Loading...
HomeMy WebLinkAboutPW18-144 - Amendment - #1 - Hokkaido Drilling, Inc. - Clark Springs Clear Well Pump Removal & Inspection - 05/03/2018 ANT Records Management Document CONTRACT COVER SHEET This is to be completed by the Contract Manager prior to submission to the City Clerk's Office. All portions are to be completed. If you have questions, please contact the City Clerk's Office at 253-856-5725. ❑ Blue/Motion Sheet Attached ❑ Pink Sheet Attached Vendor Name: Hokkaido Drilling Inc. Vendor Number (JDE): Contract Number (City Clerk): Category: Contract Agreement Sub-Category (if applicable): Amendment,. .__. Project Name Clark Springs Clear Well Pump Removal and Inspection Contract Execution Date: Termination Date: 6/30/18 ..._ _..._ ..,_........ Contract Manager: Jim Reed Department: PW: Operations Contract Amount: 93.392.34 Approval Authority: ® Director ❑ Mayor ❑ City Council Other Details Hokkaido Drilling IInc., triginal,contractamountwfor,pullinc :ts, tion and reinstalling the Clark Springs Clear Well Pump and motor was $11,000 with tax. After inspections grid parts replacement of the motor and pump unit,_Ifre-amended contract amount with...ta x.ls._$1-4;392;-3 4.. Please complete all of the information below and attach a copy of your scope of work and/or bids. if a field is not applicable, please indicate. Call Nancy at 5508 with any questions, REQUEST FOR: ❑ CONTRACT ® AMENDMENT ❑ CHANGE ORDER ❑ Consultant Services Agreement (provide specialized expertise or advice) ❑ Professional Services Agreement (attorney, real property appraiser, surveyor) ® Goods & Services Agreement* (provide goods, goods& service, or a service other than consulting or professional nature) ❑ Public Works Agreement (if contract is less than $65,000, select an option below)* (provide work, construction, alteration, repair, or improvement to public facilities, other than ordinary maintenance) ❑ Public Works Agreement (Bond) ❑ Public Works Agreement (10% Holdback) * For Goads & Services and Public Works Agreements, you will need to solicit at least three (3) bids. Once obtained, prepare a memo outlining the selection process and attach a copy of the memo and bids to the request. Contract Manager: Jim Reed Project: Clark Springs Clear Well Pump Removal and Inspection Project Number: n/a Project Account Number: 41005550.64110.7410 Name of Consultant/Contractor/Vendor: Hokkaido Drilling, Inc. Contact Person: Bill Dodge Complete Address: 24511 104t^ Avenue Court East P.O. Box 100 (Including City, State, Zip Code) Graham, Wa 98338 Phone: (253) 847-3579 Fax: (253) 847-7404 Email: hokdrill@aol.com Contract Completion Date: 6/30/2018 Contract Amount (Including sales tax): $11,000 Amendment/Change Order Amount: $3,392.34 Amount Remaining $ Total (Contract + Amendment/Change Order): $14,392.34 Time extension only: ❑ For time extensions, provide an explanation why the extension is necessary. SOQ on file (only far engineering services): Yes ❑ No ® N/A ❑ Selection Memo attached: Yes ❑ No ® N/A ❑ (amendment/change order) Ci -- --------— ----- rculate for approval: Once circulated, 11ru_ ��� a copy of documents to Nancy for contract preparation. QriginLi w Contract Manager: Matiep Manager: AInitial 'w&d,1, P:LPu�IIgAtlminlsGatlon\ConlraclsV0.epuert for Contract(Operation,less th-$10k) AIril 26,2018 PUBLIC WORKS Timothy J. LaPorte, P.E., Director OPERATIONS DIVISION Dave Brock, P.E., Deputy Director/Operations Manager T Phone: 253-856-5600 WA In N IN GTON Fax: 253-856-6600 Mailing Address: 220 Fourth Avenue South Kent, WA 98032-5895 Location Address: 5821 South 240th The original contract amount for pulling, inspection and reinstalling the Clark Springs clear well pump and motor was $11,000.00 with tax. After inspection and parts replacement of the motor and pump unit, the amended contract amount with tax is $14,392.34. Thanks Jim P:Oreratiuns\FormsAAdlnmAP W OpsMemo Fonn I�ydro, wismew wano QUOTE Sales Quote Number.SQ174199 3449 ENTERPRISE AVE Sales Quote Date:04/24/18 HAYWARD,CA 94545.3220 PageA Phone No: 800-972-5945 exi. 1301 Sell To: Ship To: HOKKAIDO DRILLING INC. HOKKAIDO DRILLING INC. P.O. BOX 100 24511 - 104141 AVE.CRT.EAST GRAHAM,WA 98338 GRAHAM,WA 98338 USA USA Customer ID 8676 Ship Via HYDRO 19 Taken By DAVE WEICKUM Ship Agent Western Hydro Truck Sales Person Brian Clarke Terms 2% 1 Oth ProxNet EOM List Disc. Price Extended Item No. Description UM Oty, price % Each Price LABOR SHOP LABOR-TURBINE ONLY EA f ee9.09 aao.000 8110.00 QUOTE PARTS TO REBUILD SHORT SET EA M 951.76 951.760 951.76 QUOTE POWDER COATIING EA N 100.00 100(100 100.00 .