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HomeMy WebLinkAboutPW17-189 - Original - Charon Drilling, Inc - Contract - 04/27/17 r c ko%, r s M a,11.o KENT G w m a H INGTON 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: Charon Drilling, Inc. Vendor Number: .JD Edwards Number Contract Number: M ID - IJ6 -C This is assigned by City Clerk's Office Project Name: East Dill Well Description: ❑ Interlocal Agreement N Change Order C Amendment Contract El Other: Contract Effective mate: 4/ 7/17 Termination [date: /31/17 Contract Renewal Notice (Days) Number of days required notice for termination or renewal or amendment Contract. Manager: Bryan hand Department: PW Operations Contract Amount: 0.04 Approval Authority: (CIRCLE ONE) (Department Director Mayor City Council Detail: (i.e. address, location, parcel number, tax id, etc.): Extended the time of completion to May 31, 2017, As of: 08/2.7/14 s KENT CHANGE ORDER NO. 1 NAME OF CONTRACTOR: Charon Drilling, Inc. ("Contractor") CONTRACT NAME & PROJECT NUMBER: East Hill Well ORIGINAL CONTRACT DATE: April 20, 2017 This Change Order amends the above-referenced contract; all other provisions of the contract that are not inconsistent with this Change Order shall remain in effect. For valuable consideration and by mutual consent of the parties, the project contract 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, Contractor shall provide all labor, materials, and equipment necessary to: No change to the scope of work, however a change order is necessary to extend the time of completion to May 31, 2017 due to a delay in getting the original contract executed. 2. The contract amount and time for performance provisions of Section II "Time of Completion," and Section III, "Compensation," are hereby modified as follows: Original Contract Sum, $20,202.75 (including applicable alternates and WSST) Net Change by Previous Change Orders $0 (incl. applicable WSST) Current Contract Amount $20,202.75 (incl. Previous Change Orders) Current Change Order $0 Applicable WSST Tax on this Change $0 Order Revised Contract Sum $20,202.75 CHANGE ORDER - 1 OF 2 O(insert date)riginal Time for Completion121117 Revised Time for Completion under rile prior Change Orders (insert date) Days Required for this Change 33 calendar days Order Revised Time for Completion 5J3>Ill (insert date) Pursuant to the above-referenced contract, Contractor agrees to waive any protest it may have regarding this Change Order and acknowledges and accepts that this Change Order constitutes final settlement of all claims of any kind or nature arising from or connected with any work either covered or affected by this Change Order, including, without limitation, claims related to contract time, contract acceleration, onsite or home office overhead, or lost profits. This Change Order, unless otherwise provided, does not relieve the Contractor from strict. compliance with the guarantee and warranty provisions of the original contract, particularly those pertaining to substantial completion date. All acts consistent with the authority of the Agreement, previous Change Orders (if any), and this Change Order, prior to the effective date of this Change Order, are hereby ratified and affirmed, and the terms of the Agreement, previous Change Orders (if any), and this Change Carder 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 contract modification, which is binding on the parties of this contract. 3. The Contractor will adjust the amount of its performance bond (if any) for this project to be consistent with the revised contract sum shown in section 2, above. IN WITNESS, the parties below have executed this Agreement, which will become effective on the last date written below. CONTRACTOR:�,� �',t�r1 �t�� �'n � I P(. clTv K-�ENT: By: By sr' ature) Print Clan C Lu �.ie O PublicWorks Director l� . Its Prsint dame. Timthy . LaPor 'tor (title) DATE: . L` DATE: APPROVED AS TO FORM: (applicable if Mayors signature required) Kent Law Department ;;t•xrwea Cr, nry,�h i V,`rv:fi Cq2 ru'tCn'dry CHANGE ORDER - 2 OF 2 Client#:68161 CHARDRIL3 DATE(MMIDD/YYYY) ACORD.. CERTIFICATE OF LIABILITY INSURANCE 04/18/2017 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 be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Propel Insurance _( CCD,142 Exl:800 499-0933 ; ,No): 866 577-1326 Tacoma Commercial Insurance E-MAIL 1201 Pacific Ave,Suite 1000 ADDRESS: _ INSURER(S)AFFORDING COVERAGE NAIC N Tacoma,WA 98402 INSURER A:American States Insurance Compa 19704 INSURED Charon Drilling Inc. INSURER B:AIG Specialty Insurance Company 26883 INSURER C: 12719 224th Street E INSURER 0 Graham,WA 98338 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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 SUBR POLICY EFF POLICY EXP LTR IINSR iWVD POLICY NUMBERLIMITS MMIDD/YYYY MM/DO A X COMMERCIAL GENERAL LIABILITY X X 01C13857477 6/01/2016 06101/2017 EACH OCCURRENCE $1,000,000 QAMAF�I RENTED CLAIMS-MADE OCCUR REMI a Eaoccurrence $200 000 1 MEO EXP(Any one person) $10 000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 52,000,000 PRO- PRODUCTS-COMPIOPAGG $2,000,000 JECT LOC POLICY a OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A X ( X 01C15980445 6/01/2016 06/01/201 Eaacadenl $1,000,000 X ANY AUTO BODILY INJURY(Per