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HomeMy WebLinkAboutCAG2019-437 - Amendment - #1 - KPG, P.S. - Meet Me on Meeker Design Support Phase II - 06/5/2020ApprovalOriginator:Department: Date Sent:Date Required: Authorized to Sign: o Director or Designee o Mayor Date of Council Approval: Budget Account Number: Budget? o Yes o No Grant? o Yes o No Type:Review/Signatures/RoutingDate Received by City Attorney:Comments: Date Routed to the Mayor’s Office: Date Routed to the City Clerk’s Office:Agreement InformationVendor Name:Category: Vendor Number:Sub-Category: Project Name: Project Details: Agreement Amount: Start Date: Basis for Selection of Contractor: Termination Date: Local Business? o Yes o No* *If meets requirements per KCC 3.70.100, please complete “Vendor Purchase-Local Exceptions” form on Cityspace. Notice required prior to disclosure? o Yes o No Contract Number: Agreement Routing Form For Approvals, Signatures and Records Management This form combines & replaces the Request for Mayor’s Signature and Contract Cover Sheet forms. (Print on pink or cherry colored paper) Visit Documents.KentWA.gov to obtain copies of all agreementsadccW22373_1_20 AMENDMENT - 1 OF 2 AMENDMENT NO. 1 NAME OF CONSULTANT OR VENDOR: KPG, P.S. CONTRACT NAME & PROJECT NUMBER: Meet Me on Meeker ORIGINAL AGREEMENT DATE: October 8, 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 on-going support 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, including applicable WSST $15,114 Net Change by Previous Amendments including applicable WSST $0 Current Contract Amount including all previous amendments $15,114 Current Amendment Sum $4,969 Applicable WSST Tax on this Amendment $0 Revised Contract Sum $20,083 Original Time for Completion (insert date) 7t3t/20 Revised Time for Completion under prior Amendments (insert date) n/a Add'l Days Required (t) for this Amendment 0 calendar days Revised Time for Completion (insert date) 7/3u20 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 wíth 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: By -ø;<aénø 4"ó** Pri - C @siàiturei¡ nt Name: Elizabeth Gibson I fc Þrinninal I a seâne Architect 05127120 (title) DATE: KENT: Print Name DATE 2t) ATTEST: Kent City Clerk APPROVED AS TO FORM: (applicable ¡f Mayor's s¡gnature required) Kent Law Department KPG - l'4¡4O¡4 Amd l/Almaroof AMENDMENT-2OF2 MOMM Final Design – Amendment 1 City of Kent May 27, 2020 CITY OF KENT MEET ME ON MEEKER FINAL DESIGN CONTINUING SUPPORT Amendment 1 May 27, 2020 SCOPE OF WORK A. PROJECT DESCRIPTION/BACKGROUND KPG will provide on-going support to the City to allow for additional revisions to Meeker Street details and specifications. B. ASSUMPTIONS The following assumptions were identified to provide direction: Revisions to Meeker St standards and specifications will be based on comments and direction provided by the City. No team meetings are required, scope includes any necessary coordination required with the City, either by phone or virtual meeting. C. KPG DELIVERABLES PDF of updated details and specifications for review and final product. Electronic files (AutoCAD 2017) for Meeker Standard Details D. CITY OF KENT PROVIDED ITEMS: The City of Kent will provide/prepare the following: Submittal reviews, comments, and approvals (1 to 2 sets of comments per submittal). E. SCOPE OF WORK TASK 1 – MANAGEMENT / COORDINATION / ADMINISTRATION 1.1 The Consultant will provide continuous project management for the project duration of the project (estimate 1 month) and final invoicing. 1.2 The Consultant will provide internal quality assurance/quality control (QA/QC) reviews of all work products prior to submittal for City review. TASK 2 – UPDATE OF STANDARD CONSTRUCTION DETAILS AND SPECIFICATIONS 2.1 KPG shall provide updated Meeker St standard details, in response to redlines and comments from City staff. This includes one submittal for review and any additional minor revisions required by the City during the duration of the work. EXHIBIT A Exhibit A Hour and Fee Estimate Client: City of Kent Project: MOMM Final Design KPG PROJECT NUMBER: 19141 Amendment 1 DATE:May 27 2020 Task No. Task Description Urban Design Mgr Business Manager Project Land. Arch.Sr. Admin CAD Technician Landscape Technician Liz Gibson Suzy Rowe Coreen Schmidt, Phuong Nguyen Georgeanne Smith Mark McClure Judy Johnson Tristan Fields 166 150 128 115 100 92 Hours Fee 1.01 Project Management, Invoicing and Coordination (approx. 1 Months)2 1 1 4 597.00$ 1.04 QA/QC 2 4 6 844.00$ 4 1 4 1 0 0 10 1,441.00$ 2.01 Update Standard Details 4 8 20 32 3,528.00$ 4 0 8 0 0 20 32 3,528.00$ 8 1 12 1 0 20 42 4,969.00$ Task 1 - Project Management/Meetings and Coordination Task Total Total Hours and Labor Fee Estimate by Task Total Labor Hours and Fee Task 2 - Update of Standard Construction Details and Specifications Task Total Glient#: 1487397 KPGPS' ACORD* CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDTYYYY) 1t07t2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ON LY 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 ISSU|NG TNSURER(S), AUTHORTZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. the cert¡ficate hol der ts an U RED th e po icy(ies)m ust ADDITI ONAL IN SURED or be endorsed.tf s UBROGATI ON IS WAIVED su bj ect to the terms and conditions of the pol cy,certain po tc es may require an endorsement.A statement onthiscertificatedoesnotconfertothecertificateholdeftneuofsuchendorsem PRODUCER USI lnsurance Services NW PR 601 Union Street, Suite 1000 Seattle, WA 9810'l M 206 441-6300 61 0-362.8530 Seattle.PLCe r.com AFFORDING COVERAGE NAIC # INSURER A : Trav€ler3 lñdemnity Co of Amer¡cå 25666 INSURED KPG, P.S. fka KPG, lnc. 3131 Elliott Avenue, Suite 400 Seattle, WA 98121 INSURER B . Berkley Inaurañcê Company 32603 INSURER C . Chañer Oak Flre lnsurance Company 2561 5 INSURER D : INSURER E : INSURER F : COVERAGES GERTIFICATE NUMBER:REVISION NUMBER: rsTH IS FYCERTI TTHA THE POLICIES INSURANCEOF STEDLI BELOW HAVE ISSUEDBEEN THETO N SURED NAI\4ED FORABOVE POLICYTHE PERIODINDICATEDANDINOIWITHSTANYNGTERMREQUIREMENTCONDIOROFTIONCONTRACTANYOTHEORDOCUMERWITHNTTORESPECTTHWHICHùMACERTIFICATEBEYORISSUEDPERTMAYTHEAIN,AFFORDEDINSURANCE BY THE rcPOL DESCRIBEDIES HEREIN IS TOSUBJECT THEALL TERMS,ANDEXCLUS¡ONS OFCONDITIONS POLISUCH LIUIEò.ITSIV IVIAYSHOWN BEENHAVE BYREDUCED DPAI CLAIIVS TYPE OF INSURANCE POLICY NUMBER LIMITS EACH OCCURRENCE $1 $1 MED one PERSONAL & ADV INJURY ,l GENERAL AGGREGATE $2 PRODUCTS . COMP/OP AGG $00 A X COMMERCIAL GENERAL LIABILITY GEN'L AGGREGATE LIIVIT APPLIES PER: X OTHER: POLICY LOC CLAIMS-MADE OCCUR PRO- JECT X X 6809M677855 110'U2020 01t01t2021 $ 1 X BODILY INJURY (Per person)$ BODILY INJURY (Per acc¡dent)$ X X $ c AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON.OWNED AUTOS ONLY x X 849M680558 101t2020 01t01 $ EACH E $1 UMBRELLA LIAB EXCESS LIAB OCCUR CLAI AGGREGATE A DED X X cuP9M682435 1t0'U2020 01101t2021 PER X E.L. -EA 000 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNEFYEXECUTIVE OF FICEFYI\¡ E IVIBÊR EXCLUD ED? /N below in NH) under N/A X 6809M677855 (WA Stop Gap) 1101t2020 0110'11202 E,L, DISEASE -$1 B Professional Liability lncl: Pol X 4EC903396102 'U2020 01/01 $2,000,000 per claim $2,000,000 annl aggr OFDESCRIPTION TIONSOPERA LOCAIIONS VEHICLES 101,(ACORD RemarksAddlt¡onel bemaySchedule,attached more¡f tsspace requíred)RE PNKPG 91,|1 Meet onMe M4 eeker eTh LiGeneral ab and obilAutom Lia b¡l ctesitv ncl ude nitvpoli utom Adatic ditional nsured endo thatrsement ides Additional rednsuprov sstatu cto of whenitvKent,only ereth s writtena thatcontract ut sucres hreq nda onl withstatus,workto nvregardo beh ofalfperformed the named nsu Thered eraGen Liab and Automob Liabiileitv corcres nntai ialpollity endorseme ntspec with Nonand coPrimary wordi whenntributory ur red conwrittenngreq Thetract.neralGe Lby iab itv icypol edAttach(See )Descriptions SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE OELIVERED INACCORDANCE WITH THE POLICY PROVISIONS. City of Kent Attn: Nancy Yoshitake 220 Fourth Avenue South Kent, WA 98032-0000 AUTHORIZED REPRESENTATIVE Pf*'-- O 1988-2015 ACORD CORPORAT|ON. Ail r¡ghts reseryed The ACORD name and logo are registered marks of ACORD PYBZP ACORD 25 (2016/03) 1 of 2 #s27631547tM27627119 DESCRIPTIONS (Gontinued from Page 1) includes Separation of lnsureds Provision and Per Project Aggregate Limits. The General Liability (includes Employers Liability), Automobile Liability and Professional Liability policies include an endorsement providing that 30 days notice of cancellation will be given to the Gertificate Holder by the lnsurance Garrier. The Umbrella Liability policy is follow form to underlying General Liability policy. SAGITTA 25.3 (2016/03) 2 of 2 #s27631547tM27627119 Berkley lnsurance Company Page I of I Notice of cancellation to Gertificate Holder(s) Endorsement ln consideration of the premium paid for this Policy, it is understood and agreed that Section Vll, Conditions, H. Notice of Cancellation, is amended by