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HomeMy WebLinkAboutPW14-066 - Amendment - #8 - GEI, Consultants, Inc. - Briscoe-Desimone Levee Reach 1-4 - 11/18/2019 ,0e*1**% Agreement Routing Form KEN T For Approvals,Signatures and Records Management W.S,INorON 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 Ken Langholz Department: Public Works Date Sent: 11/20/19 Date Required: 11/26/19 �o > Authorized Director or Designee Date of 0 N/A Q, to Sign: Council �a Mayor Approval: Budget D20082 & D20083 Grant? ❑ Yes No Account Number. Type: N/A Vendor or Name: GEI Consultants, Inc. Cate g y: Contract = Vendor 346843 Sub-Category Amendment 0 Number: a Project E Name: Briscoe-Desimone Levee Reach 1-4 A.0 - Project C Details: Extend the time of completion to 12/31/20. c E Agreement 0 Basis for 0 Amount: Selection of v� Contractor: Q Start Date: 11/18/19 Termination Date: 1 Z/31/Z 0 Notice required prior to Yes No Contract Number: disclosure? ❑ ❑ �O �� (� Date Received by City Attorney: Comments: 0! c 0 0 a� L 0 �o M Date Routed to the Mayor's office: in d Date Routed to the City Clerk's Office: 'a a, Dote Sent to Originator. Visit Documents.KentWA.gov to obtain copies of all agreements adccW22373_6_19 • KENT WAS H I N G T O N AMENDMENT NO. 8 NAME OF CONSULTANT OR VENDOR: GEI Consultants, Inc. CONTRACT NAME & PROJECT NUMBER: Briscoe-Desimone Levee Reach 1-4 ORIGINAL AGREEMENT DATE: March 25, 2014 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: No change to the scope of work, however an amendment is needed to extend the time of completion to December 31, 2020 due to as-builts and certification documents need to be completed. 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, $399,124 including applicable WSST Net Change by Previous Amendments $65,690 including applicable WSST Current Contract Amount $464,814 including all previous amendments Current Amendment Sum $0 Applicable WSST Tax on this $0 Amendment Revised Contract Sum $464,814 AMENDMENT - 1 OF 2 Original Time for Completion 3/1/15 (insert date) Revised Time for Completion under 12/31/19 prior Amendments (insert date) Add'I Days Required (f) for this 366 calendar days Amendment Revised Time for Completion 12/31/20 (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: &b CITY O ENT: By: By: _ / lb—' 1rFe) t nature) Print Name: O Print Name: Ti othy J. LaPorte P.E. Tts � Its Public Works Director titt�J (ti le) DATE: !t DATE: 2 d ATTEST: APPROVED AS TO FORM: (applicable if Mayor's signature required) k Kent City Clerk Kent Law Department GE)-Briscoe-Uesimone Levee 5 Amd B/Langholz AMENDMENT - 2 OF 2 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/VYYY) 3/6/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS .RTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES _GLOW. 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 endorsement(s). PRODUCER JLT Specialty USA CONTACTNAME Donna M.Bona 135 Main Street aC°NNo Ext: 415-930 9049 nA Suite 1600 E-MAIL ic No San Francisco, CA 94105 ADDRESS: donna,bof a Itus.Com INSURERS AFFORDING COVERAGE NAIC k www.jltus.com California License:OH01556 INSURER A: National Union Fire Ins Co Pittsburgh PA 19445 INSURED INSURER B: Steadfast Insurance Company26387 GEI Consultants, Inc. 180 Grand Ave INSURERC: Oakland CA 94612 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 47415471 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMlDO/YYYY) (MM/DDIYYYYI LIMITS A COMMERCIAL GENERAL LIABILITY 518-02-76 3/1/2019 3/1/2020 EACH OCCURRENCE $1,000,000 � CLAIMS-MADE ❑✓ OCCUR PREMISES(Ea occurrence) $300,000 ✓ Contractual Liability Included MED EXP(Any one person) $25,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PECOT- ❑✓ LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: ;AUTOMOBILE LIABILITY 2961705-AOS 3/1/2019 3/1/2020 CD Ea acadentSINGLE LIMIT $1,000,000 ✓ ANY AUTO 2961704-MA 3/1/2019 3/1/2020 BODILY INJURY(Per person) $1,000,000 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE ✓ AUTOS ONLY ✓ AUTOS ONLY Per accident $ Medical Payments $5 000 B /I UMBRELLA LIAB V OCCUR SXS-7447104-00 3/1/2019 3/1/2020 EACH OCCURRENCE $1,000,000 S LIAR CLAIMS-MADE AGGREGATE $1,000,000 RETENTION$ A WOMPENSATION 012016047-AOS 3/1/2019 3/1/2020 AND EMPLOYERS'LIABILITY y I N 