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HomeMy WebLinkAboutL11-082 - Amendment - #5 - Aquatic Management Group, Inc. - Kent Pool Sub-Lease Agreement - 05/25/2015 CITY CLERK KENT CITY OF KENT Wns",N G 10N 220 4" Avenue South Kent, WA 98032 Fax: 253-856-6725 PHONE: 253-856-5725 Lease Agreement Cover Sheet This document is to be used in lieu of the Contract Over Sheet SECTION 1 - CONTRACT PROCESSING AND TENANT SET-UP: Contract Number. ._ 6 0! 1. Responsible Department/Division: Parks, and Recreation Dept Admin 2. Contact Person and Title: Phung Huynh, Accountant Telephone Extension: 510�2 3. Tenant (Customer) Name- Aquatic Management Group Inc. 4. Tenant (Customer) Number: 160465 5. General Ledger Account Number: 10006221.56250 6. King County Tax Parcel Number: 20�2205-9066 7. Address of Parcel: 25316 101't Ave SE Kent, WA 8. Type of Lease: Sub-Lease (Operating Agreement) Addendum No., 5 9. Council Authorization Date: 5/11/2011 10. Mayor Signature Date: 5/27/2011 SECTION 2 - LEASE DURATION AND IMPORTANT DATES: 11. Lease Start Date: 5/26/2015 with annual Amendments 12. Tenant Lease Option Renewal Notification Due Date: Annual 13. Lease Termination Date: 5/25/2016 14. Lease Duration: Annual SECTION 3 - RENT DETERMINATION AND DUE DATE: 15. Rent: 1.00/year at Fair Market Value per 5/13/11 Appraisal 16. Rent Due Date: Annual 17. Calculation of Rental Increase(s): N/A Lease Agreement Over Sheet—Page 1 of 2 SECTION 4 - LEASEHOLD EXCISE TAX: 18. Is this lease subject to leasehold excise taxes? ® YES (go to Question 19) ❑ NO, reason: 19. Are leasehold excise taxes for this tenant centrally assessed, i.e. directly collected from the tenant by the Washington State Department of Revenue? ❑ YES (attach written verification received directly from DOR or indirectly through the tenant, e.g. DOR notification letter) ® NO (go to Question 20) 20. Does Lease Rent include Leasehold Excise Tax? (Leasehold taxes must be broken out on the invoice and coded: Business unit.32500.0303) ❑ YES Calculate the leasehold excise tax (Stated Rent divided by 1.1284) ® NO Calculate the leasehold excise tax (Stated Rent times .1284) SECTION 5 - APPLICABLITY OF UTILITIES: 21. Applicability of Utilities - Check all that utilities that are affected and indicate provider (e.g. City of Kent), Account Number or basis of exclusion. ® Does Not Apply ❑ Water: ❑ Sewer: ❑ Drainage: ❑ Garbage: ❑ Electricity/Natural Gas: SECTION 6 - MONETARY PENALTIES AND LATE INTEREST CHARGES: 22. Monetary Penalties: N/A 23. Late Interest: N/A SECTION 7 - OTHER LEASE CONSIDERATIONS: Special lease considerations, e.g. non-monetary rent, etc ® None (check box if no considerations) Lease Agreement Cover Sheet—Page 2 of 2 KENT W.5HI 0G 0. AMENDMENT NO. Five to 2011 Kent Pool Sub Lease Agreement NAME OF CONSULTANT OR VENDOR: Aquatic Management Group (AMG) CONTRACT NAME & PROJECT NUMBER: Kent Pool ORIGINAL AGREEMENT DATE: May 26, 2011 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: As set in the terms of the agreement dated March 26, 2011, the current sublease agreement with AMG is schedueld to expire on May 25, 2012. This Change Order will extend the agreement to May 25, 2013. 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, $$95,000.00 including applicable WSST Net Change by Previous Amendments $-0- including applicable WSST Current Contract Amount $95,000.00 including all previous amendments Current Amendment Sum $-0- Applicable WSST Tax on this $-0- Amendment Revised Contract Sum $95,000.00 AMENDMENT - 1 OF 2 .......... Original Time for Completion 5/25/2015 (insert date) Revised Time for Completion under n/a prior Amendments (insert date) Add`) Days Required for this 365 calendar days Amendment Revised Time for Completion 5/25/2016 (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 dame written below. CONSULTANT/VENDOR: CITY OF KENT. By: By: Print Name: Pri ��iLnature)(signature) � a e Its tom' ~°,'- Its w (title) (title) DATE: '" DATE: l 'C APPROVED AS TO FORM: (applicable if Mayor's signature required) Kent Law Department Kent Pool Sub Lease Agreement"mime Extension AMENDMENT - 2 OF 2 A�oRo® CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DDlYYYY) 4/7/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER CONTACT NAME: HUB International Northwest, LLC PHONE 425-489-4500 FAX 425-485-8489 12100 NE 195th Street, Suite 200 ° Bothell WA 98011 E'M aes ,now.info@hubinternational.com INSURERS AFFORDING COVERAGE NAIC 0 INSURER A:Great American Insurance Company 16691 INSURED AMG-001 INSURER B:Great American Assurance Company 26344 Aquatic Mgmt Group Inc. INSURER C: PO Box 129 INSURER D: Kent WA 98035-0129 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:636855680 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TYPE OF INSURANCE POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MMlDD/YWY MMIDDIYYYY LIMITS A X I COMMERCIAL GENERAL LIABILITY MAC0686137 /15/2015 I /15/2016 EACH OCCURRENCE S1,000,000 DAMAGE TO -D CLAIMS-MADE T OCCUR PREMISES(EaE occurrence) $300.000 MED EXP(Any one person) $10,000 PERSONAL BADVINJURY _$1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY❑PRO ❑ JECT LOC PRODUCTS-COMPIOP AGO $3,000,000 OTHER: COMBINED SINU1Erf9IT_ $ A AUTOMOBILE LIABILITY MAC0686137 /15/2015 /15/2016 Ea accident $1,000,000 ANY AUTO BODILY INJURY(Per person) S AUTOS�ED SCHEDULED AUTOS BODILY INJURY(Per accident) S NON-OWNED PROPERTY DAMAGE S Ix HIREDAUTOS N AUTOS Per accident 5 B X UMBRELLA LIAB X OCCUR UMS0686138 /15/2015 /15/2016 EACH OCCURRENCE $4.000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED I I RETENTION$ $ A WORKERS COMPENSATION MAC0686137 /15/2015 /15/2016 STATUTE FI x ERH WA Stop Gap AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVEa NIA E.L.EACH ACCIDENT S1,000,000 OFFICERIMEMBER EXCLUDED' (M yyandatory in NH) E-I I.DISEASE-EA EMPLOYE $1,000,000 if es.describe under DESCRIPT ON OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER IS AN ADDITIONAL INSURED PER CG8224 12/01. 