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PW17-246 - Change Order - #4 - NPM Construction Co. - S 208th ST Rd Repair and Guardrail Installation Project - 10/17/2017
j%dry y � � WMMU W..HI�CTONRecords M %/� Document Of I CONTRACT COVER SHEET This is to be completed by the Contract Manager prior to submission to the City Clerk's Office. All portions are to be completed. If you have questions, please contact the City Clerk's Office at 253-856-5725. Vendor Name: NPM Construction Vendor Number: JD Edwards Number Contract Number: p �7 Z? G ID�' This is assigned by City Clerk's Office Project Name: S. 208th Street Road Repair and Guardrail Installation Description: ❑ Interlocal Agreement M Change Order ❑ Amendment ❑ Contract ❑ Other: No. 4 Contract Effective Date: 10/17/17 Termination Date: 52 working days Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Stephanie Anderson Department: PW - Engineering Contract Amount: $2n.5n6.27 Approval Authority: ❑ Director ® Mayor ❑ City Council Meeting Date Detail: (i.e. address, location, parcel number, tax id, etc.): Change Order #4 addition of crosswalk near Blue Origin is needed based on increased mid-block pedestrian crossing activity between manufacturing facilities. Work is adRded to NPM's active contract to construct the crosswalk on a timely manner. * T CHANGE ORDER NO. #4 NAME OF CONTRACTOR: N'PMI Construction Co. ("Contractor") CONTRACT NAME & PROJECT NUMBER: S 208th Street Road Repair and Guard=i! InstWllatior ORIGINAL CONTRACT DATE: May 31. 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: Install curb ramps, associated pavement markings, and signage for new pedestrian crossing on 21600 block of 76th Avenue S East Hill Elementary School due to a recent traffic study which determined that a new pedestrian crossing with ADA compliant curb ramps and signage are required to ensure pedestrian safety. 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, $303,855.50 (including applicable alternates and WSST) Net Change by Previous Change Orders $69,608.59 (incl. applicable WSST) Current Contract Amount $373,464.09 (incl. Previous Change Orders) Current Change Order $20,506.27 Applicable WSST Tax on this Change $0.00 .v..................... Order Revised Contract Sum $393,970.36 CHANGE ORDER - 1 OF 3 Original Time for Completion 20 working days (insert date) ...................._ .._.._....... Revised Time for Completion under 22 working days prior Change Orders (insert date) ........................... ._................ . Days Required (f) for this Change 10 calendar days Order _......... ..._....... .. _ Revised Time for Completion 52 working days (insert date) 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. _ .._........._........... CONTRACTOR: CITY OF KEN By: ✓� d �'r?t, m By: (S signature) atu Print Name: t ✓ 2J Pint Na ignl Its - A'a is (title) (ti of DATE: 1��' /o / DATE: i / CHANGE ORDER - 2 OF 3 ..._.._._......_......_ ................... _..........._.. APPROVED AS TO FORM: (applicable if Mayor's signature required) Kent Law Department [In this field,you may enter the electronic(ilepa[h where the contract has been saved] CHANGE ORDER - 3 OF 3 T FILE NO: 200.2 CHANGE ORDER WORKSHEET NO. 4 Construction Management Division - Public Works Project: Project Ni 16-3005 Project Engineer: Joe Araucto Fed-Aid No.: N/A Project Manager: Phil McConnell Contractor: NPINI Construction ............ ...................... ................................ Date: 9/13/2017 ................... I. PROPOSED CHANGE Install curb ramps, associated pavement markings, and signage for new pedestrian crossing on 21600 blk of 76" Av S II. REASON AND BACKGROUND FOR CHANGE Recent traffic study determined that a new pedestrian crossing with ADA compliant curb ramps and siqnaqe are required to ensure pedestrian safety for multiple businesses in the area III. METHOD OF PAYMENT NEW PAY ITEM(S) Not Applicable Change Order No. FOR ACCOUNTING USE ONLY ...... ..............I.............. ................. —- -— --------- S h No. Item Description Total Est. Oty this nit Unit Price Total Estimated Cost of Qty PE Item 1 i Demolishion and installion of 1 1 LS $20,506.27 $20,506.27 new curb ramp,associated pavement markings and siqnaqe Inde dent Estim ate EPAYITEM P rrtk�qQNLY- Payment be made � PAY THIS PAY ESTIMATE - REOUIRED _ CQ_at a aterda p1etic1n11cf�__ Materiel SupmittaIaBggyrqA- cog tricn nr New Sub Re_ qrd? No DELETE EXISTING PAY ITEMS) per 1-09.5 Z Not Applicable Change Order No. FOR ACCOUNTING USE ONLY s.h. -No'. B.L. No-- ------ Ite-m—De-scription city unit Unit Price cost of Item ......... ........... ................ ------ Ll independent Estimate Attached - REQUIRED INCREASE/DECREASE TO EXISTING PAY ITEM(S) Not Applicable Change Order No. I FOR ACCOUNTING USE ONLY - Item Descri Q-ty------------ Unit.. nit Price Cost of Item 'Sch. No. B.I."No. REV. DATE: 4/01/10 / FILE NO: 200.2 T _. Independent Estimate Attached - REQUIRED TOTAL ESTIMATED COST OF CHANGE ORDER ,* 20 5 6.27 *Total of the Cost of Item Columns THIS PAY ESTIMATE $20,50„6 27o W„ m„ IV. WORKING DAYS Original Contract 20 Due This Change Order* 10 Previous Total 30 DATE; ,,, ...DATE: * Explanation/Justification Reouired: additional work to contract TOTAL WORKING DAYS* _ 52 *This Change Order + Previous Total All work, materials and measurements to be in accordance with the Standard Specifications and Contract Special Provisions for the type of work described. Capital Projects Manager: �F�r�, �l+ ,Ay(`:rbtun_ _�' ._ ......._. Date: ". I ..'�° „..s.. .A� .. 0 i.I McConni^-....� (//"/ J . + / Construction Supervisor: .. Date. �o - Paul Kuehne Construction Manager: ..n ,..�'' Date: (' � ,✓` Eric Connor 2 REV. DATE: 4/01/10 N P M CONSTRUCTION COMPANY PRi PUBLIC WORKS::COMMERCIAL::RESIDENTIAL ' Concrete Paving &General Construction N P M Construction Lo General Contractor October 5, 2017 Jason Bryant City of Kent 220 Fourth Ave S Kent WA 98032 ADA Added Locations (1) 10011' Ave SE & SE 24011 St (2)76°h Ave S Mid-block REVISION 3 SITE 1: 100rh Ave SE &SE 2401h Street at East Hill Elementary School Mobilization:.........$3,000.00 - Mobilize TESC:......$200.00 - Install 2 EA CS inserts N of future ramps Project Temporary Traffic and Pedestrian Control:........$3,100.00 - Project Traffic Control Plans - Project Temporary Traffic Control Saw Cut & Demo:......$4,992.00 - Approx 100 LF saw cut - Provide temporary access during construction - Remove approx. 60 LF Cement Concrete Curb & Gutter - Remove approx. 7 LF Curb - Remove approx. 40.5 SY Cement Concrete Sidewalk - Remove approx, 25 SY Asphalt Pavement HMA (4" to 6").....$3.600.00 - 9 Tons Cl 'k" PG64-22 Electrical;.......$4,612.00 - Remove Speed Zone Flasher - Remove existing base and restore - New foundation including materials - Install existing Speed Zone Flasher Earthwork and Concrete:......$11,484.00 - Approx. 60 LF New Cement Concrete Curb and Gutter - Approx. 19 SY New Cement Concrete Sidewalk - 2 EA Type Parallel Curb Ramps incl 32 SF Truncated Domes - Approx. 62 LF Pedestrian Curb Permanent Signing:.......