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HomeMy WebLinkAboutCAG2019-019 - Amendment - #3 - Transportation Solutions, Inc. - 4th Ave & Willis Roundabout Project - 12/31/2019 Agreement Routing Form 7KEN T For Approvals, Signatures and Records Management WASHINGTON 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 Thomas Leyrer Department: Public Works Date Sent: 12/23/19 Date Required: 12/30/19 �v > Authorized Director or Designee Date of c N/A Q, to Sign: Council Ca ✓ Mayor Approval: Budget R90112 Grant? Yes No Account Number: Type: N/A Vendor or Name: Transportation Solutions, Inc. Cate 9 y: Contract c Vendor 153209 Sub-Category Amendment o Number: Project Name: 4th Avenue and Willis Street Roundabout ,. 0 = Project �. Details: Prepare a Project Signage Plan for the project. 411 E Agreement 24 390 Basis for y Amount: Selection of Contractor: a Start Date: Mayor's signature Termination Date: iZ 31 20 Notice required prior to Yes No Contract Number: disclosure? Date JectW&y.W7&.4&rMyL. Comments: a� 1 11h C4� in�U a rr, o �; a'�, z��°I wcu ►tiee� r REC61 ED KEINIT LAW DEPT. p1 Date Routed to the Mayor's Office: City ot Kent N /���� Office of the Mayor d Date Routed to the City Cler 's Office: Date Sent to Originator: Visit Documents.KentWA.gov to obtain copies of all agreements adccW22373_6_19 • KENT W n 5 H 1 N G T O N AMENDMENT NO. 3 NAME OF CONSULTANT OR VENDOR: Transuortation Solutions, Inc. CONTRACT NAME & PROJECT NUMBER: 4t" Avenue and Willis Street Roundabout ORIGINAL AGREEMENT DATE: January 18, 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 services to prepare a Project Signage Plan for the project. For a description, see the Consultant's Scope of Work which is attached as Exhibit A-1 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, $79,570 including applicable WSST Net Change by Previous Amendments $85,180 including applicable WSST Current Contract Amount $164,750 including all previous amendments Current Amendment Sum $24,390 Applicable WSST Tax on this $0 Amendment Revised Contract Sum $189,140 AMENDMENT - 1 OF 2 Original Time for Completion 12/31/19 (insert date) Revised Time for Completion under 12/31/20 prior Amendments (insert date) Add'I Days Required (f) for this 0 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: CITY OF KENT: By: By: t (s gnature�` �,ture) Print me: �� Print Name: Dana Ralph Its Q-5i Its Mayor rlrl ) `��l i lrir DATE: I Z Z (� DATE:_ ATTEST: APPROVED AS TO FORM: (applicable if Mayor's signature required) Kent City Clerk Kent Law Department TSI-41h&Willis Roundabout Amd 3/Leyrer AMENDMENT - 2 OF 2 8250.165th Avenue NE Suite 100 Redmond,WA 98052-6628 Transportation Solutions,Inc. T 425.883-4134 f 425.867-0898 www.isinw.com Supplement No.3 I CITY of Kent—Willis St(SR 516) and 41h Avenue S Roundabout 12/17/2019 I Exhibit A-1 Supplement No. 3 E d Scope of Services City of Kent Roundabout Design Consultant Services-4th Avenue&Willis Street Roundabout Transportation Solutions, Inc. TASK DESCRIPTION A. Supplement No. 3- Purpose and Intent SuppNo3-Task 1—Prepare Project Signage Plan The CITY desires to have the CONSULTANT project team prepare the signage plans for this roundabout project. Additional project management time is necessary due to the extended schedule for this task. The CONSULTANT will work closely with the CITY staff team to review existing signage, discuss and coordinate signage needs that are unique for roundabout applications and related issues on a State route,and prepare a bid ready package that can be added to the CITY's overall project plan set. The CONSULTANT shall review best practices and examples used by WSDOT and the CITY to develop a recommendation for project signage. This may include power illuminated "Do Not Block Circle" signs and Monotube Cantilever Sign for east bound traffic on SR 516. The CITY desires to have this work completed by the end of February 