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. 220 4th Ave South Kent WA 98032 AUTHORIZED REPRESENTATIVE I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Administrative Offices GREAT 301E nth Street CG 82 24 AMF.RICAN. Cincinnati OH 45202-4201 INSURANCE GROUP 513 369 5000 ph (Ed. 12 01) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SOCIAL SERVICE AGENCY GENERAL LIABILITY BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following provision is added to SECTION (2) With respect to the insurance af- II - WHO IS AN INSURED forded the Additional Insured identified in Paragraph A.(1) of 5. AUTOMATIC ADDITIONAL INSURED(S) this endorsement, the following additional provisions apply: a. Additional Insured - Manager or Lessor of Premises (a) This insurance applies only to liability arising out of the (1) This policy is amended to include ownership, maintenance or as an insured any person or or- use of that portion of the ganization (hereinafter called Ad- premises leased to you. ditional Insured) from whom you lease or rent property and which (b) The Limits of Insurance ap- requires you to add such person plicable to the Additional In- or organization as an Additional sured are the lesser of those Insured on this policy under: specified in the written con- tract or agreement or in the (a) a written contract; or Declarations for this policy and subject to all the terms, (b) an oral agreement or con- conditions, and exclusions tract where a Certificate of for this policy. The Limits of Insurance showing that per- Insurance applicable to the son or organization as an Additional Insured are inclu- Additional Insured has been sive of and not in addition to issued; the Limits of Insurance shown in the Declarations. but the written or oral contract or agreement must be an "insured (c) In no event shall the cov- contract," and, erages or Limits of Insurance in this Coverage Form be in- currently in effect or be- creased by such contract. come effective during the term of this policy; and (d) Coverage provided herein is excess over any other valid (ii) executed prior to the "bodily and collectible insurance injury," "property damage," available to the Additional I n- "personal and advertising in- sured whether the other in- jury." surance is primary, excess, Includes copyrighted material of Insurance Service Office with its permission. Copyright, Insurance Services Office, Inc., 2001 CG 82 24 (Ed. 12101 ) XS (Page 1 of 4) contingent or on any other tomarily provided by the basis unless a written con- policy forms specified in and tractual arrangement specifi- required by the contract. cally requires this insurance to be primary. (c) In no event shall the cov- erages of Limits of Insurance (3) This insurance does not apply to: in this Coverage Form be in- creased by such contract. (a) Any "occurrence" or offense which takes place after you c. Additional Insured - Contractual cease to be a tenant in that Obligations premises. (1) This policy is amended to include (b) Structural alterations, new as an Insured any person or or- construction or demolition ganization (hereinafter called Ad- operations performed by or ditional Insured) that you are re- on behalf of the "Additional quired by a written "insured con- Insured." tract" to include as an Insured, b. Additional Insured - Funding subject to all of the following provisions: Sources (1) This policy is amended to include (a) Coverage is limited to liability as an Insured any Funding Source arising out of: which requires you in a written (i) your ongoing oper- contract to name the Funding ations performed for Source (hereinafter called Addi- such Additional Insured; tional Insured) as an Insured but or only with respect to liability aris- ing out of your premises, "your (II) that Insured(s financial work" for such Additional Insured, control of you; or or acts or omissions of such Ad- ditional Insured in connection with (iii) the maintenance, opera- the general supervision of "your tion or use by you of work" and only to the extent set equipment leased to forth as follows: you by such Additional Insured; or (a) The Limits of Insurance ap- plicable to the Additional In- (iv) a state or political sub- sured are the lesser of those division permit issued specified in the written con- to you. tract or agreement or in the Declarations for this policy (b) Coverage does not apply to and subject to all the terms, any "occurrence" or offense: conditions, and exclusions for this policy. The Limits of (i) which took place be- Insurance applicable to the fore the execution of, Additional Insured are inclu- or subsequent to the sive of and not in addition to completion or expira- the Limits of Insurance tion of, the written "in- shown in the Declarations. sured contract", or (b) The coverage provided to (ii) which takes place after the Additional Insured(s) is you cease to be a ten- not greater than that cus- ant in that premises. Includes copyrighted material of Insurance Service Office with its permission. Copyright, Insurance Services Office, Inc., 2001 CG 82 24 (Ed. 12101 ) XS (Page 2 of 4) (c) With respect to architects, work" done under a contract for that engineers, or surveyors, person or organization and included in coverage does not apply to the "products-completed operations "Bodily Injury," "Property hazard." Damage," "Personal and Ad- vertising Injury" arising out 3. NON-OWNED OR CHARTERED WATER- of the rendering or the fail- CRAFT ure to render any profes- sional services by or for you Section I - Coverages, Coverage A, Item including: 2.g.