HomeMy WebLinkAboutPW14-067 - Amendment - #2 - GEI Consultants, Inc. - Brisco-Desimone Levee Improvements Reach 2 & 3 - 12/16/2015 ® e erg tr
KENT - Document
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: GEI Consultants, Inc.
Vendor Number:
JD Edwards Number
Contract Number: ?v I'd - h(-D`l _ bu,b
This is assigned by City Clerk's Office
Project Name: Briscoe-Desimone Levee Reach 2 & 3
Description: ❑ Interlocal Agreement ❑ Change Order ® Amendment ❑ Contract
❑ Other:
Contract Effective Date: 12/16/15 Termination Date: 7/1/16
Contract Renewal Notice (Days):
Number of days required notice for termination or renewal or amendment
Contract Manager: Kelly Casteel Department: Engineering
Contract Amount: $0.00
Approval Authority: (CIRCLE ONE) Department Director Mayor City Council
Detail: (i.e. address, location, parcel number, tax id, etc.):
Extend the time of completion to July 1, 2016 because asbuilts and punch lists require
finalization.
As of: 08/27/14
KEN T
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AMENDMENT N . 2
NAME OF CONSULTANT OR VENDOR: GEI Consultants, Inc.
CONTRACT NAME & PROJECT NUMBER: Briscoe-Desimone Levee Reach 2 & 3
ORIGINAL AGREEMENT DATE: April 3, 2014
This Amendment is made between the City and the above-referenced Consultant or
Vendor and amends the original Agreement and all prior Amendments. All other provisions of
the original Agreement or prior Amendments not inconsistent with this Amendment shall remain
in full force and effect. For valuable consideration and by mutual consent of the parties,
Consultant or Vendor's work is modified as follows:
1. Section I of the Agreement, entitled "Description of Work," is hereby modified to
add additional work or revise existing work as follows:
In addition to work required under the original Agreement and any
prior Amendments, the Consultant or Vendor shall:
The scope of work remains the same, however an amendment
is needed to extend the time of completion to July 1, 2016
because as-builts and punch lists require finalization.
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, $152,552.00
including applicable WSST
Net Change by Previous Amendments $0
including applicable WSST
Current Contract Amount $152,552.00
including all previous amendments
Current Amendment Sum $0
Applicable WSST Tax on this $0
Amendment
Revised Contract Sum $152,552.00
AMENDMENT - 1 OF 2
Original Time for Completion 6/1/15
(insert date)
Revised Time for Completion under 12/31/15
prior Amendments
(insert date)
Add'I Days Required (f) for this 183 calendar days
Amendment
Revised Time for Completion 7/1/16
(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: r t'f z�44 m CITY OE,KENT:
By: ..: By
(Sig ature °3 (signature)
Print Name. °, r .g Print Name: TimothyJ. LaPorte, P.E.
Its P Its Public Works Director
(title M ,,�tritle)
DATE: l"ZI t�* . I DATE: ! f"r e/
APPROVED AS TO FORM:
(applicable if Mayor's signature required)
Kent Law Department
GBI-Briscoe-Dulmone Levee 4 Am Z/Cas[eel
AMENDMENT - 2 OF 2
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�--^� GEICONS-01 KPAWLOWSKI j
onT3/612 DrcYrvl j
� CERTIFICATE OF LIABILITY IAISURCaNCE_ _ _ 3t612o1s
4 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS
BERTIFICATE 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 IN5URER(5),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPDRTAN T: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION 1.5 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
cordflcate holder In of such endorsement(s).
