HomeMy WebLinkAboutCAG2019-206 - Amendment - #2 - SH&H Valuation, LLC - Mill Creek at 76th Ave S Flood Protection Improvements - 09/18/2019 Y
Agreement Routing Form
KEN T For Approvals, Signatures and Records Management
W A-I N G T O N
This form combines&replaces the Request for Mayor's Signature and Contract Cover Sheet forms.
(Print on pink or cherry colored paper)
Originator: Nancy for Cheryl Rolcik-Wil Department: Public Works
Date Sent: 9/18/19 Date Required. 9/20/19
c Authorized Director or Designee Date of
to Sign: Council to
aMayor Approval:
Budget D20076 Grant? Yes W1 No
Account
Number: Type: N/A
Vendor or
Name: SH&H Valuation Cate 9 Y: Contract
C Vendor 1207939 Sub-Category Amendment
o Number:
o Project
E Mill Creek at 76th Ave. S. Flood Proteciton Improvements
E Name:
0
C� Project
Details: Provide additional appraisal services
c
Agreement 1 500 Basis for
0 Amount: Selection of
Contractor:
a Start Date: 9/18/19 Termination Date: 12/31/19
Notice required prior to 1:1Yes 1:1No Contract Number: T b , ZGI _
disclosure? (Y
Date Received by City Attorney: Comments:
c
0
0
N
41
i
Date Routed to the Mayor's Office:
'vf
d Date Routed to the City Clerk's Office:
a
cc Date Sent to Originator.
Visit Documents.KentWA.gov to obtain copies of all agreements
adccW22373_6_19
•
KENT
WASH N G T G N
AMENDMENT NO. 2
NAME OF CONSULTANT OR VENDOR: SH&H Valuation, LLC
CONTRACT NAME & PROJECT NUMBER: Mill Creek at 761h Ave. S. Flood Protection
Improvements
ORIGINAL AGREEMENT DATE: April 10, 2019
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 appraisal services. For a description, see
Exhibit A which is attached and incorporated by this reference.
2. The contract amount and time for performance provisions of Section II "Time of
Completion," and Section III, "Compensation," are modified as follows:
Original Contract Sum, $13,500
including applicable WSST
Net Change by Previous Amendments $0
including applicable WSST
Current Contract Amount $13,500
including all previous amendments
Current Amendment Sum $1,500
Applicable WSST Tax on this $0
Amendment
Revised Contract Sum $15,000
AMENDMENT - 1 OF 2
Original Time for Completion 8/1/19
(insert date)
Revised Time for Completion under 12/31/19
prior Amendments
(insert date)
Add'I Days Required (f) for this 0 calendar days
Amendment
Revised Time for Completion 12/31/19
(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:
y y
( gnature) (slgnat re)
Print Name: Chad C. Johnson, MAI Print Name: Carla Maloney, P.E.
Its Partner Its Design Engineering Mana eq r_
(title) (title)
DATE: September 18, 2019 DATE:
ATTEST: APPROVED AS TO FORM:
(applicable if Mayor's signature required)
f(/�( Kent Cit4 Clerk Kent Law Department
SH&H-Mill Creek at 76"Amd 2/Rolcik-Wilcox
AMENDMENT - 2 OF 2
EXHIBIT A
Rolcik-Wilcox, Cheryl
From: Chad Johnson <ChadJ@shhapp.com>
Sent: Sunday, July 07, 2019 9:38 PM
To: Rolcik-Wilcox, Cheryl; Martindale, Delores
Cc: Alex Ball
Subject: Jorgensen/HRP
=EXTERNAL
Hi Cheryl and Dee,
It's been a bit of radio silence from my end for the last week or so as my family and I have been trekking across about
half of the country. We are in the home stretch now and I'll be back Thursday(with a mountain of stuff to catch up
on). I am aware of the issue of the easement that was added to the 76th Ave S project. After I was able to read through
the documentation and correspond/speak with Alex, it appears that this was not part of the original scope of work. If
the typos pointed out(I always hate those)were the only things to deal with,we could have moved through those fairly
quickly. However,the new easement changes the after scenario for each property and will require use to rework the
appraisals to get you what you need.