(2) is replaced with: (i) the preparing, approv- (2) A watercraft you do not own that is: ing, or failing to pre- pare or approve maps, (a) less than 51 feet long; and drawings, opinions, re- ports, surveys, change (b) not being used to carry persons or orders, designs or property for a charge, specifications; and 4. BROADENED PERSONAL AND ADVERTISING (ii) supervisory, inspection, INJURY or engineering services. Unless "Personal and Advertising Injury" is ex- If an Additional Insured endorsement is at- cluded from this policy: tached to this policy and specifically names a person or organization as an Insured, then the SECTION V - DEFINITIONS Item 14. is re- coverage in Section II - WHO IS AN placed by: INSURED 5. Automatic Additional Insured(s) does not apply to that person or organization. 14. "Personal and Advertising Injury" means injury, including consequential bodily in- 2. BLANKET WAIVER OF SUBROGATION jury," arising out of one or more of the following offenses: SECTION IV - COMMERCIAL GENERAL a. false arrest, detention or imprison- LIABILITY CONDITIONS, Item 8. is replaced ment; with: b. malicious prosecution; 8. Transfer of Rights of Recovery Against Others to us and Blanket Waiver of c. the wrongful eviction from, wrongful Subrogation entry into, or invasion of the right of private occupancy of a room, dwelling a. If an Insured has rights to recover all or premises that a person occupies by or part of any payment we have made or on behalf of its owner, landlord or under this Coverage Part, those rights lessor; are transferred to us. The Insured must do nothing after loss to impair them. d. oral, written, televised, videotaped, or At our request, the Insured will bring electronic publication of material, in "suit" or transfer those rights to us and any manner, that slanders or libels a help us enforce them. person or organization or disparages a person's or organization's goods, pro- b. If required by a written "insured con- ducts or services; tract", we waive any right of recovery we may have against any person or e. oral, written, televised, videotaped, or organization because of payments we electronic publication of material, in make for injury or damage arising out any manner, that violates a person's of your ongoing operations or "your right of privacy; or Includes copyrighted material of Insurance Service Office with its permission. Copyright, Insurance Services Office, Inc_, 2001 CG 82 24 (Ed. 12101) XS (Page 3 of 4) f. mental injury, mental anguish, humili- Subject to 5. above, the Damage to Prem- ation, or shock, if directly resulting ises Rented to You Limit is the most we from Items 14.a. through 14.e. will pay under Coverage A for damages because of "property damage" to your g. the use of another's advertising idea in building, or to personal property of others your "advertisement"; or in your care, custody and control while at premises rented to you or temporarily h. infringing upon another's copyright, occupied by you with permission of the trade dress or slogan in your "adver- owner, arising out of any one fire. tisement." The Damage to Premises Rented To You 5. MENTAL INJURY, MENTAL ANGUISH, Limit is replaced by the following Damage HUMILIATION, OR SHOCK INCLUDED IN to Premises Rented To You Limit. BODILY INJURY DEFINITION The Damage to Premises Rented To You Section V - Definitions, Item 3. is replaced Limit is the greater of: with: (1) $300,000; or 3. "Bodily injury" means physical injury, sick- ness, or disease, including death of a per- (2) the amount shown in the Declarations son. "Bodily injury" also means mental in- for Damage to Premises Rented to jury, mental anguish, humiliation, or shock You Limit. if directly resulting from physical injury, sickness, or disease to that person. B. This provision is subject to all the terms of SECTION III - LIMITS OF INSURANCE. 