HomeMy WebLinkAboutPW15-172 - Amendment - #1 - Gray & Osborne Inc - Coating Analysis of Cambridge - 07/15/2015 Records M .� #� ; � eme`
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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: Gray & Osborne, Inc.
Vendor Number:
JD Edwards Number
Contract Number: __� r , ?
This is assigned by City Clerk's Office
Project Name: Coating Analysis of Cambridge & 125,000 Tanks
I
Description: ❑ Interlocal Agreement ❑ Change Order ® Amendment ❑ Contract
❑ Other:
Contract Effective Date: 7/15/15 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: $7,445.00
Approval Authority: (CIRCLE ONE Department Director Mayor City Council
Detail: (i.e. address, location, parcel number, tax id, etc.):
Coating analysis for Cambridge tank.
As of: 08 27 14
KENT
W ASNINOtON
AMENDMENT NO. 1
NAME OF CONSULTANT OR VENDOR: Gray and Osborne, Inc.
CONTRACT NAME & PROJECT NUMBER: Coating Analysis of Cambridge & 125,000 Tanks
ORIGINAL AGREEMENT DATE: May 8, 2015
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:
Provide the recommended surface repair for the spalling concrete
inside/outside the vault, and a recommended NSF 61 approved coating
for sealing for the Cambridge and 125,000 Gallon Reservoirs project.
For a detailed description, see Exhibit A which is attached and
incorporated by this reference.
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, $6,450.00
including applicable WSST
Net Change by Previous Amendments $0
including applicable WSST
Current Contract Amount $6,450.00
including all previous amendments
Current Amendment Sum $995.00
Applicable WSST Tax on this $0
Amendment
Revised Contract Sum $7,445.00
AMENDMENT - 1 OF 2
Original Time for Completion 12/31/15
(insert date)
Revised Time for Completion under N/A
prior Amendments
(insert date)
Add'I Days Required (f) for this O calendar days
Amendment
Revised Time for Completion 12/31/15
(insert date)
The Consultant or Vendor accepts all requirements of this Amendment by signing below,
by its signature waives any protest or claim it may have regarding this Amendment, and
acknowledges and accepts that this Amendment constitutes full payment and final settlement of
all claims of any kind or nature arising from or connected with any work either covered or
affected by this Amendment, including, without limitation, claims related to contract time,
contract acceleration, onsite or home office overhead, or lost profits. This Amendment, unless
otherwise provided, does not relieve the Consultant or Vendor from strict compliance with the
guarantee and warranty provisions of the original Agreement.
All acts consistent with the authority of the Agreement, previous Amendments (if any),
and this Amendment, prior to the effective date of this Amendment, are hereby ratified and
affirmed, and the terms of the Agreement, previous Amendments (if any), and this Amendment
shall be deemed to have applied.
The parties whose names appear below swear under penalty of perjury that they are
authorized to enter into this Amendment, which is binding on the parties of this contract.
IN WITNESS, the parties below have executed this Amendment, which will
become effective on the last date written below.
CONSULTANT/VENDOR: CITY OF KENT:
_ (slgri ture (signature)
Prig ame: {j am J .e4` _.r Print Name '1 4,g&!1/ ;/
Its 9 r.a 7 j - Its 7 avi l LY ✓r€e5li) 'R
---n (title) r (title)
DATE: P. " eyl DATE: ,.i_J*°
APPROVED AS TO FORM:
(applicable if Mayor's signature required)
Kent Law Department
[In this field,you may enter the eledronlc filepath where the contrail has been saved]
AMENDMENT - 2 OF 2
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} CCNS ULTINO ENGINEERS
1 EXHIBIT A
June 29, 2015
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Mr. Mark Howlett;P:E:
Design Engineering Manager
City of Kent
4.00 West Gowe
Kent,Washington 98032
SUBJECT: SCOPE.OF WORK FOR CONTRACT AMENDMENT 1, CAMBRIDGE
AND 125K RESERVOIR RECOATING—KENT SPRINGS VAULT
REHABILITATION
CITY OF KENT,KING COUNTY, WASHINGTON
G&O0540 00
C _
Dear Mr:Howlett:
As requested;we are providing this Contract Amendment 1,which includes a scope of
work and budget,for rehabilitating the existing clear well vault:at the Kent Springs site.
