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CAG2019-471 - Amendment - Change Order #1 - Guardrail Repair - Additional Repair on Smith Street
Agreement Routing Form KEN 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 Gursimran Singh Department: Public Works Date Sent. 1/23/20 Date Required: 1/27/20 oAuthorized Director or Designee Date of ._. a to Sign: Council N/A QMayor Approval: Budget R00602 Grant? Yes No Account Number: Type: N/A Vendor or Name: Petersen Brothers, Inc. Cate 9 v: Contract C Vendor 33561 Sub-Category Amendment 0 Number. to Project E Name: Guardrail Repair 0 Project �,. Details: Additional repair on Smith St. c °i Agreement Basis for y Amount: $2,208.18 Selection of Contractor: Q Start Date: TV 22/20 Termination Date: Z/Z$/Z0 Notice required prior to Yes 1:1No Contract Number. C� 2 Q�G� (�.� I disclosure? Date Received by City Attorney: Comments: of c 0 0 cc N L i+ CA Date Routed to the Mayor's Office: in d Date Routed to the City Clerk's Office: 0 Date Sent to Originator: Visit Documents.KentWA.gov to obtain copies of all agreements adccW22373_6_19 • KEN T W A S H I N G T O N CHANGE ORDER NO. 1 NAME OF CONTRACTOR: Petersen Brothers, Inc. ("Contractor") CONTRACT NAME & PROJECT NUMBER: Guardrail Repair - Seven Locations ORIGINAL CONTRACT DATE: November 20, 2019 This Change Order amends the above-referenced contract; all other provisions of the contract that are not inconsistent with this Change Order shall remain in effect. For valuable consideration and by mutual consent of the parties, the project contract 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, Contractor shall provide all labor, materials, and equipment necessary to: Repair additional damage on Smith Street, 260 feet east of Jason Avenue. For a description and Contractor's quote, see Exhibit A which is attached and incorporated by this reference. 2. The contract amount and time for performance provisions of Section II "Time of Completion," and Section III, "Compensation," are hereby modified as follows: Original Contract Sum, $27,043.12 (including applicable alternates and WSST) Net Change by Previous Change Orders $0 (incl. applicable WSST) Current Contract Amount $27,043.12 (incl. Previous Change Orders) Current Change Order $2,208.18 Applicable WSST Tax on this Change $0 Order Revised Contract Sum $29,251.30 CHANGE ORDER - 1 OF 3 Original Time for Completion 12/28/20 (insert date) Revised-Time for Completion under +n—/a prior Change Orders (insert date) —----------------- ——----------Days Required (±) for this Change 0 calendar days Order Revised Time for Completion i2/28/20 (insert date) Pursuant to the above-referenced contract, Contractor agrees to waive any protest it may have regarding this Change Order and acknowledges and accepts that this Change Order constitutes final settlement of all claims of any kind or nature arising from or connected with any work either covered or affected by this Change Order, including, without limitation, claims related to contract time, contract acceleration, onsite or home office overhead, or lost profits, This Change Order, unless otherwise provided, does not relieve the Contractor from strict compliance with the guarantee and warranty provisions of the original contract, particularly those pertaining to substantial completion date. All acts consistent with the authority of the Agreement, previous Change Orders (if any), and this Change Order, prior to the effective date of this Change Order, are hereby ratified and affirmed, and the terms of the Agreement, previous Change Orders (if any), and this Change Order 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 contract modification, which is binding on the parties of this contract. 3. The Contractor will adjust the amount of its performance bond (if any) for this project to be consistent with the revised contract sum shown in section 2, above. IN WITNESS, the parties below have executed this Agreement, which will become effective on the last date written below. CONTRACTOR: CITY OF KENT: By: By: -k (signature) Lp. signature) Print Name: Print Name: David A. Brock, P.E. Its Its DeQUtV 'rector Operations Manager DATE: (title) DATE: 1(title) 2—i CHANGE ORDER - 2 OF 3 ATTEST: APPROVED AS TO FORM: (applicable if Mayor's signature required) r 1 Kent City Clerk Kent Law Department Petersen Brothers-Guardrail Repair-7 Sites CO 1/Singh CHANGE ORDER - 3 OF 3 EXHIBIT A ESTIMATE LOCATION: Site 7(Extended Damage): Smith St - 260 ft east of Jason Ave �� L1MIT +�•ri _ .� �-�- 30 ` k DESCRIPTION OF WORK QUANTITY Remove existing damaged type 1 W-Beam guardrail 37.5 Ln. Ft Install new weathering steel type 1 W-Beam guardrail 37.5 Ln. Ft Project Temporary Traffic Control 1 LS Include applicable taxes in all appropriate work items, not as separate pay item. r- � z Y � w W o ) a Z Z w a J WIn NE U v J l O W (n }� Zw E W F" 1 W Qr� W UO UJ aCO cn W uw oa U. !— z � a C/) � '` T LLJo D W W CJ p WW cn X W -� N nd uase� Cl) W C- ca uj 4-a CO a Z U) S� it op W , .V-4 a N V �Jejo U ro � O 0 J b 0 Y 4 � • • � � �A w A. w . ,;VC&W 9 Fwacu, l etc, 2008 EAST VALLEY HIGHWAY SUMNER,WASHINGTON 98390 (253)833-2544(253)863-8136 FAX(253)863-5951 Contractors#CC-01 PETERBI187NZ Project Name: KENT GUARDRAIL REPAIRS OCT 2019 7 SITES(SITE 7 EXTENDED DAMAGE ONLY) BID DATE: 11/18/2019 PAY ITEM DESCRIPTION QUANTITY UNIT UNIT PRICE EXTENSION 704 Remove Existing Damaged Type 12.50 L.F. 16.23 202.88 1 W-Beam Guardrail 705 Beam Guardrail Type 1 12.50 L.F. 117.98 1,474.75 Weathering Steel 706 Lane Closure 1.00 EACH 530.55 530.55 THIS PRICING IS FOR THE EXTENDED DAMAGE ONLY IT DOES NOT REPLACE ANY OF THE ORIGINAL SITE 7 WORK TOTAL QUOTE 2,208.18 Name: Phone: Email: This quote contains the following exclusions/qualifications: **Price includes applicable taxes. **Price does not include traffic control unless specified. **Prices include material&installation,bond and insurance. **This quote sheet to become part of any subcontract agreement. **Any deletion or change to above bid items must be agreed to prior to bid opening. **Beam Guardrail is available in 12.5'and 6.25'lengths **Prices are good if contract is received within 30 days after award of job,after 30 days prices must be renegotiated. IF ACCEPTED PLEASE SIGN AND FAX BACK TO 253-863-5951 NO WORK WILL BE PERFORMED WITHOUT