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HomeMy WebLinkAboutPW16-195 - Original - Ferguson Waterworks - E George St Water Main Upgrade - 05/11/2016 ri "WIT, /rr , /// ��/�%i/jr/i ///r/ ////�/ME // /� R(e cir d s M 0 m �` r^� E�11 I rf%f/ra Document vMaeni�rarar� 51 m/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: Ferguson Waterworks Vendor Number: JD Edwards Number Contract Number: lu— This is assigned by City Clerk's Office Project Name: E. George St. Water Main Upgrade Description: ❑ gnterlocal Agreement 0 Change Order ❑ Amendment 0 Contract ❑ Other: Contract Effective Date: 5/1.1./1.6 Termination Date: 7/31./1.6 Contract Renewal Notice (Days) Number of days required notice for termination or renewal or amendment Contract Manager: Josh Harris Department: PAN Operations Contract Amount: $9,070.00 Approval Authority: (CIRCLE CANE)( Department Director Mayor City Council Detail: (i.e. address, location, parcel number, tax id', etc.): Supply materials for the project ,._..., __._... m .. As of: 08/27/14 • KENT ww„ .,o•a." GOODS & SERVICES AGREEMENT between the City of Kent and Ferguson Waterworks THIS AGREEMENT is made by and between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and Ferguson Waterworks organized under the laws of the State of Washington, located and doing business at 2042 112th St. S., Tacoma, WA 98444-1537, Phone: (253) 283-5483/Fax: (253) 531-9909, Contact; Thomas Roselli (hereinafter the "Vendor"), AGREEMENT I. DESCRIPTION OF WORK. Vendor shall provide the following goods and materials and/or perform the following services for the City: The Vendor shall supply the City's Water Department with materials for the East George Street Water Main Upgrade project. For a list of materials, see the Vendor's quote which is attached as Exhibit A and incorporated by this reference. Vendor acknowledges and understands that it is not the City's exclusive provider of these goods, materials, or services and that the City maintains Its unqualified right to obtain these goods, materials, and services through other sources. II. TIME OF COMPLETION. Upon the effective date of this Agreement, Vendor shall complete the work and provide all goods, materials, and services by July 31, 2016. III. COMPENSATION. The City shall pay the Vendor an amount not to exceed Nine Thousand, Seventy Dollars ($9,070.00), Including applicable Washington State Sales Tax, for the goods, materials, and services contemplated in this Agreement. The City shall pay the Vendor the following amounts according to the following schedule: After receipt of all materials listed In Exhibit A and receipt of invoice. If the City objects to all or any portion of an invoice, it shall notify Vendor and reserves the option to only pay that portion of the invoice not in dispute. In that event, the parties will immediately make every effort to settle the disputed portion. GOODS &SERVICES AGREEMENT - 1 ($20,000 or Less, incl. WSST) i A. Defective or Unauthorized Work. The City reserves its right to withhold payment from Vendor for any defective or unauthorized goods, materials or services. If Vendor is unable, for any reason, to complete any part of this Agreement, the City may obtain the goods, materials or services from other sources, and Vendor shall be liable to the City for any additional costs Incurred by the City. "Additional costs" shall mean all reasonable costs, Including legal costs and attorney fees, Incurred by the City beyond the maximum Agreement price specified above. The City further reserves Its right to deduct these additional costs incurred to complete this Agreement with other sources, from any and all amounts due or to become due the Vendor. B. Final P1ymen Waiver of Claims. VENDOR'S ACCEPTANCE OF FINAL PAYMENT SHALL CONSTITUTE A WAIVER OF CLAIMS, EXCEPT THOSE PREVIOUSLY AND PROPERLY MADE AND IDENTIFIED BY VENDOR AS UNSETTLED AT THE TIME REQUEST FOR FINAL PAYMENT IS MADE. IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent Contractor- Employer Relationship will be created by this Agreement. By their execution of this Agreement, and in accordance with Ch. 51.08 RCW, the parties make the following representations: A. The Vendor has the ability to control and direct the performance and details of Its work, the City being interested only in the results obtained under this Agreement. B. The Vendor maintains and pays for its own place of business from which Vendor's services under this Agreement will be performed. C, The Vendor has an established and independent business that is eligible for a business deduction for federal Income tax purposes that existed before the City retained Vendor's services, or the Vendor is engaged in an independently established trade, occupation, profession, or business of the same nature as that involved under this Agreement. D. The Vendor is responsible for filing as they become due all necessary tax documents with appropriate federal and state agencies, including the Internal Revenue Service and the state Department of Revenue. E. The Vendor has registered its business and established an account with the state Department of Revenue and other skate agencies as may be required by Vendor's business, and has obtained a Unified Business Identifier (UBI) number from the State of Washington. F. The Vendor maintains a set of books dedicated to the expenses and earnings of Its business. V. TERMINATION. Either party may terminate this Agreement, with or without cause, upon providing the other party thirty (30) days written notice at its address set forth on the signature block of this Agreement. VI. CHANGES. The City may issue