HomeMy WebLinkAboutPW17-423 - Change Order - #1 - LaVelle Vac & Drainage, LLC - James Street Pipe Repair - 08/16/2017 01
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I,Nucurds M h t
KENT
Wnar .craw 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 Dame: Lavelle `lac & Drainage, LLC
Vendor Plumber:
JD Edwards Number
Contract Number: PV n — �>' 0
This is assigned by City Clerk's Office
Project Dame: .James St. Pipe Repair
Description: El Interlocal Agreement El Change Order ❑ Amendment ❑ Contract
❑ Other:
Contract Effective Date: 8/16/1.7 Termination Date: 8/22/17
Contract Renewal Notice (Days):
Dumber of days required notice for termination or renewal or amendment.
Contract Manager: Jens Vincent Department P Operations
Contract Amount: 2,440.00
Approval Authority: (CIRCLE ONE) Department Directory Mayor City Council
Detail: (i.e. address, location, parcel number, tax , c.):
Additional equipment needs to be obtained to perform the repair.
As of: 08/27/14
s
KENT
CHANGE ORDER NO. 1
NAME OF CONTRACTOR: Lavelle Vac & Drainage, LLC ("Contractor")
CONTRACT NAME & PROJECT NUMBER: James Street Pipe Repair
ORIGINAL CONTRACT DATE: July 11, 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 additional equipment is
necessary to perform the repair. For a description, see the
Contractor's propopsal which is attached as Exhibit A and incorporated
by this reference.
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, $7,420.60
(including applicable alternates and
WSST)
Net Change by Previous Change Orders $742.06
(incl. applicable WSST)
Current Contract Amount $8,162.66
(incl. Previous Change Orders)
Current Change Order $2,200.00
Applicable WSST Tax on this Change $220.00
Order
Revised Contract Sum $10,582.66
CHANGE ORDER - 1 OF 3
Original Time for Completion 8/22/17
(insert date)
Revised Time for Completion under n/a
prior Change Orders
(insert date)
Days Required (±) for this Change 0 calendar days
Order
Revised Time for Completion 8/22/17
(insert date) I
In accordance with Sections 1-04.4 and 1-04.5 of the Kent and WSDOT Standard
Specifications, and Section VII of the Agreement, the Contractor accepts all requirements of this
Change Order by signing below. Also, 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
Order 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.
6NTk4CTOR: CITY OF KENT-
9 B By:
n ture,
Y"
Print Name: P7 Print Name: Timothy J. LaPorte, P.E.
I ts-_A4 rl IA A Its Public Works Director
DATE, DATE:
CHANGE ORDER - 2 OF 3
APPROVED AS TO FORM:
(applicable if Mayor's signature required)
Kent Law Department
LaVette•James Repair CO L/Vtncent
CHANGE ORDER - 3 OF 3
EXHIBIT A LaVelle Vac & Drainage, LLC Proposal
roposal
C . Box 302£ Date Proposal
P.
t�M Federal WA 9. 8063 $l14f2017 I'B-2017-130
Name!Address Project Address
City of Kent ,lames St
220 Fourth Avenue South Kent, WA
Kent,WA 98032
f,aVelle Vac & Drainage hereby proposes to furnish the material, labor and supplies necessary
to complete the work as described below;
Description
LVD proposes to install (1)additional 15" in diameter by 24" in length, single flare Link-Pipe grouting sleeves to abandon Tee:
connection located approximately 115'downstream from manhole i'i S'11 MAA28.
The above service to be done on a one-tirne basis ol'$2,200.00-t sales tax
Inclusions:
-CCTV truck Nvith operator
-2 Link-pipe grouting sleeves
-2-Extra laborers
-Support truck w/equipment
-DVD copy of inspection report&repair
Exceptions fir,Exclusions:
-Cancelation notice must be given 48 hours prior to scheduled start time or•liability charges could occur.
Sales tax,permits, licenses,additional insurance and bonding arc not included in price.
-"Berms are net 30 upon completion of Link-Pipe repair. A 40%restocking fee plus shipping Nvill be charged on all returned sleeves.
Special orders sleeves are not returnable. Lavelle Vac& Drainage L X will not be responsible for any back charges under any
circumstances.
Please note: By signing below you are confirming that the correct size/type ofpipe to be repaired is 15" RCP ID.Any incorrect pipe
information will be subject to additional charges.
All pricing may be :subject to change after 30 days of submittal if not Subtotal
accepted.
2'2{TQ'Qb
Acceptance of Proposal Sales Tax (10.0%) $220.00
The above prices„ specifications, and conditions are satisfactory and are
hereby accepted. By signing you are authorizing LaVelle Vac & Drainage, Total
L.LC to proceed with the work as specified above. `}2,42(}°(T
Authorized Signature
Client#:106966 LAVEVACU
ACORD. CERTIFICATE OF LIABILITY INSURANCE D 71011dDD/YYYY)
/0712017
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(8),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 endomement(s).
PRODUCER Abby Mumford
Propel Insurance N --- —__ _-- I
Tacoma Commercial Insurance A Ext.800 499-0933 Arc No):868 677-1326
Abigall.Mumford@propolinsurance.com
1201 Pacific Ave,Suite 1000 INBUREMS AFFORDING COVERAGE NAIC�
Tacoma,WA 98402 _ INSURER A:Western National Assurance Comp 24465
INSURED LaVelle Vac&Drainage,LLC INSURERS;
Po Box 3028 INSURER C:
INsuRERD
Federal Way,WA 98063
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 POUCY 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.
I --ODL 57UO --- - v--- pp I Yap
TYPE_OF INSURANCE _ POLICY NUMBER ( I MNY4 LIMITS
A . X1 COMMERCIAL GENERAL LIABILITY X X CPPI00161408 9108/2016 0910812017 EACH OCCURRENCE ___ s1 OOO OOO
CLAIMS-MADE FillOCCUR I PREMI5ESQEOEO Y�an�)__. 5300'000
�- MEo EXP iAltir one versant s 10,000
PERSONAL&ADV INJURY - $1.000�000
GEN.L AGGREGATE LIMIT APPLIES PER: _GENERAL AGGREGATE s2,000,000
POLICY a JECT LOC PRODUCTS:COMPIOPAGG S2sOOOL000.
A AUTOMOBILE LIABILITY —A X X CPPICOO82009 — 9/08/2016 091081201sood"n7,E w ' — 1,000000
X ANY AUTO i BODILY INJURY(Par person) S
ALL ONMED "���SCHEDULED {
—_!AUTOS l- AUTOS BODILY INJURY(PereorJdenp S
-Xi HIRED AUTOS ix I AM
ED PROPERTY DAMAGE
4 AUTOS
A X UMBRELLA UAay q
OCCUR 9/D8120
X X UM13100018908 16 09/081201 EACH OCCURRENCE s2,000,000
y EXCESS UAS CLAIMS-MADE AGGREGATE _ 52,000 QOQ-_
NO I X RETENTION S1000O _ S _
A WORKERS COMPENSATION X CPP100161408 9/08/2018 091081201 PY�lI X a
AND EMPLOYERS'UA8IUTY —_. ___._..._....
