HomeMy WebLinkAboutPW17-388 - Amendment - #1 - Shearer Design LLC - LID 363: S 224th St Improvements - 10/09/2018 106 KENTRecords 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: Shearer Design LLC
Vendor Number (JDE):
Contract Number (City Clerk): PW 11 - 3 `00 Z
Category: Contract Agreement
Sub-Category (if applicable): Amendment
Project Name: S. 224`" Street Improvements
Contract Execution Date: Date of the Mayor's signature Termination Date: 12/31/20
Contract Manager: Jason Bryant Department: PW: Engineering
Contract Amount: $49,940.40
Approval Authority: ❑ Director ® Mayor ❑ City Council
Other Details: Provide additional engineering,support during the final construction
phase of the S. 224`" St. Improvements - 84"° Ave. S. to 88tr' Ave. S. Project,
KENT
AMENDMENT NO. 1
NAME OF CONSULTANT OR VENDOR: Shearer Designi LLC
CONTRACT NAME & PROJECT NUMBER: S. 224"h Street Improvements
ORIGINAL AGREEMENT DATE: lulu 7. 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:
Provide additional engineering support during the final
construction phase of the S. 224th St. Improvements - 84`h Ave.
S. to 88rh Ave. S. Project. 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, $150,90468
including applicable WSST
Net Change by Previous Amendments $11
including applicable WSST
—urr __... _...... ------..
Cent Contract Amount $150,904.68
including all previous amendments
Current Amendment Sum $49,940.40
_.....,__ —_._,.. ._._� _. _ ._...... — ...... _— ._....�.w__.,
Applicable WSST Tax on this $0
Amendment
.......i_ .__— ____..—__.____ —_ ....---- ._.... ---- .—
Revised Contract Sum $21111,845.08
AMENDMENT - 1 OF 2
Original Time for Completion 12/31/20
(insert date)
Revised Time for Completion under u/a
i prior Amendments [
f (insert date)
Add'I Days Required t for this 0 calendar days
_. �
Y q ( } ys 1
�I Amendment
Revised Time for Completion I2131/20
(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.
CONSULTANT/VENDOR: CITY OF KENT:
. .
(Signahrc)
Print Name: �`\, q acre
) Print Name: Dana aalpl1_
Itsm ......... t fit l 3`
Its
-----Mayor ... -
(nde) (¢rEta„o
DATE: v .1r' �,
-- ... DATE: __..
_ ._ _ ...
APPROVED AS TO FORM:
(applicable it Mayors signature required)
*ntw Department
AMENDMENT - 2 OF 2
BtlICS EXHIBIT SHEARER DES193N L.L.Q.
SHHER DESIGN LiteBridge Design, Construction Engineering and Infrastructure Aesthetics
3613 Phinney Ave N#B
Seattle,WA 98103
(206)781-7830
August2, 2018
City of Kent Public Works
400 West Gowe
Kent WA, 98032
Subject: S. 22411 Street& State Route 167 (Construction Support)
Attn: Garrett Inouye/Jason Bryant
Dear Garrett:
We are happy to provide continued engineering services to the City of Kent for the S. 224t" Street& State Route 167
project. Our initial budget was consumed by unexpected work on the SEW wall layout, panel shop drawings and girder
shop drawings. In order to finish the project we would like to request a supplement to complete the following scope of
services for this project,
General. This supplement shall encompass engineering support during the final construction phase of the S. 224tn
Street bridge and SEW walls.
Task 2 RFI&Shop Drawings
Under this task we will review and comment on project submitted shop drawings and request for information(RFI)
from the Contractor that pertain to bridge drawings prepared by Shearer Design in the bid set.
Areas Covered
• Reinforcement Shop Drawings
• Material Review
• Bearings
• Railing
• Structural Earth Walls
Task 3 Routine Inspections
This task will cover onsile inspections for compliance with the bid documents or for construction problem solving.
Areas Covered
• Reinforcement (deck, barrier)
• Final Punch list
• AS-Built Plans
• Project Meetings
Task 4 Project Management
This task will cover the general project coordination and project meeting points. Included will be;
• Conference calls with the City to discuss the project progress,
\\SHEARERSERVER\D-DriveLADMIN\Job Contracts\C-0177 Kent S 224th\Construction Support\0177 S 224th Construction Support
Sup 2.docx
' '�'.. SHEARER DESIGN LLC.
DESIGNSHEARER fito I Bridge Design, Constnrotion Engineering and fnfrastruofure Aesthetics
3613 Phlnney Ave N#6
Seattle,WA 98103
(209)781-7830
• Communicate periodically through the advancement of the construction to discuss any interim results,
challenges and directions,
• Invoicing.
Task 5 Load Rating
This task shall provide a load rating report of the AS-built structure for the City Records and the WSDOT structures inventory. The
load rating shall be completed in accordance with the WSDCT BDM Chapter 13 and the AASHTO Manual for bridge evaluation
(current edition),
Deliverables:
• Road Rating report
Please see the enclosed spreadsheet for a summary of our estimated cost & hours for this phase of the project We
look forward to working with you again on this project. If you have any questions please feel free to call.
