HomeMy WebLinkAboutPW15-128 - Change Order - #1 - Motors and Controls Corporation - MCC Replacement at Clark Springs - 06/30/2015 i
r
Records M r � sg����� �, a� �g �� ,
{ " eme�
KENT
W/.9HINOTON Document�'�j£
i4 p iA` dX A`.
r
CONTRACT COVER SHEET
This is to be completed by the Contract Manager prior to submission
to City Clerks Office. All portions are to be completed.
If you have questions, please contact City Clerk's Office.
Vendor Name: Motors and Controls Corporation
Vendor Number:
)D Edwards Number
Contract Number: CAN'V - !1 1?-,(-- 060-
This is assigned by City Clerk's Office
Project Name: MCC Replacement at Clark Springs
Description: ❑ Interlocal Agreement ® Change Order ❑ Amendment ❑ Contract
❑ Other:
Contract Effective Date: 6/30/15 Termination Date: 12/31/15
Contract Renewal Notice (Days):
Number of days required notice for termination or renewal or amendment
Contract Manager: Kevin Swinford Department: Operations
Contract Amount: $5,841.82
Approval Authority: (CIRCLE ONE) Department Director Mayor City Council
Detail: (i.e. address, location, parcel number, tax id, etc.):
Motors and Controls Corporation shall replace the Motor Control Center at Clark Springs,
AS o9/27/1
I
KENT
WPSMINGT ON
CHANGE ORDER NO. 1
i
NAME OF CONTRACTOR: Motors and Controls Corporation ("Contractor")
CONTRACT NAME & PROJECT NUMBER: MCC Replacement at Clark Springs
ORIGINAL CONTRACT DATE: 4/1/15
This Change Order amends the above-referenced contract; all other provisions of the
contract that are not inconsistent with this Change Order shall remain in effect. For valuable
consideration and by mutual consent of the parties, the project contract 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, Contractor shall provide all labor, materials, and
equipment necessary to:
The Scope of Work remains the same, however a change order is
needed to extend the time of completion to December 31, 2015.
2. The contract amount and time for performance provisions of Section II "Time of
Completion," and Section III, "Compensation," are hereby modified as follows:
Original Contract Sum, $5,841.82
(including applicable alternates and
WSST)
Net Change by Previous Change Orders $N/A
(incl. applicable WSST)
Current Contract Amount $5,841.82
(incl. Previous Change Orders)
Current Change Order $0
Applicable WSST Tax on this Change $0
Order
Revised Contract Sum $5,841.82
Original Time for Completion 6130115
(insert date)
Revised Time for Completion under N/A
prior Change Orders
(insert date)
Days Required (f) for this Change 184 calendar days
Order
Revised Time for Completion 12/31/15
(insert date)
In accordance with Sections 1-04.4 and 1-04.5 of the Kent and WSDOT Standard
Specifications, and Section VII of the Agreement, the Contractor accepts all requirements of this
Change Order by signing below. Also, pursuant to the above-referenced contract, Contractor
agrees to waive any protest it may have regarding this Change Order and acknowledges and
accepts that this Change Order constitutes final settlement of all claims of any kind or nature
arising from or connected with any work either covered or affected by this Change Order,
including, without limitation, claims related to contract time, contract acceleration, onsite or
home office overhead, or lost profits. This Change Order, unless otherwise provided, does not
relieve the Contractor from strict compliance with the guarantee and warranty provisions of the
original contract, particularly those pertaining to substantial completion date.
All acts consistent with the authority of the Agreement, previous Change Orders (if any),
and this Change Order, prior to the effective date of this Change Order, are hereby ratified and
affirmed, and the terms of the Agreement, previous Change Orders (if any), and this Change
Order 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 contract modification, which is binding on the parties of this
contract.
3. The Contractor will adjust the amount of its performance bond (if any) for this
project to be consistent with the revised contract sum shown in section 2, above.
IN WITNESS, the parties below have executed this Agreement, which will
become effective on the last date written below.
CONTRACTOR: CITY OF KENT:
frp
By: By:
(signature) (signature)
Print Name �s�w;�.r ��: Print Name PN 1:;= e4 . 1:R06K
Its P; zS; Its c 6r_a;n (7"dv ;` 7a'rv':tf'Pz
DATE:- 15e DATE:_
ExHIBITA
Scope of Work,
MCC to have custom sized backpan made to City of Kent.measurements.
