HomeMy WebLinkAboutCAG2020-040 - Amendment - #1 - All Battery Sales & Services, Inc. - 2020 Recycling Events - 08/20/2020ApprovalOriginator: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: All Battery Sales and Service, Inc.
CONTRACT NAME & PROJECT NUMBER: 2020 Recycling Events
ORIGINAL AGREEMENT DATE: January 28, 2020
This Amendment is made between the City and the above-referenced Consultant or
Vendor and amends the original Agreement and all prior Amendments. All other provisions of
the original Agreement or prior Amendments not inconsistent with this Amendment shall remain
in full force and effect. For valuable consideration and by mutual consent of the parties,
Consultant or Vendor’s work is modified as follows:
1. Section I of the Agreement, entitled “Description of Work,” is hereby modified to
add additional work or revise existing work as follows:
In addition to work required under the original Agreement and any
prior Amendments, the Consultant or Vendor shall:
Provide additional anticipated battery recycling services for the
October 17, 2020 Recycling Event. For a description, see the
Vendor'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
$3,500
Net Change by Previous Amendments
including applicable WSST
$0
Current Contract Amount
including all previous amendments
$3,500
Current Amendment Sum $1,000
Applicable WSST Tax on this
Amendment
$0
Revised Contract Sum $4,500
8/20/20
EXHIBITA
Battery Recycling Scope of Work for Kent Recycling Events 2020
All Battery Sales and Service will provide battery recycling for municipal recycling
events including the following:
- 1 trained staff member
- 1 transport van
- All collection buckets, bins, pallets, containment kit, eyewash station, first
aid and fire extinguisher.
Recycle event charges are as follows:
- Staff / truck (LSE) _ $200.00 for day
- Alkaline Battery recycling =$.50 per Lb.
- Automotive cores are credited @ $.11 per Lb.
Scope of work includes setting up a collection station for batteries that includes a
covered canopy area with eyewash station. Staff member is trained to greet the
public professionally and with courtesy, collect batteries and sort as time permits
on site. Staff will also be properly equipped with PPE to include: Steel toe boots,
safety vest, acid resistant gloves, safety glasses, and long sleeve shirt. Site to be
left as staff found it.
The amount of recycling, including staff, for all 3 events will not exceed $3500.00
tota I.
Please Note: Due to the amount of batteries collected in the previous two free
Recycle Collection Events and the numbers we are expecting at the Saturday,
October 1711 event, we are requesting to increase the contract by $1,000.00 for a
not to exceed amount of $4,500.00.
727 134t' St SW, Everett, WA 98204 PH: (425) 743-7677 FAX: (425) 742-1739
EXHIBITA
Battery Recycling Scope of Work for Kent Recycling Events 2O2O
All Battery Sales and Service will provide battery recycling for municipal recycling
events including the following:
- L trained staff member
- L transport van
- All collection buckets, bins, pallets, containment kit, eyewash station, first
aid and fire extinguisher.
Recycle event charges are as follows:
- Staff / truck (LSE) = 5200.00 for day
- Alkaline Battery recycling =5.50 per Lb.
- Automotive cores are credited @ S.11 per Lb.
Scope of work includes setting up a collection station for batteríes that includes a
covered canopy area with eyewash station. Staff member is trained to greet the
public professionally and with courtesy, collect batteries and sort as tíme permits
on site. Staff will also be properly equipped with PPE io include: Steel toe boots,
safety vest, acid resistant gloves, safety glasses, and long sleeve shirt. SÍte to be
left as staff found it.
The amount of recycling, including staff, for all 3 events will not exceed 53500.00
total.
Please Note: Due to the amount of batteries collected in the previous two free
Recycle Collection Events and the numbers we are expecting at the Saturday,
October LTth event, we are requesting to increase the contract by S1,OOO.00 for a
not to exceed amount of $4,500.00.
727 t34th St SW, Everett, WA 98204 PH: (a251743-7677 FAX: (425) 742-L739
COVERAGES
CERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE NUMBER REVISION NUMBER
OATE (MM/DD/YYYY)
01t28t2020
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFIGATE 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 CONSTTTUTE A CONTRACT BETWEEN THE |SSU|NG TNSURER(S), AUTHORTZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: lf the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. lf SUBROGATION lS WA|VED, subject to
the terms and condit¡ons 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
Parker, Smith & Feek, lnc
2233 112th Avenue NE
Bellevue, WA 98004
425-709-3600 425-709-7460
INSURER(S) AFFORDING COVERAGE NAIC #
tNsuRER A . Travelers lndemnity Co. of America
INSURED
All Battery Sales and Service
727 134th Street SW
Everett, WA 98204
tNsuRER B : Travelers Cas. & Surety Co. of America
INSURER C :
INSURER D :
INSURER E :
INSURER F
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.
INSRtlÞ TYPE OF INSURANCE tNqÞ PC}I ICY NIIMRFR POLIGY EI-F POLICY EXP
IMM/DD/YYYYì LIMITS
A GENERAL LIABILITY
,<CO¡/MERCIAL GENERAL LIABILITY
CLAII\,,IS-IVIADE OCCUR
AGGREGATE LIMIT APPLIES PERi
K
x
X
Y6300K737037TtA1 I 11t01t2019 1110112020 EACH OCCURRENCE s 1.000.000
UAMAGE IQ RTNIET)
ÞRFMISFS ltra a¡¡, rrron¡e\s 300,000
l\¡ED EXP lAnv one oerson)$ 10,000
PERSONAL & ADV INJURY s 1,000,000
GENERAL AGGREGATE $ 2,000,000
PRODUCTS - COI\IPlOP AGG s 2,000,000
$
AUTOMOBILE L¡ABILITY
x ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
SCHEDULED
AUTOS
NON-OWNED
AUTOS
X
81 0016060451 914G 11t01t2019 11101t2020 q 1,000,000
BODILY INJURY (Per person)$
BODILY INJURY (Per accidenl)$
$
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLA¡I\,,1S-MADE
EACH OCCURRENCE $
AGGREGATE $
DED RETENTION $$
B WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOFVPARTNERiEXECUTIVE
OFFICERYI\,IEMBER EXCLUDED?
