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HomeMy WebLinkAboutPW16-245 - Amendment - #2 - COWI North America, Inc. - Value Engineering Study for S 228th St UPRR Grade Separation Project - 11/14/2017 /J,,,gY/ i�n% �/ u KKE T /alr ��/��ol W gSNiNGTON Document 1 an Mf"( I CONTRACT COVER SHEET This is to be completed by the Contract Manager prior to submission to City Clerks Office. All portions are to be completed. If you have questions, please contact City Clerk's Office. Vendor Name: COWI North America, Inc. Vendor Number: JD Edwards Number Contract Number: This is assigned by City Clerk's Office Project Name: S. 2281h St. UPRR Grade Separation Description: ❑ Interlocal Agreement ❑ Change Order ® Amendment ❑ Contract ❑ Other: Contract Effective Date: 11/14/17 Termination Date: 12/31/18 Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Susanne Smith Department: Engineering Contract Amount: 90.00 Approval Authority: (CIRCLE ONE) Department Director Mayor City Council Detail: (i.e. address, location, parcel number, tax id, etc.): Extend the time of completion to December 31, 2018 due to the overall project schedule has ..been extended. _ As of: 08/27/14 KE➢�IT AMENDMENT NO. 2 NAME OF CONSULTANT OR VENDOR: COWI (North America. Inc. CONTRACT NAME & PROJECT NUMBER: S. 2281h St. t1PRR Grade Seoaration ORIGINAL AGREEMENT DATE: Jun This Amendment is made between the City and the above-referenced Consultant or Vendor and amends the original Agreement and all prior Amendments. All other provisions of the original Agreement or prior Amendments not inconsistent with this Amendment shall remain in full force and effect. For valuable consideration and by mutual consent of the parties, Consultant or Vendor's work is modified as follows: 1. Section I of the Agreement, entitled "Description of Work," is hereby modified to add additional work or revise existing work as follows: In addition to work required under the original Agreement and any prior Amendments, the Consultant or Vendor shall: No change is necessary to the Scope of Work, however an amendment is needed to extend the time of completion to December 31, 2018 due to the overall project schedule has been extended. 2. The contract amount and time for performance provisions of Section II "Time of Completion," and Section III, "Compensation," are modified as follows: ...................._. Original Contract Sum, $6,331.30 including applicable WSST __-_ ........_.._.__ _ _ ___... Net Change by Previous Amendments $2,930.00 including applicable WSST _ ....-._ ____............. — Current Contract Amount $9,261.30 including all previous amendments .... -.................... _ _... Current Amendment. Sum $0 _ —_........ Applicable WSST Tax on this $0 Amendment Revised Contract Sum $9,261.30 AMENDMENT - 1 OF 2 ....-------- _ _..._.__.......- Original Time for Completion 12/31/16 (insert date) Revised Time for Completion under 12/31/17 prior Amendments (insert date) Add'I Days Required (t) for this 365 calendar days Amendment Revised Time for Completion 12/31/18 (insert date) The Consultant or Vendor accepts all requirements of this Amendment by signing below, by its signature waives any protest or claim it may have regarding this Amendment, and acknowledges and accepts that this Amendment constitutes full payment and final settlement of all claims of any kind or nature arising from or connected with any work either covered or affected by this Amendment, including, without limitation, claims related to contract time, contract acceleration, onsite or home office overhead, or lost profits. This Amendment, unless otherwise provided, does not relieve the Consultant or Vendor from strict compliance with the ,guarantee and warranty provisions of the original Agreement. All acts consistent with the authority of the Agreement, previous Amendments (if any), and this Amendment, prior to the effective date of this Amendment, are hereby ratified and affirmed, and the terms of the Agreement, previous Amendments (if any), and this Amendment shall be deemed to have applied. The parties whose names appear below swear under penalty of perjury that they are authorized to enter into this Amendment, which is binding on the parties of this contract. IN WITNESS, the parties below have executed this Amendment, which will become effective on the last date written below. --- ._..._. __....._....