6. MEDICAL PAYMENTS C. This provision 5. does not apply if Damage A. The Medical Expense Limit in Paragraph 7. to Premises Rent to You Liability of COV- of SECTION III - LIMITS OF INSURANCE ERAGE A (SECTION 1) is excluded either is replaced by the following Medical Ex- by the provisions of the Coverage Part or pense Limit. by endorsement. The Medical Expense Limit provided by 8. SUPPLEMENTARY PAYMENTS this policy shall be the greater of: A. In the SUPPLEMENTARY PAYMENTS - a. $10,000; or COVERAGES A and B provision, Item 1.b., and 1.d are replaced with: b. The amount shown in the Declarations 1.b. Up to $500 for cost of bail bonds for Medical Expense Limit. required because of accidents or traf- B. This provision 7. is subject to all the terms fic law violations arising out of the use of SECTION III - LIMITS OF INSURANCE. of any vehicle to which the Bodily In- jury Liability Coverage applies. We do not have to furnish these bonds. C. This provision 7. does not apply if COVERAGE C. MEDICAL PAYMENTS is 1.d. All reasonable expenses incurred by excluded either by the provisions of the the Insured at our request to assist us Coverage Part or by endorsement. in the investigation or defense of the claim or "suit," including actual loss of 7. DAMAGE TO PREMISES RENTED TO YOU earnings up to S500 a day because of LIMIT time off work. A. SECTION III - LIMITS OF INSURANCE, This endorsement does not change any other Item 6. is replaced with: provision of the policy. Includes copyrighted material of Insurance Service Office with its permission. Copyright, Insurance Services Office, Inc., 2001 CG 82 24 (Ed. 12101) XS (Page 4 of 4) DATE(MMIDDIYYYY) ACoRD® CERTIFICATE OF LIABILITY INSURANCE 4/7/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(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 endorsements. PRODUCER CONTACT NAME: HUB International Northwest, LLC PHONE FAx 12100 NE 195th Street, Suite 200 -(AIC.-No,Est) 425-489-4500 �Dl;425-485-8489 Bothell WA 98011 ADDRESS now.info@hubinternational.com INSURERS AFFORDING COVERAGE NAIC q INSURER A:Great American Insurance Company 16691 _ INSURED AMG-001 INSURER B:Great American Assurance Company 26344 Aquatic Mgmt Group Inc. INSURER C: _ PO Box 129 Kent WA 98035-0129 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:2101821311 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR J TYPE OF INSURANCEADDLSUBKI POLICY EFF POLICY EXP LTR INSO WVD POLICYNUMBER MMIDDIYYYY1 IMMIDDIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY MAC0686137 /15/2015 /15/2016 EACH OCCURRENCE S1,000,000 DA AGE To RENTED CLAIMS-MADE �X OCCUR PREMISES E.occurrence $300,000 MED EXP(Any one person) $10.000 PERSONAL S AOV INJURY $1,000.000 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S3,000,000 _ POLICY E PRO ❑LOC JECT PRODUCTS-COMPlOPAGG $3,000,000 OTHER: $ A AUTOMOBILE LIABILITY MAC0686137 /1512015 411512016 UMbINLU Ea accident) $1,000,000 ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) S X HIRED AUTOS AUTOS r AUTOSNON-OWNED Per accide"RTORnt) $ AUTOS S B X UMBRELLA LIAB X OCCUR UMB0686138 115/2015 /15/2016 EACH OCCURRENCE S4,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $4.000.000 DED RETENTION$ $ A WORKERS COMPENSATION MAC0686137 /15/2015 /15/2016 STATUTE XI ERH WA Stop Gap AND EMPLOYERS'LIABILITY IN ANY PROPRIETORIPARTNERIEXECUTIVE Y❑ NIA E.L.EACH ACCIDENT $1,000.000 OFFICEWMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $1,000.000 DESCRIPdesTtieunder ION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT I S1.000.000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER IS AN ADDITIONAL INSURED PER CG8224 12/01. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Des Moines Pool Metropolitan Park District ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 98711 Des Moines WA 98198 AUTHORIZED REPRESENTATIVE �a���� I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Administrative Offices GREAT E Street CG 82 24 AMF.RICf1N. Cincinnati O OH 45202-4201 INSURANCE GROUP 6133696000ph (Ed. 12 01) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SOCIAL SERVICE AGENCY GENERAL LIABILITY BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following provision is added to SECTION (2) With respect to the insurance af- II - WHO IS AN INSURED forded the Additional Insured identified in Paragraph A.(1) of 5. AUTOMATIC ADDITIONAL INSURED(S) this endorsement, the following additional provisions apply: a. Additional Insured - Manager or Lessor of Premises (a) This insurance applies only to liability arising out of the (1) This policy is amended to include ownership, maintenance or as an insured any person or or- use of that portion of the ganization (hereinafter called Ad- premises leased to you. ditional Insured) from whom you lease or rent property and which (b) The Limits of Insurance ap- requires you to add such person plicable to the Additional In- or organization as an Additional sured are the lesser of those Insured on this policy under: specified in the written con- tract or agreement or in the (a) a written contract; or Declarations for this policy and subject to all the terms, (b) an oral agreement or con- conditions, and exclusions tract where a Certificate of for this policy. The Limits of Insurance showing that per- Insurance applicable to the son or organization as an Additional Insured are inclu- Additional Insured has been sive of and not in addition to issued; the Limits of Insurance shown in the Declarations. but the written or oral contract or agreement must be an "insured (c) In no event shall the cov- contract," and, erages or Limits of Insurance in this Coverage Form be in- (i) currently in effect or be- creased by such contract. come effective during the term of this policy-, and (d) Coverage provided herein is excess over any other valid (ii) executed prior to the "bodily and collectible insurance injury," "property damage," available to the Additional I n- "personal and advertising in- sured whether the other in- jury." surance is primary, excess, Includes copyrighted material of Insurance Service Office with its permission. Copyright, Insurance Services Office, Inc., 2001 CG 82 24 (Ed. 12101 ) XS (Page 1 of 4) contingent or on any other tomarily