21, 2020. B. Information, Responsibilities, and Services Provided by the CITY • City to provide signage inventory of existing street signage within the project limits. C. General Project Assumptions This Scope of Services for Supplement No. 3 is based upon certain assumptions and exclusions, identified below and under specific tasks. The following assumptions were used in the development of this scope of services: • Plans will be developed following WSDOT requirements for signage along SR 516, • The CONSULTANT will prepare a 60%design to include 3 to 5 plan sheets,as determined by the CONSULTANT, that show location, type, and callouts; prepare signage quantities, and prepare signage specifications. • The CITY will review the 60%submittal and provide comments within 2 weeks. V2_SuppNo3_KentS cop eofWork_12172019,doc Page 1 of 5 �' 8250 165th Avenue NE Suite 100 Redmond,WA 98052.6628 Transportation Solutions,Inc. T 425-883.4134 F 425.867.0898 www.tsinw.com Supplement No.3 CITY of Kent—Willis St(SR 516)and 41h Avenue S Roundabout 12/17/2019 • The CONSULTANT will update the plans and submit a final 100%design to include 3 to 5 plan sheets that show location,type,and callouts; prepare signage quantities,and prepare signage specifications. D. Change Management This is a time and materials Supplement with a not to exceed maximum. The level of effort for various tasks is an estimate and may vary. CONSULTANT will work closely with CITY staff to identify and determine if additional request for work items and/or task requests are out of the scope and fee contained herein. E. Payment CONSULTANT invoice period closes on the 15th day of each month. CONSULTANT shall prepare monthly progress reports discussing work activity that occurred during the reporting period. The progress report will identify any unforeseen changes in the scope and schedule and will forecast key work activity for the upcoming reporting period. Exhibit A-3 provides the Estimate Fee for Supplement No. 1. The estimated cost for the maximum not to exceed amount is as follows: Original Contract Labor $ 73,970 Expenses $ 5,600 Original Contract $ 79,570 Supplement No. 1 Supplement No. 1—Labor $ 58,820 Supplement No. 1—Expenses $ 200 Supplement No. 1—Total $ 59,020 Supplement No. 2 Supplement No. 2—Labor $ 26,045 Supplement No. 2—Expenses $ 11S $ 26,160 Supplement No. 3 Supplement No. 3—Labor $ 21,175 Supplement No. 3—Expenses $ 115 Supplement No. 3—Expenses $ 3,100 24 390 Revised Maximum Not to Exceed Amount $189,140 V2_SuppNo3_KentScopeofwork_12172019.doc Page 2 of 5 8250.165th Avenue NE Suite 100 TS1 Redmond,WA 98052-6628 Transportation Solutions,Inc. T 425-883.4134 F 425-867.0898 www.tsinw.com Supplement No.3 CITY of Kent—Willis St(SR 516)and 41h Avenue S Roundabout 12/17/2019 F. Schedule CONSULTANT has provided an approximate schedule shown in Exhibit A-2. The schedule shows approximate durations of work activity by task. The CONSULTANT cannot control review times by the CITY and/or other agencies, if any. The specific date for notice to proceed is subject to the CITY's approval process. SuppNo3-Task 1—Prepare Project Signage Plan SuppNo3-Task 1 -1.0 Project Management Project management will be on-going during the course of the project. CONSULTANT's project manager will maintain regular communication with the CITY's project manager. CONSULTANT will monitor the project's scope, schedule,and budget, will coordinate and communicate status reports, and other similar project management tasks. SuppNo3-Task 1 -1.1 Field Review and Coordination The CONSULTANT will work with the CITY staff to review existing street signage that will be eliminated and need to be replaced. The review with include on site field work as well as other on-line tools such as Google. CONSULTANT will evaluate if monotube cantilever other sign mounting method(s) should be used for the eastbound lane signage. SuppNo3—Task 