#;RFPWINP3-... ,,...._....- &-Nlf°7'IV lB°•G'FIakRGhfr ...._ ...._._..,.q. ._...-44frw M1Ct;00C1.-^--- ....__-440tAir FREIGHT TO PASCO AND BACK" ±A, fN Amount Subject to Amount Exempt Subtotal: 2,371.76 Sales Tax from Sales Tax Invoice Discount: 0.00 0,00 2.371.76 Total Sales Tax: (LOU Total: 2,371,76 From: Rick Stegner<rick@oenterelectric.com> To: HOKDRILL<HOKDRILL AOL.COM> Subject: MOTOR REPAIR Date:Tue,Apr 24,2018 10:43 am Bill US MOTOR HP-15 RPM-1770 FR-2S4T 230/460 DISASSEMBLE MOTOR TEST WINDINGS-ROTOR WASH-BAKE WINDINGS-CLEAN PARTS-BALANCE ROTOR INSTALL NEW BEARINGS REASSEMBLE TEST PAINT. $749.93 Thanks Rick Stegner Center Electric 1212 South 30th Street i Tacoma,WA,98409 (253)383- 416 / / / / �������|����� �o� � AMENDMENT" ^°��m u� NAME OF CONSULTANT [}RVENDOR: Hokkaido Drilling InQ CONTRACT N&ME8i PROJECT NUMBER: ORIGINAL AGREEMENT DATE: April 9,2M This Amendment is made between the City and the above-referenced Consultant or � Vendor and amends the original Agreement and all prior Amendments. All other provisions of � the original Agreement Or prior Amendments not inconsistent with this Amendment shall remain � in full force and effect. For valuable consideration and by mutual consent of the parties, Consultant or Vendor's work ia modified asfollows: 1" Section l of the Agreement/ entitled "Description of Work," is hereby modified to add additional work or revise existing work a$ follows: In addition to work required under the original Agreement and any prior Amendments, the Consultant mr Vendor shall: Provide additional services for the project. Fora description, see the Contractor's Scope of Work which is attached as Exhibit A and incorporated by this reference. 2. The contract amount and time for performance provisions of Section 11 "Time of COM0p|8tion/, and Section III, "C$nnpensabon/" are modified as follows: Original Contract Sum,; $11'000m - -- including applicable WSST Net Change by Previous Amendments '$6 including applicable WSST urrent Contract Amount including all previous amendments e WSST Tax on Amendment Revised Cwit�ract Sum $14,39234 ' - AMENDMENT- 10FI Original Time for Completion ( June 30, 2018 (insert date) Revised 11-Time for Completion 1-1 under N/A prior Amendments (insert date) Add'I Days Required (t) for this O calendar days Amendment Revised Time for Completion June 30, 2018 (insert date) I The Consultant or Vendor accepts all requirements of this Amendment by signing below, by its signature waives any protest or claim it may have regarding this Amendment, and acknowledges and accepts that this Amendment constitutes full payment and final settlement of all claims of any kind or nature arising from or connected with any work either covered or affected by this Amendment, including, without limitation, claims related to contract time, contract acceleration, onsite or home office overhead, or lost profits. This Amendment, unless otherwise provided, does not relieve the Consultant or Vendor from strict compliance with the guarantee and warranty provisions of the original Agreement. All acts consistent with the authority of the Agreement, previous Amendments (if any), and this Amendment, prior to the effective date of this Amendment, are hereby ratified and affirmed, and the terms of the Agreement, previous Amendments (if any), and this Amendment shall be deemed to have applied. The parties whose names appear below swear under penalty of perjury that they are authorized to enter into this Amendment, which is binding on the parties of this contract. IN WITNESS, the parties below have executed this Amendment, which will become effective on the last date written below. CONSULTANT/VENDOR: CITY OF KENT. BY E ti r f2_ k3y� e7 _....,., rrvl (siA,l xzxCrtrtr) Print Name 11° y�, � ._ Print Name: Timothy J. LaPorte, P.E. Its ...,.,,,, r ._. r ✓fir __...., Its: Public +' le: Director DATE: S ' DATE: „ ,. _... - ATTEST: APPROVED AS TO FORM: (applicable if Mayor's signature required) Kent City Clerk Kent Law Department ................. AMENDMENT - 2 OF 2 EXHIBIT A PUBLIC WORKS Timothy]. LaPorte, P.E., Director OPERATIONS DIVISION Dave Brock, P.E., Deputy Director/Operations Manager Iss Phone: 253-856-5600 Fax: 253-856-6600 Mailing Address; 220 Fourth Avenue South Kent, WA 98032-5895 Location Address: 5821 South 240th The original contract amount for pulling, inspection and reinstalling the Clark Springs clear well pump and motor was $11,000.00 with tax. After