PROPER AUTHORIZATION By --- Date: Title Phone_ Company Name_ Fax. Address: '4���® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/05/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT, If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME:NTA Sue Martin HENTSCHELL&ASSOC INC H NE Ext: (253)272-1151 aC,No: (253)272-1225 1436 S.Union Ave. AIL ADDRESS: SueM hentschell.com INSURER(S)AFFORDING COVERAGEa2i5682 AIC# Tacoma WA 98405-1925 INSURER A: Phoenix Insurance Company623 INSURED INSURER B: Travelers Ind CO Of CT Petersen Brothers,Inc. INSURER C: Travelers Property&Casualty Co ofAmerica6742008 East Valley Hwy INSURER D: Great American Insurance Company16691 INSURER E Sumner WA 98390 INSURER F: COVERAGES CERTIFICATE NUMBER: *2019-2025 GLAU UMB 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. TLimited Ll TYPE OF INSURANCE IN D POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS RCIAL GENERAL LIABILITYEACH OCCURRENCE $ 1,000,000 AIMS-MADE ®OCCUR 300,000 PREMISES Ea occurrence Eyers Liability(Stop Gap) 10,000 MED EXP(An one person) S Job Site Pollution Y Y DT-CO-526D9518-COF-19 11/01/2019 11/01/2020 1,000,000 PERSONAL BADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ® PRO- ElJECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ AUTOS ONLY AUTOS B OWNED SCHEDULED Y Y 81O-OL622021-19-26G 11/01/2019 11/01/2020 BODILY INJURY(Per accident) $ HIRED NON-OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ Per accident X UMBRELLA LIAB X OCCUR $ 1,000,000 EACH OCCURRENCE C EXCESS LIAB CLAIMS-MADE Y Y CUP-OKt98781-19-26 11/01/2019 11/01/2020 $ 1,000,000 AGGREGATE DED RETENTION$ O WORKERS COMPENSATION S AND EMPLOYERS'LIABILITY PER OTH- Y/N STATUTE ER A ANYPROPRIMBER/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) EXCLUDED? ❑ N/A DT-CO-526D9518-COF-19 11/01/2019 11/01/2020 (Mandatory In NH) 1,000,000 If yes,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 Excess Liability Policy(Following Form) Limits: D Occurrence Form TUE0196246-08 11/01/2019 11/01/2020 Occurrence $5,000,000 Aggregate $5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) [Job#: Job Type:19-1731 RE:Guardrail Repairs 7 locations in Kent,WA. City of Kent is included as additional insureds. Certificate Holder is included in Blanket Additional insured as required by written contract or agreement as attached forms listed below: General Liability:CGD 246(04/19)Blanket Additional Insured including Completed Operations.CGT100(02/19) Primary Non-Contributory.;CGD 316 (02/19)Blanket Waiver of Subrogation CGD211 ((01/04)Per Project Aggregate.;Automobile:CAT353(02/15) Additional Insured&Waiver. Auto Extension CAT474(02/16)Additional Insured Primary Non Contributory. Umbrella:E00001 (7/16) Excess Liability Following Form. 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 Public Works Department ACCORDANCE WITH THE POLICY PROVISIONS. 400 West Gowe AUTHORIZED REPRESENTATIVE Kent WA 98032IL 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD TRAVELERSJ� POLICY NUMBER: DT-CO-526D9518-PHX-19 EFFECTIVE DATE: 11-01-19 ISSUE DATE: 11-13-19 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS. IL TO 02 11 89 COMMON POLICY DECLARATIONS IL T8 01 10 93 FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS PN U3 20 04 19 LIBERALIZATION LETTER-GL PRODUCT MODERN IL TO 05 06 10 COMMON POLICY CONDITIONS-WASHINGTON IL TO 30 12 90 NON-STANDARD PAYMENT SCHEDULE IL TO 03 04 96 LOCATION SCHEDULE IL T3 02 07 86 CALCULATION OF PREMIUM-COMPOSITE RATE(S) IL F1 18 10 13 AMENDMENT OF NAMED INSURED - WASHINGTON GENERAL LIABILITY - CONTRACTORS CG TO 01 11 03 COML GENERAL LIABILITY COV PART DEC CG F3 07 11 08 DEDUCTIBLE LIAB INSURANCE - WASHINGTON CG TO 07 09 87 DECLARATIONS PREMIUM SCHEDULE CG TO 08 11 03 KEY TO DECLARATIONS PREMIUM SCHEDULE CG TO 34 02 19 TABLE OF CONTENTS - COM GEN LIAB COV CG T1 00 02 19 CONMERCIAL GENERAL LIABILITY COV FORM CG T8 00 GENERAL PURPOSE ENDORSEMENT CG T8 01 GENERAL PURPOSE ENDORSEMENT CG T8 02 GENERAL PURPOSE ENDORSEMENT CG T8 03 GENERAL PURPOSE ENDORSEMENT CG T8 04 GENERAL PURPOSE ENDORSEMENT CG T8 05 GENERAL PURPOSE ENDORSEMENT CG T8 06 GENERAL PURPOSE ENDORSEMENT CG T8 07 GENERAL PURPOSE ENDORSEMENT CG D2 70 01 10 ADD'L INS ENGS, ARCHITECTS, SURVEYORS CG D3 25 01 04 ADDITIONAL INSURED - MORTGAGEE,ASSIGNEE CG D3 61 03 05 ADD'L INSURED-OWNERS,LESSEES,CONTRACTORS CG D3 73 11 05 ADD'L INSURED,OWNERS,LESSEES,CONTRACTORS CG 20 10 10 01 ADDL INSD-OWNER/LESSEE/CONTRACTOR B CG 20 37 07 04 ADD INSURED-OWNRS,LESSEES,CONT COMPL OPS GN O1 13 11 03 EMPLOYERS OVERHEAD LIABILITY CG D2 03 12 97 AMEND-NON CUMULATION OF EACH OCC CG D2 11 01 04 DESIGNATED PROJECT(S) GEN AGGR LIMIT CG D2 46 04 19 BLANKET AI-W/COMP OPS IF REQ BY CONTRACT CG D3 16 02 19 XTEND ENDORSEMENT FOR CONTRACTORS CG D8 23 02 19 ELECTRONIC DATA LIABILITY COVERAGE CG D2 93 11 03 EXCL-CONSTRUCT MANAGE ERRORS & OMISSIONS CG D3 22 01 04 EXCLUSION-SUITS BY ONE NAMED INSURED CG D3 91 08 13 EXCL-PROJ SUBJ TO WRAP-UP-LTD EXCEPTIONS CG D5 46 10 11 EXCL - ARCHITECT/ENG/SURVEY PROF SERV CG D6 18 10 11 EXCL-VIOLATION OF CONSUMER FIN PROT LAWS CG DO 76 06 93 EXCLUSION-LEAD CG D1 42 02 19 EXCLUSION-DISCRIMINATION CG D1 73 02 19 AMEND-POLL EXCL-INCL LTD COV POLL COST IL T8 01 10 93 PAGE: 1 OF 2 TRAVELERS POLICY NUMBER: DT-CO-526D9518-PHX-19 EFFECTIVE DATE: 11-01-19 ISSUE DATE: 11-13-19 GENERAL LIABILITY - CONTRACTORS (CONTINUED) CG D2 04 12 17 EXCL-EXTERIOR INSULATION & FINISH SYSTEM CG D2 40 09 15 EXCLUSION -SILICA OR SILICA-RELATED DUST CG T4 81 11 88 EXC-HAZARD-CONNECTED DESIGNATED EXPOSURE CG F2 66 02 19 WA CHANGES EMPLOY RELATED PRACTICES EXCL CG F4 66 01 08 WASHINGTON CHANGES-WHO IS AN INSURED CG F2 41 05 02 WASHINGTON - FUNGI OR BACTERIA EXCLUSION CG TO 09 09 93 EMPLOYEE BENEFITS LIAB COV PART DEC CG TO 43 01 16 EMPLOYEE BENEFITS LIAB TABLE OF CONTENTS CG T1 01 01 16 EMPLOYEE BENEFITS LIABILITY COV FORM INTERLINE ENDORSEMENTS IL T3 68 01 15 FEDERAL TERRORISM RISK INS ACT DISCLOSE IL T4 12 03 15 AMNDT COMMON POLICY COND-PROHIBITED COVG IL T4 14 01 15 CAP ON LOSSES CERTIFIED ACT OF TERRORISM IL 01 23 11 13 WASHINGTON CHANGES - DEFENSE COSTS IL O1 98 09 08 NUCLEAR ENERGY LIABILITY EXCLUSION IL T8 01 10 93 PAGE: 2 OF 2 POLICY NUMBER: 810-OL622021-19-26-G EFFECTIVE DATE: 11/01/2019 ISSUE DATE: 11/11/2019 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS IL TO 02 11 89 COMMON