HomeMy WebLinkAboutPW18-006 - Original - Northstar Chemical, Inc. - 2018 Water Treatment Chemical Supply - 01/02/2018 Records Manag
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wa o Document
CONTRACT COVER SHEET
This is to be completed by the Contract Manager prior to submission
to City Clerks Office. All portions are to be completed.
If you have questions, please contact City Clerk's Office.
Vendor Name: Northstar Chemical Inc.
Vendor Number:
JD Ed..�wards Number
Contract Number:
This is assigned by City Clerk's Office
Project Name: 2018 Water Treatment Chemical Supply
Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment M Contract
❑ Other:
Contract Effective Date: 1/2/18 Termination Date: 12/31/18
Contract Renewal Notice (Days):
Number of days required notice for termination or renewal or amendment
Contract Manager: Tom Cunninqham Department: PW Operations
Contract Amount: $4,752.00
Approval Authority: (CIRCLE ONE) ( Department Director Mayor City Council
Detail: (i.e. address, location, parcel number,t id, etc.):
Provide water treatment chemicals for 2018.
As of: 06/27/14
L I
NT
GOODS & SERVICES AGREEMENT
between the City of Kent and
Northstar Chemical, Inc.
THIS AGREEMENT is made by and between the City of Kent, a Washington municipal corporation
(hereinafter the "City"), and Northstar Chemical, Inc. organized under the laws of the State of
Washington, located and doing business at 14200 SW Tualatin-Sherwood Rd., Sherwood, OR 97140,
Phone: (503) 625-3770, Contact: Julie DeBellis (hereinafter the "Vendor").
AGREEMENT
I. DESCRIPTION OF WORK.
Vendor shall provide the following goads and materials and/or perform the following services for
the City:
The Vendor shall supply the City of Kent Water Department with a water treatment chemical
(bid item 7) according to the bid proposal submitted October 24, 2017, which is attached as
Exhibit A and incorporated by this reference.
Vendor acknowledges and understands that it is not the City's exclusive provider of these goods,
materials, or services and that the City maintains its unqualified right to obtain these goods, materials,
and services through other sources.
II. TIME OF COMPLETION. Upon the effective date of this Agreement, Vendor shall complete
the work and provide all goods, materials, and services by December 31, 2018.
III. COMPENSATION. The City shall pay the Vendor an amount not to exceed Four Thousand,
Seven Hundred Fifty Two Dollars ($4,752.00), including applicable Washington State Sales Tax, for the
goods, materials, and services contemplated in this Agreement. The City shall pay the Vendor the
following amounts according to the following schedule:
............................................................................
_
Compensation of up to $4,752.00 is based on an estimate annual need. Actual need may
vary as follows:
Item 7: zero to 2,400 gals.
Therefore, actual compensation will be between $0 and $4,752.00 and be based on the
exact quantity of chemicals ordered by the City.
Vendor shall be paid after submittal of invoice.
GOODS & SERVICES AGREEMENT - 1
($20,000 or Less, incl. WSST)
If the City objects to all or any portion of an invoice, it shall notify Vendor and reserves the option
to only pay that portion of the invoice not in dispute. In that event, the parties will immediately make
every effort to settle the disputed portion.
A. Defective pr!Jnauthorized Work. The City reserves its right to withhold payment from
Vendor for any defective or unauthorized goods, materials or services. If Vendor is unable,
for any reason, to complete any part of this Agreement, the City may obtain the goods,
materials or services from other sources, and Vendor shall be liable to the City for any
additional costs incurred by the City. "Additional costs" shall mean all reasonable costs,
including legal costs and attorney fees, incurred by the City beyond the maximum
Agreement price specified above. The City further reserves its right to deduct these
additional costs incurred to complete this Agreement with other sources, from any and all
amounts due or to become due the Vendor.
B. Final Payment: Waiver of Claims. VENDOR'S ACCEPTANCE OF FINAL PAYMENT SHALL
CONSTITUTE A WAIVER OF CLAIMS, EXCEPT THOSE PREVIOUSLY AND PROPERLY MADE
AND IDENTIFIED BY VENDOR AS UNSETTLED AT THE TIME REQUEST FOR FINAL PAYMENT
IS MADE.
IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent Contractor-
Employer Relationship will be created by this Agreement. By their execution of this Agreement, and in
accordance with Ch. 51.08 RCW, the parties make the following representations:
A. The Vendor has the ability to control and direct the performance and details of its
work, the City being interested only in the results obtained under this Agreement.
B. The Vendor maintains and pays for its own place of business from which Vendor's
services under this Agreement will be performed.
C. The Vendor has an established and independent business that is eligible for a
business deduction for federal income tax purposes that existed before the City
retained Vendor's services, or the Vendor is engaged in an independently established
trade, occupation, profession, or business of the same nature as that involved under
this Agreement.
D, The Vendor is responsible for filing as they become due all necessary tax documents
with appropriate federal and state agencies, including the Internal Revenue Service
and the state Department of Revenue.
E, The Vendor has registered its business and established an account with the state
Department of Revenue and other state agencies as may be required by Vendor's
business, and has obtained a Unified Business Identifier (UBI) number from the
State of Washington.
F. The Vendor maintains a set of books dedicated to the expenses and earnings of its
business.
V. TERMINATION. Either party may terminate this Agreement, with or without cause, upon
providing the other party thirty (30) days written notice at its address set forth on the signature block of
this Agreement.
VI. CHANGES. The City may issue a written amendment for any change in the goods,
materials or services to be provided during the performance of this Agreement. If the Vendor determines,
for any reason, that an amendment is necessary, Vendor must submit a written amendment request to
the person listed in the notice provision section of this Agreement, section XIV(D), within fourteen (14)
calendar days of the date Vendor knew or should have known of the facts and events giving rise to the
requested change. If the City determines that the change increases or decreases the Vendor's costs or
time for performance, the City will make an equitable adjustment. The City will attempt, in good faith, to
GOODS & SERVICES AGREEMENT - 2
($20,000 or Less, including WSST)
reach agreement with the Vendor on all equitable adjustments. However, if the parties are unable to
agree, the City will determine the equitable adjustment as it deems appropriate. The Vendor shall
proceed with the amended work upon receiving either a written amendment from the City or an oral order
from the City before actually receiving the written amendment. If the Vendor fails to require an
amendment within the time allowed, the Vendor waives its right to make any claim or submit subsequent
amendment requests for that portion of the contract work. If the Vendor disagrees with the equitable
adjustment, the Vendor must complete the amended work; however, the Vendor may elect to protest the
adjustment as provided in subsections A through E of Section VII, Claims, below.