person) 5 ALL OWNED SCHEDULED BODILY INJURY(Per accident) 5 AUTOS AUTOS X HIRED AUTOS Ix NON-OWNED PROPERTY DAMAGE 5 AUTOS Per accident S A X UMBRELLALIAB X OCCUR 01SU4301414 6/01/2016 06/01/201 EACH OCCURRENCE s2000000 EXCESS LIAR CLAIMS-MADE AGGREGATE s2,000,000 DED X IT $10000 1 $ WORKERS COMPENSATION j PTATUTE OTH- A 01C13857477 6/01/2016 06/01/201 AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YI N i E.L.EACH ACCIDENT 52 0OO OOO OFFICER/MEMBER EXCLUDED? a i!NIA: (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE s2,000,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S B Pollution i I CP05030885 6/01/2016 06/01/2017 $1,000,000 Lim/$10K Ded A Leased Rented j 101C13857477 61011201610610112017 $25,000 Limit Equipment I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached It more space Is required) RE:East Hill Well Additional Insured status as respects General Liability applies per attached form(s). CERTIFICATE HOLDER CANCELLATION City of Kent SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn:Timothy J. LaPorte,P.E. ACCORDANCE WITH THE POLICY PROVISIONS. 220 Fourth Avenue South Kent,WA 98032 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #S26712151M2660568 BMC00 This,page has b&6ivleft blank mtenttionally. .ir. ., COMMERCIAL GENERAL LIABILITY Insurance CG 86 74 12 07 01 C13857477 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS LIABILITY PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: DUTY TO DEFEND or B or medical expenses under COV- ERAGE C. Paragraph a. of SECTION I — COVERAGE A and No other obligation or liability to pay sums or COVERAGE B is replaced by the following: perform acts or services is covered unless ex- a. We will pay those sums that the insured be- plicitly provided for under SUPPLEMENTARY comes legally obligated to pay as damages PAYMENTS — COVERAGES A AND B. because of "bodily injury", "property damage" or "personal injury and advertising EMPLOYERS LIABILITY injury" to which this insurance applies. We will have the right and duty to defend the in- The last paragraph of exclusion e. of SECTION I — sured against any "suit" seeking those dam- COVERAGE A is replaced by the following: ages. Our duty to defend begins once you This exclusion does not apply to liability assumed notify us of a "suit" as described in SEC- by the insured under an "insured contract" ex- TION IV — COMMERCIAL GENERAL LI- cept for that part of a contract or agreement that ABILITY CONDITIONS, 2.b. However, we indemnifies any person or organization for their will have no duty to defend the insured against any "suit" seeking damages for sole liability. "bodily injury", "property damage", or WRONGFUL EVICTION "personal injury or advertising injury" to which this insurance does not apply. We may, at our discretion, investigate any The following exclusion is added to SECTION I — "occurrence" and settle any claim or "suit" COVERAGE B: that may result. But: The wrongful eviction from, wrongful entry into, (1) The amount we will pay for damages is or invasion of the right of private occupancy of a limited as described in SECTION III — room, dwelling or premises arising out of any: LIMITS OF INSURANCE; and (1) "property damage" to the room, dwell- (2) Our right and duty to defend ends when ing or premises; or we have used up the applicable limit of (2) "bodily injury" sustained through occu- insurance in the payment of judgments pancy of a room, dwelling or premises. or settlements under COVERAGES A Safeco and the Safeco logo are registered trademarks of Safeco Corporation CG 86 74 12 07 Page 1 of 5 ADDITIONAL INSURED — BY WRITTEN CON- This insurance does not apply to "bodily TRACT, AGREEMENT OR PERMIT, OR SCHED- injury", "property damage", or ULE "personal and advertising injury" arising out of operations performed for the state The following paragraph is added to SECTION II — or municipality; WHO IS AN INSURED: c. The insurance with respect to any architect, 4. Any person or organization shown in the Sched- engineer, or surveyor added as an insured ule or for whom you are required by written con- by this endorsement does not apply to tract, agreement or permit to provide insurance "bodily injury", "property damage", or is an insured, subject to the following additional "personal and advertising injury" arising out provisions: of the rendering of or the failure to render any professional services by or for you, in- a. The contract, agreement or permit must be cluding: in effect during the policy period shown in the Declarations, and must have been exe- (1) The preparing, approving, or failing to cuted prior to the "bodily injury", "property prepare or approve maps, drawings, opinions, reports, surveys, change or- injury or "personal and advertising injury . ders, designs or specifications; and b. The person or organization added as an in- (2) Supervisory, inspection or engineering sured by this endorsement is an insured only services. to the extent you are held liable due to: d. This insurance does not apply to "bodily (1) The ownership, maintenance or use of injury" or "property damage" included within that part of premises you own, rent, the "products-completed operations lease or occupy, subject to the following hazard". additional provisions: e. A person's or