adding the following provision: ln the event this Policy is to be cancelled by you or by us, we agree to give thirty (30) days prior not¡ce to the certificate holde(s) with mailing addresses on file with the agent of record. This provision does not apply if cancellation is due to nonpayment of premiums to us or to a finance company authorized to cancel this Policy. Any notification rights provided by this endorsement apply only to active certificate holder(s) who were issued a certificate of insurance applicable to the Policy Period stated in Declarations, ltem 2. Failure to provide such notice to the certificate holder(s) will not amend or extend the date the cancellation becomes effective, nor will it negate cancellation of the policy. Failure to send notice shall impose no liability of any kind upon us or our agents or representatives. Whenever printed in this Endorsement, lhe boldface type terms shall have lhe same meanings as indicated in the policy Form. All other provisions ofthe Policy remain unchanged. lnsured KPG PS dba KPG. lnc Policy Number -02 Effective Dale of This Endorsement 01t01t2020 Aulhorized Representative 3.8DP0713130 (07-13)26963-903396 1 -72104 Policy Form: 8DP0417001 (04-17) This page has been left blank intentionally Berkley Insurance Company Page 1 of 1 Amendatory Endorsement - Washington ln consideration of the premium paid for this Policy, it is understood and agreed that Section Vll. Conditions is amended as follows: H. Notice of cancellation and Nonrenewal is deleted and replaced with the following: H, Notice of Cancellation and Nonrenewal This Policy may be canceled by the Named lnsured identified in the Declarations, by notifying us or our authorized representative in one of the following ways: 1. surrender of the Policy; 2. written notice by mail, fax or email; or 3. verbal notice. Upon receipt of such notice, we will cancel this Policy effective on the later of: 1. the date on which notice is received or the Policy is surrendered, or 2. the date of cancellation requested by the lnsured. We will not cancel this Policy except for nonpayment of premium, fraud or material misrepresentation in procuring this insurance or in relation to any Claim, or changes in law affecting this Policy. lf we cancel this policy, we w¡Í mail or deliver written notice of cancellation to the fìrst Named lnsured, as weil as any other Insured, person or entity endorsed onto the Policy as having an interest in any Claim or Circumstance. The notice will include the reason for cancellation. We will provide you at least ten (10) days-notice before the effective date of cancellation if we cancel for nonpayment of premium. lf we cancel for any other reason, we will provide at least sixty (60) days- notice before the effective date of cancellation. lf this Policy is canceled, we will send the first Named lnsured any premium refund due. The refund will be pro rata. The cancellation will be effective even if we have not made or offered a refund. We will give the first Named Insured and any other Insured endorsed onto the Policy written notice sixty (60) daysprior to the expiration of this Policy if we do not intend to renew this insurance subjèct to any state requiiementi. The notice wlll include our reason for nonrenewal. Proof of mailing will be sufficient [roof of notice. J. Subrogation is deleted and replaced with the following: J. Subrogation ln the event of any payment under this Policy, we shall be subrogated to all of your rights of recovery against anyperson or organization. You must do everything reasonably necessary to secure sucñ rights and must ão notnin!after a Ctaim is made to jeopardize them. We -nereby waiv"e our subrógation rights againît a client of yours to theextent that you had, prior to a Claim or Circumstance, entered into a written agreemãnt to waive sucn'rignts. nnyrecovery shall first be paid to you to the extent of any Damages or Claim Expãnses paid by you and tné ¡alanceshall be paid to us. We will be entitled to recovery only after you have been fully comþénsated for the losssustained, including your deductible. Our right of subrogation will not exceed the -amount of our payment forDamages or Claim Expenses. 3 2 K. First Named lnsured as sole Agent is deleted and replaced with the following: K. First Named lnsured as Sole Agent The first Named lnsured ¡n ltem 1 of the Declarations will be the sole agent and will act on behalf of all lnsuredsfor the payment or return of premium, receipt and acceptance of any eñdorsements, notices or provisions of thisPolicy, giving notice of cancellation to us or our authorized representãtive, the payment of any deductibles, and toexercise the rights provided in section e Extended Reporting period option. Whenever printed in this Endorsement, the boldface type terms shall have the same meanings as indicated in the policy Form. All other provisions ofthe Policy remain unchanged. lnsured KPG PS dba KPG. lnc. Policy Number -02 Effective Date of This Endorsement 01t01t2020 Authorized Representative 4-8DP0713257 (07-13)21052-9033961-12104 Policy Form: 8DP0417001 (04-17) This page has been left blank intentionally COMMERCIAL AUTO POLICY: 849M680558 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM The following replaces Paragraph A.5., Transfer of Rights Of Recovery Against Others To Us, of the CONDITIONS Section: 5. Transfer Of Rights Of Recovery Against Oth- ers To Us We waive any right of recovery we may have against any person or organization to the extent required of you by a written contract executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of the operations contemplated by such contract. The waiver ap- plies only to the person or organization desig- nated in such contract. @ 2015 The Travelers lndemnity Company. All rights reserved. lncludes copyrighted material of lnsurance services office, lnc. with its permission cA T3 40 02 1s Page 1 of 1 This page has been left blank intentionally COMMERCIAL AUTO POLICY: BAgM680SSB THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLAN KET ADDITIONAL INSURED This endorsement modifies insurance provided under the following BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM The following is added to Paragraph c. in A.1., Who ls An lnsured, of SECTION ll - COVERED AUTOS LIABILITY COVERAGE in the BUSINESS AUTO COVERAGE FORM and Paragraph e. in 4.1., Who ls An lnsured, of SECTION ll - COVERED AUTOS LIABILITY COVERAGE in the MOTOR CARRIER COVERAGE FORM, whichever Coverage Form is part of your policy: This includes any person or organization who you are required under a written contract or agreement between you and that person or organization, that is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to name as an additional insured for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent of that person's or organization's liability for the conduct of another "insured". cA T4 37 02 16 @ 2016 The Travelers lndemnity Company. All rights reserved. lncludes copyrighted material of lnsurance services offlce,-lnc. with its permission. Page 1 of 1 This page has been left blank intentionally COMMERCIAL AUTO 849M680558 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON.CONTRIBUTORY WITH OTHER INSURANCE This endorsement modifies insurance provided under the following BUSINESS AUTO COVERAGE FORM PROVISIONS 1. The following is added to Paragraph 4.1.c., Whols An Insured, of SECTION ll - COVERED AUTOS LIABILITY COVERAGE: This includes any person or organization who you are required under a written contract or agreement between you and that person or organization, that is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to name as an additional insured for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent of that person's or organization's liability for the conduct of another "insured". 