Please see the enclosed spreadsheet for a summary of our estimated cost and hours for this project. We look forward
to working with you again on this exciting project. If you have any questions please feel free to call.
Sincerely„
David R. Shearer S.E.
Principal Bridge Engineer
SHEARER DESIGN
1lSHEARERSERVERID-DriveADMIN\Job Contracts\G-0177 Kent S 224th1Construction Support10177 S 224th Construction Supper(
Sup 2.docx
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CERTIFICATE OF LIABILITY INSURANCE DATE[MI
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19tiEp 10th Ave NE PHONE ...., „_.. _._.
Poulsbo WA 98370 Mt.,u 360-5,98 5028
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CERTIFICATE HOLDER CANCELLATION
SHOULtHB-20-15
ANYVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE E THEREOF, NOTICE WILL BE DELIVERED IN
City Df Kent ACCOROLICY PROVISIONS,
4 W Gowe
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Kent WA 98032 AUTryORIZE
,.CORD 25 2016103 1 - ACORD CORPORATION. All rights reserved,
( 1 The ACORD name and logo are registered marks of ACORD
Shearer Design LLC- The Hartford Policy #52SBAIJ6571
BUSINESS LIABILITY COVERAGE FORM
(b) Rented to, in the care, custody or b. Coverage under this provision does not
control of, or over which physical apply to:
control Is being exercised for arty (1) "Roddy Injury' or 'property damage'
purpose by you, any of your that oau rsd;or
"employees', 'volunteer workers', (2) "Personal and advertising injury'
any partner or member(if you eree arising out of an offense committed
a partnership or Joint venture), or
any member (if you are a limited before you acquired or formed the
` Ilablifycompany), - organ¢ation.
b. Real Estate Manager 4. Operator Of Mobile Equipment
Any person (other than your'employee'or NRth respect to "mobile equipment' rsgistered in
"volunteer worker"), or any crgair zatlon your name under any motor vefdde registration
while acting as your real estate manager. law, any person Is an insured while diving such
c. Temporary Custodians Of Your equlpmard along a public highway with your
Property permissbn, Any other person or organtzation
responsbla for the conduct of such person is
Any person or organ¢adon having proper also an insured, but only with rasped to Ilablfrty,
temporary custody of your property if you arising out of the operation of the equlp narr, and
die, but only: - only if no other insurance of any Wuxi is avallable
(1) With respect to liability arising out of the to that person or organ¢ation for this liability.
mafrtenance or use of that property, and Hawerer, no person or organtration Is an Insured
(2) Until your legal represenladve has with respect to:
been appointed. a. "Bodily Injury" to a cc-employee" of the
d. Legal Representative If You Die person driving the equlpment;or
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only with rasped to duties as such. That rented to, In the charge of or occx pied by
- representative will have all your rights and you or the employer of any person who Is
duties under this Insurance an insured under this provision.
9. Lhnnamed Subsidiary 5. Operator of Nonowned Watercraft
Any subsidiary and subsidiary thereof, of lMth respect to watercraft you do not own that
yours which Is a legally Incorporated enttty Is less than 51 feet long and Is not being used
of which you awn a financial interest of to carry persons for a charge, any person Is an
more than 50% of the voting stock on the insured while operating such watercraft with
effective data of this Coverage Part your permission. Any other person or
The Insurance afforded herein for any organizatlon responsible for the conduct of
subsidiary not shown In the Declarations such person is also an Insured, but only with
as a named Insured does not apply to respect to liability arising out of the operation
Injury or damage with rasped to which an be insurance of any kind is available to that
Insured under another policy or would be
insured under this insurance is also of the watercraft, and only if no other
person orargan¢atlon for this liability,
an Insured under such policy but for its However, no parson or organization is an
termination or upon the exhaustion of Its Insured with rasped to;
Imps of insurance. H. 'Bodily injury" to a co-'employes' of the
3. Newly Acquired Or Farmed Organization person operating the watercraft;or
Any organization you newly acquire or form, b• 'Property damage" to property owned by,
other than a partnership, joint venture or rented to, In the charge of or occupied by
united Ilability company, and over which you you or the employer of any person who is
maintain financial interest of more than 50% of an insured under this provision.