organization's status as an in- (a) This insurance does not apply to sured under this endorsement ends when any "occurrence" which takes place your operations for that insured are com- after you cease to be a tenant in pleted. any premises leased to or rented to f. No coverage will be provided if, in the ab- you; sence of this endorsement, no liability would (b) This insurance does not apply to be imposed by law on you. Coverage shall any structural alterations, new con- be limited to the extent of your negligence struction or demolition operations or fault according to the applicable principles performed by or on behalf of the of comparative fault. person or organization added as an g. The defense of any claim or "suit" must be insured; tendered as soon as practicable to all other (2) Your ongoing operations for that in- insurers which potentially provide insurance sured, whether the work is performed for such claim or "suit". by you or for you; h. The insurance provided will not exceed the (3) The maintenance, operation or use by lesser of: you of equipment leased to you by such (1) The coverage and/or limits of this policy, person or organization, subject to the or following additional provisions: (2) The coverage and/or limits required by (a) This insurance does not apply to said contract, agreement or permit. any "occurrence" which takes place after the equipment lease expires; NON-OWNED WATERCRAFT AND NON-OWNED (b) This insurance does not apply to AIRCRAFT LIABILITY "bodily injury" or "property damage" arising out of the sole Exclusion g. of SECTION I — COVERAGE A is re- negligence of such person or or- placed by the following: ganization; g. "Bodily injury" or "property damage" arising (4) Permits issued by any state or political out of the ownership, maintenance, use or subdivision with respect to operations entrustment to others of any aircraft, "auto" performed by you or on your behalf, or watercraft owned or operated by or rented subject to the following additional pro- vision: Page 2 of 5 or loaned to any insured. Use includes oper- "Property damage" to: ation and "loading or unloading". (1) Property you own, rent, or occupy, in- This exclusion applies even if the claims cluding any costs or expenses incurred against any insured allege negligence or by you, or any other person, organiza- other wrongdoing in the supervision, hiring, tion or entity, for repair, replacement, employment, training or monitoring of others enhancement, restoration or mainte- by that insured, if the "occurrence" which nance of such property for any reason, caused the "bodily injury" or "property including prevention of injury to a per- damage" involved the ownership, mainte- son or damage to another's property; nance, use or entrustment to others of any (2) Premises you sell, give away or aban- aircraft, "auto" or watercraft that is owned or operated by or rented or loaned to any in- don, if the "property damage" arises out of any part of those premises; sured. This exclusion does not apply to: (3) Property loaned to you; (1) A watercraft while ashore on premises (4) Personal property in the care, custody you own or rent; or control of the insured; (2) A watercraft you do not own that is: (5) That particular part of real property on which you or any contractors or sub- (a) Less than 52 feet long; and contractors working directly or indirectly (b) Not being used to carry persons or on your behalf are performing oper- property for a charge; ations, if the "property damage" arises out of those operations, or (3) Parking an "auto" on, or on the ways (6) That particular part of any property that next to, premises you own or rent, pro- must be restored, repaired or replaced vided the "auto" is not owned by or because "your work" was incorrectly rented or loaned to you or the insured; performed on it. (4) Liability assumed under any "insured contract" for the ownership, mainte- Paragraphs (1), (3) and (4) of this exclusion Hance or use of aircraft or watercraft; or do not apply to "property damage" (other than damage by fire) to premises, including (6) "Bodily injury" or "property damage" the contents of such premises, rented to arising out of: you. A separate limit of insurance applies to (a) the operation of machinery or Damage To Premises Rented To You as equipment that is attached to, or described in SECTION III — LIMITS OF part of, a land vehicle that would INSURANCE. Paragraph (2) of this exclu- qualify under the definition of sion does not apply if the premises are "your "mobile equipment" if it were not work" and were never occupied, rented or subject to a compulsory or financial held for rental by you. responsibility law or other motor ve- Paragraphs (3), (4), (5) and (6) of this exclu- hicle insurance law in the state sion do not apply to liability assumed under where it is licensed or principally a sidetrack agreement. garaged; or Paragraph (6) of this exclusion does not ap- (b) the operation of any of the machin- ply to "property damage" included in the ery or equipment listed in Paragraph "products-completed operations hazard". f.(2) or f.(3) of the definition of "mobile equipment". Paragraph 6. of Section III is replaced by the follow- (6) An aircraft you do not own provided it is ing: not operated by any insured. 