MCC will mount and wire new soft start, control relays,main circuit
breaker, and any new control components required to interface the soft start
with existing cover control and feedback to SCADA system. MCC will
modify main breaker mounting on backpan to insure alignment with existing
disconnect mechanism after relocation of the backpan. All connections to
existing cover control will be wired to the backpan with a pigtail of
sufficient length to make terminations on the door during installation by
COK personnel. They will be labeled per generated wiring diagram. MCC
will design and create a new schematic for all of the above. One day of
start-up services is included after installation is complete. Backpan will be
UL/ETL labeled.
II
EXHIBIT B
INSURANCE REQUIREMENTS FOR
SERVICE CONTRACTS
Insurance
The Contractor 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 Contractor, their agents, representatives, employees or
subcontractors.
A. Minimum Scope of Insurance
Contractor shall obtain insurance of the types described below:
1. 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 City shall be named as an insured under the
Contractor'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.
2. 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.
3. Workers' Compensation coverage as required by the
Industrial Insurance laws of the State of Washington.
B. Minimum Amounts of Insurance
Contractor shall maintain the following insurance limits:
1. Commercial General Liability insurance shall be written with
limits no less than $2,000,000 each occurrence, $2,000,000
general aggregate and a $2,000,000 products-completed
operations aggregate limit.
2. Automobile Liability insurance with a minimum combined
single limit for bodily injury and property damage of
$2,000,000 per accident.
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 Contractor'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 Contractor's insurance and
shall not contribute with it.
2. The Contractor'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 contractor 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 Contractor'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
Contractor shall furnish the City with original certificates and a copy of the
amendatory endorsements, including but not necessarily limited to the
additional insured endorsement, evidencing the insurance requirements of
the Contractor before commencement of the work.
F. Subcontractors
Contractor 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 Contractor.
MOTOR-2 OF ID; DB
ACt7/e®' CERTIFICATE OF LIABILITY INSURANCE DATE/3012(MMM 0 1 6 )
��- 03(30l2016
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 pollcy(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 endorsements,
PRODUCER cxAorNBracT Michael J Nichols CIC CRM
Redmond General Insurance Agcy PHONE Eat426-886-2283 a
PO Box 847 c xo:426-885-6631
°
Redmond,WA 98073-0847 aoo Iiss•
Michael J Nichols,CIC,CRM
INSURER($)AFFORDING COVERAGE NATO/
wsuR A to lAmerican Fire&casualty Co
INSURED Motors&Controls Corp. INSURER 0:Ohio Casualty Insurance Cc 24074
Brian Friedle INSURERC:
8030 South 222nd Street
Kent,WA 98032 INSURER D;
INSURER E;
14 RERP:
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.
INSft TYPE OF INSURANCE POLICYNUMBER MIDC MMIUD LIMITS
LLA TO
MERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE �OCCUR X X BKA66366982 11101/2014 11/01/2015 p e $ 1,000,000
MED EXP one person $ 16,000
X StO P Gap PERSONAL&ADV IN)URY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY❑JECT LOG PRODUCTS-COMPJOP AGO $ 2,000,000
OTHER: $
COMBINED SINGLE LIMIT $ 1,000,000
AUTOMOBILE LIABILITY ae IJ nQ
A X ANYAUTO BAA66366982 11/0112014 1110112016 BODILY INJURY(Perperwn) $
ALLOWNED
NED SCHEDULED BODILY INJURY(Per accident) $
X HIRED AUTOS X NON-0WNED PROPERTY AMAGE $
AUTOS are
$
X UMBRELLA UAS X OCCUR EACH OCCURRENCE $ 2,000,000
B EXCESS ME CLAIMSbtADE US056366982 11/01/2014 1110112016 AGGREGATE $ 200,000
DED X RETENTION$ 0 $
WORKERS COMPENSATION PER
AND EMPLOYERS'LIABILITY �tI CORTH
A ANY PROPRIETOR,PARTNERIEXECUTIVE Y!� NIA 13KA66366982 11/01/2014 1110112016 E.L.EACH ACCIDENT $ 1,000,000
OFFICE"EMBER EXCLUDED? �LUJI
�Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,00
f199 deacdce under
OSGIRIP ON OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1000,00
DESCRIPTION OF OPERATION$r LOCATIONS I VEHICLES(ACORD 101,ASElttanal Ramaks Sohadule,may be attached It more space is required)
Kent Public Works Is Included as an additional Insured er written
contract,and Waiver of Subrogation applies perform C988100413 attached.
