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HomeMy WebLinkAboutPW18-157 - Amendment - #1 - Historical Research Associates, Inc. - Lower Russell Road Levee - 09/11/2018 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. El Blue/Motion Sheet Attached 0 Pink Sheet Attached Vendor Name; Historical Research Associates, Inc, Vendor Number (JDE): Contract Number (City Clerk): 00 z Category: Contract Agreement Sub-Category (if applicable): Arnen-d-ment-1-.- Project Name: Lower Russell Road Levee Contract Execution Date: 9/11/18 Termination Date: 12/31/18 Contract Manager: Toby Hallock Department: PW: Engineering Contract Amount: $3.775.00 Approval Authority: M Director El Mayor El City Council Other Details; Am-eln,01-a previous cultural alresources report for an architectural and archaeological survey conducted in May and June, 2018. `'s K�11T AMENDMENT NO. 1 NAME OF CONSULTANT OR VENDOR: "istorical ResqArgh Agsociates, I CONTRACT NAME & PROJECT NUMBER: Lower Russell Road Levee ORIGINAL AGREEMENT DATE: April 17, 2018 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: Amend a previous cultural resources report for an architectural and archaeological survey conducted in May and June, 2018. For a description, see the Consultant'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 II "Time of Completion," and Section III, "Compensation," are modified as follows: Original Contract Sum, $15,313.00 including applicable WSST --_..............__.. _.... _ -..... ................_. ._......... Net Change by Previous Amendments $0 including applicable WSST Current Contract Amount $15,313.00 including all previous amendments Current Amendment Sum $3,775.00 ........ ................ Applicable WSST Tax on this $o Amendment Revised Contract Sum $19,088.00 AMENDMENT - 1 OF 2 Original Time for Completion 12/31/18 (insert date) Revised Time for Completion under n/a prior Amendments (insert date) Add'I Days Required (f) 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 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. _ __r...._...._.__ w._..._.._..., -.---..---- _.. CONSULTANT/VENDOR: CITY_�F KENT: By: B . (s(d aatuf-) aaatine) Print Name: jyji� Print Name, irnothy J. LaPorte,-P_EE Its Its_ Public Works Director �- (rare) E DATE:�at� l ._.._._ DATE: 'i, // _. —. .......... _ _...... APPROVED AS TO FO M: (appura6Y.If Mayer -.•id t�dCueC l' c urreGd AAIA Kert'Caw Department HI{II-LI?",,1 ll M Levee ARd"Na I Iork AMENDMENT - 2 OF 2 EXHIBIT A HISTORICAL RESEARCH ASSOCIATES, INC. Scope of Work: Amendment to the Cultural Resources Inventory for the Russell Road Properties, City of Kent, King County, Washington Iistoric il Rc e-arch rlssociatcs, Inc. (I fRA) is Pleased m provide the follow ng scope_ of work (SOW) for cultural resources services to We (AN (A Kent for its Russell Rd. Properties Mrotation project (14 jc ct). Ms scope of WON covers the tasks required to amend a previous' cultural resourecs report for an atr laxa-taral and archaeological survey conducted ur the Citi of Kant, King y County, Washington on two parcels (000670-OOI I and 0(106204M17) east of Russell Rd. in May and June 2011 1& resulting report, Celknul Re o"mes]tlrre,rh�"r/iunr fni /be N r,t.ael/I{oUd l'iope�7iz.�, CvFy o/Kern, I( rry C,onutV, a""a.i/iin{lon, a as finalized m Auf*uat 20to' Based on consultation with DAM and other srakeholdenk the (my of ken Propose to rnnve a barn (the Dvoral: Barn) warn Parcel 00062040011, previously mown as the-Skinny Kitty Farm, to a new location on a neighboring parcel owned by the City of bent "I'he. new Iocation, Parccl 000620- 00O1, w a 3T6 kamc parcel dirmdp cast of Parcel 000620-0011. Funding for the Project is expected to InCludc local (City of Kent) funds. Therefore, the Project feguires review under SfQQ and compliance svidiRevised Code of Washington (RCV ) 27.44 (human remains) and R M 2753 (archaeological resources) is rcguired. 