That being said,when we started this project,and didn't know exactly what we were up against,we bid each of the
three properties at$4,500. The third parcel (I'm spacing on the name right now) is one that we were told may not
materialize for a few months. If you looked closely at the invoice, you will see that we charged less than$4,500 ($3,500)
for the HRP appraisal and $4,500 for the Jorgensen report, which was a bit more involved from an analysis
standpoint. With the new easement document Lion do hand that will repo` wdiLy nor a___nalwsis, I'm proposing
that some compensation would be reasonab e $1,000 to rework HRP n $1,500 to rewor�Jorgen�sen . We still have
some room to work with under the existing contract at this po t snio I'm hoping is =sn the change in
scope. Please let me know what you think either way.
We are slammed right now and Alex and I are up to our eyeballs in appraisals. It might be a week or two until we can
hop on the modifications. I seem to recall that the project manager,Suzanne, indicated a longer timeframe for this
project, but I wanted to make sure that receiving updated/modified reports by the end of the month will work for you.
Hope you both enjoyed your weekend,
Chad
* SH & H
Chad Johnson, MAI I Partner
Real Estate Appraiser& Consultant
t. 253.564.3230 x103 I f.253.564.3143
SH&H Valuation and Consulting
6419 Lakewood Drive West
Tacoma, WA 98467
chadi@shhapp,com
1
SHHVA-1 QP ID: )r�
DATE(MM/DD/YYYYI
CERTIFICATE OF LIABILITY INSURANCE
ov1 a/2a19
(^THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsements.
PRODUCER 253-284-7900 CONTACT Julie Ellis,ACSR
Taylor-Thomason Ins.Brokers _NAM --
3401 South 19th Street PHONE 253-284-7900 _ FAX
INC,.No,Ext) I(A/C,No):253-284-7901
P.O. Box 7187 EMAIL JulieE ttib.net
Tacoma,WA 98417 ADDREss;._____@
Tom Taylor,Jr.CPCU,ARM,AAICOVERA�iE
wSgRERA:Ohio Casualty lnsuranc C
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Tacoma,WA 96467 ---......—.-..._......"._-__
I INSURER D:
INSURER F
COVERAGES
C RT FI ATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INSR FADD I�Sua _. __._.. ._ P
POLICY CFF POLICY EXP T--- --" "`-- T
1 TYPE OF INSURANCE POLICY NUMBER , / LIMITS _
A I COMMERCIAL GENERAL LIABILITY I
EAPHOucuRaFrvcE a 2,000.000
CLA MSMADE ( OCCUR I 0110112019i01l01/2020 _ 2OOfl A00
i.. ._� (. ; X 'BZS570217$2 DAMAGE TO RENTED
X Business Owners ( eR1�4lSLStfavxsttnsc] 1s
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PERSONAL.8 AD✓IN;URr 1
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PRODUCTS•40MPr>JP A( SOTHE'R .S 4,000,000
A ' AUTOMOBILE LIABILITY
i i COMBINED SINGLE LIMIT 1,000,000
1Ee issXl2eD__ 1.__.._
ANY AUTO X :!BZS57021782 01/0112019EO1101/2020 BOJiLYINJURYLForrp rsom 1.
OWNED (— SCHEDULED .._
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X 1 HIRED X NON O ED I I - _
AUTOS ONLY ; AUTOS ONLY AROP[RT.
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DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is roquiredl
Tile City of Kent is named as additional insured with respects to operations Of the named insured.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF H
THE EXPIRATION DATE
TI1 EOF,DESCRIBED POLICIES NOTIICE WILLL CANCELLED
ECDELVERED BEFORE INCity of Kent ACCORDANCE WITH THE POLICY PROVISIONS,
Public Works Engineering
220 4th Ave So AUTHORIZED REPRESENTATIVE
Kent,WA 98032
ACORD 25(2016103)
The ACORD name and logo are registered marrks9of ACORDCORD CORPORATION. All rights reserved.
_rriwr��Faors TNT r oFznis��ritzkav
COMMERCIAL GENERAL LIABILITY
CG 76 35 02 07
Policy #BZS57021782
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
LIABILITY PLUS ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization: City of' Kent
as required by written contract.