CERTIFICATE HOLDER CANCELLATION
KENT•01
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Kent Public Works ACCORDANCE WITH THE POLICY PROVISIONS.
220 4th Ave S
Kent,WA 98032 AUUTTHHOORRMEEDD REPRESENTATIVE
��•jP^'^— iMbarlf_glelee
®1988.2014 ACORD CORPORATION. All rights reserved. ,
ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD
Coverage to wovldatl In: K ibmb5696,6g 62
Yd�0,1' ! American Flre.and beau.?Ity Cvm any .. i 1
TA-Mutual. Palley Period:
INBURAaaa From 11/0112914 To 11/01/2015
Common Policy Declarations 12:01 am Standard Time
at Insured Malling Location
Named Insured Agent;
MOTORS AND CONTROLS CORP (425)485-9552
REDMOND GENERAL INSURANCE AGENCY
DBA BRUNNI-COLBATH
SIM POLICY FORMS AND ENDORSEMENTS - CONTINUED
This section lists all of the Forms and Endorsements for your policy. Refer to these documents as needed for
detailed Information concerning your coverage.
FORM @gMBEII. TITLE
Pon CO 80 08 10 09 Employee Benefits Liability Coverage Form
CO 84 94 12 08 Exolusion Consolidated Insurance Programs Wrap-Up
R4 99 b8 09 A1oa'Cienulatlan Liublllty Limi. Same o urrence
('CG 88 ID 04 13 Commercl41 General iLlal0k *1 Extension
CO-88 77 12 OS Medical Expense At Your Request Endorsement
CO 89 27 10 09 Washington Exclusion -Asbestos
CP 00 10 04 02 Building and Personal Property Coverage Form
b CP 00 30 04 02 Business Income(and Extra Expense)Coverage Form
CP 00 9007 88 Commercial Property Conditions
CP Ol 26 0108 Washington Changes _
CP 0140 07 06 Exclusion of Loss Due to Virus or Bacteria
CP Ol 60 12 98 Washington Changes -Domestic Abuse I
CP 04 05 04 02 Ordinance or Law Coverage
CP 10 30 04 02 Causes of Loss -Special Form
CP 12 18 08 88 Loss Payable Provisions - Washington j
CP 72 97 04 02 Equipment Breakdown Enhancement Endorsement -Special Form
CP 73 07 02 08 Business Income Coverage -Actual Loss Sustained
CP 88 00 07 10 Property Extension Endorsement
g CP 99 93 10 90 Tentative Rate
a IL 0123 11 13 Washington Changes-Defense Costs
IL 0146 08 10 Washington Common Policy Conditions
IL 0157 07 02 Washington Changes -Actual Cash Value
A IL 0173 07 02 Washington Changes -Excluded Causes of Loss
IL 0198 09 08 Nuclear Energy Liability Exclusion Endorsement (Broad Form)
IL 09 35 07 02 Exclusion of Certain Computer-Related Losses -
IL 09 52 03 08 Cap on Losses From Certified Acts of Terrorism
IL 09 96 0107 Conditional Exclusion of Terrorism Involving Nuclear, Biological or Chemical
Terrorism (Relating to Dispostlon of Federal Terrorism Risk Insurance Act)
IL 88 24 01 12 Washington Conditional Exclusion of Terrorism- Involving Nuclear, Biological or
Chemical Terrorism (Relating to Disposition of Federal Terrorism Risk Insurance
Act)
To report a claim, call your Agent or 1.000-362.0000
DS 70 210108
1af2Bl14 1B2B69B1 MINUS 255 NCAOPPNO INSURED COPY 002582 PASS 29 OF 160
Coverage Is Provided In: Policy Number
Libexty Amerlosn F(re end Casu�ll ,Company BAA (15) 50 365962
iVluttt 1. 0
1Na` uaexoT' from 11101(2014 To 11/01/2015
Common Policy Declarations 12:01 am standard Time
at Insured Meiling Location
Named Insured
MOTORS AND CONTROLS CORP (425)485-9552
REDMOND GENERAL INSURANCE AGENCY
DBA BRUNNI-COLBATH
POLICY FORMS AND ENDORSEMENTS
This section lists the Forms and Endorsements for your policy. Refer to these documenis as needed for detailed
Information concerning your coverage.