6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we TENANTS' PROPERTY DAMAGE LIABILITY will pay under COVERAGE A for damages be- cause of "property damage" to any one prem- When Damage To Premises Rented To You Limit is ises, while rented to you, or in the case of shown in the Declarations, SECTION I — COVER- damage by fire, while rented to you or temporar- AGE A, exclusion j., is replaced by the following: ily occupied by you with permission of the owner. J. Damage To Property CG 86 74 12 07 Page 3 of 5 The Damage To Premises Rented To You Limit is the a. "Bodily injury" or "property damage" ex- higher of $200,000 or the amount shown in the Dec- pected or intended from the standpoint of the larations as Damage To Premises Rented To You insured. This exclusion does not apply to Limit. "bodily injury" or "property damage" result- ing from the use of reasonable force to pro- WHO IS AN INSURED — MANAGERS tect persons or property. The following is added to Paragraph 2.a. of SECTION INCREASED MEDICAL EXPENSE LIMIT II — WHO IS AN INSURED: The medical expense limit is amended to $10,000. Paragraph (1) does not apply to executive officers, or to managers at the supervisory level or above. KNOWLEDGE OF OCCURRENCE SUPPLEMENTARY PAYMENTS — COVERAGES A The following is added to Paragraph 2. SECTION IV AND B — BAIL BONDS — COMMERCIAL GENERAL LIABILITY CONDITIONS Duties In The Event Of Occurrence, Paragraph 1.b. of SUPPLEMENTARY PAYMENTS Offense, Claim Or Suit of: — COVERAGES A AND B is replaced by the follow- ing: Knowledge of an "occurrence", claim or "suit" by b. Up to $3,000 for cost of bail bonds required your agent, servant or employee shall not in itself because of accidents or traffic law violations constitute knowledge of the named insured unless an arising out of the use of any vehicle to which officer of the named insured has received such notice the Bodily Injury Liability Coverage applies. from the agent, servant or employee. We do not have to furnish these bonds. INSURED CONTRACT SUPPLEMENTARY PAYMENTS — COVERAGES A The following definition is added to SECTION V — AND B — INDEMNITEES AND ADDITIONAL IN- DEFINITIONS, Definition 9. "insured contract" par- SUREDS agraph f.: Paragraph 2.f.(1) (d) of SUPPLEMENTARY PAY- (4) That part of any contract or agree- MENTS — COVERAGES A AND B is replaced by ment that indemnifies any person the following: or organization for the indemnitee's (d) Cooperate with us with respect sole tort liability. to coordinating other applicable OTHER INSURANCE insurance and self-insured retention available to the in- The first paragraph of Other Insurance of SECTION demnitee; and IV — COMMERCIAL GENERAL LIABILITY CON- EMPLOYEES AS INSUREDS — HEALTH CARE DITIONS is replaced with the following: SERVICE If other valid and collectible insurance, or any self-in- Paragraph 2.a.(1) d. of SECTION II — WHO IS AN sured retention, is available to the insured for a loss INSURED is deleted, unless excluded by separate we cover under COVERAGE A or B of this Coverage endorsement. Part, our obligations are limited as follows: EXTENDED COVERAGE FOR NEWLY ACQUIRED METHOD OF SHARING ORGANIZATIONS The second paragraph of 4.c. Method of Sharing of Paragraph 3.a. of SECTION 11 — WHO IS AN IN- SECTION IV — COMMERCIAL GENERAL LIABIL- SURED is replaced by the following: ITY CONDITIONS is replaced with the following: a. Coverage under this provision is afforded If any of the other insurance does not permit contri- only until the end of the policy period. bution by equal shares or is subject to a self-insured retention, we will contribute by limits. Under this EXTENDED "PROPERTY DAMAGE" method, each insurer's share is based on the ratio of its applicable limit of insurance or self-insured re- Exclusion a. of SECTION I — COVERAGE A is tention or both combined to the total applicable limits amended to read: Page 4 of 5 of insurance of all insurers and the amount of any our right to collect additional premium or exercise our self-insured retention. right of cancellation or non-renewal. UNINTENTIONAL FAILURE TO DISCLOSE ALL LIBERALIZATION CLAUSE HAZARDS The following paragraph is added to SECTION IV — The following is added to Paragraph 6. Representa- COMMERCIAL GENERAL LIABILITY CONDI- tions of SECTION IV — COMMERCIAL GENERAL TIONS: LIABILITY CONDITIONS: 10. If a revision to this Coverage Part, which would If you unintentionally fail to disclose any hazards ex- provide more coverage with no additional isting at the inception date of your policy, we will not premium, becomes effective during the policy deny coverage under this Coverage Form because of period in the state shown in the Declarations, such failure. However, this provision does not affect your policy will automatically provide this addi- tional coverage on the effective date of the re- vision. CG B6 74 12 07 Page 5 of 5 This page has beenleft;blank intentionally.:. REPRINTEO FROM THE FORMS UBRARY.... 