$2,945.00 PO Box 1229 V 425.996.0566 LIC#NPMCOCC9070L Maple Valley WA 98038 F 425.99&6673 www.npmconstruction.com N P M CONSTRUCTION COMPANY poli PUBLIC WORKS::COMMERCIAL::RESIDENTIAL P M i Concrete Paving &General Construction N P M Construction Co General Contractor - Remove 2 EA existing CROSSING sign August 23, 2017 ADA Added Locations (1) 100rh Ave SE & SE 240th St (2)76th Ave S Mid-block Page Two Remove 2 EA existing "NO PARKING sign w/post Install new "AHEAD" (24"x12") on existing post Install 2 EA new SCHOOL CROSSING SIGN ASSMBLY (S1-1 [36"x36"], W16-71P [24"x12"] w/posts Install 2 EA new NO STOPPING OR STANDING (R7-402 [12"x18"] Pavement Marking:...........$5,170.00 - Remove existing pavement marking (grinding) - Approx. 140 SF Plastic Crosswalk Approx, 810 LF 4" Plastic Line Cleanup/Restore:............$1,141.00 - Restoration/Clean and Der ize SITE 2: 761h Ave S Mid-block: Mobilization:.........$1,500.00 - Mobilization TESC:............$200.00 - Install 2 EA CB inserts one N and one S of future ramps Project Temporary Traffic and Pedestrian Control:...........$2,550.00 (net add of $800.00) - Project Traffic Control Plans - Project Temporary Traffic Control Saw Cut & Demo;..........$2,870.00 (added $300.00) - Approx 80 LF saw cut (includes gutter edge with intent to not disturb asphalt) - Remove approx. 45 LF Cement Concrete Curb & Gutter - Remove approx. 30 SY Cement Concrete Sidewalk Electrical:...........$300.00 - Adjust 1 EA 3-Box to grade Install City-provided anti-skid lid Earthwork and Concrete:.........$6,669.00 (added $520.00) - Approx. 45 LF New Cement Concrete Curb and Gutter Approx. 14 SY New Cement Concrete Sidewalk - 2 EA Type Parallel Curb Ramps incl 16 SF Truncated Domes - Approx. 23 LF Pedestrian Curb Permanent Signing:.............$1,882.00 - Install new 2 EA W11-2 (30"00") 'mcl Telespar post of l PO Box 1229 V 425.996,0566 LIC 4NPMCOCC9070L Maple Valley WA 98038 F 425.996.6673 www.npmconstruction.corn NT M CONSTRUCTION COMPANY PUBLIC WORKS::COMMERCIAL::RESIDENTIAL Concrete Paving &General Construction PPM Construction Ca General Contractor - Install new 2 EA W16-7P (24"x12") incl no post August 23, 2017 ADA Added Locations (1) 10011h Ave SE & SE 240`h St (2) 761h Ave S Mid-block Page Three Install new 2 EA R1-b (30"x30") incl Telespar post Pavement Marking:.........$3,148.00 - New Plastic Crosswalk - New Plastic Stop Bar (2 Each) Cleanup/Restore:.........$750.00 - Restoration/Clean and Derr iize File Intent & Affidavit:.........$80.00 - File Intent to Pay Prev Wages - File Affidavit of Wages Paid Sales Tax is included on material and rentals Performance/Payment bond is excluded_.please add 3% for bond Total Quote:.............$51,825.00 ADD for Pavement Markings on 76rh Ave S...........$3,948.00 NEW QUOTE TOTAL: $60,193.00 (added $820.00) FOR SATURDAY AND AFTER HOURS WORK ONLY PLEASE ADD 15% TO COVER OVERTIME AND POSSIBLE PLANT FEES Availability: Approx start Mid September Duration: 10 to 12 working days Thank you Nando PO Box 1229 V 425.996.0566 LIC kNPMCOCC9070L Maple Valley WA 98038 F 425.996.6673 www.npmconstruction.com TE CERTIFICATE OF LIABILITY INSURANCE oA8/3/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Lee Anna Bonds HUMBLE 6 DAVENPORT INS BROKERS INC PHONE (425)226-8221. PAX 1'r25p 1,9S-Y}4? (AID,.No,Eiro. INC,Not; 3500 Maple Valley Hwy AIL ADDRESS..LasAnna@humbledavenport.corn INSORERIS)AS HORDING COVERAGE. NAIL Renton WA 98058 MSURERA20hio Security Ins Co 24082 INSURED INSURERB:Travels?r9 Ca,s Ins Ca of Amer 19046 Nando Perry Merlino INsURERc:The Ohio Casualty Insurance Cc 24074 DBA: NPM Construction Co INSUREFi 25443 SE 184th St INSURERS: Maple Valley WA 98038 INSURER Fi COVERAGES CERTIFICATE NUMBER:CL178318387 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 NOTIMTHSTANDING 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 POOL SUER POLICY EFR POL{CYIEXP LTR TYPE OF INSURANCE one. POLICY NUMBER (M 1 14 l UAMJDOO`yyy 1 LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED 1,000,000 A CLAIMS MADEX OCCUR PREMISES(Ea occurrence) S' X PKS54857964 9/2/2017 9/2/2010 PER EXP Any one Person) S 15,000 PERSONAL A ADS INJURY 5 1,000,000 BEN LAGGREGATE UPI FAPPLAS PER GENERAL AGGREGATE S 2,000,000 POLICY X Pi LOC PRODUCTS-COMPIOPAGG 5 2,000,000 OTER. $ AUTOMOBILE LIABILITY COMILICU, JI0 5 1,000,000 B X ANY AUTO DO DI LY I WILEY(Per person) S ALL OWNED SCHEDULED BA1C424929 7/24/2017 7/24/2016 BODILY I NJU RY(Per accident) S AUTOS AUTOS X NOR OWNEDP ROPSV fY CAVIAREX HIRED AUTOS X AUTOS' (Po'ae.di S 91 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 C EXCESS LIAR CLAIMS-MADE AGGREGATE 4 2,000,000 DED RETENTION X E9054857964 9/2/2017 9/2/2018 WORKERS COMPENSATION PER TH AND EMPLOYERS'LIABILITY YIN SrAHITE X ER ANY PROPRIETORPARTNERIEXECU NEE WA Stop Gap EL EACH ACCIDENT S 1,000,000 OFFICERIMEMEER EXCLUDED? NIA A (MandaWry in NH) BKS54857964 9/2/2017 9/2/201e EL DISEASE EA EMPLOYEE S 1,000,000 Ifyee,describe under DESCRIIIFIOIV OF OPERATON9 below ELDISEAS'E-POLICY LINNr $ 1.000.000 DESCRIPTION of OPERATIONS I LOCATIONS I VEHICLES ACORD 101,Additional Remarks Schedule,may be ada ched if more space is required) PROJECT: South 208th Street Road Repair and Guardrail Installation. Project #16-3005. City of Kent Public Works Department is named as additional insured with respects to the operations of the named insured per form CG6810. Coverage is primary and non-contributory and waiver of subrogation applies. Completed operations apply per form CG8583. Per project aggregate applies per form CGB870. Additional Insured Status Applies to the Auto Liabililty, the coverage is primary 5 non-contributory and waiver of subrogation applies per form CAT420. Umbrella Liability follows form. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Kent THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Public Works Department ACCORDANCE WITH THE POLICY PROVISIONS. 400 West Gowe Kent, WA 98032 AUTHORIZED REPRESENTATIVE �y Anne Bon(( :/kEEAld IJ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(2014m) 6_11 A CERTIFICATE OF LIABILITY INSURANCE DATE B/3/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTAC7 Lee Anna Bonds NAME_ HUMBLE b DAVENPORT INS BROKERS INC PHONE Ea): (425)226-8221 FAXAIC No Na: 19251255-9342 3500 Maple Valley Hwy ADDRESS:LeeAnna@humbledavenport.com INSURER(S)AFFORDING COVERAGE NAIC N Renton WA 98058 INSURER A_Ohio Security Ins Cc 24082 INSURED INSURER B:Travelers Cas Ins Co of Amer 19046 Nando Perry Merlino INSURER C:The Ohio Casualty Insurance Cc 24074 DBA: HEM Construction Co INSURER D: 25443 SE 184th St INSURER E: Maple Valley WA 98038 INSIIRFRF' COVERAGES CERTIFICATE NUMBER:CL178318387 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 JAM SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE urvrt POLICY NUMBER IMM t 1MM LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 A CLAIMS MADEX OCCUR PREMIETORENTED 1,DOE,000 DAMAGE (Ea RENTED nce) 5 X BKS54857964 9/2/2017 9/2/2018 MED EXP(Any one person) 5 15,000 PERSONAL E BEV INJURY S 1,000,000 YEN[AGGREGATE LIMIT APPLI ES PER'. GENERAL AGGREGATE 2,000,000 POLICY X FRt7 LOC PRODUCTS-COMNOPAGG 5 2,ODO,000 IV C,T OTHER AUTOMOBILE LIABILITY UONBINED SINGLE LIMIT 1,000,000 (Ea accldarlt) B X ANY AUTO BODILY INJURY(Per Dason) ., AUTONMEO SCHEDULED RA C424929 7/24/2011 7/24/2010 BODILY INJURY f tl [ $ AUTOS AU I OS X ('cr accl en) NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Par accident) " X UMBRELLA LIAR