FORM NUMBER TITLE
AC 00 31 01 14 Changes In Your Policy
CA 00 0103 06 Business Auto Coverage Form
CA 0135 0109 Washington Changes '.
CA 21 34 01 08 Washington Underinsured Motorists Coverage
CA 23 93 01 06 Washington Exclusion of Terrorlsm Involving Nuclear, Biological or Chemical
Terrorism
CA 85 47 12 93 Temporary Substitute Auto -Physical Damage Insurance - '........
CA 85 53 12 93 Recreational Trailers and Boat Trailers
/.. 5 06 13 P itva. r Seem la [)ndta os)exclusion...
/ a g to Oi 10 [3usiness Auto CoVemBa Enhancement Endorsement
CA 99 03 03 06 Auto Medical Payment Coverage
IL 0123 it 13 Washington Changes -Defense Costs
IL 0146 08 10 Washington Common Policy Conditions
IL 01 98 09 08 Nuclear Energy Liability Exclusion Endorsement (Broad Form)
s
n
p
In witness whereof, we have caused this policy to be signed by our authorized officers.
t )L 9. '
dam-
Dexter Logg ttt Paul Condrin
Secretary President
" ��ama�nrrrafara��i
To report a claim, call yourAgenr or 1-900-302,0000
DS 70 210108
10/28/14 56065982 N0108648 235 NCAOPPNO INSURER COPY 002584 PAGE 12 OF 64
i
COMMERCIAL GENERAL LIABILITY
CG 88 10 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL GENERAL LIABILITY EXTENSION
This endorsement modifies Insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
I
INDEX
SUBJECT PAGE
s NON-OWNED AIRCRAFT 2
„ ® NON-OWNED WATERCRAFT 2
PROPERTY DAMAGE LIABILITY-ELEVATORS 2
EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) 2
MEDICAL PAYMENTS EXTENSION 3
EXTENSION OF SUPPLEMENTARY PAYMENTS -COVERAGES A AND B 3
3 ADDITIONAL INSUREDS -BY CONTRACT, AGREEMENT OR PERMIT 3
PRIMARY AND NON-CONTRIBUTORY- ADDITIONAL INSURED EXTENSION 8
ADDITIONAL INSUREDS -EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE" 6
WHO IS AN INSURED -INCIDENTAL MEDICAL ERRORSIMALPRACTICE AND WHO IS AN
INSURED -FELLOW EMPLOYEE EXTENSION -MANAGEMENT EMPLOYEES 6
NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES 7
FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES 7
KNOWLEDGE OF OCCURRENCE, OFFENSE,CLAIM OR SUIT 7
t
LIBERALIZATION CLAUSE 7
BODILY INJURY REDEFINED 7
EXTENDED PROPERTY DAMAGE 8
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - 8
WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU
® 2013Liberty Mutual Insurance
CG 88 10 04 13 Includes copyrighted material of Insurance services Office,Inc.,with Its permission. Page 1 of 8
With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by
the endorsement,
A. NON-OWNED AIRCRAFT
Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability,
exclusion g.Aircraft, Auto Or Watercraft does not apply to an aircraft provided:
1. It is not owned by any Insured;
2. It is hired, chartered or loaned with a trained paid crew;
3. The pilot in command holds a currently effective certificate, Issued by the duly constituted authority of
the United States of America or Canada, designating her or him a commercial or airline pilot; and
4. It is not being used to carry persons or property for a charge.
However, the Insurance afforded by this provision does not apply If there Is available to the insured other
valid and collectible Insurance, whether primary, excess (other than Insurance written to apply specifically
in excess of this policy), contingent or on any other basis, that would also apply to the loss covered under
this provision.
B. NON-OWNED WATERCRAFT
Under Paragraph 2. Exclusions of Section I-Coverage A-Bodily Injury And Property Damage Liability,
Subparagraph (2) of exclusion g.Aircraft, Auto Or Watercraft Is replaced by the following:
This exclusion does not apply to:
(2) A watercraft you do not own that Is:
(a) Less than 62 feet long; and
(b) Not being used to carry persons or property for a charge.
C. PROPERTY DAMAGE LIABILITY-ELEVATORS
1, Under Paragraph 2. Exclusions of Section I -Coverage A- Bodily Injury And Property Damage Llabll-
Ity, Subparagraphs (3), (4) and (6) of exclusion J. Damage To Properly do not apply If such 'property
damage" results from the use of elevators. For the purpose of this provision, elevators do not Include
vehicle lifts. Vehicle lifts are lifts or hoists used in automobile service or repair operations.