1-1.2 Prepare 60%5iignaee Plans Layouts, Details, Quantity,and Specs The CONSULTANT will develop 3 to 5 plan sheets, as determined by the CONSULTANT, at an appropriate scale to show the location,type, size, and callout of all new signage. The CONSULTANT will prepare quantity estimates and prepare an outline of WSDOT/CITY specifications. The CONSULTANT will used GuideSIGN PLUS software from Transoft Solutions to develop the signage sizes and plan sheets. The CONSULTANT will design a power illuminated sign that states "Do Not Block Circle" to be installed at 4 locations with vehicle detection loops. The CONSULTANT will prepare drawings of a Monotube Cantilever Sign,following WSDOT Bridge Standard Drawings as follows: + 10.1-A1-0(General Notes) • 10.1-A2-1(Monotube Cantilever Layout) • 10.1-A2-2 (Monotube Cantilever Details 1) + 10.1-A2-3 (Monotube Cantilever Details 2) • 10.1-A4-1 & 10.1-A4-2 (Foundation Type 1) or 10.1-A4-3 (Foundation Type 2 & 3) The CONSULTANT will work with David Evans &Associates, SUBCONSULTANT, who review the plans developed by the CONSULTANT. SUBCONSULTANT will provide comments and drawings in the form of relines on the plans and/or comment resolution form pages. V2_SuppNo3_KentScopeofwork_12172019.doc Page 3 of 5 8250.165th Avenue NE S Suite 100 Redmond,WA 98052.6628 Transportadon Solutions,Inc. T 425.883.4134 F 425.867.0898 www.tsiow.com Supplement No.3 CITY of Kent—Willis St(SR 516)and 41h Avenue S Roundabout 12/17/2019 Assumptions: The CITY will provide geotechnical data for Monotube Cantilever Sign at the location specified by the CONSULTANT. The cantilever sign will be within the maximums listed in the WSDOT BDM Table 10.1.4-2 for H,sign area,XYZ and Z. The sign bridge foundation will be within WSDOT parameters. The CONSULTANT will be the engineer of record of the design and stamp the drawings,subject to the SUBCONSULTANT providing a check and providing a stamped technical memo at the end of the check. Deliverables: • Plans sheets as outlined above. • Signed and stamped technical memo by SUBCONSULTANT's structural engineer. SuppNo3—Task 1-1.3 Prepare 100%Sienage Plans Layouts Details Quantity,and Specs The CONSULTANT will update the plan set based on CITY comments made regarding the 60% submittal and prepare a final 100%Signage Plan submittal to include the development of plan sheets outlined in the 60%submittal,at an appropriate scale to show the location,type,size, and caliout of all new signage. The CONSULTANT will prepare quantity estimates and prepare an outline of WSDOT/CITY specifications. EXHIBIT A-2 SCHEDULE AND MILESTONES TASK APRROXIMATE DATE Begin End SuppNo3—Task 1 Project Management On-Going Field Review/Coordination Jan 6, 2020 to Jan 17, 2020 60%Submittal Jan 13, 2020 to Jan24,2020 City Review Jan 24, 2020 to Feb 7,2020 100%Submittal Feb 7, 2020 to Feb 21, 2020 V2_SuppNo3_Kent5copeofWork_12172019.doc Page 4 of 5 8250.165th Avenue NE Suite 100 Redmond,WA 98052 6628 Transportation Solutions,Inc. T 425-883.4134 IF 425.867-0898 " www.tsinw.com i Supplement No.3 ) CITY of Kent—Willis St(SR 516)and 4th Avenue S Roundabout 12/17/2019 EXHIBIT A-3 i P ExhibltA-3 Supplment No.3-Fee Estimate 12/17/2019 City of Kent-4th Avenue S&Willis Street Roundabout-Design Consultant Services Transportation Solutions Inc-Fee Schedule PIC PM Sr Engr Sr Engr Transp,Engr Planner 1 Admin VS JE ALB MINA MAO JS JB Victor Jeff Andrew Michelle Mary Ann Jennifer Jill Salemann Elekes Bradien Mach Olson Salemann Berberich Bill Rate--> $ 226.56 $ 204 83 $ 161.38 $ 173,80 $ 145.86 $ 98.00 $ 124.14 Anticipate Work Elements Task(s) Task Hrs Task Cost SuppNo3-Task 1-Prepare Project Signage Plan 2 5 0 80 38 0 2 127 $21,172.08 Task 1.0 Project Management 2 5 8 2 Task 1.1 Field Review/Coordination with City 12 Task 1.2 60%Signage Layout,Plans,Details 48 Task 1.2 60%Signage (Do Not Block) 8 Task 1.2 60%Signage (Cantilever Sign) 24 Task 1.3 