(Mandatory ¡n NH)
lf yes, describe under
DESCRIPTION OF OPERATIONS b6low
N
N/A
u80K7566541 9 14G
-- WA STOP GAP 1110112019 1110112020
WC STATU-x loJS-
E.L. EACH ACCIDENT $ 1,000,000
E.L, DISEASE - EA EIV1PLOYEE $ 1,000,000
E,L, DISEASE - POLICY LIMIT $ 1,000,000
DESCRIPTIONOFOPERATIONS/LOCATIONS/VEHICLES (AttachACORDl0l,Add¡t¡onalRemarksschedulE,¡fmorespaceisrequ¡red)
Recycling Collection Events held at:
317120 Hogan Park,24400 Russell Road, Kent, WA 98032
6/6/20 Kent Phoenix Academy, 11000 SE 264th St., Kent, WA 98030...
(See Attached Description)
The City of Kent
220 - 4TH AVENUE SOUTH
Kent, WA 98032
SHOULO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION OATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZÉD REPRESENTATIVE
ACORD 25 (2010/05)
@ 1988-2010 ACORD CORPORATION. All rights reserved
The ACORD name and logo are registered marks of ACORD
lÕf1t (cÂ[4ûü)
DESCRIPTIONS (Gontinued from Page 1)
10117120 Hogan Park,24400 Russel Road Kent, WA 98032
The City of Kent is an additional insured on the general liability and automobile policies per the attached endorsements/forms.
CANCELS AND REPLACES PREVIOUSLY ISSUED CERTIFICATE.
2o{16 (cAM0û)
ÏRAVEÆRÉ1
POLICY NUMBER:
EFFECTIVE DATE:
ISSUE DATE:
Y-630- 0K737037-TI A-1 g
1f-01-19
1l -'l 9.'l I
LISTING OF FORT,IS, ENDORSEMENTS AND SCHEDULE NUMBERS
THIS LISTING SHT¡WS THE NUMBER OF FORMS. SCHEDULES AND EIüORSEMENTS
BY LII\E OF BUSINESS.
DELUXE PROFERTY
DX T0 00 1t 12
COMMERCTAL GENERAL LIABILITY
COH¡NON POLÎCY DECLARATIONS
FORMS. ENDORSËMENTS AND SCFfrDULE NUMBERS
LIBERALIZATION LETTER-GL PRODUCT MOD€RN
COMHON POLICY CONDITIONS'¡,IA_DELUXE
LOCATION SCHEDULE
CALCULATION OF PREMIUM-COMPOSITE RATE(S)
AMENEMENT OF NAMED INSUR€D . I¡,ASHINGTON
EARLIER NOT CÂNCEL,/NONRENE|¡TAL PROV BY US
DELUXE PROP COV PART OECLARATIONS
TABLE OF CONTENTS _ DELUXE PROP COV PART
DELUXE PROPERTY COVERAGE FORM
DELUXE Br (n¡¡O ee ) COVeR¡er ronu
CAUSES OF LOSS-EQUIPMENT BREAKDOh¡N
DELUXE ORDINANCE OR LAW GOVERAGE
SELI-ING PRICE - STOCK HELD FOR SALE
LOSS PAYABLE PROVISIONS
JOINT OR DISPUTED LOSS AGREEMENT
UÏTLITY SERVICES_DIRECT DÀMAGE
UTILITY SERVICES-TIME ELEMËNT
FEDËRAL TERRORISM RISK INSURANCE ACT DIS
WA CHAI.IGES
TASHINGTT]N CHANGES _ DOMESTIC ABUSE
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DECLARATIONS PREMIUM SCHEDULE
KEY TO DECLARATIONS PREMIUM SCHEDULE
TABLE OF CONTEMTS * COM GEN LIAB COV
COMMERCIAL GENERAL LIABILITY COV FORM
TOTAL GENERAL AGGREGATE LIMITED PROÜECTS
LIMIT OF COV FOR DESIG NI TO DESIG PREM
AMEND-NON CUFIULATION OF EACH OCC
BLANKET AI-IC/COiiP OPS IF REQ BY CONTRACT
XTEÎ\¡D E¡ÞT FOR MFRS & bIHOLESÀLERS
FUNGI OR BACTERIA EXCLUSION
Ai¡END CONTRAC LIAB EXCI-EXC TO NAMED INs
EXCL-VIOLATI0N OF coNSUt{ER FIN PROT LAt¡rS
EXCLUSION*LEAD
013375
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TRAYELERÉ1
POLICY NUMBER:
EFFECTIVE DATE:
ISSUE DATE:
Y-630*0K737037-TI A* I I
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COMMERCIAL GENERAI- LIABILITY (CONTINUED)
19
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INTERLI NE E NDORSÊI4ENTS
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E XCLUSI ON.DI SCRI MI NATI ON
EXCL-EXTERIOR INSULATION & FINISH SYSTEI.I
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l{A CHANGES EMPLOY RELATED PRACTICES EXCL
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EMPLOYEE tsENEFITS LIABILITY COV FORM
FEDERÀL TERRORISM RISK INS ACT DISCLOSE
AMNDT COMMON POLICY COND-PROHIBITEÞ COVG
cAP oN LOSSES CERTIFIËD ACT oF TERR0RISÍT{
WASHINGTON CHANGES - DEFET.ISE COSTS
OREGON CHANGE S_DOMESTIC PARTI'¡ERSHIP
NUCLEAR ENERGY LIABILITY EXCLUSION
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COMMERCIAL GENERAL LIABILITY
THIS ENEORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLV.