01 C115980445 COMMERCIAL AUTO CA 71 10 03 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. EXTENDED CANCELLATION CONDITION BLANKET ADDITIONAL INSURED Paragraph 2.b. of the CANCELLATION Common SECTION II — LIABILITY COVERAGE — A.1. WHO Policy Condition is replaced by the following: IS AN INSURED provision is amended by the addition of the following: b. 60 days before the effective date of cancellation if we cancel for any other reason. e. Any person or organization for whom you are re- quired by an 'insured contract" to provide insur- TEMPORARY SUBSTITUTE AUTO — PHYSICAL ance is an insured", subject to the following DAMAGE COVERAGE additional provisions: Under paragraph C. — CERTAIN TRAILERS, MO- (1) The "insured contract" must be in effect BILE EQUIPMENT AND TEMPORARY SUBSTITUTE during the policy period shown in the Decla- AUTOS of SECTION 1 — COVERED AUTOS, the rations,and must have been executed prior following is added: to the bodily injury or "property damage". (2) This person or organization is an Insured" If Physical Damage coverage is provided by this Cov- only to the extent you are liable due to your erage Form, then you have coverage for: ongoing operations for that insured, whether the work is performed by you or for you, and Any "auto" you do not own while used with the per- only to the extent you are held liable for an mission of its owner as a temporary substitute for a "accident" occurring while a covered "auto" covered "auto" you own that is out of service be- is being driven by you or one of your em- cause of its breakdown, repair, servicing, `loss" or ployees. destruction. (3) There is no coverage provided to this person BROAD FORM NAMED INSURED or organization for "bodily injury" to its em- ployees, nor for "property damage" to its property. SECTION II — LIABILITY COVERAGE — A.I. WHO IS AN INSURED provision is amended by the addition (4) Coverage for this person or organization of the following: shall be limited to the extent of your negli- gence or fault according to the applicable d. Any business entity newly acquired or formed by principles of comparative negligence or fault. you during the policy period provided you own (5) The defense of any claim or "suit" must be 50% or more of the business entity and the tendered by this person or organization as business entity is not separately insured for soon as practicable to all other insurers Business Auto Coverage. Coverage is extended up to a maximum of 180 days following acquisi- which potentially provide insurance for such tion or formation of the business entity. Coverage claim or "suit". under this provision is afforded only until the end of the policy period. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services Office, Inc., 1997 CA 71 10 03 07 Page 1 of 6 EP ""REPRINTED FROM THE FORMS LIBRARY"" (6) The coverage provided will not exceed the PERSONAL EFFECTS COVERAGE lesser of: A. SECTION III — PHYSICAL DAMAGE COVER- (a) The coverage and/or limits of this policy; AGE, A.4. COVERAGE EXTENSIONS, is or amended by adding the following: (b) The coverage and/or limits required by c. Personal Effects Coverage the "insured contract". For any Owned "auto" that is involved in a (7) A person's or organization's status as an covered "loss", we will pay up to $500 for "insured" under this subparagraph d ends "personal effects" that are lost or damaged when your operations for that "insured" are as a result of the covered "loss", without completed. applying a deductible. EMPLOYEE AS INSURED EXTRA EXPENSE — BROADENED COVERAGE Under Paragraph A. of Section II — LIABILITY COV- Paragraph A. — COVERAGE of SECTION III — ERAGE item f, is added as follows: PHYSICAL DAMAGE COVERAGE is amended to add: Your "employee" while using his owned "auto", or an "auto" owned by a member of his or her household, 5. We will pay for the expense of returning a stolen in your business or your personal affairs, provided you covered "auto" to you. do not own, hire or borrow that "auto". This coverage is excess to any other collectible insurance coverage. AIRBAG COVERAGE FELLOW EMPLOYEE COVERAGE Under paragraph B. — EXCLUSIONS of SECTION III — PHYSICAL DAMAGE COVERAGE, the following is Exclusion 5. FELLOW EMPLOYEE of SECTION II — added: LIABILITY COVERAGE — B. EXCLUSIONS is amended by the addition of the following: The exclusion relating to mechanical breakdown does not apply to the accidental discharge of an airbag. However, this exclusion does not apply if the "bodily injury" results from the use of a covered "auto" you NEW VEHICLE REPLACEMENT COST own or hire, and provided that any coverage under this provision only applies in excess over any other Under Paragraph C — LIMIT OF INSURANCE of collectible insurance. Section III — PHYSICAL DAMAGE COVERAGE sec- tion 2 is amended as follows: BLANKET WAIVER OF SUBROGATION 2. An adjustment for depreciation and physical con- We waive the right of recovery we may have for pay- dition will be made in determining actual cash ments made for "bodily injury" or "property damage" value in the event of a total loss. However, in the on behalf of the persons or organizations added as event of a total loss to your "new vehicle" to "insureds" under Section II — LIABILITY COVERAGE which this coverage applies, as shown in the — A.1.D. BROAD FORM NAMED INSURED and declarations, we will pay at your option: A.1.e. BLANKET ADDITIONAL INSURED. a. The verifiable "new vehicle" purchase price you paid for your damaged vehicle, not in- PHYSICAL DAMAGE — ADDITIONAL TRANS- cluding any insurance or warranties pur- PORTATION EXPENSE COVERAGE chased; The first sentence of paragraph A.4. of SECTION III b. The purchase price, as negotiated by us, of — PHYSICAL DAMAGE COVERAGE is amended as a new vehicle of the same make, model and follows: equipment, not including any furnishings, parts or equipment not installed by the We will pay up to $50 per day to a maximum of manufacturer or manufacturer's dealership. $1,500 for temporary transportation expense incurred If the same model is not available pay the by you because of the total theft of a covered "auto" purchase price of the most similar model of the private passenger type. available; Page 2 of 6 REPRINTED FROM THE FORMS LIBRARY'"' c. The market value of your damaged vehicle, a. Actual cash value of the damaged or stolen not including any furnishings, parts or equip- property as of the time of the "loss", less an ment not installed by the manufacturer or adjustment for depreciation and physical manufacturer's dealership. condition; or This coverage applies only to a covered "auto" b. Balance due under the terms of the loan or of the private passenger, light truck or medium lease that the damaged covered "auto" is truck type (20,000 Ibs or less gross vehicle subject to at the time of the "loss", less any weight) and does not apply to initiation or set up one or all of the following adjustments: costs associated with loans or leases. (1) Overdue payment and financial TWO OR MORE DEDUCTIBLES penalties associated with those payments as of the date of the Under SECTION III — PHYSICAL DAMAGE COV- "loss". ERAGE, if two or more "company" policies or cover- (2) Financial penalties imposed under a age forms apply to the same accident, the following lease due to high mileage, exces- applies to paragraph D. Deductible: sive use or abnormal wear and tear. a. If the applicable Business Auto deduct- (3) Costs for extended warranties, Cre- ible is the smaller (or smallest) deduct- dit Life Insurance, Health, Accident ible it will be waived; or or Disability Insurance purchased b. If the applicable Business Auto deduct- with the loan or lease. ible is not the smaller (or smallest) de- (4) Transfer or rollover balances from ductible it will be reduced by the amount previous loans or leases. of the smaller (or smallest) deductible; (5) Final payment due under a "Balloon or Loan". c. If the loss involves two or more Busi- (6) The dollar amount of any ness Auto coverage forms or policies un-repaired damage that occurred the smaller (or smallest) deductible will prior to the "total loss" of a covered be waived. "auto". For the purpose of this endorsement "company" means: (7) Security deposits not refunded by a lessor. a. Safeco Insurance Company of America (8) All refunds payable or paid to you b. American States Insurance Company as a result of the early termination c. General Insurance Company of America of a lease agreement or any war- ranty or extended service agree- d. American Economy Insurance Company ment on a covered "auto". e. First National Insurance Company of (9) Any amount representing taxes. America (10) Loan or lease termination fees f. American States Insurance Company of Texas GLASS REPAIR — WAIVER OF DEDUCTIBLE g. American States Preferred Insurance Under paragraph D. — DEDUCTIBLE of SECTION III Company — PHYSICAL DAMAGE COVERAGE, the following is h. Safeco Insurance Company of Illinois added: LOAN/LEASE GAP COVERAGE No deductible applies to glass damage if the glass is repaired rather than replaced. Under paragraph C — LIMIT OF INSURANCE of SECTION III — PHYSICAL DAMAGE COVERAGE, AMENDED DUTIES IN THE EVENT OF ACCI- the following is added: DENT, CLAIM, SUIT OR LOSS 4. The most we will pay for a total "loss" in any one The requirement in LOSS CONDITION 2.a. — "accident" is the greater of the following, subject DUTIES IN THE EVENT OF ACCIDENT, CLAIM, to a$1,500 maximum limit: SUIT OR LOSS — of SECTION IV — BUSINESS AUTO CONDITIONS that you must notify us of an CA 71 10 03 07 Page 3 of 6 EP "*REPRINTED FROM THE FORMS LIBRARY.... "accident" applies only when the "accident" is known deductible and excess provisions, we will provide to: coverage equal to the broadest coverage applicable to any covered "auto" you own. (1) You, if you are an individual; (2) A partner, if you are a partnership; or HIRED AUTO PHYSICAL DAMAGE COVERAGE — LOSS OF USE (3) An executive officer or insurance manager, if you are a corporation. SECTION III — PHYSICAL DAMAGE AA.b. Form does not apply. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Subject to a maximum of $1,000 per accident, we will cover loss of use of a hired "auto" if it results from SECTION IV — BUSINESS AUTO CONDITIONS — an accident, you are legally liable and the lessor in- 6.2. is amended by the addition of the following: curs an actual financial loss. If you unintentionally fail to disclose any hazards ex- RENTAL REIMBURSEMENT COVERAGE isting at the inception date of your policy, we will not A. We will pay for rental reimbursement expenses deny coverage under this Coverage Form because of incurred by you for the rental of an "auto" be- such failure. However, this provision does not affect cause of a covered "loss" to a covered "auto". our right to collect additional premium or exercise our Payment applies in addition to the otherwise ap- right of cancellation or non-renewal. plicable amount of each coverage you have on a HIRED AUTO — LIMITED WORLD WIDE COVER- covered "auto". No deductibles apply to this AGE coverage. B. We will pay only for those expenses incurred Under Section IV — Business Conditions, Paragraph during the policy period beginning 24 hours after B.7.b.e(1) is replaced by the following: the "loss" and ending, regardless of the policy's (1) The "accident" or "loss" results expiration, with the lesser of the following number from the use of an "auto" hired for of days: 30 days or less. 1. The number of days reasonably required to repair or replace the covered "auto". If RESULTANT MENTAL ANGUISH COVERAGE "loss" is caused by theft, this number of days is added to the number of days it takes SECTION V — DEFINITIONS — C. is replaced by the to locate the covered "auto" and return it to following: you. "Bodily injury" means bodily injury, sickness or dis- 2• 30 days. ease sustained by a person including mental anguish C. Our payment is limited to the lesser of the fol- or death resulting from any of these. lowing amounts: HIRED AUTO PHYSICAL DAMAGE COVERAGE 1. Necessary and actual expenses incurred. If hired "autos" are covered "autos" for Liability cov- 2• $50 per day. erage and if Comprehensive, Specified Causes of D. This coverage does not apply while there are Loss or Collision coverages are provided under this spare or reserve "autos" availableto you for your Coverage Form for any "auto" you own, then the operations. Physical Damage Coverages provided are extended to "autos" you hire or borrow. E. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay The most we will pay for loss to any hired "auto" is under this coverage only that amount of your $50,000 or Actual Cash Value or Cost of Repair, rental reimbursement expenses which is not al- whichever is smallest, minus a deductible. The de- ready provided for under the PHYSICAL DAM- ductible will be equal to the largest deductible appli- AGE COVERAGE Coverage Extension. cable to any owned "auto" of the private passenger or light truck type for that coverage. Hired Auto Phy- F. The Rental Reimbursement Coverage described sical Damage coverage is excess over any other col- above does not apply to a covered "auto" that is lectible insurance. Subject to the above limit, described or designated as a covered "auto" on Page 4 of 6 •'REPRINTED FROM THE FORMS LIBRARY"•• Rental Reimbursement Coverage Form the manufacturer for the installation of a CA 99 23. radio. AUDIO, VISUAL AND DATA ELECTRONIC C. Limit of Insurance EQUIPMENT COVERAGE With respect to this coverage, the LIMIT OF IN- A. Coverage SURANCE provision of PHYSICAL DAMAGE COVERAGE is replaced by the following: 1. We will pay with respect to a covered "auto" 1. The most we will pay for "loss" to audio, vi- for "loss" to any electronic equipment that sual or data electronic equipment and any receives or transmits audio, visual or data accessories used with this equipment as a signals and that is not designed solely for the result of any one "accident" is the lesser of: reproduction of sound.This coverage applies only if the equipment is permanently installed a. The actual cash value of the damaged in the covered "auto" at the time of the or stolen property as of the time of the "loss" or the equipment is removable from a "loss"; or housing unit which is permanently installed b. The cost of repairing or replacing the in the covered "auto" at the time of the damaged or stolen property with other "loss", and such equipment is designed to property of like kind and quality. be solely operated by use of the power from the "auto's" electrical system, in or upon the c. $1,000. covered "auto". 2. An adjustment for depreciation and physical 2. We will pay with respect to a covered "auto" condition will be made in determining actual for "loss" to any accessories used with the cash value at the time of the "loss". electronic equipment described in paragraph 3. If a repair or replacement results in better A.I. above. than like kind or quality, we will not pay for However, this .does not include tapes, the amount of the betterment. records or discs. D. Deductible 3. If Audio, Visual and Data Electronic Equip- ment Coverage form CA 99 60 or CA 99 94 1. If loss" to the audio, visual or data elec- is attached to this policy, then the Audio, Vi- tronic equipment or accessories used with sual and Data Electronic Equipment Cover- this equipment is the result of a "loss"to the age described above does not apply. covered "auto" under the Business Auto Coverage Form's Comprehensive or Colli- B. Exclusions sion Coverage, then for each covered "auto" The exclusions that apply to PHYSICAL DAM- our obligation to pay for, repair, return or re- AGE COVERAGE, except for the exclusion relat- place damaged or stolen property will be re- ing to Audio, Visual and Data Electronic duced by the applicable deductible shown in Equipment, also apply to this coverage. In addi- the Declarations. Any Comprehensive Cov- tion, the following exclusions apply: erage deductible shown in the Declarations does not apply to "loss" to audio, visual or We will not pay for either any electronic equip- data electronic equipment caused by fire or ment or accessories used with such electronic lightning. equipment