2. The following is added to Paragraph 8.5., Other Insurance of SECTION lV - BUSINESS AUTO CONDITIONS: Regardless of the provisions of paragraph a. and paragraph d. of this part 5. Other lnsurance, this insurance is primary to and non-contributory with applicable other insurance under which an additional insured person or organization is the first named insured when the written contract or agreement between you and that person or organization, that is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, requires this insurance to be primary and non-contributory. cA T4 74 02 16 O 2016 The Travelers lndemnity Company. All rights reserved. lncludes copyrighted mator¡al of lnsurancé services'office,-tnc. wirñ its permission Page 1 of 1 This page has been left blank intentionally COMMERCIAL AUTO POLICY ENDORSEMENT - CÀ T8 04 01 20 POIJICY NI'MBER BA-9M680558-20-GRP ** THrs ENDORSEMEMT cHANcEs THE PoLrcY. PLEASE RE.AÐ rT CÀREFUIJLY. ** NOTICE OF CAI.TCEI.IJÀTION IT IS AGREED TITÀT: THIS E¡{DORSEMENT CHANGES THE POLICY. PLEÀSE READ IT CÀREFULLY. DESIGNATED ENTTTY - NOTICE OF CÀI.ICEIJLÀTION PROVIDED BY US THIS ENDORSEMENT MODIFIES INSUR.AI{CE PROVIDED I'NDER THE FOIJIJOWING: ÀIJL COVERÀGE PARTS INCI.I'DED IN THIS POLICY SCHEDULE CÀI,ICEI¡I¡ATION: NIIMBER OF DÀYS NOTICE OF CAI{CELLÀTION: 30 PERSON OR ORGAI{IZÀTION: ÀI{Y PERSON OR ORGAIIIZATION TO I{IIOM YOU ITAVE AGREED IN À WRTTTEN CONTRÀCT THÀT NOTICE OF CÀI.ICELLÀTION OF THIS POIJICY WTIJL BE GIVEN, BUT ONI¡Y IF:1. YOU SE¡ID US À WRTTTEN REQUEST TO PROVIDE SUCH NOTICE, INCI.I'DING THE NA¡,ÍE ÀITD ADDRESS OF SUCH PERSON OR ORGAI{IZÀTION, ÀFTER THE FIRST NAIÍED INSURED SHOWN TN THE DEcLARÀTroNs REcErvEs NorrcE FROM us oF THE cÀNcELIJÀTroN OF THIS POLICY; Àl.ID2. wE RECETVE SUCH WRITTEN REQUEST ÀT LEÀST 14 DAYS BEFORE THE BEGINNING OF THE APPIJICÀBLE NT'MBER OF DAYS SHOWN INTHTS SCHEDULE. AÐDRESS: THE ÀÐDRESS FOR THAT PERSON OR ORGANIZÀTION INCI.I'DED IN SUCH WRITTEN REQUEST FROM YOU TO US. PROVISIONS:A. rF wE cAl'IcEL THrs PoIJrcY FoR ÀNv srÀTuroRrl.y pERMrrrED REASON OTHER THAN NONPAY-}ÍENT OF PREMIIIM WE WIIJIJ MAII¡ NOTTCE OF CÀ¡{CELIJATION TO THE PERSON OR ORGÀI.IIZATION SHOWN IN THE SCHEDULE ABOVE. WE WILLMAII¡ SUCH NOTICE TO THE .ADDRESS SHOWN IN THE SCHEDUI¡E ÀBOVE AT I,EÀST THE NT'¡IBER OF DÀYS SHOWN FOR CÀI.TCELLATION IN THE SCHEDULE ÀBOVE BEFORE THE EFFECTIVE DÀTE OF CÀ¡ICELI,ÀTTON.B. TF WE DECIDE TO NOT RENEW THIS POLICY FOR À}IT STATUTORILY PERMITTED REÀSON, ÀIiID A NT'MBER OF DÀYSIS SHOWN FOR NONRENEWAL IN THE SCHEDULE ÀBOVE, WEWILL MÀTL NOTICE OF THE NONRENETüÀIJ TO THE PERSON OR ORGÀI.TIZATION SHOWN IN THE SCHEDULE ÀBOVE. WE WILIJI,ÍÀIL SUCH NOTICE TO THE ÀÐDRESS SHOWN TN THE SCHEDUIJE ABOVE AT LE.AST THE NI'MBER OF DAYS SHOWN FOR NONRENE!{AIJ IN THE SCHEDUIJE ABOVE BEFORE THE EXPIRÀTION DÀTE. EFFECTIVE DATE O1-01-20 PÀGE OOO1 DÀTE OF ISSUE EXPIRATION DATE O]--01.-21 L2 - 31- t_9 This page has been left blank intentionally COMMERCIAL GENERAL LIABILITY POLICY: 6809M677855 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR ARCHITECTS, ENGINEERS AND SURVEYORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE - This endorsement broadens coverage. However, coverage forany injury, damage or medical expenses described in any of the provisions of in¡s endorsement mãy be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening proviéions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following ìisting is ageneral coverage description only. Read all the provisions of this endorsement and the rest of your fiolicycarefully to determine rights, duties, and what is and is not covered. A. Non-Owned Watercraft - 75 Feet Long Or Less B. Who ls An lnsured - Unnamed Subsidiaries C. Who ls An lnsured - Retired Partners, Members, Directors And Employees D. Who ls An lnsured - Employees And Volunteer Workers - Bodily lnjury To Co-Employees, Co- Volunteer Workers And Retired Partners, Members, Directors And Employees E. Who ls An lnsured - Newly Acquired Or Formed Limited Liability Companies F. Blanket Additional lnsured - Controlling lnterest G. Blanket Additional lnsured Mortgagees, Assignees, Successors Or Receivers PROVISIONS A. NON.OWNED WATERCRAFT 75 FEET LONG OR LESS 1. The following replaces paragraph (2') of Exclusion 9., Aircraft, Auto Or Watercraft,in Paragraph 2. of SECTTON | - COVERAGES - COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY: (2) A watercraft you do not own that is: (a) 75 feet long or less; and (b) Not being used to carry any person or property for a charge; 2. The following replaces paragraph 2.e. of SECTION II - WHO IS AN INSURED: e. Any person or organization that, with your express or implied consent, either H. Blanket Additional lnsured Governmental Entities - Permits Or Authorizations Relating To Premises l. Blanket Additional lnsured Governmental Entities - Permits Or Authorizations Relating To Operations J. lncidental Medical Malpractice K. Medical Payments - lncreased Limit L. Amendment Of Excess lnsurance Condition -Professional Liability M. Blanket Waiver Of Subrogation - When Required By Written Contract Or Agreement N. Contractual Liability - Railroads uses or is responsible for the use of a watercraft that you do not own that is: (1') 75 feet long or less; and (2) Not being used to carry any person or property for a charge; B. WHO IS AN INSURED UNNAMED SUBSIDIARIES The following is added to SECTTON lt - WHO tS AN INSURED: Any of your subsidiaries, other than a partnership or joint venture, that is not shown as a Named lnsured in the Declarations is a Named lnsured if: a. You are the sole owner of, or maintain an ownership interest of more than 50% in, such subsidiary on the first day of the policy period; and cG D3 79 02 19 @2017 The Travelers lndemnity Company. A¡l rights reserved.lncludes copyrighted material of lnsurance services office, tnc. with its permission Page 1 of 6 COMMERCIAL GENERAL LIABILITY b. Such subsidiary is not an insured under similar other insurance. No such subsidiary is an insured for "bodily injury" or "property damage" that occurred, or "personal and advertising injury" caused by an offense committed: a. Before you maintained an ownership interest of more than 50% in such subsidiary; or b. After the date, if any, during the policy period that you no longer maintain an ownership interest of more than 50% in such subsidiary. For purposes of Paragraph 1. of Section ll- Who ls An lnsured, each such subsidiary will be deemed to be designated in the Declarations as: a. A limited liability company; b. An organization other than a partnership, joint venture or limited liability company; or c. A trust; as indicated in its name or the documents that govern its structure. C. WHO IS AN INSURED _ RETIRED PARTNERS, MEMBERS, DIRECTORS AND EMPLOYEES The following is added to Paragraph 2. of SECT¡ON II - WHO IS AN INSURED: Any person who is your retired partner, member, director or "employee" that is performing services for you under your direct supervision, but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. However, no such retired partner, member, director or "employee" is an insured for: (1) "Bodily injury": (a) To you, to your current partners or members (if you are a partnership or joint venture), to your current members (if you are a limited liability company) or to your current directors; (b) To the spouse, child, parent, brother or sister of that current partner, member or director as a consequence of Paragraph (1)(a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraph (1Xa) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. Unless you are in the business or occupationof providing professional health care services, Paragraphs (1Xa), (b), (c) and (d) above do not apply to "bodily injury" arising out of providing or failing to provide first aid or "Good Samaritan services" by any of your retired partners, members, directors or "employees", other than a doctor. Any such retired partners, members, directors or "employees" providing or failing to provide first aid or "Good Samaritan services" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. (2) "Personal injury": (a) To you, to your current or retired partners or members (if you are a partnership or joint venture), to your current or retired members (if you are a limited liability company), to your other current or retired directors or "employees" while in the course of his or her employment or performing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of that current or retired partner, member, director, "employee" or "volunteer worker" as a consequence of Paragraph (2Xa) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraph (2Xa) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. (3) "Property damage" to property: (a) Owned, occupied or used by; or (b) Rented to, in the care, custody or control of, or over which physical control is being exercised for any purpose by; you, any of your retired partners, membersor directors, your current or retired "employees" or "volunteer workers", any current partner or member (if you are a partnership or joint venture), or any current member (if you are a limited liability company) or current director. @2017 The Travelers lndemnity Company. All rights reserved. lncludes copyrighted material of lnsurance Services Office, lnc. with its permission. Page 2 of 6 cG D3 790219 D. WHO IS AN INSURED - EMPLOYEES AND VOLUNTEER WORKERS - BODILY INJURYTO CO.EMPLOYEES, CO-VOLUNTEER WORKERS AND RETIRED PARTNERS, MEMBERS, DIRECTORS AND EMPLOYEES The following is added to Paragraph 2.a.