Prepare 100%Final Signage Plan Deliverable 12 Task 1.3 60%Signage (Do Not Block) 2 Task 1.3 600/.Signage (Cantilever Sign) 4 Labor Estimate 2 5 0 so 38 0 2 127 $21,172.08 rd S 2.92 $ 453.11 1,024.16 13,903.68 5,542.85 248,28 $21,175,00 Expense Estimate 1 trips @ 60 miles/trip Travel 200 miles 0.58 $/mile $ 118.00 David Evens&Associates-Structural Review of Sign $3,100 $3.100 rd s (1.00) $ 3,216.00 Grand Total $24,390.00 V2_SuppNo3_KentScopeofWork_12172019.doc Page S of 5 TRANSOL-02 R1 KJOHNSON A�CORO CERTIFICATE OF LIABILITY INSURANCE DATE(M/201YYY) 12/92019 `'S 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 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER NAMEACT Kassi Johnson AssuredPartners of Washington,LLC PHONE FAX P.O.Box 847 (A/c,No,Ext):(425)952-2661 (vc No); Redmond,WA 98073 ADORE s:kassi.johnson@assuredpartners.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Charter Oak Fire Insurance Company 25615 INSURED INSURER B:Travelers Casualty Insurance Company of Americ 31194 Transportation Solutions,Inc. INSURER C:Travelers Property&Casualty Co.of America 36161 8250 165th Ave NE#100 INSURER D:Travelers Casualty&Surety of America 31194 Redmond,WA 98052 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR NSR ADDL BR TYPE OF INSURANCE SU WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR X 6808894C1501942 12/31/2019 12/31/2020 DAMAGE TO RENTED 300,000 X WA Stop Gap PREMISES Ea occurrence) $ MED EXP An one person) 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X �OTHER: RO- ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 ECT AUTOMOBILE LIABILITY ECOM aBINED SINGLE LIMIT $ 1,000,000 X ANYAUTO BA9K958883 3/23/2019 3/23/2020 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X HIRED X NON-OWNED PPERTY accident) $ AUTOS ONLY AUTOS ONLY C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE CUP5C5105711942 12/31/2019 12/31/2020 AGGREGATE $ 1,000,000 DED X RETENTION$ 5,000 A WORKERS COMPENSATION STER AT TE X ORH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 6808894C1501942 12/31/2019 12/31/2020 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NIA underSEASE 1,000,000 (Mandatory in E.L. -EA EMPLOYEE $ _ If yes,describe a under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1,000,000 D Professional Liab 105932134 5/13/2019 5/13/2020 Per Claim: 3,000,000 D Professional Liab. 105932134 5/13/2019 5/13/2020 Aggregate: 4,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:4th Avenue and Willis Street Roundabout It is agreed that the City of Kent is included as Additional Insured as required by written contract.Coverage is primary and non-contributory. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Kent THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 220 Fourth Avenue South ACCORDANCE WITH THE POLICY PROVISIONS. Kent,WA 98032 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy#:6808894C1501942 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS: 1. WHO IS AN INSURED (SECTION II) is amended in a written contract for this insurance to to include as an insured any person or organiza- apply on a primary or contributory basis. tion (called hereafter "additional insured") whom 3. This insurance does not apply: you have agreed in a written contract, executed prior to loss, to name as additional insured, but a. on any basis to any person or organization only with respect to liability arising out of "your for whom you have purchased an Owners work" or your ongoing operations for that addi- tional insured performed by you or for you. b. to "bodily injury," "property damage," "per- 2. With respect to the insurance afforded to Addi- sonal injury," or "advertising injury" arising tional Insureds the following conditions apply: out of the rendering of or the failure to render a. Limits of Insurance — The following limits of any professional services by or for you, in- cluding: liability apply: 