The Vendor accepts all requirements of an amendment by: (1) endorsing it, (2) writing a separate
acceptance, or (3) not protesting in the way this section provides. An amendment that is accepted by
Vendor as provided in this section shall constitute full payment and final settlement of all claims for
contract time and for direct, indirect and consequential costs, including costs of delays related to any
work, either covered or affected by the change.
VII. CLAIMS. If the Vendor disagrees with anything required by an amendment, another
written order, or an oral order from the City, including any direction, instruction, interpretation, or
determination by the City, the Vendor may file a claim as provided in this section. The Vendor shall give
written notice to the City of all claims within fourteen (14) calendar days of the occurrence of the events
giving rise to the claims, or within fourteen (14) calendar days of the date the Vendor knew or should
have known of the facts or events giving rise to the claim, whichever occurs first . Any claim for
damages, additional payment for any reason, or extension of time, whether under this Agreement or
otherwise, shall be conclusively deemed to have been waived by the Vendor unless a timely written claim
is made in strict accordance with the applicable provisions of this Agreement.
At a minimum, a Vendor's written claim shall include the information set forth in subsections A,
items 1 through 5 below.
FAILURE TO PROVIDE A COMPLETE, WRITTEN NOTIFICATION OF CLAIM WITHIN
THE TIME ALLOWED SHALL BE AN ABSOLUTE WAIVER OF ANY CLAIMS ARISING IN
ANY WAY FROM THE FACTS OR EVENTS SURROUNDING THAT CLAIM OR CAUSED
BY THAT DELAY.
A„ Notice of Claim. Provide a signed written notice of claim that provides the following
information:
1„ The date of the Vendor's claim;
2. The nature and circumstances that caused the claim;
3, The provisions in this Agreement that support the claim;
4. The estimated dollar cost, if any, of the claimed work and how that estimate
was determined; and
5. An analysis of the progress schedule showing the schedule change or
disruption if the Vendor is asserting a schedule change or disruption.
B, Records. The Vendor shall keep complete records of extra costs and time incurred as a
result of the asserted events giving rise to the claim. The City shall have access to any of
the Vendor's records needed for evaluating the protest.
The City will evaluate all claims, provided the procedures in this section are followed. If the
City determines that a claim is valid, the City will adjust payment for work or time by an
equitable adjustment. No adjustment will be made for an invalid protest.
C. Vendor's Dut to Complete Protested Work. In spite of any claim, the Vendor shall proceed
promptly to provide the goods, materials and services required by the City under this
Agreement.
GOODS & SERVICES AGREEMENT - 3
($20,000 or Less, including NSST)
D, Failure to Protest Constitutes Waiver. By not protesting as this section provides, the Vendor
also waives any additional entitlement and accepts from the City any written or oral order
(including directions, instructions, interpretations, and determination).
E. Fgjolure to Follow Procedures Constitutes Waiver. By failing to follow the procedures of this
section, the Vendor completely waives any claims for protested work and accepts from the
City any written or oral order (including directions, instructions, interpretations, and
determination).
VIII. LIMITATION OF ACTIONS. VENDOR MUST, IN ANY EVENT, FILE ANY LAWSUIT ARISING
FROM OR CONNECTED WITH THIS AGREEMENT WITHIN 120 CALENDAR DAYS FROM THE DATE THE
CONTRACT WORK IS COMPLETE OR VENDOR'S ABILITY TO FILE THAT SUIT SHALL BE FOREVER BARRED.
THIS SECTION FURTHER LIMITS ANY APPLICABLE STATUTORY LIMITATIONS PERIOD.
IX. WARRANTY. Vendor warrants that it will faithfully and satisfactorily perform all work
provided under this Agreement in accordance with the provisions of this Agreement. In addition to any
other warranty provided for at law or herein, this Agreement is additionally subject to all warranty
provisions established under the Uniform Commercial Code, Title 62A, Revised Code of Washington.
Vendor warrants goods are merchantable, are fit for the particular purpose for which they were obtained,
and will perform in accordance with their specifications and Vendor's representations to City. The Vendor
shall promptly correct all defects in workmanship and materials: (1) when Vendor knows or should have
known of the defect, or (2) upon Vendor's receipt of notification from the City of the existence or
discovery of the defect. In the event any part of the goods are repaired, only original replacement parts
shall be used—rebuilt or used parts will not be acceptable. When defects are corrected, the warranty for
that portion of the work shall extend for an additional year beyond the original warranty period applicable
to the overall work. The Vendor shall begin to correct any defects within seven (7) calendar days of its
receipt of notice from the City of the defect. If the Vendor does not accomplish the corrections within a
reasonable time as determined by the City, the City may complete the corrections and the Vendor shall
pay all costs incurred by the City in order to accomplish the correction.
X. DISCRIMINATION. In the hiring of employees for the performance of work under this
Agreement or any sub-contract, the Vendor, its sub-contractors, or any person acting on behalf of the
Vendor or sub-contractor shall not, by reason of race, religion, color, sex, age, sexual orientation, national
origin, or the presence of any sensory, mental, or physical disability, discriminate against any person who
is qualified and available to perform the work to which the employment relates.
Vendor shall execute the attached City of Kent Equal Employment Opportunity Policy Declaration,
Comply with City Administrative Policy 1.2, and upon completion of the contract work, file the attached
Compliance Statement.
XI. INDEMNIFICATION. Vendor shall defend, indemnify and hold the City, its officers,
officials, employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or
suits, including all legal costs and attorney fees, arising out of or in connection with the Vendor's
performance of this Agreement, except for that portion of the injuries and damages caused by the City's
negligence.
The City's inspection or acceptance of any of Vendor's work when completed shall not be grounds
to avoid any of these covenants of indemnification.
IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE INDEMNIFICATION
PROVIDED HEREIN CONSTITUTES THE VENDOR'S WAIVER OF IMMUNITY UNDER INDUSTRIAL
INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF THIS INDEMNIFICATION. THE PARTIES
FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY NEGOTIATED THIS WAIVER.
In the event Vendor refuses tender of defense in any suit or any claim, if that tender was made
pursuant to this indemnification clause, and if that refusal is subsequently determined by a court having
jurisdiction (or other agreed tribunal) to have been a wrongful refusal on the Vendor's part, then Vendor
shall pay all the City's costs for defense, including all reasonable expert witness fees and reasonable
GOODS & SERVICES AGREEMENT - 4
($20,000 or Less, including WSST)
attorneys' fees, plus the City's legal costs and fees incurred because there was a wrongful refusal on the
Vendor's part.
The provisions of this section shall survive the expiration or termination of this Agreement.
XII. INSURANCE. The Vendor shall procure and maintain for the duration of the Agreement,
insurance of the types and in the amounts described in Exhibit B attached and incorporated by this
reference.
XIII. WORK PERFORMED AT VENDOR'S RISK. Vendor shall take all necessary precautions
and shall be responsible for the safety of its employees, agents, and subcontractors in the performance of
the contract work and shall utilize all protection necessary for that purpose. All work shall be done at
Vendor's own risk, and Vendor shall be responsible for any loss of or damage to materials, tools, or other
articles used or held for use in connection with the work.
XIV. MISCELLANEOUS PROVISIONS.
A. Recyclable Materials. Pursuant to Chapter 3.80 of the Kent City Code, the City requires its
contractors and consultants to use recycled and recyclable products whenever practicable. A price
preference may be available for any designated recycled product.
B. Non-Waiver of Breach. The failure of the City to insist upon strict performance of any of the
covenants and agreements contained in this Agreement, or to exercise any option conferred by this
Agreement in one or more instances shall not be construed to be a waiver or relinquishment of those
covenants, agreements or options, and the same shall be and remain in full force and effect.
C. Resolution of Dis utes and Governing Law. This Agreement shall be governed by and
construed in accordance with the laws of the State of Washington. If the parties are unable to settle any
dispute, difference or claim arising from the parties' performance of this Agreement, the exclusive means
of resolving that dispute, difference or claim, shall only be by filing suit exclusively under the venue, rules
and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in
writing to an alternative dispute resolution process. In any claim or lawsuit for damages arising from the
parties' performance of this Agreement, each party shall pay all its legal costs and attorney's fees incurred
in defending or bringing such claim or lawsuit, including all appeals, in addition to any other recovery or
award provided by law; provided, however, nothing in this paragraph shall be construed to limit the City's
right to indemnification under Section XI of this Agreement.
D. Written Notice. All communications regarding this Agreement shall be sent to the parties at
the addresses listed on the signature page of the Agreement, unless notified to the contrary. Any written
notice hereunder shall become effective three (3) business days after the date of mailing by registered or
certified mail, and shall be deemed sufficiently given if sent to the addressee at the address stated in this
Agreement or such other address as may be hereafter specified in writing.
E. Assi ng imen - Any assignment of this Agreement by either party without the written consent
of the non-assigning party shall be void. If the non-assigning party gives its consent to any assignment,
the terms of this Agreement shall continue in full force and effect and no further assignment shall be
made without additional written consent.
F. Modification. No waiver, alteration, or modification of any of the provisions of this
Agreement shall be binding unless in writing and signed by a duly authorized representative of the City
and Vendor.
G. Entire Agreement. The written provisions and terms of this Agreement, together with any
Exhibits attached hereto, shall supersede all prior verbal statements of any officer or other representative
of the City, and such statements shall not be effective or be construed as entering into or forming a part
of or altering in any manner this Agreement. All of the above documents are hereby made a part of this
Agreement. However, should any language in any of the Exhibits to this Agreement conflict with any
language contained in this Agreement, the terms of this Agreement shall prevail.
GOODS & SERVICES AGREEMENT - 5
($20,000 or Less, including WSST)
H. Compliance with laws. The Vendor agrees to comply with all federal, state, and municipal
laws, rules, and regulations that are now effective or in the future become applicable to Vendor's business,
equipment, and personnel engaged in operations covered by this Agreement or accruing out of the
performance of those operations.
I. Public Records ACt. The Vendor acknowledges that the City is a public agency subject to the
Public Records Act codified in Chapter 42.56 of the Revised Code of Washington and documents, notes,
emails, and other records prepared or gathered by the Consultant in its performance of this Agreement
may be subject to public review and disclosure, even if those records are not produced to or possessed by
the City of Kent. As such, the Vendor agrees to cooperate fully with the City in satisfying the City's duties
and obligations under the Public Records Act.
J. Cj_ty- Business License Rg uq iced. Prior to commencing the tasks described in Section I,
Contractor agrees to provide proof of a current city of Kent business license pursuant to Chapter 5.01 of
the Kent City Code.
K. Counterparts and—Si RL This Agreement may be executed in any
number of counterparts, each of which shall constitute an original, and all of which will together constitute
this one Agreement. Further, upon executing this Agreement, either party may deliver the signature page
to the other by fax or email and that signature shall have the same force and effect as if the Agreement
bearing the original signature was received in person.
IN WITNESS, the parties below execute this Agreement, which shall become effective on
the last date entered below. All acts consistent with the authority of this Agreement and prior
to its effective date are ratified and affirmed, and the terms of the Agreement shall be deemed
to have applied.
V NDOR CITY OF KENT.
signature) (signature)
print a e: _ i.:5 Print Name: David A. Brock P.E.
fits, y') P n SP& v. �—d Y"` Its: Interim Director Operations Manager
(title)
DAfE:, DATE: / Z /
m_ ---- —...................-
_... ---------------
ES TO BE SENT TO: NOTICES TO BE SENT TO:
VENDOR: CITY OF KENT:
Julie DeBellis Timothy J. LaPorte, P.E.
Northstar Chemical, Inc. City of Kent
14200 SW Tualatin-Sherwood Rd. 220 Fourth Avenue South
Sherwood, OR 97140 Kent, WA 98032
(503) 625-3770 (telephone) (253) 856-5500 (telephone)
(503) 625-1478 (facsimile) (253) 856-6500 (facsimile)
---------------
NortM1s[ar-201a WaLer Chemicals/Cunningham
GOODS & SERVICES AGREEMENT - 6
($20,000 or Less, including NSST)
DECLARATION
CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY
The City of Kent is committed to conform to Federal and State laws regarding equal opportunity.
