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Home My WebLink AboutPW17-569 - Original - Traffic Control Plan Co of Washington - East Valley Highway Preservation - 12/21/2017 fo Records Mf �, �// TT / , ...... /%�� Document %i /7/ /00100 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: Traffic Control Plan of WA Vendor Number: JD Edwards Number A Contract Number: I I This is assigned by City Clerk's Office Project Name: East Valley Hiqhwav Preservation Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ® Contract ❑ Other: Contract Effective Date: 12/21/17 Termination Date: 12/31/18 Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Garrett Inouye Department: Public Works Desiqn Contract Amount: ts.2sn Approval Authority: ® Department Director ❑ Mayor ❑ City Council Detail: (i.e. address, location, parcel number, tax id, etc.): Traffic control plans for the East Valley Highway Preservation Proiect .......... . ........ As of: 08/27/14 ^ � GOODS & SERVICES AGREEMENT between -the City of Kent and � Traffic Control Plan Co of Washington � lK!3 AGREEMENT is made by and between the City o| Kent, a Washington mun|dpa| corporation � (hereinafterthe "[i^/"), and TraM1cCnnqn| Nan Cnu/ Washington uogan|zcd uod,rthe laws offhe State of Washington, bcmred and doing businc»s at: 1339 42"x St NE., Auburn WA 9800I, Phone: (25]) Z5B- l4i9. and' Contact Chnxh4`herGrose 1he "Vendnr"). I DESCRIPTION OF WORK. Vendor shall provide the h/||uw|ng goods and muL�ha|s and/or perform ihc following sorviccs for the City: (n provide traffic Control Plans for thr, East Valley Mighvvmy Preservation Project. For a description see Ihe vendor's scope o[ work which is attached Era Exhibit Aand incorporated try thisreference. - - �� -- �� -- - ------- ------- ___'__ | Vendor acknowledges and understands (hat it is not the CiLy's exclusive provider of these goods, rnatcrio|o, urservicesandthottheOiynna|ntainsit:sunqua||fiedhgh\ tnuhta|nthcsegouds, rnaicriab, arid services through other sourcrs. 11. TIME OF COMPLETION. Upon t1he effective date of this Agreenriont, Vendor shall con-1plete I lie work and provide all goods, materials, arid services hy DccennhcrJl, 2018. HL COMPENSATION. TheCityshaUpnythcVrndnranannounLnoLtnexcnodFiveThuusond Tvvo Hundred and Fifty Dollars ($5,250V0), including applicable Washington State Sales Tax, for LAe goods, materials, and services con\cmp|nted in this Ag/eenoenL Thc OLy shall pay the Vendor the following amounts according tn tire following schedu|c: Vendor shall be paid after submittal of traffic control plans arid invoice, l[ the City objects Lo all or any portion of an invoice, it shall notify Vendor and reserves Hqe option to only pay that pnrtionm/ the invoice riot |ndispute, b/ that event, the parties will irornedialne|ymake every effort tn settle the disputed portion. GOODS & SE&V\LE6AGREEMENT z ($z0,000 or-Los�, incl. N/S6T) A� , The [ity reserves its right to eiLhho|d payment huno vcngoriorany Mcc1|vC ur unauthorized gonUs, nnahcha|y o/ scrvoeL )fVnndo' is unah(c, (or any reosnn, to connp|ctr any part of this Agreement, the City may obtain the goods, noa0er|ab or services from other suurcc4 and Vendor shall he |iab|e to the city for any addiUnna| costs incurred by the OR, "Addibona| cosLo' shall mean all reusonah|e costs, including legal costs and oftorncy fees, incurrcd by Lhe [hy beyond the rnnximurn Agreement price speared above. The My further rcsrrvcs Is nght to deduct thcse addhhuna| cosis incurred to complete tNo Agpcenoent with Other sources, from any and aU arnuonts due ortobeconnc due rho, Yundor, DFirlobl, Uanfnb,� VtNDOR'S ACCEPTANCE Of FINAL PAYMFNT 5U4LL CONSTITUTE A WAIVER OF [LA{M3/ [X[[PT TMO5[ PREVlUU5LY AND PROPERLY MADE AND lD[NTlFlI-D 8Y VENDOR AS UNSETTLtDAT THE TlM[ KEOUL3T FOR FlNAL PAY MENT [SMADI�::. IV. INDEPENDENT CONTRACTOR. Tho pariics Inicnd that an lndcpcndcnl Contractor Employer Rdndnnship will be cruat.cd by ihis AgrccrncnC By Lho11- execution of this Ayrccnncnt, and in accnndanccw|th Ch 51K00R[VV, the particsnnakc the following reprevwniLaiioos: A. The Vendor has, the ability to control and direct the perfonnoncr and dcta||s of its ;York, the City heing ridnerested wily in the results obtained under tlws A(ji-eernijit, 8, The. Vendor maintains ond pays for us own plaice of business from which Vendnr's serv/ccs under this Agreement vv|Ubepelornned, Ch No Vendor has an established and independent husincss that is o|igib|c far a busmess dedoct)on for federal Income tax purposes that existed heh>rc the City retained VnnMnr'sservices, vr tire Vendor /sengaged in anindcpcodcnUycstoh||ohod trade, occupation, profession, nrbusioeysuf the sarnc nature asLhot involved under thusAgrcconcnt, D, rho Vrndor |s respondb{c for filing as they become one all occcssaryLax ducun/enis withappropriote [edcra| and state agcndcs, nc|ud(ng the lnterna| Rcvcnue5crv|ce and the state UcpnkrneniufKcvenuc. L the Vendor has pcyisnened its business and estah|ishcd an account with ihe state Department of Revonuc and nthcr sb.abc� agencies os may hc requited by Vendor's business, anti has obtained a Unided Du`{nnsn Identifier (UBD nunnbc, from thc 5totcofVVash|ngtun, [, rho. VcodorrooinLoiny a set othnoks drd|raicd to the ic,pmnses and carnings of Is business, %N TERMINATION. E!thcrpa/dy may terminate thisAy/eeroenk wnLh or without cause, upon providing die other party thirty (]0) days w/hhen notice atitsaddress faith on the signature. block of thsAgrcernenL VI. CHANGES. The My may Muo a whticn a/ncndnncnt for any change in the goods, rnatcr|abororrv)ccstoheprov|dedUuringhheperfurmancenfLhisAgnecrncnt, lftheVeodorde(ennine4 for any reason, 11hnt. an anocndnnonL is nccessary, Vendor rnust suhnn|t a wr|(cen arncndrnrnt request to the person ||sted in the neLice ppov|s|on scHun of hh(s Agreement, secbon XlV(D), *iihin fourteen (14) cn|endar days of the date. Vendor know or shnu|d have known of the hycts and events giving nse to the, requcstedchmngc. D the OiyccLerrninesChat the change increases ordecrcases the Vendor's costs or Urne for performance, the, Oly will avoke an equilahle adjustment. The My will atterniet, in good taRli, to reach agrcuroont with the Vendor on all equitable adjustments, Mnweve,/ i[ the parties are unah|c to agree, Hhc City will determine the equitable adjuytnocnL as i< deems app'npriatc. The Vendor shall proceed with the arnended work Lynn receiving c|thera written arncndrnent from Me [ityoronora| Met from the City ba[orc.? actually receiving Lhc written aroeodnnnn�, D the Vendor (ni|s to reqoire. an 600DS8cSFkVJ[ESAC;u[-sMEmT 2 arnendrncnt *i(hin he time allowed, the Vendor wruve,- its light In Make any ck.)ivn or sullunit SiAJ',e(jUeAt arncndoncnL requests for ihoL par[ on of [he contract vvurk� If thc Vendor disagrees with the pqu|toNc aUjustrnenL, the Vendor rnustcnmP|etc the arncndcd work; however, thcVrodnrrnay c|cct to protest the adjustnocniasprovidedinsubooct|vnsAUhrouyhI_ o/ SrcUdnVll, Oa)rns, hdn* ]lie Vcndor accepts all rcquircrnent` oton anoendrnenthy� (1) rndors|ng it, (2) writing ascparatc acccptuncc, n/ (3) not protesting in the Way this section prnx|de�, Anannendroco17 that isacccp1cdby Ycodur as provided in this section shall consUiutc full paynnent and final scidcnncnt of aU c|oirns for contract dnoc and for- direct., |nd|rec� and consequential cosits, |ndudinq cuMy of delays related to any work, c,ithcr covered or affected by the changc. Vll� CLAIMS., It the Vendor disagrees with anything required by an amcndnocnt, another rur!Den oidet, or an oral coder from the City, including any direction, instrUCtion, riferpretation, or detcrnninaUon by the City, the. Vendor may file dainn as provideci in Lh|s scctino� TheVcndorshu|{ give wriLturl notice In the City of ..ill clamis vvithin roorteen (11) calenclai days at' Ubc occ-urrencc, of thp events giving riyc to the dairns, or vvithin huuctccn (14) calendar days of the date the Vendor knew or should havc known of Lhe facts ur rvrnfs giving rise. to the do!nn, whichever occurs hrcA . Any darn for dnmaDus, additional payn.unt [or any reason, or extension o/ nine, whether under this Aorcerncrm or otherwise, shall br, conclusively deemed to have bccn waived by tile Vendor uo|rss, nbmehvvritten dairn ismadeinstricLaccorduncc with tile app|icnb|eprnvisionyof lihisAgneenncnt, Al: a rninionurn, o Vendor's written dainn �ha|| include the information suL forth in subsections 4. itcnoS, lthrnugh5below FAILUIRIE r0 PROVIDE A COMPLIEFE/ WRITTIEN NorIFICA11-1014 OF CLA114 WITHIN THE UIME ALLOWED SHALL 111E AN ABSOLurE WAIVER OF- ANY CLAIMS ARISING IN ANY WAY FROM THE FAcrs OR EVENTS SURROUNDING T'HAT CILAIM OR CAUSHEID BY TILAII i A. k!o|�iLoo{ [|di[,.. P/ovidcasiyncd written not|cco[ claim that provides the following info,nnaUnn: 1. The date of the. Vendor's dainn; 2� Thc nature and cirounnslanccsthot caused the do|rn� 3. Thc provisions |n this Agreement that support the claim; 4, The esUrnaLcd du||orcustr, if any, of the dnioned nnrk and flow ihor csdrnatc wasd0ern/incd; and 5, Art analysis of Uhc progress schedule showing file schedule change or diurupdoni[ Lhe Vendor is assorting aschcdu|e change ordisruption. Th: Ycodur .;hall keep cnmp!etc /ccnrds nf extra and Urnc incurred al�, a /esur of tire assorted events giving r|sctu dhc da!ro� The City sho|| huvc access to any of tire Vendo''srecords needed hurova|uaUngLhwp,otcsL, The Dtyvv||| cvu|uate all c|oims' provided the prncedurrsin this sccUunare ru||nwcd. ][ Lhc City dcterrn\nesthat a claim isva|id, tire, City w||| adjust paynncnl. for work n/ U/nubyan equitable adfustment, No adjustment: will de nrade for an invalki pircitest C, til . ln spite of any daim, the, VendnrshnU p,ucced promptly Lo provide the goods, routcrio|s and services rcquircd by Lhc City under this 4grecnnenL D f�1Ky[e'tO >r[Qi�St'{]��kiu(ssm(@ivr!i- 8ynnf. PruirshngaiU`issecUcm provides, the VCnUcr also waives any addidona| cntiUrnornl: and accepts from the City any written or oral order (indudlng directions, instructions, inLcrp,otaUono, and dcrurrninadon), E [��U�� \�§��|� Oy failing to follow the procedures ofthis secUoo, fire Vendor completely waives any c|ainos for- protested work arid occrpry [rnm Lhc 6OOUsKscnVl[ESA( AEcMENT s /*20,000o( /o(/ud6ny N/rJ7) City any written or oral order (including dire(tions, instructions, lnterpretations, arid dotcnnination). VIII. LIMITATION OF ACTIONS. VENDOR MUST' IN ANY EYFNT, FILE ANY LAVV\U[TAR[5lNG FROM OR CONNECTED WITH THl3 AGREEMENT WITHIN 120 CALENDAR DAYS FROM THE DATL THE CONTRACT WORK IS COMPLE-11FORVENDOR'SAW111Y ]OFILE THAT SUITSHAILLBEFOREVERBARRED, TMI5SE[Tl0N FURTHER UMlT5 ANY APPLICABLE STATUTORY LIMITATIONS PERIOD, IX WARRANTY, Vendor Warrants that |t 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. Uni8nnn Commercial Code, Title, OZA, Revised [ndc ('If Washington, Vendor warrants goods are merchantable, are fit for the particular purpose for which they were obtained, arid will perform in accordance with their specificatious and Vendor's representations to City. The Vendor shall promptly cot roct all dnf,ch in v/orknnanship and nnnteria|s: (1) when Vendor knows or should have known of the defect, or (2) upon Vendor's receipt of notification [rurn the City of the existence or discovery (if the defect, In the event any part of the goods are repaired, only original replacement parts shall bu uscd--rehui|toru`cd parts will not beacceptable, When defects are corrected, the warranty for that portion of the work shall extend for an additional year beyond the anginal warranty period applicable to the overall work, The Vendor shall begin to correct any defects within seven (7) ca|cndarduys of its receipt of notice from the City of the defect, If the Vendor does not accorxp|ish \hc corrections within a reasonable time as determined hy the City, the City may correlate the corrections and the Vendor shall pay all costs incurred hy the City |n order to accomplish the correcbnn, X. DISCRIMINATION. In the hiring of employees for the performance of work under this Ag/ccnncnt or any soh-conthract, the Vendor, its sub-contractors, or any person acting on behalf of Line Vendor or sub-contractor shall riot., by reason of race, religion, color, sex, age, sexual orientation, national origin, oi- the presence of any sensory, mental, or physical disability, discriminate against any person who |squa|iUed and available to perform the work to which the ennp/uynncntr6ates, Vendor shall execute the attached (-.ity of Kent Equal Employment Opportunity Policy Declaration, Comply whin City Administrative Policy L2, and upon completion of the contract work, file the attached Compliance Statement, XI.. INDEMNIFICATION. Vcndur shall defend, indemnify and hold the City, its officers, officials, employees, agents and volunteers harrinless from driy and all clairris, Injuries, darnages, losses or suits, including all legal costs and attorney (crs/ arising out of or in connection with the Vendor's performance of this Agreement, except for ihot portion u[ the Injuries arid damages caused by the C|ty\ negligence, Thc C|ty's inspection vr acceptance of any of Vendor's work when connp|ctcd shall not be grounds in avoid anyof these covenants v[ indepnniMcoMon, lT IS FURTHER SPECIFICALLY AND EXPRE53iY UNDERSTOOD THAT THE INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE VENDOR'S WAIVER OF lMMUN]TY UNDER !N�[�USTKl/\L l@:�i)RA|V(�E. T{TL[� 51R[VV, SOLELY F(]R T�1EP(/RP06tSOF �rMIS }NDEMNIFICAD0|Y, lf�E PAR l7E5 [U14TMtRACKN0WLEDGETHATTHEY HAVE wYUTUALLY NEGO|IATEDTHlS VVAlVER, In the event Vendor refuses tender of defense in any suit or any doino, if that tender was trade pursuant tual|s |ndernn|OuaUondausc, and |fthatn:yosa| )SsuhsequcnUydcterno|ncdbyncuurthaving jurisdiction (or other agreed t,ibuoa|) to have been a wrnngfo| refusal on the Vendor's, part, then Vendor shall pay all the CiLy's costs for defense, induding all reasonable expert witness fees and reasonable attorneys' fees, Phis the Oty's legal costs and fees incurred becausr there was a wrongful refusal on the Vendor's part. The provisions u[ this section shm!| survive the expiration or termination n[ this Agreement. 600D5 & SERVICES ACREEMENT 4 I. PubIIC_RecGr s 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. 1 ity Busiruess -d)a„ggrrefl. 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. t. eaulnld�r{arti1^} and `niugnnatRnes J, by„fax tat .Fij) tll. 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. VENDOR: CITY OE l£ENT: agfrnd�r"/ Iy ,�.,, ,� Print Print Narne VC+C C40r D' Name: G: awvt��* 9 tr H� F C1 c1 T. 83�v,,eA, k Its. _Own.e' r- _ ..... . ®e _ I Its: `Jefx,ay Public Works Director (d�lh y f DATE � � J � DATE NOTICES TO BE SENT TO. NOTICES TO BE SENT TO: VENDOR: CITY OF KENT® Christopher Grose Timothy ]. LaPorte, P.E, Traffic Control Plan Co of Washington City of Kent 1339 42od St NE 220 Fourth Avenue South Auburn, WA 98002 Kent, WA 98032 (253) 258-1419 (telephone) (253) 856-5500 (telephone) (253) 270-2250 (facsimile) (253) 856-6500 (facsimile) GOODS & SERVICES AGREEMENT - 6 ($20,000 or Less, including WSST) 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 sale 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 five requirements referenced above. For Title: iry Date: -7..... . EEO COMPLIANCE DOCUMENTS - 1 of 3 CITY OF KEN7[ ADMINISTRATIVE POLICY NUMBER: 12 EFFE[TlVE [)ATE� ]anuaryI, 1998 SUBJECT: MlNOK[TYAND WOMEN SUPERSEDES: April 1, 1996 CON-TRACTORS APPROVED BY Jim White, Mayor Equal employment opportunity requirements for the City of Kent will conform to federal and state laws, All contractors, subcontractors, consultants arid suppliers of the City must guarantee equal ernp|0yrAeUt opportunity within their organization and, if holding Agreements with the City amounting t8 $1O/UO0 or more within any given year/ must take tire following affirmative steps: 1� Provide a written statement to all new employees and subcontractors indicating commitment asan equal opportunity employer, 2, Actively consider for pnonnotiUn and advancement available minorities and vvonoen, Any contractor, subcontractor, consultant or supplier who vv|i|fU||y disregards the [ity's nondiscrimination and equal opportunity requirements shall be considered in breach of contract and subject to suspension ur termination for all or part Df the Agreement. Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public Works Departments to assume the following dudes for their respective departments, 1� Ensuring that contractors, auhc8ntractors, consultants, and suppliers subject to these regulations are familiar with the regulations arid the Oty's equal employment opportunity policy Z� Monitoring to assure adherence to fedGk]i/ state and local |ow/6/ policies and guidelines. EEO [OMPLlANCEDOCUMENTS 2uf3 CITY OF KIENT 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 firrn 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� For: Title: Date: EEO COMPLIANCE DOCUMEN rs - 3 of 3 EXHIBIT A City of Kent 12620/17 400 W Grove St Kent, WA 98032 ATTN: Garrett Inouye Project objective: To provide all traffic control plans (TCP) for project. Key points that Traffic Control Plan Co. of WA, LLC will provide: O IC P (sea. of WA LLC will dlat't traffic control plans within 10 working days after 'notice to proceed' has been given tor- piolect" Working days shall be considered MON- FRI (holidays ex ludegl). °"10 dray wiredraw strain, at 6AM the day after`notic(c to preve,a rul r.:ca+�traa,t tira� l'ar era stit,lnee9 and deliw�rr.,,o via ernail to 'I-CP Co. of WA f_ln,C. n,"r i Ir�ok rhva9sa r; � ¢II in� M1 lr Px«;� oopi4adt O No charge will be applied to any in-house consultations or pre-cons that are requested. O Payment terms for providing TCP's for this