ADDITIONAL INSURED — BY WRITTEN lease or occupy, subject to the following
CONTRACT, AGREEMENT OR PERMIT, OR additional provisions:
SCHEDULE
(a) This insurance does not apply to
The following paragraph is added to WHO IS AN any "occurrence" which takes place
INSURED (Section II): after you cease to be a tenant in
any premises leased to or rented to
4. Any person or organization shown in the Sched- you;
ule or for whom you are required by written con
tract, agreement or permit to provide insurance (b} This insurance does not apply to
is an insured, subject to the following additional any structural alterations, new con
provisions: struction or demolition operations
performed by or on behalf of the
a. The contract, agreement or permit must be person or organization added as an
in effect during the policy period shown in insured;
the Declarations, and must have been exe
prior to the "bodily (2) Your ongoing operations for that in-
cuted
p y injury", "property sured, whether the work is erformed
damage", or "personal and advertising P
injury", by you or for you;
b. The person or organization added as an in- (3) The maintenance, operation or use by
sured by this endorsement is an insured only you of equipment leased to you by such
to the extent you are held liable due to: person or organization, subject to the
(1) The ownership, maintenance or use of following additional provisions:
that part of premises you own, rent, (a) This insurance does not apply to
any "occurrence" which takes place
after the equipment lease expires;
Includes Copyrighted Material of Insurance Services Office, Inc., with its permission.
Copyright, Insurance Services, 2001
CG 76 35 02 07
P=ge ? of a
EP
REPRINTED F.R010 THE FORMS LIBRARY""
(b) This insurance does not apply to This exclusion applies even if the claims
"bodily injury" or "property dam- against any insured allege negligence or
age" arising out of the sole negli- other wrongdoing in the supervision, hiring,
gence of such person or employment, training or monitoring of others
organization; by that insured, if the "occurrence" which
caused the "bodily injury" or "property
(4) Permits issued by any state or political damage" involved the ownership, mainte-
subdivision with respect to operations nance, use or entrustment to others of any
performed by you or on your behalf, aircraft, "auto" or watercraft that is owned
subject to the following additional pro- or operated by or rented or loaned to any in-
vision: sured.
This insurance does not apply to 'bodily This exclusion does not apply to:
injury", "property damage", or
"personal and advertising injury" arising (1) A watercraft while ashore on premises
out of operations performed for the state you own or rent;
or municipality. (2) A watercraft you do not own that is:
c. The insurance with respect to any architect, (a) Less than 52 feet long; and
engineer, or surveyor added as an insured (b) Not being used to carry persons or
by this endorsement does not apply to property for a charge;
"bodily injury", "property damage", or "per-
sonal and advertising injury" arising out of (3) Parking an "auto" on, or on the ways
the rendering of or the failure to render any next to, premises you own or rent, pro-
professional services by or for you, includ- vided the "auto" is not owned by or
ing: rented or loaned to you or the insured;
(1) The preparing, approving, or failing to (4) Liability assumed under any "insured
prepare or approve maps, drawings, contract" for the ownership, mainte-
opinions, reports, surveys, change or- nance or use of aircraft or watercraft; or
ders, designs or specifications; and (5) "Bodily injury" or "property damage"
(2) Supervisory, inspection or engineering arising out of:
services. (a) the operation of machinery or
d. This insurance does not apply to 'bodily equipment that is attached to, or
injury" or "property damage" included within part of, a land vehicle that would
the `products-completed operations haz qualify under the definition of
It
and". mobile equipment" if it were not
subject to a compulsory or financial
A person's or organization's status as an insured un- responsibility law or other motor ve-
der this endorsement ends when your operations for hicle insurance law in the state
that insured are completed. where it is licensed or principally
garaged; or
No coverage will be provided if, in the absence of this (b) the operation of any of the machin-
endorsement, no liability would be imposed by law on ery or equipment listed in Paragraph
you. Coverage shall be limited to the extent of your f.(2) or f.(3) of the definition of
negligence or fault according to the applicable princi- "mobile equipment",
pies of comparative fault, (6) An aircraft you do not own provided it is
NON-OWNED WATERCRAFT AND NON-OWNED not operated by any insured.
AIRCRAFT LIABILITY TENANTS' PROPERTY DAMAGE LIABILITY
Exclusion g, of COVERAGE A (Section 1) is replaced When a Damage To Premises Rented To You Limit is
by the following: shown in the Declarations, Exclusion j, of Coverage
A, Section I is replaced by the following:
g. "Bodily injury" or "property damage" arising
out of the ownership, maintenance, use or j. Damage To Property
entrustment to others of any aircraft, "auto"
or watercraft owned or operated by or rented "Property damage" to:
or loaned to any insured. Use includes oper- (1) Property you own, rent, or occupy, including
ation and "loading or unloading". any costs or expenses incurred by you, or
Page 2 of 4
• ' ""REPRIN I Et?FROM THE FORMS LIBRARY""
any other person, organization or entity, for WHO IS AN INSURED — MANAGERS
repair, replacement, enhancement, restora-
tion or maintenance of such property for any The following is added to Paragraph 2.a. of WHO IS
reason, including prevention of injury to a AN INSURED (Section II):
person or damage to another's property;
(2) Premises you sell, give away or abandon, if Paragraph (1) does not apply to executive officers, or
the "property damage" arises out of any part to managers at the supervisory level or above.