__ L ENDOR: CITY F1 KENT: CONSULTANT V �r By: _ ✓ .. BY. L�eg4� (signature) siLJ . e) Print Name: ,GA"*"�"�s'',0 )'*i r Print Name: imothLaPorte E (title) (t le) Its!" -�rluo'R. � ta ' i��� �.-r�n,r/G��""�t� Its Public Works C�irector DATE: /I /Z01 3 DATE: __...w...._ ........ ------- _.. - ... _........_.. APPROVED AS TO FORM: (applicable if Mayor's signature required) Kent Law Department cow]-228"uaaa vE-Amd z/S—th AMENDMENT — 2 OF 2 ' CERTIFICATE OF LIABILITY INSURANCE DATE,MMI°° O`YY) 3/30/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS 'RTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LOW. 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 endorsementls). PRODUCER CONTACT WILLIS A&E CERTIFICATE TEAM Willis of Illinois, Inc. NAM -— FAx 233 South Wacker Drive t'uO.Nc"Bx1y.312-288 7700 _ VVC Ndl._312 234 0643 E"MAA, Certificates wIUls.com Suite 2000 .nDarREss: .......,ficartes@wIllis.com IL 80606 ..., ..INSURERIB)AFFORDING COVERAGE MAID# ...... .. ...... _ w .., INSURER A Travelers Indemnity Cori 25658 ........._. .... ... ............... .. ._ ....... .. .... .. ..... . ....... .:...::..... .. - ......... ...... ............ ........ _ INSURED ''',INSURER B�Navigators Insurance Cori 42307 :::_...___------"------------..__._.....------._...._.._.-`-----.....---------------------........._..._..---------........._. CON North America, Inc INsuRFRc Lexinaton Insurance 19437 1191 2nd Ave, Suite 1110 """ " - ""�" """"` Seattle WA 98101 INSORra n, INSURER F' INCIIRFR F. COVERAGES CERTIFICATE NUMBER;357569152 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 POLICIYE�S.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. "INSR" ... ...... ... ......... .... _.....,...rtADDL SWBR`......,,. .........,..,.. """" ',,.'""" POLT_IW `PIND Y tkP ........,..,.._ .,_....,,,.....__ ...... ......________-__ LTR TYPE OF NSURANCE IN-RD WVD POLICY NUMBER IMMIODMIY_VI IMMIDOIVVVYI LIMITS A X COMMERCIAL GENERAL LABILITY Y Y 680-7F350701 4/112017 411/2018 EACH OCCURRENCE $1000,000 Y5E'Y"C"ti 0—LI'H .,.... ______...,... r $1 CLP.IMS MADE X OCCUR R ( a r 000000 PFMIPUIP F ,. .. m . .............� MED EXP(Any one Person) $10,000 PERSONAL&ADS INJURY $1,000000 GIN(L AGGREGA I E LIMI I APPLIES PER GENERAL AGGREGA RE $2000000 g POLICY PRO LOS PRODUCTS-CONNOR AGE $2000000 C .... ...... ...._ 8A-7 F35627A (E&add drentJ__, $ _ AU LIABILITY V V 4fV2017 4l112018 BODILY INJU $1000000 UTGMDBI 0TER ' R V(Porp.lson7 �$ ALL OWNED SCHEDULED BODILY INJURY(Pera001d.np 5 _ AUTOS AUTOS - NON-OAMED 114tOpriR1 Y b&M1ACr— $ HIkED AUTOS AUTOS (leraoddorq)_ $ B UMBRELLA LIAB X OCCUR Y Y CHIIEXR1411111V M1l2017 4/1/2018 EACH OCCURRENCE S5.000,000 X ExCE55 LIAB CLAIMS MADEAGGREGA HE $5000000 DEC ., RFrFNTION"S_ .. ....... $ WORKERS COMPENSATION PER OFIH AND EMPLOYERS'LIABILITY YIN LrNPIJTF FR ANY PROPRIETOR/PARTNER/EXECUTIVE NIA EL EACH ACLI DER $ OFFICER/MEMBER EXCLUOE09 '—"— " (Mardi In NHI EL DISEASE-EA EMPLOYEE'. $ 'If yes,describe order "--"- ---'-"'-- --"--- Q_5CRIPTInN nF r1PFRAPON5 helnw EL DISEASE-POLICY LIMIT 3 C Prafe a.III Liability 27015014 4/1/2017 V1/2018 $3,000,coo per claim $3,000.000 aggregate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO101,AdditionalRema Is.Schedule,may be atlxched if more space Is required) Additional Insured is included in General Liability&Automobile Liability coverage as required by written contract. Excess Liability follows form over the General.Liability, Automobile Liability, and Employers Liability coverage. THE CITY OF KENT, ITS ELECTED AND/OR APPOINTED OFFICIALS, ITS OFFICERS, EMPLOYEES,AGENTS, VOLUNTEERS,AND REPRESENTATIVES ARE ADDITIONALLY INSURED, UNDER THE GENERAL LIABILITY AND AUTO LIABILITY COVERAGES, INSOFAR AS THE WORK, OBLIGATIONS AND ACTIVITIES PERFORMED BY THE OWNER/DEVELOPER AND AUTHORIZED BY THE CITY OF KENT PERMIT ARE CONCERNED. GENERAL LIABILITY AND AUTO LIABILITY POLICIES ARE PRIMARY& NON-CONTRIBUTORY. EXCESS LIABILITY COVERAGE IS FOLLOW FORM EXCESS. 