(t) of SECTION II - WHO IS AN INSURED: Paragraphs (lXa), (b) and (c) above do not apply to "bodily injury" to a current or retired co- "employee" while in the course of the co- "employee's" employment by you or performing duties related to the conduct of your business, orto "bodily injury" to your other "volunteer workers" or retired partners, members or directors while performing duties related to the conduct of your business. E. WHO tS AN TNSURED - NEWLY ACQUTRED OR FORMED LIMITED LIABILITY COMPANIES The following replaces Paragraph 3. of SECTION II - WHO IS AN INSURED: 3. Any organization you newly acquire or form, other than a partnership or joint venture, and of which you are the sole owner or in which you maintain an ownership interest of more than 50%, will qualify as a Named tnsured if there is no other similar insurance available to that organization. However: a. Coverage under this provision is afforded only: (1) Until the 180th day after you acquire or form the organization or the end ofthe policy period, whichever is earlier, if you do not report such organization in writing to us within '180 days after you acquire or form it; or (2) Until the end of the poticy period, when that date is later than 180 days after you acquire or form such organization, if you report such organization in writing to us within 180 days after you acquire or form it; b. Coverage A does not apply to "bodilyinjury" or "property damage', that occurred before you acquired or formed the organization; and c. Coverage B does not apply to ',personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. For the purposes of paragraph 1. of Sectionll - Who ls An lnsured, each such COMMERCIAL GENERAL LIABILITY organization will be deemed to be designated in the Declarations as: a. A limited liability company; b. An organization other than a partnership, joint venture or limited liability company; or c. A trust; as indicated in its name or the documents that govern its structure. F. BLANKET ADDITIONAL INSURED CONTROLLING INTEREST 1. The following is added to SECTTON il - WHO IS AN INSURED: Any person or organization that has financial control of you is an insured with respect to liability for "bodily injury", "property damage"or "personal and advertising injury,, that arises out of: a. Such financial control; or b. Such person's or organization's ownership, maintenance or use of premises leased to or occupied by you. The insurance provided to such person or organization does not apply to structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. 2. The following is added to paragraph 4. of SECTIO N II - WHO IS AN INSURED: This paragraph does not apply to any premises owner, manager or lessor that has financial control of you. G. BLANKET ADDITIONAL INSURED MORTGAGEES, ASSIGNEES, SUCCESSORS OR RECEIVERS The following is added to SECTTON il - WHO tS AN INSURED: Any person or organization that is a mortgagee, assignee, successor or receiver and that you have agreed in a written contract or agreementto include as an additional insured on this Coverage Part is an insured, but only with respect to its liability as mortgagee, assignee, successor or receiver for "bodily injury", "property damage" or "personal and advertising inju4/' that: a. ls "bodily injury" or ,'property damage', that occurs, or is "personal and advertising injury" caused by an offense that is committed, CG D3 79 02 19 @ 2017 The Travelers lndemnity Company. Ail r¡ghts reserved.lncludes copyr¡ghted material of lnsurance services'office,-lnc. with ¡ts permiss¡on Page 3 of 6 COMMERCIAL GENERAL LIABILITY subsequent to the signing of that contract or agreement; and b. Arises out of the ownership, maintenance or use of the premises for which that mortgagee, assignee, successor or receiver is required under that contract or agreement to be included as an additional insured on this Coverage Part. The insurance provided to such mortgagee, assignee, successor or receiver is subject to the following provisions: a. The limits of insurance provided to such mortgagee, assignee, successor or receiver will be the minimum limits that you agreed to provide in the written contract or agreement, or the limits shown in the Declarations, whichever are less. b. The insurance provided to such person or organization does not apply to: (1) Any "bodily injury" or "property damage" that occurs, or any "personal and advertising injury" caused by an offense that is committed, after such contract or agreement is no longer in effect; or (2) Any "bodily injury", "property damage" or "personal and advertising injury" arising out of any structural alterations, new construction or demolition operations performed by or on behalf of such mortgagee, assignee, successor or receiver. H. BLANKET ADDITIONAL INSURED GOVERNMENTAL ENTITIES - PERMITS OR AUTHORIZATIONS RELATING TO PREMISES The following is added to SECTION ll - WHO lS AN INSURED: Any governmental entity that has issued a permit or authorization with respect to premises owned or occupied by, or rented or loaned to, you and that you are required by any ordinance, law, building code or written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of the existence, ownership, use, maintenance, repair, construction, erection or removal of any of the following for which that governmental entity has issued such permit or authorization: advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, elevators, street banners or decorations. I. BLANKET ADDITIONAL INSURED GOVERNMENTAL ENTITIES PERMITS OR AUTHORIZATIONS RELATING TO OPERATIONS The following is added to SECTION ll - WHO lS AN INSURED: Any governmental entity that has issued a permit or authorization with respect to operations performed by you or on your behalf and that you are required by any ordinance, law, building code or written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of such operations. The insurance provided to such governmental entity does not apply to: a. Any "bodily injury", "property damage" or "personal and advertising injury" arising outof operations performed for the governmental entity; or b. Any "bodily injury" or "property damage" included in the "products-completed operations hazard". J. INCIDENTAL MEDICAL MALPRACTICE 1. The following replaces Paragraph b. of the definition of "occurrence" in the DEFINITIONS Section: b. An act or omission committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to a person, unless you are in the business or occupation of providing professional health care services. 2. The following replaces the last paragraph of Paragraph 2.a.(1) of SECTION ll - WHO lS AN INSURED: Unless you are in the business or occupationof providing professional health care servíces, Paragraphs (1Xa), (b), (c) and (d) above do not apply to "bodily injury" arising out of providing or failing to provide: (a) "lncidental medical services" by any of your "employees" who is a nurse, nurse assistant, emergency medical technician, paramedic, athletic trainer, audiologist, dietician, nutritionist, O 2017 The Travelers lndemnity Company. All rights reserved. lncludes copyrighted material of lnsurance Services Office, lnc. with its permission Page 4 of 6 cG D3 79 02 19 occupational therap¡st or occupational therapy assistant, physical therapist or speech-language pathologist; or (b) First aid or "Good Samaritan services" by any of your "employees" or "volunteer workers", other than an employed or volunteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first aid or "Good Samaritan services" during their work hours for you will be deemed to be acting within the scope of their employment by you or pedorming duties related to the conduct of your business. 3. The following replaces the last sentence of Paragraph 5. of SECTION tlt - LtMtTS OF INSURANCE: For the purposes of determining the applicable Each Occurrence Limit, all related acts or omissions committed in providing orfailing to provide "incidental medical services", first aid or "Good Samaritan services" to any one person will be deemed to be one "occurrence". 4. The following exclusion is added to Paragraph 2., Exclusions, of SECTION I - COVERAGES - COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury" or "property damage" arising out of the violation of a penal statute or ordinance relating to the sale of pharmaceuticals committed by, or with the knowledge or consent of the insured. 5. The following is added to the DEFtNtTtoNs Section: "lncidental medical services" means: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment,'advice or instruction, or the related furnishing of food or beverages; or b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. 6. The following is added to paragraph 4.b., Excess lnsurance, of SECTION lV COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any valid and collectible other insurance, whether primary, , excess, contingent or on any other basis, COMMERCIAL GENERAL LIABILITY that is available to any of your "employees" for "bodily injury" that arises out of providing or failing to provide "incidental medical services" to any person to the extent not subject to Paragraph 2.a.