of those premises;
SUPPLEMENTARY PAYMENTS — COVERAGES A
(3) Property loaned to you; AND B — BAIL BONDS — TIME OFF FROM
(4) Personal property in the care, custody or WORK
control of the insured;
Paragraph 1.b. of SUPPLEMENTARY PAYMENTS —
(5) That particular part of real property on which COVERAGES A AND B is replaced by the following:
you or any contractors or subcontractors
working directly or indirectly on your behalf b. Up to $3,000 for cost of bail bonds required
are performing operations, if the "property because of accidents or traffic law violations
damage" arises out of those operations, or arising out of the use of any vehicle to which
the Bodily Injury Liability Coverage applies.
(6) That particular part of any property that must We do not have to furnish these bonds.
be restored, repaired or replaced because
"your work" was incorrectly performed on it. Paragraph 1.d. of SUPPLEMENTARY PAYMENTS —
Paragraphs (1), (3) and (4) of this exclusion do COVERAGES A AND B is replaced by the following:
not apply to "property damage" (other than d. All reasonable expenses incurred by the in-
damage by fire) to premises, including the con-
tents of such premises, rented to you. A separate sured at our request to assist us in the in-
vestigation or defense of the claim or �°suit",
ises Rented To You as described in Section III including actual loss of earnings up to $500
— Limits Of Insurance. a day because of time off from work.
t Paragraph (2) of this exclusion does not apply if EMPLOYEES AS INSUREDS — HEALTH CARE
the premises are "your work" and were never SERVICES
occupied, rented or held for rental by you.
Paragraphs (3), (4), (5) and (6) of this exclusion Provision 2.a.(1)(d) of WHO IS AN INSURED (Section
do not apply to liability assumed under a side- II) is deleted, unless excluded by separate endorse
track agreement. ment.
Paragraph (6) of this exclusion does not apply to EXTENDED COVERAGE FOR NEWLY ACQUIRED
"Property damage" included in the "products- ORGANIZATIONS
completed operations hazard".
Provision 3.
IS
Paragraph 6. of LIMITS OF INSURANCE (Section III) replaced byatheffol owOing:AN INSURED (Section II) is
is replaced by the following:
a. Coverage under this provision is afforded
6. Subject to 5. above, the Damage To Premises only until the end of the policy period.
Rented To You Limit is the most we will pay un-
der Coverage A for damages because of EXTENDED "PROPERTY DAMAGE"
"property damage" to any one premises, while
rented to you, or in the case of damage by fire, Exclusion a. of COVERAGE A (Section 1) is replaced
while rented to you or temporarily occupied by by the following:
you with permission of the owner.
a. "Bodily injury" or "property damage" expected
The Damage To Premises Rented To You limit is the or intended from the standpoint of the insured,
higher of the Each Occurrence Limit 'shown in the This exclusion does not apply to "bodily injury"
Declarations or the amount shown in the Declarations or "property damage" resulting from the use of
as Damage To Premises Rented To You Limit. reasonable force to protect persons or property.
CG 76 35 02 07
Page 3 of 4
EP
"RE PRINTED FROM THE FORMS LIERARY'"'
EXTENDED DEFINITION OF BODILY INJURY interrupted only by a street, roadway, waterway, or
right-of-way of a railroad.
Paragraph 3. of DEFINITIONS (Section V) is replaced
by the following: INCREASED MEDICAL EXPENSE LIMIT
3. "Bodily injury" means bodily injury, sickness or The Medical Expense Limit is amended to $10,000.
disease sustained by a person, including mental
anguish or death resulting from any of these at KNOWLEDGE OF OCCURRENCE
any time.