a written amendment for any change in the goods, materials or services to be provided during the performance of this Agreement. If the Vendor determines, for any reason, that an amendment is necessary, Vendor must submit a written amendment request to the person listed in the notice provision section of this Agreement, section XIV(D), within fourteen (14) calendar days of the date Vendor knew or should have known of the facts and events giving rise to the requested change. If the City determines that the change increases or decreases the Vendor's costs or time for performance, the City will make an equitable adjustment. The City will attempt, in good faith, to reach agreement with the Vendor on all equitable adjustments. However, if the parties are unable to agree, the City will determine the equitable adjustment as it deems appropriate. The Vendor shall proceed with the amended work upon receiving either a written amendment from the City or an oral order from the City before actually receiving the written amendment, If the Vendor fails to require an GOODS&SERVICES AGREEMENT- 2 ft20.000 or Less, Including WSST) amendment within the time allowed, the Vendor waives its right to make any claim or submit subsequent amendment requests for that portion of the contract work. If the Vendor disagrees with the equitable adjustment, the Vendor must complete the amended work; however, the Vendor may elect to protest the adjustment as provided in subsections A through E of Section VII, Claims, below. The Vendor accepts all requirements of an amendment by: (1) endorsing It, (2) writing a separate acceptance, or (3) not protesting in the way this section provides. An amendment that is accepted by Vendor as provided in this section shall constitute full payment and final settlement of all claims for contract time and for direct, Indirect and consequential costs, Including costs of delays related to any work, either covered or affected by the change. VII. CLAIMS. If the Vendor disagrees with anything required by an amendment, another written order, or an oral order from the City, including any direction, instruction, interpretation, or determination by the City, the Vendor may file a claim as provided in this section. The Vendor shall give written notice to the City of all claims within fourteen (14) calendar days of the occurrence of the events giving rise to the claims, or within fourteen (14) calendar days of the date the Vendor knew or should have known of the facts or events giving rise to the claim, whichever occurs first . Any claim for damages, additional payment for any reason, or extension of time, whether under this Agreement or otherwise, shall be conclusively deemed to have been waived by the Vendor unless a timely written claim Is made in strict accordance with the applicable provisions of this Agreement. At a minimum, a Vendor's written claim shall include the Information set forth In subsections A, items 1 through 5 below. FAILURE TO PROVIDE A COMPLETE, WRITTEN NOTIFICATION OF CLAIM WITHIN THE TIME ALLOWED SHALL BE AN ABSOLUTE WAIVER OF ANY CLAIMS ARISING IN ANY WAY FROM THE FACTS OR EVENTS SURROUNDING THAT CLAIM OR CAUSED BY THAT DELAY. A. Notice of Claim. Provide a signed written notice of claim that provides the following information: 1. The date of the Vendor's claim; 2. The nature and circumstances that caused the claim; 3. The provisions In this Agreement that support the claim; 4. The estimated dollar cost, if any, of the claimed work and how that estimate was determined; and 5. An analysis of the progress schedule showing the schedule change or disruption If the Vendor is asserting a schedule change or disruption. B. Records. The Vendor shall keep complete records of extra costs and time incurred as a result of the asserted events giving rise to the claim. The City shall have access to any of the Vendor's records needed for evaluating the protest. The City will evaluate all claims, provided the procedures In this section are followed. If the City determines that a claim Is valid, the City will adjust payment for work or time by an equitable adjustment. No adjustment will be made for an invalid protest. C. Vendor's Duty to Complete Protested Work. In spite of any claim, the Vendor shall proceed promptly to provide the goods, materials and services required by the City under this Agreement. D. Failure to Protest Constitutes Waiver. By not protesting as this section provides, the Vendor also waives any additional entitlement and accepts from the City any written or oral order (including directions, Instructions, interpretations, and determination). E. Failure to Follow Procedures Constitutes Waiver. By falling to follow the procedures of this section, the Vendor completely waives any claims for protested work and accepts from the GOODS &SERVICES AGREEMENT- 3 I.t2o.000 or Less. Including WSST) City any written or oral order (including directions, Instructions, interpretations, and determination). VIII. LIMITATION OF ACTIONS. VENDOR MUST, IN ANY EVENT, FILE ANY LAWSUIT ARISING FROM OR CONNECTED WITH THIS AGREEMENT WITHIN 120 CALENDAR DAYS FROM THE DATE THE CONTRACT WORK IS COMPLETE OR VENDOR'S ABILITY TO FILE THAT SUIT SHALL BE FOREVER BARRED. THIS SECTION FURTHER LIMITS ANY APPLICABLE STATUTORY LIMITATIONS PERIOD. IX. WARRANTY. Vendor warrants that it will faithfully and satisfactorily perform all work provided under this Agreement In accordance with the provisions of this Agreement. In addition to any other warranty provided for at law or herein, this Agreement is additionally subject to all warranty provisions established under the Uniform