POLICY DECLARATIONS IL T8 01 01 01 FORMS ENDORSEMENTS AND SCHEDULE N011BERS IL TO 05 06 10 COMMON POLICY CONDITIONS - WASHINGTON IL TO 30 12 90 NON-STANDARD PAYMENT SCHEDULE IL F1 18 10 13 AMENDMENT OF NAMED INSURED - WASHINGTON IL T3 02 07 86 CALCULATION OF PREMIUM - COMPOSITE RATES IL T8 25 CALCULATION OF PREMIUM - COMPOSITE RATES COMMERCIAL AUTO CA TO O1 02 15 BA- COVERAGE PART DECS (ITEMS 1 & 2) CA TO 03 02 15 BUS AUTO COV PART DECLARATIONS-4&5 CA T3 95 02 15 DEDUCTIBLE COVERAGE CA TO 30 02 16 BUSINESS AUTO/MC COV PART-UM SUPPL SCHD CA TO 31 02 15 TABLE OF CONTENTS-BUSINESS AUTO COV FORM CA 00 01 10 13 BUSINESS AUTO COVERAGE FORM CA O1 35 10 13 WASHINGTON CHNG CA 21 34 10 13 WASHINGTON UNDERINSURED MOTORISTS COVERAGE CA 99 03 10 13 AUTO MEDICAL PAYMENTS COVERAGE CA 99 10 10 13 DRIVE OTHER CAR COVERAGE - BROADENED COVERAGE FOR NAMED INDIVIDUALS CA 99 16 10 13 HIRED AUTOS SPECIFIED AS COVERED AUTOS YOU OWN CA T4 52 02 16 SHORT TERM HIRED AUTO - ADDITIONAL INSURED AND LOSS PAYEE CA T4 59 02 15 A14ENDMENT OF EMPLOYEE DEFINITION CA T4 74 02 16 BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE CA T3 53 02 15 BUSINESS AUTO EXTENSION ENDORSEMENT INTERLINE ENDORSEMENTS IL T4 12 03 15 AMNDT COMMON POLICY COND-PROHIBITED COVG IL O1 23 11 13 WASHINGTON CHANGES - DEFENSE COSTS IL O1 98 09 08 NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (BROAD FORM) IL T8 01 01 01 PAGE: 1 OF 1 POLICY NUMBER: CUP-OK198781-19-26 EFFECTIVE DATE: 11/01/2019 ISSUE DATE: 11/13/2019 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS PN U3 26 04 19 LIBERALIZATION LETTER PRODUCT MODERNIZATION - UMBRELLA IL T8 01 01 01 FORMS ENDORSEMENTS AND SCHEDULE NUMBERS UMBRELLA / EXCESS EU 00 02 07 16 POLICY DECLARATIONS EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE POLICY EU 00 03 08 18 SCHEDULE OF UNDERLYING INSURANCE EU 00 01 07 16 EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE EU 02 34 07 16 AMENDMENT OF COVERAGE - DEFINITIONS EU 03 22 08 18 CONSTRUCTION IDENTIFIED HAZARDS EXCLUSIONS - COVERAGE B EU 03 46 08 18 NON CUMULATION OF OCCURRENCE LIMIT EU 01 44 07 16 COVERAGE FOR FINANCIAL INTEREST IN FOREIGN INSURED ORGANIZATIONS HU 00 07 07 16 CAP LOSSES - CERT ACTS TERRORSM AND EXCL EU 02 09 08 18 NUCLEAR ENERGY LIABILITY EXCLUSION (BROAD FORM) - COVERAGES A AND B EU 02 16 08 18 POLLUTION NOT RELATED TO AUTOS EXCLUSION WITH LIMITED EXCEPTIONS - COVERAGE A EU 03 12 08 18 AIR LIAB EXCL-UNMAN AIR EXCEPT - COV A&B EU 03 31 08 18 DISCRIMINATION EXCLUSION - COVERAGE B EU 03 38 08 18 FUNGI OR BACTERIA EXCLUSION - COVERAGE B - WASHINGTON EU 03 44 08 18 LEAD EXCLUSION - COVERAGE B EU 03 48 08 18 POLLUTION LOSS, COST OR EXPENSE EXCLUSION - COVERAGE A EU 03 63 08 18 SILICA OR SILICA-RELATED DUST EXCLUSION - COVERAGE B EU 00 74 07 16 WASHINGTON CHANGES INTERLINE ENDORSEMENTS IL T3 68 01 15 FEDERAL TERRORISM RISK INSURANCE ACT DISCLOSURE IL T8 01 01 01 PAGE: 1 OF 1 COMMERCIAL GENERAL LIABILITY c. Method Of Sharing a. The statements in the Declarations are If all of the other insurance permits contribution accurate and complete; by equal shares, we will follow this method also. b. Those statements are based upon Under this approach each insurer contributes representations you made to us; and equal amounts until it has paid its applicable c. We have issued this policy in reliance upon limit of insurance or none of the loss remains, your representations. whichever comes first. If any of the other insurance does not permit The unintentional omission of, or unintentional error in, any information provided by you which we relied contribution by equal shares, we will contribute upon in issuing this policy will not prejudice your by limits. Under this method, each insurer's rights under this insurance. However, this provision share is based on the ratio of its applicable limit does not affect our right to collect additional of insurance to the total applicable limits of premium or to exercise our rights of cancellation or insurance of all insurers. nonrenewal in accordance with applicable insurance d. Primary And Non-Contributory insurance If laws or regulations. Required By Written Contract 7. Separation Of Insureds If you specifically agree in a written contract or Except with respect to the Limits of Insurance, and agreement that the insurance afforded to an any rights or duties specifically assigned in this insured under this Coverage Part must apply on Coverage Part to the first Named Insured, this a primary basis, or a primary and non- insurance applies: contributory basis, this insurance is primary to other insurance that is available to such insured a. As if each Named Insured were the only which covers such insured as a named insured, Named Insured; and and we will not share with that other insurance, b. Separately to each insured against whom claim provided that: is made or"suit" is brought. (1) The"bodily injury'or"property damage"for 8• Transfer Of Rights Of Recovery Against Others which coverage is sought occurs; and To Us (2) The "personal and advertising injury" for If the insured has rights to recover all or part of any which coverage is sought is caused by an payment we have made under this Coverage Part, offense that is committed; those rights are transferred to us. The insured must subsequent to the signing of that contract or do nothing after loss to impair them.At our request, agreement by you. the insured will bring "suit" or transfer those rights 5. Premium Audit to us and help us enforce them. a. We will compute all premiums for this Coverage 9. When We Do Not Renew Part in accordance with our rules and rates. If we decide not to renew this Coverage Part,we will b. Premium shown in this Coverage Part as mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal advance premium is a deposit premium only. At not less than 30 daysbefore the the close of each audit period we will compute expiration date. If notice is mailed, proof of mailing will be sufficient the earned premium for that period and send notice to the first Named Insured. The due date Proof of notice. for audit and retrospective premiums is the date SECTION V—DEFINITIONS shown as the due date on the bill. If the sum of 1. "Advertisement" means a notice that is broadcast or the advance and audit premiums paid for the published to the general public or specific market poicy period is greater than the earned segments about your goods, products or services premium, we will return the excess to the first for the purpose of attracting customers or Named Insured. supporters. For the purposes of this definition: c. The first Named Insured must keep records of a. Notices that are published include material the information we need for premium placed on the Internet or on similar electronic computation, and send us copies at such times means of communication; and as we may request. b. Regarding websites, only that part of a website 6. Representations that is about your goods, products or services By accepting this policy, you agree: for the purposes of attracting customers or supporters is considered an advertisement. Page 16 of 21 C 2017 The Travelers Indemnity Co g Company.