TRANSFER OF RIGHTS OF RECOVERY The following is added to Paragraph 2. Duties In The
Event Of Occurrence, Offense, Claim Or Suit of
The following is added to Paragraph 8. Transfer Of COMMERCIAL GENERAL LIABILITY CONDITIONS
Rights Of Recovery Against Others To Us of COM-
MERCIAL GENERAL LIABILITY CONDITIONS (Sec- Knowledge of an "occurrence", claim or "suit" by
tion IV): your agent, servant or employee shall not in itself
We waive any rights of recovery we may have against constitute knowledge of the named insured unless an
any person or organization because of payments we officer of the named insured has received such notice
make for injury or damage arising out of your ongoing from the agent, servant or employee.
operations or `your work" done under a contract with UNINTENTIONAL FAILURE TO DISCLOSE ALL
that person or organization and included in the HAZARDS
"products-completed operations hazard". This waiver
applies only to a person or organization for whom you The following is added to Paragraph 6. Representa-
are required by written contract, agreement or permit tions of COMMERCIAL GENERAL LIABILITY CONDI-
to waive these rights of recovery. TIONS (Section IV):
AGGREGATE LIMITS OF INSURANCE — PER
LOCATION If you unintentionally fail to disclose any hazards ex-
isting at the inception date of your policy, we will not
For all sums which the insured becomes legally obli- deny coverage under this Coverage Form because of
such failure. However, this provision does not affect
gated to pay as damages caused by "occurrences" our right to collect additional premium or exercise our
under COVERAGE A (Section 1), and for all medical
expenses caused by accidents under COVERAGE C right of cancellation or non renewal.
(Section 1), which can be attributed only to operations LIBERALIZATION CLAUSE
at a single 'location":
Paragraphs 2.a. and 2.b. of Limits of Insurance (Sec- The following paragraph is added to COMMERCIAL
GENERAL LIABILITY CONDITIONS (Section IV):
tion III) apply separately to each of your "locations"
owned by or rented to you. 10. If a revision to this Coverage Part, which would
provide more coverage with no additional pre-
"Location" means premises involving the same or mium, becomes effective during the policy period
connecting lots, or premises whose connection is in the state shown in the Declarations, your pol-
icy will automatically provide this additional cow
erage on the effective date of the revision.
Page 4 of 4
LIA Administrators & Insurance Services
APPRAISAL AND VALUATION A S P E N
PROFESSIONAL LIABILITY INSURANCE POLICY
DECLARATIONS
ASPEN AMERICAN INSURANCE COMPANY
(A stock insurance company herein called the "Company")
175 Capitol Blvd. Suite 100
Rocky Hill, CT 06067
Date Issued Policy Number Previous Policy Number
1 1/27/2018 AA1004449-04 AA1004449-03
THIS IS A CLAIMS MADE AND REPORTED POLICY. COVERAGE IS LIMITED TO LIABILITY FOR ONLY THOSE
CLAIMS THAT ARE FIRST MADE AGAINST THE INSURED DURING THE POLICY PERIOD AND THEN REPORT-
ED TO THE COMPANY IN WRITING NO LATER THAN SIXTY(60) DAYS AFTER EXPIRATION OR TERMINATION
OF THIS POLICY, OR DURING THE EXTENDED REPORTING PERIOD, IF APPLICABLE, FOR.A WRONGFUI:,
ACi'COMMITTL-D ON OR AFTER THE RETROACTIVE DATE AND BEFORI-,:THE END OF THE POLICY
PERIOD. PLEASE READ THE POLICY CAREFULLY.
Item
1. Customer ID: 168390
Named Insured:
S H& 11 VALUATION, LLC
S H& H Valuation and Consulting
6419 Lakewood Drive West
Tacoma, WA 98467
2. Policy Period: From: 12/10/2018 To: 12/10/2019
12:01 A.M. Standard Time at (lie address stated in i above.
3. Deductible: $2,500 Each Claim
4. Retroactive Date: 12/10/2015
5. Inception Date: 12/10/2015
6. Limits of Liabilitv: A. $i,000,000 F,ach Claim
B. $2,000,000 Aggregate
7. Mail all notices, including notice of Claim, to:
L1A Administrators& Insurance Services
1600 Anacapa Street
Santa Barbara, California 93101
(800) 334-0652; Fax: (805) 962-0652
8. Annual Premium: $8,128.00
I
9. Forms attached at issue: LIA002 (12/14) LIA WA(1U14) L1A012 (12/14) L1A013 (10/14)
LIA018 (10/14) LIA025A (11/14) LIA02513 (11/14) LIA.122(10/14)
This Declarations Page, together with the completed and signed Policy Application including all attachments and exhibits thereto, at;d
the Policy shall constitute the contt-act between the Named Insured and th• )n vlly_
l 1/27/2018
Date By
LIA-001 (12/l�I) Authorised Sig attire
Aspen American Insurance Company