OCCEIR EACH OCCURRENCE $ 2,000,000 L, EXCESS LIAS CLAIMS-MADE AGGREGATE 5 2,000,000 DED RETENTIONS X ES054857964 9/2/2017 9/2/2018 WORKERS COMPENSATION )TRTI)TE9 X oTH AND EMPLOYERS'LIABILITY YINEFY ANY PROPRIETOR/PARTNERIEXECUTIVE WA stop Gap EE EAOH ACOIDEINT $ 1,000,000 OFUCERIMEMBER EXCLUDED' NIA A (Mandatcryio NH) BKS54857964 9/2/2017 9/2/2016 ELDISEASE-EAEMPLOYEE $ 1,000,000 If yyLs,de,Grlba under IDEROR6F_-FON OR OPERATIONS below EL DISEASE POLICYLIMIT 5 1,000,000 DESCRIPTION OF OPERATIONS l LOCATI DNS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be ada ched IT more space is required) Project: 1st Avenue N. Improvements - W. Smith St. to W. James St. Project Number: 07-3033. City of Kent, the WSDOT, Sound Transit, and King County Metro are named as additional insured with respects to the operations of the named insured per form CG8810. Coverage is primary and non-contributory and waiver of subrogation applies. Completed operations apply per form CG8583. Per project aggregate applies per form CG8870. Additional insured and waiver of subrogation applies to the Auto per form CAT420. Excess follow form. CERTIFICATE HOLDER CANCELLATION' (253) 856-6500 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Kent THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Public Works ACCORDANCE WITH THE POLICY PROVISIONS. 400 West Gowe Kent, WA 98032 AUTHORIZED REPRESE NTA TIVE ,a Am", ISuno ./I I I HIV1V ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(2A491) Coverage Is Provided In: Policy Number: Libel ty Ohlo Security Insurance Company W (18( 54 85 79 64 ,r Mutual. Pollcy Period: INS ueancE From 0 9/0 212 01 7 To 091021211118 Common Policy Declarations 12:01 am Standard Time at Insured Mailing Location Named Insured Agent NANDO PHURY MERI INO (423) 126-8221 DBA NPM CONSIRUC110I: HUMELE &. DAVENPORT INS BROKERS INC SUMMARY OF LOCATIONS 'This policy parvidcs coverage Ibr Lhe folksving under one or mmr voverage parts Please refer to Ilia individual Coverage Declarations Schedules, or, rho individual Coverage Forim for locauuns or territory definition ter that specitic Coverage Part. 0001 '25443 SE 184@t Sr, Maple Vallcy, WA 98 09 8-73 04 POLICY FORMS AND ENDORSEMENTS 'Phis section lists the Form_ and Endorsemcnes for your policy, Rcher to these docuinenrs as needed for doodad information concerning your coverage.. FORM NUMBER TITLE CG 00 01 04 13 CoIIUIWI;iel GCHMI Lability Coverage Form - Ckcunuiicc CO 01 81 05 08 W1ohington Chxngcs CO OL 97 12 07 Washingmn Changes Employment-Related Practices: Exclusion CU 04 42 I t 03 .Stop Gap - Employers Liability Coverage Endorsement -Washington CG 04 50 05 08 Washminon Chances - Who is An Insured CG 21 06 05 14 FXCInaIOn A,ceas Or 17i.;elosu2 Of Con Gdontial Or Personal Information And Data-leclaled Liability - With Limited Bodily Injury BxcepGmt CG 11 70 01 15 Cap on Losses from Certified AcL, uf'I nonvm CG 21 76 01 15 Exclusion of Punitive i?arnages Related to a Certified Ac[ of'Larrorism CCi 21 86 12 04 Exclusion - ExW1101 hrvulation and Finish Systems CG 21 96 03 05 Silioa of Silica-Rclatcd Dusk Exclusion - CC] 22 79 04 13 Exclusion - Contriiclms - Professional Liability CG 24 26 04 13 Amcndmcnt of Insued Contract Definition CG 26 77 12 04 Ulashingtu❑ - Fungi or Bacrcria Exclusion CG 84 g4 12 08 EACILISIOn -Consolidated Ltsurame Programs Wiap-IJp CG 8c 99 08 09 Non-Curwhihon Liability Litni(a Same Occurrence In witness' whereof, WC have caused this policy Lo be mgncd by our au(hon/cii offi(els. Mark Touhay Paul Condnn Socmtaty Presidcat To report a claim, call your Agent or 1.800-362-0000 DS 70 21 11 16 O1l'tgt7 54tW%N NO]146H )n NCAOPPNO FoOREO COPY oosoaa PAGF 14 OF 122 i Coverage Is Provided In: Policy Number: (.^PL� Ohio Security Insurance Company BRS(18( 54057964 M L11 LIal, 9450 Seward Road,Fairfield, Ohio 45014 Policy Parise: INSURANCE From 09/02(2017 To 09102/201B 12 01 am Standard Time Common Policy Declarations at insured Mailing Location Named Insured Agent NANDO PERRY MERLLNO (425) 226-8221 DBA NPM CONSTRUCTION FIUMBLE & DAVENPORf INS BROKERS INC REG s� POLICY FORMS AND ENDORSEMENTS - CONTINUED This section lists all of the Norms and F,ndor5ements Cor your policy. Rcfcr to these documents as needed for Mattel de[ailnd infonnahmr c.oucem mg youe coverage. FORM NUMBER TITLE -�= ✓CG 85 83 04 13 Blanket Additional Insured Concoctions - Products - Complclod Operations ✓CG 88 10 04 13 Commercial Gonnral LiabiLly Extension CG 88 67 12 08 Nirocny Dnrnage-Borrowed Equipment - $100,000 Limit �'CG 88 70 12 08 Consnuelion Project(s)-General Aggregate Limit (Per Project) CG 88 77 12 08 Medical Expense AC Your Request Endoesement CG 89 27 10 09 Washington Exclusion -Asbestos CO 91 98 95 15 Disclosure and Notice Caneeming Fully Fanned and Minimi a Flermurn Endorsements CL 01 03 03 10 Common Poliuy Condition, - Washington CL 04 65 01 01 Loss payable Endorwinerrt-Washington CL 06 00 01 15 Certfiied Tenodsrn Loss CL 07 00 10 06 Virus or Bacteria Exclusion CM 76 l3 07 13 Waiver of'Iheft Deductible IL 01 23 1 1 13 Washington Charges - Defense Costs IF 01 46 08 10 Washington Common Policy Conditions 1L 01 98 09 08 Nuclear Energy Liability Exclusion Endorsement (Broad Form) IM 20 97 04 04 Amcndalory Endorsement - Washington 11vf 70 00 04 04 Contractors` Equipment Coverage 1NI 71 00 06 04 Installation Floeter Coverage IM 79 02 05 04 Loss Payable Schedule to report a claim, call your Agent or 1.800-362-0000 DS 70 21 11 16 07/2I/11 64667964 N01746BO 235 NCAOPPNO INSUBEa COPY 005040 PAGE 15 OF 122 TRAVELERSJ POLICY NUMBER: BA-I C424929-17-SEL EFFECTIVE DATE: 07-24-1 7 ISSUE DATE: OG-05-17 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS. SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS. IL TO 02 11 89 COMMON POLICY DECLARATIONS IL T8 01 10 93 FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS IL TO 05 06 10 COMMON POLICY CONDITIONS-WASHINGTON COMMERCIAL AUTOMOBILE CA TO 01 02 15 BA- COVERAGE PART DECS (ITEMS 1 & 2) CA TO 02 02 15 BA COVERAGE PART DECS (ITEM 3) CA TO 03 02 15 BA COVERAGE PART DECS (ITEMS 4 & 5) CA TO 31 02 15 TABLE OF CONTENTS-BUSINESS AUTO COV FORM CA 00 01 10 13 BUSINESS AUTO COVERAGE FORM CA T4 20 02 15 AUTO COVERAGE PLUS ENDORSEMENT CA T4 59 02 15 AMENDMENT OF EMPLOYEE DEFINITION CA 01 35 10 13 WASHINGTON CHANGES INTERLINE ENDORSEMENTS IL T4 12 03 15 AMNDT COMMON POLICY COND-PROHIBITED COVG IL 01 23 11 13 WASHING70N CHANGES - DEFENSE COSTS IL 01 98 09 06 NUCLEAR ENERGY LIABILITY EXCLUSION es o� _s IL TS 01 10 99 PAGE : 1 OF 1 o19 a15 COMMERCIAL GENERAL LIABILITY CG 88 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY EXTENSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART INDEX Oil SUBJECT PAGE NON-OWNED AIRCRAFT 2 NON-OWNED WATERCRAFT 2 PROPERTY DAMAGE LIABILITY -ELEVATORS 2 EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) 2 MEDICAL PAYMENTS EXTENSION 3 EXTENSION OF SUPPLEMENTARY PAYMENTS -COVERAGES AAND B 3 ADDITIONAL INSUREDS -BY CONTRACT, AGREEMENT OR PERMIT 3 PRIMARY AND NON-CONTRIBUTORY. ADDITIONAL INSURED EXTENSION 5 ADDITIONAL INSUREDS -EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE" 8 WHO IS AN INSURED -INCIDENTAL MEDICAL ERRORS/MALPRACTICE AND WHO IS AN INSURED -FELLOW EMPLOYEE EXTENSION -MANAGEMENT EMPLOYEES 8 NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES T FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES T KNOWLEDGE OF OCCURRENCE, OFFENSE,CLAIM OR SUIT T LIBERALIZATION CLAUSE T BODILY INJURY REDEFINED T EXTENDED PROPERTY DAMAGE 8 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - 8 WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU © 2013Liberly Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office,mc.,wlth Its permission. Page 1 of 8 VVith respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. A. NON-OWNED AIRCRAFT Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability, exclusion g, Aircraft, Auto Or Watercraft does not apply to an aircraft provided: 1. It is not owned by any insured, 2. It is hired, chartered or loaned with a trained paid crew; 3. The pilot in command holds a currently effective certificate, issued by the duly constituted authority of the United States of America or Canada, designating her or him a commercial or airline pilot; and 4. It is not being used to carry persons or property for a charge. However, the insurance afforded by this provision does not apply if there Is available to the insured other valid and collectible insurance, whether primary, excess (other than insurance written to apply specifically in excess of this policy), contingent or on any other basis, that would also apply to the loss covered under this provision. B. NON-OWNED WATERCRAFT Under Paragraph 2. Exclusions of Section I-Coverage A-Bodily Injury And Property Damage Liability, Subparagraph (2) of exclusion g.Aircraft, Auto Or Watercraft is replaced by the following: This exclusion does not apply to: (2) A watercraft you do not own that is: (a) Less than 52 feet long; and I Not being used to carry persons or property for a charge. C. PROPERTY DAMAGE LIABILITY -ELEVATORS 1. Under Paragraph 2. Exclusions of Section I -Coverage A -Bodily Injury And Property Damage Liabil- ity, Subparagraphs (3), (4) and (6) of exclusion j. Damage To Property do not apply if such "property damage" results from the use of elevators. For the purpose of this provision, elevators do not include vehicle lifts. Vehicle lifts are lifts or hoists used in automobile service or repair operations. 2. The following is added to Section IV - Commercial General Liability Conditions, Condition 4. Other Insurance, Paragraph Is. Excess Insurance: The insurance afforded by this provision of this endorsement is excess over any property insurance, whether primary, excess, contingent or on any other basis. D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) If Damage To Premises Rented To You is not otherwise excluded from this Coverage Part: 1. Under Paragraph 2. Exclusions of Section I-Coverage A-Bodily Injury and Property Damage Liability: a. The fourth from the last paragraph of exclusion j. Damage To Property is replaced by the follow- ing: Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire, lightning, explosion, smoke, or leakage from an automatic fire protection system) to: (1) Premises rented to you for a period of 7 or fewer consecutive days; or (if) Contents that you rent or lease as part of a premises rental or lease agreement for a period of more than 7 days. Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" to contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described in Section III - Limits of Insurance. © 2013 Liberty Mutual Insurance CG 8B 10 04 13 Includes copyrighted rnalerial of Insurance Services Office,Inc.,with its permission. Page 2 of 8 b. The last paragraph of subsection 2. Exclusions is replaced by the following: Exclusions c, through n. do not apply to damage by fire, lightning, explosion, smoke or leakage from automatic fire protection systems to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to Damage To Premises Rented To You as described in Section III -Limits Of Insurance. 2. Paragraph 6. under Section III -Limits Of Insurance is replaced by the following: 6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to: a. Any one premise: ®_ (1) While rented to you; or (2) While rented to you or temporarily occupied by you with permission of the owner for ® damage by fire, lightning, explosion, smoke of leakage from automatic protection sys-tems; or b. Contents that you rent or lease as part of a premises rental or lease agreement. ® 3. As regards coverage provided by this provision D. EXTENDED DAMAGE TO PROPERTY RENTED TO -® YOU (Tenant's Property Damage) - Paragraph 9.a. of Definitions is replaced with the following: _ 9.a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, or leakage from automatic fire protection systems to premises while rented to you or temporarily occupied by you with the permission of the owner, or for damage to contents of such premises that are included in your premises rental or lease agreement, is not an "insured contract". E. MEDICAL PAYMENTS EXTENSION If Coverage C Medical Payments is not otherwise excluded, the Medical Payments provided by this policy are amended asfollows: Under Paragraph 1. Insuring Agreement of Section I -Coverage C -Medical Payments, Subparagraph (b) of Paragraph a. is replaced by the following: (b) The expenses are incurred and reported within three years of the date of the accident; and F. EXTENSION OF SUPPLEMENTARY PAYMENTS -COVERAGES AAND B 1. Under Supplementary Payments -Coverages A and B, Paragraph i.b. is replaced by the following: b. Up to $3,000 for cost of bail bonds required because of accidents or traffic law violations arising cut of the use of any vehicle to which the Bodily Injury Liability Coverage applies, We do not have to furnish these bonds. 2. Paragraph i.d. is replaced by the following: d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $500 a day because of time off from work. G. ADDITIONAL INSUREDS -BY CONTRACT, AGREEMENT OR PERMIT 1. Paragraph 2. under Section II -Who Is An Insured is amended to include as an insured any person or organization whom you have agreed to add as an additional insured in a written contract, written agreement or permit. Such person or organization is an additional insured but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused in whole or in part by: a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your on going operations for the additional insured that are the subject of the written contract or written agreement provided that the "bodily injury" or "property damage" occurs, or the "per- sonal and advertising Injury" is committed, subsequent to the signing of such written contract or written agreement; or © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 3 of 8 b. Premises of facilities rented by you or used by you; or c. The maintenance, operation or use by you of equipment rented or leased to you by such person or organization; or d. Operations performed by you or on your behalf for which the state or political subdivision has Issued a permit subject to the following additional provisions: (1) This insurance does not apply to "bodily injury", "property damage", or "personal and ad- vertising injury" arising out of the operations performed for the state or political subdivision; (2) This insurance does not apply to "bodily injury" or "property damage" included within the "completed operations hazard". (3) Insurance applies to premises you own, rent, or control but only with respect to the following hazards: (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 expo- sures; or (b) The construction, erection, or removal of elevators; or (c) The ownership, maintenance, or use of any elevators covered by this insurance. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insur- ance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. With respect to Paragraph 1.a. above, a person's or organization's status as an additional insured under this endorsement ends when: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project.. With respect to Paragraph 1.b. above, a person's or organization's status as an additional insured under this endorsement ends when their written contract or written agreement with you for such premises or facilities ends. With respects to Paragraph i.e. above, this insurance does not apply to any "occurrence" which takes place after the equipment rental or lease agreement has expired or you have returned such equipment to the lessor. The insurance provided by this endorsement applies only if the written contract or written agreement is signed prior to the "bodily injury" or"property damage". We have no duty to defend an additional insured under this endorsement until we receive written notice of a "suit" by the additional insured as required in Paragraph b. of Condition 2. Duties In the Event Of Occurrence, Offense, Claim Or Suit under Section IV - Commercial General Liability Condi- tions. © 2013LIbeuy Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office,Inc_,with its permission. Page 4 of 8 2. With respect to the insurance provided by this endorsement, the following are added to Paragraph 2. Exclusions under Section I-Coverage A-Bodily Injury And Property Damage Liability: This insurance does not apply to: a. "Bodily injury' or "property damage" arising from the sole negligence of the additional insured. b. "Bodily Injury" or "property damage" that occurs prior to you commencing operations at the location where such "bodily injury" or "property damage" occurs. c. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the render- ing of, or the failure to render, any professional architectural, engineering or surveying services, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (2) Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in ® the supervision, hiring, employment, training or monitoring of others by that insured, if the ''occur- rence" which caused the "bodily injury" or "property damage", or the offense which caused the ® "personal and advertising injury", involved the rendering of, or the failure to render, any professional architectural, engineering or surveying services. of "Bodily Injury" or "property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed, or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. e. Any person or organization specifically designated as an additional insured for ongoing operations by a separate ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS endorsement is- sued by us and made a part of this policy. 3. With respect to the insurance afforded to these additional insureds, the following Is added to Section III -Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits of Insurance shown in the Declarations; whichever Is less. This endorsement shall not increase the applicable Limits of Insurance shown In the Declaralio ns. H. PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED EXTENSION This provision applies to any person or organization who qualifies as an additional insured under any form " or endorsement under this policy. Condition 4. Other Insurance of SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS is amend- ed as follows: a. The following is added to Paragraph a. Primary Insurance: If an additional insured's policy has an Other Insurance provision making Its policy excess, and you have agreed in a written contract or written agreement to provide the additional insured coverage on a primary and noncontributory basis, this policy shall be primary and we will not sock contribution from the additional insured's policy for damages we cover. w 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office,Inc ,with Its permission. Page 5 of 8 I The following is added to Paragraph b. Excess Insurance: When a written contract or written agreement, other than a premises lease, facilities rental contract or agreement, an equipment rental or lease contract or agreement, or permit issued by a state or political subdivision between you and an additional insured does not require this insurance to be primary or primary and non-contributory, this insurance is excess over any other insurance for which the addi- tional insured is designated as a Named Insured. Regardless of the written agreement between you and an additional insured, this insurance is excess over any other Insurance whether primary, excess, contingent or on any other basis for which the additional Insured has been added as an additional insured on other policies, I. ADDITIONAL INSUREDS -EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE" This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this policy. 1. The following is added to Condition 2. Duties In The Event Of Occurrence, Offense, Claim or Suit: An additional insured under this endorsement will as soon as practicable a. Give written notice of an "occurrence" or an offense that may result in a claim or "suit" under this insurance to us; b. Tender the defense and indemnity of any claim or "suit" to all insurers whom also have insurance available to the additional insured; and c. Agree to make available any other insurance which the additional insured has for a loss we cover under this Coverage Part. d. We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a"suit" by the additional insured. 2. The limits of insurance applicable to the additional insured are those specified in a written contract or written agreement or the limits of Insurance as stated In the Declarations of this policy and defined in Section III - Limits of Insurance of this policy, whichever are less. These limits are inclusive of and not in addition to the limits of insurance available under this policy. J. WHO IS AN INSURED -INCIDENTAL MEDICAL ERRORS l MALPRACTICE WHO IS AN INSURED -FELLOW EMPLOYEE EXTENSION -MANAGEMENT EMPLOYEES Paragraph 2.a.