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HomeMy WebLinkAboutCAG2019-032 - Amendment - #1 - Krazan & Associates, Inc. - 640 Pressure Zone Booster Station - 11/26/2019 ,OeN�� Agreement Routing Form KENT For Approvals, Signatures and Records Management WA5MINGTON 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 Phil McConnell Department: Public Works Date Sent: 11/27/19 Date Required: 12/4/19 �o > Authorized Director or Designee Date of A. to Sign: Council N/A Ca Mayor Approval: Budget W20031 Grant? ❑ Yes ❑✓ No Account Number: Type: N/A Vendor or Name: Krazan & Associates, Inc. Cate 9 v: Contract = Vendor 34943 Sub-Category Amendment 0 Number: E Project Name: 640 Pressure Zone Booster Station 0 - Project C Details: Provide additional testing services. c IV E Agreement 10 370 Basis for 0 Amount: Selection of L Contractor: a Start Date: 11/26/19 Termination Date: 6/30/20 Notice required prior to Yes No Contract Number: &A CT,zo 19 o3,A disclosure? Date Received by City Attorney: Comments: c a 0 a 0 R Date Routed to the Mayor's Office: in d Date Routed to the City Clerk's Office: d Date 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. 1 NAME OF CONSULTANT OR VENDOR: Krazan & Associates, Inc. CONTRACT NAME & PROJECT NUMBER: 640 Pressure Zone Booster Station ORIGINAL AGREEMENT DATE: January 25, 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 testing services for the 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, $12,162.50 including applicable WSST Net Change by Previous Amendments $0 including applicable WSST Current Contract Amount $12,162.50 including all previous amendments Current Amendment Sum $10,370.00 Applicable WSST Tax on this $0 Amendment Revised Contract Sum $22,532.50 AMENDMENT - 1 OF 2 Original Time for Completion 12/31/20 (insert date) Revised Time for Completion under n/a prior Amendments (insert date) Add'I Days Required (t) for this -184 calendar days Amendment __— Revised Time for Completion 6/30/20 (rnseI 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:� By: t r L — By: (signature) (sign ure) Print Name: William B. Throne Print Name: Timothy J. LaPorte, P.E. Its Operations Manager Its Public Works Director (title) (titl ) DATE: November 20,2019 DATE: _ ATTEST: APPROVED AS TO FORM: (applicable if Mayor's signature required) Kent City Clerk Kent Law Department 4 Krazan-640 0oo5tw Station Amd 1)Mc<onmll AMENDMENT - 2 OF 2 EXHIBIT A Now KXaZat & ASSOCIATES , INC . (TFOTECIINICAL ENGINEERING • ENV.IRONMENTAL ENGINEERING CONSTRUCTION TESTING & INSPECTION November 8,2019 KA Project No.066-19017 KA Proposal No.T19625WAT E Phil McConnell Tel: 253-8`56=5542 CITY OF KENT Email: pmcconnell@kentwa.gov 220 4"'Avenue South Kent, WA 98032 RE: Change Order#1 640 Pressure Zone Booster Pump Station 11300 SE 236t" Place—Kent, Washington Dear Mr. McConnell, During the course of the project we have been requested to provide additional testing services which were in excess of our original quantities. This change order will rectify all changes and provide for some additional budget to see us into December. If you have any questions or wish to discuss this request, lease do not hesitate to contact me at our office. DESCRIPTION UNIT RATE, COST Original Contract $12,162.50 Reinforced Concrete inspection 52 hours $65.00 $3,380.00 Structural Masonry Inspection 3 hours $65.00 $195.00 Proprietary Anchor Inspection 50 hours $65.00 $3,250.00 Concrete Compression Samples 30 each $25.00 $750.00 Concrete Sample Pickup 6 each $65.00 $390.00 Proctor/Sieve Analysis 2 each $325.00 $650.00 Trip Charge 26 each $15.00 $390.00 Project Management 13 hours $105.00 $1,365.00 CHANGE ORDER TOTAL $10,370.00 PREVIOUSLY SUBMITTED CHANGE ORDERS $0 PREVIOUSLY APPROVED CHANGE ORDERS $0 REVISED PROJECT TOTAL $22,532.50 City of Kent KRAZAN&ASSOCIATES,INC. Signature Date Signature Date William B.Throne Project Manager Name Title Arame Title 825 Center Street,Suite A•Tacoma,WA 98409•(253)939-2500•FAX(253)939-2556 With Offices Serving the Western United States ALCC> �® DATE(MMIDD/YYYY) `./ CERTIFICATE OF LIABILITY INSURANCE F10i4i2019 "41S 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 --rELOW. 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 CONTACT (WC) Heffernan Insurance Brokers NAME: Shelaine Gonsalves PHONE a1350 Carlback Avenue (A/C, . 925-934-8500 No):925-934-8278 Walnut Creek CA 94596 EMAIL ADDRESS: ShelaineG heffins.com INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:Travelers Property Casual Company of America 25674 KRAZ8AS-01 Krazan &Associates, Inc. INSURER B: 215 West Dakota Avenue INSURER C Clovis CA 93612 INSURER D INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:1341954771 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. IN SR ADDL S BR LTR TYPE OF INSURANCEINSD wvnPOLICY NUMBER MM/DDY YYY MO DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y 6600F55445ATIL19 10/1/2019 10/1/2020 EACH OCCURRENCE PREMISES $1,000,000 CLAIMS-MADE 1K OCCUR DAMAGE OIN Ea occurrence) $100,000 X STOP GAP MED EXP(Any one person) $5,000 X Deductible$0 PERSONAL&ADV INJURY $1,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000.000 POLICY JECOT- LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY Y 8100F55445ATIL19 10/1/2019 10/1/2020 COMBINED SINGLE LIMIT $1,000,000 X ANY AUTO Ea accident BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ NIA E.L.EACH ACCIDENT $ (Mandatory In NH)If yes,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re:Various Projects at Various Location in Kent,WA.The City of Kent is included as an additional insured(primary and non-contributory)includes products& completed operations on General Liability policy and additional insured(primary and non-contributory)on Automobile Liability policy per the attached endorsements,if required.Per project aggregate Is included on General Liability policy per the attached endorsement,if required.Cancellation notice endorsements for General Liability and Automobile Liability policies are attached,if required. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Kent ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Bryan Higgins 220 Fourth Avenue South AUTHORIZED REPRESENTATIVE Kent, WA 98032 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 6600F55445ATIL19 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - ALL PROJECTS SUBJECT TO A WRAP-UP INSURANCE PROGRAM WITH LIMITED EXCEPTIONS FOR CERTAIN ONGOING OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SELF-INSURED EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following exclusion is added to Paragraph 2., "property damage" occurs after the expiration Exclusions of Section I — Coverage A— Bodily of all such coverage. Injury And Property Damage Liability: The exceptions in this exclusion do not apply to This insurance does not apply to "bodily injury" or "bodily injury" or "property damage" included in 11 property damage" arising out of any project that the "products-completed operations hazard" even is or was subject to a "wrap-up insurance pro- if you are required to provide such coverage for gram". an additional insured by a written contract or This exclusion does not apply to "bodily injury" or agreement. "property damage" arising out of your ongoing 2. The following is added to Section V — Defini- operations that: tions: a. Are being performed at any location owned "Wrap-up insurance program" means any agree- by, or rented to, you that is outside the pro- ment or arrangement, including any contractor- ject site for that project and is not covered by controlled, owner-controlled or similar insurance the "wrap-up insurance program" for that pro- program, under which some or all of the contrac- ject; or tors working on a specific project, or specific pro- b. Are punch list or warranty work, if coverage jects, are required to participate in a program to was available to the insured under the "wrap- obtain insurance that: up insurance program" for "bodily injury" or a. Includes the same or similar insurance as "property damage" arising out of your ongo- that provided by this Coverage Part; and ing operations and the "bodily injury" or b. Is issued specifically for injury or damage arising out of such project or projects. r� CG D3 91 03 07 cp 2007 The Travelers Companies,Inc. Page 1 of 1 POLICY NUMBER: 6600F55445ATIL19 COMMERCIAL GENERAL LIABILITYISSUE DATE: - - THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED (CONTRACTORS OPERATIONS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON(S) OR ORGANIZATION(S): City of Kent PROJECT/LOCATION OF COVERED OPERATIONS: Re: Various Projects at Various Location in Kent, WA. 1. WHO IS AN INSURED —(Section II) is amended "written contract requiring insurance" for that to include the person or organization shown in the additional insured, the insurance provided to Schedule above, but: the additional insured shall be limited to the a) Only with respect to liability for "bodily injury", limits of liability required by that"written con- "property damage" or"personal injury"; and tract requiring insurance". This endorsement shall not increase the limits of insurance de- a) If, and only to the extent that, the injury or scribed in SECTION III _ LIMITS OF INSUR- damage is caused by acts or omissions of ANCE. you or your subcontractor in the performance of "your work" on or for the project, or at the b) The insurance provided to the additional in- location, shown in the Schedule. The person sured does not apply to "bodily injury", "prop- or organization does not qualify as an addi- erty damage" or "personal injury" arising out tional insured with respect to the independent of the rendering of, or failure to render, any acts or omissions of such person or organiza- professional architectural, engineering or sur- tion. veying services, including: 1. The insurance provided to the additional insured I. The preparing, approving, or failing to by this endorsement is limited as follows: prepare or approve, maps, shop draw- s) In the event that the Limits of Insurance of draw- ings opinions, reports, surveys, field or- ders or change orders, or the preparing, this Coverage Part shown in the Declarations approving, or failing to prepare or ap- exceed the limits of liability required by a prove, drawings and specifications; and CG D3 69 09 05 ©2005 The St.Paul Travelers Companies,Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY i. Supervisory, inspection, architectural or a) If a claim is made or"suit" is brought against engineering activities. the additional insured, the additional insured a) The insurance provided to the additional in- must: sured does not apply to "bodily injury" or I. Immediately record the specifics of the "property damage" caused by"your work" and claim or"suit" and the date received; and included in the "products-completed opera- i. Notify us as soon as practicable. tions hazard". 1. The insurance provided to the additional insured The additional insured must see to it that we receive written notice of the claim or "suit" as by this endorsement is excess over any valid and soon as practicable. collectible "other insurance", whether primary, ex- cess, contingent or on any other basis, that is c) The additional insured must immediately send available to the additional insured for a loss we us copies of all legal papers received in con- cover under this endorsement. However, if a "writ- nection with the claim or"suit", cooperate with ten contract requiring insurance"for that addi- us in the investigation or settlement of the tional insured specifically requires that this insur- claim or defense against the "suit", and oth- ance apply on a primary basis or a primary and erwise comply with all policy conditions. non-contributory basis, this insurance is primary c) The additional insured must tender the de- to"other insurance" available to the additional in- fense and indemnity of any claim or"suit"to sured which covers that person or organization as any provider of"other insurance"which would a named insured for such loss, and we will not cover the additional insured for a loss we share with that "other insurance". Butthe insur- cover under this endorsement. However, this ance provided to the additional insured by this condition does not affect whether the insur- endorsement still is excess over any valid and ance provided to the additional insured by this collectible "other insurance", whether primary, ex- endorsement is primary to "other insurance" cess, contingent or on any other basis, that is available to the additional insured which cov- available to the additional insured when that per- ers that person or organization as a named son or organization is an additional insured under insured as described in paragraph 3.above. such "other insurance". 5. The following definition is added to SECTION V. — 1. As a condition of coverage provided to the addi- DEFINITIONS: tional insured by this endorsement: "Written contract requiring insurance"means a) The additional insured must give us written that part of any written contract or agreement notice as soon as practicable of an "occur- under which you are required to include a rence" or an offense which may result in a person or organization as an additional in- claim. To the extent possible, such notice sured on this Coverage Part, provided that should include: the "bodily injury" and "property damage" oc- i. How, when and where the "occurrence" curs and the "personal injury" is caused by an or offense took place; offense committed: ii. The names and addresses of any injured a. After the signing and execution of the persons and witnesses; and contract or agreement by you; I. The nature and location of any injury or b. While that part of the contract or damage arising out of the "occurrence" or agreement is in effect; and offense. b. Before the end of the policy period. Page 2 of 2 ©2005 The St.Paul Travelers Companies,Inc. CG D3 69 09 05 POLICY NUMBER: 660OF55445ATIL19 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE - ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS b. The"personal injury"or"advertising injury"for COMMERCIAL GENERAL LIABILITY CONDITIONS which coverage is sought arises out of an of- (Section IV), Paragraph 4. (Other Insurance), is fense committed amended as follows: subsequent to the signing and execution of that 1. The following is added to Paragraph a. Primary contract or agreement by you. Insurance: 2. The first Subparagraph (2) of Paragraph b. Ex- However, if you specifically agree in a written con- cess Insurance regarding any other primary in- tract or written agreement that the insurance pro- surance available to you is deleted. vided to an additional insured under this 3. The following is added to Paragraph b. Excess Coverage Part must apply on a primary basis, or Insurance, as an additional subparagraph under a primary and non-contributory basis, this insur- Subparagraph (1): ance is primary to other insurance that is avail- That is available to the insured when the insured able to such additional insured which covers such is added as an additional insured under any other additional insured as a named insured, and we policy, including any umbrella or excess policy. will not share with that other insurance, provided that: a. The "bodily injury" or "property damage" for which coverage is sought occurs; and GG DO 37 04 05 Copyright 2005 The St. Paul Travelers Companies, Inc. All rights reserved. Page 1 of 1 POLICY NUMBER: 660OF55445ATIL19 COMMERCIAL GENERAL LIABILITY ISSUE DATE: - -THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY DESIGNATED PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Project Designated Project(s): General Aggregate(s): Various Projects at Various Location in Kent, WA. A. For all sums which the insured becomes legally 3. Any payments made under COVERAGE A. obligated to pay as damages