012016046-CA ✓ STATUTE EERH �ANYPROPRIETOR/PARTNER/EXECUTIVE 3/1/2019 3/1/2020 E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? ❑ NIA (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $1 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 B Contractor's Pollution Liability/ PECO233595-03 3/1/2019 3/1/2020 Each Claim $1,000,000 Prof Liab(retro date:01/01/74) Aggregate $1,000,000 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Project: Kent Briscoe-Desimone Levee Reach 1,City of Kent The City of Kent,King County and the King County Flood Control District are named as Additional Insured with respect to general liability for ongoing and completed operations,auto,and umbrella liability as required by written contract,for liability arising out of the operations of the named insured while performing work for the City,the District,and the County.General,Auto and Umbrella Liability is primary and Non-contributory as required per written contract.A Waiver of Subrogation and 30-day notice of cancellation will be issued In accordance with policy terms and conditions. CERTIFICATE HOLDER CANCELLATION City of Kent Public Works Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: Mr. Ken Langholz THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN '10 Fourth Avenue South ACCORDANCE WITH THE POLICY PROVISIONS. nt WA 98032 AUTHORIZED REPRESENTATIVE Donna Bor a ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 47415471 1 19-20 GL AU UM13 $1M--We—$IM-CPL PL I Nellie Reyna 1 3/6/2019 4:19:03 PH (PST) I Page 1 of 11 This certificate cancels and supersedes ALL previously issued certificates. ENDORSEMENT This endorsement, effective 12:01 A.M. 03/01/2019 forms a part of Policy No.CA 296-17-05 issued to GE CONSULTANTS, INC. by NATIONAL UNION FIRE INSURANCE COMPANY OF P I TTSBURGH, PA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE ADDITIONAL INSURED: Any person or organization for whom you are contractually bound to provide Additional Insured status but only to the extent of such person's or organization' s liability arising out of the use of a covered "auto" , SECTION II - COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. - Who Is Insured, is amended to add: d. Any person or organization, shown in the schedule above, to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered "auto". However, the insurance provided will not exceed the lesser of: (1) The coverage andior limits of this policy, or Q) The coverage and"or limits required by said contract or agreement. ?1�- AUTHORIZED REPRESENTATIVE 87950 (9114) Includes copyrighted information of Insurance Services Office, Inc., Page 1 of 1 with its permission. 47415471 19-20 GL AU UMH $lM WC $lM CPL PL I Nellie Reyna 1 3/6/2019 4:19:03 PM (PST) I Page 2 of 11 This certificate cancels and supersedes ALL previously issued certificates. ENDORSEMENT # This endorsement, effective 12:01 A.M. 03/01/2019 forms a part of Policy No.CA 296-17-05 issued to GE I CONSULTANTS, INC. By NATIONAL UNION FIRE INSURANCE COMPANY OF P I TTSBURGH, PA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIMITED ADVICE OF CANCELLATION PROVIDED VIA E-MAIL TO ENTITIES OTHER THAN THE FIRST NAMED INSURED This policy is amended as follows: In the event that the Insurer cancels this policy for any reason other than non-payment of premium, and 1. the cancellation effective date is prior to this policy's expiration date; 2. the First Named Insured is under an existing contractual obligation to notify a certificate holder when this policy is canceled (hereinafter, the "Certificate Holder(s)") and has provided to the Insurer, either directly or through its broker of record, the email address of a contact at each such entity; and 3. the Insurer received this information after the First Named Insured receives notice of cancellation of this policy and prior to this policy's cancellation effective date, via an electronic spreadsheet that is acceptable to the Insurer, the Insurer will provide advice of cancellation (the "Advice") via e-mail to each such Certificate Holders within 30 days after the First Named Insured provides such information to the Insurer; provided, however, that if a specific number of days is not stated above, then the Advice will be provided to such