(1) of Section II-Who Is An Insured is replaced with the following'. (1) "Bodily injury" or "personal and advertising injury": (a) To you, to your partners or members (If you are a partnership or joint venture), to your members (if you are a limited liability company), to a co-"employee" while in the course of his or her employ- ment or performing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of that co-"employee" or "volunteer worker" as a consequence of Paragraph (1) (a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1) (a) or I above, or (d) Arising out of his or her providing or failing to provide professional health care services. However, if you are not in the business of providing professional health care services or providing profes- sional health care personnel to others, or if coverage for providing professional health care ser- vices is not otherwise excluded by separate endorsement, this provision (Paragraph (d)) does not apply. Paragraphs (a) and (b) above do not apply to "bodily injury' or "personal and advertising injury" caused by an "employee" who is acting in a supervisory capacity for you. Supervisory capacity as used herein means the "employee's" job responsibilities assigned by you, includes the direct supervision of other "employ- ees" of yours. However, none of these "employees" are insureds for "bodily Injury" or "personal and 0 20131-iberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 6 of 8 advertising injury" arising out of their willful conduct, which is defined as the purposeful or willful intent to cause "bodily injury" or "personal and advertising injury", or caused in whole or in part by their intoxica- tion by liquor or controlled substances, The coverage provided by provision J. is excess over any other valid and collectable insurance available to your "employee". K. NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES Paragraph 3. of Section II -Who Is An Insured is replaced by the following: 3. Any organization you newly acquire or form' and over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a. Coverage under this provision is afforded only until the expiration of the policy period in which the entity was acquired or formed by you; I Coverage A does not apply to "bodily injury' or "property damage" that occurred before you acquired or formed the organization; and c. Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. d. Records and descriptions of operations must be maintained by the first Named Insured. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations or qualifies as an insured under this provision, — L. FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES Under Section IV -Commercial General Liability Conditions, the following is added to Condition 6. Repre- sentations: Your failure to disclose all hazards or prior "occurrences" existing as of the inception date of the policy shall not prejudice the coverage afforded by this policy provided such failure to disclose all hazards or prior "occurrences" is not intentional. M. KNOWLEDGE OF OCCURRENCE, OFFENSE,CLAIM OR SUIT Under Section IV - Commercial General Liability Conditions, the following is added to Condition 2. Duties In The Event of Occurrence, Offense, Claim Or Suit: Knowledge of an "occurrence', offense, claim or "suit" by an agent, servant or "employee" of any insured shall not in itself constitute knowledge of the insured unless an insured listed under Paragraph 1. of Section II -Who Is An Insured or a person who has been designated by them to receive reports of "occurrences", offenses, claims or "suits' shall have received such notice from the agent, servant or "employee". N. LIBERALIZATION CLAUSE If we revise this Commercial General Liability Extension Endorsement to provide more coverage without additional premium charge, your policy will automatically provide the coverage as of the day the revision is effective in your state. 0. BODILY INJURY REDEFINED Under Section V -Definitions, Definition 3. is replaced by the following: 3. "Bodily Injury" means physical injury, sickness or disease sustained by a person. This includes mental anguish, mental injury, shack, fright or death that results from such physical injury, sick- ness or disease. © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 7 of 8 P. EXTENDED PROPERTY DAMAGE Exclusion a. of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY is replaced by the following: a. Expected Or Intended Injury "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. Q. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - WHEN REQUIRED IN A CONTRACT ORAGREEMENT WITH YOU Under Section IV -Commercial General Liability Conditions, the following is added to Condition 8. Trans- fer Of Rights Of Recovery Against Others To Us: We waive any right of recovery we may have against a person or organization 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" provided: 1. You and that person or organization have agreed in writing in a contract or agreement that you waive such rights against that person or organization; and 2. The injury or damage occurs subsequent to the execution of the written contract or written agree- ment. © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission.. Page 8 of 8 COMMERCIAL GENERAL LIABILITY CG 85 83 04 13 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED CONTRACTORS—PRODUCTSICOMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Paragraph 2.under Section 11—Who Is An Insured Is amended to include as an insured any person or organization whom you have agreed to add as an additional Insured In a written contract or written agreement.Such person or organization is an additional insured but only with respect to liability for 'bodily injury"or"property damage": 1. Caused by"your work"performed for that additional insured that is the subject of the written contract or written agreement',and 2. Included in the"productscompleled operations hazard". However: a) The insurance afforded to such additional insured only applies to the extent permitted by law;and b) If coverage provided to the additional Insured is required by a contract or agreement.the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additlonal insured i The insurance provided by this endorsement applies only if the written contract or written agreement is signed prior to the"bodily injury"or"property damage". 'Ii We have no duty to defend an additional insured under this endorsement until we receive written notice of a'suit"by the additional insured as required In Paragraph b.of Condition 2.Duties In The Event OF Occurrence,Offense,Claim Or Suit under Section IV—Commercial General Liability Conditions. j B. With respect to the insurance provided by this endorsement,the following are added to Paragraph 2. Exclusions under Section I—Coverage A—Bodily Injury And Property Damage Liability: This insurance does not apply to: 1. "Bodily injury'or'property damage"that occurs prior to you commencing operations at the location where such"bodily injury"or"property damage"occurs. 2. "Bodily injury'or"property damage"arising out of the rendering of,or the failure to render,any professional architectural,engineering or surveying services including: a. The preparing,approving or failure to prepare or approve,maps,shop dawings, opinions,reports,surveys,field orders,change orders or drawing and specifications;and b. Supervisory,Inspection,architectural or engineering activities. C 2013114erty Mutual Insurance CG 85 83 0413 Indudes copyrighted material of Insurance Services Once,Inc.,with Its pennlsslon. Page 1 of 2 C. With respect to the Insurance afforded by this endorsement,oxcluslon I.Damage To Your Work of Paragraph 2,Exclusions.under Section I—Coverage A—Bodily Injury And Property Damage Liability is replaced by the following: I. Damage To Your Work "Property damage"to"your work'arising out of it or any part of it and included In the"products- completed operations hazard". D. With respect to the insurance afforded to these additional insureds,the following is added to Section II— Limits of Insurance: If coverage provided to the additional insured is required by a contract or agreement,the most we will pay on behalf of the additional Insured is the amount of insurance: 1. Required by contract or agreement;or 2. Available under the applicable Limits of Insurance shown in the Declaration. whichever Is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. E. With reorient to the insurance afforded by this endorsement,Section IV—Commercial General Liability Conditions is amended as follows. 