Commercial Code, Title 62A, Revised Code of Washington. Vendor warrants goods are merchantable, are fit for the particular purpose for which they were obtained, and will perform in accordance with their specifications and Vendor's representations to City. The Vendor shall promptly correct all defects In workmanship and materials: (1) when Vendor knows or should have known of the defect, or (2) upon Vendor's receipt of notification from the City of the existence or discovery of the defect. In the event any part of the goods are repaired, only original replacement parts shall be used—rebuilt or used parts will not be acceptable. When defects are corrected, the warranty for that portion of the work shall extend for an additional year beyond the original warranty period applicable to the overall work. The Vendor shall begin to correct any defects within seven (7) calendar days of Its receipt of notice from the City of the defect. If the Vendor does not accomplish the corrections within a reasonable time as determined by the City, the City may complete the corrections and the Vendor shall pay all costs incurred by the City in order to accomplish the correction. X. DISCRIMINATION. In the hiring of employees for the performance of work under this Agreement or any sub-contract, the Vendor, Its sub-contractors, or any person acting on behalf of the Vendor or sub-contractor shall not, by reason of race, religion, color, sex, age, sexual orientation, national origin, or the presence of any sensory, mental, or physical disability, discriminate against any person who is qualified and available to perform the work to which the employment relates. Vendor shall execute the attached City of Kent Equal Employment Opportunity Policy Declaration, Comply with City Administrative Policy 1.2, and upon completion of the contract work, file the attached Compliance Statement. XI. INDEMNIFICATION. Vendor shall defend, indemnify and hold the City, its officers, officials, employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or suits, Including all legal costs and attorney fees, arising out of or in connection with the Vendor's performance of this Agreement, except for that portion of the Injuries and damages caused by the City's negligence. The City's inspection or acceptance of any of Vendor's work when completed shall not be grounds to avoid any of these covenants of Indemnification. IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE VENDOR'S WAIVER OF IMMUNITY UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF THIS INDEMNIFICATION. THE PARTIES FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY NEGOTIATED THIS WAIVER. In the event Vendor refuses tender of defense in any suit or any claim, if that tender was made pursuant to this indemnification clause, and if that refusal Is subsequently determined by a court having jurisdiction (or other agreed tribunal) to have been a wrongful refusal on the Vendor's part, then Vendor shall pay all the City's costs for defense, Including all reasonable expert witness fees and reasonable attorneys' fees, plus the City's legal costs and fees incurred because there was a wrongful refusal on the Vendor's part. The provisions of this section shall survive the expiration or termination of this Agreement. GOODS &SERVICES AGREEMENT- 4 i.t.?n_nnn or Less. including WSST) XII. INSURANCE. The Vendor shall procure and maintain for the duration of the Agreement, Insurance of the types and In the amounts described in Exhibit B attached and incorporated by this reference. XIII. WORK PERFORMED AT VENDOR'S RISK. Vendor shall take all necessary precautions and shall be responsible for the safety of its employees, agents, and subcontractors In the performance of the contract work and shall utilize all protection necessary for that purpose. All work shall be done at Vendor's own risk, and Vendor shall be responsible for any loss of or damage to materials, tools, or other articles used or held for use in connection with the work. XIV. MISCELLANEOUS PROVISIONS. A. Recyclable Materials. Pursuant to Chapter 3.80 of the Kent City Code, the City requires its contractors and consultants to use recycled and recyclable products whenever practicable.. A price preference may be available for any designated recycled product. B. Non-Waiver of Breach. The failure of the City to insist upon strict performance of any of the covenants and agreements contained in this Agreement, or to exercise any option conferred by this Agreement In one or more instances shall not be construed to be a waiver or relinquishment of those I covenants, agreements or options, and the same shall be and remain In full force and effect. C. Resolution of Disputes and Governing Law. This Agreement shall be governed by and construed In accordance with the laws of the State of Washington. If the parties are unable to settle any dispute, difference or claim arising from the parties' performance of this Agreement, the exclusive means of resolving that dispute, difference or claim, shall only be by filing suit exclusively under the venue, rules and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in writing to an alternative dispute resolution process. In any claim or lawsuit for damages arising from the parties' performance of this Agreement, each party shall pay all its legal costs and attorney's fees incurred in defending or bringing such claim or lawsuit, including all appeals, in addition to any other recovery or award provided by law; provided, however, nothing In this paragraph shall be construed to limit the City's right to indemnification under Section XI of this