HomeMy WebLinkAboutPK16-221 - Original - Fountain Works LLC - Town Square Plaza Fountains - 05/24/2016 i
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WAS H fiNGT ON
an
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: Fountain Works LLC
Vendor Number:
JD Edwards Number
Contract Number: I U I
This is assigned by City Clerk's Office
Project Name: Town Square Plaza Fountains _
Description: ❑ Interlocal Agreement ❑ Change Order ❑ amendment xContract
❑ Other
Contract Effective Date: Upon Signature 5/16 Termination Date: 90 days
Contract Renewal Notice (Days)
Number of days required notice for termination or renewal or amendment
Contract Manager: Garin Lee Department: Park Operations
Contract Amount: $10,508.00
Approval Authority: (CIRCLE ONE) IDepartment Director I Mayor City Council
Detail: (i.e. address, location, parcel number, tax id, etc.):
As of: 08/27/14
IN
•
KENT
WASHiNOTON
GOODS & SERVICES AGREEMENT
between the City of Kent and
Fountain Works LLC
THIS AGREEMENT is made by and between the City of Kent, a Washington municipal corporation
(hereinafter the "City"), and Fountain Works LLC organized under the laws of the State of Texas, located
and doing business at 7126 Oaklawn Drive, San Antonio, Texas 78229; P: 210-858-9016 (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:
Service to be performed on fountain located in the CIty of Kent, Town Square Park. Includes
labor to check out issues with compressor and logic controlling compressor to PLC, inspect
control panels and VFD's.; labor to check fountain cans and relay cards to make sure
fountain operation is working correctly; labor to install fountain parts ordered in 2015, set
pump pressures and test DMX controls; Also includes service charge (Travel) air fare to
Seattle and re turn flight and Service charge (Travel) expenses, food and lodging as
described in Exhibit A, attached.
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 within 90 days from date of contract.
III. COMPENSATION. The City shall pay the Vendor an amount not to exceed TEN
THOUSAND FIVE HUNDRED EIGHT DOLLARS AND NO CENTS ($10,508.00)
, 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:
Vendor will submit a final invoice to the City of Kent upon completion of work as described
in I. Description of Work.
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 - I
($20,000 or Less, ind. WSST)
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 Payment: Waiver of Claims. VENDOR'S ACCEPTANCE OF FINAL PAYMENT SHALL
CONSTITUTE A WAIVER OF
VENDOR OR ASMS, EXCEPT THOSE
UNSETTLED AT THE TIME REQU ST FOR F NA L
AND IDENTIFIED B 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:
s of
A. The Vendor theCity being g ability to control and direct the performance and interested only in the results obtained under this Agreement.
its
work, the
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 state 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
($20,000 or Less, including WSST)
ht to make any claim or
mit subsequent
amendment within the time allowed, the Vendor waives work.
If th Vendor disagrees with the equitable
amendment requests for that portion of the contract
r, the
adjustment, the Vendor must complete the amended work; howeve VII, Claims, belowor may elect to protest the
adjustment as provided in subsections A through E o
The Vendor accepts all requirements of an amendment by: (1) endorsing it, (2) writing a separate
accept or (3) not protesting in the way this section arOn nt andnfinalesettlementent at is of allccepted by
cla claims or
P
Vendor as provided in this section shall constitute u p Y
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
tation, or
written order, or an oral order from the City, including
any provided rintth s,section.tiThe Vendor shall give
determination by the City, the Vendor may file a claim calendar days of the occurrence of the events
written notice to the City of all claims within fourteen (14)
new
ul
99 ivin rise to the claims, or within fourteen (14) calendar days of t evedate the Vendor k first . Any r sho ford
have known of the facts or events giving rise tot e this claim, whicr
damages, additional payment for any reason, or extension of n waived bytthe whether
art timely writtenecla m
otherwise, shall be conclusively deemed to have I cable provisions of this Agreement.
is made in strict accordance with the app
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, SOLUTE EN NOTIFICATION OF CLAIM WITHIN
WA WAIVER OF ANY CLAIMS ARISING IN
THE TIME ALLOWED SHALL BE AN AB
ANY WAY FROM THE FACTS OR EVENTS SURROUNDING THAT CLAIM OR CAUSED
BY THAT DELAY.
Provide a signed written notice of claim that provides the following
A. Notice of Claim.
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 schedule showing 5. An analysis of thepr sgress asserting a schedule change eor disruption.
hange or
disruption if the Vendor
rnprecords of
e incurred as a
B. Records. The Vendor shall keep col r sel toe extra m
the claim. The City shall have access to any of
result of the asserted events giving
the Vendor's records needed for evaluating the protest.
re The City will evaluate all claims, provided the procedures in this sectientor work ol�wed. if t me bytan
City determines that a claim is valid, the City will adjust pay
equitable adjustment. No adjustment will be made for an invalid protest.
he Vendor shall
eed
C. Vendor's Dut to Com lete Protested Work. Ind services required te of any claim, t by the City undercth s
promptly to provide the goods, materials a
Agreement.
p, Failure to Protest Consti Vendor
tutes Waiver. By notprotesting from theiCity aion ny written or oral order
also waives any additional entitlement and A
(including directions, instructions, interpretations, and determination).
llow
he procedures of this
E. Failure to Follow Procedures Constitutes Waiver.claimsBy failing to for protested owork tand accepts from he
section, the Vendor completely waives any
GOODS &SERVICES AGREEMENT - 3
($20,000 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
M THE DATE THE
FROM OR CONNECTED WITH THIS AGREEMENT ABILITY TO FILE THAT SUIT SHALL BE FOREVER BARRED.
CONTRACT WORK IS COMPLETE OR VENDOR'S
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 erein, this CommercialgCode, Title 62A, Revisedreement is additionally uCode of Washington.
bject to all warranty
provisions established under the Uniform they
Vendor warrants goods are merchantable, are fit for the nd Vlcular endor'surpose for representat olns to City e The Vendor
e obtained,
and will perform in accordance with their specifications a should
shall promptly correct all defects in workmanship Ceint ofaterials: (1) when not notification from the Vendor
City of then existence oe
known of the defect, or (2) upon Vendor'sP original
discovery of the defect. In the event will notbe acceptable.goodsart of the When defects isare repaired, are corrected, hlecwa replacement
shall be used—rebuilt or used parts w eriod applicable
that portion of the work shall extend for an additional year beyond the original warranty alendar days of its
to the overall work. The Vendor shall begin to correct any defects within seven (7) Y
receipt of notice from the City of the defect.
Vor does not complete the correlctions andish the rthe'Vendor ons shall
reasonable time as determined by the City, the City may
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 reason of ra e, religion, colo�rsexyagerssexual acting
orientatonalf of the
n national
Vendor or sub-contractor shall not, by
origin, or the presence of any sensory, mental, or which icalhe employmentdiscriminate against any person who
is qualified and available to perform the work t
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
nattornearfeess arnsingny and out of all claims,
nmconnect on damages,he Vendor's
suits, including all legal costs a Y
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 CONSTITUTESP OF THIS INDEMNIFICATION
VENDOR'S WAIVER OF
UNDER
THE PARTIES
INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES
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
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,and including
nculrred becaule expert se there was therewrongful refusal oness fees and a hle
attorneys' fees, plus the Ciy s legal costs a
Vendor's part.
The provisions of this section shall survive the expiration or termination of this Agreement.
GOODS &SERVICES AGREEMENT - 4
($20,000 or Less, including WSST)
ndor
maintain for the
XII. INSURAN and nhtheeamounts shall described and
Exhibit % attached duration
Agreement,
insurance of the type incorporated this
refererce.