ANY PROPRIETORIPARTNEWEXECUT!VE�'u I Stop Gap EL EACN ACCIDENT S1,000.000
OFFICER/MEMBER EXCLUDED? ' N I N I A
(Maltlatory In NH) E L DISEE.EA 51,000,000
if yes.neavilm under - AS -'-
DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $1,0001000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD101.Additional Remadla Schedule,may be aNeched If morespece Is required)The City of Kent8 Included a8
additional Insured per the attached. Umbrella forms follow underlying policy forms
CERTIFICATE HOLDER CANCELLATION
ANY OF THE AE CANCELLED BEFE
City of Kent THEULD EXPIRATION DATE WTHEREOF.DESCRIBED NOTICE POLICIES
W(LL B aLIVEREDORIN
Public Works Department ACCORDANCE WITH THE POLICY PROVISIONS.
400 West Gowe
Kent,WA 98032 AUTHORIZED REPRESENTATIVE
ram'' 't•�„
I
01988-2014 ACORD CORPORATION.All rights reserved.
ACORD 25(2014101) 1 of 1 The ACORD name and logo are registered marks of ACORD
NS2772133IM2541812 ALW00
This page has been left blank intentionally.. =
to
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Policy#CPP100151408 COMMERCIAL GENERAL LIABILITY
WNGL840716
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS -
AUTOMATIC STATUS WHEN REQUIRED IN
CONSTRUCTION AGREEMENT WITH YOU
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Section II — Who Is An Insured is amended to a. The preparing, approving,or failing to pre-
include the following: pare or approve, maps, shop drawings,
Any person(s) or organizations(s) for whom you opinions, reports, surveys, field orders,
have performed operations is also an additional change orders or drawings and specifica-
insured, if you and such person(s) or organiza- tions;or
tion(s) have agreed in writing in a contract or b. Supervisory, inspection, architectural or
agreement that such person(s) or organization(s) engineering activities.
be added as an additional insured on your policy This exclusion applies even if the claims
for completed operations. Such person(s) or or-
ganizations) is an additional insured only with re- against an additional insured allege negli-
° ° gence or other wrongdoing in the supervision,
spect to liability for 'bodily injury or property
damage" caused, in whole or part, by"your work" hiring, employment, training or monitoring of
others by that insured, if the "occurrence'
at the location specified in the written contract or which caused the "bodily Injury" or "property
agreement and included in the products- damage", or the offense which caused the
completed operations hazard". "personal and advertising injury", involved the
However, the insurance afforded to such additional rendering of or failure to render any profes-
insured: sional services by you with respect to your
1. Only applies to the extent permitted by law; providing engineering, architectural or survey-
and ing services in your capacity as an engineer,
architect or surveyor.
2. Will not be broader than that which you are re- 2, 'Bodily injury" or "property damage' that oc-
quired by the contract or agreement to provide curs prior to the execution of, or subsequent to
for such additional insured. the expiration of, the contract or agreement in
B. With respect to the insurance afforded to these which you agreed that such person(s) or or-
additional insureds, the following additional exclu- ganization(s) be added as an additional in-
sions apply: sured.
This insurance does not apply to:
I. "Bodily injury", "property damage"or"personal
and advertising injury" arising out of the ren-
dering of, or the failure to render, any profes-
sional architectural, engineering or surveying
services, including:
WN GL 64 07 15 Page 1 of 2
Includes copyrighted material of Insurance Services Office,Inc.,with its permission.
C. With respect to the insurance afforded to these 1• The minimum amount required by the contract
additional insureds, the following is added to Sec- or agreement; or
tion III—Limits Of Insurance: 2. The Limits of Insurance shown in the DeGara-
If coverage provided to the additional insured is lions;
j required by a contract or agreement, the most we whichever is less.
Iwill pay on behalf of the additional insured is: This endorsement shall not increase the applicable
Limits of Insurance shown in the Declarations.
i
i
l
f
WN GL 84 0715 Page 2 of 2
Includes copyrighted material of Insurance Services Office,Inc.,with Its perrnlssion.
COMMERCIAL GENERAL LIABILITY
CG 20 01 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY -
OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
The following is added to the Other Insurance 12) You have agreed in writing in a
Condition and supersedes any provision to the contract or agreement that this insur-
contrary: ance would be primary and would not
Primary And Noncontributory Insurance seek contribution from any other insur-
a
This insurance is primary to and will not nce available to the additional insured.
seek contribution from any other insurance
available to an additional insured under
your policy provided that:
(1) The additional insured is a Named In-
sured under such other insurance; and
CG 20 01 04 13 * insurance Services Office, Inc., 2012 Page 1 of 1
Policy #C PIP 100151408 WN GL 39 0715
COMMERCIAL GENERAL LIABILITY ENHANCEMENT ENDORSEMENT
The Commercial General Liability Enhancement Endorsement is an optional endorsement that provides coverage en-
hancements. The following is a summary of broadened coverages provided by this endorsement. No coverage is pro-
vided by this summary, refer to following endorsement for changes in your policy.
I
I�
SUMMARY OF COVERAGES PAGE
Bodily Injury And Property Damage Liability
• Non Owned Watercraft Up To 50 Feet......................................................................................2
Property Damage Liability
• Elevators....................................................................................................................................3
• Fire, Lightning, Explosion Or Sprinkler Leakage Exception.......................................................3
• Borrowed Equipment($25,000 Per Occurrence,$50,000 Aggregate,
$2.500 Deductible Per Occurrence........................................................................................ 3
Supplementary Payments—Amended
• Bail Bonds Up To$5,000............................. .............................................. ....................__. .4
• Loss of Earnings Up To$500/Day ............................................................................................4
Who is An Insured Amendments
• Employee Bodily Injury To A Co-Employee...............................................................................4
• Newly Formed Or Acquired Organizations For Up To 180 Days...............................................4
• Blanket Additional Insured—Vendors—As Required By Contract............................................4
• Blanket Additional Insured—Lessor Of Leased Equipment......................................................6
• Blanket Additional Insured—Managers Or Lessors Of Premises..............................................6
• Blanket Additional Insured—State Or Governmental Agency Or Subdivision
Or Political Subdivision—Permits Or Authorizations..............................................................7
• Blanket Additional Insured—State Or Governmental Agency Or Subdivision
Or Political Subdivision—Permits Or Authorizations Relating To Premises....................... ..B
Damage To Premises Rented To You — $300,000...... ............................................................... ........9
Medical Payments Increased Limit — $10,000 Or Amount Shown on Declarations.............................9
Conditions
• Knowledge of Occurrence,Offense, Claim Or Suit Amended...................................................9
• Unintentional Failure To Disclose Hazards................................................................................9
• Waiver of Subrogation............................................... ..........10
Insured Contract Amended...................................................................................................................10
Personal And Advertising Injury Redefined
• Televised,Videotaped Or Electronic Publication.......... ................................... ...... ... ...........10
WN GL 39 0715 Includes copyrighted material of the Insurance Service Office,Inc.,with its permission. Page 1 of 10
WNGL390716
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
COMMERCIAL GENERAL LIABILITY ENHANCEMENT ENDORSEMENT
This endorsement modifies the insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified
by this endorsement. The SECTIONS of the Commercial General Liability Coverage Form identified in this endorsement
will be amended as shown below.