1. The limits which you agreed to provide; 1. The preparing, approving or failing to prepare or approve maps, drawings, or opinions, reports, surveys, change or- 2. The limits shown on the declarations, ders, designs or specifications; and whichever is less. 2. Supervisory, inspection or engineering b. This insurance is excess over any valid and services. collectible insurance unless you have agreed CG D1 05 04 94 Copyright, The Travelers Indemnity Company, 1994. Page 1 of 1 Includes Copyrighted Material from Insurance Services Office, Inc. Policy#:6808894CI501942 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR SMALL BUSINESSES 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 coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Who Is An Insured — Unnamed Subsidiaries C. Who Is An Insured— Newly Acquired Or B. Who Is An Insured— Employees And Volunteer Formed Limited Liability Companies Workers—Bodily Injury To Co-Employees And D. Incidental Medical Malpractice Co-Volunteer Workers E. Blanket Waiver Of Subrogation PROVISIONS b. An organization other than a partnership,joint A. WHO IS AN INSURED — UNNAMED venture or limited liability company; or SUBSIDIARIES c. A trust; The following is added to SECTION II — WHO IS as indicated in its name or the documents that AN INSURED: govern its structure. Any of your subsidiaries, other than a partnership B. WHO IS AN INSURED — EMPLOYEES AND or joint venture, that is not shown as a Named VOLUNTEER WORKERS — BODILY INJURY Insured in the Declarations is a Named Insured TO CO-EMPLOYEES AND CO-VOLUNTEER if: WORKERS a. You are the sole owner of, or maintain an The following is added to Paragraph 2.a.(1) of ownership interest of more than 50% in, such SECTION II —WHO IS AN INSURED: subsidiary on the first day of the policy Paragraphs (1)(a), (b) and (c) above do not period; and apply to "bodily injury" to a co-"employee" while b. Such subsidiary is not an insured under in the course of the co-"employee's" employment similar other insurance. by you or performing duties related to the No such subsidiary is an insured for "bodily conduct of your business, or to "bodily injury" to injury" or "property damage" that occurred, or your other "volunteer workers" while performing g "personal and advertising injury" caused by an duties related to the conduct of your business. offense committed: C. WHO IS AN INSURED — NEWLY ACQUIRED a. Before you maintained an ownership interest OR FORMED LIMITED LIABILITY COMPANIES of more than 50% in such subsidiary; or 1. The following replaces the first sentence of b. After the date, if any, during the policy period Paragraph 3. of SECTION II — WHO IS AN that you no longer maintain an ownership INSURED: interest of more than 50% in such subsidiary. Any organization you newly acquire or form, For purposes of Paragraph 1. of Section II —Who other than a partnership or joint venture, and Is An Insured, each such subsidiary will be of which you are the sole owner or in which deemed to be designated in the Declarations as: you maintain an ownership interest of more a. A limited liability company; than 50%, will qualify as a Named Insured if CG D8 42 02 19 ©2018 The Travelers Indemnity Company.All rights reserved. Page 1 of 3 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. COMMERCIAL GENERAL LIABILITY there is no other similar insurance available scope of their employment by you or to that organization. performing duties related to the conduct 2. The following replaces the last sentence of of your business. Paragraph 3. of SECTION II — WHO IS AN 3. The following replaces the last sentence of INSURED: Paragraph 5. of SECTION III — LIMITS OF For the purposes of Paragraph 1. of Section INSURANCE: 11 — Who Is An Insured, each such For the purposes of determining the organization will be deemed to be applicable Each Occurrence Limit, all related designated in the Declarations