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 nts o use recycled andecyclab e products whenever Materials. Pt Chapter
t City Code,
practicable.eeq A pricer
es its
contractors and consults
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
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
the
the non-assigning
Agreement shall continuel be void. if n full force and effect ae non-assigning party lndsno further assignment consent to any shall be
the terms of thisg
made without additional written consent.
F. Modification. 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 Acireement. 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
($20,000 or Less, including WSST)
......................
I. Public Records Act. The Vendor acknowledges that the City Is a public agency subject to the
Public Records Act codified In Chapter 42.56 of the Revised Code of Washington and documents, notes,
emalls, and other records prepared or gathered by the 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.
J. City Business Llcei3se Reguired. Prior to commencing the tasks described In Section I,
Contractor agrees to provide proof of a current city of Kent business license pursuant to Chapter 5.01 of
the Kent City Code.
K. CounteEParts and 31griatyces by Fax or Email. This Agreement may be 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 on
the last date entered below.
VENDOR: CITY OF KENT:
By. By;
(srarurel rtj�_q 11 (signaivre)
Print Name:jft;- P nt Nam Jeff Watling
Its:, -R, kA e!!;. Its: Parks Irector
furl )
DATE:—. DATE: 2-
NOTICES TO BE SENT TO: NOTICES TO BE SENT TO:
VENDOR: CITY OF KENT:
Michael Perry Ben Levenhagen
Fountain Works LLC Downtown Grounds Lead - Parks Operations
7126 Oaklawn Drive City of Kent
San Antonio, TX 78229 220 Fourth Avenue South
Kent, WA 98032
210-858-9016 (telephone)
(facsimile) (253) 856-5133 (telephone)
(253) 856-6120 (facsimile)
[In this TWd,you may ants,the dechc4c njapath when th2 contract his been saved)
GOODS & SERVICES AGREEMENT- 6
tt2Q QQQ or J a= ItIrlud.1na WEST)
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.
By signing below, I agree to fulfill the five requirements referenced above.
By. -fir' ' ��.
For: / i'[ J
Title: +-C k �L
Date:
EEO COMPLIANCE DOCUMENTS - 1 of 3
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,o consultants ai suppliers ifholding Agreements the C ty
st guarantee
equal employment opportunity within their organization and
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.
the
Any contractor, subcontractor, consultant or supplier shallvbe ho conlsidlered inly r egards breach of contract
nondiscrimination and equal opportunity requirements
and subject to suspension or termination for all or part of the Agreement.
Contract Compliance Officers will be appointed by fthe ort Directors
respe of
Planning, Parks, and Public
Works Departments to assume the following duties
1. Ensuring that contractors, subcontractors, consultants, and suppliers subject t0
00rtunse
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 complied 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,
1
7126 Oaklawn Dr.
San Antonio,Texas 78229
www.fountain-works.com
210-858-9016
michael@fountain-works.com
Service Location .. .._.
Customer 220 Ath Ave.South
Name. City Of Kent Kent WA
Address 220 dth Ave.South
Kent WA
Phone (253)855-5120
(253)505-9548
Item(s), bate Am ount Tax Approved
C1ty Nama .,. Qasaription...., . ..,,,. ... .. .... $639.a0 $1,278.60 NON Yes
2 Traveil Service charge Service charge(Travel)Air Fare to Seattle and return flight $$
5.ao $1,52a.00 NON Yes
16 Labor-Tethnidan Labor to cheek out asswes with compressor and tagie controllung compressor to PLC.Inspect central genets and VFD's... .. ,. .. ._.
1 Tsaveil Ser1.vice charge Service charge(Travel)Travel expenses food and lodging. ..._ ., .
$2 200.00 $2 200.0 p NON es
24 Lobar-Tectniclan Lobar to cheek fountain cans and relay cards to make sure fountain operation is wanking correctly,
$95.00 $2 280.00 NON Yes
Lpress, and test QMX controls
_ $95.a0 $3230.00 NON Yes
3A Lobar-Technician Labor to CnslalY 4owntam parts ordered yin 2015 set pump
Subtotal $10 568.,pp
Tax Y_ _ _�__..__....w..__ _._$ta.500.00
.00
Total
_... Notes
- - Each additional day will be 1855.00 plus air fare change fee's
Terms ..
Signature Date
EXHIBIT B
INSURANCE REQUIREMENTS FOR
CONSTRUCTION PROJECTS
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. Automobile Liabili 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.
Commercial General Liability insurance shall be written on ISO occurrence form CG
00 01 and shall cover liability arising from premises, operations, independent
contractors,products-completed operations,personal injury and advertising injury,
and liability assumed under an insured contract. The Commercial General Liability
insurance shall be endorsed to provide the Aggregate Per Project Endorsement ISO
form CG 25 03 1185. There shall be no endorsement or modification of the
Commercial General Liability insurance for liability arising from explosion, collapse
or underground property damage. The City shall be named as an insured under the
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. Workers' Compensation coverage as required by the Industrial Insurance laws of the
State of Washington.
B. Minimum Amounts of Insurance
Contractor shall maintain the following insurance limits:
1. Automobile Liability insurance with a minimum combined single limit
for bodily injury and property damage of $1,000,000 per accident.
2. Commercial General Liability insurance shall be written with limits no
less than$1,000,000 each occurrence, $2,000,000 general aggregate
and a$2,000,000 products- completed operations aggregate limit.
BX]HIBIT B (Continued)
C. Other Insurance Provisions
The insurance policies are to contain,or be endorsed to contain,the following provisions
for Automobile Liability, Commercial General Liability and Builders Risk 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.
D. Contractor's Insurance For Other Losses
The Contractor shall assume full responsibility for all loss or damage from any cause
whatsoever to any tools, Contractor's employee owned tools,machinery,equipment, or
motor vehicles owned or rented by the Contractor, or the Contractor's agents, suppliers or
contractors as well as to any temporary structures, scaffolding and protective fences.
E. Acceptability of Insurers
Insurance is to be placed with insurers with a current A.M. Best rating of not less than
A:VII.
F. Verification of Coverage
Contractor shall famish the City with original certificates and a copy of the amendatory
endorsements, including but not necessarily limited to the additional insured
endorsement, evidencing the Automobile Liability and Commercial General Liability
insurance of the Contractor before commencement of the work. Before any exposure to
loss may occur,the Contractor shall file with the City a copy of the Builders Risk
insurance policy that includes all applicable conditions, exclusions, definitions,terms and
endorsements related to this project.
G. 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.
,acoR CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDD/YYYY)
10/15/2015
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(ies)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 Wortham Insurance&Risk Management NAMNT CT
E:
131 Interpark Blvd. PHONE PAX
San Antonio, TX 78216 E-MAIL AIC Not:
ADDRESS:
INSURERS AFFORDING COVERAGE NAIC#
www.worthaminsurance.com INSURER A: Cincinnati Insurance Company
10677
INSURED INSURERB: Texas Mutual Insurance Company 22945
Fountain-Works LLC
7126 Oaklawn Drive INSURERC:
San Antonio TX 78229-3021 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 26941598 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 ADDL R POLICY EFF PDLICY EXP
LTR POLICY NUMBER MMfDD MMID LIMITS
A �/ COMMERCIAL GENERAL LIABILITY EPP0266712 7/14/2015 7/14/2016 EACH OCCURRENCE S 1,000,000
TO
CLAIMS-MADE ❑✓ OCCUR PREMISES Ea occurrence S 1,000,000
MED EXP(Any one person) S 10,000
PERSONAL&ADV INJURY S 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2.000,000
POLICY a JECT LOC PRODUCTS-COMPIOPAGG $ 2,000,000
OTHER: $
A AUTOMOBILE LIABILITY EBA0266712 7/14/2015 7/14/2016 COMBINED SINGLE LIMIT
Ea accident $ 11000,000
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY(Per accident) $
NON-OWNED PROPERTY DAMAGE
HIRED AUTOS AUTOS Per accident S
S
A ✓ UMBRELLA LIAR OCCUR EPP0266712 7/14/2015 7/14/2016
EACH OCCURRENCE S 1,000000
EXSS LIAB CLAIMS-MADE AGGREGATE S 1,000,000
R7DECDF
RETENTION$0
B WORKERS COMPENSATION TSF0001259969 10/25/2015 10/2512016 S
AND EMPLOYERS'LIABILITY YIN ✓ PER
ER'*
ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? N 1 A E.L.EACH ACCIDENT $ 1,000,000
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000
If yes,deso be under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
RE: Fountain Maintenance
CERTIFICATE HOLDER CANCELLATION
Clty of Kent SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Fourth Ave. South THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
220
Kent WA ?8032
Ave. ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
John L.Wortham&Son,L.P.