I PRODUCER COONTA.CT Kathryn Pawlowski
Ames&Gough PHONE617 328 6556 fAN
859 Willard Street TAN"IT— U'( ) we No:(617 328-6886
5uIPe 3zo noOBEss:bostonrNamesgough.com
Quincy,MA D2169 -
INGUIER(St AFFORDING COVERAGE NAG W
INSURER A;National Union Fire Inaurance Company of Pittsburgh PA'19446
INSURED INSURER e:Continental casualty Company(DNA)A(XV) 20443
GEI Consultants,Inc. INSURERc:AIG Specialty Insurance Company A(XV) 26863
180 Grand Ave RSURER o',
Oakland,CA 84612 NSURERE:
INSURER P
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER;
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISPED BELOW HAVE BEEN ISSUED TO THE INSURED NAMECABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT VVITH RESPECT TOWHICH THIS
CERTIFICATE MAY BE I,SSUF_D OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POIIv ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS 8HOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
AAUIR SPeD - - FGLICYEFP PD!!C 'XP LIMITS
4R TYPEDFINSURANCE POIICI NUMBER fM-'DDIY i M�YYY - _
A VGENMAGGREGATELJMff�PUES
RAL LIABILITY EACH OCCURRENCE a 1,000,000
� y� WTJSGETISRENTED--- -
L'J OCCUR X X 7046470 0310112015 0310112016 PREMISES E 'Once 5 30D,000
MEP EP(Agy Arsn) s 15,000
_ I PERSONAL&ADV INJURY S _ 1,006,000AERIES PER; GENERAL AGGREGATE S 2000,000
POLICYn Pr �LOS PRODUCTS-CDMPIOPAGG S 2,000,000
OTHER:
ON ICE LIABILITY COMBINEuSN LC LIMIT- 8 1,000,00D
(Ca accida�AU ANY AUTO X X 2245367 03/0112015 03101/2016 BODILY p r eon) a
A X AI.I.Own ED SCHEDULED BODILY INJURY(Pr Wdenll S
AUTOS AUTOS ;
HIRED AVrUB NON.OWNED PROPERTY GAMACE $
X X AUTOS .erawleenlL
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X UMBRELLAUA X OOCUR EACH OCCURRENCE__ E 4,000,000
g yxcass JA Cl AITAS-MADE X X G011396137 DBTV2015 OWDII2015 AGGREGATE f 4,000,000
—_
f Cgu X RETENTIONS 0
V/CRNERS COMPENSATION X STATUTE FO-HH
AND EMPLOYERS'LIABILITY -" -
A ANY BE
YIN X 026034972 (03101I2016 03101/2016 E.L.EncH AcclorNT v I
1OOD,000
0G"BER/MEMBER E%CLUCEDi CN] HIA In NHl E.L PI6EA6F-EA EfdP;.OYE 5 _ -lON56alnw E.L.DID-AoE-POLICY LIMIT iS C Prof,Liability 17758026 0310112015 03i0112016 Per Claim C &Pollution Lia� 17788026 03/0112015 03101l2016 A grerate
Aggregate
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLE. Noce.W.Addllloaal H—W11.ol,oeWa,m 1 no rlixopue II more zpaae is rogitlredl
All Coverages are in accordance with the policy terms and cand Lions.
Project:Kant Briscoe-Desimona Levee Rcach 2 B 3 Construction Support,City of Kent
The City of Kent,King County and the King County Flood Control District are earned as Additional Insured on a primary and non-contributory basis with
respect to general liability for ongoing and completed operations,auto,and umbrella liability as required by written contract,for Ilablllly arising out of the
operations of the named Insured while performing worst for the City,the District,and the County,General Liability policy Includes saverabilily of Interest/
SEE ATTACHED ACORD 101
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE.ABOVE DESCRIBED NOTICE
V BE CANCELLED RED IN
CI of Kent Public Worsts Department THE EXPIRAT'IUN DATE THEREOF, NOTICE Nlila. BE DELIVERED IN
CityACCORDANCE WITH THE POLICY PRDVISIONS,
Attn:Mr.Kon Langh Glz
20 Fourth Avenue South ------ -- _
Kent,WA 90032 AUTHORIZED REPRESENTA'nVE
-- O1e88-2014 ACORD CORPORATION, All rights reserved, - I
ACORD 25(2014/01) Thu ACORD name end logo are registered marks ofACORD
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AGENCY CUSTOMER ID;
GEICONS-01 KPAWLOWSKI
ADDITIONAL REMARKS SCHEDULE Page 1 of 1
AeE@CY� NAMEDINSURED
re .8,Gough GEI Consultants,Inc.
-- -------- - 180 Grand Ave
eoucv NUMe5R Oakland,CA 94612
SEE PAGE 1 _
' CARRIER NAC CeDE
--�
.SEE PAGE 1 SEEP 1 srFscnve Dpte:SEE PAGE 1 '.