as: acts or omissions committed in providing or a. A limited liability company; failing to provide "incidental medical services", first aid or "Good Samaritan b. An organization other than a partnership, services" to any one person will be deemed joint venture or limited liability company; to be one "occurrence". or 4. The following exclusion is added to c. A trust; Paragraph 2., Exclusions, of SECTION I — as indicated in its name or the documents COVERAGES — COVERAGE A — BODILY that govern its structure. INJURY AND PROPERTY DAMAGE D. INCIDENTAL MEDICAL MALPRACTICE LIABILITY: 1. The following replaces Paragraph b. of the Sale Of Pharmaceuticals definition of "occurrence" in the "Bodily injury" or "property damage" arising DEFINITIONS Section: out of the violation of a penal statute or b. An act or omission committed in ordinance relating to the sale of providing or failing to provide "incidental pharmaceuticals committed by, or with the medical services", first aid or "Good knowledge or consent of, the insured. Samaritan services" to a person, unless 5. The following is added to the DEFINITIONS you are in the business or occupation of Section: providing professional health care "Incidental medical services" means: services. 2. The following replaces the last paragraph of a. Medical, surgical, dental, laboratory, x- ray or nursing service or treatment, Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED: advice or instruction, or the related furnishing of food or beverages; or Unless you are in the business or occupation of providing professional health care b. The furnishing or dispensing of drugs or services, Paragraphs (1)(a), (b), (c) and (d) medical, dental, or surgical supplies orappliances. above do not apply to "bodily injury" arising out of providing or failing to provide: 6. The following is added to Paragraph 4.b., (a) "Incidental medical services" by any of Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY your "employees" who is a nurse, nurse CONDITIONS: assistant, emergency medical technician, paramedic, athletic trainer, This insurance is excess over any valid and audiologist, dietician, nutritionist, collectible other insurance, whether primary, occupational therapist or occupational excess, contingent or on any other basis, therapy assistant, physical therapist or that is available to any of your "employees" speech-language pathologist; or for "bodily injury" that arises out of providing (b) First aid or "Good Samaritan services" or failing to provide "incidental medical services" to any person to the extent not by any of your "employees" or "volunteer subject to Paragraph 2.a.(1) of Section II — workers", other than an employed or Who Is An Insured. volunteer doctor. Any such "employees" or "volunteer workers" providing or failing E. BLANKET WAIVER OF SUBROGATION to provide first aid or "Good Samaritan The following is added to Paragraph 8., Transfer services" during their work hours for you Of Rights Of Recovery Against Others To Us, will be deemed to be acting within the Page 2 of 3 ©2018 The Travelers Indemnity company.All rights reserved. CG D8 42 02 19 Includes copyrighted material of Insurance services Office, Inc.,with its permission. COMMERCIAL GENERAL LIABILITY of SECTION IV — COMMERCIAL GENERAL a. "Bodily injury" or "property damage" that LIABILITY CONDITIONS: occurs; or If the insured has agreed in a contract or b. "Personal and advertising injury" caused by agreement to waive that insured's right of an offense that is committed; recovery against any person or organization, we subsequent to the execution of the contract or waive our right of recovery against such person agreement. or organization, but only for payments we make because of: CG D8 42 02 19 ©2018 The Travelers Indemnity Company.All rights reserved. Page 3 of 3 Includes copyrighted material of Insurance Services Office,Inc.,with its permission.