Agreement. D. Written Notice. All communications regarding this Agreement shall be sent to the parties at the addresses listed on the signature page of the Agreement, unless notified to the contrary. Any written notice hereunder shall become effective three (3) business days after the date of mailing by registered or certified mail, and shall be deemed sufficiently given if sent to the addressee at the address stated In this Agreement or such other address as may be hereafter specified in writing. E. Assignment. Any assignment of this Agreement by either party without the written consent of-the non-assigning party shall be void. If the non-assigning party gives Its consent to any assignment, the terms of this Agreement shall continue in full force and effect and no further assignment shall be made without additional written consent. F. Modificatlon. No waiver, alteration, or modification of any of the provisions of this Agreement shall be binding unless in writing and signed by a duly authorized representative of the City and Vendor. G. Entire Agreement. The written provisions and terms of this Agreement, together with any Exhibits attached hereto, shall supersede all prior verbal statements of any officer or other representative of the City, and such statements shall not be effective or be construed as entering Into or forming a part of or altering In any manner this Agreement. All of the above documents are hereby made a part of this Agreement. However, should any language in any of the Exhibits to this Agreement conflict with any language contained In this Agreement, the terms of this Agreement shall prevail. H. Compliance with Laws. The Vendor agrees to comply with all federal, state, and municipal laws, rules, and regulations that are now effective or In the future become applicable to Vendor's business, equipment, and personnel engaged in operations covered by this Agreement or accruing out of the performance of those operations. GOODS &SERVICES AGREEMENT- 5 (<b?n nnn nr►acc- inrladina WSST) public Records Act. The Vendor acknowledges that the City Is a public agency subject to the Public Records Act r-odifled In Chapter 42,56 of the Revised Code of Washington and documents, notes, gathered, by t emails, and other records prepared or he Consultant In its performance of this Agreement may be subject to public review and disclosure, even If those records are not produced to or possessed by the City of Kent. As such, the Vendor agrees to cooperate fully with the City in satisfying the city's duties and obligations under the Public Records Act. �C�Qusine—ssrlcens - to commencing the tasl<s described in Section 1, Reqt.flred,. prior Contractor agrees to provide proof of a current city of Kent business license pursuant to Chapter 5,01 of the Kent City Code. l „ Counter arty and Siqnatuufs—by-jfcAaL err_Email. This Agreement maybe executed in any number of counterparts, each of which shall constitute an original, and all of which will together constitute this one Agreement, Further, upon executing this Agreement, either party may deliver the signature page to the other by fax or email and that signature shall have the same force and effect as if the Agreement bearing the original signature was received In person. IN WITNESS, the parties: below execute this Agreement, which shall become effective Oil the last date entered below, ElllDflR CITY OF KENT: U By (slgnatu�� (signature) Print Name: David A. Brock, PE, Print Flame'._ fain` Tts: P ibIl Worl<s Operations Manager "'or" Its: (title) DATE: DATE: NOTICES BE SENT TO- NOTICES TO: BE SENT TO. VENDOR: CITY OF KENT: Thomas Rosell! IT" Imothy 1 LaPorte, P.E. Ferguson Waterworks City of Kent R042 112"' St. S. 220 Fourth Avenue South Tacoma, WA 98444-1537 Kent, WA 98032 (253) 263-5483 (telephone) (253) 856-5500 (telephone) (253) 531-9909 (facsimile) (253) 856-6500 (facsimile) Geerqe th1310 RP111'BTTTs GOODS &SERVICES AGREEMENT- 6 i&,.)n nnn ry i r. . Inrludina WSST) DECLARATION CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY The City of Kent is committed to conform to Federal and State laws regarding equal opportunity. As such all contractors, subcontractors and suppliers who perform work with relation to this Agreement shall comply with the regulations of the City's equal employment opportunity policies. The following questions specifically identify the requirements the City deems necessary for any contractor, subcontractor or supplier on this specific Agreement to adhere to. An affirmative response Is required on all of the following questions for this Agreement to be valid and binding. If any contractor, subcontractor or supplier willfully misrepresents themselves with regard to the directives outlines, it will be considered a breach of contract and it will be at the City's sole determination regarding suspension or termination for all or part of the Agreement; The questions are as follows: 1. I have read the attached City of Kent administrative policy number 1.2. 2. During the time of this Agreement I will not discriminate in employment on the basis of sex, race, color, national origin, age, or the presence of all sensory, mental or physical disability. 3. During the time of this Agreement the prime contractor will provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 4. During the time of the Agreement I, the prime contractor, will actively consider hiring and promotion of women and minorities. 