(1) of Section il - Who ls An lnsured. K. MEDICAL PAYMENTS - INCREASED LIMIT The following replaces Paragraph 7. of SECTION III- LIMITS OF INSURANCE: 7. Subject to Paragraph 5. above, the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury" sustained by any one person, and will be the higher of: a. $10,000; or b. The amount shown in the Declarations of this Coverage Part for Medical Expense Limit. L. AMENDMENT OF EXCESS ]NSURANCE CONDITION _ PROFESSIONAL LIABILITY The following is added to paragraph 4.b., Excess Insurance, of SECTION lV COMMERCIAL GENERAL LIABILIW CONDITIONS: This insurance is excess over any of the other insurance, whether primary, excess, contingentor on any other basis, that is professional Liability or similar coverage, to the extent the loss is not subject to the professional services exclusion of Coverage A or Coverage B. M. BLANKET WAIVER OF SUBROGATION WHEN REQUIRED BY WRITTEN CONTRACT OR AGREEMENT The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION lV - COMMERCTAL GENERAL LIABILITY CONDITIONS: lf the insured has agreed in a written contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of: a. "Bodily injury" or "property damage', that occurs; or b. "Personal and advertising injury" caused by an offense that is committed; subsequent to the signing of that contract or agreement. cG D3 79 02 19 @2017 The Travelers lndemnity Company. All rights reserved. lncludes copyrighted material of lnsurance services office, lnc. with its permission. Page 5 of 6 COMMERCIAL GENERAL LIABILITY N. CONTRACTUAL LIABILITY - RAILROADS 1. The following replaces Paragraph c. of the definition of "insured contract" in the DEFINITIONS Section: c. Any easement or license agreement; 2. Paragraph f.(1) of the definition of "insured contract" in the DEFINITIONS Section is deleted. @ 2017 The Travelers lndemnity Company. All rights reserved. lncludes copyrighted material of lnsurance Services Office, lnc. with ¡ts permission. Page 6 of 6 cG D3 79 02 19 COMMERCIAL GENERAL LIABILITY ISSUE DATE:12/31/2019POLICY NUMBER: 680-9M677855 -2O- 47 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TOTAL AGGREGATE LIMIT OTHER THAN PROJECTS AND DESIGNATED PROJECT AND LOCATION AGGREGATE LIMITS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE - LIMITS OF INSURANCE AND DESIGNATED PROJECTS AND LOCATIONS LIMITS OF INSURANCE Total Aggregate Limit $ 8, 000, OO0 (Other Than Projects and Products-Completed Operations) Designated Location Aggregate Limit $ 2 ,000, 000 (Other Than Products-Completed Operations) Designated Project Aggregate Limit $ 2 , 000, 000 (Other Than Products-Completed Operations) General Aggregate Limit $ 2,000, OOO (Other Than Products-Completed Operations) Designated Projects: Each "project" for which you have agreed, in a written contract whichis in effect during this policy period, to provide a separate GeneralAggregate Limit, provided that the contract ¡s siqned by you beforethe "bodi ly injury" or "property damage" occurs. Designated Locations:All locations l¡sted in ltem 3. of the common policy Declarations orin any Master Pac Account Exposure Endorsement ¡nclúoed in thispol icy. PROVISIONS 1. The General Aggregate Limit (Other Than Products-Completed Operations) shown in the Declarations is replaced by the Limits of lnsurance shown in the Schedule - Limits Oflnsurance And Designated projects And Locations. 2. The following replaces paragraph 1. of SECTTON III_ LIMITS OF INSURANCE: 1. The Limits of lnsurance shown in the Declarations or the Schedule - Limits Of lnsurance And Designated projects And Locations, whichever apply, and the rules below fix the most we will pay regardless of the number of: a. lnsureds; b. Claims made or "suits" brought; cG D4 69 02 19 @ 2017 f he Travelers lndemnity Company. All rights reserved. lncludes copyrighted mater¡al of lnsurance servicesoff¡ce, lnc. witn its permission. Page '1 of 3 COMMERCIAL GENERAL LIABILITY 3. c. Persons or organizations making claims or bringing "suits"; or d. "Projects" or "locations". The following replaces Paragraph 2. of SECTION III- LIMITS OF INSURANCE: 2. a. The Total Aggregate Limit shown in the Schedule - Limits Of lnsurance And Designated Projects And Locations is the most we will pay for the sum of all amounts under the Designated Location Aggregate Limit and all amounts underthe General Aggregate Limit. This includes: (1) Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard"; (2) Damages under Coverage B; and (3) Medical expenses under Coverage C. b. The Designated Project Aggregate Limit shown in the Schedule Limits Of lnsurance And Designated Projects And Locations applies and is further subject to all of the following provisions: (1) The Designated Project Aggregate Limit is the most we will pay for the sum of: (a) Damages under Coverage A because of "bodily injury" and "property damage" caused by "occurrences"; and (b) Medical expenses under Coverage C for "bodily injury" caused by accidents; that can be attributed only to operations at a single "project". (2) The Designated Project Aggregate Limit applies separately to each "project". (3) The Designated Project Aggregate Limit does not apply to damages because of "bodily injury" or "property damage" included in the "products- completed operations hazard". lnstead, the Products-Completed Operations Aggregate Limit described in Paragraph 3. below applies to such damages. (4) The Designated Project Aggregate Limit does not apply to damages under Coverage B. lnstead, the General Aggregate Limit described in Paragraph 2.d. below applies to such damages. (5) Any payments made for damages or medical expenses to which the Designated Project Aggregate Limit applies will reduce the Designated Project Aggregate Limit for the applicable "project". Such payments will not reduce the Total Aggregate Limit, the General Aggregate Limit described in Paragraph 2.d. below, the Designated Project Aggregate Limit for any other "project" or the Designated Location Aggregate Limit. c. Subject to the Total Aggregate Limit described in Paragraph 2.a. above, the Designated Location Aggregate Limit shown in the Schedule Limits Of lnsurance And Designated Projects And Locations applies and is further subject to all of the following provisions: (1) The Designated Location Aggregate Limit is the most we will pay for the sum of: (a) Damages under Coverage A because of "bodily injury" and "property damage" caused by "occurrences"; and (b) Medical expenses under Coverage C for "bodily injury" caused by accidents; that can be attributed only to operations at a single "location". (2) The Designated Location Aggregate Limit applies separately to each "location". (3) The Designated Location Aggregate Limit does not apply to damages because of "bodily injury" or "property damage" included in the "products- completed operations hazard". lnstead, the Products-Completed Operations Aggregate Limit described in Paragraph 3. below applies to such damages. (4) The Designated Location Aggregate Limit does not apply to damages under Coverage B. lnstead, the General Aggregate Limit described in @ 20'17 The Travelers lndemnity Company. All rights reserved. lncludes copyrighted material of lnsurance Services Office, lnc. with its permission Page 2 of 3 cG D4 69 02 19 Paragraph 2.d. below applies to such damages. (5) Any payments made for damages or medical expenses to which the Designated Location Aggregate Limit applies will reduce: (a) The TotalAggregate Limit; and (b) The Designated Location Aggregate Limit for the applicable "location". Such payments will not reduce the General Aggregate Limit described in Paragraph 2.d. below, the Designated Project Aggregate Limitor the Designated Location Aggregate Limit for any other "location". d. Subject to the Total Aggregate Limit described in Paragraph 2.a. above, the General Aggregate Limit shown in the Schedule - Limits Of lnsurance And Designated Projects And Locations applies and is further subject to all of the following provisions: (1) The General Aggregate Limit is the most we will pay for the sum of: (a) Damages under Coverage A because of "bodily injury" and "property damage" caused by "occurrences", and medical expenses under Coverage C for"bodily injury" caused by accidents, that cannot be attributed only to operations at asingle "project" or a single "location"; and (b) Damages under Coverage B. (2) The General Aggregate Limit doesnot apply to damages for "bodily injury" or "property damage" includedin the "products-completed oper-ations hazard". lnstead, the Products-Completed Operations Aggregate Limit described in Paragraph 3. below applies to such damages. (3) Any payments made for damages or medical expenses to which the COMMERCIAL GENERAL LIABILITY General Aggregate Limit applies will reduce: (a) The TotalAggregate Limit; and (b) The GeneralAggregate Limit. Such payments will not reduce the Designated Project Aggregate Limit for any "project" or the Designated Location Aggregate Limit for any "location". 4. The following replaces Paragraph 3. of SECTTON III- LIMITS OF INSURANCE: 3. The Products-Completed Operations Aggre- gate Limit shown in the Declarations is the most we will pay under Coverage A for damages because of "bodily injury" or "property damage" included in the "products- completed operations hazard". Any payments made for such damages will not reduce the Total Aggregate Limit, the General Aggregate Limit, the Designated Project Aggregate Limit for any "project" or the Designated Location Aggregate Limit for any "location". 