SECTION I—COVERAGES AMENDMENTS (4) Liability assumed under any "insured con-
COVERAGE A — BODILY INJURY AND PROPERTY tract"for the ownership, maintenance or use
DAMAGE LIABILITY of aircraft or watercraft; or
(5) "Bodily injury" or "property damage" arising
A. Non Owned Aircraft Or Watercraft out of:
Item 2.Exclusions, Paragraph g. is replaced by theThe operation of following: (a) ment that is attached cto, or part of,t a
g. Aircraft,Auto Or Watercraft land vehicle that would qualify under the
"Bodily injury" or "property damage" arising out definition of"mobile equipment"if it were
of the ownership, maintenance, use or entrust- not subject to a compulsory or financial
ment to others of any aircraft, 'auto" or water- responsibility law or other motor vehicle
craft owned or operated by or rented or loaned insurance law where it is licensed or
to any insured. Use includes operation and principally garaged;or
"loading or unloading". (b) The operation of any of the machinery
This exclusion applies even if the claims against or equipment listed in Paragraph f. (2)
any insured allege negligence or other wrong- or f. (3) of the definition of "mobile
doing in the supervision, hiring, employment, equipment",
training or monitoring of others by that insured, if B. Damage To Property Coverage Extensions
the"occurrence"which caused the"bodily injury" Item 2. Exclusions, Paragraph j. is replaced by the
or"property damage"involved in the ownership, following:
maintenance, use or entrustment to others of
any aircraft, "auto"or watercraft that is owned or j• Damage To Property
operated by or rented or loaned to any insured. "Property damage"to:
This exclusion does not apply to: (1) Property you own, rent, or occupy, including
(1) A watercraft while ashore on premises you any costs or expenses incurred by you, or
own or rent; any other person, organization or entity, for
(2) A watercraft you do not own that is: repair, replacement, enhancement, restora-
tion or maintenance of such property for any
(a) Less than 50 feet long;and reason, including prevention of injury to a
(b) Not being used to carry persons or prop- person or damage to another's property;
erty for a charge; (2) Premises you sell, give away or abandon, if
This Subparagraph (2) applies to any per- the"property damage"arises out of any park
son, who with your expressed or implied of those premises;
consent, either uses or is responsible for the (3) Property loaned to you;
use of the watercraft; (4) Personal property in the care, custody or
(3) Parking an "auto"on,or on the ways next to, control of the insured;
premises you own or rent, provided the
"auto" is not owned by or rented or loaned to
you or the insured;
WN GL 39 07 15 Includes copyrighted material or the Insurance Service Office,Inc.,with its permission. Page 2 of 10
(6) That particular part of real property on which Paragraph (6) of this exclusion does not apply to
you or any contractors or subcontractors "property damage" Included in the "products-com-
working directly or indirectly on your behalf pleted operations hazard".
are performing operations, If the "properly The insurance provided for "property damage" from
damage"arises out of those operations;or the use of elevators and for "property damage" to
(6) That particular part of any property that must borrowed equipment is excess over any other valid
be restored, repaired or replaced because and collectible property insurance (including any de-
ductible portion thereof) available to the insured
Paragraphs (1), (3) and (4) of this exclusion do not whether primary, excess, contingent or on any other
apply to "property damage" (other than damage by basis.
fire, lightning, explosion or sprinkler leakage) to C. Damage To Premises Rented To You
premises, including the contents of such premises, Item 2. Exclusions, the last paragraph is replaced
rented to you for a period of seven or fewer by the following:
consecutive days. A separate limit of insurance
applies to Damage To Premises Rented To You as Exclusions c.through In. do not apply to damage by
described in SECTION III — LIMITS OF fire, lightning, explosion or sprinkler leakage to
INSURANCE. However, the provisions of this premises while rented to you or temporarily occupied
paragraph do not apply if coverage for Damage To by you with permission of the owner. A separate
Premises Rented To You is excluded by en- limit of insurance applies to this coverage as de-
dorsement. scribed in Paragraph fi. of SECTION III—LIMITS OF
Paragraph (2) of this exclusion does not apply if the INSURANCE,
premises are "your work" and were never occupied, COVERAGE B — PERSONAL AND ADVERTISING
rented or held for rental by you. INJURY LIABILITY
Paragraphs(3)and(4)of this exclusion do not apply D. Personal And Advertising Injury
to the use of elevators. g 1 ry
Item 2. Exclusions is amended by replacing Sub-
Paragraphs (3), (4), (5) and (6) of this exclusion do paragraphs b.and c.with the following:
not apply to liability assumed under a sidetrack
agreement. b. Material Published With Knowledge Of
Falsity
Paragraph (4) of this exclusion does not apply to "Personal and advertising injury" arising out of
"property damage"to borrowed equipment while not oral, written, televised, videotaped arising
electronic
being used to perform operations at the jobsite.Subject to Paragraph 2. of SECTION III — LIMITS p by or the direction of the insured withublication, in any manner, of material, if done
OF INSURANCE, the rules below fix the most we knowledge of its falsity.
will pay for"property damage"under this provision:
(1) $25,000 any one"occurrence", regardless of the c. Material Published Prior To Policy Period
number of persons or organizations who sustain "Personal and advertising injury" arising out of
damages because of that"occurrence"; oral, written, televised, videotaped or electronic
(2) $50,000 annual aggregate; and publication, in any manner, of material whose
first publication took place before the beginning
(3) We will pay only for damages in excess of of the policy period.
$2,500 as a result of any one "occurrence", re-
gardless of the number of persons or organiza-
tions who sustain damages because of that"oc-
currence". We may, or if required by law, pay all
or any part of any deductible amount, if applica-
ble, to effect settlement of any claim or "suit".
Upon notice of our payment of a deductible
amount, you shall promptly reimburse us for the
part of the deductible amount we paid.