provided by the basis unless a written con- policy forms specified in and tractual arrangement specifi- required by the contract. cally requires this insurance to be primary. (c) In no event shall the cov- erages of Limits of Insurance (3) This insurance does not apply to: in this Coverage Form be in- creased by such contract. (a) Any "occurrence" or offense which takes place after you c. Additional Insured - Contractual cease to be a tenant in that Obligations premises. (1) This policy is amended to include (b) Structural alterations, new as an Insured any person or or- construction or demolition ganization (hereinafter called Ad- operations performed by or ditional Insured) that you are re- on behalf of the "Additional quired by a written "insured con- Insured." tract" to include as an Insured, subject to all of the following b. Additional Insured - Funding provisions: Sources 1 This policy is amended to include (a) Coverage is limited to liability ( ) p y as an Insured any Funding Source arising out of: which requires you in a written (i) your ongoing oper- contract to name the Funding ations performed for Source (hereinafter called Addi- such Additional Insured; tional Insured) as an Insured but or only with respect to liability aris- ing out of your premises, "your (ii) that Insured's financial work" for such Additional Insured, control of you; or or acts or omissions of such Ad- ditional Insured in connection with (iii) the maintenance, opera- the general supervision of "your tion or use by you of work" and only to the extent set equipment leased to forth as follows: you by such Additional Insured; or (a) The Limits of Insurance ap- plicable to the Additional In- (iv) a state or political sub- sured are the lesser of those division permit issued specified in the written con- to you. tract or agreement or in the Declarations for this policy (b) Coverage does not apply to and subject to all the terms, any "occurrence" or offense: conditions, and exclusions for this policy. The Limits of (i) which took place be- Insurance applicable to the fore the execution of, Additional Insured are inclu- or subsequent to the sive of and not in addition to completion or expira- the Limits of Insurance tion of, the written "in- shown in the Declarations. sured contract", or (b) The coverage provided to (ii) which takes place after the Additional Insured(s) is you cease to be a ten- not greater than that cus- ant in that premises. Includes copyrighted material of Insurance Service Office with its permission. Copyright, Insurance Services Office, Inc., 2001 CG 82 24 (Ed. 12/01) XS (Page 2 of 4) (c) With respect to architects, work" done under a contract for that engineers, or surveyors, person or organization and included in coverage does not apply to the "products-completed operations "Bodily Injury," "Property hazard." Damage," "Personal and Ad- vertising Injury" arising out 3. NON-OWNED OR CHARTERED WATER- of the rendering or the fail- CRAFT ure to render any profes- sional services by or for you Section I - Coverages, Coverage A, Item including: 2.g.(2) is replaced with: (i) the preparing, approv- (2) A watercraft you do not own that is: ing, or failing to pre- pare or approve maps, (a) less than 51 feet long; and drawings, opinions, re- ports, surveys, change (b) not being used to carry persons or orders, designs or property for a charge. specifications; and 4. BROADENED PERSONAL AND ADVERTISING (ii) supervisory, inspection, INJURY or engineering services. Unless "Personal and Advertising Injury" is ex- If an Additional Insured endorsement is at- cluded from this policy: tached to this policy and specifically names a person or organization as an Insured, then the SECTION V - DEFINITIONS Item 14. is re- coverage in Section II - WHO IS AN placed by: INSURED 5. Automatic Additional Insured(s) 14. "Personal and Advertising Injury" means does not apply to that person or organization, injury, including consequential "bodily in- 2. BLANKET WAIVER OF SUBROGATION jury," arising out of one or more of the following offenses: SECTION IV - COMMERCIAL GENERAL a. false arrest, detention or imprison- LIABILITY CONDITIONS, Item 8. is replaced ment; with: b. malicious prosecution; 8. Transfer of Rights of Recovery Against Others to us and Blanket Waiver of c. the wrongful eviction from, wrongful Subrogation entry into, or invasion of the right of private occupancy of a room, dwelling a. If an Insured has rights to recover all or premises that a person occupies by or part of any payment we have made or on behalf of its owner, landlord or under this Coverage Part, those rights lessor; are transferred to us. The Insured must do nothing after loss to impair them. d. oral, written, televised, videotaped, or At our request, the Insured will bring electronic publication of material, in "suit" or transfer those rights to us and any manner, that slanders or libels a help us enforce them. person or organization or disparages a person's or organization's goods, pro- b. If required by a written "insured con- ducts or services; tract", we waive any right of recovery we may have against any person or e. oral, written, televised, videotaped, or organization because of payments we electronic publication of material, in make for injury or damage arising out any manner, that violates a person's of your ongoing operations or "your right of privacy; or Includes