inspection and parts replacement of the motor and pump unit, the amended contract amount with tax is $14,392.34. Thanks Jim P;C}�F.vstianstFeusexcWhnieriP'NJt)�yM1Acsnirzermir QUOTE SSIM QLKft NuMbwz=74199 3449 ENTERPRISE AVE Sales 0w1e Date:04W8 HAYWARD,CA 94545-3220 Page:1 Plane No: 800-972-SM ext.1301 Se1To: Ship To: HOKKAIDO DRB.LING INC. HOKKAIDO DRILLING INC. P.O_BOX 100 M11-104TH AVE.CRT.EAST GRAHAM,WA 98338 GRAHAM,WA 98338 USA USA Ship Via HYDRO 19 Customer ID 8676 Hydro _ Taken 8 DAVE W Ship Terms W le ProxNet EOM Person Brian Clarke List Disc Price Extemiled hem No. UBII aly_ Price % Each Price Liam Stiop LABOR-TURBINE Y EA PARTS TO ^ET FJl p POWDER 'ri �1_� aS1.Ttsa 051:06 cAXJTE � 1 109.00`"FREIGHT TO PAS CK., 21go i Amount Subject to AnauM Exempt Suhmtal: 2,9T1.76 Sales Tax from Sales Tax Invoice Di6coha , aoo am 2,971.76 Total Sales Tax: 0.00 Total: 2.871.76 Rom:Ries Stegner teaeCt'iu.conv To:HOKDRI L<HOKDRILL A.CH..00m> SuNect MOTOR REPAIR Data:Tue,Apr 24,301810.43 am Bill US MOTOR HP-15 RPM-1770 FR-2S4T 2301460 DISASSEMBLE MOTOR TEST WINDINGS-ROTOR WASH43AKE WINDINGS-CLEAN PARTS-BALANCE ROTOR INSTALL NEW BEARINGS REASSEMBLE TEST PAINT $749.93 Thanks Rids Stegner Center EkzWc 1212 South 30th Street Tacoma,WA,99409 ���o (253)383-4416 � ✓, .� ! CERTIFICATE OF LIABILITY INSURANCE BATE IMMIDD"NYY) 4ASd2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate hold da is an ADOCTtlONAL INSURED,the po0cyllasy must have ADDITIONAL INSURED prowlRioes or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of[he policy, certain policies may require an entlorsement. A statement on this certific ate does.not confer rights to the certificate holder in lieu of such andowaamont)a). PRODUCER Liberty Mututal Insurance MAykAk PO Box 188065 PNDNE VAX Fairfield, OH 45018 VAINR.EAIV, Boo ss2 713z q)c,wg1,_ Soo aa5rise E MAIL AUPRRBS; Busalee 'erv)cp(�ILlberiyMuutal.00rn NSURER)S'AFFORDIMCCOVERAGE NABS .... INSURERA One Security Insurance Company 24082 INSURED Hokkaido Drilling Inc IN$URERe Ohio Casualty Insurance Company , 24074 H . PO Box 100 INSURER Graham VVA 98338 INSURER .... ..... ,... . .. INSURERE,___.. _... _. .. .; . INSURER COVERAGES CERTIFICATE NUMBER: 41222363 (REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUE 0 TO THE INSURED NAMED ABOVE FOR -HE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPE(;I f0 WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCR BED HEREIN IS SUBJECT 10 ALL THE TERMS, HXCL USIONS AND CONDITIONS OF SUCH POLICIES,(LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS AILOO GaTk':... _.. POLICY Eric " Forney EXP LIMITS .. ._., _. . f rvPE OE INSURANCE IN$18�1W®_....... P4Llcy MUMflER IMMflJOPYy'YTj,�,tMM14nt1M1'MY) .. T A COMMERCIAL GENERAL LIABILITY � � .BK558049215 e/1/2017 6/t/2018 rryf^YI{1l.[`URFi1.dIG'Y 5 1✓ DAMACk YD RIENIP'n t)6')(J(j0(j LRPMiR"Jr. ,uu,x.N 51;00W)00 .. MID I xP(Any one pervruy 515,000 Vi H3fl NA.SADV INJURY S1,D00DBt) cl rd ,no r mnlT nl In 51'ER r,ENERALa4,f..nr.T,Arr, s2000000 ✓ POLL ALL . ' Lar; )PRODUcrs.o(IMPrOP ABC, s 2 000 0o0OFFER -. .............__ w._w..w..r..__. _ AAu rnMoan Ellaan.try BAS58(149215 6/112017 67112018 ifp� urvrSLE tuMlx R5 ls1 q0B DY7(V WYAUL0 aoOR Y INJURY(Ie I11o11) i,t _ TAIstra Rtl t9 DILFJ:A AUTOSD rdJS NIY ;AD ( bC1Dll Y IN IUR- ( Erarcdanpls HINAM NONIOW'N1 0 j j PF40PETOY DAMAGE AUVOIS DHIY I AcRYO Oct I {Poe SCANT le I$ _ I i t b UMBRELLA uAa _J OCCUR IUSD86049215 6!1@017 61/2018 nrH occuaer ncr , 1, 00 EXCeasLOS GlR1MS NauL , Auat hA I 1,000000 wrD ✓ Rrrc NnraNs10,000 )- _ AnD HMMSCOMPEN ERIV A E�R kY[CUrIVE _.®....... ......_..._..... .,___� S.....YIN ._ fManAslaryceMPEMSATIDN �RKS6804B215 i 8l1120'17 Eli l2018 v� I o1u I, I I R If FICELP,reIMDER@16CLUDE61 NIA( f Lf(r; 1 11000000 CFFIO£ PRI a Nil] I ";ftrp Gap DSEASE FQ y Y I LQV 51 000 000_ beleear I n��scwuPrlDN nF rlx^RIbA�n(BNN naww � I E 1 000 000 R,. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORO 101,AOalllonal Remark.Schedule may be attached It more space is,equlred) CPrtlficale bolder IA Acld%ior.al Insured if required by written contacd or Antren agreement subject to General Liability Blanket Additional insured Provision 1 his Frolkcyy Is Primary and wa wall not ask for Corcribution of the policy Issued to the Additional Insured.Waiver of Subrogation Applies. Please sea form CG 88 10 04 13 attached. 30 Day Notice of Cancellation'10 Day Notice of Cancellation for Cancellation for Non-Payment of Premium CERTIFICATE HOLDER CANCELLATION C ltxy Ot Kent SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 220 of Kent Avenue South THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Kent th 98032 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE i d 4.. Lois Schulte 4 /ffJ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD m zz23 s� 1 e6011rl. 1 11 in " en Ivan I ...e 1 oC ro I COMMERCIAL GENERAL LIABILITY CG 88 10 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY EXTENSION This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART INDEX SUBJECT PAGE NON-OWNED AIRCRAFT 2 NON-OWNED WATERCRAFT 2 PROPERTY DAMAGE LIABILITY—ELEVATORS 2 EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) 2 MEDICAL PAYMENTS EXTENSION 3 EXTENSION OF SUPPLEMENTARY PAYMENTS —COVERAGES A AND B 3 ADDITIONAL INSUREDS — BY CONTRACT, AGREEMENT OR PERMIT 3 PRIMARY AND NON-CONTRIBUTORY—ADDITIONAL INSURED EXTENSION 5 ADDITIONAL INSUREDS —EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE" 6 WHO IS AN INSURED—INCIDENTAL MEDICAL ERRORS/MALPRACTICE AND WHO IS AN INSURED— 6 FELLOW EMPLOYEE EXTENSION —MANAGEMENT EMPLOYEES NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES 7 FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES 7 KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT 7 LIBERALIZATION CLAUSE 7 BODILY INJURY REDEFINED 7 EXTENDED PROPERTY DAMAGE 8 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US— 8 WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU ©2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 8 rzzz' I ssoa seas 1 r-ia easc n [.on ce I _ �na . I n/rr xo u, v z n Nrc (er rl I Faye of is With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement, A. NON-OWNED AIRCRAFT Under Paragraph 2. Exclusions of Section I —Coverage A- Bodily Injury And Property Damage Liability, exclusion g. Aircraft, Auto Or Watercraft does not apply to an aircraft provided 1. It is not owned by any insured, 2. It is hired, chartered or loaned with a trained paid crew, 3. The pilot in command holds a currently effective certificate, issued by the duly constituted authority of the United States of America or Canada, designating her or him a commercial or airline pilot, and 4. It is not being used to carry persons or property for a charge. However, the insurance afforded by this provision does not apply if there is available to the insured other valid and collectible insurance, whether primary, excess (other than insurance written to apply specifically in excess of this policy), contingent or on any other basis, that would also apply to the loss covered under this provision. B. NON-OWNED WATERCRAFT Under Paragraph 2. Exclusions of Section I —Coverage A—Bodily Injury And Property Damage Liability, Subparagraph (2) of exclusion g.Aircraft,Auto Or Watercraft is replaced by the following, This exclusion does not apply to: (2) A watercraft you do not own that is. (a) Less than 52 feet long; and (b) Not being used to carry persons or property for a charge. C. PROPERTY DAMAGE LIABILITY—ELEVATORS 1. Under Paragraph 2. Exclusions of Section I —Coverage A—Bodily Injury And Property Damage Liability, Subparagraphs(3), (4)and(6)of exclusion j. Damage To Property do not apply if such "property damage" results from the use of elevators. For the purpose of this provision, elevators do not include vehicle lifts. Vehicle lifts are lifts or hoists used in automobile service or repair operations. 2. The following is added to Section IV—Commercial General Liability Conditions, Condition 4.Other Insurance, Paragraph b. Excess Insurance: The insurance afforded by this provision of this endorsement is excess over any property insurance, whether primary, excess, contingent or on any other basis. D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) If Damage To Premises Rented To You is not otherwise excluded from this Coverage Part 1. Under Paragraph 2. Exclusions of Section I -Coverage A- Bodily Injury and Property Damage Liability; a. The fourth from the last paragraph of exclusion j. Damage To Property is replaced by the following Paragraphs (1), (3)and (4) of this exclusion do not apply to"property damage" (other than damage by fire, lightning, explosion, smoke, or leakage from an automatic fire protection system) to: (i) Premises rented to you for a period of 7 or fewer consecutive days, or (ii) Contents that you rent or lease as part of a premises rental or lease agreement for a period of more than 7 days. Paragraphs (1), (3)and (4)of this exclusion do not apply to"property damage" to contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described in Section III—Limits of Insurance. ©2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copynghted material of Insurance Services Office, Inc..,with its permission, Page 2 of 8 111211 (,I eJ I 1I- L, MJ II ( I of i I,I , I 1 $cliul t,f 1 9/5III II I 1 1;Sq ,, (v:') I ,q" , "I II i b. The last paragraph of subsection 2. Exclusions is replaced by the following: Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke or leakage from automatic fire protection systems to premises while rented to you or temporarily occupied by you with permission of the owner, A separate limit of insurance applies to Damage To Premises Rented To You as described in Section III—Limits Of Insurance. 2. Paragraph 6. under Section III—Limits Of Insurance is replaced by the following. 6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of"property damage"to a. Any one premise: (1) While rented to you, or (2) While rented to you or temporarily occupied by you with permission of the owner for damage by fire, lightning, explosion, smoke or leakage from automatic protection systems, or b. Contents that you rent or lease as part of a premises rental or lease agreement. 3. As regards coverage provided by this provision D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) -Paragraph 9.a, of Definitions is replaced with the following. 9.a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, or leakage from automatic fire protection systems to premises while rented to you or temporarily occupied by you with the permission of the owner, or for damage to contents of such premises that are included in your premises rental or lease agreement, is not an "insured contract". E, MEDICAL PAYMENTS EXTENSION If Coverage C Medical Payments is not otherwise excluded, the Medical Payments provided by this policy are amended as follows. Under Paragraph 1. Insuring Agreement of Section I —Coverage C— Medical Payments, Subparagraph (b) of Paragraph a. is replaced by the following (b) The expenses are incurred and reported within three years of the date of the accident, and F, EXTENSION OF SUPPLEMENTARY PAYMENTS—COVERAGES A AND B 1. Under Supplementary Payments—Coverages A and B, Paragraph 1.b. is replaced by the following: b. Up to $3,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies, We do not have to furnish these bonds. 2. Paragraph 1 A. is replaced by the following: d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or"suit", including actual loss of earnings up to $500 a day because of time off from work. G. ADDITIONAL INSUREDS -BY CONTRACT, AGREEMENT OR PERMIT 1. Paragraph 2. under Section II—Who Is An Insured is amended to include as an insured any person or organization whom you have agreed to add as an additional insured in a written contract, written agreement or permit. Such person or organization is an additional insured but only with respect to liability for"bodily injury', "property damage' or"personal and advertising injury" caused in whole or in part by. a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your on going operations for the additional insured that are the subject of the written contract or written agreement provided that the"bodily injury" or"property damage'occurs, or the "personal and advertising injury" is committed, subsequent to the signing of such written contract or written agreement, or Oc 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 3 of 8 a2z�a3 , I ;onvvc Io .x,, ,, 1 '11 1 1,ud'L! I s.n„ire 1 n/s/2o2a 22.>9 s< ", �e ,'. 1 aaae a "r Lu I I Premises or facilities rented by you or used by you, or C. The maintenance, operation or use by you of equipment rented or leased to you by such person or organization, or d. Operations performed by you or on your behalf for which the state or political subdivision has issued a permit subject to the following additional provisions. (1) This insurance does not apply to"bodily injury", ry°, "property damage", or"personal and advertising injury" arising out of the operations performed for the state or political subdivision, (2) This insurance does not apply to "bodily injury' or"property damage" included within the "completed operations hazard". (3) Insurance applies to premises you own, rent, or control but only with respect to the following hazards: a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners, or decorations and similar exposures, or (b) The construction, erection, or removal of elevators, or (c) The ownership, maintenance, or use of any elevators covered by this insurance. However. 1. The insurance afforded to such additional insured only applies to the extent permitted by law, and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. With respect to Paragraph 1.a. above, a person's or organization's status as an additional insured under this endorsement ends when: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project(other than service, maintenance or repairs)to be performed by or on behalf of the additional insureds) at the location of the covered operations has been completed,or (2) That portion of"your work"out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. With respect to Paragraph 1.1b, above, a person's or organization's status as an additional insured under this endorsement ends when their written contract or written agreement with you for such premises or facilities ends With respects to Paragraph 1.c. above, this insurance does not apply to any"occurrence"which takes place after the equipment rental or lease agreement has expired or you have returned such equipment to the lessor. The insurance provided by this endorsement applies only if the written contract or written agreement is signed prior to the"bodily injury" or"property damage". We have no duty to defend an additional insured under this endorsement until we receive written notice of a"suit" by the additional insured as required in Paragraph b. of Condition 2. Duties In the Event Of Occurrence, Offense, Claim Or Suit under Section IV—Commercial General Liability Conditions. ©2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc with its permission Page 4 of 8 �rnz� 1 rnnev,s 1 r rn Ma�Ca ,u.�cA t _. sari„rie 1 a/s/zor� zsaa nN MM 1 1-,., y A ro 2. With respect to the insurance provided by this endorsement, the following are added to Paragraph 2. Exclusions under Section I -Coverage A -Bodily Injury And Property Damage Liability: This insurance does not apply to, a. "Bodily injury' or"property damage" arising from the sole negligence of the additional insured, b. "Bodily injury' or"property damage"that occurs prior to you commencing operations at the location where such "bodily injury'or"property damage' occurs. C. "Bodily injury", "property damage"or"personal and advertising injury"arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications, or (2) Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the"occurrence"which caused the"bodily injury" or"property damage', or the offense which caused the"personal and advertising injury", involved the rendering of, or the failure to render, any professional architectural, engineering or surveying services, d. "Bodily injury"or"property damage"occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed, or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. e. Any person or organization specifically designated as an additional insured for ongoing operations by a separate ADDITIONAL INSURED—OWNERS, LESSEES OR CONTRACTORS endorsement issued by us and mace a part of this policy. 3. With respect to the insurance afforded to these additional insureds, the following is added to Section III— Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance a. Required by the contract or agreement: or b. Available under the applicable Limits of Insurance shown in the Declarations, whichever is less, This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. H. PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED EXTENSION This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this policy. Condition 4. Other Insurance of SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows' a. The following is added to Paragraph a. Primary Insurance: If an additional insured's policy has an Other Insurance provision making its policy excess, and you have agreed in a written contrac: or written agreement to provide the additional insured coverage on a primary and noncontributory basis, this policy shall be primary and we will not seek contribution from the additional insured's policy for damages we cover 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 5 of B I The following is added to Paragraph b. Excess Insurance: When a written contract or written agreement, other than a premises lease, facilities rental contract or agreement, an equipment rental or lease contract or agreement, or permit issued by a state or political subdivision between you and an additional insured does not require this insurance to be primary or primary and non-contributory, this insurance is excess over any other insurance for which the additional insured is designated as a Named Insured. Regardless of the written agreement between you and an additional insured, this insurance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional insured has been added as an additional insured on other policies I. ADDITIONAL INSUREDS - EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE" This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this policy. 1. The following is added to Condition 2. Duties In The Event Of Occurrence, Offense, Claim or Suit: An additional insured under this endorsement will as soon as practicable: a. Give written notice of an "occurrence'or an offense that may result in a claim or''suit" under this Insurance to us, b. Tender the defense and indemnity of any claim or 'suit"to all insurers whom also have insurance available to the additional insured, and C. Agree to make available any other insurance which the additional insured has for a loss we cover under this Coverage Part, d. We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a "suit" by the additional insured. 2. The limits of insurance applicable to the additional insured are those specified in a written contract or written agreement or the limits of insurance as stated in the Declarations of this policy and defined in Section III—Limits of Insurance of this policy, whichever are less. These limits are inclusive of and not in addition to the limits of insurance available under this policy. J. WHO IS AN INSURED -INCIDENTAL MEDICAL ERRORS/MALPRACTICE WHO IS AN INSURED - FELLOW EMPLOYEE EXTENSION -MANAGEMENT EMPLOYEES Paragraph 2.a.(1) of Section II -Who Is An Insured is replaced with the following; (1) "Bodily injury"or"personal and advertising injury" (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability company), to a co-"employee"while in the course of his or her employment or performing duties related to the conduct of your business, or to your other .'volunteer workers"while performing duties related to the conduct of your business, (b) To the spouse, child, parent, brother or sister of that co-"employee"or"volunteer worker'as a consequence of Paragraph (1) (a)above: (C) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1)(a)or(b) above, or (d) Arising out of his or her providing or failing to provide professional health care services. However, if you are not in the business of providing professional health care services or providing professional health care personnel to others, or if coverage for providing professional health care services is not otherwise excluded by separate endorsement, this provision (Paragraph(d)) does not apply e2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc with is permission Page 6 of 8 a;are: I ;eooeve I i i-ln rn"sr r I"'ir I , " ,emaia I n!s/mora 'I 11 ea "I tLIM I r or io Paragraphs(a)and (b) above do not apply to"bodily injury' or"personal and advertising injury" caused by an "employee"who is acting in a supervisory capacity for you. Supervisory capacity as used herein means the "employee's"job responsibilities assigned by you, includes the direct supervision of other"employees" of yours. However, none of these"employees"are insureds for"bodily injury" or"personal and advertising injury" arising out of their willful conduct, which is defined as the purposeful or willful intent to cause"bodily injury" or"personal and advertising injury", or caused In whole or in pall by their Intoxication by liquor or controlled substances, The coverage provided by provision J. is excess over any other valid and collectable insurance available to your "employee". K. NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES Paragraph 3. of Section II -Who Is An Insured is replaced by the following: 3. Any organization you newly acquire or form and over which you maintain ownership or majority interest. will qualify as a Named Insured if there is no other similar insurance available to that organization. However a. Coverage under this provision is afforded only until the expiration of the policy period in which the entity was acquired or formed by you', I Coverage A does not apply to "bodily injury"or"property damage"that occurred before you acquired or formed the organization; and C. Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. it. Records and descriptions of operations must be maintained by the first Named Insured. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations or qualifies as an insured under this provision. L. FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES Under Section IV—Commercial General Liability Conditions,the following is added to Condition 6. Representations; Your failure to disclose all hazards or prior"occurrences" existing as of the inception date of the policy shall not prejudice the coverage afforded by this policy provided such failure to disclose all hazards or prior"occurrences" is not intentional, M. KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT Under Section IV—Commercial General Liability Conditions,the following is added to Condition 2. Duties In The Event of Occurrence,Offense, Claim Or Suit: Knowledge of an "occurrence", offense, claim or"suit" by an agent, servant or"employee" of any insured shall not in itself constitute knowledge of the insured unless an insured listed under Paragraph 1. of Section II —Who Is An Insured or a person who has been designated by them to receive reports of "occurrences", offenses, claims or"suits" shall have received such notice from the agent, servant or "employee' N. LIBERALIZATION CLAUSE If we revise this Commercial General Liability Extension Endorsement to provide more coverage without additional premium charge, your policy will automatically provide the coverage as of the day the revision is effective in your state. O. BODILY INJURY REDEFINED Under Section V— Definitions, Definition 3. is replaced by the following: 3. "Bodily Injury' means physical injury, sickness or disease sustained by a person. This includes mental anguish, mental injury, shock, fright or death that results from such physical injury, sickness or disease. 2013 Il Mutual insurance CG 88 10 04 13 Includes copyrighted material of Insurance SeNicrs Office,Inc.,with its permission Page 7 of 8 A 1'AiI I I _so,,J ,I I II-1B Mast C—I i fl—LI 1 1_ 1 9,11,,1E ,i/111111 11 19;II pM )T' P.Sge 6 , 10 P. EXTENDED PROPERTY DAMAGE Exclusion a. of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY is replaced by the following' a. Expected Or Intended Injury "Bodily injury" or"property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury"or"property damage" resulting from the use of reasonable force to protect persons cr property. Y Q. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US—WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU Under Section IV — Commercial General Liability Conditions, the following is added to Condition 8. Transfer Of Rights Of Recovery Against Others To Us: We waive any right of recovery we may have against a person or organization because of payments we make for injury or damage arising out of your ongoing operations or"your work"done under a contract with that person or organization and included in the "products-completed operations hazard"provided: 1. You and that person or organization have agreed in writing in a contract or agreement that you waive such rights against that person or organization, and 2. The injury or damage occurs subsequent to the execution of the written contract or written agreement ©2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc„with its permission. Page 8 of 8 uaa,'a e I seonvzrs I " " < .Cic.Ce I io's I a/s/aore a :D_sa Nm [vo'r'i I Vase 9 " .o COMMERCIAL GENERAL LIABILITY CG 90 61 05 11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, AMENDMENT OF CANCELLATION PROVISIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Any term or provision of the Cancellation Conditions of the policy or any endorsement amending or replacing such Conditions is amended by the following. A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the person or organization shown in the Schedule below. In no event will the' notice to the person or organization scheduled below exceed the notice to the first named insured, B. Our obligation to send notice to the person of urganlzation listed in the Schedule below will terminate at[he earlier of the current policy period expiration or when you no longer have a legal or contractual obligation to such person or organization to maintain insurance coverage under a policy which requires that such person or organization be notified in the event of cancellation. SCHEDULE 1. Name: 2. Address: 3. Number of days advance notice; All other terms and conditions of this policy remain unchanged. 02011 Liberty Mrlllal Agency Corporation. All righls reserved. CG 60 61 05 11 Includes copyrighted matanaI of Insurance SaNICeS orOce, tw.,with its permission. Page 1 of 1 w uzz�r I sr on srz rs I nio wae�e r. r ,nee I s�mnc. I n/s/zero rz � .sa am troe, I e,yc n o[ ro