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HomeMy WebLinkAboutPW16-193 - Amendment - #1 - Shearer Design LLC - Garrison Creek Bridge - 12/02/2016 h 4a iny Kiecor „� KEN`T �` WASH,NGTON Document CONTRACT COVER SHEET This is to be completed by the Contract Manager prior to submission to City Clerks Office. All portions are to be completed. If you have questions, please contact City Clerk's Office. Vendor Name: Shearer Design LLC Vendor Number: JD Edwards Number Contract Number: hyl(P - 11 b-- oo2- This is assigned by City Clerk's Office Project Name: Garrison Creek Bridge Description: ❑ Interlocal Agreement ❑ Change Order ® Amendment ❑ Contract ❑ Other: Contract Effective Date: 12/2/16 Termination Date: 12/31/17 Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Steve Lincoln Department: Engineering Contract Amount: $0.00 Approval Authority: (CIRCLE ONE) Department Director Mayor City Council Detail: (i.e. address, location, parcel number, tax id, etc.): Extend the time of completion to December 31, 2017 due to the work is not yet complete. As of: 08/27/14 10E i�I T AMENDMENT NO. 1 NAME OF CONSULTANT OR VENDOR: Shearer Design LLC CONTRACT NAME & PROJECT NUMBER: Garrison Creek Bridge ORIGINAL AGREEMENT DATE: May 10, 2016 This Amendment is made between the City and the above-referenced Consultant or Vendor and amends the original Agreement and all prior Amendments. All other provisions of the original Agreement or prior Amendments not inconsistent with this Amendment shall remain in full force and effect. For valuable consideration and by mutual consent of the parties, Consultant or Vendor's work is modified as follows: 1. Section I of the Agreement, entitled "Description of Work," is hereby modified to add additional work or revise existing work as follows: In addition to work required under the original Agreement and any prior Amendments, the Consultant or Vendor shall: The scope of work remains the same, however an amendment is needed to extend the time of completion to December 31, 2017 due to the work is not yet complete. 2. The contract amount and time for performance provisions of Section II "Time of Completion," and Section III, "Compensation," are modified as follows: Original Contract Sum, $16,812.00 including applicable WSST Net Change by Previous Amendments $0 including applicable WSST Current Contract Amount $16,812.00 including all previous amendments Current Amendment Sum $0 Applicable WSST Tax on this $0 Amendment Revised Contract Sum $16,812.00 AMENDMENT - 1 OF 2 Original Time for Completion 12/31/16 (insert date) Revised Time for Completion under n/a prior Amendments (insert date) Add'] Days Required (f) for this 365 calendar days Amendment Revised Time for Completion 12/31/17 (insert date) The Consultant or Vendor accepts all requirements of this Amendment by signing below, by its signature waives any protest or claim it may have regarding this Amendment, and acknowledges and accepts that this Amendment constitutes full payment and final settlement of all claims of any kind or nature arising from or connected with any work either covered or affected by this Amendment, including, without limitation, claims related to contract time, contract acceleration, onsite or home office overhead, or lost profits. This Amendment, unless otherwise provided, does not relieve the Consultant or Vendor from strict compliance with the guarantee and warranty provisions of the original Agreement. All acts consistent with the authority of the Agreement, previous Amendments (if any), and this Amendment, prior to the effective date of this Amendment, are hereby ratified and affirmed, and the terms of the Agreement, previous Amendments (if any), and this Amendment shall be deemed to have applied. The parties whose names appear below swear under penalty of perjury that they are authorized to enter into this Amendment, which is binding on the parties of this contract. IN WITNESS, the parties below have executed this Amendment, which will become effective on the last date written below. CONSULTANT/VENDOR: CITY OF KENT: By: Y . (signature) -1, .(signature) Print Name: Print Name: Timothy J. LaPorte P.E. Its - , Its Public Works Director (title) 11 title DATE: g �I E rd1 DATE:_/ APPROVED AS TO FORM: (applicable if Mayor's signature required) Kent Law Department Shearer-Garrison Crk Bridge Amd 1/UDCDIn AMENDMENT — 2 OF 2 ® CERTIFICATEOF LIABILITY Y INSURANCE DATE IrnMloDlt'YYYI� 2/8/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), 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 J. LOW Hall and Companyompany PH ON n Exn360-598-3 Hail UU&IL .Compa y alc M1oL360-598-3703 19660 10th Ave NE ADDRESS: aliandcompany com PoulsboWA98370 INSURER(S)AFFORDING COVERAGE NAIC# .__. INSURER A:Hart`ord Casualty Insurance ComDanT- P9424 INSURED 12609 INSURERB:Traveles Casualty and Surety Compa 19038- Shearer Design LLC INSURER 0: 3613 Phinney Ave N#B - "— - - Seattle WA 98103 INSURER D: INSURER E: _ INSURER F: COVERAGES CERTIFICATE NUMBER:426238464 - 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 TD Wt{ICH 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. IL1Sµ TYPE OF INSURANCE ADUL SUBRr- - POLICY EFF POLICY EXP _ INSR MD POLICY NUMBER MMIDD/YYYY MMIDDIYYYY LIMITS A GENERAL LIARILITV Y Y .52SBAIJ6571 2l9/2016 2/0/2017 EACH OCCURR ENCE $2,000,000 IX COMMERCIAL GENERAL LIABILITY PREIJIISEB Ea occ11 urrm. $30D,000 CLAWS-MADE X 1 OCCUR MED EXP Any one person) S10,000 X OCP/XCU/BFPO PEft501JAL8ADV INJU.RV is� ' X Separation lDsds i GENERAL AGGREGATE f$4 00,000 GENT AGGREGATE LIMIT APPI IFS PER: pRODUGT3-COMP/OP All 00,000 POLICY X FIR � LOU AUTOMOBILE LIABILITY Y Y 52SBAIJB571 219,12016 2/9/2017 Eaacci6entJ g2,D_D0,000 ANY AUTO BOULYINJURY(Perperson) s ALL OWNED SCHEDULED BODILY INJURY P r - AUTOS AUTOS ( e aceidenp $2,000,000 X HIRED AUTOS X NON OWNED PROPERTY DAMAGE _ AUTOS IPeraccitlen0 .