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
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® WORKERS' COMPENSATION AND EMPLOYERS
xasm.t LIABILITY INSURANCE POLICY
Instuance Cor<npany
WC420601
TEXAS NOTICE OF MATERIAL CHANGE ENDORSEMENT
This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the
Information Page.
In the event of cancellation or other material change of the policy, we will mail advance notice to the person or
organization named in the Schedule.The number of days advance notice is shown in the Schedule.
This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule
1. Number of days advance notice: 30
2. Notice will be mailed to:
ALL CERTIFICATE HOLDERS
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 on 1 011 5/201 5
at 12:01 A.M.standard time,forms a part of
Policy No.TSF0001259969 of the Texas Mutual Insurance Company
Issued to Fountain-Works LLC Endorsement No. 1
Premium$ 0.00
Authorized Representative
WC420601(ED.1-94)
WASENDRS 1-06-2012
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EPP0266712 Fountain-Works LLC
10/15/2015 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
CinciPlus
BUSINESS AUTO EXPANDED COVERAGE (XCO)
ENDORSEMENT E VA
This endorsement modifies insurance provided by the following: 66110 3W--7(a
BUSINESS AUTO COVERAGE FORM __r5ed0017.599(A
With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply un-
less modified by this endorsement.
A. Who is an Insured-Amended personal affairs, provided you do not
SECTION II - LIABILITY COVERAGE, A.
own, hire or borrow that"auto".
Coverage, 1.Who is an Insured is amended B. Liability Coverage Extensions - Supple-
by adding the following: mentary Payments -Higher Limits
The following are"insureds": SECTION If - LIABILITY COVERAGE, A.
1. Any subsidiary which is a legally incorpo- Coverage, 2. Coverage Extensions, a. Sup-
rated entity of which you own a financial Sup-
plementary Payments is amended by:
interest of more than 50% of the voting 1. Replacing the $2,000 Limit of Insurance
stock on the effective date of this cover- for bail bonds with$4,000 in(2);and
age form. 2. Replacing the$250 Limit of Insurance for
However, the insurance afforded by this reasonable expenses with$500 in(4).
provision does"insured"
apply to any subsidi-
ary that is an insured under any other
automobile liability policy, or would be an SECTION 11 - LIABILITY COVERAGE B. Ex.
"insured" under such policy but for termi- clusions,6. Fellow Employee is amended by
nation of such policy or the exhaustion of adding the following:
such policy's limits of insurance.
2. Any organization that is newly acquired or But this exclusion does not apply if the
bodily injury results from the use of a
formed by you and over which you covered "auto" you own or hire. Cover-
maintain majority ownership. age is excess over any other collectible
The insurance provided by this provision: insurance.
a. Is effective on the date of acquisition D. Hired Auto-Physical Damage
or formation, and is afforded for 180 If hired "autos" are covered "autos" for Liabil-
days after such date; ity Coverage, then Comprehensive and Colli-
b. Does not apply to "bodily injury" or sion Physical Damage Coverages as pro-
"property damage" resulting from an vided under SECTION III - PHYSICAL DAM-
"accident" that occurred before you AGE COVERAGE of this Coverage Part are
acquired or formed the organization; extended to "autos" you hire of the private
passenger type or light truck (10,000 pounds
c. Does not apply to any newly ac- or less gross vehicle weight) type, subject to
quired or formed organization that is the following:
a joint venture or partnership;and
1. The most we will pay for "loss" to any
d. Does not apply to an insured under hired "auto"is$35,000 or the actual cash
any other automobile liability policy, value or cost to repair or replace, which-
or would be an insured under such a ever is the least, minus a deductible.
policy but for the termination of such
policy or the exhaustion of such pol- 2. The deductible will be equal to the largest
icy's limits of insurance. deductible applicable to any owned
"auto" of the private passenger type or
3. Any of your "employees" while using a light truck type for that coverage, or
covered "auto" in your business or your $1,000, whichever is less.
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3. Hired Auto - Physical Damage coverage S. We will pay under this coverage only that
is excess over any other collectible insur- amount of your rental reimbursement ex-
ance. penses which is not already provided for
under SECTION III - PHYSICAL DAM-
4. Subject to the above limit,deductible, and AGE COVERAGE,A. Coverage, 4.Cov-
excess provisions we will provide cover- erage Extensions.
age equal to the broadest coverage ap-
plicable to any covered "auto"you own of F. Transportation Expense-Higher Limits
the private passenger type or light truck SECTION III - PHYSICAL DAMAGE COVER-
type insured under this policy. AGE,A.Coverage, 4. Coverage Extensions
Coverage includes loss of use of that hired is amended by replacing$15 per day with $50
auto, provided it results from an "accident" for per day, and $450 maximum with $1,500
which you are legally liable and as a result of maximum in Extension a. Transportation
which a monetary loss is sustained by the Expenses.
leasing or rental concern. The most we will
pay for any one"accident"is$1,000. G. Airbag Coverage
If a limit for Hired Auto - Physical Damage is SECTION III - PHYSICAL DAMAGE COVER-
shown in the Schedule, then that limit re- AGE, B. Exclusions, 3.a, is amended by
places, and is not added to, the $35,000 limit adding the following:
indicated above. However, the mechanical and electrical
E. Rental Reimbursement breakdown portion of this exclusion does not
apply to the accidental discharge of an airbag.
SECTION III - PHYSICAL DAMAGE is This coverage for airbags is excess over any
amended by adding the following: other collectible insurance or warranty.
1. We will pay for rental reimbursement ex- H. Loan or Lease Gap Coverage
penses incurred by you for the rental of a
1. SECTION III - PHYSICAL DAMAGE
„
private passenger type auto because of COVERAGE, C. Limit of Insurance is
a "loss" to a covered private passenger deleted in its entirety and replaced by the
type "auto". Payment applies in addition following, but only for private passenger
to the otherwise applicable amount of type "autos" with an original loan or
each coverage you have on a covered
lease, and only in the event of a "total
private passenger type "auto". No de-
ductible applies to this coverage. loss" to such a private passenger type
auto .
2. We will pay only for those expenses in- a. The most we will pay for"loss" in any
curred during the policy�
24 hours after the "loss"
period beginning one"accident"is the greater of:
and ending, re-
gardless of the policy's expiration, with (1) The amount due under the
the lesser of the following number of terms of the lease or loan to
days: which your covered private pas-
a. The number of days reasonably re- senger type "auto" is subject,
quired to repair the covered private but will not include:
passenger type "auto". If "loss" is (a) Overdue lease or loan
caused by theft, this number of days payments;
is added to the number of days it
takes to locate the covered private (b) Financial penalties imposed
passenger type "auto" and return it under the lease due to high
to you; or mileage, excessive use or
abnormal wear and tear;
b. 30 days.