caused by "occur- for damages or under COVERAGE C. for rences" under COVERAGE A. (SECTION 1), and medical expenses shall reduce the Desig- for all medical expenses caused by accidents un- nated Project General Aggregate Limit for der COVERAGE C (SECTION 1), which can be that designated "project". Such payments attributed only to operations at a single desig- shall not reduce the General Aggregate Limit nated "project" shown in the Schedule above: shown in the Declarations nor shall they re- f. A separate Designated Project General Ag- duce any other Designated Project General gregate Limit applies to each designated "pro- Aggregate Limit for any other designated ject", and that limit is equal to the amount of "project" shown in the Schedule above, the General Aggregate Limit shown in the 4. The limits shown in the Declarations for Each Declarations, unless separate Designated Occurrence, Damage To Premises Rented Project General Aggregate(s) are sched- To You and Medical Expense continue to uled above. apply. However, instead of being subject to 2. The Designated Project General Aggregate the General Aggregate Limit shown in the Limit is the most we will pay for the sum of all Declarations, such limits will be subject to the damages under COVERAGE A., except applicable Designated Project General Ag- damages because of "bodily injury" or "prop- gregate Limit. erty damage" included in the "products- B. For all sums which the insured becomes legally completed operations hazard", and for medi- obligated to pay as damages caused by "occur- cal expenses under COVERAGE C, regard- rences" under COVERAGE A. (SECTION 1), and less of the number of: for all medical expenses caused by accidents un- a. Insureds; der COVERAGE C. (SECTION 1), which cannot be attributed only to operations at a single desig- nated "project" shown in the Schedule above: c. Persons or organizations making claims or bringing "suits". CG D2 11 01 04 Copyright, The Travelers Indemnity Company, 2004 Page 1 of 2 COMMERCIAL GENERAL LIABILITY 1. Any payments made under COVERAGE A. vided, any payments for damages because of for damages or under COVERAGE C. for "bodily injury" or "property damage" included in medical expenses shall reduce the amount the "products-completed operations hazard" will available under the General Aggregate Limit reduce the Products-Completed Operations Ag- or the Products-Completed Operations Ag- gregate Limit, and not reduce the General Aggre- gregate Limit, whichever is applicable; and gate Limit nor the Designated Project General 2. Such payments shall not reduce any Desig- Aggregate Limit. nated Project General Aggregate Limit. E. For the purposes of this endorsement the Defini- C. Part 2, of SECTION III— LIMITS OF INSURANCE tions Section is amended by the addition of the is deleted and replaced by the following: following definition.- 2. The General Aggregate Limit is the most we "Project" means an area away from premises will pay for the sum of: owned by or rented to you at which you are per- forming operations pursuant to a contract or a. Damages under Coverage B; and agreement. For the purposes of determining the b. Damages from "occurrences" under applicable aggregate limit of insurance, each COVERAGE A (SECTION 1) and for all "project" that includes premises involving the medical expenses caused by accidents same or connecting lots, or premises whose con- under COVERAGE C (SECTION 1) which nection is interrupted only by a street, roadway, cannot be attributed only to operations at waterway or right-of-way of a railroad shall be a single designated "project" shown in the considered a single "project". SCHEDULE above. F. The provisions of SECTION III — LIMITS OF D. When coverage for liability arising out of the INSURANCE not otherwise modified by this en- "products-completed operations hazard" is pro- dorsement shall continue to apply as stipulated. Page 2 of 2 Copyright, The Travelers Indemnity Company, 2004 CG D2 11 01 04 POLICY NUMBER: 8100F55445ATIL19 COMMERCIAL AUTOISSUE DATE: - - THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE This endorsement modifies insurance provided by the following.- BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by this endorsement. SCHEDULED PERSONS OR ORGANIZATIONS City of Kent PROVISIONS A. The following is added to Paragraph c. in A. 1., B. The following is added to Paragraph 5., Other Who Is An Insured, of SECTION 11-LIABILITY Insurance, in B. General Conditions of SEC- COVERAGE: TION IV— BUSINESS AUTO CONDITIONS: Any person or organization shown above who is Regardless of the provisions of paragraph a. and required under a written contract or agreement paragraph d. of this part 5. Other Insurance, if between you and that person or organization, that the scheduled person or organization shown is signed and executed by you before the "bodily above has other insurance under which it is the injury" or "property damage" occurs and that is in first named insured and that insurance also ap- effect during the policy period, to be named as an plies, then this insurance is primary to and non- additional insured is an "insured" for Liability Cov- contributory with that other insurance when the erage, but only for damages to which this insur- written contract or agreement between you and ance applies and only to the extent that person or that scheduled person or organization, that is organization qualifies as an "insured" under the signed and executed by you before the "bodily in- Who Is An Insured provision contained in Section jury" or "property damage" occurs and that is in I1. effect during the policy period, requires this insur- ance to be primary and non-contributory. CA T4 42 04 09 Cc,2008 The Travelers Companies, Inc. Page 1 of 1 POLICY NUMBER: 660OF55445ATIL19 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ARCHITECTS, ENGINEERS AND SURVEYORS INDUSTRYEDGE sm ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE—This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Broadened Named Insured M. Who Is An Insured — Newly Acquired Or B. Incidental Medical Malpractice Formed Organizations C. Reasonable Force — Bodily Injury Or Property N. Injury To Co-Employees And Co-Volunteer Damage Workers D. Non-Owned Watercraft — Increased To Up To O. Medical Payments Limit 75 feet P. Knowledge And Notice Of Occurrence Or E. Aircraft Chartered With Pilot Offense F. Extension Of Coverage — Damage To Q. Other Insurance Condition Premises Rented To You R. Unintentional Omission G. Personal Injury—Assumed by Contract S. Waiver Of Transfer Of Rights Of Recovery H. Increased Supplementary Payments Against Others To Us When Required By 1. Additional Insured — Owner, Manager Or Contract Lessor Of Premises T. Amended Bodily Injury Definition J. Additional Insured — Lessor Of Leased Equip- U. Amended Insured Contract Definition — Bail- ment road Easement K. Additional Insured — State Or Political V. Additional Definition — Written Contract Re- Subdivisions—Permits Relating To Premises quiring Insurance L. Additional Insured — State Or Political Subdivisions—Permits Relating To Operations PROVISIONS ever, coverage for any such additional organiza- A. BROADENED NAMED INSURED — UNNAMED tion will cease as of the date, if any, during the SUBSIDIARIES policy period, that you no longer are the sole The Named Insured in Item 1. of the Declarations owner of, or maintain the majority ownership in- is amended as follows: terest in, such organization. The person or organization named in Item 1. of B. INCIDENTAL MEDICAL MALPRACTICE the Declarations and any organization, other than 1• The following is added to the definition of"oc- a partnership, joint venture, limited liability com- currence" in the DEFINITIONS Section: pany or trust, of which you are the sole owner or Unless you are in the business or occupation in which you maintain the majority ownership in- of providing professional health care