�rights reserved. CG T1 00 02 19 Includes co � copyrighted material of Insurance Services ofece, Inc.with its permission. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR CONTRACTORS 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. Incidental Medical Malpractice B. Blanket Additional Insured — Governmental D. Blanket Waiver Of Subrogation Entities — Permits Or Authorizations Relating To E. Contractual Liability—Railroads Operations F. Damage To Premises Rented To You PROVISIONS a. An organization other than a partnership,joint A. WHO IS AN INSURED — UNNAMED venture or limited liability company; or SUBSIDIARIES b. 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. BLANKET ADDITIONAL INSURED — joint venture or limited liability company, that is GOVERNMENTAL ENTITIES — PERMITS OR not shown as a Named Insured in the AUTHORIZATIONS RELATING TO OPERATIONS Declarations is a Named Insured if: a. You are the sole owner of, or maintain an The following is added to SECTION II— WHO IS ownership interest of more than 50% in, such AN INSURED: subsidiary on the first day of the policy period; Any governmental entity that has issued a permit and or authorization with respect to operations b. Such subsidiary is not an insured under performed by you or on your behalf and that you similar other insurance. are required by any ordinance, law, building code or written contract or agreement to include as an No such subsidiary is an insured for "bodily injury" additional insured on this Coverage Part is an or "property damage" that occurred, or "personal insured, but only with respect to liability for"bodily and advertising injury" caused by an offense injury", "property damage" or "personal and committed: advertising injury" arising out of such operations. a. Before you maintained an ownership interest The insurance provided to such governmental of more than 50% in such subsidiary; or entity does not apply to: b. After the date, if any, during the policy period a. Any "bodily injury', "property damage" or that you no longer maintain an ownership "personal and advertising injury" arising out of interest of more than 50% in such subsidiary. operations performed for the governmental For purposes of Paragraph 1. of Section II —Who entity; or Is An Insured, each such subsidiary will be b. Any "bodily injury" or "property damage" deemed to be designated in the Declarations as: included in the "products-completed operations hazard". CG D3 16 02 19 ®2017 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 C. INCIDENTAL MEDICAL MALPRACTICE pharmaceuticals committed by, or with the 1. The following replaces Paragraph b. of the knowledge or consent of, the insured. definition of "occurrence" in the 5. The following is added to the DEFINITIONS DEFINITIONS Section: Section: b. An act or omission committed in providing "Incidental medical services" means: or failing to provide "incidental medical services", first aid or "Good Samaritan a. Medical, surgical, dental, laboratory, x-ray services" to a person, unless you are in or nursing service or treatment, advice or the business or occupation of providing instruction, or the related furnishing of professional health care services. food or beverages; or 2. The following replaces the last paragraph of b. The furnishing or dispensing of drugs or Paragraph 2.a.(1) of SECTION II — WHO IS medical, dental, or surgical supplies or AN INSURED: appliances. Unless you are in the business or occupation 6. The following is added to Paragraph 4.b., of providing professional health care services, Excess Insurance, of SECTION IV — Paragraphs (1)(a), (b), (c) and (d) above do COMMERCIAL GENERAL LIABILITY not apply to "bodily injury" arising out of CONDITIONS: providing or failing to provide: This insurance is excess over any valid and (a) "Incidental medical services" by any of collectible other insurance, whether primary, your "employees" who is a nurse, nurse excess, contingent or on any other basis, that assistant, emergency medical technician is available to any of your "employees" for or paramedic; or "bodily injury" that arises out of providing or (b) First aid or "Good Samaritan services" by failing to provide "incidental medical services" any of your "employees" or "volunteer to any person to the extent not subject to workers", other than an employed or Paragraph 2.a.(1) of Section II — Who Is An volunteer doctor. Any such "employees" Insured. or "volunteer workers" providing or failing D. BLANKET WAIVER OF SUBROGATION to provide first aid or "Good Samaritan services" during their work hours for you The following is added to Paragraph 8., Transfer will be deemed to be acting within the Of Rights Of Recovery Against Others To Us, scope of their employment by you or of SECTION IV — COMMERCIAL GENERAL performing duties related to the conduct LIABILITY CONDITIONS: of your business. If the insured has agreed in a contract or 3. The following replaces the last sentence of agreement to waive that insured's right of Paragraph 5. of SECTION III — LIMITS OF recovery against any person or organization, we INSURANCE: waive our right of recovery against such person or For the purposes of determining the organization, but only for payments we make applicable Each Occurrence Limit, all related because of: acts or omissions committed in providing or a. "Bodily injury" or "property damage" that failing to provide "incidental medical occurs; or services", first aid or "Good Samaritan services" to any one person will be deemed to b. "Personal and advertising injury" caused by be one"occurrence". an offense that is committed; 4. The following exclusion is added to subsequent to the execution of the contract or Paragraph 2., Exclusions, of SECTION I — agreement. COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE E. CONTRACTUAL LIABILITY—RAILROADS LIABILITY: 1. The following replaces Paragraph c. of the Sale Of Pharmaceuticals definition of "insured contract" in the "Bodily injury" or "property damage" arising DEFINITIONS Section: out of the violation of a penal statute or c. Any easement or license agreement; ordinance relating to the sale of Page 2 of 3 ®2017 The Travelers Indemnity Company.All rights reserved. CG D3 16 02 19 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. COMMERCIAL GENERAL LIABILITY 2. Paragraph f.