(c) Security deposits not re-
3. Our payment is limited to the lesser of the funded by the lessor;
following amounts:
(d) Costs for extended warran-
a. Necessary and actual expenses in- ties, Credit Life Insurance,
curred; or Health, Accident or Disabil-
b. $40 per day. ity Insurance purchased
with the loan or lease; and
4. This coverage does not apply while there (e) Carry-over balances from
are spare or reserve private passenger previous loans or leases,or
type autos available to you for your op-
erations.
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(2) Actual cash value of the stolen 1. You, if you are an individual;
or damaged property. 2. A partner, if you are a partnership;
b. An adjustment for depreciation and physical condition will be made in 3. An executive officer or insurance man-
determining actual cash value at the ager, if you are a corporation; or
time of"loss". 4. A member or manager, if you are a lim-
2. SECTION V - DEFINITIONS is amended ited liability company.
by adding the following, but only for the K. Unintentional Failure to Disclose Hazards
purposes of this Loan or Lease Gap
Coverage: SECTION IV - BUSINESS AUTO CONDI-
"Total loss" means a "loss" in which the TIONS, B. General Conditions is amended
cost of repairs plus the salvage value ex-
ceeds the actual cash value. If you unintentionally fail to disclose any haz-
ards existing on the effective date of this Cov-
erage Form,we will not deny coverage under
SECTION III - PHYSICAL DAMAGE COVER- this Coverage Form because of such failure.
AGE, D. Deductible is amended by adding L. Mental Anguish Resulting from Bodily In-
the following: Jury
No deductible applies to glass damage if the SECTION V - DEFINITIONS, C. "Bodily in-
glass is repaired in a manner acceptable to us jury" is deleted in its entirety and replaced by
rather than replaced. the following:
J. Duties In the Event of an Accident, Claim, "Bodily injury"means bodily injury,sickness or
Suit or Loss-Amended disease sustained by a person, including
SECTION IV - BUSINESS AUTO CONDI- mental anguish and death sustained by the
TIONS,A. Loss Conditions,2. Duties in the same person that results from such bodily in-
Event of Accident, Claim, Suit or Loss, a. is jury, sickness or disease. "Bodily injury"does
amended by adding the following: not include mental anguish or death that does
not result from bodily injury, sickness or dis-
This condition applies only when the "acci- ease.
dent"or"loss"is known to:
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EBA0266712 Fountain-Works LLC 10/15/2015
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CANCELLATION OR NONRENEWAL BY US
NOTIFICATION TO A DESIGNATED ENTITY
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS PACKAGE POLICY
CLAIMS-MADE EXCESS LIABILITY COVERAGE PART
COMMERCIAL AUTO COVERAGE PART
COMMERCIAL GENERAL LIABILITY COVERAGE PART
COMMERCIAL UMBRELLA LIABILITY COVERAGE PART
DENTIST'S PACKAGE POLICY
EXCESS LIABILITY COVERAGE PART
PRODUCTSICOMPLETED OPERATIONS COVERAGE PART
PROFESSIONAL LIABILITY COVERAGE PART
PROFESSIONAL UMBRELLA LIABILITY COVERAGE PART
PROFESSIONAL UMBRELLA LIABILITY COVERAGE PART-CLAIMS-MADE
SCHEDULE
Name and mailing address of person(s)or organization(s):
1. For whom you are required in a written contract that was executed on or after the
earlier of the following dates: a. the effective date of this policy, or b, the effective
date of the original policy of which this policy is a renewal or replacement, and 2. for
whom you are required in that same written contract as referred to in 1. above to provide
cancellation notice.
Number of days notice(other than nonpayment of premium): 30
A. If we cancel or nonrenew this policy for any statutorily permitted reason other than nonpayment of
premium we will mail notice to the person or organization shown in the Schedule.We will mail such notice
at least the number of days shown in the Schedule before the effective date of cancellation or nonrenewal.
B. If we cancel this policy for nonpayment of premium,we will mail notice to the person or organization shown
in the Schedule.We will mail such notice at least 10 days before the effective date of cancellation.
C. If notice is mailed, proof of mailing to the mailing address shown in the Schedule will be sufficient proof of
notice.
D. In no event will coverage extend beyond the actual expiration,termination or cancellation of the policy.
IA 4087 0811
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EOP/ ;PC6065712 Fountain-Works LLC
2
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTORS' COMMERCIAL GENERAL LIABILITY
BROADENED ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Endorsement-Table of Contents:
Coverage: Begins on Page:
1. Employee Benefit Liability Coverage..................................................................................................2
2. Unintentional Failure to Disclose Hazards..........................................................................................7
3. Damage to Premises Rented to You...................................................................................................8
4. Supplementary Payments...................................................................................................................9
5. Medical Payments................................................................................................................................9
6. Voluntary Property Damage(Coverage a.)and Care,Custody or Control
Liability Coverage(Coverage b.).........................................................................................................9
7. 180 Day Coverage for Newly Formed or Acquired Organizations..................................................10
8. Waiver of Subrogation.......................................................................................................................10
9. Automatic Additional Insured -Specified Relationships: ................................................................ Jo
• Managers or Lessors of Premises;
• Lessor of Leased Equipment;
• Vendors;
• State or Political Subdivisions-Permits Relating to Premises;
• State or Political Subdivisions-Permits;and
• Contractors'Operations
10. Broadened Contractual Liability-Work Within 50'of Railroad Property......................................... 14
11. Property Damage to Borrowed Equipment....................................................................................... 14
12. Employees as Insureds-Specified Health Care Services: ............................................................ 14
• Nurses;
• Emergency Medical Technicians;and
• Paramedics
13. Broadened Notice of Occurrence...................................................................................................... 14
B. Limits of Insurance:
The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorse-
ment, except as provided below:
1. Employee Benefit Liability Coverage
Each Employee Limit: $ 1,000,000
Aggregate Limit: $ 3,000,000
Deductible: $ 1,000
3. Damage to Premises Rented to You
The lesser of:
a. The Each Occurrence Limit shown in the Declarations;or
b. $500,000 unless otherwise stated$
4. Supplementary Payments
a. Bail bonds: $ 1,000
b. Loss of earnings: $ 350
5. Medical Payments
Medical Expense Limit: $ 10,000
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GA 233 02 07 Services Office,Inc.,with its permission. Page 1 of 15
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6. Voluntary Property Damage (Coverage a.)and Care, Custody or Control Liability Coverage
(Coverage b.)
Limits of Insurance(Each Occurrence)
Coverage a.$1,000
Coverage b.$5,000 unless otherwise stated $
Deductibles(Each Occurrence)
Coverage a.$250
Coverage b.$250 unless otherwise stated $
COVERAGE PREMIUM BASIS RATE ADVANCE PREMIUM
(a) Area (For Limits in Excess of (For Limits in Excess of
(b) Payroll $5,000) $5,000)
(c) Gross Sales
(d) Units
e Other
b. Care, Custody $
or Control
TOTAL ANNUAL PREMIUM $
11. Property Damage to Borrowed Equipment
Each Occurrence Limit: $ 10,000
Deductible: $ 250
C. Coverages: have used up the ap-
plicable limit of insur-
1. Employee Benefit Liability Coverage ante in the payment of
a. The following is added to SECTION I judgments or settle-
- COVERAGES: Employee Benefit merits.
Liability Coverage. No other obligation or liabil-
ity to pay sums or perform
acts or services is covered
(a) We will pay those sums that unless explicitly provided for
the insured becomes legally under Supplementary Pay-
obligated to pay as dam- ments.
ages caused by any act, er- (b) This insurance applies to
ror or omission of the in- damages only if the act, er-
sured, or of any other per- ror or omission, is negli-
son for whose acts the in- gently committed in the
sured is legally liable, to "administration" of your
which this insurance ap- employee benefit pro-
plies. We will have the right gram`;and
and duty to defend the in-
sured against any "suit" 1) Occurs during the pol-
seeking those damages. icy period;or
However, we will have no
duty to defend against any 2) Occurred prior to the
"suit" seeking damages to effective date of this
which this insurance does endorsement provided:
not apply. We may, at our a) You did not have
discretion, investigate any knowledge of a
report of an act, error or claim or "suit" on
omission and settle any
or before the ef-
claim or "suit" that may re- fecti a date of this
sult. But: endorsement.