WN GL 39 0715 Includes copyrighted material of the Insurance Service Office,Inc.,with Its permission. Page 3 of 10
SUPPLEMENTARY PAYMENTS—COVERAGES A The following are added:
AND B C. Blanket Additional Insured — Vendors — As Re-
E. Supplementary Payments—Coverages A and B quired By Contract
Item 1. is amended by replacing Subparagraphs b. 1. Section II —Who Is An Insured is amended to
and d.with the following: include as an additional insured any person(s)or
b. Up to $5,000 for cost of bail bonds required be- organizatlon(s) (referred to throughout this
cause of accidents or traffic law violations aris- endorsement as vendor) with whom you have
ing out of the use of any vehicle to which the agreed in a written contract, executed prior to
Bodily injury Liability Coverage applies. We do loss, to name as an additional insured, but only
not have to furnish these bonds. with respect to "bodily injury" or �property
damage"arising out of"your products"which are
d. All reasonable expenses incurred by the insured distributed or sold in the regular course of the
at our request to assist us in the investigation or vendors business.
defense of the claim or "suit", including actual However,
loss of earnings up to $500 a day because of a. The insurance afforded to such vendor only
time off from work. applies to the extent permitted by law;and
b. If coverage provided to the vendor is
SECTION 11—WHO 1S AN INSURED AMENDMENTS required by a contract or agreement, the
A. Employee Bodily Injury To A Co-Employee insurance afforded to such vendor will not
be broader than that which you are required
Paragraph 2.a.(1)is replaced by the following: by the contract or agreement to provide for
(1) 'Bodily injury" or "personal and advertising such vendor.
injury": 2. With respect to the insurance afforded to these
(a) To you, to your partners or members (if you vendors, the following additional exclusions
are a partnership or joint venture), to your apply:
members (if you are a limited liability com- a. The insurance afforded the vendor does not
pany), or to your other "volunteer workers" apply to:
while performing duties related to the con- (1) "Bodily injury" or"property damage" for
duct of your business; which the vendor is obligated to pay
(b) For which there is any obligation to share damages by reason of the assumption
damages with or repay someone else who of liability in a contract or agreement.
must pay damages because of the injury This exclusion does not apply to liability
described in Paragraph(1) (a)above; or for damages that the vendor would have
(c) Arising out of his or her providing or failing to in the absence of the contract or
provide professional health care services. agreement;
B. Newly Acquired Organizations (2) Any express warranty unauthorized by
Paragraph 3.a. is replaced by the following: you;--
a. Coverage under this provision is afforded only (3) Any physical or chemical change in the
until the 1801" day after you acquire or form the product made intentionally by the
organization or the end of the policy period, vendor;
whichever is earlier; (4) Repackaging, except when unpacked
solely for the purpose of inspection,
demonstration, testing, or the
substitution of parts under instructions
from the manufacturer, and then
repackaged in the original container;
WN GL 39 0715 Includes copyrighted material of the Insurance Service Office,Inc.,with its permission. Page 4 of 10
(5) Any failure to make such inspections, 4. With respect to the insurance afforded to these
adjustments, tests or servicing as the vendors, the following is added to Section III —
vendor has agreed to make or normally Limits Of Insurance:
undertakes to make in the usual course
j of business, in connection with the If coverage provided to the vendor is required by
distribution or sale of the products; a contract or agreement,the most we will pay on
(6) Demonstration, installation, servicing or
behalf of the vendor is:
repair operations, except such a. The minimum amount required by the
operations performed at the vendor's contract or agreement;or
premises in connection with the sale of b. The Limits of Insurance shown in the
the product; Declarations;
(7) Products which, after distribution or sale
by you, have been labeled or relabeled whichever is less.
or used as a container, part or This endorsement shall not increase the
ingredient of any other thing or applicable Limits of Insurance shown in the
substance by or for the vendor;or Declarations.
(8) "Bodily injury or "property damage" 5. With respect to the insurance afforded to these
arising out of the sole negligence of the additional insureds, the following additional
ivendor for its own acts or omissions or exclusion applies:
those of its employees or anyone else This insurance does not apply to:
acting on its behalf. However, this pp y
exclusion does not apply to: a. "Bodily injury", "property damage" or
(i) The exceptions contained in "personal and advertising injury" arising out
Subparagraphs(4)or(6);or of the rendering of, or the failure to render,
any professional architectural, engineering
(ii) Such inspections,adjustments, tests or surveying services, including:
or servicing as the vendor has 1 The re approving, or failingto
agreed to make or normally ( ) p paria g' pr g'
undertakes to make in the usual prepare Of approve, maps, shop
course of business, in connection drawings, opinions, reports, surveys,
with the distribution or sale a the field orders, change orders or drawings
and specifications; or
products.
3. This Provision C.does not apply: (2) Supervisory, inspection, architectural or
engineering activities.
a. To any insured person or organization from This exclusion applies evert if the claims
whom you have acquired such products, or allege
a
any ingredient, part or container, entering against an additional insured negligence or other wrongdoing a the
into, accompanying or containing such
products; supervision,hiring, employment,training
or monitoring of others by that insured, if
b. To any vendor for which coverage as an the "occurrence" which caused the
additional insured specifically is scheduled "bodily injury" or "property damage", or
by endorsement;or the offense which caused the "personal
c. When liability included within the "products- and advertising injury", involved the
completed operations hazard" has been ex- rendering of or failure to render any
cluded for such product either by the provi- professional services by you with
sions of the coverage part or by endorse- respect to your providing engineering,
ment. architectural or surveying services in
your capacity as an engineer, architect
or surveyor.
WN GL 39 07 15 Includes copyrighted material of the Insurance Service Office,Inc.,with its permission. Page 5 of 10
O. Blanket Additional Insured — Lessor Of Leased 4. With respect to the insurance afforded to these
Equipment additional insureds, the following additional
exclusion applies:
1. Section ll —Who Is An Insured is amended to This insurance does not apply to:
include as an additional insured any person(s)or
organization(s)from whom you lease equipment a. "Bodily injury", "property damage" or
when you and such person(s)or organization(s) "personal and advertising injury" arising out
have agreed in writing in a contract or of the rendering of, or the failure to render,
agreement, executed prior to loss, that such any professional architectural, engineering
person(s) or organization(s) be added as an or surveying services, including:
additional insured on your policy. Such (1) The preparing, approving, or failing to
person(s) or organization(s) is an insured only prepare or approve, maps, shop
with respect to liability for "bodily injury", drawings, opinions, reports, surveys,
"property damage" or"personal and advertising field orders, change orders or drawings
injury" caused, in whole or in part, by your and specifications;or
maintenance, operation or use of equipment
leased to you by such person(s) or (2) Supervisory, inspection, architectural or
organization(s). engineering activities.
However, the insurance afforded to such This exclusion applies even if the claims
additional insured: against an additional insured allege
a. Only applies to the extent permitted by law; negligence or other wrongdoing in the
and supervision, hiring, employment, training or
monitoring of others by that insured, if the
b. Will not be broader than that which you are "occurrence" which caused the "bodily
required by the contract or agreement to injury" or"property damage", or the offense
provide for such additional insured. which caused the "personal and advertising
A person(s or organization's status as an addi- injury', involved the rendering of or failure to
tional insured under this endorsement ends render any professional services by you with
when their contract or agreement with you for respect to your providing engineering,
such leased equipment ends. architectural or surveying services in your
2. With respect to the insurance afforded to these capacity as an engineer, architect or
additional insureds, this insurance does not ap- surveyor.
ply to any "occurrence" which takes place after E. Blanket Additional Insured — Managers Or Les-
the equipment lease expires. sors Of Premises
3. With respect to the insurance afforded to these 1. Section II —Who Is An Insured is amended to
additional insureds, the following is added to include as an additional insured any person(s)or
Section iIi—Limits Of Insurance: organization(s)with whom you have agreed in a
If coverage provided to the additional insured is written contract, executed prior to loss,to name
required by a contract or agreement, the most as an additional insured, but only with respect to
we will pay on behalf of the additional insured is: liability arising out of the ownership,
a. The minimum amount required by the maintenance or use of that part of the premises
contract or agreement;or leased to you, subject to the following additional
b. The Limits of Insurance shown in the exclusions.-
Declarations; This insurance does not apply to:
whichever is less. a. Any 'occurrence" which takes place after
This endorsement shall not increase the you cease to be a tenant in that premises.
applicable Limits of Insurance shown in the b. Structural alterations, new construction or
Declarations. demolition operations performed by or on
behalf of such additional insured.