$ A X UMBRELLA LIAR X OCCUR 52SBAIJ6571 �2/W2016 2/9/2017 EACH OCCURRENCE 53,000,00D EXCESS LIAB _ CLAIMS-MADE AGGREGATE $3,000,000 _ DED RETENTION$ _ _ $ A WORKERS COMPENSATION 52SBAIJ6571 219/2016 21/312017 MSTATU- Ohl- WA Stop Ga AND EMPLOVERS'LIABILITY VIN VLMJ$. P P. ANY PROPRIETOR/PARTNER/EXEGIJI OF EL.EACH AOCIDENI' STGD0000 Olardat/MPMBER EXCLUDEDi ❑ NIA (Mandatory in NH) GL.DISEASE EMPLOYE $1,000,000 Iryee,desoribe under — — DESCRIPTIONOFOPERATIONShelow _ EL DISEASE-POLICY LI...T $1000000 B Professional Usti:Claims Made 1D522308D 11111/2016 1111/2017 $1,Op0,000 Per Claim I$2,ODD,000 AOgregate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORn 101,AddRlcna(Remarks Schedule,❑more space is required) Certificate holder is/are an Additional Insured on the Commercial General Liability and Auto Liability when required by written contract or agreement regarding activities by or on behalf of the Named Insured. The Commercial General Liability insurance is primary insurance and ,any other insurance maintained by the Additional Insured shall be excess only and non-contributing with this insurance.A waiver of Subrogation applies to the Commercial General Liability,Auto Liability, Umbrella/Excess Liability and Workers Compensation/Employers 'Liability in favor of the Additional Insured, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Kent ACCORDANCE WITH THE POLICY PROVISIONS. 400 W Gowe Kent WA 98032 Al1THOR2E0 REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD firer Design LLC- The Hartford Policy # 52SBAIJ6571 BUSINESS LIABILITY COVERAGE FORM (b) Rented to, in the care, custody or b. Coverage under this provision does not control of, or over which physical apply to: control is being exercised for any (1) "Bodily Injury" or "property damage" purpose by you, any of your that occurred; or employees", "volunteer workers"'any partner or member(if you are (2) "Personal and advertising injury a partnership or joint venture), or arising out of an offense committed any member (if you are a limited before you acquired or formed the liability company), organization. b. Real Estate Manager 4. Operator Of Mobile Equipment Any person(other than your"employee"or With respect to"mobile equipment" registered in "volunteer worker"), or any organization your name under any motor vehicle registration while acting as your real estate manager, law, any person is an insured while driving such a. Temporary Custodians of Your equipment along a public highway with your Property permission. Any other person or organization responsible for the conduct of such person is Any person organization having proper also an insured, but only with respect to liability temporary custody of your property if you arising out of the operation of the equipment,and die, but only: only if no other insurance of any kind is available (1) With respect to liability arising out of the to that person or organization for this liability, maintenance or use of that properly;and However,no person or organization is an insured (2) Until your legal representative has wth respect to: been appointed. a. "Bodily injury" to a co-"employee" of the d. Legal Representative If You Pie person ddving the equipment;or Your legal representative if you 'die, but b. "Property damage" to property owned by, only with respect to duties as such. That rented to, in the charge of or occupied by' representative will have all your rights and you or the employer of any person who is duties under this insurance, an Insured under this provision. e. U-nnamed Subsidiary S. Operatorrf Nonowned Watercraft Any subsidiary and subsidiary thereof, of With respect to watercraft you do not own that yours which Is a legally incorporated entlty is less than 51 feet long and Is not being used of which you own a financial interest of to carry persons for a charge, any person is an more than 50% of the voting stock on the insured while operating such watercraft with effective date of this Coverage Part, your permission. Any other person or The insurance afforded herein for any organization responsible for the conduct of such person is also an insured, but only with subsidiary not shown in the Declarations respect to liability arising out of the operation as a named insured does not apply to of the watercraft, and only if no other injury or damage with respect to which an nsurance of any kind is available to that Insured under this insurance is also an person ororganiza on for this liability, insured under another policy or would be Lin Insured under such policy but for its However, no person or organization is an termination or upon the exhaustion of ifs insured with respect to: limits of insurance. a. 'Bodily injury" to a co-"employeo" of the 3. Newly Acquired Or Formed Organization person operating the watercraft;or Any organization you newly acquire or form, b. "Properly damage" to property owned by, other ttlan a partnership, johrt venture or rented to, in the charge of or occupied by limited liability company, and over which you you or the employer of any person who is maintain financial interest of more than 50%"of an insured underthis provision. the voting stock, will quality as a Named 6. Additional Insureds When Required By Insured jf there Is no other similar insurance Written Contract, Written Agreement Or available to that organization. Howevei: hermit a. Coverage under this provision is aforded The person(s) or organization(s) identified in only until the 180th day after you acquire Paragraphs a. through f. below are additional or form the organizatlon or the end of the insureds