1) The amount we will pay You will be
for damages is limited deemed to have
as described in SEC- knowledge of a
TION III - LIMITS OF claim or "suit"
INSURANCE;and when any
2) Our right and duty to authorized repre-
defend ends when we sentative";
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i) Reports all, or formance of investment
any part, of the vehicles;or
act, error or
omission to us 3) Advice given to any
or any other person with respect to
insurer; that person's decision
to participate or not to
11) Receives a participate in any plan
written or ver- included in the "em-
bal demand or ployee benefit pro-
claim for dam- gram".
ages because
of the act, er- (f) Workers' Compensation
ror or omis- and Similar Laws
sion;and Any claim arising out of
b) There is no other your failure to comply with
applicable insur- the mandatory provisions of
ance. any workers'compensation,
unemployment compensa-
(2) Exclusions tion insurance, social secu-
rity insurance does not apply rity or disability benefits law
to: or any similar law.
(a) Bodily Injury, Property (g) ERISA
Damage or Personal and Damages for which any in-
Advertising Injury sured is liable because of
"Bodily injury", "property liability imposed on a fiduci-
damage" or "personal and ary by the Employee Re-
tirement Income Security
Re-
advertising injury", Act of 1974, as now or
(b) Dishonest, Fraudulent, hereafter amended, or by
Criminal or Malicious Act any similar federal, state or
local laws.
Damages arising out of any
intentional, dishonest, (h) Available Benefits
fraudulent, criminal or mali- Any claim for benefits to the
cious act, error or omission, extent that such benefits
committed by any insured, are available, with reason-
including the willful or reck- able effort and cooperation
less violation of any statute. of the insured, from the ap-
(c) Failure to Perform a Con- plicable funds accrued or
tract other collectible insurance.
Damages arising out of fail- (1) Taxes, Fines or Penalties
ure of performance of con- Taxes, fines or penalties,
tract by any insurer. including those imposed
(d) Insufficiency of Funds under the Internal Revenue
Code or any similar state or
Damages arising out of an local law.
insufficiency of funds to Employment-Related
meet any obligations under U)
any plan included in the Practices
employee benefit pro- Any liability arising out of
gram". any:
(e) Inadequacy of Perform- (1) Refusal to employ;
ance of Investment / Ad-
vice Given With Respect (2) Termination of em-
to Participation ployment;
Any claim based upon: (3) Coercion, demotion,
1) Failure of any invest- evaluation, reassign-
ment, discipline, defa-
mation, harassment,
2) Errors in providing in- humiliation, discrimina-
formation on past per- tion or other employ-
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ment-related practices, (e) A trust, you are an insured.
acts or omissions;or Your trustees are also in-
sureds, but only with re-
(4) Consequential liability spect to their duties as
as a result of(1), (2) or trustees.
(3)above.
(2) Each of the following is also an
This exclusion applies insured:
whether the insured may be
held liable as an employer (a) Each of your "employees"
or in any other capacity and who is or was authorized to
to any obligation to share administer your "employee
damages with or repay benefit program".
someone else who must (b) Any persons, organizations
pay damages because of or "employees" having
the injury. proper temporary authod-
(3) Supplementary Payments zation to administer your
"employee benefit program"
SECTION I - COVERAGES, if you die, but only until your
SUPPLEMENTARY PAY- legal representative is ap-
MENTS - COVERAGES A AND pointed.
B also apply to this Coverage.
(c) Your legal representative if
b. Who is an Insured you die, but only with re-
As respects Employee Benefit Liabil- spect to duties as such.
ity Coverage, SECTION II - WHO IS That representative will
our rights and du-
AN INSURED is deleted in its en- have all y
tirety and replaced by the following: ties under this Coverage
Part.
(1) If you are designated in the (3) Any organization you newly ac-
Declarations as: quire or form, other than a part-
(a) An individual, you and your nership, joint venture or limited
spouse are insureds, but liability company, and over
only with respect to the which you maintain ownership
conduct of a business of or majority interest, will qualify
which you are the sole as a Named Insured if no other
owner. similar insurance applies to that
organization. However, cover-
(b) A partnership or joint ven- age under this provision:
ture, you are an insured.
Your members, your part- (a) Is afforded only until the
ners, and their spouses are 180th day after you acquire
also insureds but only with or form the organization or
respect to the conduct of the end of the policy period,
your business. - whichever is earlier;and
(c) A limited liability company, (b) Does not apply to any act,
you are an insured. Your error or omission that was
members are also insureds, committed before you ac-
but only with respect to the quired or formed the or-
conduct of your business. ganization.
Your managers are in- c. Limits of Insurance
sureds, but only with re-
spect to their duties as your As respects Employee Benefit Liabil-
managers. ity Coverage, SECTION III - LIMITS
(d) An organization other than OF INSURANCE is deleted in its en-
a partnership, joint venture tirety and replaced by the following:
or limited liability company, (1) The Limits of Insurance shown
you are an insured. Your in Section B. Limits of Insur-
"executive officers" and di- ance, 1. Employee Benefit Li-
rectors are insureds, but ability Coverage and the rules
only with respect to their below fix the most we will pay
duties as your officers or di- regardless of the number of:
rectors. Your stockholders
are also insureds, but only (a) Insureds;
with respect to their liability
as stockholders.
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(b) Claims made or "suits" (b) The deductible amount
brought; stated in the Declarations
applies to all damages
(c) Persons or organizations sustained by any one "em-
"makinsu suits"; claims or bringing �ployee", including such
employees dependents
(d) Acts,errors or omissions;or and beneficiaries, because
of all acts, errors or omis-
(e) Benefits included in your sions to which this insur-
"employee benefit pro- ance applies.
gram".
(c) The terms of this insurance,
(2) The Aggregate Limit shown in including those with respect
Section B. Limits of Insurance, to:
1. Employee Benefit Liability i
Coverage of this endorsement 1) defend Our right
the insured
and duty to
is the most we will pay for all st any
"suits"
against damages because of acts, er- again
rors or omissions negligently 9 those dam-
committed in the "administra- ages;and
tion" of your "employee benefit 2) Your duties, and the
program". duties of any other in-
(3) Subject to the limit described in volved insured, in the
(2) above, the Each Employee event of an act, error or
Limit shown in Section B. Limits omission,or claim,
of Insurance, 1. Employee apply irrespective of the
Benefit Liability Coverage of application of the deductible
this endorsement is the most we amount.
will pay for all damages sus-
tained by any one "employee", (d) We may pay any part or all
including damages sustained by of the deductible amount to
such "employee's" dependents effect settlement of any
and beneficiaries,as a result of: claim or "suit" and, upon
(a) An act, error or omission;or notification of the actiontaken, you shall promptly
(b) A series of related acts, er- reimburse us for such part
rors or omissions, regard- of the deductible amount as
less of the amount of time we have paid.
that lapses between such d. Additional Conditions
acts,errors or omissions,
negligently committed in the As respects Employee Benefit Li-
„ ability Coverage, SECTION IV -
administration of your em- COMMERCIAL GENERAL LIABIL-
ployee benefit program". ITY CONDITIONS is amended as
However, the amount paid un- follows:
der this endorsement shall not (1) Item 2. Duties in the Event of
exceed, and will be subject to Occurrence, Offense, Claim or
the limits and restrictions that Suit is deleted in its entirety and
apply to the payment of benefits replaced by the following:
in any plan included in the em-
ployee benefit program". 2. Duties in the Event of an Act, Error or
(4) Deductible Amount Omission,or Claim or Suit
(a) Our obligation to pay dam- a. You must see to it that we are noti-
on behalf of the in- noti-
fied as soon as practicable of an act,
ages
ages applies only too the error or omission which may result in
amount of damagessured the a claim. To the extent possible, no-
inex-
cess of the deductible tice should include:
amount stated in the Decla- (1) What the act, error or omission
rations as applicable to was and when it occurred; and
Each Employee. The limits
of insurance shall not be (2) The names and addresses of
reduced by the amount of anyone who may suffer dam-
this deductible. ages as a result of the act, error
or omission.