the voting stock, will qualify as a Named 6. Additional Insureds When Required By
Insured if there Is no other similar Insurance Written Contract, Written Agreement Or
avallabie to that organlzatfon. However. Permit
a. Coverage under this provision Is afforded The person(s) or organlzatfon(s) Identiftad in
only urrtif the 180th day after you acquire Paragraphs a. through f, below are addrdorial
or form the organlzatfon or the end of the Insuresds when you have agreed, In a vo tten
pocky period, whichever Is earfler,and
Form SS 00 06 04 05 Page 11 of 24
The Hartfnrrl
BUSINESS LIABILITY COVERAGE FORM
contract, written agreement or because of a W Any failure to make such
permit Issued by a state or political Inspections, adjustments, tests or
subdtvlslon, that such person or organization servicing as the vendor has
be added as an add tloial Insured an your agreed to make or normally
poricy, provided the Injury or damage occurs undertakes to make In the usual
subsequent to the execution of the contract or course of business, in connection
agreement, or the issuance of the permit, with the distribution or sale of the
A person or organization is an additional products;
insured under this provision only for that (f) Demonstralti installation,
period of time required by the contract, servRcing or repair operations,
agreement or permit except such operations performed
However, no such person or organization is an at the vendor's premises in
additional insured under this provision if such uannection with the sale of the
person or organlzah'on is included as an product;
additional Insured by an endorsement issued (g) Products which, after distribution
by us and made a part of this Coverage Part, or sale by you, have been labeled
including all persons or organizations added or relabeled or used as a
as additional Insureds under the specific container, part or ingredient of any
additfonal Insured coverage grants in Seclion other thing or substance by or for
F.—Optional Additional Insured Coverages, the vendor;or
a. Vendors (h) "Bodily, injury", or "property
Any person(s) or organization(s) (referred to damage" arising out of the sale
below as vendor), but only with respect to negligence of the vendor for its
"bodily injury" or "property damage" arising own acts or omissions or those of
out of 'your products" which are distributed its employees or anyone else
or sold in the regular course of the vendor's acting on its behalf. However,this
business and only if this Coverage Part exclusion does not apply toi
provides coverage for "bodily injury" or (i) The exceptions contained in
"property damage" included within the Subparagraphs(d)or(f);or
"products-completed operations hazard". (ii) Such Inspections, adjustments,
(1) The insurance afforded to the vendor tests or servicing as the vendor
Is subject to the following additional has agreed to make or normally
exclusions: undertakes to make in the usual
This insurance does not apply to: course of business, in
connection with the distribution
(a) "Bodily Injury" or "properly or sale of the products.
damage" for which the vendor is (2) This insurance does not apply to any
obligated to pay damages by insured person or organzation from
reason of the assumption whom you have acquired such products,
liability in a contractor agreementt.. or any ingredient, part or container,
liabThis exclusion does not apply entering Into, accompanying or
vendor
for damages that hee
vendor would have In the absence containing such products,
of the contract or agreement; b. Lessors Of Equipment
(b) Any express warranty (1) Any person or organtzadon from
unauthorized by you; whom you lease equipment; but only
with respect to their liabilityfor"bodll
(c) Any physical or chemical change injury", p "property damage" or
in the product made Intentionally arsenal and advartlsin u
by the vendor; p g injury'
ry"
(d) Repackaging, except when caused. In whole or In part, by your
P maintenance, operation or use of
unpacked solely for the purpose of equipment leased to you by such
Inspection, demonstration, tasting, person or organization.
or the substitution of parts under
Instructions fiwn the manufacturer,
and then repackaged In he
original container;
Page 12 of 24 Form 88 00 08 04 05
BUSINESS LIABILITY COVERAGE FORM
(2) With respect to the Insurance afforded 9. Permits Issued By State Or Political
to these addit[anal insureds, this Subdivisions
insurance does not apply to any (1) Any state or political subdivision, but
"occurrence" which takes place after only with respect to operators
you cease to lease that equipment performed by you'or on your behalf for
C. Lessors Of Land Or Premises which the state or political subdNIsion
has issued a permit.
(1) Any person e l organizationrprmix from 2 With respect to the Insurance afforded
whom you lapse land or premises, but ( ) to these additional Insureds, this
only with respect to liability arising out insurance does not apply to;
of the ownership, maintenance or use
of that part of the land or premises (a) "Bodily injury", "property damage"
leased to you. or "personal and .advertising
(2) With respect to the insurance afforded injury" arising out of operations
to these additional insureds, this performed for the state or
insurance does not apply to: municipality;or
(a) Any "occurrence" which takes (b) "Bodily injury" or"property damage"
plare after you cease to lease that included w thln than "product's
land or be a tenant in that completed operations hazard".
premises;or f. Any Other Party
(b) Structural alterations, new (1) Any other person or organization who
constructlon or demolition is not an Insured under Paragraphs a.
operations performed by or on through 9. above, but only with
behalf of such person or respect to liability for "bodily injury",
organization. "property damage"" or "personal and
d. Architects, Engineers Or Surveyors advertising Injury" caused,In whole or
in pad, by your Sets or omissions or
(1) Any architect,engineer, or surveyor, but the acts or emissions of thosa acting
only with respect to liability for "bodity, on your behalf:
injury", "property damage" or "personal
and advertising injury" caused, In whole (a) In the performance of your
or in part, by your acts or omissions or ongoing operations;
the acts or emissions of those acting on (b) in connection with your premises
your behalf. owned by or rented to you; or
(a) in connection with your premises; (c) In connection with "your work"and
or included within the "products-
(b) In the performance of your completed operations hazard", but
ongoing operations performed by only If
you or on your behalf. (1) The written contract or written
(2) With respect to the Insurance afforded agreement requlryrs You to
to these additional Insureds, the provido such coverage to
following additional exclusion applies: such additional Insured; and
This Insurance does not apply to (11) This Coverage Fart provides
"bodily injury"' "property damage" or coverage for "t od'iiY Injury" or
"personal and advertising injury"° property damage" included
arising out of the rendering of or the within the products-
failure to render any professional completed operations hazard".