copyrighted material of Insurance Service Office with its permission. Copyright, Insurance Services Office, Inc_, 2001 CG 82 24 (Ed. 12101) XS (Page 3 of 4) f. mental injury, mental anguish, humili- Subject to 5. above, the Damage to Prem- ation, or shock, if directly resulting ises Rented to You Limit is the most we from Items 14.a. through 14.e. will pay under Coverage A for damages because of "property damage" to your g. the use of another's advertising idea in building, or to personal property of others your "advertisement"; or in your care, custody and control while at premises rented to you or temporarily h. infringing upon another's copyright, occupied by you with permission of the trade dress or slogan in your "adver- owner, arising out of any one fire. tisement." The Damage to Premises Rented To You 5. MENTAL INJURY, MENTAL ANGUISH, Limit is replaced by the following Damage HUMILIATION, OR SHOCK INCLUDED IN to Premises Rented To You Limit. BODILY INJURY DEFINITION The Damage to Premises Rented To You Section V - Definitions, Item 3. is replaced Limit is the greater of: with: (1) $300,000; or 3. "Bodily injury" means physical injury, sick- ness, or disease, including death of a per- (2) the amount shown in the Declarations son. "Bodily injury" also means mental in- for Damage to Premises Rented to jury, mental anguish, humiliation, or shock You Limit. if directly resulting from physical injury, sickness, or disease to that person. B. This provision is subject to all the terms of SECTION III - LIMITS OF INSURANCE. 6. MEDICAL PAYMENTS C. This provision 5. does not apply if Damage A. The Medical Expense Limit in Paragraph 7. to Premises Rent to You Liability of COV- of SECTION III - LIMITS OF INSURANCE ERAGE A (SECTION 1) is excluded either is replaced by the following Medical Ex- by the provisions of the Coverage Part or pense Limit. by endorsement. The Medical Expense Limit provided by 8. SUPPLEMENTARY PAYMENTS this policy shall be the greater of: A. In the SUPPLEMENTARY PAYMENTS - a. $10,000; or COVERAGES A and B provision, Item 1.1b., and 1.d are replaced with: b. The amount shown in the Declarations 1.1b. Up to $500 for cost of bail bonds for Medical Expense Limit. required because of accidents or traf- fic law violations arising out of the use B. This provision 7. is subject to all the terms of any vehicle to which the Bodily In- of SECTION III - LIMITS OF INSURANCE. jury Liability Coverage applies. We do not have to furnish these bonds. C. This provision 7. does not apply if COVERAGE C. MEDICAL PAYMENTS is 1.d. All reasonable expenses incurred by excluded either by the provisions of the the Insured at our request to assist us Coverage Part or by endorsement. in the investigation or defense of the claim or "suit," including actual loss of 7. DAMAGE TO PREMISES RENTED TO YOU earnings up to S500 a day because of LIMIT time off work. A. SECTION III - LIMITS OF INSURANCE, This endorsement does not change any other Item 6. is replaced with: provision of the policy. Includes copyrighted material of Insurance Service Office with its permission. Copyright, Insurance Services Office, Inc., 2001 CG 82 24 (Ed. 12101) XS (Page 4 of 4) A ® Y DATE(MMIDDIYYW) CERTIFICATE OF LIABILITY INSURANCE 4/7/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT NAME: _ HUB International Northwest, LLC PHONE 425 FAX 425-485-8489 12100 NE 195th Street, Suite 200 AtC,No.-EXt) -489-4500 N°1. E-MAIL Bothell WA 98011 I Ss.now.info@hubinternational,com INSURER(S)AFFORDING COVERAGE _ NAIC 0 _ INSURERA:GreatAmerican Insurance Company 16691 INSURED AMG-001 INSURERS:Great American Assurance Company 26344 Aquatic Mgmt Group Inc. INSURER C: PO Box 129 INSURER D: Kent WA 98035-0129 -- - --- INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1340799103 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 WTH 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. IN RI TYPE OF INSURANCE POLICY EFF POLICY EXP LTR IN SD WVD POLICY NUMBER MMIDDIYYYY) IMMIDDIYYYYI LIMITS A j( I COMMERCIAL GENERAL LIABILITY MAC0686137 /15/2015 /15/2016 EACH OCCURRENCE $1,000,000 DAMAGE_7CLAIMS-MADE XT OCCUR PREMISES(Ea EoccuNTEence S300,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S3,000,000 JECT POLICY❑ PRO- u LOC _PRODUCTS-COMP/OP AGG 53,000,000 u — OTHER: $ A AUTO MOBILE LIABILITY MAC0686137 /15/2015 /15/2016 Eaaccideltt) $1,000,000 ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS NON-OWNED PROPERTY DAMA E S HIRED AUTOS AUTOS (Per accident X X $ B X UMBRELLA LIAB X OCCUR UMB0686138 411512015 411512016 EACH OCCURRENCE $4,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED I I RETENTION S S A WORKERS COMPENSATION MAC0686137 /15/2015 /15/2016 STATUTE I X I ERH WA Stop Gap AND EMPLOYERS'LIABILITY -- ANY PROPRIETOR/PARTNER/EXECUTIVE — NIA EL EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDE(? (Mandatory in NH) E-I I.DISEASE-EA EMPLOYEE $1,000,000 If Yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached It more space Is required) CERTIFICATE HOLDER IS AN ADDITIONAL INSURED PER CG8224 12/01. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Highline School District Facilities Service Dept ACCORDANCE WITH THE POLICY PROVISIONS. 