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b. If a claim is made or"suit" is brought b. Method of Sharing
against any insured, you must: If all of the other insur-
(1) Immediately record the specifics ance permits contribu-
of the claim or "suit" and the tion by equal shares,
date received; and we will follow this
method also. Under
(2) Notify us as soon as practicable. this approach each in-
surer contributes equal
You must see to it that we receive amounts until it has
written notice of the claim or"suit"as paid its applicable limit
soon as practicable. of insurance or none of
c. You and any other involved insured the loss remains,
must: whichever comes first.
(1) Immediately send us copies of If any of the other in-
any demands, notices, sum- surance does not per-
monses or legal papers re- mit contribution by
ceived in connection with the equal shares, w will
claim or"suit'; contribute by limits.
Under this method,
(2) Authorize us to obtain records each insurer's share is
and other information; based on the ratio of its
applicable limit of in-
(3) Cooperate with us In the investi- surance to the total ap-
gation or settlement of the claim licable limits of insur-
or defense against the "suit"; ance of all insurers.
and
c. No Coverage
(4) Assist us, upon our request, in
the enforcement of any right This insurance shall not
against any person or organiza- cover any loss for
tion which may be liable to the which the insured is
insured because of an act, error entitled to recovery un-
or omission to which this insur- der any other insur-
ance may also apply. ance in force previous
to the effective date of
d. No insured will, except at that in- this Coverage Part.
sured's own cost, voluntarily make a
payment, assume any obligation, or e. Additional Definitions
incur any expense without our con- As respects Employee Benefit Li-
sent, ability Coverage, SECTION V -
(2) Item 5. Other Insurance is de- DEFINITIONS is amended as fol-
leted in its entirety and replaced lows:
by the following: (1) The following definitions are
5. Other Insurance added:
If other valid and collectible 1. "Administration"means:
insurance is available to the a, Providing information to
insured for a loss we cover "employees", including
under this Coverage Part, their dependents and
our obligations are limited beneficiaries, with ye-
as follows: spect to eligibility for or
a. Primary Insurance scope of "employee
benefit programs";
This insurance is pri-
mary except when c. b. Interpreting the "em-
below applies. If this ployee benefit pro-
insurance is primary, grams`;
our obligations are not c. Handling records in
affected unless any of connection with the
the other insurance is "employee benefit pro-
also primary. Then,we grams`; or
will share with all that
other insurance by the d. Effecting, continuing or
method described in b. terminating any "em-
below. ployee's" participation
Includes copyrighted material of Insurance page 6 of 15
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in any benefit included benefits, workers' com-
in the "employee bene- pensation and disability
fit program". benefits;and
However, "administration" d. Vacation plans, includ-
does not include: ing buy and sell pro-
grams; leave of ab-
ductions;Handling payroll de- sence programs, in-
cluding military, mater-
b. The failure to effect or nity, family, and civil
maintain any insurance leave; tuition assis-
or adequate limits of tance plans; transpor-
coverage of insurance, tation and health club
including but not limited subsidies.
to unemployment in- (2) The following definitions are
surance, social security deleted in their entirety and re-
benefits, workers' com- placed by the following:
pensation and disability
benefits. 21. "Suit" means a civil pro-
2. "Cafeteria plans" means ceeding in which money
plan authorized by applica- damages because of an
ble law to allow "employ- act which this r or omission to
insuranae applies
ees�� to elect to pay for are alleged. "Suit"includes:
tain benefits with pre-tax-tax
dollars. a. An arbitration pro-
3. "Employee benefit pro- ceeding in which such
grams" means a program damages are claimed
providing some or all of the and to which the in-
following benefits to "em- sured must submit or
ployees", whether provided does submit with our
through a "cafeteria plan"or consent;
otherwise: b. Any other alternative
a. Group life insurance; dispute resolution pro-
group accident or ceeding in which such health insurance; den- damages are claimedand to which the in-
tal, vision and hearing sured submits with our
plans; and flexible consent;or
spending accounts;
provided that no one c. An appeal of a civil
other than an "em- proceeding.
ployee" may subscribe
to such benefits and 8. "Employee" means a per-
such benefits are made son actively employed, for-
generally available to merly employed, on leave
those"employees"who of absence or disabled, or
satisfy the plan's eligi- retired. "Employee" in-
bility requirements; cludes a 'leased worker".
"Employee" does not in-
b. Profit sharing plans, clude a"temporary worker".
employee savings
plans, employee stock 2. Unintentional Failure to Disclose Haz-
ownership plans, pen- ards
sion plans and stock SECTION IV-COMMERCIAL GENERAL
subscription plans, LIABILITY CONDITIONS, 7. Represen-
provided that no one tations is hereby amended by the addi-
other than an em- tion of the following:
ployee" may subscribe
to such benefits and Based on our dependence upon your
such benefits are made representations as to existing hazards, if
generally available to unintentionally you should fail to disclose
all "employees" who all such hazards at the inception date of
are eligible under the your policy, we will not reject coverage
plan for such benefits; under this Coverage Part based solely on
c. Unemployment insur- such failure.
ance, social security
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3. Damage to Premises Rented to You e) Settling, cracking,
shrinking or ex-
a. The last Subparagraph of Paragraph pansion; or
2. SECTION I - COVERAGES, Nesting or infesta-
COVERAGE A. - BODILY INJURY fl g
AND PROPERTY DAMAGE, 2. LI- tion, or discharge
ABILITY Exclusions is hereby de- or release of
leted and replaced by the following: waste products or
secretions, by in-
Exclusions c.through q.do not apply sects, birds, ro-
to damage by fire, explosion, light- dents or other
ning, smoke or soot to premises animals.
while rented to you or temporarily
occupied by you with permission of {b) Loss caused directly or indi-
theowner. rectly by any of the follow-
ing:
b. The insurance provided under SEC- 1 Earthquake, volcanic
TION I - COVERAGES, COVERAGE ) eruption, landslide or
A. BODILY INJURY AND PROP- anypother earth move-
to DAMAGE LIABILITY applies
to "property damage" arising out of ment;
water damage to premises that are 2) Water that backs up or
both rented to and occupied by you. overflows from a
(1) As respects Water Damage Le- sewer, drain or sump;
gal Liability, as provided in 3) Water under the
Paragraph 3.b.above: ground surface press-
The exclusions under SECTION ing on, or flowing or
I - COVERAGES, COVERAGE seeping through:
A. BODILY INJURY AND a) Foundations,
PROPERTY DAMAGE LIABIL. walls, floors or
ITY, 2. Exclusions, other than i. paved surfaces;
War and the Nuclear Energy
Liability Exclusion, are deleted b) Basements,
and the following are added: whether paved or
This insurance does not apply not; or
to: c) Doors,windows or
(a) "Property damage": other openings.