Certificate Holder(s) as soon as reasonably practicable after the First Named Insured provides such information to the Insurer. Proof of the Insurer emailing the Advice, using the information provided by the First Named Insured, will serve as proof that the Insurer has fully satisfied its obligations under this endorsement. This endorsement does not affect, in any way, coverage provided under this policy or the cancellation of this policy or the effective date thereof, nor shall this endorsement invest any rights in any entity not insured under this policy. The following Definitions apply to this endorsement: i 1. First Named Insured means the Named Insured shown on the Declarations Page of this policy. 2. Insurer means the insurance company shown in the header on the Declarations page of this policy. i All other terms, conditions and exclusions shall remain the same. i r a I a Authorized Representative kt 107414 (03/1 1) Page 1 a i 47415471 19-20 GL AU UMB $1M44Q,-i-PL PL Nellie Reyna 1 3/6/2019 4:19:03 PM (PST) Page 3 of 11 This certificate cancels and supersedes ALL previously issued certificates. ENDORSEMENT This endorsement, effective 12:01 A.M. 03/01/2019 forms a part of policy No. CA 296-17-05 issued to GE CONSULTANTS, INC, by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Section IV - Business Auto Conditions, A- - Loss Conditions, 5. - Transfer of Rights of Recovery Against Others to Us, is amended to add: However, we will waive any right of recover we have against any person or organization with whom you have entered into a contract or agreement because of payments we make under this Coverage Form arising out of an "accident' or "loss" if: (1) The "accident' or "loss" is due to operations undertaken in accordance with the contract existing between you and such person or organization; and (2) The contract or agreement was entered into prior to any "accident' or"loss". No waiver of the right of recovery will directly or indirectly apply to your employees or employees of the person or organization, and we reserve our rights or lien to be reimbursed from any recovery funds obtained by any injured employee. /AUT14ORIZED REPRESENTATIVE 62897 (6/95) 47415471 19-20 GL AU UMS $lM WC $1M CPL PL I Nellie Reyna 1 3/6/2019 4:19:03 PM (PST) Page 4 of 11 This certificate Cancels and supersedes ALL previously issued Certificates. GEI Consultants, Inc. POLICY NUMBER. GL 518-02-76 COMMERCIAL GENERAL LIABILITY CG20100413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) _ Location(s) Of Covered Operations ANY PERSON OR ORGANIZATION WHOM YOU PER THE CONTRACT OR AGREEMENT, BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR AGREEMENT YOU HAVE ENTERED INTO. _. Information required to complete this Schedule, if no t shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to that which you are required by the contract include as an additional insured the Person(s) or or agreement to provide for such additional organization(s) shown in the Schedule, but only insured. with respect to liability for "bodily injury", B. With respect to the insurance afforded to these "property damage" or "personal and advertising additional insureds, the following additional injury" caused, in whole or in part, by: exclusions apply: PP y 1. Your acts or omissions; or This insurance does not apply to "bodily injury" 2. The acts or omissions of those acting on or "Property damage" occurring after: your behalf; 1. All work, including materials, parts or in the performance of your ongoing operations equipment furnished in connection with such for the additional insured(s) at the location(s) work, on the project (other than service, designated above. maintenance or repairs) to be performed by However: or on behalf of the additional insured(s) at the location of the covered operations has 1. The insurance afforded to such additional been completed; or insured only applies to the extent permitted by law; and 2• That portion of "your work" out of which the injury or damage arises has been put to 2. If coverage provided to the additional its intended use by any person or insured is required by a contract or organization other than another contractor or agreement, the insurance afforded to such subcontractor engaged in