As such all contractors, subcontractors and suppliers who perform work with relation to this
Agreement shall comply with the regulations of the City's equal employment opportunity
policies.
The following questions specifically identify the requirements the City deems necessary for any
contractor, subcontractor or supplier on this specific Agreement to adhere to. An affirmative
response is required on all of the following questions for this Agreement to be valid and binding.
If any contractor, subcontractor or supplier willfully misrepresents themselves with regard to the
directives outlines, it will be considered a breach of contract and it will be at the City's sole
determination regarding suspension or termination for all or part of the Agreement;
The questions are as follows:
1. I have read the attached City of Kent administrative policy number 1.2.
2. During the time of this Agreement I will not discriminate in employment on the basis of
sex, race, color, national origin, age, or the presence of all sensory, mental or physical
disability.
3. During the time of this Agreement the prime contractor will provide a written statement to
all new employees and subcontractors indicating commitment as an equal opportunity
employer.
4. During the time of the Agreement I, the prime contractor, will actively consider hiring and
promotion of women and minorities.
5. Before acceptance of this Agreement, an adherence statement will be signed by me, the
Prime Contractor, that the Prime Contractor complied with the requirements as set forth
above.
By signing below, I agree to fulfill the ive retirements referenced above.
By: L^�
For:
Title: l AA �k'06Lv i- SbV41 t
Date:LZ-12-11 _
EEO COMPLIANCE DOCUMENTS - 1 of 3
CITY OF KENT
ADMINISTRATIVE POLICY
NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998
SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996
CONTRACTORS APPROVED BY Jim White, Mayor
POLICY:
Equal employment opportunity requirements for the City of Kent will conform to federal and
state laws. All contractors, subcontractors, consultants and suppliers of the City must guarantee
equal employment opportunity within their organization and, if holding Agreements with the City
amounting to $10,000 or more within any given year, must take the following affirmative steps:
1. Provide a written statement to all new employees and subcontractors indicating
commitment as an equal opportunity employer.
2. Actively consider for promotion and advancement available minorities and women.
Any contractor, subcontractor, consultant or supplier who willfully disregards the City's
nondiscrimination and equal opportunity requirements shall be considered in breach of contract
and subject to suspension or termination for all or part of the Agreement.
Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public
Works Departments to assume the following duties for their respective departments.
1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these
regulations are familiar with the regulations and the City's equal employment opportunity
policy.
2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines.
EEO COMPLIANCE DOCUMENTS - 2 of 3
CITY OF KENT
EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT
This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded the
Agreement.
I, the undersigned, a duly represented agent of
Company, hereby acknowledge and declare that the before-mentioned company was the prime
contractor for the Agreement known as that was entered into on
the (date), between the firm I represent and the City of
Kent.
I declare that I complied fully with all of the requirements and obligations as outlined in the City
of Kent Administrative Policy 1.2 and the Declaration City of Kent Equal Employment Opportunity
Policy that was part of the before-mentioned Agreement.
By w
For.
Title;
Date;
EEO COMPLIANCE DOCUMENTS - 3 of 3
EXHIBIT A
WATER TREATMENT CHEMICAL SUPPLY FOR 2018
PROPOSALFORM
The undersigned hereby proposes to provide all equipment, labor, materials and supplies to
perform the service as specified in this contract (see Special Provisions 1.3 & 1.6) for the
following fees:
Bidder's Name:
Item Estimated Description Bid Unit Total
Annual Unit Prices
Us ace
7 2,400 12 1/2% Sodium Hypochlonte in
GALS* 500-1,000 Gal. Deliveries BULK GAL.
FOB 212th St. Treatment Plant
Total
*Estimated annual need is 2,400 Gals. Actual need may vary.
/ Co art Submitting Proposal
C r,
Authiar' d ignature
Note o tractor must submit a firm proposal for the contract term(s).
EXHIBIT B
INSURANCE REQUIREMENTS FOR
SERVICE CONTRACTS
Insurance
The Contractor shall procure and maintain for the duration of the Agreement,
insurance against claims for injuries to persons or damage to property which
may arise from or in connection with the performance of the work hereunder
by the Contractor, their agents, representatives, employees or
subcontractors.
A. Minimum Scope of Insurance
Contractor shall obtain insurance of the types described below:
1. AutomobilewLigbility insurance covering all owned, non-owned,
hired and leased vehicles. Coverage shall be written on Insurance
Services Office (ISO) form CA 00 01 or a substitute form providing
equivalent liability coverage. If necessary, the policy shall be
endorsed to provide contractual liability coverage.
2. Coommercial General I_ia�bility, insurance shall be written on ISO
occurrence form CG 00 01 and shall cover liability arising from
premises, operations, independent contractors, products-completed
operations, personal injury and advertising injury, and liability
assumed under an insured contract. The Commercial General
Liability insurance shall be endorsed to provide the Aggregate Per
Project Endorsement ISO form CG 25 03 11 85. The City shall be
named as an insured under the Contractor's Commercial General
Liability insurance policy with respect to the work performed for the
City using ISO additional insured endorsement CG 20 10 11 85 or a
substitute endorsement providing equivalent coverage.
3. Workers`Compensation_coverage as required by the Industrial
Insurance laws of the State of Washington.
B. Minimum Amounts of Insurance
Contractor shall maintain the following insurance limits:
1. Automobile Liability_ insurance with a minimum combined single
limit for bodily injury and property damage of $1,000,000 per
accident.
2. Commer!JA General Liability insurance shall be written with limits
no less than $1,000,000 each occurrence, $2,000,000 general
aggregate and a $2,000,000 products-completed operations
aggregate limit.
EXHIBIT B (Continued)
C. Other Insurance Provisions
The insurance policies are to contain, or be endorsed to contain, the following
provisions for Automobile Liability and Commercial General Liability
insurance:
1. The Contractor's insurance coverage shall be primary insurance as
respect the City. Any Insurance, self-insurance, or insurance pool
coverage maintained by the City shall be excess of the Contractor's
insurance and shall not contribute with it.
2. The Contractor's insurance shall be endorsed to state that coverage
shall not be cancelled by either party, except after thirty (30) days
prior written notice by certified mail, return receipt requested, has
been given to the City.
3. The City of Kent shall be named as an additional insured on all
policies (except Professional Liability) as respects work performed
by or on behalf of the contractor and a copy of the endorsement
naming the City as additional insured shall be attached to the
Certi care of Insurance. The City reserves the right to receive a
certified copy of all required insurance policies. The Contractor's
Commercial General Liability insurance shall also contain a clause
stating that coverage shall apply separately to each insured against
whom claim is made or suit is brought, except with respects to the
limits of the insurer's liability.
D. Acceptability of Insurers
Insurance is to be placed with insurers with a current A.M. Best rating of not
less than A:VII.
E. Verification of Coverage
Contractor shall furnish the City with original certificates and a copy of the
amendatory endorsements, including but not necessarily limited to the
additional insured endorsement, evidencing the insurance requirements of
the Contractor before commencement of the work.
F. Subcontractors
Contractor shall include all subcontractors as insureds under its policies or
shall furnish separate certificates and endorsements for each subcontractor.
All coverages for subcontractors shall be subject to all of the same insurance
requirements as stated herein for the Contractor.
114443
AC"RH CERTIFICATE OF LIABILITY INSURANCE ulvzon
"I
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAT;ON 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 INSURERISI, AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION 19 WAIVED, subject to the terms and conditions of the 3011CYL certain policies may terlope.an cndDrsemerrt. A statement on
this certificate does not confer rights to the Certificate holder in lieu of such ondorsement(s).
PRODUCER 550PAU San Francisco Carts
Commercial Lines-(628)201-1)001 PHONF FAN
Lj4 (415)644,7700 1 877)302-0977
USI Insurance Services National, Inc.-CA Lic# OD08408 Certificates
Cerifi cates@wellsao.com
AunRE.eN201 Mission St, I IIT Floor Fg
INSORER(SI AFOROING COVERAGE NAIF 9
San Francisco,CA 94105 INSURER A- Aspen Specialty Insurance Co 10717
NSIORC) INSuqFR R XL Specialty Insurance Company 37886
Northstar Chemical Company,Inc sasER C SAIF Corporation 36196
14200 S.W.Tualatin-Shemyood Rd. Is"
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Sherwood, OR 97140 INMIRST,f,
COVERAGE$ CERTIFICATE NUMBER: 12493131 REVISION NUTIIBER: See below
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N3W,ATF D NO TWTJ iSTANOW-' AN V F*01,11 REMY Tr I r.",RKI OR CONDIT ON ()F ANY CON TRAC- UP 0 It if-R D"Ak ANIT NI As 7 11 M W1 I"T TO IOPCH
11
ki,)N I',!. 520F.D OR MAY rq 121OS,J TNT- FlaJRANC�'F: AO CIRDN) bi( 1HE A �Cplbf D 111HUN 15 SUBJE Q' TO 0.LL If
INSR TYPE OF INSURANCIE ANSI,loari; LH riSjOyfIo,
LiAiP0LJCiYNL'Nr3r.R.................IMMi
.................. LmhIT
------------
A X COMMERCIALIGPNEPAL LUUMLITY ERAFJRW17 07/01/2017 07/0V2018 I MY)um)
CLAITM t,AD1 '1100 0010
x I Puflufim"IDL10d.d'rca ns Dar.) LI; f 1," 001)
x 5N(IOU WINJ JNd 'd4L9 Aj (JOU(IIII,
11 OD
3
TIRCI "ODORID kel
B AUTOMOVIL(IIJABILITY i AECO05013E 0710112017 07/01/2018 1, L I MH I DIDaDD
Jf"i IFw4vori
ANY AU 10
OwN00
-nViNEI)
�A"r c(*'
"fin D NON,
'U I,5G onoe I Y
x Mr-S 90 y $5,000 Ded
A X_J UMINWILLALIA0 EXAEJRX17 07/01/2017 0710lI2018 nu cur
IIKC 656 UAS 11011001y)
C rAN�INOPKEM COMPENSATION 9769SO 07/0112017 07/01/2018
AND EMPLOYERS'LIABILITY . . .......—-—-------
V,N 1 000 J010
ORAIARTNE ,X[r,(yr "J'G
ANYPIFNFIROT NIA, OREGON
'XIO'DOO
...............
110DO1101)
DESCRIPTION OF OPERATIONS ILOCATIONSOVENCLES JACOPO 10 Add1II1111,I[9.Po,,k,3hrd,l. may be atO,N.d llnmr sLeut m
Evidence of Coverage
CERTIFICATE HOLDER CANCELLATION
.......................-................................
City of Kent SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE IPIEREOF, NOTICE WILL BE DELIVERED IN
220 4th Avenue South ACCORDANCE WITH THE POLICY PROVISIONS.
Kent,WA 98032
AUThORIZEDREPRESENTAnVE
The ACORD name and logo are registered marks of ACORD 1,,)1988-2015 ACORD CORPORATION, All rights reserved.