17810 8th Ave S Burien WA 98148-1788 AUTHORIZED REPRESENTATIVE I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Administrative Offices GREAT 301E nth StreetCG 82 24 AMF;RICAN. Cincinnati OH 45202.4201 INSURANCE GROUP 5133695000ph (Ed. 12 01) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SOCIAL SERVICE AGENCY GENERAL LIABILITY BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following provision is added to SECTION (2) With respect to the insurance af- II - WHO IS AN INSURED forded the Additional Insured identified in Paragraph A.(1) of 5. AUTOMATIC ADDITIONAL INSURED(S) this endorsement, the following additional provisions apply: a. Additional Insured - Manager or Lessor of Premises (a) This insurance applies only to liability arising out of the (1) This policy is amended to include ownership, maintenance or as an insured any person or or- use of that portion of the ganization (hereinafter called Ad- premises leased to you. ditional Insured) from whom you lease or rent property and which (b) The Limits of Insurance ap- requires you to add such person plicable to the Additional In- or organization as an Additional sured are the lesser of those Insured on this policy under: specified in the written con- tract or agreement or in the (a) a written contract; or Declarations for this policy and subject to all the terms, (b) an oral agreement or con- conditions, and exclusions tract where a Certificate of for this policy. The Limits of Insurance showing that per- Insurance applicable to the son or organization as an Additional Insured are inclu- Additional Insured has been sive of and not in addition to issued; the Limits of Insurance shown in the Declarations. but the written or oral contract or agreement must be an "insured (c) In no event shall the cov- contract," and, erages or Limits of Insurance in this Coverage Form be in- (i) currently in effect or be- creased by such contract. come effective during the term of this policy; and (d) Coverage provided herein is excess over any other valid (ii) executed prior to the "bodily and collectible insurance injury," "property damage," available to the Additional In- "personal and advertising in- sured whether the other in- jury." surance is primary, excess, Includes copyrighted material of Insurance Service Office with its permission. Copyright, Insurance Services Office, Inc., 2001 CG 82 24 (Ed. 12101) XS (Page 1 of 4) contingent or on any other tomarily provided by the basis unless a written con- policy forms specified in and tractual arrangement specifi- required by the contract. cally requires this insurance to be primary. (c) In no event shall the cov- erages of Limits of Insurance (3) This insurance does not apply to: in this Coverage Form be in- creased by such contract. (a) Any "occurrence" or offense which takes place after you c. Additional Insured - Contractual cease to be a tenant in that Obligations premises. (1) This policy is amended to include (b) Structural alterations, new as an Insured any person or or- construction or demolition ganization (hereinafter called Ad- operations performed by or ditional Insured) that you are re- on behalf of the "Additional quired by a written "insured con- Insured." tract" to include as an Insured, b. Additional Insured - Funding subject to all of the following provisions: Sources (a) Coverage is limited to liability (1) This policy is amended to include arising out of: as an Insured any Funding Source which requires you in a written (i) your ongoing oper- contract to name the Funding ations performed for Source (hereinafter called Addi- such Additional Insured; tional Insured) as an Insured but or only with respect to liability aris- ing out of your premises, "your (i i) that Insured's financial work" for such Additional Insured, control of you; or or acts or omissions of such Ad- ditional Insured in connection with (III) the maintenance, opera- the general supervision of "your tion or use by you of work" and only to the extent set equipment leased to forth as follows: you by such Additional Insured; or (a) The Limits of Insurance ap- plicable to the Additional In- (iv) a state or political sub- sured are the lesser of those division permit issued specified in the written con- to you. tract or agreement or in the Declarations for this policy (b) Coverage does not apply to and subject to all the terms, any "occurrence" or offense: conditions, and exclusions for this policy. The Limits of (i) which took place be- Insurance applicable to the fore the execution of, Additional Insured are inclu- or subsequent to the sive of and not in addition to completion or expira- the Limits of Insurance tion of, the written "in- shown in the Declarations. sured contract", or (b) The coverage provided to (ii) which takes place after the Additional Insured(s) is you cease to be a ten- not greater than that cus- ant in that premises. Includes copyrighted material of Insurance Service Office with its permission. Copyright, Insurance Services Office, Inc., 2001 CG 82 24 (Ed. 12101) XS (Page 2 of 4) (c) With respect to architects, work" done under a contract for that engineers, or surveyors, person or organization and included in coverage does not apply to the "products-completed operations "Bodily Injury," "Property hazard." Damage," "Personal and Ad- vertising Injury" arising out 3. NON-OWNED OR CHARTERED WATER- of the rendering or the fail- CRAFT ure to render any profes- sional services by or for you Section I - Coverages, Coverage A, Item including: 2.g.