1 ,0 Project Approach The area of impacts (AI) for this Project expand; the ojigutd Al to include the portion of Parcel 000620-0001 onto which the Dvotrk Barn wilt bu 'novc 4s gnm d disturbance is expected to be lhrvred ro preparuig the site for the baru's relocation, the Al will not be expanded to include neighboring parcels or the entirety of Nrml0006210011. To complete, the required archaeological study, 1 Ili Proposea the following rasks: Task 1 Health and Safety Plan (HASP) Priur to initiating field work, HR1's Health wild Safety (;oord naiorwill rc«se ftne previously prepared health and Safety plan for the Project to incorponve any new requiremears to be followed by the archaeological field crow while in die field. Task 2 Archaeological Survey 1H(A mitt conduct an archaeological pedestrian inventory and shovel probing within the_expanded Al. 1'edentran survey tran;cces will be 20 me rc rs (m) apart where feasible. Nato awn n tnsects may he used acuuthrig to the judgment of the field suh>eninor. Ate suchmologi es will seek out and examine all ground exposures for cvidencc of subsurface teatures and/or-cultural materials. Afl. survey areas will hc, plotted on a M. Geological Survey (USGS) aluadrangle snap at a scale appropriate to the size of the sun cy area or rc corded using a Global positioning System (GI'S) initrurnctit. Subsurface excavations; will consist of the excavation of up to tour 10-40 centimeter (tin) diameter shoed probes POPQ rn depths of 1 rn Mowed by auger probe excavation to the greatest depth possible (generally 25 to 3 rn below ground aurfeee). Placement of SPs and auger probes:will be determined by the field snperAmm and Al be contingent upon the proposed project design, information Mini the background research, and conchitons in tyre field. All ticavate_d sediments will he screened through 025-inch mesh to idennfy ;my small cultural Acros that may he presant. All Spe Will be eornplct El bscicfilled and their locations will be plotted onto a project map and recorded using the GPS instrunnent l gdcf cress will take and record overwiew photographs of representative soil profiles in SPs. Task 3 Archaeological Amendment HRA prepared chair and final versions of a nchnical teport entitled Lulkn'al Rrrnre er Ltoea/i utLorte�nt lhr K"rrell Road Propoit"ei t.rly of Kent Kia{o Co.,tsf,, ff'ajhan¢fon for the Project in]Line and August 2018, The goal of FIRMS initial survey relxxtwas to describ, the spcotuations of the propoac_dPtoject; to describe the cukurd resari vs rsublecr to direct t and/or Lutitect impacts within Hie f=p',ose AI; and ❑7 provide rccommendwtrons as to the hest way to avoid, nruvnvzc, or rmi gan potential ad,eve mp,rcts to cultural resources. Newly sarped work will result in nn amendment to <ialte,'a/Re.