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUM6ER: ACOR025 FORMTITLE: CertlBcate DrLlabllity Insurance _ _
Description of OperationslLocationsfVehicles:
cross liability provisions.Umbrella policy sits In excess of the general liability,auto and employer's liability.All policies Include a
waiver of subrogation in favor of The City of Kent, King County and the King County Flood Control District. 30,day notice of
cancellation will be issued in accordance with policy terms and conditions.
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- _ - --
AGORD 1 01 (2 00 8101) OD 2008 ACORO CORPORATION. A11 rights reserved.
The ACORD name and logo are registered rnarks of ACORD
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END DRSEMENTA
This endorsement, effective 1 2:01 A.M. 03/01/20 is forms a part of Business Auto Policy
Policy No. 2248367 Issued to GEf Consultants, Inc.
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By National Uaioc Fire Insurance Company
THIS ENDDRSEfVIENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. i
LIMITED ADVICE OF CANCELLATION PROVIDED VIA E-MAIL
TO ENTITIES DTHER THAN THE FIRST NAMED INSURED
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This policy Is amended as follows;
In the event that the Insurer anneals this policy for any reason other than non-payment of premium,
and
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1. the cancellation effective date!s prior to this policy's expiration data; l
2, the First Named Insured Is tinder on existing contractual obligation to notify a certificate
holder when this policy is canceled (hereinafter, the "Certificate Nolder(s)") and has
provided to the Insurer, either directly or through Its broker of record, the email address
of a contact at each such entity; and
3. the Insurer received this Information after the First Named Insurers rocelvee notice of
cancellation of this policy and prior to this policy's cancellation effective date, via an
electronic spreadsheet that Is acceptable to the insurer,
the Insurer will provide advlon of canoellatfon (the "Advice") via o-mail to each such Certificate
Holders within days after the First Named Insured provides such information to the Insurer, '.....
provided, however, that If a specific number of days is not stated above, then the Advice will be
provided to such Certificate Holdar(s) as soon as reasonably practicable after the First Named
Insured provides such Information to the Insurer,
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Proof of the Insurer smelling the Advice, using the Information provided by the First Named Insured,
will serve as proof that the Insurer has fufP satisfied its obligations under this ondorsomant.
This endorsement does not ONO, he any way, coverage provfdad under this policy or the
cancellation of this policy or the effective date thereot, nor shal this endorsement Invest any rights
In any entity not insured under this policy,
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The following Definitions apply to this endorsement:
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1. First Named Insured means the Named Insured shown on the Declarations Page of thls
policy.
2. Insurer means the insurance company shown in the header on the Declarations page of this
policy,
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All other terms, conditions and exclusions shall remain the same, -
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Authnrized Representative
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107416 03/11, Page 1
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I iENDORSEMENT
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This endorsement, efteotive 12(01 A.M. 03/01/2015 terms a part of
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poflcy No 2248367 issued to GEI CONSULTANTS, INC.
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by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA
THIS ENDORSEMENT CHANGES THE POLICY. PLEA5E READ IT GAREFULLY,
ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT
Tlds endorsement modlflos Insurance provided under the foRowing.'
BUSINESS AUTO COVERAGE FORM
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SCHEDULE "
ADDITIONAL INSURED:
ANY FERSON OR ORGANIZATION FOR WHOM YOU ARE CONTRACTUALLY
HOUND TO PROVIDE ADDITIONAL INSURED STATUS BUT ONLY TO THE EXTENT OF
SUCH PERSON OR 00ANITATIONS LIABILITY ARISING OUT OF THE USE OF A C
COVERED AUTO,
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I, SECTION II LIABILITY COVERAGE,A. Coverage, 1.-4Ilho Is Insured, Is amanded to add: II
d, Any person or nroanization, shown in the schedule above, to whom you becamu obligated
to Include as an additional Insured under this policy,as a result of any contractor agreement ;I
you enter Into which mqulms you to furnish Insurance to that person or organizatloo of the
type provided by this policy, but only with respect to ilability arlsing out of use of a covered
"auto", However, the insurance provided will not exoead the lesser of:
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ilI The oovarage and/or limits of this policy, or
(2) The ooverage and/or Emits required by said con±rant or agreomant. �!