when you have agreed, in a written policy period,whichever is earn r, and Form SS 00 08 04 05 Page 1'f of 24 BUSINESS LIABILITY COVERAGE FORM contract, written agreement or because'of a (ef Any Failure to make such permit issued by a state or political inspections, adjustments, tests or subdivision, that such person or organization servicing as the vendor has be added as an additional insured on your agreed to make or normafly policy, provided the injury or damage occurs undertakes to make in the usual subsequent to the execution of the contact or course of business, in connection agreement,or the issuance of the permit with the distribution or sale of the A person or organization is an additional products; insured under this provision only for that (f) Demonstration, installation, period of time required by the contract, servicing or repair operations, agreement or permit. except such operations performed at the vendor's premises In However, no such person or organization is an connection with the.sale of the additional insured under this provision if such product; person or organization is included as an additional insured by an endorsement issued (g) Products which, atfer distribution by us and made a part of this Coverage Part, or sale by you, have been labeled including all persons or organizations added or relabeled or used as a as additional insureds under the specific container, part or ingredient of any additional insured coverage grants in Section other thing or substance by or for F.—Optional Additional Insured Coverages. the vendor;or a, Vendors (h) "Bodily, injury" or "property f Any person(s)or organization(s) (referred to damage" a ot out of the sole below as vendor), but only with respect to negligence of the vendor for its own acts or omissions or those of "bodily injury" or "property damage" arising its employees or anyone else out of "your products"which are distributed acting on its behalf. However,this or sold in the regular course of the vendor's exclusion does not apply tot business and only if this Coverage Part Provides coverage for "bodily injury" cr (i) The exceptions contained in "property damage" included within ffia Subparagraphs(d) or(f);or "products-completed operations hazard". (H) Such inspections, adjustments, (1), The insurance afforded to the vendor tests or servicing as the vendor is subject to the following additional has agreed to make or normally exclusions: undertakes to make in the usual course of business, in This insurance does not epnly to: connection with the distribution (a) "Bodily injury" or "properly orsale of the products. damage" for which the vender is (2) This insurance does not apply to any obligated to pay damages by insured person or organization from reason of the assumption of whom you have acquired such products, liability in a contract or agreement. or an it This exclusion does not apply to Y 9 redient, part a container, entering into, accomppanying or Iiabi0ty for damages that the containing such products. vendorwould have in the absence of the contract or agreement; J. Lessors Of Equipment (b) Any express warranty (1) Any person or organization from unauthorized by you; whom you lease equipment; but only with respect to their liability for"bodily (c) Any physical or chemical change injury", "property damage" or in the product made intentionally "personal and advertising injury" by the vendor; caused, in whole or in part, by your (d) Repackaging, except when maintenance, operation or use of unpacked solely for the purpose of equipmant leased to you by such inspection, demonstration, testing, person or organization. or the substitution of parts under _ instructions from the manufacturer, and then repackaged in the - original container; Page 12 of 24 Form SS 00 08 04 05 I BUSINESS LIABILITY COVERAGE FORM (2) With respect to the insurance afforded e. Permits Issued By State Or Political to these additional insureds, this Subdivisions insurance does not apply to any (1) Any state or political subdivision, but "occurrence" which takes place after only with respect to operations you cease to lease that equipment. performed by you or on your behalf for c. Lessors Of Land Or Premises which the state or political subdivision (1) Any person or organization from has issued a permit. whom you lease land or premises, but (2) With respect to the insurance afforded only with respect to liability arising out to these additional insureds, this of the ownership, maintenance or use insurance does not apply to; of that part of the land or premises (a) "Bodily injury", "property damage" leased to you. or "personal and advertising (2) With fesoect to the insurance afforded injury" arising out of operations to these additional insureds, this performed for the state or Insurance does not apply to: municipality;or (a) Any "occurrence" which lakes (b) "Bodily injury"or"property damage" place after you cease to lease that included within the "products- land or be a tenant in that completed operations hazard". Premises;or f. Any Other Party (b) Structural alterations, new (1) Any other person or organization who construction or demolition is not an insured under Paragraphs a. operations performed by or on through e, above, but only with behalf of such person or respect to liability for "bodily injury", organization. "property damage" or "personal and all. Architects, Engineers Or Surveyors advertising injury" caused, In whole or (1) Any architect, engineer,or surveyor, but in part, by your acts or omissions or only with respect to liability for "'bodily the acts or omissions of those acting injury", "'property damage" or."personal on your behalf: and advertising injury" caused, in whole (a) In the performance of your