5. The following is added to the DEFtNtTtONS Section: "Location" means any designated location shown in the Schedule - Limits Of lnsurance And Designated Projects and Locations that is ownedby or rented to you. For the purposes of determining the applicable aggregate limit of insurance, each "location" that includes a premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway or waterway, or by a right-of- way of a railroad, will be considered a single "location". "Project" means any designated project shown inthe Schedule Limits Of lnsurance And Designated Projects And Locations that is away from premises owned by or rented to you and at which you are performing operations pursuant toa contract or agreement. For the purposes of determining the applicable aggregate limit of insurance, each "project', that includes a premises involving the same or connecting lots, or premises whose connection is interrupted only bya street, roadway or waterway, or by a right-of- way of a railroad, will be considered a single "project". cG D4 69 02 19 @ 20'17 The Travelers lndemnity Company. All rights reserved.lncludes copyrighted material of lnsurance services-office, lnc. with its permission Page 3 of 3 This page has been left blank intentionally COMMERCIAL GENERAL LIABILITY POLICY: 6809M677855 COMMERCIAL GENERAL LIABILITY COVERAGE FORM 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 lnsured shown in the Declarations, and any other person or organization qualifying as a Named lnsured 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 ll - Who ls An lnsured. Other words and phrases that appear in quotation marks have special meaning. Refer to Section V - Definitions. SECTION I- COVERAGES COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY 1. lnsuring Agreement a. We will pay those sums that the insured becomes legally obligated to pay as damages because of "bodily injury" or "property damage" to which this insurance applies. We will have the right and duty to defend the insured against any "suit" seeking those damages. However, we will have no duty to defend the insured against any "suit" seeking damages for "bodily injury" or "property damage" to which this insurance does not apply. We may, at our discretion, investigate any "occurrence" and settle any claim or "suit" that may result. But: (1) The amount we will pay for damages is limited as described in Section ill - Limits Of lnsurance; and (2) Our right and duty to defend end when we have used up the applicable limit of insurance in the payment of judgments or settlements under Coverages A or B or medical expenses under Coverage C. No other obligation or liability to pay sums or perform acts or services is covered unless explicitly provided for under Supplementary Payments. b. This insurance applies to "bodily injury" and "property damage" only if: (1) The "bodily injury" or "property damage" is caused by an "occurrence" that takes place in the "coverage territory"; (2) The "bodily injury" or "property damage" occurs during the policy period; and (3) Prior to the policy period, no insured listed under Paragraph 1. of Section ll - Who ls An lnsured and no "employee" authorized by you to give or receive notice of an "occurrence" or claim knew that the "bodily injury" or "property damage" had occurred, in whole or in part. lf such a listed insured or authorized "employee" knew, prior to the policy period, that the "bodily injury" or "property damage" occurred, then any continuation, change or resumption of such "bodily injury" or "property damage" during or after the policy period will be deemed to have been known prior to the policy period. c. "Bodily injury" or "property damage" which occurs during the policy period and was not, prior to the policy period, known to have occurred by any insured listed under paragraph 1. of Section ll - Who ls An lnsured or any "employee" authorized by you to give or receive notice of an "occurrence" or claim, includes any continuation, change or resumption of that "bodily injury" or "property damage" after the end of the policy period. d. "Bodily injury" or "property damage', will be deemed to have been known to have occurred at the earliest time when any insured listed under Paragraph 1. of Section ll - Who ls An lnsured or any "employee" authorized by you to give or receive notice of an "occurrence', or claim: (1) Reports all, or any part, of the "bodily injury" or "property damage" to us or any other insurer; @ 2017 The Travelers lndemnity Company. All rights reserved. lncludes copyr¡ghted material of lnsurance services office, lnc. w¡th its permission (2) Receives a written or verbal demand or claim for damages because of the "bodily injury" or "property damage"; or (3) Becomes aware by any other means that "bodily injury" or "property damage" has occurred or has begun to occur. cG T1 00 02 19 Page 'l of 21 venture or limited liability company that is not shown as a Named lnsured in the Declarations. This paragraph does not apply to any such partnership, joint venture or limited liability company that otherwise qualifies as an insured under Section lt - Who ls An lnsured. SECTION III- LIMITS OF INSURANCE 1. The Limits of lnsurance shown in the Declarations and the rules below fix the most we will pay regardless of the number of: a. lnsureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 2. The General Aggregate Limit is the most we will pay for the sum of: a. Medical expenses under Coverage C; b. Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard"; and c. Damages under Coverage B. 3. The Products-Completed Operations Aggregate Limit is the most we will pay under Coverage A for damages because of "bodily injury" and "property damage" included in the "products-completed operations hazard". 4. Subject to Paragraph 2. above, the Personal And Advertising lnjury Limit is the most we will pay under Coverage B for the sum of all damages because of all "personal injury" and "advertising injury" sustained by any one person or organization, 5. Subject to Paragraph 2. or 3. above, whichever applies, the Each Occurrence Limit is the most we will pay for the sum of: a. Damages under Coverage A; and b. Medical expenses under Coverage C; because of all "bodily injury" and "property damage" arising out of any one "occurrence". For the purposes of determining the applicable Each Occurrence Limit, all related acts or omissions committed in providing or failing to provide first aid or "Good Samaritan services" to any one person will be deemed to be one "occurrence". 6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "premises damage" to any one premises. The Damage To Premises Rented To You Limit will be: COMMERCIAL GENERAL LIABILITY a. The amount shown for the Damage To Premises Rented To You Limit in the Declarations of this Coverage Part; or b. $300,000 if no amount is shown for the Damage To Premises Rented To You Limit in the Declarations of this Coverage Part. 7. Subject to Paragraph 5. above, the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury" sustained by any one person. The Limits of lnsurance of this Coverage Part apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. ln that case, the additional period will be deemed part of the last preceding period for purposes of determining the Limits of lnsurance. SECTION IV _ COMMERCIAL GENERAL LIABILITY CONDITIONS 1. Bankruptcy Bankruptcy or insolvency of the insured or of the insured's estate will not relieve us of our obligations under this Coverage Part. 2. Duties ln The Event Of Occurrence, Offense, Claim Or Suit a. You must see to it that we are notified as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occurrence" or offense took place; (2) The names and addresses of any injured persons and witnesses; and (3) The nature and location of any injury or damage arising out of the "occurrence" or offense. b. lf a claim is made or "suit" is brought against any insured, you must: (1) lmmediately record the specifics of the claim or "suit" and the date received; and (2) Notify us as soon as practicable. You must see to it that we receive written notice of the claim or "suit" as soon as practicable. c. You and any other involved insured must: (1) lmmediately send us copies of any demands, notices, summonses or legal papers received in connection with the claim or "suit"; @ 2017 The Travelers lndemnity Company. All rights reserved. lncludes copyrighted material of lnsurance Services Office, lnc. with its permission. cG T1 00 02 19 Page 13 of 21 COMMERCIAL GENERAL LIABILITY (2) Authorize us to obtain records and other information; (3) Cooperate with us in the investigation or settlement of the claim or defense against the "suit"; and (4) Assist us, upon our request, in the enforcement of any right against any person or organization which may be liable to the insured because of injury or damage to which this insurance may also apply. d. No