(1) of the definition of "insured a. Any premises while rented to you or contract' in the DEFINITIONS Section is temporarily occupied by you with permission deleted. of the owner; or F. DAMAGE TO PREMISES RENTED TO YOU b. The contents of any premises while such The following replaces the definition of "premises premises is rented to you, if you rent such damage" in the DEFINITIONS Section: premises for a period of seven or fewer „ � Premises damage" means "property damage"to: consecutive days. CG D3 16 02 19 ®2017 The Travelers indemnity Company.AN rights reserved. Page 3 of 3 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (Includes Products-Completed Operations If Required By Contract) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS (1) Any "bodily injury", "property damage" or The following is added to SECTION II— WHO IS AN "personal injury" arising out of the providing, INSURED: or failure to provide, any professional An person or organization that architectural, engineering or surveying Y P 9 you agree in a written contract or agreement to include as an services, including: additional insured on this Coverage Part is an (a) The preparing, approving, or failing to insured, but only: prepare or approve, maps, shop a. With respect to liability for "bodily injury" or drawings, opinions, reports, surveys, "property damage" that occurs, or for "personal field orders or change orders, or the injury" caused by an offense that is committed, preparing, approving, or failing to subsequent to the signing of that contract or prepare or approve, drawings and agreement and while that part of the contract or specifications; and agreement is in effect; and (b) Supervisory, inspection, architectural or b. If, and only to the extent that, such injury or engineering activities. damage is caused by acts or omissions of you or your subcontractor in the performance of "your (2) Any "bodily injury" or "property damage" work" to which the written contract or agreement caused by "your work" and included in the applies. Such person or organization does not "products-completed operations hazard" qualify as an additional insured with respect to unless the written contract or agreement the independent acts or omissions of such specifically requires you to provide such person or organization. coverage for that additional insured during The insurance provided to such additional insured is the policy period. subject to the following provisions: c. The additional insured must comply with the a. If the Limits of Insurance of this Coverage Part following duties: shown in the Declarations exceed the minimum limits required by the written contract or (1) Give us written notice as soon as practicable agreement, the insurance provided to the of an "occurrence" or an offense which may additional insured will be limited to such result in a claim. To the extent possible, such minimum required limits. For the purposes of notice should include: determining whether this limitation applies, the (a) How, when and where the "occurrence" minimum limits required by the written contract or or offense took place; agreement will be considered to include the minimum limits of any Umbrella or Excess (b) The names and addresses of any injured liability coverage required for the additional persons and witnesses; and insured by that written contract or agreement. This provision will not increase the limits of (c) The nature and location of any injury or insurance described in Section III — Limits Of damage arising out of the "occurrence" Insurance. or offense. b. The insurance provided to such additional (2) If a claim is made or "suit" is brought against insured does not apply to: the additional insured: CG D2 46 0419 0 2018 The Travelers Indemnity Company. All rights reserved. Page 1 of 2 COMMERCIAL GENERAL LIABILITY (a) Immediately record the specifics of the (4) Tender the defense and indemnity of any claim or"suit' and the date received; and claim or "suit" to any provider of other (b) Notify us as soon as practicable and see insurance which would cover such additional to it that we receive written notice of the insured for a loss we cover. However, this claim or"suit' as soon as practicable. condition does not affect whether the insurance provided to such additional (3) Immediately send us copies of all legal insured is primary to other insurance papers received in connection with the claim available to such additional insured which or "suit', cooperate with us in the covers that person or organization as a investigation or settlement of the claim or named insured as described in Paragraph 4., defense against the "suit', and otherwise Other Insurance, of Section IV — Commercial comply with all policy conditions. General Liability Conditions. Page 2 of 2 0 2018 The Travelers Indemnity Company.AM rights reserved. CG D2 46 04 19 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Z 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 the 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. ZZ A. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF B. BLANKET ADDITIONAL INSURED USE — INCREASED LIMIT C. EMPLOYEE HIRED AUTO 1. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT D. EMPLOYEES AS INSURED J. PERSONAL PROPERTY ti E. SUPPLEMENTARY PAYMENTS — INCREASED K. AIRBAGS a LIMITS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR F. HIRED AUTO — LIMITED WORLDWIDE COV- LOSS ERAGE— INDEMNITY BASIS M. BLANKET WAIVER OF SUBROGATION `v G. WAIVER OF DEDUCTIBLE— GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS PROVISIONS A. BROAD FORM NAMED INSURED this insurance applies and only to the extent that The following is added to Paragraph A.1., Who Is person or organization qualifies as an "insured" w An Insured, of SECTION II — COVERED AUTOS under the Who Is An Insured provision contained LIABILITY COVERAGE: in Section II. ti Any organization you newly acquire or form dur- C. EMPLOYEE HIRED AUTO ing the policy period over which you maintain 1. The following is added to Paragraph A.1., 50% or more ownership interest and that is not Who Is An Insured, of SECTION II — COV- separately insured for Business Auto Coverage, ERED AUTOS LIABILITY COVERAGE. Coverage under this provision is afforded only un- An "employee" of yours is an "insured" while til the 180th day after you acquire or form the or- operating an "auto" hired or rented under a ganization or the end of the policy period, which- contract or agreement in an "employee's" ever is earlier, name, with your permission, while performing B. BLANKET ADDITIONAL INSURED duties related to the conduct of your busi- ness. The following is added to Paragraph c. in A.1., 2. The following replaces Paragraph b. in B.5., Who Is An Insured, of SECTION II — COVERED Other Insurance, of SECTION IV — BUSI- AUTOS LIABILITY COVERAGE: NESS AUTO CONDITIONS: Any person or organization who is required under b. For Hired Auto Physical Damage Cover- a written contract or agreement between you and age, the following are deemed to be cov- that person or organization, that is signed and ered "autos" you own: executed by you before the "bodily injury" or (1) Any covered "auto" you lease, hire, "property damage" occurs and that is in effect rent or borrow; and during the policy period, to be named as an addi- (2) Any covered "auto" hired or rented by tional insured is an "insured" for Covered Autos your "employee" under a contract in Liability Coverage, but only for damages to which an "employee's" name, with your CA T3 53 02 15 ©2015 The Travelers Indemnity company.All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services office,Inc.with its permission. COMMERCIAL AUTO permission, while performing duties (a) With respect to any claim made or "suit" related to the conduct of your busi- brought outside the United States of ness. America, the territories and possessions However, any "auto"that is leased, hired, of the United States of America, Puerto rented or borrowed with a driver is not a Rico and Canada: covered "auto". (i) You must arrange to defend the "in- D. EMPLOYEES AS INSURED sured" against, and investigate or set- The following is added to Paragraph A.1., Who Is tle any such claim or "suit" and keep An Insured, of SECTION II —COVERED AUTOS us advised of all proceedings and ac- tions. LIABILITY COVERAGE: (ii) Neither you nor any other involved Any "employee" of yours is an "insured" while us- "insured" will make any settlement Z ing a covered "auto" you don't own, hire or borrow without our consent. z in your business or your personal affairs. E. SUPPLEMENTARY PAYMENTS — INCREASED (iii) We may, at our discretion, participate LIMITS in defending the "insured" against, or in the settlement of, any claim or 1. The following replaces Paragraph A.2.a.(2), "suit". q of SECTION II — COVERED AUTOS LIABIL- (iv) We will reimburse the "insured" for ITY COVERAGE: sums that the "insured" legally must (2) Up to $3,000 for cost of bail bonds (in- pay as damages because of "bodily °�. cluding bonds for related traffic law viola- injury" or "property damage" to which tions) required because of an "accident" this insurance applies, that the "in- we cover. We do not have to furnish sured" pays with our consent, but these bonds. only up to the limit described in Para- 2. The following replaces Paragraph A.2.a.(4), graph C., Limits Of Insurance, of of SECTION II — COVERED AUTOS LIABIL- SECTION II — COVERED AUTOS ITY COVERAGE: LIABILITY COVERAGE. v We will reimburse the "insured" for (4) All reasonable expenses incurred by the ( ) the reasonable expenses incurred "insured" at our request, including actual loss of earnings up to $500 a day be- with our consent for your investiga- cause of time off from work. tion of such claims and your defense of the "insured" against any such F. HIRED AUTO — LIMITED WORLDWIDE COW suit", but only up to and included ERAGE—INDEMNITY BASIS within the limit described in Para- The following replaces Subparagraph (5) in Para- graph C., Limits Of Insurance, of graph B.7., Policy Period, Coverage Territory, SECTION II — COVERED AUTOS of SECTION IV — BUSINESS AUTO CONDI- LIABILITY COVERAGE, and not in TIONS: addition to such limit. Our duty to (5) Anywhere in the world, except any country or make such payments ends when we jurisdiction while any trade sanction, em- have used up the applicable limit of bargo, or similar regulation imposed by the insurance in payments for damages, United States of America applies to and pro- settlements or defense expenses. hibits the transaction of business with or (b) This insurance is excess over any valid within such country or jurisdiction, for Cov- and collectible other insurance available ered Autos Liability Coverage for any covered to the "insured" whether primary, excess, "auto" that you lease, hire, rent or borrow contingent or on any other basis. without a driver for a period of 30 days or less (c) This insurance is not a substitute for re- and that is not an "auto" you lease, hire, rent quired or compulsory insurance in any or borrow from any of your "employees", country outside the United States, its ter- partners (if you are a partnership), members ritories and possessions, Puerto Rico and (if you are a limited liability company) or Canada. members of their households. Page 2 of 4 ©2015 The Travelers Indemnity Company.All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL AUTO You agree to maintain all required or (2) In or on your covered "auto". compulsory insurance in any such coun- This coverage applies only g pp yin the event of a total try up to the minimum limits required by theft of your covered "auto". local law. Your failure to comply with No deductibles apply to this Personal Property compulsory insurance requirements will not invalidate the coverage afforded by