�rreiree. Ian,�lrtp,rhorr.r�or'rSe Kre,rsell Knad Pruptr/es, ("dr nf'leaal, K'a"Nrrr C oaruty, ll-�oshznjyo a that 6[united to an archaecdo ical survey of the, proposed relocation site for the thorak Harm l draft of the amcndui in M he submitted to the City of Kent for corrrmeat in electronic format (P,dolac pdQ We finalized, HRA will submit an electronic Final amendment for submittal to I IAHP. HRA assumes submittal of no mrore than one Amendment to the Cultural Resources Inventory for the Russet[ Road Properties, City of Kent, King County, Washington September 4, 2018 2 draft amendment and no more than one round of subsequent revisions. The report amendment will nclude: • 'I lie methods used during fieldworl: and the results; a A description )f any archaeological resources identified and documented; HRA's recommendation, for completion of any additional cultural resources compliance obligations stemming from the results of our studv; m A surnirtaty of project procedures Char should be followed in thee event of an unanticipated discover}' of buried cultural materials or human remains during demolition of testotauon activities; • References cited; and + Archaeological Site forms for all documented archaeological sites. I'hc report will include such tabtes, neaps, photographs, and other graphics as are needed to depict the scope of the study and results. 2.0 Schedule LIRA staff can initiate the first task of the Project(revised Health and Safety plan) within five (5) business days of written notice io procc_ed (1sITP) and acceptance of this SOW and f_rt t Fstirriate front the City of Kent (c-mail Nl P is acceptable). Task nvo will be scheduled to begin within five (5) busjrjeLss clays of completion of the revised Health and Safety Plan. Preparation of the report amendman, indud ng unnpilarion of the project results, will be completed within twenty (20) bu1t1e35 days of completion of the fieldwork, HRA will produce a final report within five (5) business days of receipt of cotrmients. Aiiiicipatcd completion date for the above described wort, is by Friday, October '12, 2015. Delays to this schedule resulting fi�om the actions or inaction of other parties cannot be IIRA's responsibiIa.y. 3>0 Cost Proposal IMA proposes to conduct the archaeological stud}, Masks I-4 described in Section 1 0) on the schedule presented in Section 2.0 for a cost of$3,775, applied on a rime and materials h Isis (see attachud spreadsheet). "I hcsc figures assume that: 'The City of Kent will be. responsible for all formal consultation with 1)1U IP and affected Tribes: Amendment to the Cultural Resources Inventory for the Russell Road Properties, City of Kent, King County, Washington September 4, 2018 3 • Up to 4 shovel probe;; will A excavated; • lAcconNne:nces with the Ory of Kent, DAM' or other entities swill ilot exceed two (2) hours over the term of the project; • The C:rty of Kern will provide reaps (('IS shape files are preferred) of the Al and design plans of the proposed project to IIRd ill a format that can be adapted for use it its report, • Reporting will not include prcimamo n of NEW or SEPA documenori )n: • Reporting will not include the prepazation of agreement documents (e.g., Memoranda of Agrcament); • if fit(! project 1.etsts hwyond December-11, 2018, the remaining budget will be revised ro reflect I llzf%,e annual chance ill rates; • No arc,hnec loo-ind Me or isolate "411 be recorded by this project. Amendment to the Cultural Resources Inventory for the Russell Road Properties, City of Kent, King County, Washington September 4, 2018 4 f y Z 7 4 _. C] v� ✓�w P n pM N Z C Q i m Q.... N OE p � a = n K � � ------------ � m _ 'o N x a i " o= a vQ c 3 m u, ."o `C4" A Fl, m d w 6 6 a -E - p g O d K 4 x r � r- w 16 x rr arm^pC", c r w wa N l V r'4 i Ir lql �l. W �Ir r r � n� I (f1 I! iG- wr r rnr 'm �l J6%� II, rr J � �I R r r -�� HRAHIST-01 ACORO" T__-.�IC Em DATE(MmIDDIrYrr) CERTIFICATE OF LIABILITY INSURANCE 04n&2018 rINSURED S CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.Tt TIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICI. OW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED RESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed, UBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on certificate does not cooler rights to the certiNcate holder In lieu of such andorsemon�sJ CER HpMEACT Candice Hyer ula Office PHONE '" West Insurance, Inc. (AIN N E 0 (AX No) ox 4386 Ltd .88 ch_yerpaynewest.com -- — ula,MT 59808 — --- -- - -- -.... _, .. NSUREFUS)AFFORDING COVERAGE NAICp -.__- 'Charter Clak Fire Insurance Co 25615 D "MNSURERa Travelers Indemnity Company of Connecticut 25682 BRA Historical Research Associates IRSIIRFR c The Travelers Indemnity Companv 25658 P.O. Box 7086 INSURER D Darwin Select Insurance Co. Missoula, MT 59807 - -- -- -- INSURER E ...... „...- ... .-.... .........-_. ._ ... INSURERF —.._..,,,, ... __._..... ._.. .... C4-w�.R.AGI�� _ CERTIFO�dTE.N' ,�R�,.� __ RLVI510N NWMIBER: 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. INSH= AODtSU9R _. --- POIUCY EFR POLICY EXP TYPE OF INSURANCE POLICY NUMBER_ LIMITS A X COMMERCIAL GENERAL LIABILITY - tNhyQ IfluUlQ �I 1,000,000 CLAIMS MACE X rA(19(1(,UIRR}tI ( ..i OCCUR HAMM F IC DIM rPO I � X X 6805C5fi03281842 01101/201B 01101f2019 300,000 f 1NLMIS@„$'4Ga RAbMlrfet&9d _ 1 MFO PAY LNVrri Mxrnl......1.$. ... 5000 r FRSONAL A Arty INdIijRy ... s 1,000000 C ErvRAgGiRE 6GAIE.LIMIT APPLIES PFR'. GENERALACDRLFAIC $ 2,OOUQQQ 4. 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El NIA EL LACI A(CAWNT 1 andAory n I Ifmy describe undRv E I"D1SNASF FA CMPLOYEE,S DESCR4RTIi,TN C)F K)P@IiATG N,S lrvilarw k 0 OY C.A.S HeTI V GMI _ - D Professional I_dab. —S .S— ___ 03062472 011g1J2Q 6 01101Y2(119 Occurrence 3,000,000...... D Professional Llab. 03062472 01/0112018 OV0112019 Aggregate 3,000,000 OE50RIPTlUM OF�OP@RATmMaI LOGATIDNey VEHIGLESm�A"CORD 1a1 ._....�...... -',".�._......_,.,_, ,Add, ona l RamerMI Schedule maY be atl.hed II mo Race re reNulred) RE: Lower Russell Road Levee Project General Liability Additional Insured primary&noncontributory per form CGD037(attached) Auto Liability Additional Insured per form CAT420(attached) 30 Day Notice of Cancellation ERTI�tC TE HO-DEL -- _—. .�_..w_ .... ....�.-_-- CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 8 City of Kent,Washington THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 220 Forth Avenue South ACCORDANCE WITH THE POLICY PROVISIONS. Kent,WA 98032 ., _._.... ...._..��..__.. .m....�......�..-�.-.�...._�. AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) — -- © 9 188-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 680-5C560328-18-42 EFFECTIVE DATE: 01/01/2018 ISSUE DATE: 10/24/2017 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS IL TO 19 02 05 COMMON POLICY ➢ECLARATIONS * IL TO 25 08 01 RENEWAL CERTIFICATE * MP TO 01 02 05 BUSINESSOWNERS COVERAGE PART DECLARATIONS * IL TS 01 Ol 01 FORMS ENDORSEMENTS AND SCHEDULE NUMBERS IL T3 16 05 12 COMMON POLICY CONDITIONS - WASHINGTON * IL TO 20 02 05 ADDITIONAL LOCATIONS BUSINESSOWNERS * MP TO 25 02 05 SPECIAL PROVISIONS - LOSS PAYEE * CP T9 62 07 11 LOSS PAYABLE PROVISIONS-WA MP T1 30 02 05 TABLE OF CONTENTS - BUSINESSOWNERS COVERAGE PART - DELUXE PLAN MP T1 02 02 05 BUSINESSOWNERS PROPERTY COVERAGE SPECIAL FORM MP T1 05 02 05 AMENDATORY PROVISIONS - OFFICES * MP T3 07 03 97 PROTECTIVE SAFEGUARDS ENDORSEMENT FOR SPRINKLERED LOCATIONS AND RESTAURANTS MP T3 25 01 15 FEDERAL TERRORISM RISE INSURANCE ACT D18CLOSUXE * MP T3 34 02 05 ELECTRONIC DATA PROCESSING - INCREASED LIMIT MP T3 50 11 06 EQUIPMENT BREAKDOWN - SERVICE INTERRUPTION LIMITATION MP T3 56 02 08 AMENDATORY PROVISIONS - GREEN BUILDING AND BUSINESS PERSONAL PROP COV ENHANCEMENTS CP 01 60 12 98 WASHINGTON CHANGES - DOMESTIC ABUSE MP T4 31 07 16 WASHINGTON CHANGES * CP T4 38 05 42 LENDERS` LOSS PAYABLE ENDORSEMENT COMMERCIAL GENERAL LIABILITY CG TO 34 11 03 TABLE OF CONTENTS - COMMERCIAL GENERAL LIABILITY COVERAGE FORM CG 00 01 10 01 CG 00 01 10 01 COMMERCIAL GENERAL LIABILITY COVERAGE FORM CG D2 55 11 03 AMENDMENT OF COVERAGE - POLLUTION CG D3 09 11 03 AMENDATORY ENDR- PRODUCTS-COMPLETED OPERATIONS HAZARD CG D4 71 01 15 AMENDMENT OF COVERAGE B - PERSONAL AND ADVERTISING INJURY LIABILITY * GN 01 13 11 03 EMPLOYERS OVERHEAD LIABILITY CG DO 37 04 05 OTHER INSURANCE - ADDITIONAL INSUREDS CG D1 05 04 94 BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS CG DI 86 11 03 XTEND ENDORSEMENT CG D2 03 12 97 AMEND - NON CUMULATION OF EACH OCC * CG D2 47 08 05 ADDITIONAL INSURED (CONTRACTORS) TEXT IN THIS FORM HAS CHANGED, OR THE FORM WAS NOT ON POLICY BEFORE, IL T8 01 01 01 PAGE: 1 OF 3 k d t POLICY NUMBER: 680-5c560328-18-42 I EFFECTIVE DATE: 01/01/2018 ISSUE DATE: 10/24/2017 COMMERCIAL GENERAL LIABILITY (CONTINUED) * CO T8 01 01 18 GENERAL PURPOSE ENDORSEMENT CG D4 13 04 08 AMEND COVG - POLLUTION-EQUIP EXCEPTION CG D2 56 11 03 AMENDMENT OF COVERAGE - PROPERTY DAMAGE CG D3 26 10 11 EXCLUSION - UNSOLICITED COMMUNICATION CG D3 56 05 14 MOBILE EQUIPMENT REDEFINED - EXCLUSION OF VEHICLES SUBJECT TO MOTOR VEHICLE LAWS CG D4 21 07 08 AMEND CONTRAL LIAB EXCL - EXC TO NAMED INS CG D6 18 10 11 EXCLUSION - VIOLATION OF CONSUMER FINANCIAL PROTECTION LAWS a CG D7 46 01 15 EXCLUSION - ACCESS OR DISCLOSURE OF CONFIDENTIAL OR PERSONAL INFORMATION CG D1 42 01 99 EXCLUSION - DISCRIMINATION CG D3 37 02 05 PROFE99IONAL SERVICES EXCLUSION - LEGAL SERVICES I CG F2 45 07 02 EXCLUSION - WAR - WASHINGTON CO T4 78 02 90 EXCLUSION - ASBESTOS CO 26 61 10 01 MONTANA CHANGES - MEDICAL PAYMENTS CG F2 66 11 03 WASHINGTON CHANGES - EMPLOYMENT-RELATED PRACTICES EXCLUSION CG F4 66 01 08 WASHINGTON CHANGES - WHO IS AN INSURED I MULTIPLE SUBLINE ENDORSEMENTS CG T3 33 11 03 LIMITATION WHEN TWO OR MORE POLICIES APPLY COMMERCIAL INLAND MARINE ' CM TO 07 01 88 PROPERTY FLOATER COVERAGE - DECLARATIONS CM TO 11 08 05 COMMERCIAL INLAND MARINE COVERAGE PART - TABLE OF CONTENTS CM 00 01 09 04 COMMERCIAL INLAND MARINE CONDITIONS CM T1 12 02 89 PROPERTY FLOATER COVERAGE - SPECIAL FORM CM T3 98 01 15 FEDERAL TERRORISM RISK INSURANCE ACT DISCLOSURE CM T9 39 06 12 WASHINGTON CHANGES - VOLCANIC ACTION AND REPLACEMENT COST CM U1 00 06 14 WASHINGTON CHANGES INTERLINE ENDORSEMENTS " IL T4 00 12 09 DESIGNATED ENTITY - NOTICE OF CANCELLATION OR NONRENEWAL PROVIDED HY US IL T4 12 03 15 AMEDT COMMON POLICY COND-PROHIBITED COVG IL T4 14 01 15 CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM IL T3 82 05 13 EXCLUSION OF LOSS DUE TO VIRUS OR BACTERIA IL 01 23 11 13 WASHINGTON CHANGES - DEFENSE COSTS IL 01 25 11 13 COLORADO CHANGES - CIVIL UNION ' TEXT IN THIS FORM HAS CHANGED, OR THE FORM WAS NOT ON POLICY BEFORE. IL T8 01 0101 PAGE: 2 OF 3 POLICY NUMBER: 680-5C560328-18-42 EFFECTIVE DATE: 01/01/2018 ISSUE DATE: 10/24/2017 INTERLINE ENDORSEMENTS (CONTINUED) IL 01 29 12 16 MONTANA CHANGES - MORTGAGEHOLDERS IL O1 39 12 02 OREGON CHANGES IL 01 42 09 OB OREGON CHANGES - DOMESTIC PARTNERSHIP IL O1 57 07 02 WASHINGTON CHANGES - ACTUAL CASH VALUE IL O1 67 10 13 MONTANA CHANGES - CONFORMITY WITH STATUTES IL 01 69 09 07 COLORADO CHANGES - CONCEALMENT, MISREPRESENTATION OR FRAUD IL O1 73 07 02 WASHINGTON CHANGES - EXCLUDE➢ CAUSES OF LOSS IL O1 80 09 07 MONTANA CHANGES - CONCEALMENT, MISREPRESENTATION OR FRAUD IL 01 98 09 08 NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (BROAD FORM) POLICY HOLDER NOTICES * PN T4 54 01 08 IMPORTANT NOTICE REGARDING INDEPENDENT AGENT AND BROKER COMPENSATION * PN MP 57 04 17 IMP NOT PROT SAFEGUARDS SPRK AND REST PN MP 38 01 11 IMPORTANT NOTICE - JURISDICTIONAL INSPECTIONS •TEXT IN THIS FORM HAS CHANGED, OR THE FORM WAS NOT ON POLICY BEFORE, IL T8 01 01 01 PAGE: 3 OF 3 a W w w e o oo 0 H M a mc m in H w�q Cz� FWD m N 4i W U 7q F UZ W ,z. 0 W E xH y� 0 W 07.14 ii E�Ea� Wq "�i ki q P w O H P7 mU W U � [Lw m H �r ,z, � � [U" W� gp DP W W V q ON HPP Vl07. aW1H 6+ O �naPu 7. fG a od v�qqq"LWvly1i RV7 OZO OZO p6m w �C O7 MW8. oqw� � W UmPQtFoEi ayZO. OUU) saa�z OHEiC H g P, v VP { W W wH i W w H U pZ > = mH qWUq29 zDw OaqRa�Q�' uUW,[2WqZz t V F �� wU W0 O - Uw E El v H p - HWN 9 PH q r C H LL W o a �O W N N 0trW W WO [ O C. O VI Ca 4 9WO OO a � r) 1 Ix aya xH Wq P 00 x a n C FCM ca ? 0 n wg UaH NOH WW O0a1w c"�yry 44 HE A H O �.wNL� mMn O ul ul ulb l.fl mltl nut It11[1 MMbm �O Muth mu 0H W m p O ,O a-1 r-1 �-i �-1 rl rl �-i ri ri ri rl rl rl rl rl rl rl rl rl a U] V] HOH �i NNNNNOHn1NNN OO HOHONO O Nt+ H q HHO CI O p OO p H 00000 HH O H HH OH �1 rIC [q H p 4 0 0 0 O O O M M O m n N W u 1 M d• O (1 M O 4 N M O .1 N0uj Ow0 44404o �-1p W W W �-IH riHNmMN W W d 1 a W HHH UW H µµ- P HHo W W PEA P' µpa NNN¢ NM gHOO P q�HyS FF r tmmq ^••a H NN U U � UUU � U [IUUUUUCIUUUU Op�e.l Hh COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE - ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS b. 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Excess Coverage Part must apply on a primary basis, or Insurance, as an additional subparagraph under a primary and noncontributory basis, this insur- Subparagraph (t): ante is primary to other insurance that is avail- That is available to the insured when the insured able to such additional insured which covers such is added as an additional insured under any other additional insured as a named insured, and we policy, including any umbrella or excess policy. will not share with that other insurance, provided that: a. The "bodily injury" or "property damage" for which coverage is sought occurs; and CG DO 37 04 05 Copyright 2005 The St. Paul Travelers Companies, Inc. All rights reserved. Page 1 of 1 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. AUTO COVERAGE PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE —This endorsement 'broadens coverage. However, coverage for any Injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing Is a general cover- age description only Limltadons and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BLANKET ADDITIONAL INSURED H. AUDIO, VISUAL AND DATA ELECTRONIC B. EMPLOYEE HIRED AUTO EQUIPMENT—INCREASED LIMIT C, EMPLOYEES AS INSURED 1. WAIVER OF DEDUCTIBLE —GLASS D. SUPPLEMENTARY PAYMENTS — INCREASED J, PERSONAL PROPERTY LIMITS K, AIRBAGS E. TRAILERS— INCREASED LOAD CAPACITY L. AUTO LOAN LEASE GAP F. HIRED AUTO PHYSICAL DAMAGE M. BLANKET WAIVER OF SUBROGATION G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES— INCREASED LIMIT A. BLANKET ADDITIONAL INSURED performing duties related to the conduct of I he following is added to Paragraph A.1. Who Is your business. An Insured, of SECTION II — COVERED AUTOS 2. The following replaces Paragraph b. in B.5., LIABILITY COVERAGE: Other Insurance, of SECTION IV — BUSI- Any person or organization who is required under NESS AUTO CONDITIONS. a written contract or agreement between you and b. For Hired Auto Physical Damage Cover- that person or organization. that is signed and age, the following are deomod to be cov, executed by you before the "bodily injury" or ered "autos" you own "property damage" occurs and that Is in effect (1) Any covered "auto" you lease, hire, during the policy period, to be named as an addi- tional insured is an "insured" for Covered Autos rent or borrow and Liability Coverage, but only for damages to which (2) Any covered "auto" hired or rented by this insurance applies and only to the extent that your 'empleyee" under a contract in person or organization qualifies as an "Insured" an "employee's" name, with your under the Who Is An Insured provision cor rood permission, while performing duties In Section Il related to the conduct of your bn6- B. EMPLOYEE HIRED AUTO ness. 1. The following Is added to Paragraph A.t, However, any "auto" that is leased, hired, Who Is An Insured, of SECTION II — COV- rented or borrowed with a driver is not a ERED AUTOS LIABILITY COVERAGE. covered "auto An "employee" of yours Is an "insured" while C, EMPLOYEES AS INSURED operating a covered "auto" hired or rented The following Is added to Paragraph A,1., Who Is under a contract or agreement in an 'em_ An Insured. of SECTION 11 — COVERED AUTOS ployee's" name, with your permission, while LIABILITY COVERAGE. CA T4 20 02 15 /Ot5 Ilr avela,s lu sm (( r,on ry All riI,rhIs r (�rdad. Page 1 of 3 Incfin .. ol /righiu n,�lefiai otln uran „qr•,i Ot¢,r, Im eV I ranri slrn. COMMERCIAL AUTO Any "employee" of yours is an "Insured" while us- (2) An adjustment for depreciation and physical ing a covered "auto"you don't own, hire or borrow condition will be made in determining actual in your business or your personal affairs cash value in the event of a total"loss". D. SUPPLEMENTARY PAYMENTS — INCREASED (3) If a repair or replacement results in better LIMITS than like kind or quality, we will not pay for the 1. The following replaces Paragraph A.2.a.(2) of amount of betterment. SECTION II— COVERED AUTOS LIABILITY (4) A deductible equal to the highest Physical COVERAGE: Damage deductible applicable to any owned (2) Up to $3,000 for cost of ball bonds (in- covered ''auto'', cluding bonds for related traffic law viola- (5) This Coverage Extension does not apply to. tions) required because of an "accident' (a) Any ''auto" that is hired, rented or bor- we cover. We do not have to furnish rowed with a driver, or these bonds. (b) Any "auto" that Is hired, rented or bar- 2. The following replaces Paragraph A.2.a.(4) of rowed from your''employee". SECTION II — COVERED AUTOS LIABILITY COVERAGE. G. PHYSICAL DAMAGE — TRANSPORTATION (4) All reasonable expenses incurred by [he EXPENSES— INCREASED LIMIT "insured" at our request, including actual The following replaces the first sentence in Para- loss of earnings up to $500 a day be- graph A.4.a., Transportation Expenses of cause of time off from work. SECTION III — PHYSICAL DAMAGE COVER- E. TRAILERS — INCREASED LOAD CAPACITY AGE, The fallowing replaces Paragraph C.I. of SEC- We will pay up to $50 per day to a maximum of TION I—COVERED AUTOS. $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- 1. "Trailers" with a load capacity of 3,000 ered 'auto'' of the private passenger type. pounds or less designed primarily for travel H. AUDIO, VISUAL AND DATA ELECTRONIC on public roads. EQUIPMENT— INCREASED LIMIT F. HIRED AUTO PHYSICAL DAMAGE Paragraph CA.b. of SECTION III — PHYSICAL The following is added to Paragraph A.4., Cover- DAMAGE COVERAGE is deleted. age Extensions, of SECTION III — PHYSICAL I, WAIVER OF DEDUCTIBLE— GLASS DAMAGE COVERAGE. Hired Auto Physical Damage Coverage The following is added to Paragraph D., Deducti- ble, of SECTION III — PHYSICAL DAMAGE If hired 'autos" are covered "autos" for Covered COVERAGE: Autos Liability Coverage but not covered "autos" No deductible for a covered "auto" will apply to for Physical Damage Coverage, and this policy glass damage if the glass is repaired rather than also provides Physical Damage Coverage for an replaced, owned "auto", then the Physical Damage Cover- J. PERSONAL PROPERTY age is extended to "autos" that you hire rent or The following is added to Paragraph AA., Cover- borrow subject to the following. age Extensions, of SECTION III — PHYSICAL (4) The most we will pay for "loss" to any one DAMAGE COVERAGE' "auto" that you hire, rent or borrow is the Personal Property Coverage lesser of, We will pay up to S400 for "loss" (o wearing as- (a) $50,000; pare) and other personal property which Is; (b) The actual cash value of the damaged or (1) Owned by an "insured", and stolen property as of the time of the (2) In or on your covered "auto"_ ''loss"] or This coverage only applies in the event of a total (c) The cost of repairing or replacing the theft of your covered ''auto'' damaged or stolen property with other No deductibles apply to Personal Property cover- property of like kind and quality. age. Page2of3 P 20 5 h(l [rurulers lurhrnt�CL)nlO11y Ml nrhtvn imd CAT4200215 'Ind,des yI ghI rd I,)[In ,rdnr e SO "I i s 0ifv 1 Inc vith 1(;harmis�:;ie+n. COMMERCIAL AUTO K. AIRBAGS (2) Any: The following is added to Paragraph B,3., EXOIu- (a) Overdue lease or loan payments at the sions, of SECTION III — PHYSICAL DAMAGE time of the"loss COVERAGE. (b) Financial penalties imposed under a Exclusion 3.a. does not apply to "loss" to one or lease for excessive use, abnormal wear more airbags in 'a covered "auto" you own that In- and tear or high mileage; flate due to a cause other than a cause of "loss" set forth in Paragraphs A,1.b. and A,1.c., but (c) Security deposits not returned by the les- only: sor a. If that "auto" Is a covered "auto" for Cumpre_ (d) Costs for extended warranties, Credit Life henslve Coverage under this policy, Insurance, Health, Accident or Disability L. The airbags are not covered under any war- Insurance purchased with the loan or ranty, and lease, and c. The airbags were not intentionally inflated. (e) Carry-over balances from previous loans orleases. We will pay up to a maximum of $1,000 for any M. BLANKET WAIVER OF SUBROGATION one "loss". L. AUTO LOAN LEASE GAP The following replaces Paragraph A.S., Transfer Of Rights Of Recovery Against Others To Us, The following is added to Paragraph AA., Cover- of SECTION IV — BUSINESS AUTO CONDI- age Extensions, of SECTION III — PHYSICAL TIONS. DAMAGE COVERAGE: Auto Loan Lease Gap Coverage for Private S. Transfer Of Rights Of Recovery Against Passenger Type Vehicles Others To Us In the event of a total "loss" to a covered "auto" of We waive any right of recovery we may have the private passenger type shown in the Schedule against any person nr organization to the ex- or Declarations for which Physical Damage Cov- tent required of you by a written contract exe- erage is provided, we will pay any unpaid amount cuted prior to any "accident" or "loss", pro- due on the lease or loan for such covered "auto" vided that the"accident" or"loss" arises out of less the following: the opera'ions contemplated by such con- (1) The amount paid under the Physical Damage tract The waiver applies only to the person or Coverage Section of the policy for that "auto'; organization designated to such contract. and CA T4 20 02 15 201 1 f10nor niw,rs hid unity All riyhL*. :";ved. Page 3 of 3 Indn I'll 1gppigh0e nc r•,"d of 11 lllr'Ii,",Office. Inc l ( pemris:;inn