WN G L 39 07 15 Includes copyrighted material of the Insurance Service Office.Inc.,with its permission. Page 6 of 10
However: F. Blanket Additional Insured — State Or
a. The insurance afforded to such additional Governmental Agency Or Subdivision Or Politi-
insured only applies to the extent permitted cal Subdivision—Permits Or Authorizations
by law;and Section II —Who Is An Insured is amended to in-
b. If coverage provided to the additional clude as an additional insured any state or
insured is required by a contract or governmental agency or subdivision or political
agreement, the insurance afforded to such subdivision with whom you have agreed in a written
additional insured will not be broader than contract, executed prior to loss, to name as an
that which you are required by the contract additional insured, subject to the following
or agreement to provide for such additional provisions:
insured. 1. This insurance applies only with respect to op-
t. With respect to the insurance afforded to these erations performed by you or on your behalf for
additional insureds, the following is added to which the state or governmental agency or sub-
Section III—Limits Of Insurance: division or political subdivision has issued a
If coverage provided to the additional insured is permit or authorization.
required by a contract or agreement, the most However:
we will pay on behalf of the additional insured is: a. The insurance afforded to such additional
a. The minimum amount required by the insured only applies to the extent permitted
contract or agreement; or by law; and
b. The Limits of Insurance shown in the b. If coverage provided to the additional
Declarations; insured is required by a contract or
agreement, the insurance afforded to such
whichever is less. additional insured will not be broader than
This endorsement shall not increase the that which you are required by the contract
applicable Limits of Insurance shown in the or agreement to provide for such additional
Declarations. insured.
3. With respect to the insurance afforded to these 2. This insurance does not apply to:
additional insureds, the following additional a. "Bodily injury", "property damage" or "per-
exclusion applies:
This insurance does not apply to: sonar and advertising injury" arising out of
pp y operations performed for the federal govern-
a. "Bodily injury", "property damage" or ment, state or municipality;or
"personal and advertising injury" arising out b. "Bodily injury" or "property damage" in-
of the rendering of, or the failure to render, cluded within the "
engineering products-completed op-
any professional architectural, en
9 9 erations hazard".
or surveying services, including: 3. With respect to the insurance afforded to these
(1) The preparing, approving, or failing to additional insureds, the following is added to
prepare or approve, maps, shop Section iII—Limits Of Insurance:
drawings, opinions, reports, surreys, If coverage provided to the additional insured is
field orders, change orders or drawings required by a contract or agreement, the most
and specifications; or we will pay on behalf of the additional insured is:
(2) Supervisory, inspection, architectural or a. The minimum amount required by the
engineering activities. contract or agreement;or
This exclusion applies even if the claims b. The Limits of Insurance shown in the
against an additional insured allege Declarations;
negligence or other wrongdoing in the
supervision, hiring, employment, training or whichever is less.
monitoring of others by that insured, if the This endorsement shall not increase the
"occurrence" which caused the "bodily applicable Limits of Insurance shown in the
injury" or"property damage", or the offense Declarations.
which caused the "personal and advertising
injury", involved the rendering of or failure to
render any professional services by you with
respect to your providing engineering,
architectural or surveying services in your
capacity as an engineer, architect or
surveyor.
WN GL 39 07 15 Includes copyrighted material of the Insurance Service Office,Inc.,with its permission. Page 7 of 16
4. With respect to the insurance afforded to these b. The construction, erection or removal of
additional insureds, the following additional elevators; or
exclusion applies: c. The ownership, maintenance or use of any
This insurance does not apply to: elevators covered by this insurance.
a. "Bodily injury', "property damage" or However,
"personal and advertising injury" arising out a. The insurance afforded to such additional
of the rendering of, or the failure to render, insured only applies to the extent permitted
any professional architectural, engineering by law;and
or surveying services,including: b. If coverage
g provided to the additional
(1) The preparing, approving, or failing to insured is required by a contract or
prepare or approve, maps, shop agreement, the insurance afforded to such
drawings, opinions, reports, surveys, additional insured will not be broader than
field orders, change orders or drawings that which you are required by the contract
and specifications; or or agreement to provide for such additional
(2) Supervisory, inspection, architectural or insured.
engineering activities. 2. With respect to the insurance afforded to these
This exclusion applies even if the claims additional insureds, the following is added to
against an " additional insured allege Section III—Limits Of Insurance:
negligence or other wrongdoing in the If coverage provided to the additional insured is
supervision, hiring, employment, training or required by a contract or agreement, the most
monitoring of others by that insured, if the we will pay on behalf of the additional insured is:
"occurrence" which caused the "bodily
injury" or"property damage", or the offense a. The minimum amount required by the
which caused the "personal and advertising contract or agreement;or
injury", involved the rendering of or failure to b. The Limits of Insurance shown in the
render any professional services by you with Declarations;
respect to your providing engineering, whichever is less.
architectural or surveying services in your
capacity as an engineer, architect or This endorsement shall not increase the
surveyor. applicable Limits of Insurance shown in the
Declarations.
G. Blanket Additional Insured — State Or 3. With respect to the insurance afforded to these
Governmental Agency Or Subdivision Or Politi- additional insureds, the following additional
cal Subdivision — Permits Or Authorizations Re- exclusion applies:
lating To Premises This insurance does not apply to:
Section II —Who Is An Insured is amended to in- a. "Bodily injury", "property damage" or
clude as an additional insured any state or "personal and advertising injury" arising out
governmental agency or subdivision or political of the rendering of, or the failure to render,
subdivision with whom you have agreed in a written any professional architectural, engineering
contract, executed prior to loss, to name as an or surveying services, including:
additional insured,subject to the following provision: (1) The preparing, approving, or failing to
1. This Insurance applies only with respect to the prepare or approve, maps, shop
following hazards for which the state or drawings, opinions, reports, surveys,
governmental agency or subdivision or political field orders, change orders or drawings
subdivision has issued a permit or authorization and specifications; or
in connection with premises you own, rent or
c lies: (2) Supervisory, inspection, architectural or
control and to which this insurance applies: engineering activities.