coverage. this policy, but we will only be liable to the K. AIRBAGS f same extent we would have been liable The following is added to Paragraph B.3., Exclu- had you complied with the compulsory in- sions, of SECTION III — PHYSICAL DAMAGE surance requirements. COVERAGE: (d) It is understood that we are not an admit- Exclusion 3.a. does not apply to 'loss" to one or �» ted or authorized insurer outside the more airbags in a covered "auto" you own that in- United States of America, its territories flate due to a cause other than a cause of "loss" and possessions, Puerto Rico and Can- set forth in Paragraphs A.1.b. and A.1.c., but ada. We assume no responsibility for the only: furnishing of certificates of insurance, or a. If that "auto" is a covered "auto" for Compre- for compliance in any way with the laws hensive Coverage under this policy; of other countries relating to insurance. b. The airbags are not covered under any war- G. WAIVER OF DEDUCTIBLE—GLASS ranty; and The following is added to Paragraph D., Deducti- c. The airbags were not intentionally inflated, ble, of SECTION III — PHYSICAL DAMAGE We will pay up to a maximum of $1,000 for any .� COVERAGE: one 'loss". No deductible for a covered "auto" will apply to L. NOTICE AND KNOWLEDGE OF ACCIDENT OR glass damage if the glass is repaired rather than LOSS replaced. The following is added to Paragraph A.2.a., of H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF SECTION IV— BUSINESS AUTO CONDITIONS: USE— INCREASED LIMIT Your duty to give us or our authorized representa- The following replaces the last sentence of Para- tive prompt notice of the "accident" or "loss" ap- graph AA.b., Loss Of Use Expenses, of SEC- plies only when the "accident" or "loss" is known ti TION III—PHYSICAL DAMAGE COVERAGE: to: However, the most we will pay for any expenses (a) You (if you are an individual); for loss of use is $65 per day, to a maximum of (b) A partner(if you are a partnership); $750 for any one "accident". (c) A member (if you are a limited liability com- I. PHYSICAL DAMAGE — TRANSPORTATION pany); EXPENSES—INCREASED LIMIT (d) An executive officer, director or insurance The following replaces the first sentence in Para- manager (if you are a corporation or other or- graph A.4.a., Transportation Expenses, of ganization); or SECTION III — PHYSICAL DAMAGE COVER- (e) Any "employee" authorized by you to give no- AGE: tice of the "accident'or"loss". We will pay up to $50 per day to a maximum of M. BLANKET WAIVER OF SUBROGATION $1,500 for temporary transportation expense in- The following replaces Paragraph A.5., Transfer curred by you because of the total theft of a cov- Of Rights Of Recovery Against Others To Us, ered "auto" of the private passenger type, of SECTION IV — BUSINESS AUTO CONDI- J. PERSONAL PROPERTY TIONS: The following is added to Paragraph AA., Cover- 5. Transfer Of Rights Of Recovery Against age Extensions, of SECTION III — PHYSICAL Others To Us DAMAGE COVERAGE: We waive any right of recovery we may have Personal Property against any person or organization to the ex- We will pay up to $400 for "loss" to wearing ap- tent required of you by a written contract signed and executed prior to any "accident' parel and other personal property which is: or"loss", provided that the "accident' or"loss" (1) Owned by an "insured"; and arises out of operations contemplated by CA T3 53 02 15 ®2015 The Travelers Indemnity Company.All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL AUTO such contract. The waiver applies only to the The unintentional omission of, or unintentional person or organization designated in such error in, any information given by you shall not contract. prejudice your rights under this insurance. How- N. UNINTENTIONAL ERRORS OR OMISSIONS ever this provision does not affect our right to col- The following is added to Paragraph B.2., Con- lect additional premium or exercise our right of cealment, Misrepresentation, Or Fraud, of cancellation or non-renewal. SECTION IV—BUSINESS AUTO CONDITIONS: C U :a �v R .w a.: ^Z U ti ti C Page 4 of 4 ©2015 The Travelers Indemnity Company.All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE Z v This endorsement modifies insurance provided under the following: f BUSINESS AUTO COVERAGE FORM PROVISIONS 2. The following is added to Paragraph 6.5., Other y 1. The following is added to Paragraph A.1.c., Who Insurance of SECTION IV — BUSINESS AUTO Is An Insured, of SECTION II — COVERED CONDITIONS.- AUTOS LIABILITY COVERAGE: Regardless of the provisions of paragraph a. and This includes any person or organization who you paragraph d. of this part 5. Other Insurance, this are required under a written contract or insurance is primary to and non-contributory with agreement between you and that person or applicable other insurance under which an organization, that is signed by you before the additional insured person or organization is the "bodily injury" or "property damage" occurs and first named insured when the written contract or that is in effect during the policy period, to name f agreement between you and that person or as an additional insured for Covered Autos organization, that is signed b *. 9 g y you before the Liability Coverage, but only for damages to which "bodily injury" or "property damage" occurs and this insurance applies and only to the extent of that is in effect during the policy period, requires that person's or organization's liability for the this insurance to be primary and non-contributory. conduct of another"insured". A ~,a ZZ 4 CA T4 74 02 16 a 2016 The Travelers Indemnity Company.All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.with its permission. UMBRELLA EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE THIS POLICY, IN PART, PROVIDES FOLLOW-FORM LIABILITY COVERAGE. COVERAGE WILL APPLY ON A CLAIMS-MADE BASIS WHEN FOLLOWING CLAIMS-MADE UNDERLYING INSURANCE. COVERAGE WILL APPLY ON A DEFENSE-WITHIN-LIMITS BASIS WHEN FOLLOWING UNDERLYING INSURANCE UNDER WHICH DEFENSE EXPENSES ARE PAYABLE WITHIN, AND NOT IN ADDITION TO, THE LIMITS OF INSURANCE. WHEN FOLLOWING SUCH UNDERLYING INSURANCE, PAYMENT OF DEFENSE EXPENSES UNDER THIS POLICY WILL REDUCE, AND MAY EXHAUST, THE LIMITS OF INSURANCE OF THIS POLICY. PLEASE READ THE ENTIRE POLICY CAREFULLY. Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy, the words "you" and "your" refer to the Named Insured shown in the Declarations and any other person or organization qualifying as a Named Insured under this policy. The words "we", "us" and "our" refer to the company providing this insurance. The word "insured" means any person or organization qualifying as such under SECTION II — WHO IS AN INSURED. Other words and phrases that appear in quotation marks have special meaning. Refer to SECTION VI — DEFINITIONS. SECTION I—COVERAGES provisions to the contrary contained in this A. COVERAGE A — EXCESS FOLLOW-FORM insurance. LIABILITY 3. The amount we will pay for damages is limited as described in SECTION III — LIMITS OF 1. We will pay on behalf of the insured those INSURANCE. sums, in excess of the "applicable underlying 4. For the purposes of Paragraph 1. above: limit", that the insured becomes legally obligated to pay as damages to which a. The applicable limit of insurance stated Coverage A of this insurance applies, for the policies of "underlying insurance" provided that the "underlying insurance" would in the Schedule Of Underlying Insurance apply to such damages but for the exhaustion will be considered to be reduced or of its applicable limits of insurance. If a exhausted only by the following sublimit is specified in any "underlying payments: insurance", Coverage A of this insurance (1) Payments of y judgments or applies to damages that are in excess of that settlements for damages that are sublimit only if such sublimit is shown for that covered by that "underlying "underlying insurance" in the Schedule Of insurance". However, if such Underlying Insurance. "underlying insurance" has a policy 2. Coverage A of this insurance is subject to the period which differs from the policy period of this Excess Follow-Form same terms, conditions, agreements, And Umbrella Liability Insurance, any exclusions and definitions as the "underlying insurance", except with respect to any such payments for damages that would not be covered by this Excess EU 00 01 07 16 0 2016 The Travelers Indemnity Company.All rights reserved. Page 1 of 22 UMBRELLA T. WAiVER OR TRANSFER OF RIGHTS OF provision does not affect our right to collect RECOVERY AGAINST OTHERS TO US additional premium or to exercise our rights of 1. If the insured has rights to recover all or part cancellation or nonrenewal in accordance with of any payment we have made under this applicable insurance laws or regulations. insurance, those rights are transferred to us W. WHEN LOSS IS PAYABLE and the insured must do nothing after loss to If we are liable under this insurance, we will pay impair them. At our request, the insured will for injury, damage or loss after: bring suit or transfer those rights to us and help us, and with respect to Coverage A, the 1. The insured's liability is established by: "underlying insurer", enforce them. a. A court decision; or If the insured has agreed in a contract or b. A written agreement between the agreement to waive that insured's right of claimant, the insured, an "under) recovery against any person or organization, insurer" and us, and y yin g we waive our right of recovery against that person or organization, but only for payments 2. The amount of the "applicable underlying we make because of an "event" that takes limit" or "self-insured retention" is paid by or place or is committed subsequent to the on behalf of the insured. execution of that contract or agreement by SECTION VI—DEFINITIONS such insured. 2. Reimbursement of any amount recovered will A. With respect to all coverages of this insurance: be made in the following order: 1. "Applicable underlying limit" means the sum of: a. First, to any person or organization a. The applicable limit of insurance stated (including us or the insured) who has paid for the policies of "underlying insurance" any amount in excess of the applicable in the Schedule Of Underlying Insurance limit of insurance; subject to the provisions in Paragraphs b. Next, to us, and 4.a.(1), (2) and (3) of COVERAGE A — c. Then, to any person or organization EXCESS FOLLOW-FORM LIABILITY of (including the insured and with respect to SECTION I—COVERAGES; and Coverage A, the "underlying insurer") that b. The applicable limit of insurance of any is entitled to claim the remainder, if any. "other insurance"that applies. 3. Expenses incurred in the process of recovery The limits of insurance in any policy of will be divided among all persons or "underlying insurance"will apply even if: organizations receiving amounts recovered according to the ratio of their respective a. The "underlying insurer" claims the recoveries. insured failed to comply with any term or U. TRANSFER OF YOUR RIGHTS AND DUTIES condition of the policy; or UNDER THIS INSURANCE b. The "underlying insurer" becomes 1. Your rights and duties under this insurance bankrupt or insolvent. may not be transferred without our written 2. "Auto hazard" means all "bodily injury" and consent except in the case of death of an "property damage" to which liability insurance individual Named Insured. afforded under an auto policy of "underlying 2. If you die, your rights and duties will be insurance" would apply but for the exhaustion transferred to your legal representative but of its applicable limits of insurance. only while acting within the scope of duties as 3, "Electronic data" means information, facts or your legal representative. Until your legal programs stored as or on, created or used on, representative is appointed, anyone having or transmitted to or from computer software proper temporary custody of your property will (including systems and applications software), have your rights and duties but only with hard or floppy disks, CD-ROMs, tapes, drives, respect to that property. cells, data processing devices or any other V. UNINTENTIONAL OMISSION OR ERROR media which are used with electronically The unintentional omission of, or unintentional controlled equipment. error in, any information provided by you which we 4. "Event" means an "occurrence", offense, relied upon in issuing this policy will not prejudice accident, act, error, omission, wrongful act or your rights under this insurance. However, this loss. Page 16 of 22 cJ 2016 The Travelers Indemnity Company.All rights reserved. EU 00 01 07 16