2. The following Is added to Section IV - Commercial General Liability Conditions, Condition 4. Other
Insurance, Paragraph b. Excess Insurance:
The Insurance afforded by this provision of this endorsement is excess over any property Insurance,
whether primary, excess, contingent or on any other basis.
D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage)
s
c If Damage To Premises Rented To You Is not otherwise excluded from this Coverage Part: I
1. Under Paragraph 2.Exclusions of Section i-Coverage A-Bodily Injury and Property Damage Liability:
a. The fourth from the last paragraph of exclusion J. Damage To Property Is replaced by the follow-
n Ing:
Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage
by fire, lightning, explosion, smoke, or leakage from an automatic fire protection system) to:
(1) Premises rented to you for a period of 7 or fewer consecutive days; or
(it) Contents that you rent or lease as part of a premises rental or lease agreement for a period of
more than 7 days.
Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" to contents of
premises rented to you for a period of 7 or fewer consecutive days.
A separate limit of Insurance applies to this coverage as described In Section III - Limits of
Insurance.
® 20131-Iberty Mutual Insurance
CG 88 10 04 13 Includes copyrighted material of Insurance Services Office,Inc.,wlth Its permission. Page 2 of 8
b. The last paragraph of subsection 2.Exclusions Is replaced by the following:
Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke or leakage
from automatic fire protection systems to premises while rented to you or temporarily occupied by
you with permission of the owner. A separate limit of insurance applies to Damage To Premises
Rented To You as described In Section III -Limits Of Insurance.
2. Paragraph 6. under Section III-Limits Of Insurance Is replaced by the following:
6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will
a n y under
Coverage
premise:A for damages because of"property damage" to:
s
(1) While rented to you; or
(2) While rented to you or temporarily occupied by you with permission of the owner for
damage by fire, lightning, explosion, smoke or leakage from automatic protection sys-
tems; or
b. Contents that you rent or lease as part of a premises rental or lease agreement.
MM 3. As regards coverage provided by this provision D. EXTENDED DAMAGE TO PROPERTY RENTED TO
YOU (Tenant's Property Damage) -Paragraph 9.a. of Definitions Is replaced with the following:
a 9.a. A contract for a lease of premises. However, that portion of the contract for a lease of premises
that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, or
leakage from automatic fire protection systems to premises while rented to you or temporarily
occupied by you with the permission of the owner, or for damage to contents of such premises
that are Included in your premises rental or lease agreement, is not an"insured contract".
E. MEDICAL PAYMENTS EXTENSION
If Coverage C Medical Payments Is not otherwise excluded, the Medical Payments provided by this policy
are amended as follows:
Under Paragraph 1. Insuring Agreement of Section I-Coverage C-Medical Payments, Subparagraph
(b) of Paragraph a. is replaced by the following:
(b) The expenses are Incurred and reported within three years of the date of the accident; and
F. EXTENSION OF SUPPLEMENTARY PAYMENTS -COVERAGES A AND B
1. Under Supplementary Payments -Coverages A and B,Paragraph 1.b. Is replaced by the following:
b. Up to $3,000 for cost of ball bonds required because of accidents or traffic law violations arising
out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have
to furnish these bonds.
a 2. Paragraph 1.d. Is replaced by the following:
d. All reasonable expenses Incurred by the Insured at our request to assist us in the Investigation or
defense of the claim or "suit", Including actual loss of earnings up to $500 a day because of time
off from work.
z G. ADDITIONAL INSUREDS -BY CONTRACT, AGREEMENT OR PERMIT
1. Paragraph 2. under Section 11 -Who Is An Insured is amended to Include as an Insured any person or
organization whom you have agreed to add as an additional Insured In a written contract, written
agreement or permit. Such person or organization Is an additional Insured but only with respect to
liability for "bodily Injury", "property damage" or "personal and advertising Injury" caused in whole
or In part by:
a. Your acts or omissions, or the acts or omissions of those acting on your behalf, In the performance
of your on going operations for the additional Insured that are the subject of the written contract or
written agreement provided that the "bodily injury" or "property damage" occurs, or the "per-
sonal and advertising Injury" Is committed, subsequent to the signing of such written contract or
written agreement; or
® 2013 Liberty Mutual Insurance
CG 88 10 04 13 Includes copyrighted material of Insurance Services Office,Inc.,with Its permission. Page 3 of 8 �
I
b. Premises or facilities rented by you or used by you; or
c, The maintenance, operation or use by you of equipment rented or leased to you by such person or
organization; or
d. Operations performed by you or on your behalf for which the state or political subdivision has
Issued a permit subject to the following additional provisions:
(1) This insurance does not apply to "bodily injury", "property damage", or "personal and ad-
vertising injury" arising out of the operations performed for the state or political subdivision;
(2) This insurance does not apply to "bodily Injury" or "property damage" Included within the
"completed operations hazard".