BLANKET ADDITIONAL INSURED
(lncludes Products-Completed Operations lf Required B¡r Contract)
This endorsement modifes insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PR,OVISIONS
The following is added to SECÎON ¡l - WHO lS AN
INSURED:
Any person or organization that you agree in a
writen contract or agreernent to include as an
additional insured on this Coræiage Part is an
insured, but only:
a. With respect to liability for ."bodily injurly'' or
"property damage" that occurs, or for "personal
injur/' caused by an offense lhat is committed,
subsequent to the sígning of that contract or
agreement and while that part of the contract or
agreement is in effect; and
b. lf, and only to the extent that, such injury or
damage is caused by acts or omissions of you or
¡our subcontractor in the performance of "¡our
worl('to which the written contract or agreement
applies. Such person or organization does not
qualiþ as an additional insured with respect to
the independent acts or omissions of such
person or organization.
The insurance provided to such additional insured is
subject to the following provisions:
a. lf the Limits of lnsurance of this Coverage Part
shown in the Declarations exceed the minimum
limits required by the written contract or
agreement, the insurance provided to the
additional insured will be limited to such
minimum required limits. For the purposes of
determining whether this limitation applies, the
minimum limits required bythe written contract or
agreement will be considered to include the
minimum limits of any Umbrella or Excess
liability coverage required for the additional
insured by that writen contâct or agreement
This provision will not increase the limits of
insurance described in Section lll - Limits Of
lnsurance.
b. The insurance provided to such additional
insured does not apply to:
(1) Any "bodily injury", "property damage" or
"personal injury" arising out of the providing,
oti failure to provide, any professional
architectural, engin eering or surveying
services, including:
(a) The preparing, approving, or failing to
prepare or approve, maps, shop
drawings, opinions, reports, surve)Ë,
field orders or change orders, or the
preparing. approving, or failing to
prepare or ãpprove, drawings and
specifications; and
(b) Supervisoqr, inspection, architectural or
engineering activities,
(2) Any "bodily injurt'' or "property damage"
caused by "your worl(' and included in the
'tproducts-completed operations hazard"
unless the written contract or ägreement
specifically requires )rcu to provide such
covÊrage for that additional insured during
the policy period.
c. The additional insured must comply with the
following duties:
(1) Give us r¡ritten notice as soon as practicable
of an "occurrence" or an ofiense which may
result in a claim. To the extent possible, such
notice should include:
(a) How, when and where the "occunence"
or offense took place;
(b) The names and addresses of any injured
persons and witnesses: and
(c) The nature and location of any injury or
damage arising out of the "occurrence"
or offense.
(Z) lf a claim is made or "suif is brought against
the additional ínsured:
CG Þ2 46 0¡t 19 Õ 2018 Th€ Travelers lndemnity Company. All rights rcserved.Page 1 of 2
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COMMERCIAL GENERAL LIABI LITY
(a) lmmediately record the specifics of the
claim or'suit" änd the date receíved: and
(b) Notify us as soon as practicable and see
to it that we rêceive written notice of the
claim or'suit" as soon as practicable"
(3) lmmediately send us copies of all legal
papers received in connection with the claimor "suit', cooperãte with us in the
investigation or settlement of the claim or
defense against the "suit', and otherwise
comply with all policy conditions.
(4) Tender thê defense and indemnity of any
claim or "suit' 'to any provider of other
insurance which would cover such additional
insured for a loss we cover. However, this
condition does not affect whether the
insurance provided to such additional
insured ís primary to other insurance
available to such additional insured which
coìrers that person or organization as a
named insured as described in paragraph 4,,
Other lnsurance. of Section lV - Commercial
General Liability Conditions.
01 3443
Page 2 of 2 @ 2018 Ths Trave lers tndemníty Company, All righls.rçserved,CG Dz ¡f6 0419
COMMERCIAL GENERAL LIABILIry
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAR,EFULLY.
XTEND ENDORSEMENT FOR MANUFACTURERS AND
WHOLESALERS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
GENERAL DESCRIPTION OF COVERAGE * This endorsement broadens co\êrage. However, co_v€rage for any
inþry, damage or medical expenses described in any of the provisions of this endorsement may úe ex.luded or
llmited by another endorsement to this Coverage Part, and these coverage broadening provisions do not applyto
the extent that coverage is excluded or limited by such an endorsement. The following listing is a general
co\¡erage description only. Read all the provisions of this endorsement and the rest of your policy carefulþ to
determine rights, duties, and what is and is not covered.
À Who ls An lnsured - Unnamed Subsidiaries
B. \,Vlto ls An lnsured - Employees And Volunteer
Workers - Bodily lnjury To Co-Ernployees And
CoVolunteer Workers
C. Wìt ls An lnsured - Newly Acquired Or Formed
Limited Liability Companies
D. Blanket Additional lnsured - Broad Form Vendors'
Ë Blanket Additional lnsured - Controll¡ng lnterest
F. Blanket Additional lnsured * Mortgagees,
Assignees, Successors Or Receivers
G. Blanket Additional lnsured Governmental
Entities - Permits Or Authorizations Relating To
Premises
PROVIS¡ONS
A. WHO IS AN INSUREE UNNAMED
SUBSIDIARIES
-t'he following is added to SECTTON lt - WHO tS
AN INSUR,ED:
Any of your subsidiaries, other than a pârtnersh¡p
or þint venture, that is not shown as a Named
lnsured in the Declarations is a Named lnsured if:
a. You arë the sole owner of, or maintain an
ownership interest of more than 50Zo in. such
subsidiary on the first day of the policy period;
and
b. Such subsidiary is not an insured under
similar other insurance.