ACORD 25(201 BIAS)
* Y CERTIFICATE OF LIABILITY INSURANCE D
ATE
i7YY'
FHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON TH. f LSRTIFIC . THIS7ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE IF ORDEDICIES3ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUIS=' �SURERIZEDREPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
MPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSUR+-:C6 .r;.ssiorsed.f SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an ernorcorrent on
<his cortif1cate does not confer rights to the certificate holder In lieu of such endor5omcitt(s)
'R-mur.ER CONTACT San Francisco Certs
%.mmercial Lines-(628)201-9001 NAME:PNUNL 415 644 7700 I ..x
rAYC.My EXt1: ( ) .,c,Nulf877)302 0977
cJl Insurance Services National, Inc.-CA Lic#'.OD08408 LMAAUIU.ss Carl8icales aQAVQ:AsfargD.com
1 Mission St, 11111 Floor _. INSURERISTArroRDINGCOVER, Ni
n Francisco CA 94105 INSURER A Aspen Specialty Insurance Co 10717
I USED INsuaER R. XL Specialty Insurance Comps. , , ,. 378815 -
Ahstar Chemical Company, Inc. I"Super,C^ SAIF Corporation i 36196
'14200 S.W.Tualatin-Sherwood Rd. INSURER D:
INSURER r
ierwood,OR 97140 INSUREPP
r1VERAGES CERTIFICATE NUMBER: 12557021 REVISION - <. r ER: See below
'PHIS IS TO CER'I"IFFY THAT THE POLICIES OF INSURANCE LBTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED � FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT 'Al' RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 'S S'JUJECT TO ALL THE TERMS,
'_XCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
TYPE OF INSURANCE
CC{IR 1NSr11 uvnf POLICY ppyr Mi rFf,Il, LIMITS
�
IADDI isua(al....ERAEJRVV17 NUN1aER 07/01/2017 O07/01r12018 lA(r+<tr+ Is^ s
it ce I
�. _UL .L __1
jTXXIO,
MMERCIAL GENERALLIABILITV -I g 1D00000
. i7Ai dPdLY(+fr h r 3D00)0
PILL XP(M
V11`rrv,l rvi 5 00coo5000
P9 R5ONAl W tN,llD 'V1.... _ _ Bn. �: . 000000
L .. - GFaff h41 WIfA14 S 2,000000
orI i 1 nuGraEeA r l IMIT am cur s pr n
` Put ley X �INo X..)Lac 2 000 o00"—
I lxuowctrt i1 i n,1, a
4tel _ '" t,)MPINrD"', 101W1 I'
AUTOMOBILEuaslurr AE00050135 07101I2017 07l01/2018 f's ,,,lie, l} x t o00000
X ANY AUTO ROUIIYINJU'
i OWNED OHFI'IULGC BODILY IN W i , d Idnnl}
% UMBRELLA LIAB % N-(JWNE[1 FRDPCIitY OU N S
J1 ros oNLv It ur iA,2H+,oL .— �...
HIRED NC 000 Ded
AUTOS ONLY au'
� AUTOS ONLY AU
x MCS 90 $5
_..._.,1 ........ -
___... _.
_ ri aws.MAUI_ EXAEJRX17 07/0112017 07/01/2018 LACHOCIL g sDDD DDD
I u1 [uR I
EXCESS
w"- WORKERS COMPENSATION AU1[F IR 1 $ t/D0000
Va R❑R RETENTION. 07/0112D17 07/01/2018 EUN .�"fg-i('�.5
NIA Cr
AND EMPLOYERS LIABILITY 87698D % 'µrAr9! N to
ANvcaonaFTORiPnRTNEwExLcurrvE OREGON It lin, 4A ITS1,000000
1 I II I ORFA blri DV El $ ODD 000
C _... .,,.._
Y/YJ
OFFICERIMt MB6RE%CLUDED9
MyYe delory In NH �� �
- Ricr GRFRATIONS all. FI DISEALI, G.-C, L.pMli s ,ODD 000
MS�CIPTION OF
I
i. 9CRIPTION OF OPERATIONS(LOCATIONS i VEHICLES (ACORD 101,Addidonal Remarks Schedule,may be attached it more apace Is oxI iwdi
the City of Kent is named as additional insured as it relates to general liability and auto liability as it relates to general liabilitganc auto liability in
,cordance with the terms and conditions of the policy. Umbrella follows farm as it relates to additional insureds.The above c.d"',joe is primary and
.on-contributory where required by written contract. "".r.
o.l
R7IFICATE HOLDER CANCELLATION ^mm
I';Ify Of Kent SHOULD ANY OF THE ABOVE DESCRIBED NO-.I LIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NC ,E WILL BE DELIVERED IN
20 4th Avenue South ACCORDANCE WITH THE POLICY PROVISICP;.,
;eat,WA 98032 q+
AUTHORIZED REPRESENTATIVE -
The ACORD name and logo are registered marks of ACORD 01988.2015 ACORD COI'r.' .ATION. All rights reserved.
ACORD 25(20161031 "
ffI,,0 ,v,1m„i " -_
ERAEJRWI7 07101/2017 f y
ASPEN
.C: THIS F.NDQR%lL717ENT CHANGP.S'CBIE POLICY.PLEASO READ PT CAREFULLY
A gUTI'IONAI•tNSUIiI+:II— Y$"b-
PRIM2ATCY AND NON-CONTIBUTORY
V
It is hcrchy ingtccd dint the Pnlicy 9n nmaxndnd aN 1'nlin.ea sMcly as iCRpect .C'o rrnwSc SC<lian 1. ,Cnw npr.
IA(Budily loijwy and Propnmdy O:almSfe)and Coverndr 113(PoIwW nod A01ar ininlr,Injury):
SCIISOULE
Nu mu of 1'e riun nr O�ga•.iva lion: ''-Q(.
Rlankel.whcro regoirod by written contract
(II' w, oh'y M)louu'n uhuwc, infoenlntl un nmuirud to complete Ribs cuddrmwcnt will fro slm•c •1 did ,.
Mclnratlumm VA applh,nhl¢to tl4x and+rreen)om.l
Tho Per."Is' or otguoizationN FIIV M'll In Ill. 4cljtoinl¢. :IkIP 40 :n6 I"xu.vcl4 owit,r M., W130 IL, AN
IT.S V Ktla).pmaSraph I',nCIhie Policy t..hjecl Wall Iw+leron.. .udd rondilinlrs s5C Ill nl p:vaprnph.
Will,w: j"eu to llo:Invxunr nY AP};;p5fti15fun5 sl'Own m llw Sdw.4ulu ubo vc.Ihis P.+hey ahall he per{ >'y and
nVn conGSlYplVry wish nx5y oxhul^wulfxi urXd avtlrr.•,tit+ice:+++urulvtc nvuiluhle to n..it pnlhhnnN ur ot,gnar .C•ntlrY-
All other tmuls;ond eundilloun or Ihia Pulley Iemain unehanped,
0
ASP13R O�/I][furnt lxunUcf pnndinp�
ens
Northstar Chemical Company, Inc.
ERAEJRW17 07/01/2017 07/01/2018
Pages 5-6 and 20-22 of 34
Sotgon2. G2fJEAALPOLLVI'10NI1A8ILITY
9„ Insuring Agreements
Undo, easrt of C;avoragea 2A thtrn.fgh 21Z WA V ill pay thbsc SVmc that the owted lbecornrs ik,,. y obi"uyated. to
ka ka place d{dog 1>a palicy periodr bodily +7 iffi rpaiitxarl ihY pancagl:or t( I utfun i Aurrd'ur kin the envat go,ter Rm,y_(ovl od MPY : That
covoraga 2A.-Hostile Fbe&Building Cquipmtspt
(1) Thrt bodify injury, proporty damage or envircern.nial dallmgc arises out or heat. smoke,, (dines, vapor er scot
5om a,httsto.tiro:or
(2) The hodf6y PrtjorY is srxntntlnnd vutlflwfn a bu&d'!r(g and urn9cat ewl of lytuvU, Smoke. /dread. Yapor or s got produced pluduced yy
or originating from uqulperto'd that is used to heat cool a(dehunaidlly the bv+l!1ing, ar-that tc used ""'d w:suyr for
pors.nal'use by the 6l buinp's occepante or their geoms. _
coverase zn-Products Pollution
The bodily injury, property damage or unvfrmomel ld;QNa+nage ailLcs out of your product and is Included In tlta
pmduc": *mP1Qtcd n0er:d0on3..linaard.
OOVerilWe 2C-Trdflspurtalion Pulluuon
The ifollt UOO inctcll:nt is utumad by l .Atportalfon or misdelivery during (ranSpodatfon, and bodily
Injury, Pwogcrty d:nnusyc nr envfronnlen(al dammgc.
Cmvrra pe 2D-^contractors POI&rtion
The Pollution Incfdont If, ransr'd by your work and result: in bodily fn}+uy, pia Pcrty damage of uovir on lnontal
damng¢.
Coverage 2H-Site Time-faenfnnt Oultily Injury and Property❑mnarac
"firm, pollution (ncideolt (l) In on, al, trirde'r' or mlrfmtiiftll from or iluodyll, (0) 'my tan awned lei .lY++n, ur to) any
to"k)" thin kx occuplod by any Insured, other num all inrerod I•ota(ion: tilt' results,irl hodrfy ti fly of property
dAou'un, (wit Is demon,M1e..W', ab having cornrnmncad at an iomou tr,drlr I aur. anwJ pi.u;m dou ell hid p.1 Y oc i.,l 10 fin
dimcavelurl red later Arun 20 cillcrodmf dupe alter Its and (5) Is repoAcd to u, he YaCu r t u pC0 e.vimnd.r
ilrtya apex its commab,atme�no
In till, (vent Cdvenrry+ 3t:. (nit. llutllly Injury and Pfop.nly Vamagn) I, prechagedr Cover-10 21" 'fill nnl -"'Ply to
nornvwnod locatfans.
Coverage 2F,-Finorgency Response
Wn will pay emergency rd4p.n%e cost resulting In"" In imm nhnt noel Sitvlldcant Ilneat 1. hwn u fo health or the,
nnviroantnnt affslrog um of apolio/+nn incidenttl+ai wammd,lu thlemll the policy pctimf In inn r.v 4 r:Yt7 e: r:rrilory.
1}nverage 2U.-Cri515 f_vent
We wilt pay crPsfz cost ods(rnl out of a cricfs event that inku- place during the policy perlod �i the coverage
territory.
0 Aspr,I Specialty insutJnc" C npolr'y. 2017.
ASPLRIO9 0313 fnc9ud@s Capyrtirfhlyd tr alcrial
of 150 lImp,ldlos, In,. aced with puinr(r:vforl
t,
NI, WHO IS AN INSURED
A. If you are designated in the OeUarations as;
I, An Individual, you and your spouse are Insureds. but only with respect to the conduct of a business of which you
are the sole owner.
2. A partnership or joint venture, you are an Insured, Your members, your partners, and their spouses are also
insureds, but only with respect to the conduct of Your business.
3. A limited liability company. you are an insured. Your members are also insureds,. but only with respect to the
conduct of your business Your managers arse Insureds, but only with respect to their duties as your maltagals.
4. An organization other than a partnership, jailor venture or ltrnilad liability company, you are an insured. Your
executive Officer, and directors are insureds, but only with respect to their duties as your officers or directors.
Your slncknnlders Ore Alto insureds, but only will, respect to their hatolb y as stockhmders.
5. A trust. you are an insured. Your Irustees are also insureds, but only with respect to their duties as trustees.
B. With respect to all coverages other than Coverage 1D (Employee Benefits Administration Liability), each of the
following Is also an insured:
1. Your volelntaer workers, but only while performing dutreu related to Ilbe Conduct Of your busl'uess or your
0mployaa+, other hvan either your eXoOullVa OfficOrs, If YOU are On organization other than a partnership, joint
Ventura or !imbed llahiety eurrnpayny) Or your managers (d you are a llmnao liability company), but only for acts
wdt)tin the scope of their employroCIA by Von or while performing dotes related to the conduct of your business.
liewover, none of (base empiuyoas Or volunteer'workers are insureds for:
(a) Bodily injury or personal and advertising injury:
0) To you, to your portrays or members (if you are a partnership or joint venture), t, your members (If you
;are a hooted liability QOMPany)'.
(b) per which there is any ob'ligah011 to share damages with or repay someone else " Ito roust pay damages
because of the injury des fibed in(a)(i) above: or
(fit) Arising out Of the pmvld8ng Of failure II'O provide professional "still care surv)rer^, emzcPl incidental health
care services provided by any phy51man, dentist, nunse. amargency Medical' 1ecl)10 n or parnrnedlb who
Is employed by you to provide such zaweces and provided you are, not clog agcr,r in the bu9lnesa Of
providing such services.
(b) property damage to property:
(i) Owned, occupied or used by, or
(to) Rented to, in llle care, custody or control of, or over which physical control is being exercised for any
purpose by
you, any of your employees, Volunteer workers, any partner or member (it you are a partnership or joint
venture), or any member (d you are a limited liability company).
2. Any person (other than your employee or volunteer worker), or any organization while acting as your real estate
manager.
3 Any person or organization having proper temporary custody Of your property Ir you die, but curly:
(of With respect to liability arising out of we maintenance or use of that property: and
(b) Until your legal representative has been appointed.
4, Your legal representative it you die, but only with respect to duties as such. 1'hot representative will have all VOW
0 Aspen specially Insurance Company, 2012
ASP ERt000313 Includes copyrighted MONWrlal
of ISO properties, lire, used with permission
rights and duties under this policy.
C. Any subsidiary, associated, affiliated or allied company of corporation, including subsidiaries thereof, of which you
have moral than 50% ownership interest as of the Reception date is a Named Insured.
O. Any organization you newly acquire at form, hiller than a parmetsulp- joint venture or limited Iratol ty company. and
over which you maintain Ownership or majority interest, will th"Ity as a Named Insured if them is no Oliver similar
Insurance available In that organization.. However:
1. Coverage under the; provision is afforded only until the 1001h day after you acquire or fonn the organization or the
end of the policy period,whichever is earlier.
2. Coverage under this Policy Coca not apply to any bodily Injury, property damage, Offer'," environmental
damage, wrongful act or crisis event that occurred before you acquired or forted the organi-..ollon.
E, Solely with respect to Coverage 10 (Employee, Benefits Administration Uabiiily), each of the :allowing is also an
Insured:
1. Each of your employees who is or was authorized Io administer your employee benefits pro.,ram,
2. Any persons, organizalihns or employees having proper temporary aaAaharlzalion 10 admin l',Oe your omploy00
benefits program if you die, but only until your legal representative Is appointed.
3, your legal representative if you; die, but only with lespoet to duties as such. That re.presentatiV,L will have ail your
right's and duties as such That representative will have all your rights and duuas unctar this Policy.
r. Any person at' organization with whom you agree to include me an in+surad an vrtrsuora to an an tat de,irilUrl d personal and
Contract Is art
tnsv(ad, but: it) only with respect. to bodily injury, properly damage, ' g'
advertising Injury arising out of your Operations, Your work• efinlpmeni art promises leased or ruined by You. or your
products which are dimributed or sold in the regular course of a vendors business: and (Al) onfy ror the lesser of the
oppkcaole limits Of liability set forth its § 14. of the Poicy or the minimum limits of liability required by the Insured
contracC however:
1. A vendor is not ail insured as eespacls bodily Injury, property damage, environmental damage, emergency
response cost,crisis cast or personal and advertising Injury:
(a) for which the vendor is obligaled to pay dainages by reuaon of the assureplion of liability in a contract or
agreernant except that which the vendor would have in the abJenee 01 the CamfaCt or agreement;
(0) Arising out of any express warranty unaulhonzed by you;
(c) Arising out of any phys,eal or chomlcal change in the product made intentionally by the vender;
(o) Arising out of repackaging, except when Unpacked solely for the purpose of inspection. demonstration,
lesfngj or the 5Ub'daltotien of pans under insnur etris from you. and then,rppacltaged "r n.the,; original cOntainer;
(e) Arising out Of any failure to snake Inspections. '.Adjustments, testa or servicing as the .p,,det has agreed to
make or nomlalty undertakes to make in the usual courts Ot business, in connection v,w+ir the distribution or
sale of the products,
(f) Arising Out otl demonstration, installation, servicing or repair operations, except such c; - nnons performed at
the vendot'S location in connection with file sate of the provost or
(a) Arising out of produuis which, after diuttibution at sale by you. have been labeled or ''abeied or used as a
nortalner, part or ingredient of any other thing or substance by or for the vendor
2. A manager' of lessor Or plenlelits, a IesSar Of teased equipment. or a mongagen. assignee, nr roc"ItfOr is not an
insured as Menaces bodily injury„ properly' damage, environmental damage, amergorwy rOwponsp cost,
crisis coal or porectual and advorlising injury'.
(a) Arising out of Any occurrence, ottonse or pollution Incident that takes place alter, the equipment lease
expires or you Coate to be a tenant; of
Q Aspen Specialty insurance Company. 2012
ASPERl 00031a Includes copynghrevi mateerai
of ISO Plopedfes, Inc, used Mal Ptemissian
(b) Arising out of structural alterations. new construction or demolition operations perforntud by or on behalf of
life manager or lessor of premises, or mortgagee. assignee, or receiver,
0 Any person or organization that has at least a bvA Cnnffolling interest in you is an msuled but only with respect to
bodily Injury, property damage, environmental damage nr personal and advertising injury arising out of their
financial control of you.
No person or organization is an Insuied with rOspaa:t to One conduct of any current or past paitrioship, joint venture or
limited 1,abilny company' that Is not shown as a Narned Insuhad rn 9hr,; t')t;gAar:ISGrUns,
kt
0 Aspen Specialty hrrur-+ncu ConrpanY• 2012
ASPER11080313 Includas copyflghterf malonal
of ISO I°roperuds, Ina, used with permission
POLICY NUMBER: AECO050135 XIC 414 1013
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREF:I'_LY.
ADDITIONAL INSURED
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
AUTO DEALERS COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified
by the endorsement.
' Schedule
__.—_...... .._ — .�._.__._._.____ _-_ _........... ......... ........__ _........... .............. .. .._.- -------..
Additional Insureds) Work _
Where required by written contract executed prior to All operations
loss
COVERED AUTOS LIABILITY COVERAGE, Who Is An Insured, is amended to includ.., : c an "insured" the
person or organization listed in the Schedule above, but only with respect to liability for "boo' , injury" or "property
damage"otherwise covered under this policy caused, in whole or in part, by the negligent actn -:Ir omissions of;
i
1. You, while using a covered "auto"; or
4 Any other person„ except the addiVonal insured or any employee or agent of the additional insured,
operating a covered"auto" with your permission;
in the performance of your work as described in the Schedule above.
In no event shall any person or organization listed in the Schedule become an "insured" pursuant to this
Endorsement if such person or organization is solely negligent.
IT IS FURTHER AGREED THAT IN NO EVENT SHALL ANY CONTRACT OR AGREEMENT ALTER THE
CONDITIONS, COVERAGES OR EXCLUSIONS SET FORTH IN THIS POLICY.
All other terms and conditions of this policy remain unchanged.
XIC 414 1013 O 2013 X.L. America, Inc. All Rights Reserved. Page 1 of 1
May not be copied without permission.
Induces copyrighted material of Insurance Services Off ce, Inc., with its permission