(3) Insurance applies to premises you own, rent, or control but only with respect to the following
hazards:
(a) The existence, maintenance, repair, construction, erection, or removal of advertising
signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees,
hoist away openings, sidewalk vaults, street banners, or decorations and similar expo-
sures; or
(b) The construction, erection, or removal of elevators; or
(c) The ownership, maintenance, or use of any elevators covered by this Insurance.
However:
1. The Insurance afforded to such additional Insured only applies to the extent permitted by law; and
2. If coverage provided to the additional Insured Is required by a contract or agreement, the Insur-
ance afforded to such additional insured will not be broader than that which you are required by
the contract or agreement to provide for such additional insured.
With respect to Paragraph 1.a. above, a person's or organization's status as an additional Insured
under this endorsement ends when:
(1) All work, Including materials, parts or equipment furnished In connection with such work, on
the project (other than service, maintenance or repairs) to be performed by or on behalf of the
additional Insured(s) at the location of the covered operations has been completed; or
(2) That portion of "your work" out of which the Injury or damage arises has been put to its
Intended use by any person or organization other than another contractor or subcontractor
engaged In performing operations for a principal as a part of the same project.
With respect to Paragraph 1.b. above, a person's or organization's status as an additional Insured
under this endorsement ends when their written contract or written agreement with you for such
premises or facilities ends.
x
� With respects to Paragraph 1.c. above, this insurance does not apply to any "occurrence" which takes
place after the equipment rental or lease agreement has expired or you have returned such equipment
to the lessor.
x The Insurance provided by this endorsement applies only If the written contract or written agreement
Is signed prior to the "bodily injury" or "property damage".
We have no duty to defend an additional insured under this endorsement until we receive written
notice of a "suit" by the additional Insured as required In Paragraph b. of Condition 2. Duties In the
Event Of Occurrence, Offense, Claim Or Suit under Section IV -Commercial General Liability Condi•
tions.
i
i
® 2013 Liberty Mutual Insurance
CG 88 10 04 13 Includes copyrighted material of Insurance Services Office,Inc.,wlth Its permission. Page 4 of 8
2. With respect to the Insurance provided by this endorsement, the following are added to Paragraph 2.
Exclusions under Section 1-Coverage A-Bodily Injury And Property Damage Liability:
This Insurance does not apply to:
a. "Bodily Injury" or"property damage" arising from the sole negligence of the additional insured.
b. "Bodily Injury" or "property damage" that occurs prior to you commencing operations at the
location where such "bodily Injury" or"property damage" occurs.
I
c. "Bodily Injury", "property damage" or "personal and advertising injury" arising out of the render-
Ing of, or the failure to render, any professional architectural, engineering or surveying services,
Including:
(1) The preparing, approving, or falling to prepare or approve, maps, shop drawings, opinions,
reports, surveys, field orders, change orders or drawings and specifications; or
(2) Supervisory, Inspection, architectural or engineering activities.
This exclusion applies even If the claims against any Insured allege negligence or other wrongdoing in
the supervision, hiring, employment, training or monitoring of others by that Insured, if the "occur-
rence" which caused the "bodily Injury" or "property damage", or the offense which caused the
�—� "personal and advertising Injury", involved the rendering of, or the failure to render, any professional
e , architectural, engineering or surveying services.
® d. "Bodily injury" or "property damage" occurring after:
(1) All work, Including materials, parts or equipment furnished in connection with such work, on
the project (other than service, maintenance or repairs) to be performed by or on behalf of the
additional Insured(s) at the location of the covered operations has been completed; or
(2) That portion of "your work" out of which the Injury or damage arises has been put to Its
Intended use by any person or organization other than another contractor or subcontractor
engaged In performing operations for a principal as a part of the same project.
e. Any person or organization specifically designated as an additional Insured for ongoing operations
by a separate ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS endorsement Is-
sued by us and made a part of this policy.
3. With respect to the Insurance afforded to these additional Insureds, the following Is added to Section IIi
-Limits Of Insurance:
If coverage provided to the additional Insured Is required by a contract or agreement, the most we will
pay on behalf of the additional insured Is the amount of insurance:
a. Required by the contract or agreement; or
b. Available under the applicable Limits of Insurance shown In the Declarations;
R whichever Is less.
This endorsement shall not Increase the applicable Limits of Insurance shown In the Declaratio ns.
H. PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED EXTENSION
This provision applies to any person or organization who qualifies as an additional Insured under any form
or endorsement under this policy.
Condition 4. Other Insurance of SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS is amend-
ed as follows:
a. The following is added to Paragraph a.Primary Insurance:
If an additional Insured's policy has an Other Insurance provision making Its policy excess, and you
have agreed in a written contract or written agreement to provide the additional Insured coverage on a
primary and noncontributory basis, this policy shall be primary and we will not seek contribution from
the additional Insured's policy for damages we cover.
C 2013 Liberty Mutual Insurance
CG 88 10 04 13 Includes copyrighted material of Insurance Services Office,Inc;,with Its permission. Page 5 of 8
I
b. The following Is added to Paragraph b. Excess Insurance:
When a written contract or written agreement, other than a premises lease, facilities rental contract or
agreement, an equipment rental or lease contract or agreement, or permit Issued by a state or political
subdivision between you and an additional Insured does not require this Insurance to be primary or
primary and non-contributory, this Insurance Is excess over any other insurance for which the addi-
tional insured Is designated as a Named Insured.
Regardless of the written agreement between you and an additional insured, this Insurance Is excess
over any other Insurance whether primary, excess, contingent or on any other basis for which the
additional Insured has been added as an additional insured on other policies.
I. ADDITIONAL INSUREDS -EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE"
This provision applies to any person or organization who qualifies as an additional Insured under any form
or endorsement under this policy.
1. The following Is added to Condition 2. Duties In The Event Of Occurrence, Offense, Claim or Suit:
An additional Insured under this endorsement will as soon as practicable:
a. Give written notice of an "occurrence" or an offense that may result in a claim or "suit" under
this Insurance to us;
b. Tender the defense and Indemnity of any claim or "suit" to all Insurers whom also have
Insurance available to the additional insured; and
c. Agree to make available any other Insurance which the additional Insured has for a loss we
cover under this Coverage Part.
d. We have no duty to defend or Indemnify an additional Insured under this endorsement until
we receive written notice of a"suit" by the additional Insured.
2. The limits of Insurance applicable to the additional Insured are those specified in a written contract
or written agreement or the limits of Insurance as stated In the Declarations of this policy and
defined In Section III - Limits of Insurance of this policy, whichever are less. These limits are
inclusive of and not in addition to the limits of Insurance available under this policy.
J. WHO IS AN INSURED -INCIDENTAL MEDICAL ERRORS/MALPRACTICE
WHO IS AN INSURED -FELLOW EMPLOYEE EXTENSION -MANAGEMENT EMPLOYEES
Paragraph 2.a.(1) of Section II-Who Is An Insured Is replaced with the following:
(1) "Bodily Injury" or"personal and advertising Injury":
(a) To you, to your partners or members (if you are a partnership or joint venture), to your members (If
you are a limited liability company), to a co-"employee" while In the course of his or her employ-
ment or performing duties related to the conduct of your business, or to your other "volunteer
workers" while performing duties related to the conduct of your business;
(b) To the spouse, child, parent, brother'or sister of that co-"employee" or "volunteer worker" as a
consequence of Paragraph (1) (a) above;
s (c) For which there is any obligation to share damages with or repay someone else who must pay
damages because of the Injury described In Paragraphs (1) (a) or(b) above; or
(d) Arising out of his or her providing or failing to provide professional health care services. However,
if you are not in the business of providing professional health care services or providing profes-
sional health care personnel to others, or If coverage for providing professional health care ser-
vices Is not otherwise excluded by separate endorsement, this provision (Paragraph (d)) does not
apply.