On June 22,2615;Lance Stevens from Gray&Osborne met with Kevin Swinford at the
site to inspect the vault that is currently used as a clear well for the springs. The vault is
an existing precast Utility Vault that sits partially aboveground. The vault has
experienced some spalling and water leakage.was an identified issue.
The purpose of this scope of work is to provide a recommendation forrecoating the vault
including a technical specification for the work,
SCOPE OF WORK
i
Gray&Osborne will perform the following engineering services:
s; Specifications—A technical specifications will be prepared in CSI format
and provided to the City for inclusion into the bidding documents to be
prepared by City staff. A flyleafwith a stamped engineering.S will.be.
provided for the technical specification portion prepared by
Gray&Osborne, The specification shall include coatingmaterials and
surface preparation for repairing the spalling concrete and for lining the
interior of the vault with an NSF 61-approved lining.
701 Dexter Avenue N., Suite 200 Seattle;Washington 98109 (206)284.0860 Fax(206)263-3206
vRNa ogre v�.ee owx
Mr, Mark Howlett;P.E,
June 29,2015
Page 2
0 Cost Estimate—A design level engineering cost estimate will be
provided,
The not-to•exceed cost for these services is$995 for the technical specifications and cost.
estimate. One 90 percent and one final submittal are included.
Sincerely,
GRAY t $0"113 INC,
Russell Porter,P.E,
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CERTIFICATE OF LIABILITY INSURANCE
2 2016
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(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 Ileu of such endorsements.
PRODUCER CO TMichael J Hall&Company
-
Michael JHall&Company !ONE" Afc
Hall&Company
1966010th Ave NE nhallandcomoany Qum
Poulsbo WA 98370 INSURERS AFFORDING COVERAGE NAIO0
INSURER A I
1 INSURED 4 INSURER B.Traveliers Casuaft4gpA3UTEtLCp_CL_ 9 iL
Gray&Osborne Inc INSURER I
701 Dexter Avenue N#200 INSURER DI
Seattle WA 98109
INSURER E:
� INSURER F:
COVERAGES CERTIFICATE NUMBER:1608148507 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 CyLLApp�IIMppS.
ILTR TYPE OF INSURANCE ADS MAID POLICYNUM99R P DIC EF &RUMCD YYY LIMITS
A OENERAL LIABILITY 62SBAOU7303 )11012014 /10/2016 EACH OCCURRENCE $1,000.000
DAMAGE X COMMERCIAL GENERAL LABILITY s(Eamy $300,000 -
CLAIMS-MADE OCCUR MEO UP Anyone Parwn) $10000
X OCP/XCU/BFPD PERSONAL&AOVINJURY $1000.000
X I Separatlonlnsds GENERAL AGGREGATE $2000.000
OENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000
POLICY X P 0- LOC $
A AUTOMOBILE LIABILITY 621JECJS3278 111012014 f10/2016 e«IdemS1,000,000
X ANY AUTO BODILY IN,IURY(Per Person) $
A TOOWNED AUTOSULEO BODILY ITTNJURY(Per ecdden0 $
HIRED AUTOS VTOOwNEO eOreWrkn�t AMAGE $
i
A X UMERELLA LIAR X OCCUR 52SBADU7303 /10/2014 /10/'1015 EACH OCCURRENCE $1,000,000
EXCESS LIAR CLAIMS MADE AGGREGATE $1,000,000
D D IX N ION 10 000 $
A WORKERS COMPENSATION 62SBADU7303 110/2014 1110/2015 1VrC STATU- X OTH' ytrq Stop Oep
AND EMPLOYERS'LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVEQ NIA E.L,EACH ACCIDENT E1,000,000
OFFICERIMEMBER EXCLUDED?