services, terest on the effective date of the policy. How- "occurrence" also means an act or omission CIS D4 15 05 08(Rev.10-08) ©2008 The Travelers Companies,Inc. Page 1 of 8 COMMERCIAL GENERAL LIABILITY committed by any of your"employees" who is for "bodily injury" that arises out of providing employed by you as a registered nurse, li- or failing to provide "incidental medical ser- censed practical nurse, emergency medical vices" or "Good Samaritan services", except technician or paramedic, in providing or failing for insurance purchased specifically by you to to provide "incidental medical services" or apply in excess of the Limits of Insurance "Good Samaritan services"to a person. shown in the Declarations .for this Coverage 2. The following is added to the DEFINITIONS Part. Section: 6. The following is added to Paragraph 5. of a. "Incidental medical services" means SECTION III—LIMITS OF INSURANCE: medical, surgical, dental, laboratory, x-ray For the purposes of determining the applica- or nursing service, treatment, advice or ble Each Occurrence Limit, all related acts or instruction; the related furnishing of food omissions committed by any of your "employ- or beverages; the furnishing or dispens- ees" in providing or failing to provide"inciden- ing of drugs or medical supplies or appli- tal medical services "Good Good Samaritan ser- ances; or first aid. vices"to any one person will be deemed to be b. "Good Samaritan services" means those one 'occurrence". medical services rendered or provided in C. REASONABLE FORCE PROPERTY DAMAGE— an emergency and for which no remu EXCEPTION TO EXPECTED OR INTENDED IN- neration is demanded or received. JURY EXCLUSION 3. The following is added to Paragraph 2.a.(1) The following replaces Exclusion a., Expected Or of SECTION II—WHO IS AN INSURED Intended Injury , in Paragraph 2. of SECTION I — Paragraphs (1) (a), (b), (c) and (d) above do COVERAGES — COVERAGE A BODILY IN- not apply to any of your"employees"who are JURY AND PROPERTY DAMAGE LIABILITY: employed by you as a registered nurse, li- a. Expected Or Intended Injury Or Damage censed practical nurse, emergency medical technician or paramedic but only while per- "Bodily injury" or "property damage" expected forming the services described in Paragraph or intended from the standpoint of the in- 1. above and while acting within the scope of sured. This exclusion does not apply to "bod- their employment by you. Any such "employ- ily injury" or "property damage" resulting from ees" rendering "incidental medical services" the use of reasonable force to protect any or"Good Samaritan services" will be deemed person or property. to be acting within the scope of their employ- D. NON-OWNED WATERCRAFT — INCREASED ment by you. TO UP TO 75 FEET 4. The following exclusion is added to Para- 1. The following replaces Paragraph (2) of Ex- graph 2. Exclusions of SECTION I — COV- clusion g., Aircraft, Auto Or Watercraft, in ERAGES — COVERAGE A BODILY INJURY Paragraph 2. of SECTION I — COVERAGES AND PROPERTY DAMAGE LIABILITY: — COVERAGE A BODILY INJURY AND Sale of Pharmaceuticals PROPERTY DAMAGE LIABILITY: "Bodily injury" or "property damage" arising (2) A watercraft you do not own that is: out of the willful violation of a penal statute or (a) Less than 75 feet long; and ordinance relating to the sale of pharmaceuti- (b) Not being used to carry any person or cals committed by or with the knowledge or property for a charge. consent of the insured. 5. The following is added to Paragraph 4.b., Ex- 2. The following is added to SECTION II—WHOIS AN INSURED: cess Insurance, of SECTION IV — COM- MERCIAL GENERAL LIABILITY CONDI- Any person who, with your expressed or im- TIONS: plied consent, either uses or is responsible for the use of a nonowned watercraft that is less This insurance is excess over any valid and than 75 feet and not being used to carry per- collectible"other insurance", whether primary, son or property for a charge is included as an excess, contingent or on any other basis, that insured under this Coverage Part. is available to you or any of your"employees" Page 2 of 8 ©2008 The Travelers Companies, Inc. CG D4 15 05 08(Rev.10-08) COMMERCIAL GENERAL LIABILITY E. AIRCRAFT CHARTERED WITH PILOT of the owner, caused by: fire; explosion; light- The following is added to Exclusion g., Aircraft, ning: smoke resulting from such fire, explo- Auto Or Watercraft, in Paragraph 2. of SECTION sion, or lightning; or water. The Damage To — COVERAGES — COVERAGE A BODILY IN- Premises Rented To You Limit will apply to all JURY AND PROPERTY DAMAGE LIABILITY: "property damage" proximately caused by the This exclusion does not apply to an aircraft that same 'occurrence", whether such damage results from: fire; explosion; lightning; smoke is: resulting from such fire, explosion, or light- (a) Chartered with a pilot to any insured; and ning; or water; or any combination of any of (b) Not owned by any insured. these causes. F. EXTENSION OF COVERAGE — DAMAGE TO The Damage To Premises Rented To You PREMISES RENTED TO YOU Limit will be the higher of: 1. The following replaces the last paragraph of a. $300,000; or SECTION I—COVERAGES—COVERAGE A b. The amount shown for the Damage To BODILY INJURY AND PROPERTY DAM- Premises Rented To You Limit in the AGE LIABILITY: Declarations for this Coverage Part. Exclusions c. through n. do not apply to dam- 4. The following replaces Paragraph a. of the age to premises while rented to you, or tem- definition of "insured contract" in the DEFINI- porarily occupied by you with permission of TIONS Section: the owner, caused by: a. A contract for a lease of premises. How- a. Fire; ever, that portion of the contract for a b. Explosion; lease of premises that indemnifies any person or organization for damage to c. Lightning, premises while rented to you, or tempo- d. Smoke resulting from such fire, explosion, rarily occupied by you with permission of or lightning; or the owner, caused by: fire; explosion; e. Water. lightning; smoke resulting from such fire, explosion, or lightning; or water is not an A separate limit of insurance applies to this "insured contract"; coverage as described in SECTION III — LIM- G. PERSONAL INJURY — ASSUMED BY CON- ITS OF INSURANCE TRACT 2. The insurance under this Provision F. does The following replaces Exclusion e., Contractual not apply to damage to premises while rented Liability in Paragraph 2. of SECTION I — COV- to you, or temporarily occupied by you with ERAGES — COVERAGE B PERSONAL AND permission of the owner, caused by: ADVERTISING INJURY LIABILITY: a. Rupture, bursting, or operation of pres- "Advertising injury" for which the insured has as- sure relief devices; sumed liability in a contract or agreement. This b. Rupture or bursting due to expansion or exclusion does not apply to liability for damages swelling of the contents of any building or that the insured would have in the absence of the structure, caused by or resulting from wa- contract or agreement. ter; or c. Explosion of steam boilers, steam pipes, H. INCREASED SUPPLEMENTARY PAYMENTS steam engines, or steam turbines. 