services by or for you, Including: (2) With respect to the insurance afforded
(a) The preparing, approving, or to these additional. Insureds, this
failure to prepare or approve, insurance does not apply to:
maps, shop drawings, opinions, "Bodily Injury", 'property darnaga" or
reports, surveys, fleld orders, "personal and advertising injury"
change orders, designs or arfsing out of time rendering of, or the
drawings and specifications;or failure to render, any professional
(b) Supervisory, inspections architectural, engineering or surveying
architectural or engineering services, including:
activities.
Form SS 00 O8 04 05 Page 13 of 24
BUSINESS LIABILITY COVERAGE FORM
(a) The preparing, approving, or This General Aggregate limit does not
failure to prepare or approve, apply to 'property damage" to premises
maps, shop drawings, opinions, while rented to you or temporarily
reports, surveys, field orders, occupied by you with permission of the
change orders, designs or owner, arising out of fire, lightning or
drawings and specifications;or explosion.
(b) Supervisory, Inspection, 3. Each Occurrence Limit
architectural or engineering Subject to 2.a. or 2.1a above, whichever
actfvVes. applies, the most we will pay for the sum of all
The limits of Insurance that apply to additional damages because of all "bodily injury',
insureds are described in Sectlon D. — Limits "property damage and medical expenses
Of Insurance. arising out of any one "occurrence" is the
How this insurance applies when other Liability and Medical Expenses Limit shown in
insurance is available to an additional Insured the Declarations,
is described in the Other Insurance Conditlon The most we will pay for all medical expenses
In Secton E.—Liability And Medical Expenses because of "bodily injury" sustained by any
General Conditions, one person is the Medical Expenses Limit
No person or organization is an Insured with shown in the Declarations.
respect to the conduct of any current or past 4. Personal And Advertising Injury Limit
Partnership, joint venture or limited liability Subject to 2.b. above, the most we will pay for
company that Is not shown as a Named insured in the sum of all damages because of all
the Declarations. "personal and advertising injury" sustained by
D. LIABILITY .AND MEDICAL EXPENSES any one person or organization Is the Personal
LIMITS OF INSURANCE and Advertising Injury Limit shown in the
Declarations.
The Limitsts of insurance shown In the
1. The Most Will Pay 5. Damage To Premises Rented To You Limit Declarations and tirerules Damage To Premises Rented To You
g es below fix the most
we will pay regardless of the number of Limit Is the most we will pay under Business
Liability Coverage for damages because of
a. insureds; "property damage' to any one premises,while
b. Claims_made or"suits"brought; or rented to you, or in the case of damage by fire,
c. Persons or organizations making claims or lightning or explosion, while rented to you or
bringing"suits'. temporarily occupied by you with permission of
2. Aggregate Limits the owner.
The most we will pay for: In the case of damage by fire, lightning or
i explosion,the Damage to Premises Rented To
a. Damages because of bodily Injury" and You Limit applies to all damage proximately
property damage" included In he caused by the same event, whether such
products-completed operations hazard"Is damage results from fire, lightning or explosion
the Products-Completed Operations or any combination ofthesa,
Aggregate Limit shown in the Declarations. Apply 6. How Limits A I To Additional Insureds
b. Damages because of all other "bodily The most we will pay on behalf of a person or
injury', "property, damage" or "personal organtzation who is an additional insured
and advertising injury", including medical under this Coverage Part is the lesser of:
expenses, Is the General Aggregate Limit a. The Ilmits of Insurance specified in a
shown In the Declarations. written contract, written agreement or
This General Aggregate Limit applies permit issued by a state or political
separately to each of your "locations" subdivision;or
owned by or rented to you, b. The Limits of insurance shown in the
"Location" means premises involvfng the Declarations.
same or connecting lots, or premises Such amount shall be a part of and not In
whose connection Is interrupted only by a addition to the Limits of Insurance shown in
street, roadway or right-of-way of a the Declarations and described In this Section.
railroad.
Page 14 of 24 Form SS 00 08 04 05
BUSINESS LIABILITY COVERAGE FORM
If more than one limit of insurance under this (1) Immediately send us copies of any
policy and any endorsements attached thereto demands; notices, summonses or
applies to any claim or"suit", the most we will pay legal papers received in connection
under this policy and the endorsements is the with the claim or'suV;
single highest limit of liability of all coverages (2) Authorize us to obtain records and
applicable to such claim or "suit". However, this other Information;
paragraph does not apply to the Medical Expenses (3) Cooperate with us in the Investigation,
limit set forth in Paragraph 3,above, settlement of the claim or defense '
The Limits of Insurance of this Coverage Part apply against the"suit";and
separately to each consecutive annual period and to (4) Assist us, upon our request, In the
any remaining period of less than 12 months,starting enforcement of any right against any
with the beginning of the policy period shown in the person or organization that may be
Declarations, unless the policy period is extended liable to the Insured because of injury
after issuance for an additional period of lass than 12 or damage to which this Insurance
months. In that case, the additional period will be may also apply.
deemed part of the last preceding pedod for purposes d. Obligations At The Insured's Own Cost
of determining the Limits of Insurance.