IMandalont In NH) - E.1-DISEASE-EA EMPLOYEE $1000000
lVes descdhounder
DESCRIPTION OF OPERATIO S E.L DISEASE-POLICY LIMIT $1,000,000
B �Pfofesslonal Liab;Clelms Made 106339819 /10/2014 A0/2016 $3,000,000 Per Claim
Pollution Uab:Occurrence Form $3,000,000 Aggregate
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLE&(Attach ACORD M,AddiVonal Remarks schedule,If more apace la requimd)
Certificate holder Is/are an Additional Insured on the Commercial General Liability and Auto Liablllty when required by written contractor
agreement regarding activities byy or on behalf of the Named Insured.The Commercial General Liability Insurance Is primary Insurance and
any other Insurance maintained by the Additional Insured shall be excess only and non-contributing with this Insurance.A waiver of
subrogation applies to the Commercial General Liability,Auto Liability, Umbrella/Excess Liability and Workers Compensation I Employers
Liability In favor of the Additional Insured.
Re: Reservoir Coating Evaluation
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Cityy Of Kent ACCORDANCE WITH THE POLICY PROVISIONS.
400 West Gowe
Kent WA 98032 AUTHORIZED REPRESENTATNE
� z
01988-2010 ACORD CORPORATION. All rights reserved.
ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD
Policy M 52SBADU7303
BU61NESS LIABILITY COVERAGE FORM
(h) Rented to, in the care, custody or b. Coverage under this provision does not
control of, or over which physical apply to;
control Is being exercised for any (1) "Bodily Injury" or "property damage"
purpose by you, any of your that occurred;or
"amployees", "volunteer workers",
any partner or member (if you are (2) "Personal and advertising Injury"
a partnership or joint venture), or arising out of an offense committed
any member (if you are a limited before you acquired or farmed the
liability company). organization.
b. Real Estate Manager 4. Operator Of Mobile Equipment
Any person(other than your"employee"or With respect to"mobile equipment"registered in
".volunteer worker"), or any organization your name under any motor vehicle registration
while acting as your real estate manager. law, any person Is an'lnsured while driving such
c. Temporary Custodians Of Your equipment along a public highway with your
Property permisslon. Any other'persori or organization
Any person or organization having proper responsible for the conduct of such person is
ity
temporary custody of your property if you also an Insured, but only with reequip to
die,but only: arising out of the operation of the equipmentnt,,and
y only If no other Insurance of any kind is available
(1) With respect to liability arising out of the to that person or organization for this liability,
maintenance or use of that property;and However,no person or organization Is an Insured
(2) Until your legal representative has with respect to:
. besn,appointed. a. "Bodily Injury" to a co-"employee" of the
d. Legal Representative if You Die person driving the equipment;or
Your legal representative If you die, but b. °Property damage" to property owned by, .
only with respect to duties as such. That rented to, In the charge of or occupied by
representative will have all your rights and you or the employer of any person who is
duties under this Insurance. an insured under this provision.
e. Unnamed Subsidiary S. Operator of Nonowned Watercraft
Any subsidiary and subsidiary thereof, of With respect to watercraft you do not own that
yours which Is a legally Incorporated entity is less than 51 feet long and Is not being used
of which you own a financial Interest of to carry persons for a charge,any person Is an
more than 60% of the voting stock on the insured while operating such watercraft with
effective date of this Coverage Part, your permission. Any other person or
The Insurance afforded herein for any organization responsible for the conduct of
subsidiary not shown In the Declarations such person is also an Insured, but only with
respect to liability arising out of the operation
as a named insured does not apply to
Injury or damage with respect to which an of the watercraft, and , ,
Insured under this insurance is also an Insurance oft any
Eny only kind is availaablee to that
other
Insured under another policy or would ba parson or organization for this liability,
an Insured under such policy but for Its However, no person or organization Is an
termination or upon the exhaustion of Its Insured with respect to;
limits of Insurance. a. "Bodily Injury" to a co-"amployee" of the
S. Newly Acquired Or Formed Organization person operating the watercraft;or
Any organization you newly acquire or form, b. "Property damage" to property owned by,
other than a partnership, joint venture or rented to, In the charge of or occupied by
limited liability company, and over which you you or the employer of any person who is
maintain financial Interest of more than 50%of an insured under this provision.
the voting stock, will qualify as a Named 0. Additional Insureds When Required By
Insured If there is no other similar Insurance Written Contract, Written Agreement Or
available to that organization. However: Permit
a. Coverage under this provision Is afforded The person(s) or organizatlon(s) Identified in
only until the IBM day after you acquire Paragraphs a. through f. below are additional
or form the organization or the and of the Insureds when you have agreed, In a written _
policy period,whichever Is earlier,and
Form SS 00 OB 04 05 Ito Page 11 of 2.4
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The Hartford
Polley#62313ADU7303
BUSINESS LIABILITY COVERAGE FORM
contract, written agreement or because of a (e) Any failure to make such
permit Issued by a state or political Inspections,, adjustments, tests or
subdivision, that such person or organization servicing as the vendor has
be added as an additional Insured on your agreed to make or normally
policy, provided the Injury or damage occurs undertakes to make In the usual
subsequent to the execution of the contract or course of business, In connection
agreement,or the Issuance of the permit with the distribution or sale of the
A ,person or organization Is an additional products;
Insured under. this provision only for that (f) Demonstration, Installation,
period of time required by the contract, servicing or repair operations,
agreement or permit. except such operations performed
person or organization Is an at the vendor's premises In
However,no such
p connection with the sale of the
additional Insured under this provision If such product;
person or organization Is Included as an
additional insured by an endorsement Issued (g) Products which, after distribution
by us and made a part of this Coverage Part, or sale by you, have been labeled
Including all persons or organizations added or •relabeled or used as a
as additional Insureds under the specific container, part or Ingredient of any
additional Insured coverage grants in Section other thing or substance by or for
F.—Optional Additional Insured Coverages. the vendor;or
a. Vendors (h) "Bodily injury" or "property
Any parson(s)or organization(s)(referred to damage" arising out of the sate
below as vendor), but only with respect own acts
of the vendor for its
to
"bodily Injury' or "property damage" arising own or omissions or those of
our products"which are distributed Its employees or anyone else
out of"
y p acting'on its behalf. Howevef,this
or sold in the regular course of the vendor's exclusion does not apply to:
business and only If this Coverage Part
provides coverage for "bodily injury' or (i) The exceptions contained In
"property damage" included within the Subparagraphs(d)or(f);or
products-completed operations hazard", (it) Such inspections, adjustments,
(1) The insurance afforded to the vendor tests or servicing as the vendor
Is subject to the following additional has agreed to make or normally
exclusions: . undertakes to make in the usual
course of business, In
This Insurance does not apply to:
connection with the distribution
(a) "Bodily Injury" or "property or sale of the products.
damage" for which the vendor is (2) This insurance does not apply to any
obligated to pay damages by Insured person or organization from
reason of the assumption of whom you have acquired such products,
liability In a contract or agreement, or any ingredient, part or container,
This exclusion does not apply to entering Into, accompanying or
Itablllty for damages that the containing such products.
vendor would have in the absence
of the contract or agreement; b, Lessors Of Equipment
(b) Any express warranty (1) Any person or organization from
unauthorized by you; whom you lease equipment; but only
with respect to their liability for"bodily
(a) Any physical or chemical change Injury "property damage" or
In the product made Intentionally 'personal and advertising injury"
by the vendor; caused, In whole or In part, by your
(d) Repackaging, except when maintenance, operation or use of j
unpacked solely for the purpose of equipment leased to you by such
Inspection, demonstration, testing, person or organization.
or the substitution of parts under
instructions from the manufacturer,
and then repackaged in the
original container;
Page 12 of 24 Form SS 00 08 04 05
Poricy#52SBADU7303Pdky#
52SBAbU7'303
BUSINESS LIABILITY COVERAGE FORM
(2) With respect to.the Insurance afforded e. Permits Issued By State Or Political
to these additional insureds, this Subdivisions
insurance does not apply to any (1) Any state or political subdivision, but
occurrence" which takes place after only with respect to operations
you cease to lease that equipment. performed by you or on your behalf for
c. Lessors Of Land Or Premises which the state or political subdivision
(1) Any person or organization from has Issued a permit.
wham you lease land or promises, but (2) With respect to the Insurance afforded
only with respect to liability arising out to these additional insureds, this
of the ownership, maintenance or use insurance does not apply to:
that part of the land or premises
le (a) "Bodily Injury", "properly damage"
leased to you. or "personal and advertising
(2) With respect to the Insurance afforded Injury" arising out of operations
to these additional Insureds, this performed for' the state or
Insurance does not apply to: municipality;or
(a) Any "occurrence" which takes. (b) "Bodily Injury"or"property damage"
place after you cease to lease that Included within the "products-
land or be a tenant In that completed operations hazard",
premises;or f. Any Other Party
(b) construralction
alterations, new (1) Any other person or organhiation who
construction r ' demolition Is not an Insured under Paragraphs a.
operations performed by or on
behalf of such person or through e. above, but only with
organization. respect to liability for "bodily injury",
property damage" or "personal and
d. Architects, Engineers Or Surveyors advertising Injury" caused, in whole or
(1) Any architect, engineer,or surveyor,but in part, by your acts or omissions or
only with respect to liability for "bodily the acts or omissions of those acting
Injury', "property damage" or "personal on your behalf:
and advertising Injury"caused, In whale (a) In the performance of your
or in part, by your acts or omissions or ongoing operations;
the acts or omissions of those acting on (b) in connection with your premises
your behalf: owned by or rented to you;or
(a) In connection with your premises; (c) In connection with"your work"and
or included within the "products-
(b) In the performance of your completed operations hazard", but
ongoing operations performed by only If
you or on your behalf. (1) The written contract or written
(2) With respect to the Insurance afforded agreement requires you to
to these additional Insureds, the provide such coverage to
following additional exclusion applies: such additional Insured;and
This Insurance does not apply to (it) This Coverage Part provides
"bodily Injury", "property damage" or coverage for "bodily injury" or
personal and advertising Injury" 'property damage" Included
arising out of the rendering of or the within the "products-
failure to render any professional completed operations hazard".
services by or for you,including: (2) With respect to the Insurance afforded
(a) The preparing, approving, or to these' additional Insureds, this
failure to prepare or approve, insurance does not apply to:
maps, shop drawings, opinions,change orders, designs reports, surveys, field orders, "Bodily injury", "property damage" or
c "personal and advertising injury"
or
chang
drawings and specifications;or arising out the rendering or the
re
failure to render, any professional
ssional
(b) Supervisory, Inspection, architectural, engineering or surveying
architectural or engineering services,Including:
activities.
Form Sffi 00 08 04 05 Page 13 of 24
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Pollcy#52SBADU7303
,
BUSINESS LIABILITY COVERAGE FORM
(a) The preparing, approving, or This General Aggregate limit does not
failure to prepare or approve, apply to "property damage" to premises
maps, shop drawings, opinions• while rented to you or temporarily
reports, surveys, field orders, occupied by you with permission of the
change orders, designs or owner, arising out of fire, lightning or
drawings and specifications;or explosion.
(b) Supervisory, Irepeotign, 3. Each Occurrence Limit
architectural or ''engineering Subject to 2.a, or 2.b above, whichever
activities. applies,the most we will pay for the sum of all
The limits of Insurance that apply to additional damages 'because of all "bodily Injury",
Insureds are described in Section D, — Limits "property damage" and medical expenses
Of Insurance, arlsing out of any one "occurrence Is the
How this Insurance applies when other Liability and Medical Expenses Limit shown In
Insurance is available to an additional insured the Declarations,
Is described In the Other Insurance Condition The most we will pay for all medical expense's
in Sedtlon E.—Liability And Medical Expenses because of "bodily Injury" sustained by any
General Conditions. one person is the Medical Expenses Limit
No person or organization Is an insured with shown in the Declarations,
respect to the conduct of any current or past 4. Personal And Advertising Injury Limit
partnership, joint venture or limited liability Subject to 2.b,above,the most we will pay for
company that is not shown as a Named Insured In the sum of all damages because of all
the Declarations. "personal and advertising Injury" sustained by
D. LIABILITY AND MEDICAL EXPENSES any one person or organization Is the Personal
LIMITS OF INSURANCE and Advertising Injury Limit shown in the
1, The Most We Will Pay Declarations.
The Limits of Insurance shown in the g• Damage To Premises Rented To You Limit
Declarations and the rules below fix the most The Damage To Premises Rented To You
we will pay regardless of the number of: Limit is the most we will pay under Business
Liability Coverage for damages because of
a. Insureds; "property damage"to any one premises, while
b. Claims made or"sups"brought;or rented to you,or In the case of damage by fire,
c. Persons or organizations making claims or lightning or explosion, while rented to you or
bringing"suits", temporarily occupied by you with permission of
2. Aggregate Limits the owner.
The most we will pay for: In the case of damage by fire, lightning or
explosion,the Damage to Premises Rented To
a. Damages because of "bodily Injury" and You Limit applies to all damage proximately
"properly damage" Included in the caused by the same event, whether such
"products-completed operations hazard" Is damage results from fire, lightning or explosion
the Products-Completed Operations or any combination of these.
Aggregate Limit shown In the g, How Limits Apply To Additional Insureds
Declarations,
b. Damages because of all other "bodily The most we will pay on behalf of a person or
Injury", "property damage" or "personal organization who Is an additional Insured
and advertising Injury", including medical under this Coverage Part is the lesser of:
expenses,.Is the General Aggregate Limit a. The limits of insurance specified in a
shown in the Declarations. written contract, written agreement or
This General Aggregate Limit applies permit issued by a state or political
separately to. each of your "locations" subdivision;or
owned by or rented to you. b. The Limits of Insurance shown In the
"Location" means premises involving the Declarations,
same or connecting lots, or premises Such amount shall be a part of and not In
whose connection Is Interrupted only by a addition to the Limits of Insurance shown In
street, roadway or right-of-way of a the Declarations and described In this Sactlon.
railroad,
Page 14 of 24 Form SS 00 00 04 05
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Policy#528BADU7303
BUSINESS LIABILITY COVERAGE FORM
If more than one limit of Insurance under this (1) Immediately send us copies of any
policy and any endorsements attached thereto demands, notices, summonses or
applies to any claim or"sur,the most we will pay legal papers received, in connection
under this. policy and the endorsements Is the with the claim or"suit";
single highest limit of liability of all coverages (2) Authorize us to obtain records and
applicable to such claim or "sult". However, this other Information;
paragraph does not apply to the Medical Expenses (3) Cooperate with us In the investigation,
limit set forth in Paragraph 3.above, settlement of the claim or defense
The Limits of Insurance of this Coverage Part apply against the"suit"; and
separately to each consecutive annual period and to (4) Assist us, upon our request,, In the
any remaining period of less than 12 months,starting enforcement of any right against any
with the beginning of the policy period shown In the person or organization that may be
Declarations, unless the poilcy period is extended liable to the Insured because of injury
after Issuance for an additional period of less than 12 or damage to which this insurance
months. In that case, the additional period will be may also apply,
deemed part of the fast preceding period forpurposes
of determining the Limits of Insurance. d. Obligations At The Insured's Own Cost
E. LIABILITY AND MEDICAL EXPENSES No Insured will, except at that insured's own
GENERAL CONDITIONS cost, voluntarily make a payment assume
any obligation, or Incur any expense, other
1. Bankruptcy than fort rst aid,without our consent.
Bankruptcy or Insolvency of the insured or of e. Additional Insured's Other Insurance
the Insured's estate will not relieve Us of our If we cover a claim or "suit" under this
obligations under this Coverage Part. Coverage Par[that may also be covered
2. Duties in The Event Of Occurrence, by other Insurance available to an
Offense,Claim Or Suit additional Insured, such additional Insured
a. Notice Of Occurrence or Offense must submit such claim or "suit" to the
other insurer for defense and Indemnity,
You or any additional insured must see to
it—that we are notified as soon as However, this provision does not apply to
practicable of an "occurrence" or an the extent that you have agreed in a
offense which may result in a claim. To written contract,' written agreement or
the extent possible, notice should include: permit that this Insurance is primary and
non-contributory with the additional
(1) How,when and where the"occurrence" Insured's own Insurance.