insured will, except at that insured'ò own cost, voluntarily make a payment, assume any obligation, or incur any expense, other than for first aid, without our consent. e. The following provisions apply to Paragraph a. above, but only for purposes of the insurance provided under this Coverage Part to you or any insured listed in Paragraph 1. or 2. of Section ll - Who ls An lnsured: (1) Notice to us of such "occurrence" or offense must be given as soon as practicable only after the "occurrence" or offense is known to you (if you are an individual), any of your partners or members who is an individual (if you are a partnership or joint venture), any of your managers who is an individual (if you are a limited liability company), any of your "executive officers" or directors (if you are an organization other than a partnership, joint venture, or limited liability company), any of your trustees who is an individual (ifyou are a trust) or any "employee" 3. authorized by you to give notice of an "occurrence" or offense. (2) lf you are a partnership, joint venture, limited liability company or trust, and noneof your partners, joint venture members, managers or trustees are individuals, notice to us of such "occurrence" or offense must be given as soon as practicable only after the "occurrence" or offense is known by: (a) Any individualwho is: (i) A partner or member of partnership or joint venture; (ii) A manager of any limited liabitity company; (iii) An executive officer or director of any other organization; or (iv) A trustee of any trust; that is your partner, joint venture member, manager or trustee; or (b) Any employee authorized by such partnership, joint venture, limited liability company, trust or other organization to give notice of an "occurrence" or offense. (3) Notice to us of such "occurrence" or offense will be deemed to be given as soon as practicable if it is given in good faith as soon as pract¡cable to your workers' compensation insurer. This applies only if you subsequently give notice to us of the "occurrence" or offense as soon as practicable after any of the persons described in Paragraph e.(1) or (2) above discovers that the "occurrence" or offense may result in sums to which the insurance provided under this Coverage Part may apply. However, if this policy includes an endorsement that provides limited coverage for "bodily injury" or "property damage" or pollution costs arising out of a discharge, release or escape of "pollutants" which contains a requirement that the discharge, release or escape of "pollutants', must be reported to us within a specific number of days after its abrupt commencement, this Paragraph e. does not affect that requirement. Legal Action Against Us No person or organization has a right under this Coverage Part: a. To join us as a party or otherwise bring us into a "suit" asking for damages from an insured; or b. To sue us on this Coverage part unless all of its terms have been fully complied with. A person or organization may sue us to recover on an agreed settlement or on a final judgment against an insured; but we will not be liable for damagesthat are not payable under the terms of this Coverage Part or that are in excess of the applicable limit of insurance. An agreed settlement means a settlement and release of liability signed by us, the insured, and the claimant or the claimant's legal representative. any @ 2017 The Travelers lndemnity Company. All rights reserved. lncludes copyrighted material of lnsurance services office, lnc. with its permission Page 14 of 21 cG T1 00 02 19 4. Other lnsurance lf valid and collectible other insurance is available to the insured for a loss we cover under Coverages A or B of this Coverage Part, our obligations are limited as described ín Paragraphs a. and b. below. As used anywhere in this Coverage Part, other insurance means insurance, or the funding of losses, that is provided by, through or on behalf of: (i) Another insurance company; (ii) Us or any of our affiliated insurance companies, except when the Non cumulation of Each Occurrence Limit provision of Paragraph 5. of Section lll - Limits Of lnsurance or the Non cumulation of Personal and Advertising lnjury Limit provision of Paragraph 4. of Section lll -Limits of lnsurance applies because theAmendment Non Cumulation Of Each Occurrence Limit Of Liability And Non Cumulation Of Personal And Advertising lnjury Limit endorsement is included in this policy; (iii) Any risk retention group; or (iv)Any self-insurance method or program, in which case the insured will be deemed to be the provider of other insurance. Other insurance does not include umbrella insurance, or excess insurance, that was bought specifically to apply in excess of the Limits of lnsurance shown in the Declarations of this Coverage Part. As used anywhere in this Coverage Part, other insurer means a provider of other insurance. As used in Paragraph c. below, insurer means a provider of insurance. a. Primary lnsurance This insurance is primary except when Paragraph b. below applies. lf this insurance is primary, our obligations are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method described in Paragraph c. below, except when Paragraph d. below applies. b. Excess lnsurance (1) This insurance is excess over: (a) Any of the other insurance, whether primary, excess, contingent or on any other basis: (i) That is Fire, Extended Coverage, Builder's Risk, lnstallation Risk or similar coverage for "your work"; @ 2017 ïhe Travelers lndemnity Company. All rights reserved. lncludes copyrighted material of lnsurance Services Office, lnc. with its permission. COMMERCIAL GENERAL LIABILITY (ii) That is insurance for "premises damage"; (i¡¡) lf the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to any exclusion in this Coverage Part that applies to aircraft, "autos" or watercraft; (iv) That is insurance available to a premises owner, manager or lessor that qualifies as an insured under Paragraph 4. of Section ll - Who ls An lnsured, except when Paragraph d. below applies; or (v) That is insurance available to an equipment lessor that qualifies as an insured under Paragraph 5. of Section ll - Who ls An lnsured, except when Paragraph d. below applies. (b) Any of the other insurance, whether primary, excess, contingent or on any other basis, that is available to the insured when the insured is an additional insured, or is any other insured that does not qualify as a named insured, under such other insurance. (2) When this insurance is excess, we will have no duty under Coverages A or B to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit". lf no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. (3) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self- insured amounts under all that other insurance. (4) We will share the remaining loss, if any, with any other insurance that is not described in this Excess lnsurance provision and was not bought specifically to apply in excess of the Limits of lnsurance shown in the Declarations of this Coverage Part. cG T1 00 02 19 Page 15 of21 COMMERCIAL GENERAL LIABILITY c. Method Of Sharing lf all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. lf any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each ínsurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. d. Primary And Non-Contributory lnsurance lf Required By Written Contract lf you specifically agree in a written contract or agreement that the insurance afforded to an insured under this Coverage Part must apply ona primary basis, or a primary and non- contributory basis, this insurance is primary to other insurance that is available to such insured which covers such insured as a named insured, and we will not share with that other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal and advertising injury" for which coverage is sought is caused by an offense that is committed; subsequent to the signing of that contract or agreement by you. 5. Premium Audit a. We will compute all premiums for this Coverage Part in accordance with our rules and rates. b. Premium shown in this Coverage part as advance premium is a deposit premium only. At the close of each audit period we will compute the earned premium for that period and send notice to the first Named lnsured. The due date for audit and retrospective premiums is the date shown as the due date on the blll. lf the sum of the advance and audit premiums paid for thepolicy period is greater than the earned premium, we will return the excess to the first Named lnsured. c. The first Named lnsured must keep records ofthe information we need for premium computation, and send us copies at such times as we may reguest. 6. Representations By accepting this policy, you agree: a. The statements in the Declarations are accurate and complete; b. Those statements are based upon representations you made to us; and c. We have issued this policy in reliance upon your representations. The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not prejudice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable insurance laws or regulations. 