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 Attn: Nancy Yoshltake ACCORDANCE WITH THE POLICY PROVISIONS. 220 4th Avenue South Kent WA 98032 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY POLICYNUMBER 680-7F350701 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Names of Additional Insured Person(s)or Organ izationIs): Any person(s) or organization(s)whom the Named Insured agrees, in a written contract, to name as an additional Insured. Location of Covered Operations: (Information required to complete this Schedule, if not shown above,will be shown in the Declarations.) A. Section II—Who Is An Insured is amended to in- This insurance does not apply to"bodily injury" or clude as an additional insured the person(s) or "property damage" occurring, or "personal injury" organization(s) shown in the Schedule, but only or "advertising Injury" arising out of an offense with respect to liability for"bodily injury", "property committed,after: damage", "personal injury" or "advertising injury" 1. All work, including materials, parts or equip- caused, in whole or in part, by: ment furnished in connection with such work, 1. Your acts or omissions; or on the project (other than service, mainte- 2. The acts or omissions of those acting on your nance or repairs) to be performed by or on behalf; behalf of the additional Insured(s) at the loca- tion of the covered operations has been com- in the performance of your ongoing operations for pleted; or the additional insured(s) at the location(s) desig- nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its in- B. With respect to the insurance afforded to these tended use by any person or organization additional insureds, the following additional exclu- other than another contractor or subcontrac- sions apply: for engaged in performing operations for a principal as a part of the same project. CG D3 61 03 05 Copyright 2005 The St. Paul Travelers Companies, Inc.All rights reserved. Page 1 of 1 f Includes copyrighted material of Insurance Services Office, Inc.with its permission. COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 680-7F350701 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s)Or Organization(s): Any person(s) or organization(s)whom the Named Insured agrees, in a written contract, to name as an additional insured. Location And Description Of Completed Operations Information required to complete this Schedule,if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- location designated and described in the schedule of clude as an additional insured the person(s) or or- this endorsement performed for that additional in- ganization(s) shown in the Schedule, but only with sured and included In the"products-completed opera- respect to liability for"bodily injury" or"property dam- bons hazard". age"caused, in whole or in part, by"your work"at the 0 CG 20 37 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 j j POLICY NUMBER: 680-7F350701 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY, OTHER INSURANCE - ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS b. The"personal injury"or"advertising injury"for COMMERCIAL GENERAL LIABILITY CONDITIONS which coverage is sought arises out of an of- (Section IV), Paragraph 4. (Other Insurance), is fense committed amended as follows: subset lent to the signing and execution of that 1. _ The following is added to Paragraph a. Primary contract or agreement by you. Insurance: 2. The first Subparagraph (2) of Paragraph b. Ex- However,if you specifically agree in a written con- cess Insurance regarding any other primary in- tract or written agreement that the insurance pro- surance available to you is deleted, vided to an additional Insured under this 3. The following is added to Paragraph b. Excess Coverage Part must apply on a primary basis, or Insurance, as an additional subparagraph under a primary and non-contributory basis, this insur- Subparagraph (1): ance Is primary to other insurance that is avall- That Is available to the insured when the insured able to such additional insured which covers such Is added as an additional insured under any other additional insured as a named Insured, and we policy, including any umbrella or excess