No such subsidiary is an insured for'!bodÍly. in1ury'
ol "propert¡r damage" that occurred, or ',personal
and advert¡sing inju¡y'' caused by an offense
committed;
¡{. Blanket Additional lnsured * Governmental
Entities - Permils O¡ Authorizations Relating To
Operations
l. Blanket Additional lnsured Grantors Of
Franchises
J. lncidental Medical Malpractice
K. MedicalPayments - Increased Limit
L. Blânket Wàir¡er Of Subrogation
M. Contractual Liability * Railroads
a. Before you maintained an ownership intelest
of more than 50% in such subsidiary: or
b. Afrer the date, if any, during the policy period
that you no longer mainþin an ownership
interest of more than 50o/o in such subsidiary.
For purposes of Paragraph 1. of Section lt - \rVhols An lnsured, each such subsidiary will be
deemed to be designated in the Declarations as:
a. A limited liabilþ company:
b. An organization other than a pafinership, þint
venture or limited liability compâny: or.
c. A trust:
as indicated in its name or the documents that
govern its structure,
cG D451 02 f9 Õ 2017 Thc Traveiêrs tndemnity Company. All rígttts reserued.
lncludes copyrighte.d rnaterial of lnsurance services oflfce, inc. with its permission
Page 1 of5
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CCIMMERCIAL GENERAL LIABI LITY
B. WHO 15 AN INSURED - EMPLOYEES AND
VOLUNTEER WOR.KERS - BCIDILY INJUR.Y TO
CGEMPLOYËES AND COVOLUNTEER
WORKERS
The following is added to Paragiaph 2,a,(1) of
SECTION II -WHO IS AN INSUR,ED:
Paragraphs (1Xa), (b) and (c) above do not åpply
to "bodily injuqf to a co-"employee' while in the
course of the co"employee's" emplo¡ment byyou
or performing duties related to the conduct of your
business, or to "bodily in¡ur/' to your other
"volunteer workers" while performing duties
related to the conduct of your business.
c. wHo ts AN tNsuREÞ - NEWLY ACQU|R,ED
OR FORMED LIMITED UAB¡LITY COMPANIES
The following replaces Paragraph 3. of SÊCT|ON
II-WHO IS AN INSUR.ED:
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 ân ownership interest of more
than 50%, will qualify as a Named lnsured if
thele is no other similar insurance ar¡ailable to
that organization. However:
â, Coverage under this provrsion is afforded
only
(1) Until the l80th day after ¡ou acquire
or form the organization or the end of
the poliiy period, whichever is earlier,
f you do not report such organization
in writing to us within 180 da¡ns after
you acquire or form it or
(z) Until the end of the policy period,
when that date ¡s låter than 18O daya
after you acquire or forni such
organization, if you report such
organizallon in writing to us within
t 80 dayr after you acquire or form it;
b. Co\¡erage A does not apply to ,,bodily
injurt'' or "property damage' that occurred
before you acquired or formed the
organization; and
c. Correrage B does not apply to .personal
and advertising inþ¡y" arising out of an
offense committed before ¡ou acquired or
formed the organization.
Forthe purposes of Paragraph 1. of Section tl
- Who ls,An lnsured. each such organizat¡on
will be deemed to be designâted in the
Declarations asr
a. A limited liabiliþ company;
b. An organization, other than a partnersh¡p,
joint venture or limited liability compan)n
or
c. A trust;
as indicated in its name or the documents
tfiat govern its structure.
D. BLANKET AÞDITIONAL INSURED - BROAD
FOR.M VENDORS
The following is added to SECTTON il - WltO lS
AN INSUR.ED:
Any person or organization that is a vendor and
that you hare agreed in a writen contract or
agreement to include as an additional insured on
this Coverage Paû is an insured, but only with
respect to liability for "bodily ¡nþr¡f or ',properÇ
damage" that:
a. Occurs subsequent to the signing of that
contract or agreement; and
b. Arises out of "]eur products" that are
distributed or sold in the regular course of
such vendor's business.
The insurance provided to such vendor is subject
to the following provisions:
a. The limits of insurance provided to such
rendor 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 vendor does
not apply to:
(1) Any express warranty not author¡zed by
lou or any distribution or sale for a
purpose not authorized by you;
(2) Any change ¡¡ t'your products,' made by
such vendor;
(3) Repackaging, unless unpacked solely for
the purpose of inspection, demonstration,
testing, or the subsiitr¡tion of parts under
instructions from the manufacturer. and
then repackaged in the original container;
(4) Any failure to make such ihspectrons,
adjustments, tests or serlicing as
vendors agree to perform or normally
undertake to perform in the regular
course of business, in connection with the
distribution or sale of "your produc,ts',;
013444
Page 2 of 5 Ð 2017 The Traveters lndomnity Company. All rights reserved.
lnclude¡ copyrightod mateiial of lnsurancã serviccslofñceilnc, with its permission
CG D¡t 58 02 19
(5) Demonstration, installation, servicing or
repair operations, except such operations
performed at such r€ndor's premises in
conneqtion with the sale of "¡nrur
products"l or
(6) Your products!' thal after distribution or
sale by you, have been labeled or
relabeled or used as a container, part or
ingredient of âny other th¡ng or substance
by or on behatf of such vendor.