1) Assumed in any con- (c) Loss caused by or resulting
tract;or from water that leaks or
flows from plumbing, heat-
2) Loss caused by or re- ing,aiirion conditioning,
caused
sulowi from any of the by or resulting from freez-
ing,ing,unless:
a) Wear and tear;
1) You did your best to
b) Rust, corrosion, maintain heat in the
fungus, decay, building or structure;or
deterioration, hid-
den or latent de- 2) You drained the
fect or any quality equipment and shut off
in property that the water supply if the
causes it to dam- heat was not main-
age or destroy it- tained.
self; (d) Loss to or damage to:
c) Smog; 1) Plumbing, heating, air
d) Mechanical conditioning, fire pro-
breakdown in- tection systems, or
cluding rupture or other equipment or ap-
bursting caused pliances;or
by centrifugal 2) The interior of any
force; building or structure, or
to personal property in
the building or structure
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caused by or resulting 5. Medical Payments
from rain, snow, sleet The Medical Expense Limit of An
or ice, whether driven p Y One
by wind or not. Person as stated in the Declarations is
amended to the limit shown in Section B.
c. Limit of Insurance Limits of Insurance, 5. Medical Pay-
The Damage to Premises Rented to
ments of this endorsement.
You Limit as shown in the Declara- 6. Voluntary Property Damage and Care,
tions is amended as follows: Custody or Control Liability Coverage
(2) Paragraph 6. of SECTION III - a. Voluntary Property Damage Cov-
LIMITS OF INSURANCE is erage
hereby deleted and replaced by We will a for"property damage" to
the following: property of others arising out of opp-
6. Subject to 5. above, the erations incidental to the insureTs
Damage to Premises business when:
Rented to You Limit is the most we will pay under (1) Damage 9 is caused by the in-
COVERAGE A. BODILY sured;or
INJURY AND PROPERTY (2) Damage occurs while in the in-
DAMAGE LIABILITY, for sured's possession.
damages because of
"property damage" to With your consent, we will make
premises while rented to these payments regardless of fault.
you or temporarily occupied
by you with permission of b. Care, Custody or Control Liability
the owner, arising out of Coverage
any one "occurrence" to SECTION I - COVERAGES, COV-
which this insurance ap- ERAGE A. BODILY INJURY AND
plies. PROPERTY DAMAGE LIABILITY, 2.
(3) The amount we will pay is lim- Exclusions,J. Damage to Property,
ited as described in Section B. Subparagraphs (3), (4) and (5) do
Limits of Insurance, 3. Dam- not apply to "property damage" to
age to Premises Rented to the property of others described
You of this endorsement. therein.
4. Supplementary Payments With respect to the insurance provided by
this section of the endorsement, the fol-
Under SECTION I - COVERAGE, SUP- lowing additional provisions apply:
PLEMENTARY PAYMENTS - COVER-
AGES A AND B: a. The Limits of Insurance shown in the
Declarations are replaced by the lim-
a. Paragraph 2. is replaced by the fol- its designated in Section B. Limits of
lowing: Insurance, 6. Voluntary Property
Up to the limit shown in Section B. Damage and Care, Custody or
Limits of Insurance, 4.a.Bail Bonds Control Liability Coverage of this
of this endorsement for cost of bail endorsement with respect to cover-
bonds required because of accidents age provided by this endorsement.
or traffic law violations arising out of These limits are inclusive of and not
the use of any vehicle to which the in addition to the limits being re-
Bodily Injury Liability Coverage ap- placed. The Limits of Insurance
plies. We do not have to furnish shown in Section B. Limits of Insur-
these bonds. ance, 6. Voluntary Property Dam-
age and Care, Custody or Control
b. Paragraph 4. is replaced by the fol- Liability Coverage of this endorse-
lowing: ment fix the most we will pay in any
one "occurrence" regardless of the
All reasonable expenses incurred by number of.
the insured at our request to assist us in the investigation or defense of (1) Insureds;
the claim or "suit", including actual (2) Claims made or "suits" brought;
loss of earnings up to the limit shown or
in Section B. Limits of Insurance,
4.b. Loss of Earnings of this en- (3) Persons or organizations mak-
dorsement per day because of time ing claims or bringing"suits".
off from work.
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b. Deductible Clause 9. Automatic Additional Insured - Speci-
fied Relationships
(1) Our obligation to pay damages
your behalf applies only to a' n followiWHO IS AN
hereby added to
the
INSURED:
the amount of damages for each SECTION Il
"occurrence" which are in ex- (1) Any person or organization de-
cess of the deductible amount scribed in Paragraph 9.a.(2)
stated in Section B. Limits of below(hereinafter referred to as
Insurance, 6. Voluntary Prop- additional insured) whom you
erty Damage and Care, Cus- are required to add as an addi-
tody or Control Liability Cov- tional insured under this Cover-
erage of this endorsement. The age Part by reason of:
limits of insurance will not be re-
duced by the application of such (a) A written contract or
deductible amount. agreement; or
(2) Condition 2. Duties in the Event (b) An oral agreement or con-
of Occurrence, Offense, Claim tract where a certificate of
or Suit, applies to each claim or insurance showing that per-
"suit"irrespective of the amount. son or organization as an
(3) We may pay any part or all of additional insured has been
the deductible amount to effect issued,
settlement of any claim or "suit" is an insured, provided:
and, upon notification of the ac-
tion taken, you shall promptly (a)
reimburse us for such part of the or agreement is:
deductible amount as has been 1) Currently in effect or
paid by us. becomes effective
7. 180 Day Coverage for Newly Formed or during the policy pe-
Acquired Organizations riod;and
SECTION II - WHO IS AN INSURED is 2) Executed prior to an
amended as follows: "occurrence"or offense
to which this insurance
Subparagraph a. of Paragraph 4. is would apply; and
hereby deleted and replaced by the fol- (b) They are not specifically
lowing: named as an additional in-
a. Insurance under this provision is af- sured under any other pro-
forded only until the 180th day after vision of, or endorsement
you acquire or form the organization added to, this Coverage
or the end of the policy period, Part.
whichever is earlier;
(2) Only the following persons or
8. Waiver of Subrogation organizations are additional in-
SECTION IV- COMMERCIAL GENERAL sureds under this endorsement,
LIABILITY CONDITIONS, 9. Transfer of and insurance coverage pro-
vided to such additional in-
Rights of Recovery Against Others to vid reds is limited as provided
Us is hereby amended by the addition of herein:
the following:
(a) The manager or lessor of a
We waive any right of recovery we may premises leased to you with
have because of payments we make for whom you have agreed per
injury or damage arising out of your on- Paragraph 9.a.(1) above to
going operations or"your work" done un- provide insurance, but only
der a written contract requiring such with respect to liability aris-
waiver with that person or organization ing out of the ownership,
and included in the products-completed maintenance or use of that
operations hazard", However, our rights part of a premises leased to
may only be waived prior to the "occur- you: subject to the following
rence giving rise to the injury or damage additional exclusions:
for which we make payment under this
Coverage Part The insured must do This insurance does not
nothing after a loss to impair our rights, apply apply to:
At our request,the insured will bring suit
or transfer those rights to us and help us 1) Any "occurrence"
enforce those rights. which takes place after
Includes copyrighted material of Insurance Page 10 of 15
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you cease to be a ten- c) Any physical or
ant in that premises. chemical change
2) Structural alterations, in the product
new construction or made intentionally
by the vendor;
demolition operations
performed by or on be- d) Repackaging, un-
half of such additional less unpacked
insured. solely for the pur-
(b) Any person or organization pose of inspection,
from which you lease demonstration,
equipment with whom you testing, or the
have agreed per Paragraph substitution of
9.a.(1) above to provide in- parts under in-
surance. Such person(s)or structions from the
organization(s)are insureds manufacturer, and
a
solely with respect to their ed
then repackaged
the original
liability arising out of the container;
maintenance, operation or
use by you of equipment e) Any failure to
leased to you by such per- make such in-
son(s) or organizations(s). spections, adjust-
However, this insurance ments, tests or
does not apply to any "oc- servicing as the
currence"which takes place vendor has
after the equipment lease agreed to make or
expires. normally under-
(c) Any person or organization takes to make in
(referred to below as ven- the usual course
dor) with whom you have of business, in
agreed connection with
g per Paragraph distribution or
9.a.(1) above to provide in- sale the dis is the prod-
surance, but only with re-
spect to "bodily injury" or ucts;
"property damage" arising f) Demonstration, in-
out of"your products"which stallation, servic-
are distributed or sold in the ing or repair op-
regular course of the ven- erations, except
does business, subject to such operations
the following additional ex- performed at the
clusions: vendors premises
1) The insurance afforded in connection with
the vendor does not the sale of the
apply to:
product;
a) "Bodily injury" or g) Products which,
"property damage" after distribution or
for which the ven- sale by you, have
dor is obligated to been labeled or
pay damages by relabeled or used
reason of the as- as a container,
sumption of liabil- part or ingredient
ity in a contract or of any other thing
agreement. This or substance by or
exclusion does not
for the vendor.
apply to liability for 2) This insurance does
damages that the not apply to any in-
vendor would sured person or or-
have in the ab- ganization:
sence of the con-
tract or agree- a) From whom you
ment; have acquired
such products, or
b) Any express war- any ingredient,
ranty unauthorized part or container,
by you; entering into, ac-
Includes copyrighted material of Insurance
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of the additional in- spects any other insurance
sured;or policy issued to the addi-
tional insured, and such
2) The rendering of, or other insurance policy shall
failure to render, any be excess and / or noncon-
professional architec- tributing, whichever applies,
tural, engineering or with this insurance.
surveying services, in-
cluding: (b) Any insurance provided by
this endorsement shall be
a) The preparing, primary to other insurance
approving or fail- available to the additional
ing to prepare or insured except:
approve maps,
shop drawings, 1) As otherwise provided
opinions, reports, in SECTION IV -
surveys, field or- COMMERCIAL GEN-
ders, change or- ERAL LIABILITY
ders or drawings CONDITIONS, S. Other
and specifications; Insurance, b. Excess
and Insurance;or
b) Supervisory, in- 2) For any other valid and
spection, archi- collectible insurance
tectural or engi- available to the addi-
neering activities, tional insured as an
additional insured by
3) "Your work"for which a attachment of an en-
consolidated (wrap-up) dorsement to another
insurance program has insurance policy that is
been provided by the written on an excess
primecontractor-project basis, In such case,
manager or owner of the coverage provided
the construction project under this endorse-
in which you are in- ment shall also be ex-
volved. cess.
b. Only with regard to insurance pro- (2) Condition 11. Conformance to
vided to an additional insured desig- Specific Written Contract or
nated under Paragraph 9.a.(2) Sub- Agreement is hereby added:
paragraph (f) above, SECTION III -
LIMITS OF INSURANCE is amended 11. Conformance to Specific
to include: Written Contract or
The limits applicable to the additional Agreement
insured are those specified in the With respect to additional
written contract or agreement or in insureds described In Para-
the Declarations of this Coverage graph 9.a.(2)(f)above only:
Part,whichever are less. If no limits If a written contract or
are specified in the written contract agreement awri between you
or agreement, or if there is no writtenY
contract or agreement, the limits ap- and the additional insured
plicable to the additional insured are specifies that coverage for
those specified in the Declarations of the additional insured:
this Coverage Part. The limits of in-
suranceprovided are inclusive of and not in Be pre Services Of-
addition to the limits of insurance face additional insured
Of-
shown in the Declarations. form number CG 20 10
c. SECTION IV - COMMERCIAL GEN- or CG 20 37 where
ERAL LIABILITY CONDITIONS is edition specified);or
hereby amended as follows: b. Include coverage for
(1) Condition 5. Other Insurance is completed operations;
amended to include: or
(a) Where required by a written c. Include coverage for
contract or agreement, this "your work';
insurance is primary and I and where the limits or cov-
or noncontributory as re- erage provided to the addi-
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tional insured is more re- 11. of this endorsement fix the
strictive than was specifi- most we will pay in any one "oc-
cally required in that written currence" regardless of the
contract or agreement, the number of-
terms of Paragraphs 9.a.(3)(a), 9.a.(3)(b) or 9.b. (a) Insureds;
above, or any combination (b) Claims made or "suits"
thereof, shall be interpreted brought; or
as providing the limits or
coverage required by the (c) Persons or organizations
terms of the written contract making claims or bring
or agreement, but only to "suits".
the extent that such limits or
coverage is included within (2) Deductible Clause
the terms of the Coverage (a) Our obligation to pay dam-
Part to which this endorse- ages on your behalf applies
ment is attached. If, how- only to the amount of dam-
ever, the written contract or ages for each "occurrence"
agreement specifies the In- which are in excess of the
surance Services Office Deductible amount stated in
additional insured form Section B. Limits of Insur-
number CG 20 10 but does ance, 11. of this endorse-
not specify which edition, or ment. The limits of insur-
specifies an edition that ance will not be reduced by
does not exist, Paragraphs the application of such De-
9.a.(3)(a) and 9.a.(3)(b) of ductible amount.
this endorsement shall not
apply and Paragraph 9.b, of (b) Condition 2. Duties in the
this endorsement shall ap- Event of Occurrence, Of-
ply. fense, Claim or Suit, ap-
10. Broadened Contractual Liability-Work plies to each claim or "suit"
Within 50'of Railroad Property irrespective of the amount.
It is hereby agreed that Paragraph f.(1) of (c) We may pay any part or all
Definition 12. "Insured contract" (SEC- of the deductible amount to
TION V-DEFINITIONS) is deleted, effect settlement of any
claim or "suit" and, upon
11. Property Damage to Borrowed Equip• notification of the action
ment taken, you shall promptly
reimburse us for such part
a. The following is hereby added to Ex- of the deductible amount as
clusion J. Damage to Property of has been paid by us.
Paragraph 2., Exclusions of SEC-
TION I - COVERAGES, COVERAGE 12. Employees as Insureds - Specified
A. BODILY INJURY AND PROP- Health Care Services
ERTY DAMAGE LIABILITY: It is hereby agreed that Paragraph
Paragraphs (3) and (4) of this exclu- 2.a.(1)(d) of SECTION II - WHO IS AN
sion do not apply to tools or equip- INSURED, does not apply to your "em-
ment loaned to you, provided they ployees" who provide professional health
are not being used to perform opera- care services on your behalf as duly li-
tions at the time of loss. censed:
b. With respect to the insurance pro- a. Nurses;
vided by this section of the en- b. Emergency Medical Technicians;or
dorsement, the following additional
provisions apply: c. Paramedics,
(1) The Limits of insurance shown in the jurisdiction where an "occurrence"
in the Declarations are replaced or offense to which this insurance applies
by the limits designated in Sec- takes place.
tion B. Limits of Insurance, 11.
of this endorsement with respect 13. Broadened Notice of Occurrence
to coverage provided by this
endorsement. These limits are Paragraph a. of Condition 2. Duties in
inclusive of and not in addition to the Event of Occurrence, Offense,
the limits being replaced. The Claim or Suit (SECTION IV - COMMER-
Limits of Insurance shown in CIAL GENERAL LIABILITY CONDI-
Section B. Limits of Insurance,
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TIONS) is hereby deleted and replaced (2) The names and addresses of
by the following: any injured persons and wit-
a. You must see to it that we are noti- nesses; and
fied as soon as practicable of an (3) The nature and location of any
"occurrence" or an offense which injury or damage arising out of
may result in a claim. To the extent the`occurrence"or offense,
possible, notice should include:
This requirement applies only when
(1) How, when and where the "oc- the occurrence" or offense is known
currence"or offense took place; to an"authorized representative".
•0 4
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