policy. will not share with that other Insurance, provided that: a. The "bodily injury' or "property damage" for which coverage is sought occurs; and { CG 00 37 04 05 Copyright 2005 The St. Paul Travelers Companies, Inc.All rights reserved. Page 1 of 1 POLICY NUMBER: BA-7F35627A 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 limited 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 L WAIVER OF DEDUCTIBLE—GLASS D. SUPPLEMENTARY PAYMENTS — INCREASED d, 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 11—COVERED AUTOS 2. The following replaces Paragraph b. in B.S., LIABILITY COVERAGE: Other Insurance, of SECTION IV — BUSI- Any person or organization who is required under NESS AUTO CONDITIONS: a written contract or agreement between you and b. 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 Bred "autos"you own: "property damage" occurs and that Is in effect during the policy period, to be named as an addl- (1) Any covered "auto" you lease, hire, floral insured is an "insured" for Covered Autos rent or borrow; and 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" an "employee's" name, with your under the Who Is An Insured provision contained permission, while performing duties in Section Il. related to the conduct of your busi- B. EMPLOYEE HIRED AUTO ness. 1. The following Is added to Paragraph A.I. However, any "auto"that is leased, hired, Who Is An Insured, of SECTION II — 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 A.1., Who Is under a contract or agreement in an "am- An Insured, of SECTION 11—COVERED AUTOS ployee's" name, with your permission, while LIABILITY COVERAGE: CA T4 20 02 15 02015 The Travelers Indemnity Company.AR rights reserved. Page 1 of 3 Includes copyrighled material of Insurance services Office,Inc.with Its permission. POLICY NUMBER: BA-7F35627A COMMERCIAL AUTO Any "employee" of yours is an "insured" while us- (2) An adjustment for depreciation and physieai 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". D. SUPPLEMENTARY PAYMENTS - INCREASED (3) If a repair or replacement results in better LIMITS than like kind or quality,we will not pay for the 1. The following replaces Paragraph A.2.a.(2) of amount of betterment. SECTION If - 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". eluding bonds for related traffic law viola- (5) This Coverage Extension does not apply to: bons) 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. (b) Any "auto" that is hired, rented or. bor- 2. The following replaces Paragraph A.2.a.(4) of rowed from your"employee". SECTION II - COVERED AUTOS LIABILITY COVERAGE: G. PHYSICAL DAMAGE - TRANSPORTATION EXPENSES- INCREASED LIMIT (4) All reasonable expenses Incurred by the The following replaces Mite first sonton a In Para- Joss of earnings up to $500 a day be- graph A.4.a., Transportation Expenses, of COVER- cause of time off from work. SECTION III - PHYSICAL DAMAGE COVER- AGE: E. TRAILERS-INCREASED LOAD CAPACITY We will pay up to $50 per day to a maximum of The following replaces Paragraph C.1. of SEC- $1,500 for temporary transportation expense in- f TION I-COVERED AUTOS: curred by you because of the total theft of a cov- 1. "Trailers" with a load capacity of 3.600 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 CA.b. of SECTION III - PHYSICAL The following is added to Paragraph A.4., Cover- DAMAGE COVERAGE is deleted. age Extensions, of SECTION III - PHYSICAL I. 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 "lass" to wearing ap- (a) $50,000; 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 indemnity Oofspany-All rights reserved. CA T4 2D 02 15 Includes copyrighted malarial of Insuraj�"vices Office,Inc,with its permission. i POLICY NUMBER:BA-7F35627A COMMERCIAL AUTO r I 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 A.1.c., but (c) Security deposits not returned by the les- only: sor; a. If that "auto" is a covered "auto" for Compre- (d) Costs for extended warranties, Credit Life hensive Coverage under this policy; Insurance, Health, Accident or Disability It. The airbags are not covered under any war- Insurance purchased with the loan or ranty;and lease; and c. The alrbags were not intentionally inflated. (e) Carry-aver balances from previous loans or leases. We will pay up to a maximum of $1,000 for any M. BLANKET WAIVER OF SUBROGATION one "loss". L. AUTO LOAN LEASE GAP The following replaces Paragraph A.S., Transfer Of Rights Of Recovery Against Others To Us, The following is added to Paragraph A.4., Cover- of SECTION IV — BUSINESS AUTO CONDI- age Extensions, of SECTION III — PHYSICAL TIONS: DAMAGE COVERAGE: Auto Loan Lease Gap Coverage for Private 5. 