or offense took place; f, Knowledge Of An Occurrence, Offense,
(2) The names and addresses of any Claim Or Suit
Injured persons and witnesses;and
Paragraphs a. and b. apply to you or to
(3) The nature and location of any Injury any additional Insured only when such
or damage arising out of the 'occurrence", offense, claim or "suit" Is
"occurrence"or offense, known to:
b. Notice Of Claim (1) You or any additional Insured that Is
If a claim is made or "suit" Is brought an individual;
against any Insured, you or any additional (2) Any partner, It you or an additional
Insured must: insured Is a partnership;
(1) Immediately record the specifics of the (3) Any manager, If you or an addltlonal
claim or "suit" and the date received; Insured is a limited liability company;
and
2 Notify us as soon as practicable. (4) Any "executive officer" n insurance
( ) h' P manager, If you or an additional
You or any additional insured must see to insured is a corporation;
It that we receive a written notice of the (6) Any trustee, H you or an additional
claim or"cult"as soon as practicable. Insured Is a trust; or
c. Assistance And Cooperation Of The (6) Any elected or appointed official,If you
Insured or an additional Insured Is a political
You and any other Involved Insured must: subdivision or public entity.
Form SS 00 08 04 05 Page 115 of 24
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Policy#528BAOU7303
BUSINESS LIABILITY COVERAGE FORM
This Paragraph f. applies separately to (3) We have Issued this policy In reliance
you and any additional Insured, upon your representations,
3. Financial Responsibility Laws b. Unintentional Failure To Disclose
a, When this policy is certified as proof of Hazards
financial responsibility for the future under If unintentionally you should fail to disclose
the provisions of any motor vehicle all hazards relating to the conduct of your
financial responsibility law, the insurance business at the 'Inception date of this
provided by the policy for "bodily Injury" Coverage Part, we shall not deny any
liability and "property damage" liability will coverage under this Coverage Part
comply with the provisions of the law to because of such failure.
the extent of the coverage and limits of 7. Other insurance
insurance required by that law. If other valid and collectible. Insurance is
b. With respect to "mobile equipment" to available for a loss we cover under this
which this Insurance applies, we will Coverage Part, our obligations are limited as
provide any liability, uninsured motorists, follows:
undednsured motorists, no-fault or other
coverage required by any motor vehicle a. Primary Insurance
law. We will provide the required limits for This Insurance is primary except when b.
those coverages. below applies. If other Insurance is also
4, Legal Action Against Us primary, we will share with all that other
No person or organization has a right under Insurance by the method described In e.
this Coverage Form; below,
a. To join us as a parry or otherwise bring us b. Excess Insurance
Into a "Butt" asking for damages from an This Insurance Is excess over any of,the
Insured; or other Insurance,whether primary, excess,
b. To sue us on this Coverage Form unless contingent or on any other basis:
all of Its terms have been fully complied (1) Your Work
with. That Is Fire, Extended Coverage,
A person or organization may sue us to recover Builder's Risk, Installation Risk or
on an agreed settlement or on a final judgment similar coverage for"your work";
against an insured; but we will not be liable for (2) Premises Rented To You
damages that are not payable under the terms of That is fire, lightning or explosion
this insurance or that are In excess of the
applicable limit of Insurance. An agreed Insurance for premises rented to you
settlement means a settlement and release of or temporarily occupied by you with
liability signed by us, the insured and the permission of the owner;
claimant or the claimant's legal representative. (3) Tenant Liability
6, Separation Of insureds That Is Insurance purchased by you to
Except with respect to the Limits of Insurance, cover your liability as a tenant for
and any rights or duties specifically assigned property damage"to premises ranted
in this policy to the first Named insured, this to you or temporarily occupied by you
insurance applies: with permission of the owner;
a. As if each Named Insured were the only (4) Aircraft,Auto Or Watercraft
Named Insured;and If the loss arises out of the maintenance
b. Separately to each Insured against whom or use of aircraft,"autos"or watercraft to
a claim Is made or"suit"is brought, the extent not subject to Exclusion g.of
6. Representations Section A.—Coverages.
(5) Property Damage To Borrowed
a. When You Accept This Policy Equipment Or Use Of Elevators
By accepting this policy,you agree: If the loss arises out of "properly
(1) The statements In the Declarations damage" to borrowed equipment or
are accurate and complete; the use of elevators to the extent not
(2) Those statements are based upon subject to Exclusion k. of Section A.—
representations you made to us;and Coverages.