Coverage under this provision does not apply to;
a. Any pelson or organization trom whom you
have acquired "your products", of ãny
ingredient, part or container entering into,
accompanying or containing such products:
or
b. Any vendor for which coverage as an
additional insured specifically is scheduled by
endorsement.
E. BLANKET ADDITIONAL INSURED
CONTROLLING INTEREST
1. The following is added to SECTTON il - WHCI
IS AN ITIISURED:
Any person or organizatron that has financial
conhol of you is an insured wlth respect to
liabilþ for "bodily injuqy'', "property damage¡
or "personal and advertising injulf'that arises
oul 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 pr:ovided to such person or
organization does not apÞly 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 +. of
SECTION ¡I. WHO IS AN INSUR.ED:
This paragraph does not apply to any
premises ownër; managef or lessor that has
financial control of you.
F. BLANKET ADDITIONAL INSURED
MOR,TGAGEES, ASSIGNEES, SUCCESSORS
OR RECEIVERS
The following is added to SECT|ON tt - WHO lS
AN INSUR.ED:
Any person or organization that is a mortgagee,
assignee, successot or receiver and that you
have agreed in a written contract or agreemeni to
include as an additional insured on this Coverage
Part is an insured, but only with respect to its
COMMERCIAL GENERAL LIABILITY
liability as mortgagee, assignee, successor or
receiwr for "bodily injury'. "property damage" or
"personal and advàrtising iniiq/'-thaL
a. ls "bodily injury'' or "property damage' that
occurs, or is "personal and advertising injury"
caused by an offense thåt is committed,
subsequent to the signrng of that contlact or
agreement; and
b. Arises out of the ownership, maintenance ot
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 rnortgãgee,
assignoe, 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 contrac,t or agreement,
or the limits shown in the Declarations,
whichever are less.
b, The insurance provded to such person or
organization does not applyto:
(1) Any "bodily injur!' or "property damage"that occurs, or ãny "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 injurf, "property därnage,' or
"personal and advertising injury" arisingout of any structural aherations, ne$,
construction or demolition operations
performed by or on behalf of such
mortgagee, assignee, successof or
receiwr.
G. SLANKET ADDITIONAL INSURED
GOVER.NMENTAL ENTITIES - PETTMITS OR
AUTHOR.IZATIONS RELATING TO PREIVIIS E5
The following is added to sECTtoN il - wHo tS
AN INSUR,ED:
Any governmental entity that has issued a permit
or authorizalion with respect to premises owned
or occupied by. or rented or loaned to. ¡lou and
that you are required by any ordinance, law,
building code or written contract or agreernent t0
include as an additional insured on this Coverage
Part is an insured, but onlywith respect to liability
for "bodily in¡ur/', "property damage" or "personJland advertísing 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
cG t)4 58 02 19 ð 2017 The Travelers lndemnity Company. All rightr rcscrved.
lncþdes copyrighted mateiial of lnsur¡nce Serviceí Office, lnc, with lis permission
Page 3 of 5
H
COMMERCIAL GENERAL LIABILITY
issued such þermit or authorization: advertising
signs, awnings. canopies. cellar entrances, coal
holes, driveways, manholes, marqueeÉ, hoist
away openings, .sidewalk vaults, elevators, street
banners or decorations.
BLANKET ADDIT¡ONAL INSURED
GOVER,NMËNTAL ENTITIES - PERMITS OR
AUTHORIZATION5 RELATING TO OPER,-
ATIONS
The following is added to SECTTON tt - WHO tS
AN INSURED:
Any governmental entity that has issued a permitor authorization with respect to operations
performed by l¡ou or on your behalf and that you
arb required by any ordinance, law, building code
ol written contact of agreement to include as an
additÍonal insured on this Coverage Part is an
insured, but only wrth respect to liability for ',bodilyinjur/, "property damage" or "personal and
.advertising injuny'' arising out of such operations.
The insutance provided to such govemmental
entity does not apply to:
a. Any 'bodily inþr/, 'property dåmage" or
"personaland advertísing injury" arising out of
operations performed for the governmental
entity or
b. Any "bodily injury'' or "property damage,,included in the "products-compleied
operations hazard".
BLANKET ADDIT¡ONAL INSUR,ED
GRANTORS OF FR.ANCHISES
The following is added to sECTtoN ll - wHo ts
AN INSURED:
Any person or organization that grants a franchise
to ¡tou is an insured, but only with respect to
liability for "bodily injuriy'', "property damage,, or
"personal and advertising inþ¡/' arising out of
¡lour operations in the fianchise granted by that
person or organization-
lf a written conkact or agreement exists between
¡rcu and such additional insured, the limits of
insuränce provided to such insured will be the
minirnum timits that you agreed to provide in the
wriü,en conlract or ãgreement, or the limits shown
in the Declarations, whichever are less,
INCIDENTAL MEDICAL MALPRACTICE
1. The following replaces paragraph b. of thedefinition d 'occurrenÇe" in the
DEFINITIONS Section:
b. An act or omission commítted in providing
or failing to proúde ,'íncidental medical
services", first aid or "Good Samaritan
services" to ã person, unless you are in
the business or occupation of providing
professional health care se¡vices.
2, The following replaces the last paragraph of
Paragraph 2:a.(1) of SECT|ON [ - WHO tS
AN INSURED:
Unless you are in the business or occupation
of providing professional health care services,
Paragraphs (lXa), (b), (c) and (d) above do
not appþ to "bodily inlurf arisìng out of
provlding or failing to provide:
(a) "lncidental medical services" by any of
your 1ernployees" who is a nurse, nurse
assistant, emergency medlcal technician,
paramedic, athletic trainer, audiologist,dietician, nutritionist, occupatíonal
therapist or occupational therapy
assistant, physical therapist or speech-
language pathologist; or
(b) First aid or "Good Samaritan seruices" by
any of your "employees', or ,'rolunteer
workers", other than an employed or
volunteer doctor. Any such ,'employêes"
or "volunteer workers" provrding or failing
to provide first aid or .Good Samatitan
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
ofyour business.
3, The following replaces the last sentence of
Paragraph 5. of SECTTON il - LtMtTS OF
INSURANCE:
For thé purposes of determ¡ning the
appficable Each Occurrence Limit, all ielated
arts or omissions committed in providing olfailing to provide ,'incidental medícal
service$", 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., Exclusion¡, of SECTTON I -COVER.AGE5 - COVERAGE A - BODILYINJURY AND PROPERTY DAMAGE
LIABILITY:
Salc Ol Pharmaceutlcal¡
"Bodiþ injury'' or ',property damage" arising
out of the violation of a penal statute orordinance relating to the sale of
pharmaceuticals commited by, or with the
knowfedge or consent of. the insured,
_-I
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013445
Fage 4 of 5 Ë 2017 The Trâvefers lndemnity Company. Ail rights rese rved.lncludes copyrighted m¡terial of rnsrrrancã s¡rviceioficelnc. with its permission
cc D¡t 58 02 19
5. The following is added to the DEFINITIONS
Sectian:
"lncidental medical servicès" means:
ã. 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..
Excest lnsurance, of SECTION lV -COMMERCIAL GENERAL LIABILITY
CONDIÎIONS:
This insurance is excess over any valid and
collectible other insurance, whether primary,
excêss, contingent of on any other basís, that
is available to äny of your "employees" for
"bodily inju4l' that arises out of providing or
failing ro provide "incidental medical services"
to any person to the extent not subject to
Paragraph 2.a.(1) of Section ll - Who ls An
Insured.
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
Cowrage C for all medical expenses
because of "bodily injuryr sustained by any
one person, and will be the higher of:
COMMERCIAL GENE R.AL LIABI LITY
ã. $10,O00; or
b. Tha amount shown in the Þeclarations of
this Correrage Part for Medical Expense
Limit.
L. BLÂNKET WAIVER OF SUBROGATION
The following is added to Paragraph 8,, Transfer
Of Rights of Recovcry Against othcrs To Us,
of SECTION IV - COMIUERCIAL GENERAL
LIABILIW CONDITIONST
lf the insured has agreed in a contract or
agreement to waive that insured's rEht of
f eco\rery against.any pefson or organizaÙon, we
waive our right of recovery against such person or
organization, but only for pa¡ments we make
because of:
a. "Bodily injury'' or 'property damage" that
occursi or
b. "Personal and advertising injur/' caused by
ân offense that is committed;
subsequent to the execution of the conûact or
agreement.
M. CONTRACTUAL LIABILITY - R.AILROADS
I. The following replaces Paragraph c. of the
definition of oinsured contract" in the
DEFINITIONS Section:
c. Any easement or license agreement;
2, Paragraph. f.(1) of the definition of "insured
conträct" in the DEFINITIONS Section is
deleted.
cG Þ45t 02 19 € 2017 The lrav+lals lndemnity C0mpàny. All righrs rcsrrved.
lncludes copyrþhted m¡terial of lnsurance Service¡ Office..lnc. wlttr lts permisiion
Fage 5 of 5
POLICY NUMBER.:
EFFECTIVE DATE:
ISSUE DATE:
810-0L60604s-19-14-e
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lL T8 01 0't 01 PAGE¡ I OF 1
COMMERCIAL AUTO
THIS ENDORSEMENT CHANGES THE PCILICY. PLEASE READ IT CAREFULLY.
BUSINESS AUTO EXTENSION ENDORSEMENT
This endorsement rnodifíes insurânce provided underthe following
BUSINËSS AUTO COVERAGË FORM
GENERAL DESCRIPTION OF COVERAGE - This endorsement broådens coverâge. However, coverage for any
injury, damage or medical expenses described in any of the provisions of this endorsement mây be excluded or
limited by another endorsemeni to the Coverage Part, and these coverage broadenirrg provisions do not apply to
the extent that coverage is excluded or limited by such an endorsement. The following listing is a general Õover-
age description only. Límitatiorts and exclusions may âpply to these coverages. Read åll the provisions of this en-
dorsement and the rest of your policy carefirlly to determine rights, duties, and what is and is not covered.
A. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE - LOSS OF
B. BLANKET ADDITIONAL INSURED USE.INCRËASED LIMIT
c. EMPLOYEE HTRED AUTO t. pHystcAL CIAMAcE TRANSpORTATTON
EXPENSES - INCREASED LIMIT
D. EMPLOYEES AS TNSURED J. PER$ONAL pROpERTy
E. SUPPLEMENTARY PAYMENTS - INCREASED K, AIRBA6SLlMlrs L. Nonce AND KNowLEDGE oF AccTDENT oRF. HIRED AUTO - LIMITED WORLDWIDE COV. LOSS
ERAGË - |NDEMNITY BASTS M. SLANKET WATVER OF SUBROGATTON
G. WAIVER OF DEDUCTIBLE - GLASS N. UNTNTENTTONAL ËRRORS OR OM¡SS¡ONS
PROVISIONS
A. BROAD FORM NAMEDINSURED this insurance applies and only to the exlent thâ{
person or organization qualifies as an "insurêd"
under the Who ls An lnsured provision contained
in Section ll.
