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HomeMy WebLinkAboutPW16-172 - Amendment - #1 - Mayes Testing Engineers, Inc. - James St Pump Station - 01/10/2017 r, p��l /i/,lu� ��i�ry✓2rrr✓�,�� gemO NUM # „Io �%%,�f�'rPas o„ � 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: Maves Testinq Enqineers, Inc. Vendor Number: JD Edwards Number Contract Number: V [9- 11 " 007- This is assigned by City Clerk's Office Project Name: James Street Pump Station Description: ❑ Interlocal Agreement ❑ Change Order ® Amendment ❑ Contract ❑ Other: Contract Effective Date: 1/10/17 Termination Date: 2/28/17 Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Phil McConnell 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 February 28, 2017 to complete final inspections and report. As of: 08/27/14 KIENT w.s ��TDN AMENDMENT NO. 1 NAME OF CONSULTANT OR VENDOR: Mayes Testing Engineers, Inc. CONTRACT NAME & PROJECT NUMBER: James Street Pump, Station ORIGINAL AGREEMENT DATE: April 27, 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 February 28, 2017 to complete final inspections and report to satisfy the requirements of the Building Permit. 2. The contract amount and time for performance provisions of Section II "Time of Completion," and Section III, "Compensation," are modified as follows: ..... ..m . .... ....._.._ ... .. . Original Contract Sum, $12,540.00 including applicable WSST Net Change by Previous Amendments including applicable WSST Current Contract Amount $12,540.00 including all previous amendments Current Amendment Sum $0 ._r_ __. _.. . ...._ $0w Applicable WSST Tax on this Amendment Revised Contract Sum $12,540.00 AMENDMENT — 1 OF 2 Original Time for Completion 1/17 (insert date) _. ...., _-----.__.. _,___,-..__ . .__,....,__,_. ......._.._,.__ .w_ Revised Time for Completion under n/a prior Amendments (insert date) Add'I Days 12equired (t) for this 28 calendar days Amendment ® .........._ ____.- ....._........... Revised Time for Completion 2/28/17 (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/ rV .ENDOR: ✓ CITY KENT: /,r�// (signature /r " ( g ) / `(signature) Print Name 7/—m,.. VIM . .. r m,� „ ._. 1Y ✓ Print Name: moth J. LaPorte, P.E. Its __ "�_r-✓ c t Its P blie W rksm[�1 otor__ ...... ...-(titre) _ (tit! DATE:_ Ile t !r ._. .__. DATE:... .. ,_ ' . _ APPROVED AS TO FORM: (applicable if Mayor's signature required) Kent Law Department Mayes-lames PS Am 1/McConnell AMENDMENT - 2OF2 ACO/r®` CERTIFICATE OF LIABILITY INSURANCE DATEtMMropmy 1n/2018 Y........__12/15/2016 '-9 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS TIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES __OW. 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 1 end holder Is an ADDITIONAL INSURED,the policy(fes)must have ADDITIONAL INSURED provisions or 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 LOCkIOn CON pBDiBS 444 W,47th Street)Suite 9DGr I{afl Pw SRB �tyy MO pot 12-1 906 �a Exit: _.....tk" C ...,.._.... (816)980.90' D ao. sk s INSURERUSd AFFORDING COVERAGE NArcn e., .._._._.._ INSURER A Lexington Insurance Co_mnam 19437 RNSURED NIA'lE.S TESTiP1G ENGINEERS iN(s. INSURERS Tin P11""C INC of Amn 2S674 TERRACON CONSULTANTS.INC. .. ._.._ -. .,.....� ..... t312890 INSURERC The Travel am 2D225 CEDAR VALLEY ROAD,SUITE 710 -- . � n L LYNNWOOD WA 98036 INSURER D; INSURER E: ..........m- INS F .....� .— GEIS CT D aED. NOTWITHSTANDING ANY JE OCERTIFICATE ANcE R: 15rL- H REVISION_NgJ114$ER 7CfiXXXXX INDICATED. A ED CERTIFY TS#AT THE POD Y RE UI fEMENT,TERM LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED h WITH FOR THE O WHI HEWS 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, GNR TYPE OFINSURANCE pPiS➢ 11 POLICY NUMBER laj ryyy 11� LMMI DIY V LIMITS g X COMMERCIAL GENERAL ABILITY y N TC2J-GLSA1118L293 1/1/2017 I/l/2016 EACH OCCURRENCE 1t100000 I CLAIMS-MADE OCCUR RF:f+' """ ' ❑ Prt:r sE® cuna,lee3--0�006 X CONTRACTUALLIAR MEDBxPIARVRinefiasarp t25,000 PERSONALBADVIWURY._, $ 1,_000.000 GEN'L AGGREGATE 14MITAPf'LIEfiPER: GENERAL AGGREGATE 8 2,00,0 600 POUCY[Y] ❑LUC PRODUCTS-COMPAO AG s 2.004,0110 OTHER T e ITOMOBILEUAB�LITY y N Tc2J-cAp-131J3858 v1/zo17 t/lnnls.. .:L e�,dRea_' � � , s 2.000.000 .. ANY AUTO FJOOkY INJURY(P.,erson) $ X+X.I��liY.}x OwrvEU XXX3LXX>CXAUTOSONLYNSCTHOESDULED AUBODILY INJURY(Perprc14nn4$—' HIRED NONOWNED --X AUTOS ONLY AUT08ONLr rPgrac*Idemr' .. $ XrxxxxXX _ _,. $ S.QX7C3CxX B }{ UMBRELLA LIAB �'h' pOCCUR N N Z.UP-9)M46583 1/l/2017 1/1/2018 EACHOCGURRENCE S ��t{)qa 13 {YI EXCLUDES PROF.LIRA. --- LL----- •-+--- EXCESSLIAB ClA�MB.MAth: ( AGGRLGATIE ., $„ 0,000 OED RETENTIONS gXXX _---.