or In part, by your acts or omtsslens or ongoing operations; the acts or omissions of those acting on (b) In connection with your premises your behalf. owned by or rented to you;or (a) In connection with your premises; (c) in connection with"yourwork"and OF included within the "products- (b) In the performance of your completed operations hazard", but ongoing operations performed by only if you or on your behalf. (i) The written contract or written (2) With respect to the insurance afforded agreement requires you to to these additional insureds, the provide 'such coverage to following additional exclusion applies: such additional insured; and This insurance does not apply to (it) This Coverage Part provides "bodily injury", "property damage" or coverage for'"bodily injury" or "personal and advertising injury" "properly damage" included arising out of the rendering of or the within the "prnducts- failure to render any professional completed operations hazard", services by or for you, including: (2) With respect to the insurance afforded (a) The preparing, approving, or to these additional, Insureds, this failure to prepare or approve, insurance does not apply to: maps, shop drawings, opinions, 'Bodily injury", "property damage" or reports, surveys, field orders, "personal and advertising injury" change orders, designs or arising out of the rendedng of, or the drawings and specifications;or failure to render, any piofesslonal (b) Supervisory, inspection, architectural, engineering or surveying � architectural or engineering services. Including: activities. Form SS 00 08 04 05 Page 13 of Z4 BUSINESS LIABILITY COVERAGE FORM (a) The preparing, approving, or This General Aggregate limit does not failure to prepare or approve, apply to "property damage" to premises maps, shop drawings, opinions, while rented to you or temporarily reports, surveys, field orders, occupied by you with permission of the change orders, designs or owner, arising out of fire, lightning or drawings and specifications;or explosion. (b) Supervisory, inspection, - 3. Each Occurrence Limit architectural or engineering Subject to 2.a. or 2.13 above, whichever activities. applies, the most we will pay for the sum of all The limits of insurance that apply to additional damages because of all "bodily injury", insureds are described in Section D.— Limits "property damage and medical expenses Of Insurance. arising out of any one "occurrence" is the How this insurance applies when other Liability and Medical Expenses Limit shown in insurance is available to an additional insured the Declarations. is described in the Other Insurance Condition The most we will pay for all medical expenses in Section E.—Liability And Medical Expenses because of "bodily injury" sustained by any General Conditions. - one person is the Medical. Expenses Limit No person or organization is an insured with shown in the Declarations. respect to the conduct of any current or past 4. Personal And Advertising Injury Limit . partnership, joint venture or limited liability Subject to 2.b, above, the most we will pay for company that is not shown as a Named Insured in the sum of all damages because of all the Declarations. "personal and advertising injury" sustained by D. LIABILITY .AND MEDICAL EXPENSES any one person or organization is the Personal LIMITS OF INSURANCE and Advertising Injury Limit shown in the Declarations. 1. The Most We Will Pay 5. Damage To Premises Rented To You Limit The Limits of Insurance shown in the Declarations and the rules below fix the most The Damage To Premises Rented To You we will pay regardless of the number of: - Limit is the most via will pay under Business Liability Coverage for damages because of ae Insureds; "property damage"to any one premises,while b. Clalms.mode or"suits"brought;or rented to you, or in the case of damage by tire, c. Persons or organizations making claims or lightning or explosion, while rented to you or bringing"suits". - temporarily occupied by you with permission of 2. Aggregate Limits the owner. The most we will pay for. In the case of damage by fire, Ilghtnin.g or explosion,the Damage to Premises Rented To a. Damages bc-caoso of "bodily injury" and You Limit applies to afl damage proximately "property damage" included In the caused by the same event, whether such "products-complefed operations hazard" is damage results from fire, lightning or explosion the Products-Completed Operations or any combination of these. Aggregate Limit shown in the 6. How Limits Apply To Additional Insureds Declarations. b. Damages because of all Other "bodily The most we will pay on behalf of a person or injury", "property damage" or "personal organization who is an additional insured and advertising injury", including medical under this Coverage Part is the lesser of: expenses, is the General Aggregate Limit a. The limits of insurance specified in a shown in the Declarations. written contract, written agreement or permit issued by a state or political This General Aggregate Limit applies subdivision; or separately to each of your "locations" owned by or rented to you. b. The Limits of Insurance shown in the "Location" means premises involving:the Declarst'ons. same or connecting lots, or oremises Such amount shall be a pail of and not in whose connection is interrupted only by a addition to tl,e Limits of Insurance shown in l street, roadway or right-of-way of a the Declarations and described In this Section. railroad. - Page 14 of 24 Form SS 00 08 04 05 BUSINESS LIABILITY COVERAGE FORM If more than one limit of insurance under this (1) Immediately send us copies of any policy and any endorsements attached thereto demands; notices, summonses or applies to any claim or"suit", the