1. The following is added to Paragraph 2.Duties In The Event Of Occurrence,Offense,Claims Or Suit: An additional insured under this endorsement will as soon as practicable: a. Give written notice of an"occurrence"or an offense that may result in a claim or"suit" under this insurance to us; b. Tender the defense and indemnity of any claim or"suit"to all insurers whom also have insurance available to the additional insured;and 0. Agree to make available any other insurance which the additional insured has for a loss we cover under this Coverage Part. d. We havo no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a"suit"by the additional insured. 2. Paragraph 4.of Section IV—Commercial General Liability Conditions Is amended as follows a. The following is added to paragraph a.Primary Insurance: If an additional insured's policy has an Other Insurance prevision making Its policy excess,and you have agreed In a written contract orwritlen agreement to provide the additional Insured coverage On a primary and noncontributory basis,this policy shall be primary and we will not seek..contribution from the additional Insured's policy for damages we cover. b. The following is added to Paragraph It.Excess Insurance: When a written contract or written agreement,other than a premises lease,facilities rental contract or agreement,an equipment rental or lease contract or agreement,or permit issued by a state or political subdivision between you and an additional insured does not require this insurance to be primary or primary and non-contributory,this Insurance is excess over any other insurance forwhich the additional insured is designated as a Named Insured. Regardless of the written agreement between you and an additional insured,this insurance Is excess over any other Insurance whether primary,excess,contingent Oran any other basis for which the additional Insured has been added as an additional Insured on other policies, 02013 Dbedy Muleal Insurance CG 85 83 04 13 Includes copydghled material of Insurance services Office,Inc.,wtlh its permission Page 2 of 2 COMMERCIAL GENERAL LIABILITY CIS 88 70 12 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, CONSTRUCTION PROJECTS)•GENERAL AGGREGATE LIMIT (PER PROJECT) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A, For all sums which the insured baoarnes legally obligated Ia pay as damages caused by"arcurrences" under Section t-Coverage A•Barfly Injury Arid Property Damage Liability,and Wait medical expenses caused say accidents.under Scotian I-Coverage C Medical Payments,which cart be atlribuled only to ongoing operations at a single construction project away from premises owned by or rented to you: 1• A separate Construction Project General Aggregate Limit applies to each Coesduclien project, and that limit is equal to the amount oflhe General Aggregate Limit shown In the Declarallorm 2. The Conshuclion Project Genteel Agglegala L1rni1 is Ilia ntnst we will pay for the sum at all damages under Coverage A,except damages because of"bodily frrjury'ar'prwporly damage" included in the 'Praducfs=comp9ated operations hazard",and for medical expenses under Coverage C Fogardlass of the number of: a, Insureds; b, Claims made or"suits'brought;or C. Persons or argan¢ations making claims or bringing"suits". 3. Any payments triads under Coverage A far damages or under Coverage C for medical expenses shall reduce Ilia Construction Proleal.General Aggregate Limit for that aonstnecton project.Such payments ;;frail not reduce the General Aggregate Linait shown In the Dealarallons nor shall(trey reduce any other Construction Project General Aggregate.Limit far any other construction project, 4. Tire Ifmils shown In the Declarations for Barb Qrnurrena%Fire Damage stud Medical Expense continue to apply. However,mstead of being subject to tics General Aggregate Limit shown In tie Declarations, such fruits will be subject to Ilia applicable Construction Project General Aggregate LMIL a. For air sums width the Insured becomes legally,obligated to pay as damages caused by"accunenees" under soction l -Coverage A-Bodily Injury And Property Damage Liability,and for all medical expenses caused by accldoms under section I-Coverage C Medical Payments,which cannot be attributed only to ongoing operations at a single constructon project.away front promises owned by or - tented to you: 1. Any payments main under Coverage A for damages or under Coverage 0 for madiml expenses shall reduce the amount available under fie General Aggregate Limit or the Produals•Conrpleled Operations Aggregate Limit,whichever is applicabl%and 2. Such payments shall not reduce any Construction Project General Aggregate Limit C. Mien coverage for tpabifty ar'lsing out of ths'producla-comptoled operations hazard"is provided„any Payments for damages because of"bodily Injuay"or"property damage"included In lba pradurcls- compialsd operations hazard"will reduce tiro Products-Completed Operations Aggregate Until,and not reduce the General Aggregate Limit nor the Construction Project General Aggregate*Limit. D. If phi applicable canstfuelicn project Iids been abandoned delayed,or abandoned and then restarted,or if the authorized contracting parties deviate from pfalls,blueprints,designs,specifications or timetables„ the project will still be d'aamed to be the snore construction project, E. The provisions of Section III•Limits Of Insurance not otherwise modified by this endorsement shall continue to apply. CG 68 70 12 03 Includes copyrighted meledal or 180 Prepares,Inc.,wit Its permission, Page 1 of 1 l COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, AUTO COVERAGE PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE—This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or rallied by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BLANKET ADDITIONAL INSURED H. AUDIO, VISUAL AND DATA ELECTRONIC B. EMPLOYEE HIRED AUTO EQUIPMENT—INCREASED LIMIT C. EMPLOYEES AS INSURED I. WAIVER OF DEDUCTIBLE—GLASS D. SUPPLEMENTARY PAYMENTS — INCREASED J. PERSONAL PROPERTY LIMITS K. AIRBAGS E. TRAILERS—INCREASED LOAD CAPACITY L. AUTO LOAN LEASE GAP F. HIRED AUTO PHYSICAL DAMAGE M. BLANKET WAIVER OF SUBROGATION G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES—INCREASED LIMIT A. BLANKET ADDITIONAL INSURED performing duties related to the conduct of The following is added to Paragraph A.1., Who Is your business. An Insured, of SECTION II—COVERED AUTOS 2. The following replaces Paragraph b. in 6.5., .c LIABILITY COVERAGE: Other Insurance, of SECTION IV — BUST- - Any person or,organization who is required under NESS AUTO CONDITIONS: a written contract or agreement between you and It. For Hired Auto Physical Damage Cover- that person or organization, that is signed and