E. LIABILITY AND MEDICAL EXPENSES co insured will, except at that insured's own
cost, voluntarily make a payment, assume
GENERAL CONDITIONS any obligation, or Incur any expVtse, other
1. Bankruptcy then forfrstaid,withoutouroonsent.
Hankruptcy or insolvency of the insured or of e. Additional Insured's Other Insurance
the insured's estate will not relleve us of our If we cover a claim or "suit" under this
obligatlons under this Coverage Part. Coverage Part that may also be covered
2, Duties In The Event Of Occurrence, by other insurance available to an
Offense,Claim Or Suit additional insured, such additlonal Insured
a. Notice Of Occurrence Or Offense must submit such claim or "suit" to the
other insurer for defense and Indemnity.
You or any additional insured must see to However, this provision does not apply to
- it- that we are notified as soon as the extent that you have agreed in a
practicable of an "occurrence" or an written contract, written agreement or
offense which may result In a claim. To permit that this insurance Is primary and'.
the extent possible, notice should Include: non-contributory with the additional
(1) How,when and where the "occurrence" insured's awn Insurance,
or offense took place; f. Knowledge Of An Occurrence, Offense,
(2) The names and addresses of any Claim Or Suit
inured persons and witnesses; and Paragraphs a. and b. apply to you or to
(3) The nature and location of any injury any additional insured only when such
or damage arising out of the "occurrence", offense, claim or "suit" is
"occurrence"or offense. known to:
b. Notice Of Claim (1) You or any additional insured that is
If a claim Is made or "suit" Is brought an IndlAdual;
against any insured, you or any additional (2) Any partner, If you or an additlonal
insured must: insured Is a partnership;
(1) Immediately record the specifics of the (3) Any manager, if you or an additional
claim or "suit" and the date received; insured Is a limited liability company;
and (4) Any "executive officer" or insurance
(2) Notify us as soon as practicable. manager, ff you or an additional
You or any additional Insured must see to insured is a corporation;
it that we receive a written notice of the (5) Any trustee, if you or an additional
claim or'suit" as soon as practicable. Insured is a trust;or
c. Assistance And Cooperation Of The (6) Any elected or appointed official, if you
Insured or an additional insured Is a political
You and any other Involved insured must: subdivision or public entity.
Form SS 00 08 04 05 Page 15 of 24
I 6 ' i a
BUSINESS LIABILITY COVERAGE FORM
This Paragraph I. applies separately to (3) We have issued this policy In reliance
you and arty additional insured. upon your representations.
3. Financial Responsibility Laws b. Unintentional Failure To Disclose
a. When this policy Is certlfled as proof of Hazards
financial responsibility for the future under If unintentionally you should fail to disclose
the provisions of any motor vehicle ail hazards relating to the conduct of your
financial responsibility law, the insurance business at the inception date of this
provided by the policy for "bodily injury" Coverage Part, we shall not deny any
liability and "property damage" liability will coverage under this Coverage Part
comply with the provisions of the law to because of such failure.
the extent of the coverage and limits of 7, Other Insurance
Insurance required by that late. if b. With respect to "mobile equipment" to other valid and collectible Insurance is
available for a loss we cover under his
which this Insurance applies, we will a
provide any Ilabllity, uninsured motorists, Coverage Part, our oblige ors are limited as
follows:
underinsured motorists, no-fault or other
coverage required by any motor vehicle a. Primary Insurance
law. We will provide the required limits for This Insurance is primary except when b.
those coverages, below applies, If other Insurance Is also
4. Legal Action Against Us primary, we will share win all that other
No person or organization has a right under insurance by the method described in c.
below.
this Coverage Form:
a. To join us as a party or otherwise bring us b. Excess Insurance
into a "suit' asking for damages from an This Insurance Is excess over any of the
insured;or other Insurance, whether primary, excess,
b. To sue us on this Coverage Form unless contingent or on any other basis:
all of Its terms have been fully complied (1) Your Work.
with, That Is Fire, Extended Coverage,
A person or organ¢adon may sue us to recover Builders Risk, Installation Risk or
on an agreed settlement or on a final judgment similar coverage for"your work";
against an Insured; but we will not be liable for (2) Premises Rented To You
damages that are not payable under the terms of
this insurance or that are in excess of the That Is fire, lightning or explosion
applicable limit of Insurance. An agreed Insurance for premises rented to you
settlement means a settlement and release of or temporarily occupied by you with
liability signed by us, the Insured and the permission of the owner,
cialmantor the claimants legal representative. (3) Tenant Liability
5. Separation Of Insureds That is Insurance purchased by you to
Except with respect to the Lim is of insurance, cover your liability as a tenant for
and any rights or duties specifically assigned property damage" to premises tented
in this policy to the first Named Insured, this to you or temporarily occupied by you
insurance applies:
with permission of the owner;
a. As If each Named Insured were the only (4) Aircraft,Auto Or Watercraft
Named Insured; and f the loss arises out of the maintenance
b. Separately to each insured against whom or use of aircraft, "autos"or watercraft to
a claim Is made or"suit"is brought. the extent not subject to Exclusion g. of
Section A.—Coverages.