1. The following replaces Paragraph 1.b. of 3. The following replaces Paragraph 6. of SEC- SUPPLEMENTARY PAYMENTS — COVER- AGES A AND B of SECTION I — COVER- AGES: Subject to 5. above, the Damage To Prem- b. Up to $2,500 for cost of bail bonds re- ises Rented To You Limit is the most we will quired because of accidents or traffic law pay under Coverage A for the sum of all violations arising out of the use of any damages because of "property damage" to vehicle to which the Bodily Injury Liability any one premises while rented to you, or Coverage applies. We do not have to fur- temporarily occupied by you with permission nish these bonds. CG D4 15 05 08(Rev.10-o8) ©2008 The Travelers Companies,Inc. Page 3 of 8 COMMERCIAL GENERAL LIABILITY 2. The following replaces Paragraph 1.d. of performed by or on behalf of such SUPPLEMENTARY PAYMENTS — COVER- additional insured; or AGES A AND B of SECTION I — COVER- (3) Any premises for which coverage is AGES: excluded by another endorsement to d. All reasonable expenses incurred by the this Coverage Part. insured at our request to assist us in the 3. This Provision I. does not apply on any basis investigation or defense of the claim or to any person or organization for which cov- "suit", including actual loss of earnings up erage as an additional insured specifically is to $500 a day because of time off from work. added by another endorsement to this Cover- age Part. I. ADDITIONAL INSURED — OWNER, MANAGER J. ADDITIONAL INSURED—LESSOR OF LEASED OR LESSOR OF PREMISES EQUIPMENT 1. The following is added to SECTION II —WHO 1. The following is added to SECTION II—WHO IS AN INSURED: IS AN INSURED: Any person or organization that you have Any person or organization that you have agreed in a "written contract requiring insur- agreed in a "written contract requiring insur- ance" to include as an additional insured on ance" to include as an additional insured on this Coverage Part is an insured, but: this Coverage Part is an insured, but: a. Only with respect to liability for "bodily in- a. Only with respect to liability for"bodily in- jury" or "property damage" that occurs, or jury" or "property damage" that occurs, or "personal injury" caused by an offense "personal injury" caused by an offense committed, after you have entered into committed, after you have entered into that"written contract requiring insurance"; that "written contract requiring insurance"; and and b. Only if the "bodily injury", "property dam- b. Onlyif the "bodily injury", a e" or "personal injury" Y � 1 ry", "property dam- age" p 1 ry" is caused, in age" or whole or in part, by acts or omissions of "personal injury' is caused, in you or any person or organization per- whole or in part, by acts or omissions of forming operations on your behalf, and you or any person or organization per- arises out of the ownership, maintenance forming operations on your behalf, in the art of an maintenance, operation or use of equip- or use of that p y premises leased ment leased to you by such additional in- to you under that written contract requir- sured. ing insurance". 2. The insurance provided to such additional in- 2. The insurance provided to such additional in- sured under this Provision I. is subject to the sured under this Provision J. is subject to the following provisions: following provisions: a. The limits of insurance afforded to such a. The limits of insurance afforded to such additional insured shall be the limits additional insured shall be the limits which you agreed to provide in the "writ- which you agreed to provide in the "writ- ten contract requiring insurance", or the ten contract requiring insurance", or the limits shown in the Declarations for this limits shown in the Declarations for this C Coverage Part, whichever are less; and overage Part, whichever are less; and The insurance afforded to such additional b. The insurance afforded to such additional b. insured does not apply: insured does not apply to: pp y: ( ) Any "bodily injury" or 'property dam-1 (1) To any "bodily injury" or "property age" that occurs, or "personal injury" damage" that occurs, or "personal in- jury" caused by an offense commit- caused by an offense committed, af- ted, after the equipment lease ex- ter you cease to be a tenant in that tires; or premises; (2) Any structural alterations, new con- (2) If the equipment is leased with an struction or demolition operations operator. Page 4 of 8 ©2008 The Travelers Companies,Inc. CG D4 15 05 08(Rev.10-08) COMMERCIAL GENERAL LIABILITY 1 3. This Provision J. does not apply on any basis riod, whichever is earlier. Any such newly ac- to any person or organization for which cov- quired or formed organization that you report erage as an additional insured specifically is in writing to us within 180 days after you ac- added by another endorsement to this Cover- quire or form the organization will be covered age Part. under this provision until the end of the policy K. ADDITIONAL INSURED — STATE OR POLITI- period, even if there are more than 180 days CAL SUBDIVISIONS— PERMITS RELATING TO remaining until the end of the policy period. PREMISES N. INJURY TO CO-EMPLOYEES AND CO- The following is added to SECTION II — WHO IS VOLUNTEER WORKERS AN INSURED: The following is added to SECTION II — WHO IS Any state or political subdivision that has issued a AN INSURED: permit in connection with premises owned or oc- 1. Your "employees" are insureds with respect cupied by, or rented or loaned to, you, is an in- to "bodily injury" to a co-"employee" in the sured, but only with respect to "bodily injury", course of the co-"employee's" employment by "property damage", "personal injury" or "advertis- you, or to your "volunteer workers" while per- ing injury" arising out of the existence, ownership, forming duties related to the conduct of your use, maintenance, repair, construction, erection business, provided that this coverage for your or removal of advertising signs, awnings, cano- "employees" does not apply to acts outside pies, cellar entrances, coal holes, driveways, the scope of their employment by you or while manholes, marquees, hoist away openings, side- performing duties unrelated to the conduct of walk vaults, elevators, street banners or decora- your business. tions for which that state or political subdivision 2. Your "volunteer workers" are insureds with has issued such permit. respect to "bodily injury" to a co-"volunteer L. ADDITIONAL INSURED — STATE OR POLITI- worker" while performing duties related to the CAL SUBDIVISIONS—PERMITS RELATING TO conduct of your business, or to your "employ- OPERATIONS ees" in the course of the "employee's" em- -% The following is added to SECTION II — WHO IS ployment by you, provided that this coverage AN INSURED: for your "volunteer workers" does not apply Any state or political subdivision that has issued a while performing duties unrelated to the con- duct of your business. permit is an insured, but only with respect to"bod- ily injury", "property damage", "personal injury" or 3. Subparagraphs 2.a.(1)(a), (b) and (c) and "advertising injury" arising out of operations per- 3.a. of SECTION II — WHO IS AN INSURED formed by you or on your behalf for which that do not apply to "bodily injury"for which insur- state or political subdivision has issued such ance is provided by paragraph 1.or 2. above. permit. However, no such state or political subdi- 0. MEDICAL PAYMENTS LIMIT vision is an insured for: The following replaces paragraph 7. of SECTION 1. "Bodily injury", "property damage", "personal III—LIMITS OF INSURANCE: injury" or"advertising injury" arising out of op- Subject to 5. above, the Medical Expense Limit is erations performed for that state or political the most we will pay under Coverage C for all subdivision; or medical expenses because of "bodily injury" sus- s. "Bodily injury" or "property damage" included tained by any one person, and will be the higher within the "products — completed operations of: hazard". a. $10,000; or M. WHO IS AN INSURED — NEWLY ACQUIRED b. The amount shown on the Declarations OR FORMED ORGANIZATIONS for Medical Expense Limit. The following replaces Paragraph 4.a. of SEC- P. KNOWLEDGE AND NOTICE OF OCCUR- TION II—WHO IS AN INSURED: RENCE OR OFFENSE a. Coverage under this provision is afforded only The following is added to Paragraph 2. Duties In until the 180th day after you acquire or form The Event of Occurrence, Offense, Claim Or the organization or the end of the policy pe- CG D4 15 05 08(Rev.10-08) 2008 The Travelers Companies, Inc. Page 5 of 8 COMMERCIAL GENERAL LIABILITY Suit of SECTION IV—COMMERCIAL GENERAL ance" by the method described in c. LIABILITY CONDITIONS: below. Notice of an "occurrence" or of an offense which b. Excess