that is: 2. If "loss" to the audio, visual or data elec- t. Necessary for the normal operation of the tronic equipment or accessories used with covered "auto" for the monitoring of the this equipment is the result of a loss" to the covered "auto's" operating system; or covered "auto" under the Business Auto 2. Both: Coverage Form's Specified Causes of Loss Coverage, then for each covered "auto" our a. an integral part of the same unit housing obligation to pay for, repair, return or replace any sound reproducing equipment de- damaged or stolen property will be reduced signed solely for the reproduction of by a$100 deductible. sound if the sound reproducing 3. If "loss" occurs solely to the audio,visual or equipment is permanently installed in data electronic equipment or accessories the covered "auto"; and used with this equipment, then for each cov- b. permanently installed in the opening of ered "auto" our obligation to pay for, repair, the dash or console normally used by CA 71 10 03 07 Page 5 of 6 EP .'.'REPRINTED FROM THE FORMS LIBRARY"" return or replace damaged or stolen property SECTION V — DEFINITIONS is amended by adding will be reduced by a$100 deductible. the following: 4. In the event that there is more than one ap- Q. "Personal effects" means your tangible plicable deductible, only the highest deduct- property that is worn or carried by you, ex- ible will apply. In no event will more than one cept for tools, jewelry, money, or securities. deductible apply. R. "New vehicle" means any "auto" of which you are the original owner and the "auto" has not been previously titled and is less than 365 days past the purchase date. Page 6 of 6 -'REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS "" t Libe 'Mutual. COMMERCIAL GENERAL LIABILITY INSURANCE CG 25 03 05 09 POLICY NUMBER: 01 C13857477 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally Construction Project General Aggregate obligated to pay as damages caused by Limit for that designated construction project. "occurrences" under Section 1 — Coverage A, Such payments shall not reduce the General and for all medical expenses caused by acci- Aggregate Limit shown in the Declarations dents under Section I — Coverage C, which can nor shall they reduce any other Designated be attributed only to ongoing operations at a sin- Construction Project General Aggregate gle designated construction project shown in the Limit for any other designated construction Schedule above: project shown in the Schedule above. 1. A separate Designated Construction Project 4. The limits shown in the Declarations for General Aggregate Limit applies to each Each Occurrence, Damage To Premises designated construction project, and that Rented To You and Medical Expense con- limit is equal to the amount of the General tinue to apply. However, instead of being Aggregate Limit shown in the Declarations. subject to the General Aggregate Limit 2. The Designated Construction Project Gen- shown in the Declarations, such limits will be eral Aggregate Limit is the most we will pay subject to the applicable Designated Con- for the sum of all damages under Coverage struction Project General Aggregate Limit. A, except damages because of "bodily B. For all sums which the insured becomes legally injury" or "property damage" included in the obligated to pay as damages caused by "products-completed operations hazard", "occurrences" under Section I — Coverage A and for medical expenses under Coverage and for all medical expenses caused by acci- C regardless of the number of: dents under Section I — Coverage C, which a. Insureds; cannot be attributed only to ongoing operations at a single designated construction project shown b. Claims made or "suits" brought; or in the Schedule above: c. Persons or organizations making claims 1. Any payments made under Coverage A for or bringing "suits". damages or under Coverage C for medical 3. Any payments made under Coverage A for expenses shall reduce the amount available damages or under Coverage C for medical under the General Aggregate Limit or the expenses shall reduce the Designated Products-completed Operations Aggregate Limit, whichever is applicable; and © Insurance Services Office, Inc., 2008 CIS 25 03 05 09 Page 1 of 2 EP AFP-META2-03•PRINT001.0624-0095-Y —*REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS "" - 2. Such payments shall not reduce any Desig- Aggregate Limit nor the Designated Construction nated Construction Project General Aggre- Project General Aggregate Limit. gate Limit. D. If the applicable designated construction project C. When coverage for liability arising out of the has been abandoned,delayed,or abandoned and "products-completed operations hazard" is pro- then restarted, or if the authorized contracting vided, any payments for damages because of parties deviate from plans, blueprints, designs, "bodily injury" or "propery damage" included in specifications or timetables, the project will still the "products-completed operations hazard" will be deemed to be the same construction project. reduce the Products-completed Operations Aggregate Limit, and not reduce the General E. The provisions of Section III — Limits of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 AFP•M ETA2-03-P RINT001•D624-D096-Y