C, EMPLOYEE HIRED AUTO
1. The following is added to Paragraph 4.1.,
Who ls An lnsured, of SEûTION ll - COV-
ERED AUTOS LIABILITY COVERAGE:
An "employee" ol yours is an "insured" while
operating ân "ärlto" hired or rented under a
contrâct or âgreêment in an "ernployee's"
nâme, with your permission, while perfonning
duties related to the conduct of your busi-
ness.
2. The fcllowing replaces Paragraph b. in 8.S.,
Other lnsurance, of SECTION lV - BUSI-
NESS AUTO CONDITIONS:
b. For Hired Auto Physical Darnage Cover-
age, the following are deemed to be cov-
erðd "autos" y0u twn:
(11 Any covered "auto" you lease, hire,
rent or borrow; and
(2) Any covered "auto" hired or rented by
your "employee" under a conlracl in
an "employee's" name, with yÕur
Ç) 201 5 The Travelers lndernnity Company. All rights reserved.
lnciudes copyrighted malerial of lnsurance services offìce, lnc. with its permiss,on
The following is added to Paragraph 4.1., Who ls
An lnsured, of SECTION ll - COVERED AUTOS
LIABILITY COVÊRAGE:
Any organization you newly acquire or form dur-
ing the policy period over which you ma¡ntâin
50% or more ownershíp interest and that is not
separaìely insured for Business Auto Coverage.
Coverage under this provision is afforded orrly urt-
t¡l the 180th day after you acquire or form the or-
gånizat¡on or the end CIf the policy period, which-
ever is earlier.
B. BLANKET ADDITIONAL INSURED
ïhe follcwing is added to Paragraph c. in 4.1.,
Who ls An lnsured. of $ECTION ll - COVERED
AUTOS LIABILITY COVERAGE:
Any person or organization who is reqr:ired under
a written contracl or agreement between you and
that person or organization, thât is signed and
executed by you before the "bodily injury" or
"property damage" ocêurs ând that is in effect
during the policy period, to be named as an addi-
lional insured is an "insured" for Covered Autos
Liabílity Coverage, but only for damages to which
cA T3 53 02 15 Page 1 of 4
D
COMMERCIAL AUTO
E.
permission, while performing duties
relaled to the conducl of your busí-
ness.
However, any "auto" that is leased, hired,
rented or borrowecl with a driver is not a
covered "auto".
EMPLOYEES AS TNSURED _)
The following is added to Paragraph A.1,. Who ls
An Insured, of SECTTON il - COVERED AUTOS
LIABILITY COVERAGE:
Arry "employee" of yours is an "insured', while us_
ing a covered "auto" you don,t own, hire or borrow
in your business or your personal affairs,
SUPPLEMENTARY PAYMENTS - INCREASED
LIMITS
1. The following reptaces paragraph A.2.a.{2},
of $ECTION tt - COVERED AUTOS LtABtL-
ITY COVERAGE:
{2} Up to $3,000 for cost of bait bonds (in-
cluding bonds for related traffic law viola_
tions) required because of an "accident"
we cover. We do not have to furnish
these bonds
2. The following reptaces paragraph A,2.a.(d),
of SECTTON lt - COVERED AUTOS LtABtL-
ITY COVERAGE:
(4) All reasonaþle expenses incurred by the
"insured" at our request, including actual
loss of earnings up to SS00 a day be-
cause of time off from work.
HIRED AUTO - LIMITED WORLDWIOE COV.
ERAGE - INDEMNITY BASIS
ïhe following reptaces Subparagraph (5) in para-
graph 8.7., Policy Period, Coverage Territory,of SECTION lV - BUSINESS AUTO CONDT_
TIONS:
{5) Anywhere in the world, except any country orjurisdiction whíle any lrade sanction, em-
bargo, or s¡milar regulation irnposed by the
United States ôf America applies to and pro-
hibils the transaclion of business with or
wíthin such country or jurisdictíon, for Cov-
ered Autos Liability Coverage for any covered"auto" that you lease, hire, rent or borrow
without a driver for a period of 30 days or less
and that is nol ân ,,auto,, you lease, hire, rentor borrow from any of your "employees,,,
pâüners (if you âre a partnership), members(if you are a timited liability company) or
members of their households.
{a} With respect to âny claim rnade or',suit',
brought outside the United States of
America, the lerritories and possessíons
of the United States of America, puerto
Rico and Canada:
(i) You must arrânge 1o defend the ,.in-
sured" against, and investigate or set-
tle any such cla¡m or "suít,, ancl keep
us acJvised of all proceedings and ao
tions.
(ii) Neither you nor any other invotved
"insured" will rnake any setilement
without 0ur consent.
{iii} We måy, at our discretion, parlícipate
irr defending the ,'insured', against, orin the setilement of, âny clairn or,,suit".
(iv) We will reimburse the ',insured,, for
sums that the "insured,, legally must
pay âs damages because of ',bodily
injury" or "property darnage" to which
this insurance applies, that the ',¡n-
sured" pays with our consent, bul
only up to the limit described in para-
graph C., Limits Of lnsurance, of
SECTION II * COVERED AUTOS
LIAgILITY COVERAGE.
(v) We will reimburse the ,'insured', forthe reasonat¡le expenses incurred
with our consent for your investiga-
tion of such clairns and your defenseof the "insured" against any such
"suit", bul only up to and included
within the timit described in para-
graph C., Limits Of tnsurance, of
SECTION II _ COVERED AUTOS
LlABtLtTy COVERAGE, and not in
addition to such limit. Our duty to
make such payments ends when we
have used up lhe applicable limit of
insurance ín payrnents for clamages,
settlements or defense expenses.
{b} This insurance is excess over any valid
ånd collectible other insurance available
to the "insured" whether primary, excess,
contingent or on âny other basis.