6. Representations (5) Property Damage To Borrowed
a. When You Accept This Policy Equipment Or Use Of Elevators
By accepting this policy,you agree: If the loss arises out of "property
(1) The statements In the Declarations damage" to borrowed equipment or
are accurate and complete; the use of elevators to the extent not
(2) Those statements are based upon subject to Exclusion k, of Section A.—
representations you made to us; and Coverages.
Page 16 of 24 Form SS 00 08 04 05
BUSINESS LIABILITY COVERAGE FORM
(6) When You Are Added As An When this insurance is excess over other
Additional Insured To Other insurance, we will pay only our share of
Insurance the amount of the loss, if any, that
That is other Insurance available to exceeds the sum of'.
you covering Ilability for damages (1) The total amount that all such other
arising out of the premises or insurance would pay forthe loss in the
operadens,or products and completed absence of this insurance;and
operations, for which you have been (2) The total of all deductible and self-
added as an additional Insured by that insured amounts under all that other
insurance;or insurance.
(7) When You Add Others As An We wil share the remaining loss,if any,with
Additional Insured To This any other insurance that Is not described in
Insurance this Excess Insurance provision and was not
That Is other insurance available to an bought specifically to apply in excess of the
additional insured. Limits of Insurance shown in the
However, the following provisions Declarations of this Coverage Part
apply to other insurance available to c. Method Of Sharing
any person or organization who is an If all the other insurance permits
additional insured underthls Coverage contribution by equal shares,we will follow
Part: this method also. Under this approach,
(a) Primary Insurance When each insurer contributes equal amounts
Required By Contract until it has paid its applicable limit of
This insurance is primary if you insurance or none of the loss remains,
have agreed In a written contract, whichever comes first,
written. agreement or permit that if any of the other insurance does not permit
this insurance be primary. If other contributfon by equal shares, we will
Insurance is also primary, we will contribute by limits. Under this method,each
share with all that other insurance insurers share is based on the ratio of its
by the method described in c. applicable limit of insurance to the total
below, applicable limits of insurance of sit Insurers.
{ (b) Primary And float-Contributory 8. Transfer Of Rights Of Recovery Against
To Other Insurance When Others To Us
Required By Contract a. Transfer Of Rights Of Recovery
If you have agreed In a written if the insured has rights to recover all or
contract, written agreement or part of any payment, Including
permit that this Insurance is Supplementary Payments, we have made
primary and non-contributory with under this Coverage Part, those rights are
the additional insured's own transferred to us. The Insured must do
Insurance, this insurance is nothing after loss to Impair them. At our
primary and we will not seek request, the Insured will bring "suit" or
contribution from that other transfer those rights to us and help us
Insurance, enforce them. This condition does not
Paragraphs (a) and (b) do not apply to apply to Medical Expenses Coverage.
other insurance to which the additional b. Waiver Of Rights Of Recovery (Waiver
Insured has been added as an Of Subrogatlon)
additional Insured. If the insured has waived any rights of
When this, insurance is excess, we will recovery against any person or
have no duty under this Coverage Part to organization for all or part of any payment,
defend the Insured against any"suit'if any including Supplementary Payments, we
other insurer has a duty to defend the have made under this Coverage Part, we
insured against that "suit". If no other also waive that right, provided the Insured
Insurer defends, we wlll undertake to do waived their rights of recovery against
so, but we will be entitled to the insured's such person or organization In a contract,
rights against all those other Insurers. agreement or permit that was executed
prior to the Injury or damage.
Farm SS CO 08 0405 Page 17 of 24
COMMON POLICY CONDITIONS
All coverages of this policy are subject to the following cortdttions.
A. Cancellation (6) Falture to:
1. The first Named Insured shown In the (a) Furnish necessary heat, water,
Declarations may cancel this policy by mailing sewer service or electricity for 30
or deitvarfng to us advance Written notice of consecutive days or more, except
cancellation, duft a period of seasonal
to
2, We may cancel this policy by malling or unoccapancy; or
o delivering to the first Named Insured written (b) Pay property taxes that are owing
N notice Ofcanoeilation at least: and have been outstanding for
a. 5 days before the effective date of more than one year following the
o cancellation if any one of the following date due, except that this
conditions exists at any building that is provWon will not apply where you
Covered property it)this policy: are In a bona fide dispute wish the
(1) The building has been vacant at taxing outhorfty regarding payment
unoccupied 60 or more consecutive of such taxes.