Insurance may result in a claim must be given as soon as This insurance is excess over any of practicable after knowledge of the "occurrence"or the "other insurance", whether pri- offense has been reported to you, one of your mary, excess, contingent or on any "executive officers" (if you are a corporation), one other basis: of your partners who is an individual (if you are a (1) That is Fire, Extended Coverage, partnership), one of your managers (if you are a Builder's Risk, Installation Risk, limited liability Company), one of your trustees or similar coverage for "your who is an individual (if you are a trust), or an work"; "employee" (such as an insurance, loss control or risk manager or administrator) designated by you (2) That is Fire insurance for prem- to give such notice. ises rented to you or temporarily occupied by you with permission Knowledge by any other "employee" of an "occur- of the owner; rence" or offense does not imply that you also (3) That is insurance purchased by have such knowledge. you to cover your liability as a Notice of an "occurrence" or of an offense which tenant for "property damage" to may result in a claim will be deemed to be given premises rented to you or tempo- as soon as practicable to us if it is given in good rarily occupied by you with per- faith as soon as practicable to your workers' com- mission of the owner;or pensation, accident, or health insurer. This ap- (4) If the loss arises out of the main- plies only if you subsequently give notice of the tenance or use of aircraft, "occurrence" or offense to us as soon as practi- "autos", or watercraft to the ex- cable after you, one of your"executive officers" (if tent not subject to Exclusion g. of you are a corporation), one of your partners who Section 1 — Coverage A — Bodily is an individual (if you are a partnership), one of Injury And Property Damage Li- your managers (if you are a limited liability com- ability; or pony), one of your trustees who is an individual (if (5) That is available to the insured you are a trust), or an "employee" (such as an in- when the insured is an additional surance, loss control or risk manager or adminis- insured under any other policy, trator) designated by you to give such notice dis- including any umbrella or excess covers that the "occurrence" or offense may in- policy. volve this policy. When this insurance is excess, we Q. OTHER INSURANCE CONDITION will have no duty under Coverages A 1. The following replaces Paragraph 4., Other or B to defend the insured against Insurance of SECTION IV — COMMERCIAL any "suit" if any provider of "other in- GENERAL LIABILITY CONDITIONS: surance" has a duty to defend the in- sured against that "suit". If no pro- 4. Other Insurance vider of "other insurance" defends, If valid and collectible "other insurance" is we will undertake to do so, but we will available to the insured for a loss we be entitled to the insured's rights cover under Coverages A or B of this against all those providers of "other Coverage Part, our obligations are limited insurance". as follows: When this insurance is excess over a. Primary Insurance "other insurance", we will pay only This insurance is primary except our share of the amount of the loss, if when b. below applies. If this insur- any, that exceeds the sum of: ance is primary, our obligations are (1) The total amount that all such not affected unless any of the "other "other insurance" would pay for insurance" is also primary. Then, we the loss in the absence of this in- will share with all that "other insur- surance; and Page 6 of 8 ©2008 The Travelers Companies,Inc. CG D4 15 05 08(Rev.10-08) COMMERCIAL GENERAL LIABILITY (2) The total of all deductible and Insurance shown on the Declarations of self-insured amounts under that this Coverage Part. "other insurance". R. UNINTENTIONAL OMISSION We will share the remaining loss, if 1. The following is added to Paragraph 6. Rep- any, with any "other insurance"that is resentations of SECTION IV — COMMER- not described in this Excess Insur- ance provision. CIAL GENERAL LIABILITY CONDITIONS: c. Method Of Sharing The unintentional omission of, or uninten- tional error in, any information provided by If all of the "other insurance" permits you which we relied upon in issuing this policy contribution by equal shares, we will follow this method also. Under this n all shot prejudice your rights under this in- approach each provider of insurance surance. contributes equal amounts until it has 2• This Provision R. does not affect our right to paid its applicable limit of insurance collect additional premium or to exercise our or none of the loss remains, which- right of cancellation or nonrenewal in accor- ever comes first. dance with applicable insurance laws or regu- If any of the "other insurance" does lations. not permit contribution by equal S. WAIVER OF TRANSFER OF RIGHTS OF RE- shares, we will contribute by limits. COVERY AGAINST OTHERS TO US WHEN Under this method, the share of each REQUIRED BY CONTRACT provider of insurance is based on the The following is added to Paragraph 8. Transfer ratio of its applicable limit of insur- ance to the total applicable limits of of Rights of Recovery Against Others to Us of insurance of all providers of insu- SECTION IV — COMMERCIAL GENERAL LI- ance. ABILITY CONDITIONS: 2. The following definition is added to SECTION We waive any rights of recovery we may have V—DEFINITIONS: against any person or organization because of "Other insurance": payments we make for "bodily injury", "property damage", "personal injury" or "advertising injury" a. Means insurance, or the funding of arising out of: losses, that is provided by, through or on 1. Premises owned by you, temporarily occu- behalf of: pied by you with permission of the owner, or (1) Another insurance company; leased or rented to you; (2) Us or any of our affiliated insurance 2. Ongoing operations performed by you, or on companies, except when the Non your behalf, under a contract or agreement cumulation of Each Occurrence Limit with that person or organization; section of Paragraph 5. of LIMITS OF INSURANCE (Section III) or the Non 3. "Your work"; or cumulation of Personal and Advertis- 4. "Your products". ing Injury limit sections of Paragraph We waive these rights only where you have 4. of LIMITS OF INSURANCE (Sec- tion III) applies; agreed to do so as part of a "written contract re- ti quiring insurance" entered into by you before, and (3) Any risk retention group; in effect when, the "bodily injury" or "property (4) Any self-insurance method or pro- damage" occurs, or the "personal injury" offense gram, other than any funded by you or"advertising injury"offense is committed. and over which this Coverage Part T. AMENDED BODILY INJURY DEFINITION applies; or The following replaces the definition of "bodily (5) Any similar risk transfer or risk man-agement method. injury" in the DEFINITIONS Section: b. Does not include umbrella insurance, or "Bodily injury" means bodily injury, mental an- excess insurance, that you bought spe- guish, mental injury, shock, fright, disability, hu- cifically to apply in excess of the Limits of miliation, sickness or disease sustained by a per- ~ CG D4 15 05 08(Rev. 10-08) ©2008 The Travelers Companies, Inc. Page 7 of 8 COMMERCIAL GENERAL LIABILITY son, including death resulting from any of these at "Written contract requiring insurance" means that any time. part of any written contract or written agreement U. AMENDED INSURED CONTRACT DEFINITION under which you are required to include a person —RAILROAD EASEMENT or organization as an additional insured on this 1. Subparagraph c. of the definition of "insured Coverage Part, provided that the "bodily injury" and "property damage" occurs, and the "personal contract" in the DEFINITIONS Section is re-placed by the following: injury"is caused by an offense committed: c. Any easement or license agreement; a. After the signing and execution of the contract or agreement by you; 2. Subparagraph f.