Paragraphs (a) and (b) above do not apply to "bodily Injury" or"personal and advertising injury" caused by
an "employee" who Is acting in a supervisory capacity for you. Supervisory capacity as used herein means
the "employee's" job responsibilities assigned by you, Includes the direct supervision of other "employ-
ees" of yours. However, none of these "employees" are Insureds for "bodily Injury" or "personal and
® 20131-lberty Mutual insurance
CG 88 10 04 13 Includes copyrighted material of insurance Services Office,Inc.,wlth Its permission. Page 6 of 8
�I
advertising Injury" arising out of their willful conduct, which is defined as the purposeful or willful intent to
cause "bodily Injury" or "personal and advertising injury", or caused in whole or in part by their Intoxlca-
tion by liquor or controlled substances.
The coverage provided by provision J.Is excess over any other valid and collectable Insurance available to
your "employee".
K. NEWLY FORMED ORADDITIONALLY ACQUIRED ENTITIES
Paragraph 3. of Section If-Who Is An Insured is replaced by the following:
3. Any organization you newly acquire or form and over which you maintain ownership or majority
Interest, will qualify as a Named Insured if there Is no other similar insurance available to that
organization. However:
a. Coverage under this provision is afforded only until the expiration of the policy period in
which the entity was acquired or formed by you;
b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you
acquired or formed the organization; and
12 ISM
c. Coverage B does not apply to "personal and advertising Injury" arising out of an offense
WN committed before you acquired or formed the organization.
d. Records and descriptions of operations must be maintained by the first Named Insured.
Iiiiiam
$ No person or organization Is an Insured with respect to the conduct of any current or past partnership, joint
venture or limited liability company that is not shown as a Named Insured in the Declarations or qualifies
as an Insured under this provision.
now
L. FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES
Under Section IV -Commercial General Liability Conditions, the following is added to Condition 6. Repre-
sentations:
fi Your failure to disclose all hazards or prior "occurrences" existing as of the Inception date of the policy
shall not prejudice the coverage afforded by this policy provided such failure to disclose all hazards or
prior "occurrences" Is not intentional.
M. KNOWLEDGE OF OCCURRENCE, OFFENSE,CLAIM OR SUIT
Under Section IV -Commercial General Liability Conditions, the following is added to Condition 2. Duties
In The Event of Occurrence, Offense, Claim Or Suit:
Knowledge of an "occurrence", offense, claim or "suit" by an agent, servant or "employee" of any
Insured shall not In Itself constitute knowledge of the Insured unless an Insured listed under Paragraph
1. of Section 11 -Who Is An Insured or a person who has been designated by them to receive reports of
"occurrences", offenses, claims or "suits" shall have received such notice from the agent, servant or
"employee".
x
N. LIBERALIZATION CLAUSE
If we revise this Commercial General Liability Extension Endorsement to provide more coverage without
additional premium charge, your policy will automatically provide the coverage as of the day the revision is
effective In your state.
0. BODILY INJURY REDEFINED
Under Section V-Definitions, Definition 3. Is replaced by the following:
3. "Bodily Injury" means physical Injury, sickness or disease sustained by a person. This Includes
mental anguish, mental Injury, shock, fright or death that results from such physical Injury, sick-
ness or disease.
® 2013Liberty Mutual insurance
CG 88 10 04 13 Includes copyrighted material of Insurance Services Office,Inc.,wilh Its permission. Page 7 of 8
P. EXTENDED PROPERTY DAMAGE
Exclusion a, of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY is replaced by the
following:
a. Expected Or Intended Injury
"Bodily Injury" or "property damage" expected or Intended from the standpoint of the insured.
This exclusion does not apply to "bodily Injury" or 'property damage" resulting from the use of
reasonable farce to protect persons or property.
Q. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - WHEN REQUIRED IN A
CONTRACT OR AGREEMENT WITH YOU
Under Section IV - Commercial General Liability Conditions, the following Is added to Condition 8. Trans-
fer Of Rights Of Recovery Against Others To Us:
We waive any right of recovery we may have against a person or organization because of payments we
make for injury or damage arising out of your ongoing operations or "your work" done under a
contract with that person or organization and Included In the products-completed operations hazard"
provided:
1. You and that person or organization have agreed In writing In a contract or agreement that you
waive such rights against that person or organization; and
2. The Injury or damage occurs subsequent to the execution of the written contract or written agree-
ment.
s
a
i
® 2013 Liberty Mutual Insurance
CG 88 10 04 13 Includes copydghted'material of Insurance Services Office,Inc.,with Its permission. Page 8 of 8