-WCt Eirtt;5'"'r+efESA`Tfr2"._ .._. ...._ ,...... C AND EMPLOYERS LIABILITY N Pl:'2Kt713 13 173 742 1 7((At»1 � 1/1/2017 1/1/2018 X SE,RyT I � ,,, ER C ANY PROPRIETCR ARTNMLKECUTIVE jY�I N'� TRKUB131J384617(A7,MA,W Y1/1/2017 111/2018 ' tt�yry B OFFICER/MEMBER E%CLUDE07 1 IV I NIA TC,2KUB131J374217(CA) 1/l/2017 1/1/2018 EL EACH ACCIDENT $ 000 00 IL.,��....JJ ..�............. IManaeb,y in rvxI E.L DISEA.sE-FA EUPWYEE 1,000.000,n9y,/yy D_. __TIDn DF OPERATIDNE beIw, k4�01SShsF NCTUCW Lafrr. t B,QVI}.VU1I A.....LIABILITY Nhi. _ N N 26030216 .._...m� 1YU2017 1/l/2018 S2.,000,000 EACH CLAIM&$2000,00D � TN'TI{P.ANNUAL AGGREGA'IrE Rc�MIL ptro ect k T116106 OF 5 City of Kent J,an Is Sh ca Pi m WS,Awn,1i C�!ROvtmnrNs SchadPeA,n+ay be attaclietl If sPaRe Is regnaWE auto liability,these coves Cs me rim P Y KCnt er,cottnng IS np addifr li a Insured us respects ggtneral liability and tY, 8 primary and RrrB-tnothihutory,.as required by M1vnpttn contract.Employtr's Ilalrllity anrludcs Stop LdaP.. .. .,..... ........ .,.._..........r_�___'.,....._.,w,... CGRTIFYCaTE HC1LDER.............. ....--___w..-.., _GAMICEI.LAfl SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 14385262 01y'of Kent EgineerRg Afire Nancyy Yoshitake 400 West Goble Kent,WA 98032 ACORO 25(2016103 ...._......----........_..........._._...___._�. /�* ,• I d 1968.201 6RD CORP6,RATION All rights reserved The ACORD name and logo are registered marks of ACORD DATE(M MIUUNYYY) AC"MY CERTIFICATE OF LIABILITY INSURANCE v1/zols v 't. k... 9/2017, 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 have ADDITIONAL INSURED provisions or 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 I.ockton Companies CONTACT 444 W.47ih Street;Suite 900 PHONE ___-- ___-- ___-- I FAY "- Kansas City MO 64112-1906 ei'niL""`^ - -------- (816)960-9000 _bk[NRkSS; _-- ..-__— ....... IN SUR ERISi AFFORDING COVERAGE NAICk _........ ......_..... o..:m, ._..................._.—.-............ .______.. ........... ..._..... INSURER T,Pxinotno Tnsnrmlcn C rUnr nano 19437 INSURED NIAYES TESTING ENGINEERS.INC. INSURER B-Tsavcicrs Ploueriv Casualty Co ol'Amenca _25674 ]312890 - ..._.. TERRACON CONSULTANTS,INC. INSURER C The Travelers Indemnity Con Inv 5659 2 20225 CEDAR VALLEY ROAD,SUITE 110 INSURER D LYNNWOOD WA 98036 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 1.4385262 REVISION NUMBER: xxxxxxx 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 IADDL$UBR , .... .... ........ 1 POLPCY.E�.FF POLICY�E%P.. ._ ......... ..... ,,,,,.... iIR TYPE OF INSURANCE 4..cn nnrnI POLICY NIIMRFR 1fMMIDOIYY'YYI IMMIDDIYYYYE LIMITS B X �COMMERCIAL GENERAL LIABILITY Y N TC2J-GLSA-I1181,293 1/1/2017 1/1/2018 EACH OCCURRENCE $ 1BNDDBB C7AIeACET(3 PdCNYCD r CLAIMS MADE OCCUR PREMISEaF tEA occwrervsuj, „$ I HNN NON x CONTRACIUAL LIAB MED EXP An,one oersao $ 75000 PERSONAL dADVINJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2000,000 POLICY{X)JEOCT LOC PRODUCTS COMP/DP AGO $ 2.000.000 OTHER: ....A B AUTOMOBILE LIABILITY Y N 'CC2J-CAP-131J3858 1/12017 1/1/2018 COMBINED SINGLE UMP $ Ena ldan(1, __ 2,000,000 ANY AUTO BODI LY INJURY(Per person) $ xxxxxxx x _ .X OWNED SCHEDULED BODILY INJURY(Per dcmdenl) $ ' AUTOS ONLY AUTOS _ xxxxxxx X..- HIREo X" NON-OWNED PROPERID1 Ar'E $ XXXXXXX AUTOS ONLY AUTOS ONLY Par $ xxxxxxX B X UMBRELLA LIAB x .00CUR N N ZUP-91 M46583 1/1/2017 1/1/2018 EACH OCCURRENCE $ 5.000.000 B EXCESS LIAB (EXCLI)UPS PROF,LIAB,) :CLAIMS MADE AGGREGATE $ 5.000.000 DEo [_ RETENTION$ $ xNXXx XX WORKERS COMPENSATION F k U H C AND EMPLOYERS'LIABILITV N T(,2K1N13131 J374P17gAtJ$) 1/1/2017 I/1/2015 x 9TATUTF FR __ _ C ANY PROPRIETORIPARTNERIEXEOUTIVE YIN T1tKEiN 31J384617(A f,MA.WI) 1/1/2017 1/1/2018 EL EPGH ACCIDENT -S 1 ooawD B OFFICERIMEMPER FXGLIIDED9 N NIA TC2K11S131 J374217 ICA.) 1/1/2017 1/1/2018 -- (MandatoryinNH) ELDISEASE EA EMPLOYEE $ 1.000.000 f yes.descdbe under --.. ........... ......... DESCRIPTION OF OPERATIONS below E L DISEASE POLICY LIMIT $ 1 000.000 A PROFESSIONAL N N 26030216 I/I/2017 I/1/201R $2,000000 F.ACH CLAIM& LIABILITY $2,000,000 IN THE ANNUAL AUGRL'GATE DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) ITHIS CERII IICAI h SUPT US F In S ALL PRY.V IOUSI Y ISS U or,CERI IhICAI-ES FOR THIS HOLDER,APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERMS)REFERENCED Re. M'I'E project 8 T16106,City of Kent James Sheet Pump Station. City of Kent Engineering is an additional inured as respects general liability arid auto lisbdi(y,these coverages are primary and non-contributory,as required by aTitten contract,Employer's liability includes Stop WE. CERTIFICATE HOLDER CANCELLATION Sec Attachments 14385262 City Of Kent Engineering SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE AND:Nanc'YOSh(take THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 400 West Gowe ACCORDANCE WITH THE POLICY PROVISIONS. Kent,WA 98032 AUTHORIZED REPRE5ENTATIV ,/ Al _ ,1 ©1888 T 4015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: TC2J-GLSA-11181-293 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - AUTOMATIC STATUS IF REQUIRED BY WRITTEN CONTRACT (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II -WHO IS AN INSURED: Any person or organization that: a. You agree in a "written contract requiring insurance"to include as an additional insured on this Coverage Part; and b. Has not been added as an additional insured for the same project by attachment of an endorsement under this Coverage Part which includes such person or organization in the endorsement's schedule; is an insured, but: a. Only with respect to liability for"bodily injury", "property damage" or"personal injury", and b. Only as described in Paragraph (1), (2) or (3) below, whichever applies: (1) If the "Written contract requiring insurance" specifically requires you to provide additional insured coverage to that person or organization by the use of: (a) The Additional Insured - Owners, Lessees or Contractors- (Form B) endorsement CG 20 10 11 85; or (b) Either or both of the following: the Additional Insured - Owners, Lessees or Contractors - Scheduled Person Or Organization endorsement CG 20 10 10 01, or the Additional Insured - Owners, Lessees or Contractors - Completed Operations endorsement CG 20 37 10 01; the person or organization is an additional insured only if the injury or damage arises out of"your work" to which the "written contract requiring insurance" applies; (2) If the "written contract requiring insurance" specifically requires you to provide additional insured coverage to that person or organization by the use of: (a) The Additional Insured - Owners, Lessees or Contractors - Scheduled Person or Organization endorsement CG 20 10 07 04 or CG 20 10 04 13, the Additional Insured - Owners, Lessees or Contractors- Completed Operations endorsement CG 20 37 07 04 or CG 20 37 04 13, or both of such endorsements with either of those edition dates; or (b) Either or both of the following: the Additional Insured - Owners, Lessees or Contractors - Scheduled Person Or Organization endorsement CG 20 10, or the Additional Insured Owners, Lessees or Contractors - Completed Operations endorsement CG 20 37, without an edition date of such endorsement specified, the person or organization is an additional insured only if the injury or damage is caused, in whole or in part, by acts or omissions of you or your subcontractor in the performance Miscellaneous Attachment: M482524 Certificate ID: 14385262 of"your work" to which the "written contract requiring insurance" applies; or (3) If neither Paragraph (1) nor (2) above applies: (a) The person or organization is an additional insured only if, and to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of"your work" to which the "written contract requiring insurance" applies; and (b) The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a. If the Limits of Insurance of this Coverage Part shown in the Declarations exceed the minimum limits of liability required by the "written contract requiring insurance", the insurance provided to the additional insured will be limited to such minimum required limits of liability. For the purposes of determining whether this limitation applies, the minimum limits of liability required by the "written contract requiring insurance"will be considered to include the minimum limits of liability of any Umbrella or Excess liability coverage required for the additional insured by that"written contract requiring insurance". This endorsement will not increase the limits of insurance described in Section III - Limits Oflnsurance. b. The insurance provided to the additional insured does not apply to "bodily injury", "property damage" or"personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders or change orders, or the preparing, approving, or failing to prepare or approve, drawings and specifications; and (2) Supervisory, inspection, architectural or engineering activities. c. The insurance provided to the additional insured does not apply to "bodily injury" or "property damage" caused by"your work" and included in the "products-completed operations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured during the policy period. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured. However, if the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non-contributory basis, this insurance is primary to other insurance available to the additional insured under which that person or organization qualifies as a named insured, and we will not share with that other insurance. But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured, or is any other insured that does not qualify as a named insured, under such other insurance. 4. As a condition of coverage provided to the additional insured by this endorsement: a. The additional insured must give us written notice as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, such notice should include: (1) How, when and where the "occurrence" or offense took place, (2) The names and addresses of any injured persons and witnesses; and (3) The nature and location of any injury or damage arising out of the "occurrence" or Miscellaneous Attachment:M482524 Certificate ID: 14385262 offense. b. If a claim is made or"suit' is brought against the additional insured, the additional insured must: (1) Immediately record the specifics of the claim or"suit' and the date received; and (2) Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit' as soon as practicable. c. The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit', cooperate with us in the investigation or settlement of the claim or defense against the "suit', and otherwise comply with all policy conditions. d. The additional insured must tender the defense and indemnity of any claim or"suit'to any provider of other insurance which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insurance provided to the additional insured by this endorsement is primary to other insurance available to the additional insured which covers that person or organization as a named insured as described in Paragraph 3. above. 5. The following is added to the DEFINITIONS Section: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs, and the "personal in-jury" is caused by an offense committed, during the policy period and: a. After the signing and execution of the contract or agreement by you; and b. While that part of the contract or agreement is in effect. CG D6 04 08 13 Miscellaneous Attachment:M482524 Ceitificate ID: 14385262 POLICY NUMBER: TC2J-CAP-131J3858 COMMERCIALAUTO ISSUE DATE: 01/01/2017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE - PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE - CONTRACTORS This endorsement modifies insurance provided by the following: BUSINESS AUTO COVERAGE FORM SCHEDULE OF ADDITIONAL INSURED PERSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN CONTRACT, PROVISIONS 1. The following is added to Paragraph c. in A. 1., Who Is An Insured, of SECTION II-COVERED AUTOS LIABILITY COVERAGE: This includes any person or organization designated in the Schedule Of Additional Insured Persons Or Organizations who you are required under a written contract or agreement, that is signed by you before the"bodily injury"or"property damage" occurs and that is in effect during the policy period, to name as an additional insured for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent of that designated person's or organization's liability for the conduct of another"insured". 2. The following is added to Paragraph 5., Other Insurance, in B., General Conditions, of SECTION IV - BUSINESS AUTO CONDITIONS: Regardless of the provisions of paragraph a. and paragraph d. of this part 5. Other Insurance, this insurance is primary to and non-contributory with applicable other insurance under which the person or organization designated in the Schedule of Additional Insured Persons Or Organizations is a named insured when a written contract or agreement with you, that is signed by you before the "bodily injury" or "property damage"occurs and that is in effect during the policy period, requires this insurance to be primary and non-contributory. CA T6 00 02 16 Miscellaneous Attachment M467648 Certificate ID: 14385262