7. Separation Of lnsureds Except with respect to the Limits of lnsurance, and any rights or duties specifically assigned in this Coverage Part to the first Named lnsured, this insurance applies: a. As if each Named lnsured were the only Named lnsured; and b. Separately to each insured against whom claim is made or "suit" is brought. 8. Transfer Of Rights Of Recovery Against Others To Us lf the insured has rights to recover all or part of any payment we have made under this Coverage part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. 9. When We Do Not Renew lf we decide not to renew this Coverage part, we will mail or deliver to the first Named lnsured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date. lf notice is mailed, proof of mailing will be sufficient proof of notice. SECTION V - DEFINITIONS 1. "Advertisement" means a notice that is broadcast or published to the general public or specific market segments about your goods, products or servicesfor the purpose of attracting customers or supporters. For the purposes of this definition: a. Notices that are published include material placed on the lnternet or on similar electronic means of communication; and b. Regarding websites, only that part of a website that is about your goods, products or servicesfor the purposes of attracting customers or supporters is considered an advertisement. @ 2017 The Travelers lndemnity Company. All rights reserved. lncludes copyrighted material of lnsurance services office, lnc. with its permission. Page 16 of 21 cG T1 00 02 19 This page has been left blank intentionally GENERALPURPOSEENDORSEMENT POLICYNUMBER: 680-9M677855-20-41 oFFICE PAC TSSUE DATE: 12/31/2o1s THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CGD361 This endorsement modifies insurance provided under the following: ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAMES OF ADDTTTONAL TNSURED PERSON(S) OR ORGANTZATTON(S): Any person or organization that you agree in a written contract to include asan additional insured on this Coverage Part, provided that such written contract was signed by you before,and is in effect when, the "bodily injury"or "property damage" occurs or the "personal injury" or "advertising ínjury"offense is committed. LOCATION OF COVERED OPERATIONS: Any project to which a written contract with the Additional lnsured Person(s) or Organization(s) in the Schedule applies. (INFORMATION REQUIRED TO COMPLETE THIS SCHEDULE, IF NOT SHOWN ABOVE, WILL BE sHowN tN THE DECLARATTONS.) A. SECTION II - WHO IS AN INSURED IS AMENDED TO INCLUDE AS AN ADDITIONAL INSURED THE PERSON(S)OR ORGANIZATION(S)SHOWN IN THE SCHEDULE, BUT ONLYWITH RESPECT TO LIAB¡LITY FOR ''BODILY INJURY", 'PROPERTY DAMAGE",PERSONAL INJURY OR,,ADVERTISING INJURY'' CAUSED, IN WHOLE OR IN PART, BY: 1. YOUR ACTS OR OMISSIONS; OR 2. THE ACTS OR OMISSIONS OF THOSE ACTING ON YOUR BEHALF; lN THE PERFORMANCE OF YOUR ONGOTNG OPERATTONS FOR THE ADDTTTONALTNSURED(S) AT THE LOCATTON(S) DESTGNATED ABOVE. B. WITH RESPECT TO THE INSURANCE AFFORDED TO THESE ADDITIONAL INSURED, THE FOLLOWI NG ADDITIONAL EXCLUSIONS APPLY: This insurance does not apply to "bodily injury" or "property damage"occurring, or "personal injury" or "advertising injury" arising out of anoffense committed, after: 1. ALL WORK, INCLUDING MATERIALS, PARTS OR EQUIPMENT FURNISHED INCONNECTIONwlrH sucH woRK, oN THE PROJECT (OTHER THAN SERV|CE, MATNTENANCEOR REpAtRS)TO BE PERFORMED BY OR ON BEHALF OF THE ADD|TIONAL TNSURED(S)AT THE LOCATTON OF THE COVERED OPERATIONS HAS BEEN COMPLETED; oR 2. THAT PORTION OF ''YOUR WORK'OUT OF WHICH THE INJURY OR DAMAGE ARISESHAS cG T8 01 01 20 Page 1 of 2 GENERALPURPOSEENDORSEMENT POLICYNUMBER: 680-eM677855-20-47 OFFICE PAC TSSUE DATE: 12/31/2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. cGD361 This endorsement modifies insurance provided under the following: BEEN PUT TO ITS INTENDED USE BY ANY PERSON OR ORGANIZATION OTHER THANANOTHER CONTRACTOR OR SUBCONTRACTOR ENGAGED IN PERFORMING OPERATIONS FOR APRINCIPAL AS A PART OF THE SAME PROJECT. cG D3 61 03 05 Copyright 2OO5 The St. Paul Travelers Companies, lnc. All rights reserved lncludes copyrighted material of lnsurance Services Office, lnc. with its permission. cG T8 01 01 20 Page 2 ol 2 GENERALPURPOSEENDORSEMENT POLICYNUMBER: 680-eM6778s5-2o-47 OFFlcE PAC tssuE DATE: 12/31/2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. cG2037 This endorsement modifies insurance provided under the following: ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAMES OF ADDTTTONAL TNSURED PERSON(S) OR ORGANTZATION(S): Any person or organization that you agree in a written contract to include as an additional insured on this Coverage Part for "bodily injury" or "property damage" included in the products-completed operations hazard, provided that such contract was signed by you before, and is in effect when, the "bodily injury or "property damage" occurs. LOCATION AND DESCRIPTION OF COMPLETED OPERATIONS:Any project to which awritten contract with the Additional lnsured Person(s)or Organization(s) in the Schedule applies. (INFORMATION REQUIRED TO COMPLETE THIS SCHEDULE, IF NOT SHOWN ABOVE, WILL BE sHowN rN THE DECLARATTONS.) A. SECTION II - WHO IS AN INSURED IS AMENDED TO INCLUDE AS AN ADDITIONAL INSURED THE PERSON(S)OR ORGANIZATTON(S)SHOWN tN THE SCHEDULE, BUT ONLYW|TH RESPECT TO LIABILIry FOR "BODILY INJURY'" ''PROPERTY DAMAGE'' CAUSED, IN WHOLE OR IN PART, BY ''YOUR WORK'' AT THE LOCATION DESIGNATED ANDDESCRIBED IN THE SCHEDULE OF THIS ENDORSEMENT PERFORMED FOR THATADDITIONAL INSURED AND INCLUDED IN THE "PRODUCTS-COMPLETED OPERATIONS HAZARD". cG 20 37 07 04 Copyright ISO Properties, lnc. 2OO4 cG T8 02 01 20 Page 1 of 1 This page has been left blank intentionally POLICY NUMBER: CUP-9M682 435-2O- 4l THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SCHEDULE OF UNDERLYING INSURANCE This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE Employers Liabi I ity CarrierTHE CHARTER OAK FIRE INSURANCE COMPANY Policy Number 680-OO9M61 1 855 -2O Policy Period From: 01/O1/2O2O to: 01/O1/2021 Commercial General Liabi I ity Carrier THE CHARTER OAK F IRE INSURANCE COMPANY Policy Number 680-009M677855 -20 Policy Period From: O1/01/2O2O lo: 01/O1/2021 Automobi le Liabi I ity Ç¿¡¡is¡THE TRAVELERS INDEMN ITY COMPANY Limits Of Liability Bodi ly lnjury By Accident Each Acc i dent Bodi ly lnjury By Disease Pol icy Limit Bodi ly lnjury By Disease Each Emp I oyee Limits Of Liability Genera I Aggregate Products-Comp I eted Operations Aggregate Persona I andAdvertising lnjury Each Occurrence UMBRELLA ISSUE DATE: 12/31/2019 $1 , O00,000 $1 ,000,000 $1.000,000 $2 .000, 000 $2 , 000, 000 $1,000,000 $1,000,000 Limits Of Liability Bodi ly lnjury And Property $1,000,000 Damage Combined SingleLimit Policy Number BA-9M680558 - 20 Policy Period From: 01/O1/2O2O to: 01/O1/2021 PRODUCER:USI KIBBLE & PRENTICE oFFICE:PLANA& E 2oV EU 00 03 08 18 @ 2018 The Travelers lndemniiy Company. Ail r¡ghts reserved.Page 1 of 1 This page has been left blank intentionally POLICY NUMBER: CUP-9M682 435 -2O - 47 ISSUE DATE: 12/31/2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY - NOTICE OF CANCELLATION/NONRENEWAL PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice of Cancellation: 30 NONRENEWAL: Number of Days Notice of Nonrenewal: 30 PERSON OR ORGANIZATION: ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OR NONRENEWAL OF THIS POLICY WILL BE GIVEN, BUT ONLY IF: 1. YOU SEND US A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGAN I ZAT I ON, AFTER THE F I RST NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATI0N 0R NONRENEWAL 0F THIS POLICY; AND2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 1 4 DAYS BEFORE THE BEG I NN I NG OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS SCHEDULE, ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZ- ATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US. PROVISIONS: A. lf we cancel this policy for any statutorily permit- ted reason other than nonpayment of premium, and a number of days is shown for cancellation in the schedule above, we will mail notice of cancel- lation to the person or organization shown in the schedule above. We will mail such notice to the address shown in the schedule above at least the number of days shown for cancellation in the schedule above before the effective date of can- cellation. B. lf we decide to not renew this policy for any statu- torily permitted reason, and a number of days is shown for nonrenewal in the schedule above, we will mail notice of the nonrenewal to the person or organization shown in the schedule above. We will mail such notice to the address shown in the schedule above at least the number of days shown for nonrenewal in the schedule above be- fore the expiration date. rL T4 00 12 09 @ 2009 The Travelers lndemnity Company Page 1 of 1 This page has been left blank intentionally