(c) This insurance is not a subslitute for re_quired or compulsory insurance in any
country outside the United Slates, its ter_
rilories and possessions, puerto Rico and
Canada.
oã
F
00r 852
Page 2 of 4 (9 2015 The Travelers lndemn¡ly Company. All rights rsserved.lnçludes copyrighted materiaÍ of rnsurancá seruicesbrfi"*, rnc. with its permission
cA T3 53 02 15
You agree to maintain all required or
compulsory insurattce in any such coun-
try up to the minimum limits required by
local law. Your failure to contply with
compulsory insurance requirerïents will
nol invalidate the coverage afforded by
this policy, bul we will only be liable to the
same Bxlent we would have been liable
had you complied with the compulsory in-
surance requirements.
(d) lt is understood that we are not an admit-
ted or authorized insurer outsidê lhe
United States of America, its territories
and possessiorls, Puerto Rico and C'an-
ada. We âssume no respottsibility for the
furnishing of certificates of insurance, or
for compliance in any way with the laws
of other countries relating to insurance,
G. WAIVER OF DEDUCTIBLE - GLASS
The following is added to Paragraph D', Deducti'
ble, of SECTION lll - PHYSICAL DAMAGE
GOVERAGE:
No deductible for a covered "auto" will apply to
glass damage if lhe glâss is repaired rather than
replaced,
H. HIRED AUTO PHYSICAL DAMAGE - LOSS OF
USE.INCREASED LIMIT
The following replaces the lâsl sentence of Para-
graph 4.4.b., Loss Of Use Expenses, of $EC-
TION III- PHYSICAL DAMAGE COVERAGE:
However, the most we will pay for âny expenses
for loss of use is $65 per day, to a maximt¡m of
$750 for any one "accidenl".
I. PHYSICAL DAMAGE TRANSPORTATION
EXPENSES - INCREASED L¡MIT
The following replaces the f¡rst sentence in Para-
graph 4.4.a., Transportation Expenses, of
SECTION III - PHYSICAL DAMAGE COVER.
AGE:
We will pay up to $50 per day to â mâximum of
51,500 for lernporary transportation expense in-.- currêd by you because of the total theft of a cov-
ered "auto" of the private.passenger type.
J. PERSONAL PRCIPERTY
The following is added lo Paragraph 4.4., Cover-
age Extensions, of SECTION lll - PHYSICAL
DAMAGE COVERAGE;
Personal Property
We will pay up to $400 for "loss" to wearing ap-
parel and olher personal property which is:
{l) Owned by an "insured''; and
COMMERCIAL AUTO
(2) ln or on your covered "auto".
This coverage applies only in the event 0f â tolal
theft of your covered "auto",
No deductibles apply to this Personal Propedy
c0verâge.
K. AIRBAGS
The following is added to Paragraph 8.3., Exclu-
sions, of $ECTION lll - PHYSICAL DAMAGE
ÇOVERAGE:
Exclu.sion 3.a. does nol âpply to "loss" to one or
more airbags in a covered "auto" you own that in-
flate due to a cause other lhan a ôause of "loss"
sel forth in Paragraphs 4.1.b. anrl 4.1.c., but
only;
a. lf that "auto" is a covered "auto" for Compre-
hensive Coverage under this policy;
b. The airbags are not covered under any war-
rantY; and
c. The airbags were nol intentionally inflated.
We will pay up to a maximum of $1,000 for any
one "loss".
L. NOTICE ANO KNOWLEDGE OF ACCIDENT OR
LOSS
The following is added to Paragraph 4,2.a., of
SECTION IV - BUSINESS AUTO CONCIITIONS:
Your duty to give us or our authorized reprÊsenla-
tive prompt notice of the "accident" or "loss" ap-
plies only when the "accidenl" 0r "loss" is known
to:
(a) You (if you are an individual);
(b) A partner (if you are a partnership);
(c) A mernber (if you are a limited liability com-
pany);
(dl An executive officer, director or insurance
mânager (if you åre a corporation or other or-
ganizalion); or
(e) Any "employee" authorized by you to give rto-
tice of the "accident" or "loss".
M. BLANKET WAIVER OF SUBROGATION
The following replaces Paragraph 4.5., Transfer
Of Rights Of Recovery Against Others To Us,
of SECTION lV - BUSINESS AUTO CONDI-
TIONS:
5. Transfer Of Rights Of Recovery Against
Others To Us
We waive any right of recovery we may have
against any pêrson or organization to the ex-
tent required of you by a written contract
signed and execuled prior to any "åcçident"
or "loss", provided that the "accidenl" or "loss"
arises out of operations contemplated by
(o 201 5 The Travelers lndemnity Company All rights reserved.
¡ncludes copyrighled måterial of lnsurance Services Office, lnc. with ils pernrission
cA T3 53 02 15 Page 3 of 4
o:
COMMERCIAL AUTO
such c0ntract. The waiver applies only to the
person or organizatiûn designaled in such
conlräcl.
N. UNINTENTIONAL ERROR$ OR OMISSIONS
The following is added to Pärågraph 8.t., Gon-
cealment, Misrepresentat¡on, Or Fraud, of
SECÏION IV - BUSINESS AUTO CONT}ITIONS:
The unintentíonal omission of, or unintentional
error in, any information g¡ven by you shall not
prejudice your rights undor this irìsurance. How-
ever this provision does not affect our right to col-
lect additiorral premium or exercise our right of
cancellation or non-renewâ|.
0ô1 e53
Page 4 of 4 @ 2015 The Ttavelers lndemnity Company. All r¡ghts reserved.
lncludes copyrighted materiar of rnsurance services office, rnc. with ils permíssion.
cA T3 53 02 1s