performing additional insured will not be broader than operations for a principal as a part of the same project. CG 20 10 04 13 0 Insurance Services Office Inc., 2012 Page 1 of 2 � 47415471 1 19-20 GL AU UMS $1M We—g}r}-�pL I Nellie Reyna 1 3/6/2019 4:19:03 PM (PST) I Page 5 of 11 This certificate cancels and supersedes ALL previously issued certificates. C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III - Limits Of Insurance: If coverage provided to the additional insured is whichever is less. required by a contract or agreement, the most This endorsement shall not increase the we will pay on behalf of the additional insured applicable Limits of Insurance shown in the is the amount of insurance: Declarations. 1 Required by the contract or agreement; or Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 20 10 04 13 ❑ 47415471 i 19-20 GL AU UMB $lM WC $1M CPL PL I Nellie Reyna 1 3/6/2019 4:19:03 PM (PST) i Page 6 of 11 This certificate cancels and supersedes ALL previously issued certificates.. ENDORSEMENT # This endorsement, effective 12.01 A.M. 03/01/2019 forms a part of Policy No.GL 518-02-76 issued to GE I CONSULTANTS, INC. By NATIONAL UNION FIRE INSURANCE COMPANY OF P I TTSBURGH, PA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIMITED ADVICE OF CANCELLATION PROVIDED VIA E-MAIL TO ENTITIES OTHER THAN THE FIRST NAMED INSURED This policy is amended as follows: In the event that the Insurer cancels this policy for any reason other than non-payment of premium, and 1, the cancellation effective date is prior to this policy's expiration date; 2. the First Named Insured is under an existing contractual obligation to notify a certificate holder when this policy is canceled (hereinafter, the "Certificate Holders)") and has provided to the Insurer, either directly or through its broker of record, the email address of a contact at each such entity; and 3. the Insurer received this information after the First Named Insured receives notice of cancellation of this policy and prior to this policy's cancellation effective date, via an electronic spreadsheet that is acceptable to the Insurer, the Insurer will provide advice of cancellation (the "Advice") via e-mail to each such Certificate Holders within 30 days after the First Named Insured provides such information to the insurer; provided, however, that if a specific number of days is not stated above, then the Advice will be provided to such Certificate Holder(s) as soon as reasonably practicable after the First Named Insured provides such information to the Insurer. Proof of the Insurer emailing the Advice, using the information provided by the First Named Insured, will serve as proof that the Insurer has fully satisfied its obligations under this endorsement. This endorsement does not affect, in any way, coverage provided under this policy or the cancellation of this policy or the effective date thereof, nor shall this endorsement invest any rights in any entity not insured under this policy. The following Definitions apply to this endorsement. ". First Named Insured means the Named Insured shown on the Declarations Page of this policy 2. Insurer means the insurance company shown in the header on the Declarations page of this policy. All other terms, conditions and exclusions shall remain the same. Authorized Representative 107414 (03/1 1) Page 1 47415471 1 19-20 GL AU UMH $1M WC—$EM_-tPt PL I Nellie Reyna 1 3/6/2019 4:19:03 PM (PST) I Page 7 of 11 This certificate cancels and supersedes ALL previously issued certificates. GEI Consultants,Inc. POLICY NUMBER: GL 518-02-76 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance policy provided that: Condition and supersedes any provision to the (1)The additional insured is a Named Insured contrary: under such other insurance; and Primary And Noncontributory Insurance (2)You have agreed in writing in a contract This insurance is primary to and will not or agreement that this insurance would seek contribution from any other insurance be primary and would not seek contribu- available to an additional insured under your tion from any other insurance available to the additional insured. CG 20 01 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 47415471 19-20 GL AU UMB $1M WC $lM CPL PL I Nellie Reyna 1 3/6/2019 4:19:03 PM (PST) I Page 8 of 11 This certificate cancels and supersedes ALL previously issued certificates. . GEI Consultants, Inc. POLICY NUMBER: GL 518-02-76 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: PURSUANT TO APPLICABLE WRITTEN CONTRACT OR AGREEMENT YOU ENTER INTO. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Sec- tion IV - Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing opera- tions or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 0 Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ 47415471 1 19-20 GL AU UM6 $lM WC $lM CPL PL I Nellie Reyna 3/6/2019 4:19:03 PM (PST) I Page 9 of 11 This certificate cancels and supersedes ALL previously issued certificates. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on inception date of the policy unless a different date is indicated below. This endorsement, effective 12:01 AM 03/01/2019 forms a part of Policy No. WC 012-01-6047 Issued to GE I CONSULTANTS, INC. By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule ANY PERSON OR ORGANIZATION TO WHOM YOU BECOME OBLIGATED TO WAIVE YOUR RIGHTS OF RECOVERY AGAINST, UNDER ANY WRITTEN CONTRACT OR AGREEMENT YOU ENTER INTO PRIOR TO THE OCCURRENCE OF LOSS, Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual. This form is not applicable in California, Kentucky, New Hampshire, New Jersey, Texas, or Utah. WC 00 03 13 Countersigned by Authorized Representative 47415471 1 19-20 GL AU UMB $lM WC $1M CPL PL Nellie Reyna 1 3/6/2019 4:19:03 PM (PST) Page 10 of 11 This certificate cancels and supersedes ALL previously issued certificates. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following"attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 03/01/2019 forms a part of Policy No. WC 012-01-6046 Issued to GE I CONSULTANTS, I NC. By NATIONAL UNION FIRE INSURANCE COMPANY OF P I TTSBURGH, PA. LIMITED ADVICE OF CANCELLATION PROVIDED VIA E-MAIL TO ENTITIES OTHER THAN THE NAMED INSURED (WORKERS' COMPENSATION ONLY) This policy is amended as follows: In the event that the Insurer cancels this policy for any reason other than non-payment of premium, and 1. the cancellation effective date is prior to this policy's expiration date; 2. the Named Insured or, if applicable, any other employers named in Item 1 of the Information Page is under an existing contractual obligation to notify a certificate holder when this policy is canceled (hereinafter, the "Certificate Holder(s)") and the Named Insured has provided to the Insurer, either directly or through its broker of record, the email address of a contact at each such entity; and 3. the Insurer received this information after the Named Insured receives notice of cancellation of this policy and prior to this policy's cancellation effective date, via an electronic spreadsheet that is acceptable to the Insurer, the Insurer will provide advice of cancellation (the "Advice") via e-mail to each such Certificate Holders within 30 days after the Named Insured provides such information to the Insurer; provided, however, that if a specific number of days is not stated above, then the Advice will be provided to such Certificate Holder(s) as soon as reasonably practicable after the Named Insured provides such information to the Insurer. Proof of the Insurer emailing the Advice, using the information provided by the First Named Insured, will serve as proof that the Insurer has fully satisfied its obligations under this endorsement. This endorsement does not affect, in any way, coverage provided under this policy or the cancellation of this policy or the effective date thereof, nor shall this endorsement invest any rights in any entity not insured under this policy. The following definitions apply to this endorsement: 1. Named Insured means the insured first named employer in Item 1 of the Information Page of this policy. 2. Insurer means the insurance company shown in the header on the Information Page of this policy. All other terms, conditions and exclusions shall remain the same. AUTHORIZED REPRESENTATIVE WC 99 00 56 (Ed. 04/11) 47415471 1 19-20 GL AU UMB $1M WC $lM CPL PL I Nellie Reyna G%2019 4:19:03 PM (PST) Page 11 of 11 This certificate cancels and supersedes ALL previously issued certificates.