Page 16 of 24 Form SS 00 08 04 06
Policy#528BAOU7303
BUSINESS LIABILITY COVERAGE FORM
(6) When You Are Added As An When this insurance is excess over other
Additional Insured To Other Insurance, we will pay only our share of
Insurance the amount of the loss, if any, that
That Is other insurance available to exceeds the sum of.,
you covering liability for damages (1) The total amount that all such other
arising out of the premises or insurance would pay for the loss in the
operations,or products and completed absence of this Insurance;and
operations, for which you have been (2) The total of all deductible and satf-
added as an additional Insured by that Insured amounts under all that other
Insurance;or Insurance.
(7) When You Add Others As An We will share the remaining loss,If any,with
Additional Insured To This any other insurance that is not described In
Insurance this Excess Insurance provision and was not
That Is other insurance available to an bought specifically to apply In excess of the
additional Insured. Limits of Insurance shown In the
However, the following provisions Declarations of this Coverage Part.
apply to other Insurance available to c. Method Of Sharing
any person or organization who is an If elf the other Insurance permits
additional insured under this Coverage contribution by equal shares,we will follow
Part: this method also. Under this approach,
(a) Primary Insurance When each insurer contributes equal amounts
Required By Contract until it has paid Its applicable limit of
This Insurance is primary If you Insurance or none of the loss remains,
have agreed In a written contract, whichever comes first•
written agreement or permit.that If any of the other Insurance does not permit
this Insurance be primary. if other contribution by equal shares, we will
insurance is also primary, we will contribute by limits. Under this method,each
share with all that other Insurance insurer's share is based on the ratio of its
by the method described to c, applicable Ilrrft of insurance to the total
below, applicable limits of insurance of all Insurers.
(b) Primary And Non-Contributory 0. Transfer Of Rights Of Recovery Against
To Other Insurance When Others To Us
Required By Contract a. Transfer Of Rights Of Recovery
If you have agreed In a written If the Insured has rights to recover all or
contract, written agreement or part of any payment, Including
permit that this insurance is Supplementary Payments, we have made
primary and non-contributory with under this Coverage Part, those rights are
the additional Insured's own transferred to us. The insured must do
insurance, this Insurance Is nothing after loss to Impair them. At o4.
primary and we will not seek request, the Insured will bring "suit" or'
contribution from that other transfer those rights to us and help us
Insurance. enforce them. This condition does not
Paragraphs(a)and (b)do not apply to apply to Medical Expenses Coverage.
other insurance to which the additional b. Waiver Of Rights Of Recovery (Waiver
insured has been added as an Of Of
additional Insured. If the Insured has waived any rights of
When this Insurance Is excess, we will recovery against any person or
have no duty under this Coverage Part to organization for all or part of any payment,
defend the insured against any"suit"if any including Supplementary Payments, we
other Insurer has a duty to defend the have made under this Coverage Part, we
insured against that "cult". If no other also waive that right, provided the Insured
Insurer defends, we will undertake to do waived their rights of recovery against
so, but we will be entitled to the Insured's such person or organization In a contract,
rights against all those other insurers, agreement or permitt that wee executed
prior to the Injury or damage.
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Form SS 00 08 04 05 Page 17 of 24
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Policy#52UECJ83276
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED AND
RIGHTS OF RECOVERY AGAINST OTHERS
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
A. Any person or organization whom you are required by contract to name as additional insured Is an
"insured" for LIABILITY COVERAGE but only to the extent that person or organization qualifies as an
"insured"under the WHO IS AN INSURED provision of Section II- LIABILITY COVERAGE,
B. For any person or organization for whom you are required by contract to provide a waiver of subrogation,
the Loss Condition-TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US is applicable.
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Form HA 99 13 0187 Printed In U.S.A.