a. The existence, maintenance, repair,
construction, erection or removal of
advertising signs, awnings, canopies, cellar
entrances, coal holes, driveways, manholes,
marquees, hoist away openings, sidewalk
vaults, street banners or decorations and
similar exposures; or
WN GL 39 0715 Includes copyrighted material of the Insurance Service Office.Inc„with its permission. Page 8 of 10
This exclusion applies even if the claims
against an additional insured allege SECTION IV — COMMERCIAL GENERAL LIABILITY
negligence or other wrongdoing in the CONDITIONS AMENDMENTS
supervision, hiring, employment, training or A. Knowledge Of Occurrence
monitoring of others by that insured, if the
"occurrence" which caused the "bodily Item 2. Duties In The Event Of Occurrence, Of-
Injury" or"property damage', or the offense fense, Claim or Suit is amended by adding the fol-
which caused the"personal and advertising lowing:
injury", involved the rendering of or failure to e. You must give us or our authorized representa-
render any professional services by you with five prompt notice of an "occurrence", claim or
i respect to your providing engineering, loss only when the"occurrence", claim or loss is
architectural or surveying services in your known to:
capacity as an engineer, architect or surveyor_ (1) You,if you are an individual;
(2) A partner, if you are a partnership;
SECTION III — LIMITS OF INSURANCE AMEND- (3) An executive officer or insurance manager,if
MENTS you are a corporation;or
A. Damage To Premises Rented To You (4) A member or manager, if you are a limited
Paragraph S.is replaced by the following:
liability company.
Otherinsurance
6. Subject to Paragraph 5.above, the most we will B. -
pay under Coverage A for damages because of Item 4. Other Insurance, b. Excess Insurance (1)
"property damage" to any one premises, while (a)(11)is replaced by the following:
rented to you, or in the case of damage by fire, (ii) That is fire, lightning, explosion or sprinkler leak-
lightning, explosion or sprinkler leakage, while age insurance for premises rented to you or
rented to you or temporarily occupied by you temporarily occupied by you with permission of
with permission of the owner is the greater of: the owner;
a. $300,000;or C. Unintentional Failure To Disclose Hazards
b. The amount shown next to the Damage To Item 6. Representations is replaced by the
Premises Rented To You Limit in the Decla- following:
rations. 6. Representations And Unintentional Failure
However,the provisions of this paragraph do not To Disclose Hazards
apply if Damage To Premises Rented To You a. By accepting this policy, you agree:
Coverage is excluded by endorsement. (1) The statements in the Declarations are
B. Medical Expense Limit accurate and complete;
Paragraph 7. is replaced with the following: (2) Those statements are based upon
7. Subject to Paragraph 5.above, the most we will representations you made to us;and
pay under Coverage C for all medical expenses (3) We have issued this policy in reliance
because of"bodily injury' sustained by any one upon your representations_
person is the greater of: b. If you unintentionally fail to disclose any haz-
a. $10,000;or ards existing at the inception date of your
b. The amount shown next to the Medical Ex- policy, we will not deny coverage under this
pense Limit in the Declarations. Coverage Part because of such failure.
However, this provision does not affect our
This insurance does not apply if coverage for right to collect additional premium or exer-
Medical Expenses is excluded either by the pro- cise our right of cancellation or non-renewal.
visions of the coverage part or by endorsement.
WN GL 39 0715 Includes copyrighled material of the Insurance Service Office,Inc.,with its permission. Page 9 of 1'6
D. Waiver of Subrogation SECTION V—DEFINITIONS AMENDMENTS
Item S. Transfer of Rights of Recovery Against A. Insured Contract Amended
Others to Us is hereby amended by the addition of
the following: Paragraph 9.a.is replaced by the following:
We waive any right of recovery we may have be- a. A contract for a lease of premises. However,
cause of payments we make for injury or damage that portion of the contract for a lease of prem-
arising out of your ongoing operations or"your work" ises that indemnifies any person or organization
done under a written contract, executed prior to loss, for damage by fire, lightning, explosion or spdn-
requiring such waiver with that person or organiza- kler leakage to premises while rented to you or
tion and included in the "products-completed opera- temporarily occupied by you with permission of
tions hazard". However, our rights may only be the owner is not an"Insured contract";
waived prior to the "occurrence" giving rise to the B. Personal And Advertising Injury Redefined
injury or damage for which we make payment under Paragraph 14. d. and e. are replaced by the follow-
this Coverage Part. The insured must do nothing ing:
after a loss to impair our rights. At our request, the
insured will bring "suit" or transfer those rights to us d. Oral, written, televised, videotaped or electronic
and help us enforce those rights. publication of material that slanders or libels a
person or organization or disparages a person's
or organization's goods,products or service;
e. Oral, written, televised, videotaped or electronic
publication of material that violates a person's
right of privacy;
WN GL 39 0715 Includes copyrighted material of the Insurance Service Oftice,Inc.,with Its permission. Page 10 of 10
POLICY NUMBER:CPP 1001514 08 COMMERCIAL GENERAL LIABILITY
CG 26 03 05 09
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):
PER WRITTEN CONTRACT OF AGREE-
MENT WHERE YOU AGREED TO PRO-
VIDE A SEPARATE GENERAL AGGRE-
�GATE LIMIT OR EACH PROJECT
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. For all sums which the insured becomes le- gate Limit for that designated construction
gally obligated to pay as damages caused by project. Such payments shall not reduce
"occurrences" under Section I - Coverage A, the General Aggregate Limit shown in the
and for all medical expenses caused by accl- Declarations nor shall they reduce any
dents under Section 1 - Coverage C. which other Designated Construction Project
can be attributed only to ongoing operations General Aggregate Limit for any other
at a single designated construction project designated construction project shown in
shown in the Schedule above: the Schedule above.
1. A separate Designated Construction Proj- 4. The limits shown in the Declarations for
ect General Aggregate Limit applies to Each Occurrence, Damage To Premises
each designated construction project, and Rented To You and Medical Expense
that limit is equal to the amount of the continue to apply. However, instead of
General Aggregate Limit shown in the being subject to the General Aggregate
Declarations. Limit shown in the Declarations, such
2. The Designated Construction Project Gen- limits will be subject to the applicable
eral Aggregate Limit is the most we will Designated Construction Project General
pay for the sum of all damages under Aggregate Limit.
Coverage A, except damages because of B. For all sums which the insured becomes
"bodily injury" or "property damage" legally obligated to pay as damages caused by
included in the "products-completed oper- "occurrences" under Section I - Coverage A,
ations hazard", and for medical expenses and for all medical expenses caused by
under Coverage C regardless of the accidents under Section I - Coverage C.
number of; which cannot be attributed only to ongoing
a. Insureds; operations at a single designated construction
b. Claims made or "suits" brought; or project shown in the Schedule above:1, An
C. Persons or organizations making y payments made under Coverage A
for damages or under Coverage C for
claims or bringing "suits". medical expenses shall reduce the amount
3. Any payments made under Coverage A available under the General Aggregate
for damages or under Coverage C for Limit or the Products-completed Opera-
medical expenses shall reduce the Desig- tions Aggregate Limit, whichever is ap-
nated Construction Project General Aggre- plicable; and
CG 25 03 05 09 * Insurance Services Office, Inc., 2008 Page 1 of 2
POLICY NUMBER:UMB 1000189 08 COMMERCIAL LIABILITY UMBRELLA
CU 24 03 09 00
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL LIABILITY UMBRELLA COVERAGE PART
SCHEDULE
Name Of Person Or Organization:
ALL PARTIES WHERE SPECIFICALLY REQUIRED IN A WRITTEN CONTRACT
OR AGREEMENT RELATED TO THE WORK OF THE INSURED.