project shall be NET 30, Task 1: Proposal for East ValLey Highway Preservation Project Cost for each plan sheet shall be $175,00 ea 30 TCP sheets x $175.00 ea sheet = $5250.00 Chrjs;tophear Grose flan irnc-t, IC7wne r Traffic Control Plan Co. of WA, LLC Traffic Contmi Plan Co.of WA, LLC- O: 253.250-1419 °F: 253-270-2250-email: chriv afrmcontmlplan.not � � � �^��"� 0� (Continued) �� wo�wm� w �� nw�� C. Other Insurance Provisions The insurance policies are tucontain, orbr endorsed tncootain, the following provisions for Automobile Liability and Commercial General Liability insurance: / 1. The Contractor's insurance coverage shall be primary insurance asrespect the City. Any Insurance, sc|/-inyurancc, ur insurance pool coverage maintained by the City shall be excess u[ the Contractor's insurance and shall not contribute with it. l The Contractor's insurance shall bc endorsed to state that coverage shall not be cancelled by either party, except after thirty ( days prior i vvroeonnnccoy (erTme0rna||, rerurnrece|ptrequested/ hasbeenyiven \o the City. ]. The City of Kent shall be named as an additional insured on all policies (except Professional Liability) as respects work performed bynroil behalf 0f the contractor and a Copy of the endorSerw8nt earning the City as additional insured shall be attached to tl le ContifiCah! Of Insurance. The City reserves the right to receive a certified copy of all re-q-uj I red insurance policies. The Contractor's Commercial General Liability insurance shall also contain a clause stating that coverage shall apply separately to each insured against whorn claim is made or suit is brought, except with respects to the limits of the insurer's liability. D. Acceptability of Insurers Insurance is tobc placed with insurers with a current A.M. Best rating o[ riot less than A:VD. E. Verification of Coverage Contractor shall furnish the City with original certificates and a copy of the arne8daburyeodnrSenlewts, |nt-|udiny but nuC necessarily limited tothe addiUVmatinSuredendmrsennen[, eVidendngiheinsunance /equircnocnino[ the [00\ractorbefO|ccornrnznCcnnento[ 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 bcsubject to all n( the same insurance requirements as stated herein for the Contractor, CERTIFICATE OF LIABILITY INSURANCE DATE(MMDDIYYYY) 11l3012017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTLFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,, EXTEND OR ALTER THE COVERAGE AFFORDED; BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(Sy, AUTHORIZED REPRESENTA 71IVE 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 NAMFU PHONE iPax l I9.N'9 tl.. Nationwide Sales Solutions Inc SMAIL m.. ADDflES8; 1200''LOCUST ST ANSURERISj AFFORDING COVERAGE NAICN •DES(MOINES IA 5039H-20,10 INSURERA: DEPOSITORS INSURANCE'COMPANY 42587 INSURED INSURER B ,... ,, INSURER C TRAFFIC CONTROL PLAN CO.OF WASHINGTON,LLC INSURER D,, 1339 42ND ST NE INSURER E AUBURN WA 98002-7036 INSIIRER F COVERAGES CERTIFICATE.NUMBER:. REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANYCONTRACT OR OTHER'DOCUMENT WITH RESPECT TO NMYICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TIME TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY TPAID CLAIMS. INSYY' ,.,AWL BllBRj'.... ......... ............. "'aOLDC YYYY PM091IDOlrO .... TYPE OF pOLICV NUMBER LIMITS_TR m XCOMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 2 000 ODD .� DAMAGE TO ENTE CLAIMS MADE �X 1 OCCUR PREMISES L[n sicou renore6 _ $ 100,000- ____ MED EKE(Any one person) C$ 5000 A X ACP GLD03008459207 ''0912512017 09125/2018 PERSONAL S AOV INJURY _.�s 2,000,000 DER ( 3R Jp}drl"IIMIT A11RUP5,11R.FI S CCIPILRAL AUI.Ifit GAS y(S 4000000 X' ru3.gw I^RO Iof, PRODUCTS-COMPlOP AGO IS 4000000 OTHER. I $ AUTOMOBILE LIABILITY COMBINELIS GLLIM11 ANY AUTO BODILY INJURY(Per person) 6 - ALL OWNED AUTOS _- SCHEDULED BODILY INJURY(Fur accident) 5 HIRED NON OWNEDPROF(RVY OAMAGC - y HIRED AUTOS AUTOS !P¢r acc dtnij --. S I WMaREL�LFAV ) Or'GUR r F Id r L(LRIJ(IJ(.n I a EXCESS LUIB CLAIMS MADE AGGREGATE —"S — —' LED RETENTIONS 3 WORKERSCOMP ENSATION PER DTH- ANDEMPLOYERS'LIABILITY YIN crADEFE FR ANYPROPRIETORIPARTNE RIEXECUTIVE NIA EL EACHACCIDENT 5 OFFICER/MEMBEREXCLUDEDP -'- (Mandatory in NEI EL.DISEASE-EA EMPLOYEE S f yes,describe Under DESCRIPTION OE OPERATIONS below EL DISEASE POLICY LIMIT S I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEMCLES IACDRD ae1,Addlaonal RemaMs 8e�edule,may De attacTed R more space Is required) Certificate holder is additional insured on form CG7288. CERTIFICATE HOLDER. CANCELLATION, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Ken AUTHORIZED REPRESENTATIVE 400 W Gowe St Kristen Stevens Kent WA 98032 I Oa 1900-.201AACORDJCORPORATIGN. Allsightsroserve . ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 72 88 12 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS ENHANCEMENT (ENDORSEMENT INCLUDING MEDICAL PAYMENTS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Lost Key Coverage C. Non-Owned Watercraft 1. Under Section I - Coverages, Coverage A Under Section I - Coverages, Coverage A Bodily Injury And Property Damage Bodily Injury And Property Damage Liability, Liability, coverage is extended to include 2. Exclusions Exclusion g. Aircraft, Auto Or the following: Watercraft Paragraph (2) (a) is replaced with: If a customer's master or grand key, (a) Less than 51 feet long; and excluding electronic key card, is lost, D. Expanded Property Damage Coverage damaged or stolen while in your care, 1. For the purposes of this endorsement only: custody or control we will pay the cost of replacing the keys, including the master lock Section I - Coverages, Coverage A and all keys used in the same lock, the cost Bodily Injury And Property Damage of adjusting locks to accept the new keys, or Liability, 2. Exclusions, Exclusion j. the cost to replace the locks, whichever is Damage To Property is amended as less. follows 2. Limit of Insurance- For the purpose of this a. Paragraphs (3), (5), and (6) are deleted coverage, the most we will pay is $10,000 in their entirety. per"occurrence'' b. Paragraph (4) is deleted in its entirety B. Voluntary Property Damage and replaced with: 1. Under Section I - Coverages, Coverage A (4) Personal property in the care Bodily Injury And Property Damage Liability, custody, or control of the insured. coverage is extended to include the following: (a) For storage or sale at premises At your request, we will pay for "property you own, rent or occupy, or damage" to property of others caused by you (b) While being transported by any and while in your possession, arising out of your aircraft, "auto" or watercraft business operations and occurring during the owned or operated by or rented policy period. to or loaned to any insured. 2. Limit of Insurance- For the purpose of this c. The coverage provided by this coverage the most we will pay is $1,500 per endorsement does not apply to "occurrence". "property damage": C. Non-Owned Watercraft (1) Arising out of the disappearance or Under Section I - Coverages, Coverage A loss of use of personal property, or Bodily Injury And Property Damage Liability, (2) Included in the "products-completed 2. Exclusions Exclusion g. Aircraft, Auto Or operations hazard". Watercraft Paragraph (2) (a) is replaced with: (a) Less than 51 feet long: and CG 72 88 12 16 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 5 with its permission. ACP GLD03DO8459207 LU9Z 17282 INSURED COPY 37 0000371 CG 72 88 12 16 2. Limit of Insurance - The most we will pay F. Supplementary Payments for loss arising out of any one "occurrence" Under Section I - Coverages, Supplementary is $5,000. Payments - Coverages A and B Paragraphs 3. Deductible - Our obligation to pay for a 1.b. and 1.d. are replaced with: covered loss applies only to the amount of b. Up to $2,500 for cost of bail bonds required loss in excess of$250, because of accidents or traffic law violations We will pay the deductible amount to effect arising out of the use of any vehicle to which settlement of any claim or "suit" and upon the Bodily Injury Liability Coverage applies. notification having been taken you shall We do not have to furnish these bonds. promptly reimburse us for the deductible as d. All reasonable expenses incurred by the has been paid by us. insured at our request to assist us in the This insurance is primary to any expanded investigation or defense of the claim or damage coverage provided by a separate "suit', including actual loss of earnings up to endorsement attached to this policy, and it $500 a day because of time off from work, will supplant any deductible in said G. Newly Formed And Acquired Organizations endorsement. Under Section II - Who Is An Insured E. Damage To Premises Rented To You Paragraph 3.a. is replaced with: 1. Under Section I - Coverages, Coverage A a. Coverage under this provision is afforded Bodily Injury And Property Damage only until the 1801, day after you acquire or Liability, the last paragraph of 2. form the organization or the end of the policy Exclusions is replaced with: period, whichever is earlier; If Damage To Premises Rented To You is H. Additional Insured - Automatic Status When not otherwise excluded, Exclusions c. Required In An Agreement Or Contract With through n. do not apply to damage by fire, You lightning, explosion, smoke, or sprinkler leakage to premises while rented to you or Section II - Who Is An Insured is amended to temporarily occupied by you with permission include: of the owner. A separate limit of insurance 4. Any person(s) or organization(s) described applies to this coverage as described in in Paragraphs a. - d. below with whom you Section III- Limits Of Insurance. have agreed in writing in a contract or 2. Under Section III - Limits Of Insurance, written agreement that such person or Paragraph 6. is replaced with: organization be added as an additional insured on your policy during the policy 6. Subject to 5. above, the Damage To period shown in the Declarations. Premises Rented To You Limit is the The person or organization added as an damages because of "property damage" most e will pay under Coverage A for insured by this endorsement is an insured to any one premises, while rented to only for liability due to you, or in the case of damage by fire, a. Lessors of Leased Equipment with lightning, explosion, smoke or sprinkler respect to their liability for 'bodily injury'' leakage, while rented to you or "property damage", or "personal and temporarily occupied by you with advertising injury", caused in whole or in permission of the owner. The limit is part by your maintenance, operation or increased to $1,000,000. use of equipment leased to you by such 3. Under Section IV - Commercial General person(s) or organ ization(s). This Liability Conditions, Condition 4. Other insurance does not apply to any Insurance, b. Excess Insurance (1) (a) (ii) .,occurrence" which takes place after the is replaced with: lease expires. (ii) That is Fire, Lightning, Explosion, However, their status as additional Smoke, or Sprinkler leakage insured under this policy ends when insurance for premises rented to their lease, contract, or agreement with you or temporarily occupied by you you for such leased equipment expires. with permission of the owner. Page 2 of 5 Includes copyrighted material of Insurance Services Office, Inc., CG 72 88 12 16 with its permission. ACP GLD03008459207 LU9Z 172132 INSURED COPY 37 0000372 CG 72 88 12 16 b. Managers or Lessors of Premises d. Owners, Lessees, or Contractors with with respect to liability arising out of the respect to liability for "bodily injury", ownership, maintenance, or use of that "property damage", or "personal and part of the premises you own, rent, advertising injury" caused, in whole or in lease, or occupy. part, by: This insurance does not apply to: (1) Your acts or omissions, or (1) Any 'occurrence" which takes place (2) The acts or omissions of those after you cease to be a tenant in acting on your behalf; that premises in the performance of your ongoing (2) Structural alterations, new con- operations performed for that struction or demolilion operations additional insured, whether the work performed by or on behalf of the is performed by you or on your person or organization. behalf. However, their status as additional The insurance does not apply to: insured under this policy ends when you (1) "Bodily injury", "property damage", cease to be a tenant of such premises. or "personal and advertising injury" c. State or Political Subdivision — arising out of the rendering of or the Permits Relating to Premises with failure to render any professional respect to the following hazards for architectural, engineering, or survey which the state or political subdivision services, including: has issued a permit or authorization in (a) The preparing, approving, or connection with premises you own. rent failing to prepare or approve or control and to which this insurance maps, shop drawings. opinions, applies: reports, survey, field orders, (1) The existence, maintenance, repair, change orders, or drawings and construction, erection, or removal of specifications: or advertising signs, awnings, (b) Supervisory, inspection, archi- canopies, cellar entrances, coal tectural, or engineering activ- holes, driveways, manholes, ilies, marquees, hoist away openings, ur ''properly sidewalk vaults, street banners, or (2) "Bodily injury" or t damage" decorations and similar exposures; occurring after: or (a) All work, including materials, (2) The construction, erection, or parts, or equipment furnished in removal of elevators;or connection with such work, on the project (other than service, The ownership, maintenance, or use of maintenance or repairs) to be any elevators covered by this insurance. performed by or on behalf of the This insurance does not apply to. additional insured(s) at the (1) "Bodily injury" or "property damage" location of the covered or "personal or advertising injury" operations has been completed, arising out of operations performed or for the state or municipality; or (b) That portion of "your work" out (2) "Bodily injury" or "properly damage" of which the injury or damage included within the "products- arises has been put to its intended use other any person or completed operations hazard". organization other than another However, such state or political contractor or subcontractor subdivision's status as additional engaged in performing insured under this policy ends when the operations for a principal as a permit ends. part of the same project. CG 72 88 12 16 Includes copyrighted material of Insurance Services Office, Inc., Page 3 of 5 with its permission. ACP GLD03008459207 LU9Z 17282 INSURED COPY 37 0000373 CG 72 88 12 16 However, a person or organization's This coverage does not apply if Coverage C — slatus as additional insured under Medical Payments is excluded either by the this policy ends when your provisions of any coverage forms attached to the operations for that additional insured policy or by endorsement. are completed. K. Knowledge Of An Occurrence With respect to the insurance afforded to Under Section IV — Commercial General such additional insureds a. — d. described Liability Conditions, the following is added to above the following is added to the Section Condition 2. Duties In The Event Of III—Limits Of Insurance: Occurrence, Offense, Claim Or Suit: If coverage provided to the additional e. Knowledge of an occurrence, offense, claim insured is required by a contract or or suit by an agent or employee of any agreement, the most we will pay on behalf of insured shall not in itself constitute the additional insured is the amount of knowledge of the insured unless you: a insurance partner, if you are a partnership; or an 1. Required by the contract or agreement: executive officer, or insurance manager, if or you are a corporation receives such notice 2. Available under the applicable Limits of of an occurrence, offense, claim, or suit from Insurance shown in the Declarations, the agent or employee. whichever is less. 1. The requirements in Paragraph b. will not be This endorsement shall not increase the considered breached unless there is applicable Limits of Insurance shown in the knowledge of occurrence as outlined in Declarations, Paragraph e. above. However, the insurance afforded to such L. Unintentional Failure To Disclose Hazard additional insureds a.—d. described above. Under Section IV — Commercial General 1. Only applies to the extent permitted by Liability Conditions, Condition 6. law; and Representations the following paragraph is added: 2, Will not be broader than that which you d. Your failure to disclose all hazards or prior are required by the contract or "occurrences" or offenses existing as of the agreement to provide such additional inception date of the policy shall not insured. prejudice the coverage afforded by this I. Aggregate Limit Per Project policy provided such failure 10 disclose all Under Section III — Limits Of Insurance The hazards or prior "occurrences" or offenses is following paragraph is added to Paragraph 2: not intentional. This provision does not The General Aggregate Limit under Section III affect our right to collect additional premium Limits Of Insurance applies separately to each or exercise our right of cancellation or non- of your construction projects away from renewal. premises owned by or rented to you. M. Waiver Of Subrogation J. Medical Payments Under Section IV — Commercial General Under Section III — Limits Of Insurance, Liability Conditions, 8. Transfer Of Rights Of Paragraph 7. is replaced with: Recovery Against Others To Us the following 7. Subject to 5. above, the higher of: paragraph is added: a. $1 Q000; or If required by a written contract executed prior to loss, we waive any right of subrogation we may b. The amount shown in the Declarations have against the contracting person or for Medical Expense Limit is the most organization because of payments we make for we will pay under Coverage C for all injury or damage arising out of your ongoing medical expenses because of "bodily operations or "your work" done under a contract injury" sustained by one person. with that person or organization and included in the "products-completed operations hazard". Page 4 of 5 Includes copyrighted material of Insurance Services Office, Inc., CG 72 88 12 16 with its permission. ACP GLD03008459207 LU9Z 17282 INSURED COPY 37 0000374 CG 72 88 12 16 N. Liberalization O. Broadened Bodily Injury Definition (Mental Under Section IV - Commercial General Anguish) Liability Conditions, the following condition is Under Section V - Definitions Definition 3. added: "Bodily Injury" is replaced with: 10. Liberalization 3. "Bodily injury" means physical injury, If we revise this coverage form to provide sickness, or disease to a person and if more coverage without additional premium arising out of the foregoing, mental anguish, charge, your policy will automatically provide mental injury. shock, or humiliation, the additional coverage as of the day the including death at any time resulting therefrom. revision is effective in your state. All terms and conditions of this policy apply unless modified by this endorsement. CG 72 88 12 16 Includes copyrighted material of Insurance Services Office, Inc., Page 5 of 5 with its permission. ACP GLD03008459207 LU9Z 17282 INSURED COPY 37 0000375 A p CERTIFICATE OF LIABILITY INSURANCE DATEIMM,DDYYYYI c' �r�...." 11 M30/2017 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 AFFDNDEDI BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,ANDTHE 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 NAME PHONE FAX IAIC�No Extl ____ INC,N9l1__ Nationwide Sales Solutions Inc E-MAIL ACOORIEW 1200 LOCUST ST INCIIRFRRn AFFr1Rra-o(YIVFRAGF NAIr'p DES MOINES IA '50351-2010 INSURER A: DEPOSITORS INSURANCE COMPANY 42587 INSURED ......... __ INSURER B: INSURER C: TRAFFIC CONTROL PLAN CO.OF WASHINGTON, LLC INSURER D: 1339 42ND ST NE INSURER E: AUBURN WA 98002-7036 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED'.TO THE INSUREOr NAMED,ABINE FOR THE POICGY 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 ,n cn POLICYEFF POLICY EXP LIMITS Lm, TYPE OF INSURANCE POLICY N,IIMBFR MMA MI mvn COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 i `X PRPM Sps fa a ru o'o,.l _`s 100,000... CLAIMS-MADE /� OCCUR MED EXP(Any one person) __. $ 5,000 A X ACP GLDO 3008459207 09/25/2017 09/25/2018 I PERSONAL&ADv INJURY s 2,000,000 GEN L ACCREG,,fE LIMIT APPLVESPER (GENERAL AGCREGATC 5 4000,000 RC �. Ic01 Irt):Y I JECT LOG f PRODUCIS-COMROPAGG S 4,000000 OTHER I I �$ AUTOMOBILE LIABILITY MBINfiO VN OL LIMIT 0c ANY AUTO OODILY INJURY(Per porean) �$ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY IPeraxldenp $ HIREDAUTOS NON-0WNED (PROPERTY DAMAGE $ AUTOS (POOP mint . I� �... UMBRELLA LAB I `OCCUR j I EACH OCCURRENCE �5 (EXCESS LAB 3�CLAIMMADE� I., AGC.RE6A... ... .. -b ... ... ... .... DEB RETENTION$ $ WORKERS COMPENSATION PER O1H- ANDEMPLOYERS'LIABILITY ¢[ArI=LF Er( YIN ANYPRO/MEMSRIPARTUDEDI ECUTIVE C� NVA EL EACHACCIDENT ^ OFFICERry inN REY.CWDED4 YEI IfVs., doryinNH) EL DISEASE EA EMPLOYEE $ If Vs., desprl KI OFQunderm — - �DFS(:RIPTInN OF CIPFRATIDNS helgw E L DISEASE POLICY LIMIT b I I I I i OESCRIPTON OF OPERATON5I LOCATIONS I VEMCLES IACOI D 101,AdQfional Remarks Selledule,maybe aHaded d more space is required) Certificate holder is additional insured on form CG7288. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Kent AUTHORIZED REPRESENTATIVE 400 W Gowe St Kristen Stevens Kem WA SE032 ©1988-2014 ACORD CORPORATION. Ali rights reserved,. ACORD 25(21 The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 72 88 12 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS HA CE E T ENDORSEMENT INCLUDING MEDICAL PAYMENTS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Lost Key Coverage C. Non-Owned Watercraft 1. Under Section I — Coverages, Coverage A Under Section I — Coverages, Coverage A Bodily Injury And Property Damage Bodily Injury And Property Damage Liability, Liability, coverage is extended to include 2. Exclusions Exclusion g. Aircraft, Auto Or the following: Watercraft Paragraph(2)(a) is replaced with: If a customer's master or grand key, (a) Less than 51 feet long; and excluding electronic key card, is lost, D. Expanded Property Damage Coverage damaged or stolen while in your care, 1. For the purposes of this endorsement only: custody or control we will pay the cost of replacing the keys, including the master lock Section I — Coverages, Coverage A and all keys used in the same lock, the cost Bodily Injury And Property Damage of adjusting locks to accept the new keys, or Liability, 2. Exclusions, Exclusion j. the cost to replace the locks, whichever is Damage To Property is amended as less. follows: 2. Limit of Insurance— For The purpose of this a. Paragraphs (3), (5), and (6) are deleted coverage, the most we will pay is $10,000 in their entirety. per "occurrence". b. Paragraph (4) is deleted in its entirety B. Voluntary Property Damage and replaced with: 1. Under Section I — Coverages, Coverage A (4) Personal property in the care Bodily Injury And Property Damage Liability, custody, or control of the insured: coverage is extended to include the following: (a) For storage or sale at premises At your request, we will pay for "property you own, rent or occupy; or damage" to property of others caused by you (b) While being transported by any and while in your possession, arising out of your aircraft, "auto', or watercraft business operations and occurring during the owned or operated by or rented policy period, to or loaned to any insured. 2. Limit of Insurance—For the purpose of this c. The coverage provided by this coverage the most we will pay is $1,500 per endorsement does not apply to "occurrence". 'property damage": C. Non-Owned Watercraft (1) Arising out of the disappearance or Under Section I — Coverages, Coverage A loss of use of personal property; or Bodily Injury And Property Damage Liability, (2) Included in the 'products-completed 2, Exclusions Exclusion g. Aircraft, Auto Or operations hazard". Watercraft Paragraph (2)(a)is replaced with: (a) Less than 51 feet long; and CG 72 88 12 16 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 5 M' ✓:v with its permission. h'• PIG MN,1r"MY00W ,�9 Mw M. 16^;WlM IY'! +I'A n I..*P •. P "eW,M"r CG 72 88 12 16 2. Limit of Insurance - The most we will pay F. Supplementary Payments for loss arising out of any one 'occurrence" Under Section I — Coverages, Supplementary is$5,000. Payments — Coverages A and B Paragraphs 3. Deductible - Our obligation to pay for a 1.b. and 1.d. are replaced with: covered loss applies only 10 the amount of b. Up to $2,500 for cost of bail bonds required loss in excess of$250. because of accidents or traffic law violations We will pay the deductible amount to effect arising out of the use of any vehicle to which settlement of any claim or "suit" and upon the Bodily Injury Liability Coverage applies. notification having been taken you shall We do not have to furnish these bonds. promptly reimburse us for the deductible as d. All reasonable expenses incurred by the has been paid by us. insured at our request to assist us in the This insurance is primary to any expanded investigation or defense of the claim or damage coverage provided by a separate "suit", including actual loss of earnings up to endorsement attached to this policy, and it $500 a day because of time off from work. will supplant any deductible in said G. Newly Formed And Acquired Organizations endorsement. Under Section II — Who Is An Insured E. Damage To Premises Rented To You Paragraph 3.a. is replaced with: 1. Under Section I —Coverages, Coverage A a. Coverage under this provision is afforded Bodily Injury And Property Damage only until the 18011, day after you acquire or Liability, the last paragraph of 2, form the organization or the end of the policy Exclusions is replaced with: period, whichever is earlier: If Damage To Premises Rented To You is H. Additional Insured — Automatic Status When not otherwise excluded, Exclusions c. Required In An Agreement Or Contract With through n. do not apply to damage by fire, You lightning, explosion, smoke, or sprinkler leakage to premises while rented to you or Section 11 — Who Is An Insured is amended to temporarily occupied by you with permission include: of the owner. A separate limit of insurance 4. Any person(s) or organization(s) described applies to this coverage as described in in Paragraphs a. — d. below with whom you Section III— Limits Of Insurance. have agreed in writing in a contract or 2. Under Section III — Limits Of Insurance, written agreement that such person or Paragraph 6. is replaced with: organization be added as an additional insured on your policy during the policy 6. Subject to 5. above, the Damage To period shown in the Declarations. Premises Rented To You Limit is the most we will pay under Coverage A for The person or organization added as an damages because of "property damage'. insured by this endorsement is an insured to any one premises, while rented to only for liability due to: you, or in the case of damage by fire, a. Lessors of Leased Equipment with lightning, explosion, smoke or sprinkler respect to their liability for"bodily injury', leakage, while rented to you or "properly damage", or "personal and temporarily occupied by you with advertising injury', caused in whole or in permission of the owner. The limit is part by your maintenance, operation or increased to$1,000,000. use of equipment leased to you by such 3. Under Section IV — Commercial General person(s) or organization(s). This Liability Conditions, Condition 4. Other insurance does not apply to any Insurance, b. Excess Insurance (1) (a) (ii) "occurrence" which takes place after the is replaced with: lease expires. (ii) That is Fire, Lightning, Explosion, However, their status as additional Smoke, or Sprinkler leakage insured under this policy ends when insurance for premises rented to their lease, contract, or agreement with you or temporarily occupied by you you for such leased equipment expires. with permission of the owner. Page 2 of 5 Includes copyrighted material of Insurance Services Office, Inc., CG 72 88 12 16 with its permission. A P G p;.wPOP IRV#" 14 HM 7dfl,,11 41 a I 5' CG 72 88 12 16 b. Managers or Lessors of Premises d. Owners, Lessees, or Contractors with with respect to liability arising out of the respect to liability for "bodily injury", ownership, maintenance, or use of that "property damage", or "personal and part of the premises you own, rent, advertising injury" caused, in whole or in lease: or occupy. part, by: This insurance does not apply to: (1) Your acts or omissions; or (1) Any "occurrence" which takes place (2) The acts or omissions of those after you cease to be a tenant in acting on your behalf; that premises. in the performance of your ongoing (2) Structural alterations, new con- operations performed for that struction or demolition operations additional insured, whether the work performed by or on behalf of the is performed by you or on your person or organization. behalf. However, their status as additional The insurance does not apply to: insured under this policy ends when you (1) "Bodily injury", "property damage'' cease to be a tenant of such premises. or "personal and advertising injury" c. State or Political Subdivision — arising out of the rendering of or the Permits Relating to Premises with failure to render any professional respect to the following hazards for architectural, engineering, or survey which the state or political subdivision services, including: has issued a permit or authorization in (a) The preparing, approving, or connection with premises you own, rent failing to prepare or approve or control and to which this insurance maps, shop drawings, opinions, applies: reports, survey, field orders, (1) The existence, maintenance, repair, change orders, or drawings and construction, erection: or removal of specifications:or advertising signs, awnings, (b) Supervisory, inspection, archi- canopies, cellar entrances, coal tectural, or engineering activ- holes, driveways, manholes, hies. marquees, hoist away openings, 2 or "property sidewalk vaults, street banners, or O "Bodily injury"f y damage" decorations and similar exposures; occurring after: or (a) All work, including materials, (2) The construction, erection, or parts, or equipment furnished in removal of elevators;or connection with such work, on the project (other than service, The ownership, maintenance, or use of maintenance or repairs) to be any elevators covered by this insurance. performed by or on behalf of the This insurance does not apply to: additional insured(s) at the (1) "Bodily injury" or "property damage" location of the covered or "personal or advertising injury" operations has been completed: arising out of operations performed or for the state or municipality; or (b) That portion of "your work" out (2) "Bodily injury" or "property damage" of which the injury or damage included within the "products- arises has been put to its completed operations hazard". intended use any person r organization other than another However, such state or political contractor or subcontractor subdivision's status as additional engaged in performing insured under this policy ends when the operations for a principal as a permit ends. part of the same project. CG 72 88 12 16 Includes copyrighted material of Insurance Services Office,Inc., Page 3 of 5 with its permission. �,: i,, MOW OW, .y IN '..I; I° �'-1" r " filx'om'"! CG 72 68 12 16 However, a person or organization's This coverage does not apply if Coverage C — status as additional insured under Medical Payments is excluded either by the this policy ends when your provisions of any coverage forms attached to the operations for that additional insured policy or by endorsement. are completed. K. Knowledge Of An Occurrence With respect to the insurance afforded to Under Section IV — Commercial General such additional insureds a. — d. described Liability Conditions, the following is added to above the following is added to the Section Condition 2. Duties In The Event Of III—Limits Of Insurance: Occurrence,Offense, Claim Or Suit: If coverage provided to the additional e. Knowledge of an occurrence, offense, claim insured is required by a contract or or suit by an agent or employee of any agreement, the most we will pay on behalf of insured shall not in itself constitute the additional insured is the amount of knowledge of the insured unless you, a insurance: partner, if you are a partnership; or an 1. Required by the contract or agreement: executive officer, or insurance manager, if or you are a corporation receives such notice 2. Available under the applicable Limits of of an occurrence, offense, claim, or suit from Insurance shown in the Declarations; the agent or employee. whichever is less. f. The requirements in Paragraph b. will not be This endorsement shall not increase the considered breached unless there is applicable Limits of Insurance shown in the knowledge of occurrence as outlined in Paragraph e. above. Declarations. However, the insurance afforded to such L. Unintentional Failure To Disclose Hazard additional insureds a.—d. described above: Under Section IV — Commercial General 1. Only applies to the extent permitted by Liability Conditions, Condition 6. an and Representations the following paragraph is added: 2. Will not be broader than that which you d. Your failure to disclose all hazards or prior are required by the contract or °occurrences" or offenses existing as of the agreement to provide such additional inception date of the policy shall not insured. prejudice the coverage afforded by this I. Aggregate Limit Per Project policy provided such failure to disclose all Under Section III — Limits Of Insurance The hazards or prior "occurrences" or offenses is following paragraph is added to Paragraph 2: not intentional. This provision does not The General Aggregate Limit under Section III affect our right to collect additional premium Limits Of Insurance applies separately to each or exercise our right of cancellation or non- of your construction projects away from renewal. premises owned by or rented to you. M. Waiver Of Subrogation J. Medical Payments Under Section IV — Commercial General Under Section III — Limits Of Insurance, Liability Conditions, 8. Transfer Of Rights Of Paragraph 7. is replaced with: Recovery Against Others To Us the following 7. Subject to 5. above, the higher of: paragraph is added: a. $10,000; or If required by a written contract executed prior to loss, we waive any right of subrogation we may b. The amount shown in the Declarations have against the contracting person or for Medical Expense Limit is the most organization because of payments we make for we will pay under Coverage C for all injury or damage arising out of your ongoing medical expenses because of "bodily operations or"your work" done under a contract injury" sustained by one person. with that person or organization and included in the "products-completed operations hazard". Page 4 of 5 Includes copyrighted material of Insurance Services Office, Inc., CG 72 88 12 16 with its permission. CG 72 88 12 16 N. Liberalization O. Broadened Bodily Injury Definition (Mental Under Section IV — Commercial General Anguish) Liability Conditions, the following condition is Under Section V — Definitions Definition 3. added: 'Bodily Injury'is replaced with: 10. Liberalization 3. "Bodily injury" means physical injury, If we revise this coverage form to provide sickness, or disease to a person and if arising out ofu the foregoing, mental anguish, more coverage without additional premium mental injury, charge, your policy will automatically provide ry, shock, or humiliation, the additional coverage as of the day the including death at any time resulting therefrom. revision is effective in your state. All terms and conditions of this policy apply unless modified by this endorsement. CG 72 88 12 16 Includes copyrighted material of Insurance Services Office, Inc.. Page 5 of 5 with its permission. A' F i DY,=R R �WP"rr IIIW' Illt;•y�C. P+P �! ' W ?WTd 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, 1, the undersigned, a duly represented agent of Traffic Control Plan Co of LAlashington Company, hereby acknowledge and declare that the before-mentioned company was the prime contractor for the Agreement known as 2018 Trgffic.Sign ReplagemCnj Project, that was entered into on the December 18, 2017i (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 tfte before-mei-iti,oned Agreement, By: For., Title: Date: pwn EEO COMPLIANCE DOCUMENTS 1 l 77 c", r d s "K KEN Document WJAS HO N G TON 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: Traffic Control Plan of WA Vendor Number: JD Edwards Number Contract Number: 11 This is assigned by City Clerk's Office Project Name: East Valley Highway Preservation Description: ❑ Interlocai Agreement ❑ Change Order 0 Amendment ❑ Contract ❑ Other: Contract Effective Date: 2/12/18 Termination Date: 12/31/18 Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Garrett Inouye Department: Public Works Design Contract Amount: $7,000 Approval Authority: M Department Director Mayor 0 City Council Detail: (i.e. address, location, parcel number, tax id, etc.): Traffic control plans for the East Valley Highway Preservation Project _..... ... .. ..... ...._ ......_ . ......_...._ _..... .._ ...... As of. 08/27/14 • KENT W A S 11 I N G T O N AMENDMENT NO. 1 NAME OF CONSULTANT OR VENDOR: Traffic Control Plan Co of Washington CONTRACT NAME & PROJECT NUMBER: East Valley Highway Preservation ORIGINAL AGREEMENT DATE: December 21. 2017 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: Preparing additional traffic control plans for the project. For a detailed description see the vendors Exhibit A which is attached and incorporated by this reference. 2. The contract amount and time for performance provisions of Section II "Time of Completion," and Section III, "Compensation," are modified as follows: Original Contract Sum, $5,250 including applicable WSST Net Change by Previous Amendments $0 including applicable WSST Current Contract Amount $5,250 including all previous amendments Current Amendment Sum $1,750 Applicable WSST Tax on this $0 Amendment Revised Contract Sum $7,000 AMENDMENT - 1 OF 2 Original Time for Completion / x/ Time for� (insert date) i2 vsedaendmentsompietion under NA prio(insert date) Add'l Lays Required (±) for this 0 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 bind 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 became effective on the last date written below. O SULTAN T/VENDOR: VJ (signature) Print Name: r~ c.� sg furs) its Cwlrf6. Print Name: Timothy I I_ADnr— p E (t / its Public ks C�irector DATE / (title) t: DAT :_ , t'''`� 2,0 APPROVED AS To ('applicable if Mayor's signature required) Kent Law Department AMENDMENT - 2 F 2 EXHIBIT A M • P City of Kent 1/23118 400 W Grove ,fit Kent, WA 93032 ATTN Garrett Inouye Project objective: To provide all traffic control plans (TCP) for project. Key points that Traffic Control Plan Co.. of WA, LLC will provide: • TCP Co. of'a"A LLC will draft traffic control plans within 10 working days after "notice to proceed' has been given for project" Working days shall be considered MOO- FRI (holidays excluded), **10 day window starts at 6r AM the day after `notice to proceed`contract has been signed and delivered via email to TCP Co. of WA LLC. q No charge will be applied to any in-house consultations or pre-cons that are requested. 4 Payment terms for providing TCP's for this project shall be NET 30. Task 1 Proposal for East 'Valley Highway Preservation Project Cost for each plan sheet shall be $175.00 ea 10 TCP'sheets. x $175.00 ea sheet = $1750.00 Christopher Grose P aWEngineer/ caner Traffic Control Plan Co. of WA, LLC Traffic Control Plod Co. of WA, LLC• 0: 253-258-1419»F: 253-270-2250-email: chris@trafficcontrolplam.net DATE(MMIDDFYYYY) ACORO® CERTIFICATE OF LIABILITY INSURANCE `66. / 1 11/30/2017 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: PHONE--v - FAX AIC No, o Ext: A/C No: Nationwide Sales Solutions Inc E-MAIL aDDREss: _ 1200 LOCUST ST INSURERS AFFORDING COVERAGE NAIC# DES MOINES IA 50391-2010 INSURERA: DEPOSITORS INSURANCE COMPANY 42587 INSURED INSURER B INSURER C: TRAFFIC CONTROL PLAN CO.OF WASHINGTON,LLC INSURERD: 1339 42ND ST NE INSURER E: AUBURN WA 98002-7036 1 INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE 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 IADDL SUBRI POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDW 'rYY M1DDIYYYY t—TO', MERCUILGENERALLIABILITY EACH OCCURRENCE s 2,000,000 CLAIMS-MADE I�OCCUR REM SES Ea occuErrence $ 100-000 MED EXP(Any one person) s 5,000 A __ X ACP GLDO 3009459207 09125/2017 09/2512018jPERSONAL&ADVINJURY s 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: !GENERAL AGGREGATE — s 4,000,000 X POLICY ECT r LOC PRODUCTS-COMPIOPAGG S 4,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S Ea accident ANY AUTO BODILY INJURY(Per person) S ALL OWNED j'.'.SCHEDULED BODILY INJURY(Per accident) $ AUTOS =AUTOS NON-OWNED - PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESSLIA6 CLAIMS-MADE' AGGREGATE S DED RETENTION S s WORKERS COMPENSATION PER OTH- j AND EMPLOYERS'LIABILITY YIN: STATUTE I I ER ANYPROPRIETORIPARTNERIEXECUTIVE E.L EACH ACCIDENT !S OFFICERIMEMBEREXCLUDED? NIA (Mandatory In NH) E.L DISEASE-EA EMPLOYEE'S If y8s,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT!$ i i I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Certificate holder is additional insured on form CG7288. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Kent AUTHORIZED REPRESENTATIVE 400 W Gowe St Kristen Stevens Kent WA 98032 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD From: Christopher Grose <chds@tmMiccoouo|p|an.oet> Sent: Thursday, December 14, 2OI74:l4PM To: Wakefield, Wendy Subject: RE: Your Nationwide Commercial Insurance Attachments: imageO01.emz; Contractmr'sEnhancement.pdf Wendy- Attached is the CG7288 form., |f this is not what you need, let me know and K will call myagent. Below is an email & link pertaining to the L& I requirements for the State of Washington, As a sole proprietor, I am not required to carry VVnrknman'sCompensation. | received this reply on6J16/17 from Lila AUen1om. See below between red brackets. [HeNo[hris, Below ioa0mktoLabnr and Industries Limited Liability Companies. All mmmmagersvwho ii^m wUsomnmmbew om the LK are ax(8mded hooncmwevage. Uhewkyou Lila -011�zDtOD 'NecounCproe4z�'5�501-��m � emp|oUpr($orv|eos V�zptrflrobor and {ndo�5iri�.,5 l): 580-902-4813] As for the Automobile insurance requirements....my business does not have any vehicles listed or registered as company assets. My work is done using phone & email. | dm not visit any jobsites nor doU provide labor, equipment eronsi1ejob consults. Feel free 1u contact me with any other questions. Thank you. z COMMERCIAL GENERAL LIABILITY CG72881216 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS ENHANCEMENT ENDORSEMENT INCLUDING MEDICAL PAYMENTS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Lost Key Coverage C. Non-Owned Watercraft 1. Under Section I —Coverages, Coverage A Under Section I — Coverages, Coverage A Bodily Injury And' Property Damage Bodily Injury And Property Damage Liability, Liability, coverage is extended to include 2. Exclusions Exclusion g. Aircraft, Auto Or the following: Watercraft Paragraph (2)(a) is replaced with: If a customer's master or grand key, (a) Less than 51 feet long;and excluding electronic key card, is lost, D. Expanded Property Damage Coverage damaged or stolen while in your care, custody or control we will pay the cost of 1• For the purposes of this endorsement only: replacing the keys, including the master lock Section I — Coverages, Coverage A and all keys used in the same lock, the cost Bodily Injury And Property Damage of adjusting locks to accept the new keys, or Liability, 2. Exclusions, Exclusion j. the cost to replace the lacks, whichever is Damage To Property is amended as less. follows: 2. Limit of Insurance— For the purpose of this a. Paragraphs (3), (5), and (6) are deleted coverage, the most we will pay is $10,000 in their entirety. per"occurrence". b. Paragraph (4) is deleted in its entirety B. Voluntary Property Damage and replaced with: 1. Under Section I — Coverages, Coverage A (4) Personal property in the care Bodily Injury And Property Damage Liability, custody, or control of the insured: coverage is extended to include the following: (a) For storage or sale at premises At your request, we will pay for "property you own, rent or occupy;or damage" to property of others caused by you (b) While being transported by any and while in your possession,arising out of your aircraft, "auto", or watercraft business operations and occurring during the owned or operated by or rented policy period. to or loaned to any insured. 2. Limit of Insurance—For the purpose of this c. The coverage provided by this coverage the most we will pay is $1,500 per endorsement does not apply to "occurrence". "property damage": C. Non-Owned Watercraft (1) Arising out of the disappearance or Under Section I — Coverages, Coverage A loss of use of personal property;or Bodily Injury And Property Damage Liability, (2) Included in the "products-completed 2. Exclusions Exclusion g. Aircraft, Auto Or operations hazard". Watercraft Paragraph(2)(a) is replaced with: (a) Less than 51 feet long;and CG 72 88 12 16 Includes copyrighted material of Insurance Services Office,Inc., Page 1 of 5 with its permission. ACP GLD03008459207 LU9Z 17282 INSURED COPY 37 0000371 CG 72 88 12 16 2. Limit of Insurance - The most we will pay F. Supplementary Payments for loss arising out of any one "occurrence" Under Section I —Coverages, Supplementary is$5,000. Payments — Coverages A and B Paragraphs 3. Deductible - Our obligation to pay for a 1.b. and 1.d. are replaced with: covered loss applies only to the amount of b. Up to $2,500 for cost of bail bonds required loss in excess of$250. because of accidents or traffic law violations We will pay the deductible amount to effect arising out of the use of any vehicle to which settlement of any claim or "suit' and upon the Bodily Injury Liability Coverage applies. notification having been taken you shall We do not have to furnish these bonds. promptly reimburse us for the deductible as d. All reasonable expenses incurred by the has been paid by us. insured at our request to assist us in the This insurance is primary to any expanded investigation or defense of the claim or damage coverage provided by a separate "suit', including actual loss of earnings up to endorsement attached to this policy, and it $500 a day because of time off from work. will supplant any deductible in said G. Newly Formed And Acquired Organizations endorsement. Under Section II — Who Is An Insured E. Damage To Premises Rented To You Paragraph 3.a.is replaced with: 1. Under Section I —Coverages, Coverage A a. Coverage under this provision is afforded Bodily Injury And Property Damage only until the 180", day after you acquire or Liability, the last paragraph of 2. form the organization or the end of the policy Exclusions is replaced with: period,whichever is earlier; If Damage To Premises Rented To You is H. Additional Insured — Automatic Status When not otherwise excluded, Exclusions c. Required In An Agreement Or Contract With through in. do not apply to damage by fire, You lightning, explosion, smoke, or sprinkler Section II — Who Is An Insured is amended to leakage to premises while rented to you or temporarily occupied by you with permission include: of the owner. A separate limit of insurance 4. Any person(s) or organization(s) described applies to this coverage as described in in Paragraphs a. — d. below with whom you Section III—Limits Of Insurance. have agreed in writing in a contract or 2. Under Section III — Limits Of Insurance, written agreement that such person or Paragraph 6. is replaced with: organization be added as an additional 6. Subject to 5. above, the Damage To insured on your policy during the policy period shown in the Declarations. Premises Rented To You Limit is the most we will pay under Coverage A for The person or organization added as an damages because of "property damage" insured is this endorsement is an insured to any one premises, while rented to only for liability due to: you, or in the case of damage by fire, a. Lessors of Leased Equipment with lightning, explosion, smoke or sprinkler respect to their liability for"bodily injury", leakage, while rented to you or "property damage", or "personal and temporarily occupied by you with advertising injury", caused in whole or in permission of the owner. The limit is part by your maintenance, operation or increased to$1,000,000. use of equipment leased to you by such 3. Under Section IV — Commercial General person(s) or organization(s). This Liability Conditions, Condition 4. Other insurance does not apply to any "occurrence"which takes place after the Insurance, b. Excess Insurance (1) (a)(ii) is replaced with: lease expires. , , , However, Their status as additional (II) That is Fire Lightning Explosion insured under this policy ends when Smoke, or Sprinkler leakage their lease, contract, or agreement with insurance for premises rented to you or temporarily occupied by you you for such leased equipment expires. with permission of the owner. Page 2 of 5 Includes copyrighted material of Insurance Services Office, Inc., CG 72 88 12 16 with its permission. ACP GLD03008459207 LU9Z 17282 INSURED COPY 37 0000372 CG 72 88 12 16 b. Managers or Lessors of Premises d. Owners, Lessees, or Contractors with with respect to liability arising out of the respect to liability for "bodily injury", ownership, maintenance, or use of that "property damage", or "personal and part of the premises you own, rent, advertising injury" caused, in whole or in lease, or occupy. part, by: This insurance does not apply to: (1) Your acts or omissions; or (1) Any "occurrence" which takes place (2) The acts or omissions of those after you cease to be a tenant in acting on your behalf; that premises. in the performance of your ongoing (2) Structural alterations, new con- operations performed for that struction or demolition operations additional insured, whether the work performed by or on behalf of the is performed by you or on your person or organization. behalf. However, their status as additional The insurance does not apply to: insured under this policy ends when you (1) "Bodily injury", "property damage", cease to be a tenant of such premises. or "personal and advertising injury" c. State or Political Subdivision — arising out of the rendering of or the Permits Relating to Premises with failure to render any professional respect to the following hazards for architectural, engineering, or survey which the state or political subdivision services, including: has issued a permit or authorization in (a) The preparing, approving, or connection with premises you own, rent failing to prepare or approve or control and to which this insurance maps, shop drawings, opinions, applies: reports, survey, field orders, (1) The existence, maintenance, repair, change orders, or drawings and construction, erection, or removal of specifications:or advertising signs, awnings, (b) Supervisory, inspection, archi- canopies, cellar entrances, coal tectural, or engineering activ- holes, driveways, manholes, ities. marquees, hoist away openings, 2 "Bodilyinjury" or "property damn e" sidewalk vaults, street banners, or ( ) f y g occurring after: decorations and similar exposures; or (a) All work, including materials, (2) The construction, erection, or parts, or equipment furnished in connection with such work, on removal of elevators; or the project (other than service, The ownership, maintenance, or use of maintenance or repairs) to be any elevators covered by this insurance. performed by or on behalf of the This insurance does not apply to: additional insured(s) at the (1) "Bodily injury" or "property damage" location of the covered or "personal or advertising injury" operations has been completed; arising out of operations performed or for the state or municipality;or (b) That portion of "your work" out (2) "Bodily injury" or "property damage" of which the injury or damage included within the "products- arises has been put to its completed operations hazard". intended use by any person or com p p organization other than another However, such state or political contractor or subcontractor subdivision's status as additional engaged in performing insured under this policy ends when the operations for a principal as a permit ends. part of the same project. CG 72 88 12 16 Includes copyrighted material of Insurance Services Office, Inc., Page 3 of 5 with its permission. ACP GLD03008459207 LU9Z 17282 INSURED COPY 37 0000373