5. Before acceptance of this Agreement, an adherence statement will be signed by-me, the Prime Contractor, that the Prime Contractor complied with the requirements as set forth above. B signing below, I agree to fulfill the five requirements referenced above. I For: �(Zr k V.1 n �cx- r�1 a�6�--►� Title: G-C uX cr-CJ Date:_ t3-1-1 EEO COMPLIANCE DOCUMENTS - 1 of 3 i CITY OF KENT ADMINISTRATIVE POLICY NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998 SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996 CONTRACTORS APPROVED BY Jim White, Mayor POLICY; Equal employment opportunity requirements for the City of Kent will conform to federal and state laws. All contractors, subcontractors, consultants and suppliers of the City must guarantee equal employment opportunity within their organization and, if holding Agreements with the City amounting to $10,000 or more within any given year, must take the following affirmative steps: 1. Provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 2. Actively consider for promotion and advancement available minorities and women. Any contractor, subcontractor, consultant or supplier who willfully disregards the City's nondiscrimination and equal opportunity requirements shall be considered in breach of contract and subject to suspension or termination for all or part of the Agreement. Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public Works Departments to assume the following duties for their respective departments. 1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these regulations are familiar with the regulations and the City's equal employment opportunity policy. 2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines. EEO COMPLIANCE DOCUMENTS - 2 of 3 CITY OF KENT . EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded the Agreement. I, the undersigned, a duly represented agent of Company, hereby acknowledge and declare that the before-mentioned company was the prime contractor for the Agreement known as that was entered Into on the (date), between the firm I represent and the City of Kent. I declare that I compiled fully with all of the requirements and obligations as outlined in the City of Kent Administrative Policy 1..2 and the Declaration City of Kent Equal Employment Opportunity Policy that was part of the before-mentioned Agreement. By: For: Title: Date: EEO COMPLIANCE DOCUMENTS - 3 of 3 EXHIBIT A Scope of work: Vendor will provide the parts and materials to upgrade the four Inch water main on East George Street in the amount not to exceed $9070.70 Including Washington State sales tax. FM-RURAL WATER TRUCK %%FERGUs0N* 2042112THSTSOUTH Dallvar7o: thomap,X0041i®Eer9uaon.00m T042112 WA 0SOUTH 37 From: Thomau R0e6111 Wate1°morks Comments: nns.xTSMa IN STOCK xort nriXVERY T)MNKS STRYS. 12:31:37 APR 2112016 PEI-SEATTLEWW 92021 Price Quotation Page N 1 Phone:263-?83-6483 Fax :253.531-9909 Bid No.......: B268737 Cust 263.866-6230 04121116 Terms....,...: NET SOTH PROX Quoted By.: -TOR Custolrler: CITY OF KENT S111p To: CITY OF KENT KENT PUBLIC WORKS KENT PUBLIC WORKS ATTN:SEAN BAUER ATTN.SEAN BAUER 400 W GOWE ST 400 W GOWE ST KENT,WA 98032 KENT,WA 98032 Cust PQ#...:TO FOLLOW Job Name: EAST GEORGE ST. Item Dascriptlon Quantity Net Price UM Total EAST GEORGE ST.W.MAIN AFT52PX 8 CL62 CL DI FASTITE PIPE 260 16.760 FT 4355.00 1 793.370 EA 793.37 MA238119XOL 6 MJ X FL DI RW OL GATE VL LIA 2 � 823.896 EA 1847.79 MA236106XOL 8 FLO DI RW OL GATE VLV 1 823.895 EA 647.79 FTX 8 DI 126tF C110-FLG TEE 92 FCRXU 8X6 DI 1264 C110 FLG CONC RED 2 124,280 EA 248.66 MJ2LAX 8 MJ 0163 22-112 BEND LIA 2 72.000 EA 146.60 MJLSLAX BX12 MJ C163 LONG SLV LIA. 1 93,060 EA 93.08 MjLSLAU BX12 MJ 0163 LONG SLV LIA 1 66.680 EA 60.68 MJSCAPLAP 4 MJ C153 SLl)CAP U 2 14.040 EA 28.08A � 63.810 EA 378,67 RRGAPX 8 ROMAGRIP ACCY PK F1 DI 36 RRGAPU 6 ROMAGRIP ACCY PK FI DI 2 31.691 EA 163.03 RRGAPP 4 ROMAGRIP ACCY PK FI DI 2 7A86 EA 35.93 93 FNWNBSXIX 8ZN1501IFLONUTIBLTSET 6 7.160 EA 39.79 FNWR1 RGAX 8 RR 1/816011 RNG GSKT 6 1,968 EA 9.79 THANKS STEVE' GALL WI QUESTIONS Net Total: $8283.76 Tax:- $786.94 Frolght: $0.00 Total: $9070.70 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 1185 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. S. 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. I 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 AMI. 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. A CERTIFICATE OF LIABILITY INSURANCE page 1 of 3F�A 5/10/20 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 lieu of such endorsement(s). PRODUCER CONTACT Willis of Maryland, Inc. PHONE FAX c/o 26 Century Blvd. 610-964-8700 610-254-5600 P. 0. Box 30S191 E-MAIL certificates@willis.com Nashville, TN 37230-5191 INSURER(S)AFFORDINGCOVERAGE NAIC# IN5URERA:National union Fire Ina. Co. of Pittsburg 19445-002 INSURED Ferguson Enterprises, Inc. and Subsidiaries IN5uRERB:National Union Fire Ina. Co. of Pittsburg 19445-000 (See Attached Named insured Schedule) INSURERC:National Union Fire Ina. Co. of Pittsburg 19445-001 12500 Jefferson Avenue Newport News, VA 23602 INSURERD:New Hampshire Insurance Company 23841-001 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:24385622 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DDL SUB POLICY NUMBER POLICYEFF POUCYEXP LIMITS ILTRA X COMMERCIAL GENERAL LIABILITY y GL3333235 8/1/2015 8/1/2016 EACH OCCURRENCE $ 2,000,000 ��FFTTQRaoccccureence) $ 1,000,000 CLAIMS-MADE X OCCUR RAW@§;(t MEDEXP(Any one person) $ 10,000 PERSONAL BADVINJURY $ 21000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 5,000,000 POLICY X PRO JECT X LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY Y ADS CA7469808 8/l/2015 8/1/2016 COMBINED SINGLE LIMIT (Ea accident) S 5,000,000 C X ANYAUTO Y VA CA7469810 8/1/2015 8/1/2016 BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED Y MA CA7469809 8/1/2015 8/1/2016 BODILY INJURY(Per accident) $ X HIR DAUTOS MDarnacie NON-OWNED R AMAGE AUTOS (Peraccident� $ X Self- Physical $ Insured UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION S S D WORKERS COMPENSATION WCO24780918 8/1/2015 8/1/2016 X TAT. AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE- N/A E.L.EACH ACCIDENT $ 2,000,000 OFFICEWMEMBER EXCLUDED? iMandatoryinNH) E.L.DISEASE-EA EMPLOYEE $ 2,000,000 I yes,descnheunder DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additonal Remarks Schedulo,may be attached if more space is required) See Attached for Additional Workers' Compensation Policies: CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE City of Rent Coll:4897314 Tpl:1980216 Cert: 85622 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 031419 LOCM '4 ADDITIONAL REMARKS SCHEDULE Page-2-of �— AGENCY NAMED INSURED Ferguson Enterprises, Inc. and Subsidiaries Willis of Maryland, Inc. (See Attached Named Insured Schedule) POLICY NUMBER 12500 Jefferson Avenue Newport News, VA 23602 See First Page CARRIER NAIC CODE See First Page EFFECTIVEDATE: See First Page ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Workers' Compensation - ME Policy No. WCO24780914 Carrier: New Hamppshire Insurance Comppany Policy Period: 08/01/2015 - 08/0 /2016 Statutory Limits: EL Each Accident $2,000,000 EL Disease - Each Employee $2,000,000 EL Disease - Policy Limit $2,000,000 Workers' Compensation - CA Policy No. WCO24780913 Carrier: Ins. Co. of the State of PA Policy Period: 08/01/2015 - 08/01/2016 Statutory Limits: EL Each Accident $2,000,000 EL Disease - Each Employee $2,000,000 EL Disease - Policy Limit $2,000,000 Workers' Compensation - FL Policy No. WCO24780912 Carrier: New Hampshire Insurance Company Policy Period: 08/01/2015 - 08/01/2016 Statutory L mits: EL Each Accident $2,000,000 EL Disease - Each Employee $2,000,000 EL Disease - Policy Limit $2,000,000 Workers' Compensation - OR Policy No. WCO24780915 Carrier: New Hampshire Insurance Company Policy Period: 08/01/2015 - 08/01/2016 Statutory Limits: EL Each Accident $2,000,000 EL Disease - Each Employee $2,000,000 EL Disease - Policy Limit $2,000,000 Workers' Compensation - WI Policy No. WCO24780916 Carrier: Illinois National Insurance Company Policy Period: 08/01/2015 - 08/01/2016 Statutory Limits: EL Each Accident $2,000,000 EL Disease - Each Employee $2,000,000 EL Disease - Policy Limit $2,000,000 Workers' Compensation - MA Policy No. WCO24780917 Carrier: Ins. Co. of the State of PA Policy Period: 08/01/2015 - 08/01/2016 Statutory Limits: EL Each Accident $2,000,000 EL Disease - Each Employee $2,000,000 EL Disease - Policy Limit $2,000,000 Workers' Compensation - AK, AZ, VA Policy No. WCO24780921 Carrier: New Hampshire Insurance Company Policy Period: 08/01/2015 - 08/01/2016 Statutory Limits: EL Each Accident $2,000,000 EL Disease - Each Employee $2,000,000 EL Disease - Policy Limit $2,000,000 ACORD 101 (2008/01) Coll:4897314 Tpl:1980216 Cert:24385622 ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 031419 LOC#: A� ADDITIONAL REMARKS SCHEDULE Page-3—of �— AGENCY NAMED INSURED Ferguson Enterprises, Inc. and Subsidiaries Willis of Maryland, Inc. (See Attached Named Insured Schedule) POLICY NUMBER 12500 Jefferson Avenue Newport News, VA 23602 See First Page CARRIER NAIC CODE See First Page EFFECTIVEDATE; See First Page ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Workers' Compensation - NJ & PA Policy No. WCO24780920 Carrier: New Hamppshire Insurance Comppany Policy Period: 08/01/2015 - 08/01/2016 Statutory Limits: EL Each Accident $2,000,000 EL Disease - Each Employee $2,000,000 EL Disease - Policy Limit $2,000,000 Workers' Compensation - IL, KY, NC, NH, UT & VT Policy No. WCO24780919 Carrier: New Hamppshire Insurance Company Policy Period: 08/01/2015 - 08/0 /2016 Statutory Limits: EL Each Accident $2,000,000 EL Disease - Each Employee $2,000,000 EL Disease - Policy Limit $2,000,000 City of Kent is included as an Additional Insured under General Liability and Auto Liabilityy as required by written contract but only with respect to liability arising out of Named Insured's operations. General Liability policy shall be Primary and Non-Contributory with any other insurance in force for or which may be purchased by City of Kent. ACORD 101 (2008/01) Co11:4897314 Tp1:1980216 Cert:24385622 ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD Willis Ferguson Enterprises, Inc. and Subsidiaries. List of Named Insureds Air Cold Supply Factory Direct Appliance Air Cold Supply/Webb Distributors Ferguson Bath Kitchen and Lighting Gallery Alamo Pipe& Supply Ferguson Enterprises IV, Inc. Alaska Pipe& Supply Ferguson Enterprises of Montana, Inc. Andrews Lighting Gallery, Inc. (dba Ferguson Enterprises of Virginia, Inc. Andrews Lighting& Hardware Gallery) Ferguson Enterprises V, Inc. Arkansas Supply, Inc. Ferguson Enterprises, Inc. Ar-Jay Building Products, Inc. (dba Ferguson Enterprises, Inc. dba WPCC The Ar-Jay Center) Forwarding Atlantic American Fire Equipment Company Ferguson Enterprises, Inc. A Corp of Virginia Arkansas Supply Ferguson Enterprises NY—Metro, Inc. Build.com, Inc. Ferguson Fire& Fabrication, Inc. Builders Appliance Center, LLC Ferguson Fire & Fabrication, Inc. (flea Action CAL-STEAM, a Wolseley Company Fire Fab & Supply, Inc.) Camellia Valley Supply Ferguson Fire & Fabrication, Inc. (fka Sierra Castle Supply Company, Inc. Craft, Inc.) CastleNorth Ferguson Full Service Supply Central Pipe & Supply Ferguson Heating & Cooling CFP Ferguson Holdings, Inc. Chadwick Ferguson Hospitality Sales City Lights Design Showroom Ferguson Industrial