CA
I days, This does not appyto: b. 10 days before the effective date of
,A cancellation if we cancel for nonpayment
o (a) seasonal unoccupancy;or of premium.
(b) Buildings in the course of c. '30 days before the effectve date of
construction, renovation or cancellation if we cancel for any other
addluoa. reason.
Buildings wfth 65% or more of the rental
3. We w0 matl or deliver our notice to the first
units or floor area vacant or unoccupied Named Insured's test malling address known
are considered unoccupied undo[ this to us.
lift provision. 4. Notice of cancellation on state the effective
(2) After damage by a Covered Cause of date of cancellatfon. The policy period wtli end
Loss, permanent repairs to the on that date.
budding:
5. If this policy is canceled, we will send the first
(a) Have not started; and Named Insured any premium refund due.
(b) Have not been contracted for, Such refund will be pro rata. The cancellation
` Wthfn 30 days of fniffal payment of will be effective even if we have not made or
foss, offered a refund.
3 6. if notice is mailed, proof of mailing will be
s O The building has:
(a) An outstanding order to vacate; sufficient proof of notice,
7. if the first Named Insured cancels this policy,
(b) An outstanding demoll0on order; we will retain no less than $100 of the
or
.�, premium.
(c) Been declared unsafe by B. Changes
governmental authority.
This polcy contains all the agreements between you
®I (4) Fbtad and salvageable Items have and us concerning the insurance afforded. The first
es been or are being removed from the Named Insured shown in the t]acaarations 18
buffdfng and are not being Fepfaced, authorized to make changes In the temis of this policy
This does not apply to such removal with our consent This poacys terms cart be
that Is necessary or Incidental to any amended or waived onfy by endorsement issued
renovation or remodelhig. by us and made a part of this policy.
Form SS 00 05 12 06 Page 1 of 3
Q 2006,The Hartford
r
COMMON POLICY CONDITIONS
C, Concealment, Misrepresentation Or Fraud I. Premiums
This p04W is void in any case of Laud by you as 1 1, The first Named Insured shown In the
relates to thts policy at any time. It is also void If you Declarations.
or any other insured,at any time,intentionally conceal e, Is responsible for the payment of all
or misreprssent a materiai fact concerninct: premiums; and
1, This policy; b. Will be the payee for any return premiums
2, The Covered Property; we pay,
3. Your Interest in the Covered Properly; ar 2. The premium shown in the Declarations was
y, A claim under this policy. computed based on rates in effect at the time
the policy was issued. if applicable, on each
0. Examination of Your Books And Records renewal, continuation or anniversary Of the
We may examine and audit your books and effective data of this policy, we will compute
records as khey relate k0 the Policy at any time the premium in accordance with our rates and
ides then in effect.
during the policy period and up to three Yeats
afterward. 3. With our consent, you may continue this poky
in force by paying a continuation premium far
E_ inspections And Surveys
each successive one-year period. The
We have the right but are not obligated to:
premium must he:
i. Make inspections and surveys at any time', a, Paid to us prior to the anniversary date;and
2. Give you reports on the conditions we find; and b. Determined In accordance with Paragraph
3, Recommend changes. 2.above.
Any dhspecllons surveys, reports or Our forms then In effect Witt apply. If you do
recommendations relate only to insurability and the not pay the continuation premium, this policy
premiums to be charged, We do not make safety will expire oil the first anniversary date that we
111spectior1s. We do not undertake to Wform the duty have not received the premium.
of any person or organUation to provide for the health 4, Changes in exposures or changes in your
Or safety of any person. And we do not represent or business Operation, acquisition or use of
Warrant that conditions: locations that are not shown In the Declaratlons
1. Are safe or healthful; or may occur during the policy period, if so,wa MAY
2, Comply with laws, regulatlons, codes or requite an adduffonal premium, That prernlurn Wfi
be determined in accordance with our rates an
standards. ti rules then In effect.
This condition applies not only to us, but alsra to
J. Transfer Of Rig
any rating, advisory', rate Service or slmllar Rights Of RecOvsryAgainst Others
organization which makes insurance Irispectfons, To Us
SUradys,sports or reconnmendatdOns. Applicable to Property Coverage:
F. Insurance Under Two Or More Coverages If any person or organization to or for whom we
If two or more of this poiicy's coverages apply to make ecoverpdam payment
d-.rr his policth a rightss to
are
tha sable doss or drursage, we will not. pay one
than the actual amount of the loss cr damage. transferred to us to the extent of our paym
That person or organization must do everything
G. Liberalization necessary to secure our rights and must, do
If we adopt any revision that would broaden the nothing after less to impair theM, But you may
coverage under this policy without addi'llonal waive your rights against another party in writing:
p
ror Turn within 45 clays prior to or during the policy 1, prior to a loss to your Covered Property.
period, the broadened coverage will immediately
apply to this poiPcy, 2. ARer a loss [o your Covered Property only if, at
time of loss,that party is one of the following;
H, Other Insurance •property Coverage a, Someone insured by this insurance;
If there is other Insurance covering the same Moss
or damage, we will pay only for the amount Of b. A business firm:
covered loss or damage In excess of the amount (1) Owned or controlled by you; or
due from that Other insurance, whether you Can (2) That owns or controls you; or
collect on It or not, But we wilt 'lot pay more lhan
the applicable Limit of Insurance.
Form SS 00 05 12 oe
pace 2 of 3
4. .
COMMON POLICY CONDITIoNs
c. Yourtenant. L Premium Audit
You may also accept the usual bills of lading or a, We will compute all premiums for this policy In
shipping receipts limiting the Ilability of carriers, accordance with our rules and rates.
This will not restrict your Insurance. b. The premium amount shown In the
K. Transfer Of Your Rights And buttes Under This Declarations Is a deposft premium only. At the
Policy close of each audit period we wilt compute the
earned premium for that period. Any
Your rights and duties under this policy may not be additional premium found to be due as a result
transferred without our written consent except In of the audit are due and payable on nouoe to
the case of death of an tndlAdual Nerned Insured. the first Named Insured. If the deposit
If you die, your rights and duties will be transferred premium paid for the policy term is greater
m to your legal representative but only while acting than the earned premium, we will return the
wthin the scope of duties as your legal excess to the First Named Insured.
representative, Until your legal representative is c, The first Named Insured must maintain all
N appointed, anyone having proper temporary records related to the coverage provided by
custody of your properly will have your rights and this po!ey and necessary to finalize the
dunes but only with respect to that property, premium audit, and send us copies of the
0
m same upon our request.
m
H
0
w
N
N
N
0
Our President and Secretary have signed this policy, Where roqufred by law,the Declarations page has arso been
countersigned by our dufyauthorizedrepresentative.
555
f/
Ornrald o.Nrml,5ecrdary 'dum An&gde'President
9a
Form SS 00 05 12 06 Page 3 of 3
w
SUPER STRETCH SUMMARY
SUMMARY OF COVERAGE LIMITS
This is a summary of the Coverages and the Limits of Insurance provided by the Super Stretch Coverage form
SS 04 74 Which is Included In this policy. No coverage Is provided by this summary. Refer to coverage form
M SS 04 74 to determine the scope of your Insurance protection.
a
The Limits of Insurance for the following Additional Coverages are in addition to any other Ilmlt of Insurance provided
rI under this policy:
Blanket Coverage Limit of Insurance:$159,000
Blanket Coverages
Ac o e Media Receivable-On/Off Premises
Computers
o Debris Removal
o Personal Property of Others
o Temperature Change
Valuable Papers and Records-On/Off Premises
� Coverage
Limit
MW Brands and Labels Up to Business Personal Property Limit
ENE
Claim Expenses $ 10,000
s Computer Fraud $5,000
Employee Dishonesty(including ERISA) $25000
Fine Arts $25:000
Forgery $25,000
Laptop Computers-Worldwide Coverage $10,000
Off Premises Utillty Services—Direct Damage $25,000
Outdoor Signs Full Value
Pairs or Sets Up to Business Personal Property Limit
Property at Other Premises $10,000
Salespersons' Samples $ 5,000
Sewer and Draln Back Up Included Up to Covered Properly Limits
_ Sump C'7verflcw or Sump Pump Failure $25,000
® Tenant BuIlding and Business Personal Property $20,000
Coverage-Required by Lease
Transit Property in the Care of Carriers for Hire $10,000
Unauthorized Business Card Use $ 5,000
Form SS 84 15 09 07 Page 1 of 2
0 2007, The Hartford
The Limits of Insurance for the following Coverage Extensions are a replacement of the Umft of Insurance provided
under the Standard Property Coverage Form or the Special Property Coverage Form, whichever applies to the policy:
Coverage Limit
Newly Acq ulre d or Constructed Property—180 Days
Building $1,000,000
Business Personal Property $500,000
Business Income and Extra Expense $500,000
Outdoor Property $25,000 aggregate($1,000 per Item
Personal Effects $25,000
Property Off-Premises $25,000
the following changes,apply only If Business Income and Extra Expense are covered under this policy The Limits of
insurance for the foliowfng Business Income and Extra Expense Coverages are in addition to any other Limit of
Insurance provided under this policy:
Coverage Limit
Business Income Extension for Off-Premises Utility Services $25,000
Business Income Extension for Web Sites $50,00017 days
Business Income from Dependent Properties $50,000
The following Limit of Insurance for the following Business Income Coverage Is a replacement of the Limit of
Insurance provided under the Standard Property Coverage Form or the Special Property Coverage Form, whichever
applies to the policy:
Coverage . Lfmft
Extended Business income 90 Days
The following changes apply to Lass Payment Conditions:
Coverage Limit
Valuation Changes
Commodity Stock Included
"Finished Stock" Included
Mercantile Stock - Sold included
yI
1
k
o
- I
Page 2 of 2 Form SS 8415 09 07
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