billion. The United States government has not In accordance with` the Treasury's, procedures, charged any premium for their participation in amounts paid for losses may be subject to further covering terrorism losses. adjustments based on differences between actual B. Cap On Insurer Liability for Terrorism Losses losses and 'estimates. A "certified act of terrorism" means an act that is C. Application Of Exclusions certified by the.. Secretary.. of the Treasury, in The terms and limitations of any.terrorism exclusion, accordance.with the provisions of`federal Terrorism the inapplicability or omission of a terrorism Risk Insurance Act, to be an act of terrorism under TRIA. The criteria contained in TRIA for a "certified exclusion, or the inclusion of terrorism coverage, do not serve to create coverage for any loss which act of terrorism"include the following: would otherwise be excluded under this Coverage 1 The act results in insured losses in excess of$5 Form or Policy, such as losses excluded by the million in the aggregate, attributable to all types Pollution Exclusion,::.Nuclear Hazard Exclusion and of insurance subject to TRIA ; and 1 � the War And Military Action Exclusion. Form SS 5019 01 15 Page 1 of 1 ©2015, The Hartford (Includes copyrighted material of Insurance Services Office, Inc.with its permission) POLICY NUMBER: 72 SBM TV7180 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PERSON-ORGANIZATION CITY OF SACRAMENTO POLICE DEPARTMENT) 915 I STREET SACRAMENTO', CA 95814 LOC 001 BLDG 001 CITY OF KENT WASHINGTON ATTENTION: AC PADILLA 220 FORTH AVENUE SOUTH, KENT, WA 98032 Form 1H 12 00 11 85 T SEQ.NO. 005 Printed in U.S.A. Page 001 Process Date: 05/06/15 Expiration Date: 01/04/16 ,RE"`UEJ4 KENTPlease Fill i`r, A.11 Applicak le loxes W A 5 H I N G T O NEN .. : . Routin information AtTHE g RE VESTS MUS ���sr E. tlrEm l iqR UGH originator: �C� — /' u Phanej,C)riginator be.Sent: �S /w Date Required; Return Signed f�ocument to: �d�i� �' _ o1cC CONTRA Y TERtlr �l0i, itJi\lID TF: j / _ `�#i� l�'�D��� NAME: � 3 DATE`OF �'.��lJf�C �IPRR�O`bi�►C..:. V l3'0 e . �lrif>f Fx lanation of Document r t� 0 . l lS a• �'G T'r4c t v� CUV S {�U c. 4.�/-G�O olu V1vuSG vA I "ve I vcit 1� rtv C,uw 'J tO (� I � I ' , t ABA' 6 tea, is Must Be Routed Througe the La 1JetZ rt rat I - (This Area to be'Com 'Ieted,8 the:Law De 'ji tmen.t`` I� P Y F J i I� Received: ,� royal of haw DePt.: VE'D ' pp , Law i=�ept. Comments: Y x f KENT �. Date,For to le�layor:` f Shaded Are as, I3 s o e Cosnplete�(by Adrninistratron Staff ,{ l�.e.Ct3 nl tT1e ��a r n n tG 5 & Comments. �. r. } ! Y C g v E £'s � cis r € �t £ 3 € f� 4 z. .�. 3 fi 5, 2. 9 qua 3 Y b £ } £ # 3 t # S 3 ? f I I lage5870 3/05