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 which Physical Damage Cov- tent required of you by a written contract exe- erage is provided, we will pay any unpaid amount cuted 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 ocn- (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 CA T4 20 02 15 0 2015 The Travelers Indemnity Company.All rights reserved. Page 3 of 3 Indudes copyrighted material of Insurance Services Office,Inc.with Ile permission. POLICY NUMBER: 680-7F350701 ISSUE DATE: 04-01-16 THIS ENDORSEMENT CHANCES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY - NOTICE OF CAN CELLATIONINONRENEWAL PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice of Cancellation: 30 NONRENEWAL: Number of Days Notice of Nonrenewal: PERSON OR ORGANIZATION: ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OF THIS POLICY WILL BE GIVEN, BUT ONLY IF: 1. YOU SEND US A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE I CANCELLATION OF THIS POLICY, AND 2. WE RECEIVED SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS SCHEDULE. ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US. PROVISIONS: A. If we cancel this policy for any statutorily permit- B. If we decide to not renew this policy for any statu- ted reason other than nonpayment of premium, torlty permitted reason, and a number of days Is and a number of days Is shown for cancellation in shown for nonrenewal In the schedule above,we the schedule above, we will mail notice of cancel- will mail notice of the nonrenewal to the person or laden tO the person or Organization shown in the organization shown in the schedule above. We schedule above. We will mail such notice to the will mail such notice to the address shown in the address shown in the schedule above at least the schedule above at least the number of days number of days shown for cancellation in the shown for nomenewal in the schedule above be- schedule above before the effective date of can- Fore the expiration date. cel lation. IL T4 00 12 09 0 2009 The Travelers Indemnity Company Page 1 of 1 COMMERCIAL AUTO POLICY ENDORSEMENT - CA TB 04 04 15 POLICY NUMBER BA-7F35627A ** THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ** NOTICE OF CANCELLATION IT IS AGREED THAT: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY - NOTICE OF CANCELLATION PROVIDED BY US THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: NUMBER OF DAYS NOTICE DF CANCELLATION: 30 PERSON OR ORGANIZATION: ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OF THIS POLICY WILL BE GIVEN, BUT ONLY IF: 1. YOU SEND US A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED SHOWN IN THE DECLARATIONS RECEIVES NOTICE FROM US OF THE CANCELLATION OF THIS POLICY; AND 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS SCHEDULE. ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US. PROVISIONS: A. IF WE CANCEL THIS POLICY FOR ANY STATUTORILY PERMITTED REASON OTHER THAN NONPAYMENT OF PREMIUM WE WILL MAIL NOTICE OF CANCELLATION TO THE PERSON OR ORGANIZATION SHOWN IN THE SCHEDULE ABOVE. WE WILL MAIL SUCH NOTICE TO THE ADDRESS SHOWN IN THE SCHEDULE ABOVE AT LEAST THE NUMBER OF DAYS SHOWN FOR CANCELLATION IN THE SCHEDULE ABOVE BEFORE THE EFFECTIVE DATE OF CANCELLATION. B. IF WE DECI➢E TO NOT RENEW THIS POLICY FOR ANY STATUTORILY PERMITTED REASON, AND A NUMBER OF DAYS IS SHOWN FOR NONRENEWAL IN THE SCHEDULE ABOVE, WE WILL MAIL NOTICE OF THE NONRENEWAL TO THE PERSON OR ORGANIZATION SHOWN IN THE SCHEDULE ABOVE. WE WILL MAIL SUCH NOTICE TO THE ADDRESS SHOWN IN THE SCHEDULE ABOVE AT LEAST THE NUMBER OF DAYS SHOWN FOR NONRENEWAL IN THE SCHEDULE ABOVE BEFORE p THE EXPIRATION DATE. l EFFECTIVE DATE 04-01-16 EXPIRATION DATE 04-01-17 PAGE 0001 DATE OF ISSUE 04-30-15