(If no entry appears above, information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.)
The Transfer Of Rights Of Recovery Against Others To Us Condition under Section IV - Conditions is
amended by the addition of the following:
We waive any right of recovery we may have against the person or organization shown In the Schedule
above because of payments we make for injury or damage arising out of your ongoing operations or "your
work" done under a contract with that person or organization and included in the "products-completed
operations hazard". This waiver applies only to the person or organization shown in the Schedule above.
CU 24 03 09 00 Copyright, Insurance Services Office, Inc., 2000 Page 1 of 1
Policy#CPP100082009 WN CA 27 06 16
BUSINESS AUTO ENHANCEMENT ENDORSEMENT
The Business Auto Enhancement Endorsement Is an optional endorsement that provides coverage enhancements. The
following is a summary of broadened coverages provided by this endorsement. No coverage is provided by this
summary, refer to following endorsement for changes in your policy.
SUMMARY OF COVERAGES PAGE
Accidental Airbag Deployment Coverage 4
Auto Loan/Lease Gap Coverage 4
Blanket Additional Insured 2
Blanket Waiver of Subrogation 5
Broadened Definition of Insured includes:
• Newly Acquired Organizations for up to 180 Days 2
• Employees as Insureds 2
• Subsidiaries in Which You Own 50%or More 2
Deductible Waiver for Glass Repair 3
Employee Hired Auto 2.5
Fellow Employee Coverage 3
Hired Auto Physical Damage Coverage 4
Knowledge of Accident,Claim, Suit or Loss 5
Loss Of Use Expenses-Amended 3
Personal Effects 3
Rental Reimbursement Coverage 4
Supplementary Payments-Amended:
• Bail Bonds up to$5,000 2
• Loss of Earnings up to$5001Day 2
Transportation Expense Limits—Amended 3
Unintentional Failure to Disclose Hazards 5
WN CA 27 0616 Includes copyrighted material of Insurance Services Office,with its permission Page 1 of 5
WNCA270616
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
BUSINESS AUTO ENHANCEMENT ENDORSEMENT
This endorsement modifies the insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
.With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified
j by this endorsement. The SECTIONS of the Business Auto Coverage Form identified in this endorsement will be
amended as shown below.
SECTION II — COVERED AUTOS LIABILITY g. Any "employee" of yours is an "Insured" while
COVERAGE AMENDMENTS operating a covered"auto"hired or rented under
A. Who Is An Insured a contract or agreement In the "employee's"
name, with your permission, while performing
SECTION It — COVERED AUTOS LIABILITY duties related to the conduct of your business.
COVERAGE, A. Coverage, 1. Who Is An Insured is amended to add: B. Blanket Additional Insured
d. Any legally incorporated subsidiary of yours in SECTION II — COVERED AUTOS LIABILITY
which you own more than 50% of the voting COVERAGE, A. Coverage, 1. Who Is An Insured,
stock on the effective date of this coverage form. paragraph c,is amended to add the following:
However, "insured" does not include any Any person or organization who is required under a
subsidiary of yours that is an "insured" under written contract or agreement between you and that
any other automobile liability policy, or would be person or organization, that is signed and executed
an "insured" under such policy but for by you before the "bodily Injury" or "property
termination of such policy or the exhaustion on damage"occurs and that is in effect during the policy
such policy's limits of Insurance. period, to be named as an additional insured is an
"insured" for Liability Coverage, but only for
e. Any organization which is newly acquired or damages to which this Insurance applies and only to
formed by you and over which you maintain the extent that persons or organization qualifies as
majority ownership. However, coverage under an `Insured" under the Who Is An Insured provision
this provision: contained in Section ll.
(1) is afforded only for the first 180 days after C. Liability Coverage Extensions — Supplementary
you acquire or form the organization or until
the end of the policy period, whichever Payments
comes first; SECTION II — COVERED AUTOS LIABILITY
2 does not apply to "bodily Injury"or" roe COVERAGE, A. Coverage, 2. Coverage
( ) pp y y "property Extensions, a. Supplementary Payments is
damage"that results from an"accident"that amended by replacing subparagraphs (2) and (4)
occurred before you formed or acquired the organization; with the following:
(3) does not apply to any newly acquired or (2) Up to $5,000 for cost of bail bonds (including
formed organization that is a joint venture or bonds for related traffic law violations) required
partnership;and because of an accident we cover. We do not
(4) does not apply to an "insured" under any have to furnish these bonds.
other automobile liability (4) All reasonable expenses incurred by the
"Ensured policy, or would r- "insured" at our request, including actual loss of
mi nation of such policy or the exhaustion of under such a policy but for ter- earnings up to $500 a day because of time off
ur from work.
such policy's limits of insurance.
f. Any "employee" of yours is an "insured" while
using a covered "auto" you don't own, hire or
borrow in your business or your personal affairs.
WN CA 27 06 16 Includes copyrighted material of Insurance Services Office,with its permission Page 2 of 6
D. Fellow Employee Coverage D. Glass Repair—Deductible Waiver
SECTION II — COVERED AUTOS LIABILITY SECTION III — PHYSICAL DAMAGE COVERAGE,
COVERAGE, B. Exclusions, 6. Fellow Employee, A. Coverage, 3. Glass Breakage—Hitting A Bird
i the following is added: Or Animal — Falling Objects Or Missiles, is
Co-Employee Lawsuit Defense Cost amended by adding the following:
Reimbursement No deductible will apply to glass breakage if such
If a suit seeking damages for "bodily injury" to any glass is repaired, in a manner acceptable to us,
fellow"employee"of the"insured" arising out of and rather than replaced.
in the course of the fellow"employee's"employment E. Hired Auto Physical Damage
or while performing duties related to the conduct of SECTION III — PHYSICAL DAMAGE COVERAGE,
your business, or a suit seeking damages brought A.Coverage is amended by adding the following;
by the spouse, child, parent, brother or sister of that
fellow "employee", is brought against you, we will S. Hired Auto Physical Damage
reimburse reasonable costs that you incur in the If hired "autos" are covered "autos" for Liability
defense of such matters. Any reimbursement made Coverage and if Comprehensive, Specified
pursuant to this sub-section will be in addition to the Causes of Loss, or Collision coverages are pro-
limits of liability set forth in the Declarations, vided under this coverage form for any "auto''
you own, then the Physical Damage Coverages
SECTION III — PHYSICAL DAMAGE COVERAGE provided are extended to"autos"you hire of like
AMENDMENTS kind and use, subject to the following:
A. Transportation Expense—Limits Amended a. The most we will pay for any one "loss" is
SECTION III — PHYSICAL DAMAGE COVERAGE, $50,000 or the actual cash value or cost to
A. Coverage, 4. Coverage Extensions, a. Trans- repair or replace, whichever is less, minus adeductible;
portatlon Expenses is amended by replacing $20
per day/$600 maximum limit with $50 per day/$1000 b. The deductible will be equal to the largest
maximum. deductible applicable to any owned "auto"
for that coverage. Any Comprehensive
B. Hired Auto Physical Damage — Loss Of Use deductible does not apply to "loss" caused
Expenses—Limits Amended by fire or lightening;
SECTION III — PHYSICAL DAMAGE COVERAGE, c. Hired Auto Physical Damage coverage'Is
A. Coverage, 4. Coverage Extensions, b. Loss of excess over any other collectible insurance;
Use Expenses is amended by replacing the$20 per and
day/$600 maximum limit with $50 per day/$750 d. Subject to the above limit, deductible and
maximum limit. excess provisions we will provide coverage
C. Personal Effects Coverage equal to the broadest coverage applicable to
SECTION III — PHYSICAL DAMAGE COVERAGE, any covered"auto"you own.