(2) is replaced with: (i) the preparing, approv- (2) A watercraft you do not own that is: ing, or failing to pre- pare or approve maps, (a) less than 51 feet long; and drawings, opinions, re- ports, surveys, change (b) not being used to carry persons or orders, designs or property for a charge. specifications; and 4. BROADENED PERSONAL AND ADVERTISING (ii) supervisory, inspection, INJURY or engineering services. Unless "Personal and Advertising Injury" is ex- If an Additional Insured endorsement is at- cluded from this policy: tached to this policy and specifically names a person or organization as an Insured, then the SECTION V - DEFINITIONS Item 14. is re- coverage in Section II - WHO IS AN placed by: INSURED 5. Automatic Additional Insured(s) does not apply to that person or organization. 14. "Personal and Advertising Injury" means injury, including consequential bodily in- 2. BLANKET WAIVER OF SUBROGATION jury," arising out of one or more of the following offenses: SECTION IV - COMMERCIAL GENERAL a. false arrest, detention or imprison- LIABILITY CONDITIONS, Item 8. is replaced ment; with: b. malicious prosecution; 8. Transfer of Rights of Recovery Against Others to us and Blanket Waiver of c. the wrongful eviction from, wrongful Subrogation entry into, or invasion of the right of private occupancy of a room, dwelling a. If an Insured has rights to recover all or premises that a person occupies by or part of any payment we have made or on behalf of its owner, landlord or under this Coverage Part, those rights lessor; are transferred to us. The Insured must do nothing after loss to impair them. d. oral, written, televised, videotaped, or At our request, the Insured will bring electronic publication of material, in "suit" or transfer those rights to us and any manner, that slanders or libels a help us enforce them. person or organization or disparages a person's or organization's goods, pro- b. If required by a written "insured con- ducts or services; tract", we waive any right of recovery we may have against any person or e. oral, written, televised, videotaped, or organization because of payments we electronic publication of material, in make for injury or damage arising out any manner, that violates a person's of your ongoing operations or "your right of privacy: or Includes copyrighted material of Insurance Service Office with its permission. Copyright, Insurance Services Office, Inc., 2001 CG 82 24 (Ed. 12101) XS (Page 3 of 4) f. mental injury, mental anguish, humili- Subject to 5. above, the Damage to Prem- ation, or shock, if directly resulting ises Rented to You Limit is the most we from Items 14.a. through 14.e. will pay under Coverage A for damages because of "property damage" to your g. the use of another's advertising idea in building, or to personal property of others your "advertisement"; or in your care, custody and control while at premises rented to you or temporarily h. infringing upon another's copyright, occupied by you with permission of the trade dress or slogan in your "adver- owner, arising out of any one fire. tisement." The Damage to Premises Rented To You 5. MENTAL INJURY, MENTAL ANGUISH, Limit is replaced by the following Damage HUMILIATION, OR SHOCK INCLUDED IN to Premises Rented To You Limit. BODILY INJURY DEFINITION The Damage to Premises Rented To You Section V - Definitions, Item 3. is replaced Limit is the greater of: with: (1) $300,000; or 3. "Bodily injury" means physical injury, sick- ness, or disease, including death of a per- (2) the amount shown in the Declarations son. "Bodily injury" also means mental in- for Damage to Premises Rented to jury, mental anguish, humiliation, or shock You Limit. if directly resulting from physical injury, sickness, or disease to that person. B. This provision is subject to all the terms of SECTION III - LIMITS OF INSURANCE. 6. MEDICAL PAYMENTS C. This provision 5. does not apply if Damage A. The Medical Expense Limit in Paragraph 7. to Premises Rent to You Liability of COV- of SECTION III - LIMITS OF INSURANCE ERAGE A (SECTION 1) is excluded either is replaced by the following Medical Ex- by the provisions of the Coverage Part or pense Limit. by endorsement. The Medical Expense Limit provided by 8. SUPPLEMENTARY PAYMENTS this policy shall be the greater of: A. In the SUPPLEMENTARY PAYMENTS - a. $10,000; or COVERAGES A and B provision, Item 1.b., and 1.d are replaced with: b. The amount shown in the Declarations 1.b. Up to $500 for cost of bail bonds for Medical Expense Limit. required because of accidents or traf- B. This provision 7. is subject to all the terms fic law violations arising out of the use of SECTION III - LIMITS OF INSURANCE. of any vehicle to which the Bodily In- jury Liability Coverage applies. We do not have to furnish these bonds. C. This provision 7. does not apply if COVERAGE C. MEDICAL PAYMENTS is 1.d. All reasonable expenses incurred by excluded either by the provisions of the the Insured at our request to assist us Coverage Part or by endorsement. in the investigation or defense of the claim or "suit," including actual loss of 7. DAMAGE TO PREMISES RENTED TO YOU earnings up to $500 a day because of LIMIT time off work. A. SECTION III - LIMITS OF INSURANCE, This endorsement does not change any other Item 6. is replaced with: provision of the policy. Includes copyrighted material of Insurance Service Office with its permission. Copyright, Insurance Services Office, Inc., 2001 CG 82 24 (Ed. 12101 ) XS (Page 4 of 4)