Plastics and Pump Clayton Group, Inc. Division Clayton International, LLC Ferguson Integrated Systems Division, Inc. Cline Contract Sales Ferguson Intermountain Piping Colgan Cabinets Ferguson International Colgan Distributors Ferguson Process Services Crow Company Ferguson Valve &Automation D & C Plumbing & Heating Supply Ferguson Waterworks Davis &Warshow, Inc. Ferguson Waterworks - Midwest Pipe Davidson Electric Wholesale Supply Ferguson Waterworks - Municipal Pipe The Davidson Corporation, a Delaware Ferguson Waterworks - Red Hed Corporation Ferguson Waterworks EPPCO The Davidson Group Companies, Inc Ferguson Waterworks International Davidson Group Leasing Frischkom, Inc. Davidson Pipe Company Inc., a New York Galleria Bath &Kitchen Showplace Corporation Gilmour Supply Company, Inc. Davidson Pipe Supply Company, Inc. Global HVAC Distributors, Inc. Davies Water Ferguson Enterprises, Inc. dba Groeniger Decorative Product Source, Inc. & Company E &J Plumbing&Heating Supply Co. Gulf Refrigeration Supply Economy Plumbing and Heating Supply Co. High Country Plumbing Supply Endries International, Inc. Home Equipment Company, Inc. Energy & Process Corporation HP Products Corporation Equarius, Inc. dba Equarius Waterworks, HP Logistics, Inc. Meter&Automation Group Indiana Plumbing Supply Co., Inc. Willis Ferguson Enterprises, Inc. and Subsidiaries. List of Named Insureds Industrial Hub of the Carolinas Supply North Central Group J&G Products Tarpon Wholesale Supplies J.D. Daddario Company T&A Valve Industries, Inc. Joseph G. Pollard Co., Inc. The Parnell-Martin Companies LLC Kandall Fabricating The Plumbers Warehouse Karl's Appliances,A Ferguson Enterprise The Stock Market Lane Piping Co. Tubeco Fabrication, Inc. Lawrence Plumbing Supply Co. United Automatic Lincoln Products Water Works Supplies Linwood Pipe and Supply Webb Distributors Living Direct, Inc. Western Air Systems and Controls, Inc. Louisiana Utilities Supply Company WIA of California, Inc. Louisiana Chemical Pipe, Valve&Fitting, Wolseley Industrial Group Inc. dba Wolseley Industrial Group Wolseley Industrial Plastics LUSCO Wolseley Investments Acquisitions, Inc. Lyon Conklin & Co., Inc. Wolseley Investments, Inc. Mastercraft Cabinets Wolseley NA Construction Services, LLC McFarland Supply Co., Inc. Wolseley North America, Inc. Monotube Pile Corporation Wolseley North American Consulting, LLC Northern Water Works Supply, Inc. Wolseley North American Services, Inc. Onda-Lay Pipe and Rental, Inc. WPCC Forwarding Page's Appliances Palermo Supply Park Supply PCS Industries d/b/a HP Products Corp. Pipe Products Plumbing Decor Plumb Source Powell Pipe & Supply Company Power Equipment Direct Inc. R Supply Company Record Supply Company Redlon&Johnson Reese Kitchen, Bath & Lighting Gallery RenWes Sales S.G. Supply Company S.G. Supply Company dba SG Supply Co., a Ferguson Enterprise Sierra Craft, Inc. Ship-Pac, Inc. d/b/a HP Products Corp. SOS Sales Specialty Pipe &Tube, Inc. Specialty Pipe &Tube of Texas, Inc. Stock Loan Services LLC Summer&Dunbar P CL ICY NUMB ER: COMMER CIA L G ENERAL LIABILITY GL 3333236 CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON DR ORGANIZATION This endorsement modifies insurance provided underthe following: C OM MERC IAL G EN ERAL LIABIL ITY COV ERAG E PART SCHEDULE Name Of Additional Insured Person(s) Or Organimtion(s): Any person or organization to wham you become obligated to include as an additional insured underthis policy asa result of any contract oragreement you enterinto. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section 11 - Who Is An Insured is amended to is required by a contract or agreement, the include as an additional insured the persords) or insurance afforded to such additional insured organization(s) shown in the Schedule, but only vrill not be broader than that which you are with respect to liability for bodily injury' required by the contract or agreement to -property damage—or -personal and advertising provide forsuch additional insured. injury—caused,in whole orin part,by your aots B. With respect to the insurance afforded to these or omissions or the acts or omissions of those additional insureds, the following is added to acting on your behalf: Section III- Limits Of Insurance: 1. In the performance of your ongoing If coverage provided to the additional insured is operations;or required by a contract or agreement, the most 2. In connection with your premises owned by we will pay on behalf of the additional insured or re nted to you. is the amount of insurance: However. 1. Required by the contract oragreement;or 1. The insurance afforded to such additional 2. Available under the applicable Limits of insured only applies to the extent permitted Insurance shown inthe Declarations; by law;and whicheve ris less. 2. If coverage provided to the additional insured This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 04 13 0 Insurance Services Office,Inc.,2012 Page 1 of 1 13 ENDORSEMENT This endorsement,effective 12:01 A.M. 8/112015 forms part of policy No. CA 7469808 issued to Wolseley Investments, Inc, by National Union Fire Insurance Company Of Pittsburgh, Pa THIS ENDORSEMENT CHANGES TFE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This endarsemerzr moa fies rnsurarxe provided under the foiioWng: BUSINESS AUTO COVERAGE FORM SCHEDULE ADDITIONAL INSURED: Any person or organizabonfor whom you are contractually bound to provide additional insured status but onlyto the event cf such person or organizations liability arising outof the use of acovered "auto". 1. SECTION II - LIABILITY COVERAGE,A.Coverage, 1.