(1) of the definition of "in- b. While that part of the contract or agreement is sured contract" in the DEFINITIONS Section in effect; and is deleted. c V. ADDITIONAL DEFINITION — WRITTEN CON- . Before the end of the policy period. TRACT REQUIRING INSURANCE The following definition is added to the DEFINI- TIONS Section: Page 8 of 8 ©2008 The Travelers Companies,Inc. CIS D4 15 05 08(Rev.10-08) POLICY NUMBER: 660OF55445ATIL19 COMMON POLICY CONDITIONS -- DELUXE All Coverage Parts included In this policy are subject to the following conditions. A. CANCELLATION C. EXAMINATION OF YOUR BOOKS AND RE- 1. The first Named Insured shown ,in the Decla- CORDS rations may cancel this policy by mailing or We may examine and audit your books and re- delivering to us advance written notice of cords as they relate to this policy at any time dur- cancellation. ing the policy period and up to three years after- 2. We may cancel this policy by mailing or deliv- ward. ering to the first Named Insured written notice D. INSPECTIONS AND SURVEYS of cancellation at least: 1. We have the right but not obligated to: a, 10 days before the effective date of can- a. Make inspections and surveys at any cellation if we cancel for nonpayment of time; premium; or Give you reports on the conditions we b. 64 days before the effective date of can- b. find; and cellation if we cancel for any other rea- son. c. Recommend changes. 3. We will mail or deliver our notice to the first 2. We are not obligated to make any inspec- Named Insured's last mailing address known tions, surveys, reports or recommendations to us, and any such actions we do undertake re- 4. Notice of cancellation will state the effective lated only to insurability and the premiums to date of cancellation. If the policy is cancelled, be charged. We do not make safety inspec- Lions. We do not undertake to perform the that date will become the end of the policy pe- duty of any person or organization to provide riod. If a Coverage Part is cancelled, that date for the health or safety of workers or the pub- respects that Coverage Part only,will become the end of the policy period as lic. And we do not warrant that conditions: Cancellation will not affect coverage on any a. Are safe or healthful; or shipment in transit on the date of the cancel- b. Comply with laws, regulations, codes or lation. Coverage will continue in full force until standards. such property is delivered and accepted. 3. Paragraphs 1. and 2. of this condition apply 5. If this policy or any Coverage Part is can- not only to us, but also to any rating, advisory, celled, we will send the first Named Insured rate service or similar organization which any premium refund due, If we cancel, the re- makes insurance inspections, surveys, re- fund will be pro rata. if the first Named In- ports or recommendations. sured cancels, the refund may be less than 4. Paragraph 2. of this condition does not apply pro rata. The cancellation will be effective to any inspections, surveys, reports or rec- even if we have not made or offered a refund, ornmendatlons we may make relative to certi- 6. If notice is mailed, proof of mailing will be suf- fication, under state or municipal statutes, or- ficient proof of notice. dinances or regulations, of boilers, pressure B. CHANGES vessels or elevators. This policy contains all the agreements between E. PREMIUMS you and us concerning the insurance afforded. 1. The first Named Insured shown in the Decla- The first Named Insured shown in the Declara- rations: tions is authorized to make changes in the terms a. Is responsible for the payment of all pre- of this policy with our consent, This policy's terms miums; and cart be amended or waived only by endorsement b. Will be the payee for any return premiums issued by us and made a part of this policy, we pay. 2. We compute all premiums for this policy in accordance with our rules, rates, rating plans, IL T3 18 05 11 Includes copyrighted material of insurance Services Office,Inc.vilh its permission. Page 1 of 2 premiums and minimum premiums. The pre- 1. The Commercial Property Coverage Part; miurn shown in the Declarations was corn- 2, The Commercial inland Marine Coverage puted based on rates and rules in effect at the Part; time the policy was issued. On each renewal continuation or anniversary of the effective 3. Commercial Property forms including, but not date of this policy, we will compute the pre- limited to, the following: mium in accordance with our rates and rules a. Building and Personal Property Coverage then in effect. Form; F. TRANSFER OF YOUR RIGHTS AND DUTIES b. Business Income Coverage Form; UNDER THIS POLICY c. Commercial Property Conditions; Your rights and duties under this policy may not d. Causes of Loss—Special Form; be transferred without our written consent except in the case of death of an individual named in- e. Causes of Loss Earthquake Form. sured. 4. Commercial Inland Marine Forms including If you die, your rights and duties will be trans- but not limited to the Transportation Coverage ferred to your legal representative but only while —Special Form acting within the scope of duties as your legal Endorsements referencing the Commercial representative. Until your legal representative is Property Coverage Part, Commercial Inland appointed, anyone having proper temporary cus- Marine Coverage Part, Commercial Property tody of your property will have your rights and du- Forms, or Commercial Inland Marine Forms ties but only with respect to that property, apply to the Deluxe Property Coverage Forms G. WHEN WE DO NOT RENEW in the same manner as they apply to the If we decide not to renew this policy we will mail Forms they reference. or deliver to the first Named Insured shown in the 1, INSURANCE UNDER TWO OR MORE COVER- Deciarations written notice of the nonrenewal not AGE PARTS less than 60 days before the expiration date. If two or more of this policy's Coverage Parts ap- H. DELUXE PROPERTY COVERAGE PART- ply to the same loss or damage, we will not pay REFERENCE TO FORMS AND ENDORSE- more'than'the'actttal amount of the loss or dam- MENTS age. In some instances, the Deluxe Property Declara- tions may list endorsements included in the De- luxe Property Coverage Part that reference: This policy consists of the Common Policy Declarations and the Coverage Parts and endorsements listed in that declarations form. In return for payment of the premium, we agree with the Named Insured to provide the insurance afforded by a Coverage Part forming part of this policy, That insurance will be provided by the company indicated as insuring company In the Common Policy Declarations by the abbreviation of its name opposite that Coverage Part. One of the companies listed below (each a stock company) has executed this policy, and this policy is Counter- signed by the officers listed below: The Travelers Indernnity Company (IND) The Phoenix insurance Company (PHX) The Charter Oak Fire Insurance Company(COF) Travelers Property Casualty Company of America (TIL) The Travelers Indemnity Company of Connecticut (TCT) The Travelers Indemnity Company of America (TIA) Travelers Casualty Insurance Company of America (ACJ) Se c rellt a r�y President Page 2 of 2 Includes copyrighted material of Insurance Services Office,Inc.with its permission, IL T3 18 05 11 POLICY NUMBER: 810OF55445ATIL19 COMMON POLICY CONDITIONS -- DELUXE All Coverage Pails included in this policy are subject to the following conditions. A. CANCELLATION C. EXAMINATION OF YOUR BOOKS AND RE- 1. The first Named Insured shown 'in the Decla- CORDS rations may cancel this policy by mailing or We may examine and audit your books and re- delivering to us advance written notice of cords as they relate to this policy at any time dur- cancellation, ing the policy period and up to three years after- 2. We may cancel this policy