mostwe will pay legal papers received in connection under this policy and the endorsements is the with the claim or"suit"; single highest limit of liability of all coverages (2) Authorize us to obtain records and applicable to such claim or "suit'. However, this other information; paragraph does not apply to the Medical Expenses limit set forth In Paragraph 3, above. (3) Cooperate with us in the investigation, settlement of the claim or defense The Limits of Insurance of this Coverage Part apply against the"suit"; and separately to each consecutive annual period and to any remaining period of less than 12 months,starting (4) Assist us, upon our request, 1 the with the beginning of the policy period shown in the enforcement of any right against any Declarations, unless the policy period is extended person or organization that may be after issuance for an additional period of less than 12 liable to the Insured because of injury months. In that case, the additional period will.be or damage ,o Well this insurance deemed part of the last preceding period for purposes may also apply, of determining the Limits of Insurance. d. Obligations At The Insured's Own Cost E. LIABILITY AND MEDICAL EXPENSES No insured will, except at that insured's own GENERAL CONDITIONS any voluntarily make a payment, assume any obligation, or incur any expense, other 1. Bankruptcy than for first aid,without our consent. Bankruptcy or insolvency of the insured or of e. Additional Insured's Other Insurance the insured's estate will not relieve us of our If we cover a claim or "suit" under this obligations under this Coverage Part. Coverage Part that may also be covered 2. Duties In The Event Of Occurrence, by other insurance available to an Offense,Claim Or Suit additional insured, such additional insured a. Notice Of Occurrence Or Offense must submit such claim or "suit" to the other insurer for defense and Indemnity. You or any additional insured must see to it- that we are notified as soon as the exteHowever, this provision does not apply to practicable of an "occurrence" or an g offense which may result in a claim. To . written contract, written agreement or the extent possible, notice should include: permit that this insurance is primary and non-contributory with the additional (1) Flow, when and where the "occurrence" Insured's own insurance. oroffense lost(place; f, Knowledge Of An Occurrence, Offense, (2) The names and addresses of a,y Claim Or Suit Injured persons and valtnessesi and Paragraphs a, and In. apply to you or to (3) The nature and location of any injury any additional insured onlywhen such or damage arising out of the "occurrence", offense, claim or "suit' is "occurrence"er offense. known to: b. Notice Of Claim ('Q You or any additional insured that is If a claim is made or "suit" is brouoht an Individual; against any insured, you or any additional (2) Any partner, if you or an additional insured must: Insured is a partnership; (I) Immediately record the specifics of the claim or "suit' and the date received; O Any manager, if you or an additional insured is a limited liability company; and (4) Any "executive officer" or insurance (2) Notify us as soon as practicable. manager, if you or an additional j You or any additional Insured must see to insured is a corporation; j it that we receive a written notice of the (5) Any trustee, if you or an additional claim or"suit`as soon as practicable, insured Is a trust or c. Assistance And Cooperation Of The Insured (S) Any elected or appointed official, if you or an additional insured is a political You and any otherinvolved insured roust: subdivision or public entity. Form€S 00 08 04 05 age 15 of 24 BUSINESS LIABILITY COVERAGE FORM This Paragraph f. applies separately to (3) We have issued this policy in reliance you and any additional insured, upon your representations. 3. Financial Responsibility Laws b. Unintentional Failure To Disclose a. When this policy is certjfied as proof of Hazards financial responsibility for the future under If unintentionally you should fail to disclose the provisions of any motor vehicle all hazards relating to the conduct of your financial responsibility law, the insurance business at the inception date of this provided by the policy for "bodily injury" Coverage Part, we shall not deny any liability and "property damage" liability will coverage under fibs Coverage Part comply v✓ith the provisions of the law to because of such failure. the extent of the coverage and limits of 7. Otherinsurance Insurance required by that law. If other valid and collectible insurance is b. With respect to "mobile equipmen ' to available for a loss we cover under this which this insurance applies, we will Coverage Part,' our obligations are limited as provide any liability, uninsured motorists, follows: underinsured motorists, no-fault or other coverage required by any motor vehicle Z a. Primarylnsurance law. We will provide the required limits for This insurance is primary except when b. those coverages, below applies. If other insurance is also 4. Legal Action Against Us primary, we will share with all that other No person or organization has a right under insurance by the method described in c. this Coverage Form: below. a. To Join us as a parry or otherwise bring us b. Excess Insurance into a "suit' asking for damages from an This insurance is excess over any of the insured;or other insurance, whether primary, excess, b. To sue us on this Coverage Form unless contingent or on any other basis: all of its terms have been fully complied (1) Your Work. with. That is Fire, Extended Coverage, A person or urganizetlon may sue us to recover Builder's Risk, Installation Risk or on an agreed settlement or on a final judgment similar coverage for"your work"; against an insured; but we will not be liable for (2) Premises Rented To You darnages that are not payable under the terms of this insurance or that are in excess of the That is fire, lightning or explosion applicable limit of insurance. An agreed insurance for premises rented to you settlement means a seftement and release of or temporally occupied by you with liability signed by cis, the insured and the permission of the owner; claimant or the claimant's legal representative. (3) Tenant Liability S. Separation Of Insureds That is Insurance purchased by you to Except with respect to the Limits of Insurance, cover your liability as a tenant fnr and any rights or duties specifically assigned "property damage" to premises rented in this policy to the first Named Insured, this to you or temporarily occupied by you insurance applies: with permission of the owner; a. ,As if each Named Insured were the. only (4) Aircraft,Auto Or Watercraft Named Insured; and If the loss arises out of the malydenanca I', Separately to each insured against whom or use of aircraft,"autos"or watercraft to a claim is made or"suit"is brought, the extent not subject to Exclusion g. of Section A.—Coverages. G. Representations (5) Property Damage To Borrowed a. When You AcceptThis Policy Equipment Or Use Of Elevators By accepting this policy, you agree: If the loss arises out of "property (1) The statements in the Declarations damage" to borrowed equipment or are accurate and complete; the use of elevators to the extent not (2) Those statements are based upon subject to Exclusion k, of Section A. — representations you made to us;and Coverages, Page 16 of 24 Form SS 00 08 04 05 BUSINESS LIABILITY COVERAGE FORM (6) When You Are Added As An When this insurance is excess over other Additional Insured To Other insurance, we will pay only our share of Insurance the amount of the loss, if any, that . That is other insurance available to exceeds the sum of.- you covering liability. for damages (1) The total amount that all such other arising out of the premises or insurance would payforthe loss In the operations,or products and completed absence of this insurance;and operations, for which you have been (2) The total of ali deductible and self- added as an additlonal Insured by that insured amounts under all that other insurance; or insurance. (7) When You Add Others As An We will share the remaining loss,if any, with Additional Ensured To This any other insurance that Is not described in Insurance this Excess insurance provision and was not That is other insurance available to an bought specifically to apply in excess of the additional insured. Limits of Insurance shown in the However, the following provisions Declarations of this Coverage Part. apply to other insurance available to c. Method Of Sharing any person or organization who is an If all the other insurance permits additional insured under this Coverage contribution by equal shares,we will follow Part: this method also. Under this approach, (a) Primary Insurance When each insurer contributes equal amounts Required By Contract until It has paid its applicable limit of This insurance is primary if you insurance or none of the loss remains, have agreed in a written contract, whichever comes first. written.agreement or permit that If any of the other insurance does not permit this insurance be primary. if other contribution by equal shares, we will insurance is also primary, we will contribute by limits. Under this method,each share with all that other insurance insurer's share is based on the ratio of its by the method described in• c. applicable limit of insurance to the total below. applicable limits of insurance of all insurers. (b) Primary And Non-Contributory S. Transfer Of Rights Of Pocovory Against To Other Insurance When Others To Us Required By Contract a. Transfer Of Rights Of Recovery If you have agreed in a v✓ritlen If the insured has rights to recover all or contract, written agreement or part of any payment, Including permit that this insurance is Supplementary Payments, we have made primary and non-contributory with under this Coverage Part, those rights are the additional insured's own transferred to us. The insured must do insurance, this insurance Is nothing after loss to impair them. At our primary and we will not seek request, the Insured will 'bring "suit" or contribution from that other transfer those rights to us and help us insurance. enforce them. This condition does not Paragraphs(a) and (b) on not apply to apply to Medical Expenses Coverage. other insurance to which the additional b. Waiver Of Rights Of Recovery (Waiver. insured has been added as an Of Subrogation) additional insured. If the insured has waived any rights of When this insurance is excess, we will recovery against any person or have no duty under this Coverage Part to organization for all or part of any payment, defend the insured against any"suit'if any Including Supplementary Payments, we other insurer has a duty to defend the j insured against that "suit', If no other have made under this Coverage Part, we insurer defends, we will undertake to do afro waive that rght, provided the insured so, but we will be entitled to the insureds waived theft rights of recovery against such person or organlzatlon in a contract, j rights against all those other Insurers. - agreement or permit that was executed I prior to the injury or darnace. Form SS 00 02 04 115 Page 17 of 24 i COMMON POLICY CONDITIONS AJI coverages of this policy are Subject to the following conditions, A. Cancellation (6) Failure to; 1. The first Named Insured shown in the (a) Furnish necessary heat, water, DecfarafiJons may raneel this policy by mailing sewer service or efectrlcity for 30 or delivering to us advance writfen notice of consecutive days or more, except cancellation, during .a period of seasonal a 2. We may cancel ,his policy by mailing or unoeoupancy;or delivering to the first Named Insured written (b) ray property faxes that are owing notice of cancellation at least: and have been oufstendfng for a. 5 days before the effective date of more than one year following the canc> Elation If any one of the following date due, except that this mcondoions exists at any building -that is provision wilf net apply where you o Covered Property In this policy: are in a bona fide dispute wilt tiro u taxing authority regarding payment N () The building has been vacant or of such taxes. N unoccupied so- or more consecutive d days,This does not apply to: fa. 10 days before the effective date of . rq cancellation if we cancel for nonpayment. o (a) Seasonal tinoccupancy;or of premium. (?t) Buildings N the course of c. 30 days before the effective date of cons`wction, renovation or oancelfaftft if we oanoel for any other additforr• reason. Buildings with 6i5% or more of the rental , We will mail or dtliuer our notice to the fist un s or floor area vacant or unoccupied Named Insured's last mailingaddress knovkn are considered unoccupied under this to us. provision. k. Notice of canceflatfon ;will state the efeective (2) Ater damage by e Coveted Cause of date of cancs[lafion. The policy period will and Loss, permanent repairs to the on that date. building: 5. if this policy is canceled, we will send ilia fast (a) Naive not started;and Named Insured any,premium refund due. S � (b) Have not been eer==.traded far, seen refund wfll be pro rota. The rancella5on Vthln 30 daps of Initial .payment of will be effective even if we have not matte or foss, offered a refund. (3) The building has: 0. If notice is mailed, proof of mailing will be (a) Anoulstanding order tovacate; sufficient Proof ofnotioe, 7. If the first Named insured cancels this pOpoy, (b) An oulstandfnq demolition order; wa will retain Oct !ass than $100 of the er premium. (c) Been .declared unsafe by 3. Gltanges a governmental authority. This policy Crjrta1115 all the agreements between you I (4) Fixed and saivageabfe items have and us cenceming the insurance afforded- The Frst t been or are being removed from the Named Insured shown in the Dedaraticns is ( buifding and are not being replaced, aifthodzedtomakecftangesIn the tensof[his polfcy This does not apply to such removal Mh our consent. This policy's tents can be that ;a necessary or incidental to any amended or waived only by endorsement issued renovation or rentadeffrig. by us and made a part of this policy. Fomt Ss 00 0.512 OB Page d of 3 Q 2006,The Hartford COMMON POLICY CONDITIONS C, Concealment,Misrepresentation Or Fraud €. Premiums This policy is void in any case of fraud by you as a 1. The first Named Insured shown in the relates to this policy at any time. It Is also void If you Declarations oranyotherinsured,atanytlme,Intentionally conceal a, Is responsible for the payment of aft ormisrepresent a material fact concerning: a. ni and 1. This policy; b, Will be the payee for any return premiums 2. The Covered Property;, we pay, 3. Your interest In the Covered property;or 2. The premium shown in the Declarations was 4. A claim undert%policy, corrputed based on rates in effect at the time The policy was issued, If applicable, on each O. Examination of Your ecokgAdd Records renewal, oondnuation or anniversary of the We may examine and audit your becks and effect€ve date of this policy, we will compute records as they relate to the policy at any time the premium In accordance with our rates and during the policy period and up to three years rules then in effect, aflenvard. 3. With our consent, you may continue this policy D. inspections Arid Surveys in farce by paying a continuation prornfurn for We have the right but are not obligated to: each successive one-year period, The premium must be: 1. Make Inspections and surveys at any time: a. Paid to us priorto the anniversary date;and 2. Give you reports on the condftions we find;and b, Determined In accordance with paragraph 3. Recommend changes, 2.above. Any inspections, surveys, reports or Cur forms then In effect will apply. If you do recommendations relate only to insurability and ilia not pay the continuation premium, this policy r premiums to be charged. We do not make safety will expire on the first anniversary date that we Inspections, Wedonotunderteketo perform the duty have not received the premium, of any person or organization to provido forthe health or safety of any person. And we do not represent or 4. Changes in exposures or changes in your wairant that coiidilions: business operation, acquisition or use of . 1. Are save or ihea(th;ul; or locations that are not shown In the Decfarat€ons may occur during the policy perod, If so,we may 2. Comply with laws, regulations, codes or require an add Honal premium. That premium will standards. be determined in accordance With our rates and This condition applies not only to us, but also to rules then in effect, any rating, advisory, rate service or similar J. Transfer Of Rights Of RecovaryAgalnst Otherg organizatlon which makes fnsuranee inspections, To Us surveys, reports or reeornmendations. Applicable to Property Coverage: F, Insurance Under Two Or More Coverayas If any person or organization to or for whore we if two or more of this policy's coverages apply tc make payment under this policy has riollts 16 the same loss or damage, we will not pay more recover damages from another, those rights are than the actual amount of[lie loss or damage. Iransrerred to us to the e dent of our payment. G. Liberalization That person or organization must do everything necessary to secure our rights and must, do f we adopt any revision ttaa would hroacfen the nothing after loss (a impair them. But you may coverage under th€s policy without additional waive your rights against another party to writing; promium within 45 days prior to or during the policy period, the bfoadened coverage will immediately I. Prfcrto a loss to your Covered Properly. apply to this policy, 2, After a loss to your Covered Property only if, at N. Other Insurance -property coverage time of foss,that party is one oftho following; If there is other insurance covering the same loss a, Saireone insured by tills €nsurance; or damage, vac will pay only for the amount of b. A business firm: covered loss or damage in excess of the amount (1) Owned or coalrolfed by you;or (too from that other insurance, whether you can collect on it or not. But we will not pay more than (2) That owns or controls you;or the applicable Limit of Insurance. Page 2 of 3 Fornh hl3 0Q 05 12 06 COMMON POLICY CONDITIONS c. Yourtenant. L premium Audit You may also accept the usual Bills of lading or a. We will compute all premiums for this policy in shipping receipts Limiting the liability of carriers, accordance with our rules arid rates. This will not restrict your Insurance, b> The premium arro!nt shovm in the K. Transfer of Your Rights And DuVes Under This Declarations is a deposit premium only. At the Policy close of each audit period we will compute the earned premium for that period. Any Your rights and duties under this policy may not be additional premium found to be due as a result transferred without our written consent except in of the audit are due and payable on notice to the case of death of art indi%ddu21 Named Insured. the first Named Insured. If the deposit If you die, your rights and duties wll be transferred premium paid for the policy term is greater to your legal representative but only while acting than the earned premium, v,,e will return the within tho scope of duties as your lags[ excess to the first Named insured. o representative. Until your legal representative is c. The first Named Insured must maintain all appointed, anyone having proper temporary records related to the coverage provided By custody of your property Y411 have your rights and this policy and necessary to finaf(za the 1-4 duties Lot only wth respect tothat property. premium audit, and send us copies of the w same upon our request. m st 0 w N Cq N 0 oour President and Secretary have Signed this policy. Whc-re required By law,the Declarations page has also been x countersigned by our dury authorized representative. rYo�rl e_Huni,SEr-teary ' dodo AtiC�r'rP,President y 3 ponu SS 00 05 12 06 page 3 of 3 SUPER STRETCH SUMMARY SUMMARY OF COVERAGE'LIMITS This is a surnmary of the Coverages and the Limits of Insurance provided by the Super Stretch Coverage form SS 04 74 which Is included in this policy. No coverage Is provided by this summary. Refer to coverage form SS 04 74 to determine the scope of your Insurance protection, The Limits of Insurance for the following Additions! Coverages are in addition to any other limit of insurance provided N underthls policy: 0 Blanket Coverage Limitof Insurance:$150,000 Blanket Coverages N _ Accounts Receivable- 0n/0ff Premises N Compufers and Media o Debris Removal Personal Prop arty of Others Temperature Change Valuable Papers and Records-On/Off Premises JJo Coverage Limit Brands and Labels Up fo Business Personal Property Limit Claim Expenses $10,000 Computer Fraud $5,000 Employee Dishonesty(including ERISA) $25,000 Fine Ails $25,000 Forgery $25,000 Laptop Computers-Woildwide Coverage $10,000 Off Premises Utility Servlres—Direct Damage $25,000 Outdoor Signs Full Value Pairs or Sets Up to Business Personal Property Limit Property at Other Premises $10,000 _ — Salespersons' Samples $ 0,000 Sewer and Drain Back Up included Up to Covered Property Llmits Sump Overflow or Sump Pump Failure $25,000 Tenant Building and Business Personal Roperty $20,000 Coverage-Required by Lease Transit Property in the Care ofCartois for Hire $1Q0c0 - — Unauthorized Business Card Use $ 5,000 = I - i I i Form SS 9415 09 07 Page 1 of 2 CD 2007, The Hartford The Limits of Insurance for the fallowing Coverage Extensions are a replacement of the Limit of Insurance provided under the Standard Properly Coverage Form or the Special Property Coverage Form,whichever applles to the policy: Coverage Limit Newsy Acrauired or Constructed Property—180 Days Building $1,000,000 Business Personal Property $50Q000 Business Income and Extra Expense $500,000 Oufdo a m Property Personal $25,000 aggregate/$1,000 per tern Personal Effects $25,000 Propel Off-Premises $25,000 The following changes apply only if Business lnoome and Extra Expense are covered under this policy, The Limits of Insurance for the following Business Income and Extra Expense Coverages are in addition to any other Limit of insurance provided under this policy: Coverage ,Limit Business Income Extension for Off Premises Utility Services $25,000 Business Income Extension for Web Sites $ 50,00017 days Business Income from Dependent Properties $50,000 The following Limit of Insurance for the Vidwing Business Income Coverage Is a replacement of the Limit of Insurance provided under the Standard Property Coverage Form or the Special Property Ccverage Form, whichever applies to the policy: Coverage Limit. Extended Business income 90 Days -f Le fol lowing changes apply to Loss Payment Conditions: Coverage L ifnit Valuatirn Charges- Commodity Stock Included "Finished Stock" Included Mercantile Stack- sold included i i i i I I i Page 2 of 2 Form S5 84 15 09 07