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A tlmrlmd Rep resentotive or
Call Cer91gnattrre(In States Where
Appifoabla)
07060 (10/05) Pape 1 of 1
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ENDORSEMENT
l"his endorsement, effective 12;01 A,M, 03/01I2015 forms a part of
policy No. 22463G7 issued IO CCT Conaul lento, Inc,
by National Union Piro Tnaurance Company
THIS ENDOR$EMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
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WAIVER OF TRANSFER OF RIGHTS OP RECOVERYAGAINST OTHERS TO US j
77lls entforsemont morl!ltos Insurance provio'etl under the folloiv(nf/r i
BUSINESS-AUTO-COVERAGE-FORM
......_---_._._......-..._..............._.__._._...._.,_,___._..___..._- _
Section IV - 13Us1110OG Auto Conditions, A. Lori Conditions, 5, . Transfer of Rights of R000vely j
Against Others to Ua, is amended to add;
However, wo will waive any right of recover we have against any person or organization with whom you have
entered Into a contract or agreement because of payments we make under this Coverage Form arising out of
an"acoldenv, or NOW, If,
(1) Tha "accident' or "loss" is duo to operations undertaken In accordance with the contrast existing
between you slid such person or organization; and
(2) The contract or agreement was entered lolo prlcr to any"aocidant" or"loss".
No walver of the right of recovery wil dfrocfy or Indirectly apply to your employees Cr employees of the
person or organization, and we reserve our rights or Ilan to be reimbursed from any recovery funds obtained
by any Injured employee,
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AUTHORIZLD REPRESENTATIVE j
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6289T(619a) - .-
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ENDORSEMENT#
This endorsement, effective 12:01 A.M.3/0V2 0 1 5-0 310 112 0 1 6 forms a part of Worker's Compensation Policy
Poficy No. 026024972 Issued to GET Consatants,Tnc.
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By National Union Pee Insurance Company.
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THIS =NDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
LIMITED ADVICE OF CANCELLATION PROVIDED VIA E-MAIL
TO ENTITIES OTHER THAN THE FIRST NAMED INSURED
This policy Is amended as follows: j
In the event that the Insurer cancels this policy for any reason other than nonpayment of premium,
and
1. the cancellation effective Sate Is prior to this policy's expiration date; -
2. the First Named Insured is under an Exleting contractual obllgadon to notify a carUflcata
holder when thfs policy Is canceled (hereinafter, the "Certificate Holderfs)") and has
provided to ;he Insurer, either directly or through its broker of record, the email address
of a contact at each such entity; and
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3. the Insurer received thls Information after the First Named Insured receives notice of
cancellation of this policy and prior to this policy's cancellation effective date, via an
elartronlc spreadsheet that Is acceptable to the Insurer,
the Insurer will provide advice of cancellation (the "Advice") via e-mail to each such Certificate
Holders within days after the First Named Insured provides such information to the Insurer;
provided, however, that ;f a speclflo number of days is not stated above, than the Advice will be
Provided to such Certificate Hoidens) as soon as reasonably practicable after the First Named
Insured provides such Information to the insurer.
Proof of the Insurer entailing the Advice, using the infor obon provided by the First Named Insured,
will serve ae proof that tho Insurer has fully satisfied Its obligations under this endorsement.
This endorsement does not affect, In any way, coverage provided under this policy or the
cancellation of this policy or the effective date thereof, nor shall this endorsement Invest any rights -
In any entity not insured under this pcllcy.
The following Definitions apply to this endcrsemeht.
1. First Named Insured means the Named Insured shown on the Declarations Page of this
policy.
2. Insurer means the insurance company shown in the header on the Declarations page of this j
policy. li
Al other terms, conditions and excluslons shall remain the same.
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AUtbedZed Reprosentative
107414 03111 Ire ge1 ill
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ENDORSEMENT I
This endorsement, etfeotive 12:01 A•M, 0310 U2015 forms a part of
policy No. 7046470 Issued to 0E1 CONSULTANTS, I NO,
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by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 6
ADDITIONAL INSURED- OWNERS, LESSEES, OR CONTRACTORS . COMPLETED $
OPERATIONS V
7/trs endorsement modllles insurance pr;rv/ded un<Ixr the lollo Hdny: li
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
SCHEDULE
NAME OF ADDITIONAL.INSURED PERSON OR OROAMZATION; I p
ANY PERSON OR ORGANIZATION WHOM YOU BECOME 09LIGATED TO INCLUDE AS AN I,
ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR AORFFMF,NT YOU HAVF,
ENTERED INTO.
LOCATION AND DESCRIPTION OF COMPLETED OPERATIONS:
PER THE CONTRACT OR AOREEMENT•
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ADDITIONAL PREMIUM; ;{
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(if No oniry opponre above, lnformatlon roqulred to cotnpleto this endoreemoht wIR be shown In the
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Decluritlons as applicable to the endorsement,) i�
SECTION II -WHO IS AN INSURED Is amended to Include as an Insured;
The parson or organization shown In the Schedule, but only with respect to Ilabfllty arlaing out of I
"your work" et the location deslpnm' d and dascrlbed In the echedulo of this endorsement ,I
performed for that sddltlonal Insured end Includsd In the "products-completed operations hazard".
All other terms and nondltiona remain unchanged,
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%v Pltltho�rla d Re rasenfntive or
Counters,Fg(na Statee Whets I
Inoludosaapyyrlah(otl mmedel oP oable .'
97837 (4/08) Innun nu,e BmvWun O na lllua, I .,with iw pwmiealon, Page 1 of 1
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ENDORSEMENT
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This endorsemo,2t, effective 12:01 A.M. 03/01/2015 forms a part of 7
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policy No. 7046470 Issued to GE CONSULTANTS, INC, )
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by NATIONAL UNION PIR"c INSURANCE COMPANY 01: PITTSBUROH, PA
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED OWNERS, LESSEES, OR CONTRACTORS - R
SCHEDULED PERSON OR ORGANIZATION
Tills ondoraement mod/llas Insurance provided under the following"
COMMERCIAL GENERAL LIAEILITY COVERAGE FORM ;
SCHEDULE �!
NAME OF PERSON OR ORCANIZATIONi I;
ANY PERSON OR ORGANIZATION WHOM YOU EEGGHE OBLIGATED TO INCLUDE AS AN
ADDITIONAL INSURED AS A RESULT" OF ANY CONTRACT OR AGREEMENT YOU HAVE
ENTERED INTO,
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(If no entry appears above, Information required to compinta this endorsarnent calif be shown In the t
DBCIamt]Dne as applicable to the endorsement.)
A. SECTION II -WHO IS AN INSURED Is amended to include as an Insured;
The person or organ(zatlon shown In the schedule, but only with respect to IlabglYy erlslnp
out of ycgr ongoing op❑rat(ons performed for that additional insured.
B. With respeot to the Insuranoe afforded to those odditlonol inourode, SECTION I
COVERAGES, COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. -
Excluslons, Is emended to Include the following additions) sxelU$lOr. �
Thle Insurance does not apply to"bodlly Injury" or "property damage" o❑eurrinD after:
ill all work, Including matorlals, parts or aoulpment furnished in connection with snob
work, on'the project(ofher than servico, ma(ntenonce or repairs) to be porformad by or I'
on behalf of the additional Insuredls) at the site of ti)e covered operations has boor)
completed; or,
(2) that portion of "your work" out of which the Injury or damage wises has been put to Its
Intendod use by sny person or organization other then another contractor or
suhoontraotor angagod In performing operations for o princlpol us a part of the same
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projont.
All other terms and conditions romain unrhenged,
utlorizad Ro roa antatfva br
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Apppf antinbr" liatur❑ (Ill States Where
nalidue avpY' ,,I I
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Innurnnt,,So Nlaas Otflan, Ina.,wllh Itm pnnnlsalun,
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GET Coneul tanta, Inc. Effective 03/01/2015-03/01/2016
POLICY NUMBER: f7045470 COMMERCIAL GENERAL LIABILITY'
CG 24 04 05 09
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
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SCHEDULE
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Name Of Person Or organization: j
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Pursuant to applicable written contract or agreement you enter into,
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Information regwred to complete this Schedule, if not shown above, will be shown in the Declarations. I
The following is added to Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us of
Section IV—Conditions:
We waive any right of recovery we may have against
the person or organization shown in the Schedule
above because of payments we make for in;ury or
damage arising out of your ongoing operations or
"your work" done under a contract with that person f
of organization and included in the "products-
completed operations hazard". This waiver applies
only to the person or organization shown in [he I j
Schedule above,
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CG 24 04 05 09 C)Insurance Services Office, Inc., 2008 Page 1 of 1 ❑
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ENDORSEMENT#
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This endorsement, eitective 12:01 A.M. DUOU2015-03/0112016 forms a part of Genial Liability Package Policy
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Polley No. 7046470 Issued to GEl Consultants,Inc.