age, the following are deemed to be cov- executed by you before the "bodily injury" or ered"autos"you own: "property damage" occurs and that is in effect (1) Any covered "auto" you lease, hire, during the policy period, to be named as an addi- rent or borrow; and tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which (2) Any covered "auto" hired or rented by this insurance applies and only to the extent that your "employee" under a contract in person or organization qualifies as an "insured" ail "employee's" name, with your under the Who Is An Insured provision contained permission, while performing duties in Section II related to the conduct of your bust- -_ B. EMPLOYEE HIRED AUTO less. 1. The following is added to Paragraph A.1., However, any"auto"that is leased, hired, Who Is An Insured, of SECTION 11 — COV- rented or borrowed with a driver is not a ERED AUTOS LIABILITY COVERAGE: covered"auto". An "employee" of yours is an "insured" while C. EMPLOYEES AS INSURED operating a covered "auto" hired or rented The following is added to Paragraph AA., Who Is under a contract or agreement in an "am- An Insured, of SECTION It—COVERED AUTOS ployee's" name, with your permission, while LIABILITY COVERAGE: CA T4 20 02 15 zu 2015 The Travelers Ind emnily Company.All rights reserved. Page 1 of 3 Includes copyrighted material of Insurance Services Office,Inc,with Its permission. anazs COMMERCIAL AUTO Any "employee" of yours is an "insured"while us- (2) An adjustment for depreciation and physical ing a covered"auto" you don't own, hire or borrow condition will be made in determining actual in your business or your personal affairs. cash value In the event of a total"loss". O. SUPPLEMENTARY PAYMENTS — INCREASED (3) If a repair or replacement results in better LIMITS than like kind ar quality, we will not pay for the 1. The following replaces Paragraph A.2.a.(2) of amount of betterment. SECTION 11—COVERED AUTOS LIABILITY (4) A deductible equal to the highest Physical COVERAGE: Damage deductible applicable to any owned (2) Up to $3,000 for cost of bail bonds (in- covered"auto". cluding bonds for related traffic law viola- (5) This Coverage Extension does not apply to: tons) required because of an "accident" (a) Any "auto" that is hired, rented or bor- we cover. We do not have to furnish rowed with a driver; or these bonds. 2. The following replaces Paragraph A.2.a.(4) of (bl Any "auto" that is Hired, rented or bor- SECTION II—COVERED AUTOS LIABILITY rowed from your"employee COVERAGE: G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES—INCREASED LIMIT (4) All reasonable expenses incurred by the "insured" at our request, including actual The following replaces the fast sentence in Para- loss of earnings up to $500 a day be- graph A.4.a., Transportation Expenses, of cause of time off from work. SECTION III — PHYSICAL DAMAGE COVER- E. TRAILERS—INCREASED LOAD CAPACITY AGE: EC- We will pay up to $50 per day to a maximum of The following replaces Paragraph C.I. of S $1,500 for lernporary transportation expense in- TION I—COVERED AUTOS: curved by you because of the total theft of a COV- 1 "Trailers' with a load capacity of 3,000 ered"auto"of the private passenger type. pounds or less designed primarily for travel H. AUDIO, VISUAL AND DATA ELECTRONIC on public roads. EQUIPMENT—INCREASED LIMIT F. HIRED AUTO PHYSICAL DAMAGE Paragraph C.1.b. of SECTION III — PHYSICAL The following is added to Paragraph A.4., Cover- DAMAGE COVERAGE Is deleted. age Extensions, of SECTION III — PHYSICAL 1. WAIVER OF DEDUCTIBLE—GLASS DAMAGE COVERAGE: The following is added to Paragraph D., Deducti- Hired Auto Physical Damage Coverage ble, of SECTION III — PHYSICAL DAMAGE If hired "autos" are covered "autos" for Covered COVERAGE: Autos Liability Coverage but not covered "autos" No deductible for a covered "auto" will apply to for Physical Damage Coverage, and this policy glass damage if the glass is repaired rather than also provides Physical Damage Coverage for an replaced. owned "auto", then the Physical Damage Cover- J. PERSONAL PROPERTY age Is extended to "autos" that you hire, rent or The following is added to Paragraph A.4., Cover- borrow subject to the following: age Extensions, of SECTION III — PHYSICAL (1) The most we will pay for "loss" to any one DAMAGE COVERAGE: "auto" that you hire, rent or borrow is the Personal Property Coverage lesser of: We will pay up to $400 for "loss" to wearing ap- (a) $50,001 parel and other personal property which is: (b) The actual cash value of the damaged or (1) Owned by an"insured"; and stolen property as of the time of the (2) In or on your covered"auto". "loss";or This coverage only applies in the event of a total (c) The cost of repairing or replacing the theft of your covered"auto". damaged or stolen property with other No deductibles apply to Personal Property cover- property of like kind and quality. age. Page 2 of 3 02015 The Travelers Indemnlly company.All rights reserved. CA T4 20 02 15 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL.AUTO K. AIRBAGS (2) Any: The following is added to Paragraph B.3., Exclu. (a) Overdue lease or loan payments at the sions, of SECTION III — PHYSICAL DAMAGE time of the"loss" COVERAGE: (b) Financial penalties imposed under a Exclusion 3.a. does not apply to "loss" to one or lease for excessive use, abnormal wear more airbags in a covered "auto"you own that in- and tear or high mileage; flate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and AA.c., but (c) Security deposits not returned by the les- only: sor; a. If that "auto" Is a Covered "auto" for Cumfore- (d) Costs for extended warranties, Credit life hensive Coverage under this policy; Insurance, Health, Accident or Disability b, The airbags are not covered under any war- Insurance purchased with the loan or ranty; and lease; and c. The airbags were not intentionally inflated. (e) Carry-over balances from previous loans orleases. We will pay up to a maximum of S1,000 for any M. BLANKET WAIVER OF SUBROGATION one "loss". L. AUTO LOAN LEASE GAP The following replaces Paragraph A.5., Transfer The followingIs added to Paragraph A.4., Cover- Of Rights Of Recovery Against Others To Us, 9 of SECTION IV — BUSINESS AUTO CONDI- age Extensions, of SECTION III — PHYSICAL TIONS: DAMAGE COVERAGE: Auto Loan Lease Gap Coverage for Private S. Transfer.Of Rights Of Recovery Against Passenger Type Vehicles Others To Us In the event of a total"loss"to a covered "auto" of We waive any right of recovery we may have the private passenger type shown in the Schedule against any person or organization to the ex- or Declarations for whlch Physical Damage Cow tent required of you by a written contract axe- erage is provided, we will pay any unpaid amount culed prior to any "accident" or "loss", pro- due on the lease or loan for such Covered "auto" vided that the"accident" or"loss"arises out of less the following: the operations contemplated by such con- (1) The amount paid under the Physical Damage tract.The waiver applies only to the person or Coverage Section of the policy for that "auto" organization designated in such contract. and m= a CA T4 20 02 15 V 2015 The Travelers Indemnify Company,All rights reserved. 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