A. Coverage, 4.Coverage Extensions Is amended If a limit for Hired Auto Physical Damage is
by adding the following: indicated in the Declarations, then that limit
c. Personal Effects replaces, and is not added to, the$50,000 limit
indicated above.
We will pay up to $600 for "loss" to personal
effects,which are:
(1) Owned by an"insured"; and
(2) In or on your covered"auto."
This coverage applies only in the event of the total
theft of your covered"auto." No deductible applies to
this coverage
WN CA 27 06 16 Includes copyrighted material of Insurance Services Office,with its permission Page 3 of 6
F. Rental Reimbursement G. Accidental Airbag Deployment Coverage
SECTION III — PHYSICAL DAMAGE COVERAGE SECTION III — PHYSICAL DAMAGE COVERAGE,
A.Coverage,is amended by adding the following: A.Coverage is amended by adding the following:
6. Rental Reimbursement 7. Accidental Airbag Deployment Coverage
This coverage applies only to a covered"auto"of We will pay to reset or replace factory installed
the private passenger or light truck type as airbag(s) in any covered "auto" for accidental
follows: discharge, other than discharge due to a
a. We will pay for rental reimbursement collision loss.
expenses incurred by you for the rental of a This coverage is applicable only if comprehen-
private passenger or light truck type "auto" sive coverage applies to the covered"auto".
because of"loss" to a covered private pas- This coverage is excess over any other collecti-
senger or light truck type "auto". Payment ble insurance or reimbursement by manufac-
applies in addition to the otherwise applica- tureris warranty.
ble amount of each coverage you have on a
covered private passenger or light truck type H. Auto Loan/Lease Gap Coverage
"auto." No deductibles apply to this SECTION III PHYSICAL DAMAGE COVERAGE,
coverage. Item A., Coverage, is amended by adding the
b. We will pay only for those expenses incurred following:
during the policy period beginning 24 hours B. Auto Loan/Lease Gap Coverage
after the'loss"and ending, regardless of the
policy's expiration, with the lesser of the fol- This coverage applies only to a covered "auto'
lowing number of days: described or designated in the Schedule or in
the Declarations as including physical damage
(1) The number of days reasonably re- coverage.
quired to repair or replace the covered private passenger or light truck type In the event of a covered total "loss" to a
"auto", if"loss" is caused by theft, this covered "auto" described or designated in the
number of days is added to the number Schedule or in the Declarations, we will pay any
of days it takes to locate the covered unpaid amount due on the lease or loan for a
private passenger or light truck type covered"auto"less:
"auto'and return it to you;or a. The amount paid under the Physical
(2) 30 days. Damage Coverage Section on the policy;
c. Our payment is limited to the lesser of the and
following amounts: b. Any:
(1) Necessary and actual expenses (1) Overdue lease/loan payments at the
incurred, or time of the"loss";
(2) $50 per day, up to a maximum of (2) Financial penalties imposed under a
$1,000. lease for excessive use, abnormal wear
d. This coverage does not apply while there and tear or high mileage;
are spare or reserve private passenger or (3) Security deposits not returned by the
light truck type "autos" available to you for lessor;
your operations.
e. If "loss" results from the total theft of a (4) Costs for extended warranties, Credit
Life Insurance, Health, Accident or
covered "auto" of the private passenger or Disability Insurance purchased with the
light truck type,we will pay under this cover- loan or lease; and
age only that amount of your rental reim- (5) Carry-over balances from previous
bursement expenses which is not already ry-
provided for under SECTION III — loans or leases.
PHYSICAL DAMAGE COVERAGE, A.
Coverage,4.Coverage Extensions.
For the purposes of this Rental Reimbursement
coverage, light truck is defined as a truck with a
gross vehicle weight of 10,000 lbs. or less as
defined by the manufacturer as the maximum
loaded weight the auto is designed to cant'.
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SECTION IV — BUSINESS AUTO CONDITIONS C. Unintentional Failure to Disclose Hazards
AMENDMENTS SECTION IV—BUSINESS AUTO CONDITIONS, B.
A. Duties In The Event Of Accident, Claim, Suit Or General Conditions, 2. Concealment, Misrepre-
sentation Or Fraud, is amended by adding the
Loss Amended following paragraph:
SECTION IV—BUSINESS AUTO CONDITIONS, A. If you unintentionally fail to disclose any hazards
Loss Conditions, 2. Duties In The Event Of existing at the inception date of the policy, or during
Accident, Claim, Suit Or Loss, a. is amended by the policy period in connection with any additional
adding the following: hazards, we will not deny coverage under this Cov-
This condition applies only when the "accident" or erage Part because of such failure,
"loss"is known to: D. Employee Hired Auto
(1) You, if you are an individual; SECTION IV—BUSINESS AUTO CONDITIONS, B.
(2) A partner, if you are a partnership; General Conditions, 5. Other Insurance,
(3) An executive officer or insurance manager, if paragraph b. is deleted and replace by the following:
you are a corporation; or b. For Hired Auto Physical Damage Coverage, the
(4) A member or manager, if you are a limited following are deemed to be a covered "autos"
liability company. you own:
But, this section does not amend the provisions (1) Any covered "auto" you lease, hire, rent or
relating to notification of police, protection or exami- borrow.
nation of the property which was subject to the (2) Any covered "auto" hired or rented by your
"loss". "employee" under a contract In that
B. Blanket Waiver of Subrogation individual "employee's" name, with your
permission, while performing duties related
Section IV — BUSINESS AUTO CONDITIONS, A. to the conduct of your business.
Loss Conditions, 5. Transfer of Rights of However, an
Recovery Against Others to Us, is amended by y"auto"that is leased, hired, rented
adding the following exception: or borrowed with a driver is not a covered"auto".
However, we waive any right of recovery we may
have against any person or organization to the
extent required of you by a written contract signed
and executed prior to any "accident" or "loss%
provided that the "accident" or "loss" arises out of
operations contemplated by such contract. The
waiver applies only to the person or organization
designated in such contract.
WN CA 27 as 16 Includes copyrighted material of Insurance Services Office,with its permission Page 5 of 6