- Who Is Insured, is amends d to a dd: d. Any person or organ¢ation, shown in the schedule above, to whom you became obligated to include as an additional insured under this polb y,as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this polby, but only with respect to liability arising out of use of a covered "auto". However, the insurance provided will not exceed the lesser of: (1) The coverage and/or limits of this policy, or (2) The coverage anchor limits required byseidcontract or agreement. Authorized Representative or Counters''ggnature(in States Where Applicadel 87950(10/05) Page 1 of 1 ENDORSEMENT# This endorsement,effective 12:01 A.M. 8/112015 lorms a pan of Policy No. GL 3333235 issued to Welseley Investments, Inc. By National Union Fire Insurance Company of Pittsburgh, Pa 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: In the event that the Insurer cancels this policy lot any reason other than non-payment of premium, and 1. the cancellation effective date is prior to this policy's expiration dote; 2. the First Named Insured is under an existing contractual obligation to notify a certificate holder when this policy is canceled (heretnafter, the "Certificate Holders}") 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 Insured receives notice of cancellation of this policy and prior to this policy's cancellation effective date, via an electronic sprendsheet that is acceptable to the Insurer, the Insurer will provide advice of cancellation (the "Advice') via e-mail to each such Certificate Holders within 30 days alter 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 Holderis) as scion as reasonably practicable after the First Named Insured provides such inlorrnation to the Insurer. Proof of the Insurer emailing the Advice, using the information provided by the First Named Insured, o)il)serve as proof that the 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, not shall this endorsement invest any rights in any entity not insured under this policy. The following Definitions apply to this endorsement: 1. First Namod Insured means the Named Insured shown on the Declarations Page of this policy. 2, Insurer means the insurance company shown in tho header on the Declarations page of this policy. All other terms,conditions and exclusions shall remain the same. Authorized Representative w 107414 10311 11 Page 1 ENDORSEMENT# This endorsement, effective 12:01 A.M. 8.1 r2015 forms a part of Policy No. CA 7469806 issued to Wolseley Investments, Inc. By National Union Fire Insurance Company of Pittsburgh. Pa 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: In the event that the Insurer cancels this policy for any reason other than non-payment of premium, and 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 certificate holder when this policy is canceled thereinafter, the 'Certificate Holderisl"I 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 Insured receives 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 advice of cancellation tthe "Advice") via e-mail to each such Certificate Holders within 30 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 Holderlsl as soon as reasonably practicable after the First Named Insured provides such information to the Insurer. Proof of the Insurer emailing the Advice, using the information provided by the First Named Insured. will serve as proof that the 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 policy. The following Definitions apply to this endorsement: 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 policy. All other terms,conditions and exclusions shall remain the same. Authorized Representative 107414 503�1 11 Page 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following"attaching clause' need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement,effective 12:01 AM 8/1/2016 forms a part of Policy No.WC 024780918 Issued to Wolseley Investments, Inc. By New Hampshire Insurance Company LIMITED ADVICE OF CANCELLATION PROVIDED VIA E MAIL TO ENTITIES OTHER THAN THE NAMED INSURED (WORKERS' COMPENSATION ONLY) This policy is amended as follows: In the event that thelnsurer cancels this policy for any reason other than non-payment of premium, and 1. the cancellation effective date is prior to this policy's expiration date; 2. the Named Insured or, if applicable, any other employers named in Item 1 of the Information Page is under an existing contractual obligation to notify a certificate holder when this policy is canceled (hereinafter, the "Certificate Holder(s)") and the Named Insured 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 Named Insured receives notice of cancellation of this policy and prior to this policy's cancellation effective date, via an electronic spreadsheet that is acceptable to thilinsurer, the Insurer will provide advice of cancellation (the "Advice") via e-mail to each such Certificate Holders within 30 days after the 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 Holder(s) as soon as reasonably practicable after the Named Insured provides such information to thelnsurer. Proof of the Insurer emailing the Advice, using the information provided by the First Named Insured, will serve as proof that the 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 policy. The following definitions apply to this endorsement: 1. Named Insured means the insured first named employer in Item 1 of the Information Page of this policy. 2. Insurer means the insurance company shown in the header on the Information Page of this policy. All other terms, conditions and exclusions shall remain the same. AUTHORIZED REPRESENTATIVE WC 99 00 56 (Ed. 04111)