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By National Union Fire Insu:arcc Company.
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THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
LIMITED ADVICE OF CANCELLATION PROVIDED VIA E-MAIL
TO ENTITIES OTHER THAN THE FIRST NAMED INSURED
This policy is amended as follows:
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In the event that the Insurer cancers thle polley for any reason other Than non-payment of premfunn, 1
and
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1. the cancellation effective date Is prior to this policy's expiration date;
2, the First Named Insured is under an existing contractual obligation to notify a e'artlfleats
holder when this policy is canceled (hare in after, the "Certlflcate Holder(c)") and has
provided to the Insurer, alther directly or through Its broker of rocord, the email address
of a contact at each such entity; and
3. the Insurer received this Informatlon after the First Named Insured receives notice of
cancellation of this policy and prior to this pol'cy's cancellation effective data, vla an
sleotroalc spreadsheet that is acceptable to the Insurer, J
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the Insurer will provide advice of cancellation (the "Advice") via e mail {o each such Certificate
Holders within days after the First Named Insured provides such information to the Insurer;
provided, however, thst It a specific number of days is not stated above, then the Advice will be
provided to such Certlflcate Holders) as soon as reascnahly practicable after the First Named !
Insured provides such Information to the Insurer.
Proof of the Insurer emalling the Advice, using the information provided by the First Named Insured,
will Rsrva as proof that the Insurer has fully satisfied its obligations under this endorsement.
This endorsernont does not affect, In any way, coverage provided under this policy or the
I
cancellatlon of this policy or the effective data thereof, nor shall this endorsornent invest any rights
in any entity not insured under this policy.
The following Definitions apply to this endorsement:
First Named Insured means the Nornal Insured shown on the necJaraticns Pape of this
polley. j
2. Insurer means the Insurance company shown in the header on the Declarations page of this
pulicy,
All other terms, conditions end exclusions shall remain the same,
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Authorized Representative
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10741403/11, Pagel
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GEI Consultants, Inc. G-140428-A
Policy #6011396137 (Ed. 10101)
Eff: 03/01/15-03/01/16
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
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CHANGES - NOTICE OF CANCELLATION
This endorsement modifies insurance provided Under the following:
COMMERCIAL UINBRELLA PLUS COVERAGE PART
in the event of cancellation of this coverage, we agree to mail prior written notice of cancellation to:
SCHEDULE
Name: ANY PERSON OR ORGANIZATION YOU ARE
REQUIRED BY WRITTEN CONTRACT OR ADDRESS; PER CERTIFICATES ON FILE
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2. Addl'ess: AGREEMENT TO MAIL PRIOR WRITTEN WITH BROKER. l
NOTICE OF CA110ELLATION.
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3. Number of days advance notice: 30*
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` ID DRYS NOTICE, V7ILL APPLY I I
TO NON-PAYMENT OF PREMIUM,
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0-140426-A Page 1 of 1
(Fd. 10/01)
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WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT I ',
This endorsement Changes the policy to which It Is attached offeollvo on Inoeptlon date of Iho policy unless a different k -
dale Is fndloatad below,
(The following°altachlna cleuse need ba oomploled only When oft onaasemonl le issued aubnoquwt to preperaffon of Lhe polloy)-
This ondoraement, effeclivo 12:01 AM 03/0 1/20 15 forma a part of Polloy No. 026034972 I
lasued 10 GsI Consultants, Inc, 1
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by National Union Piro Tnenranoo Company f
Premhlm
Wo have the right to recover our payments from anyone liable for an injury covered by I* policy. We will not enforce l
our right against the person or organIzation named In the Schedula. This agreement appllos only to the extent that you
perform work under, 9 written contract that requires you to obtain this agreement from us,
This agreemant shall not operate dlreotly or Indirectly to benefit any one not named In the Schedule. I
Schedule �
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This form Is not applicable in COIlfefnla, Kentucky, New Hampshlre, New Jersey, North Dakota, Chlo, Tohnosseo, ,k j
Texas, Utah, or Washington.
WC 00 03 13 Countorsigned by
(Ed. 04184) G
Authorized Repreeontative
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