by mailing or deliv- ward. ering to the first Named Insured written notice D. INSPECTIONS AND SURVEYS of cancellation at least: 1. We have the right but not obligated to: a. 10 days before the effective date of can- a. Make inspections and surveys at any cellation if we cancel for nonpayment of time; premium; or b. 60 days before the effective date of can- b. Give you reports on the conditions we cellation if we cancel for any other rea- find; and son. c. Recommend changes, 3. We will mail or deliver our notice to the first 2. We are not obligated to make any inspec- Named Insured's last mailing address known tions, surveys, reports or recommendations to (is, and any such actions we do undertake re- 4. Notice of cancellation will state the effective lated only to insurability and the premiums to date of cancellation. If the policy is cancelled, be charged. We do not make safety inspec- that date will become the end of the policy pe- tions. We do not undertake to perform the riod. If a Coverage Part Is cancelled, that date duty of any person or organization to provide will become the end of the policy for the health or safety of workers or the pub- respects that Coverage Part only.p y period as lic. And we do not_warrant that conditions: Cancellation will not affect coverage on any a. Are safe or healthful; or shipment it) transit on the date of the cancel- b. Comply with laws, regulations, codes or lation. Coverage will continue in full force until standards. such property is delivered and accepted. 3. Paragraphs 1. and 2. of this condition apply 5. If this policy or any Coverage Part is can- not only to us, but also to any rating, advisory, celled, we will send the first Named Insured rate service or similar organization which any premium refund due. If we cancel, the re- makes insurance inspections, surveys, re- fund will be pro rata. If the first Named In- ports or recormendations. sured cancels, the refund may be less than 4. Paragraph 2, of this condition does not apply pro rata. The cancellation will be effective to any inspections, surveys, reports or rec- even if we have not made or offered a refund, ommendations we may make relative to certi- 6. If notice is mailed, proof of mailing will be SLIf- fication, under state or municipal statutes, or- ficient proof of notice. dinances or regulations, of boilers, pressure B. CHANGES vessels or elevators. This policy contains all the agreements between E. PREMIUMS you and US concerning the insurance afforded. 1. The first Named Insured shown in the Decla- The first Named Insured shown in the Declara- rations: tions is authorized to make changes in the terms a. Is responsible for the payment of all pre- of this policy with our consent. This policy's terms miums; and can be amended or waived only by endorsement issued by us and made a part of this policy. b. we be the payee for any return premiums we pay. 2. We compute all premiums for this policy in accordance with our rules, rates, rating plans, IL T3 18 05 11 Includes copyrighted material of Insurance Services Office,inc.vrith Its permission. Page 1 of 2 premiums and minimum premiums. The pre- 1. The Commercial Property Coverage Part; mium shown in the Declarations was com- puted based on rates and rules in effect at the Part; time the policy was issued. On each renewal continuation or anniversary of the effective 3. Commercial Property forms including, but not date of this policy, we will compute the pre- limited to, the following: mium in accordance with our rates and rules a, Building and Personal Property Coverage then in effect, Form; F. TRANSFER OF YOUR RIGHTS AND DUTIES b. Business Income Coverage Form; UNDER THIS POLICY c. Commercial Property Conditions; Your rights and duties under this policy may not d. Causes of Loss—Special Form; be transferred without our written consent except in the case of death of an individual named in- e• Causes of Loss—Earthquake Form. sured. 4. Commercial inland Marine Forms including If you die, your rights and duties will be trans- but not limited to the Transportation Coverage ferred to your legal representative but only while —Special Form acting within the scope of duties as your legal Endorsements referencing the Commercial representative. Until your legal representative is Property Coverage Pail, Commercial Inland appointed, anyone having proper temporary cus- Marine Coverage Part, Commercial Property tody of your property will have your rights and du- Forms, or Commercial Inland Marine Forms ties but only with respect to that property. apply to the Deluxe Property Coverage Forms G. WHEN WE DO NOT RENEW in the same manner as they apply to the If we decide not to renew this policy we will mail Forms they reference. or deliver to the first Named Insured shown in the I. INSURANCE UNDER TWO OR MORE COVER- Declarations written notice of the nonrenewal not AGE PARTS less than 60 days before the expiration date. If two or more of this policy's Coverage Parts ap- H. DELUXE PROPERTY COVERAGE PART- ply to the same loss or damage, we will not pay REFERENCE TO FORMS AND ENDORSE- more than-the-actual amount of the loss or dam- MENTS age. In some instances, the Deluxe Property Declara- tions may list endorsements Included in the De- luxe Property Coverage Part that reference: This policy consists of the Common Policy Declarations and the Coverage Parts and endorsements listed in that declarations forrn. In return for payment of the premium, we agree with the Named Insured to provide the insurance afforded by a Coverage Part forming part of this policy, That insurance will be provided by the company indicated as insuring company in the Common Policy Declarations by the abbreviation of its name opposite that Coverage Part, One of the companies listed below (each a stock company) has executed this policy, and this policy Is counter- signed by the officers listed below: The Travelers Indemnity Company (IND) The Phoenix Insurance Company (PHX) The Charter Oak Fire Insurance Company(COF) Travelers Property Casualty Company of America (TIL) The Travelers Indemnity Company of Connecticut (TCT) The Travelers Indemnity Company of America (TIA) Travelers Casually Insurance Company of America (ACJ) 4 %� Secreta `/� �President ry Page 2 of 2 Includes copyrighted material of insurance Services Office,Inc.with its permission. IL T3 18 05 11 AC" "® `./ CERTIFICATE OF LIABILITY INSURANCE E(MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE DAT,0/1/2o1s HOLDER. THIS ZTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED TE BY S THE POLICIES LOW. 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 CONTACT Dealey, Renton &Associates NAME: P. O. Box 12675 PHONE , 510-465-3090 ac No):510-452-2193 E MAIL Oakland CA 94604-2675 ADDRESS: certificates@dealeyrenton.com INSURERS AFFORDING COVERAGE NAIC# INSURER A: Lexington Insurance Companv 19437 INSURED KRA7-AASSO Krazan &Associates, Inc. INSURER e 215 West Dakota Avenue INSURER C Clovis CA 93612 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:2064568664 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 INSDPOLICY NUMBER MM DD YYYI (MMIDDIYYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑ PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: .UTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH A $ OFFICER/MEMBER EXCLUDED? ❑ NIA ACCIDENT (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Professional 028174909 1011/2019 10/1/2020 Per Claim and Pollution $1,000,000 Liability Annual Aggregate $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: All operations as performed by the named insured,Various Projects/Locations CERTIFICATE HOLDER CANCELLATION 30 Days Notice of Cancellation. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Kent ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Bryan Higgins 220 Fourth Avenue South AUTHORIZED REPRESENTATIVE Kent WA 98032 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD