HomeMy WebLinkAboutCAG2020-311 - Change Order - #1 - A Plus Tree, Inc. - Hycroft Pond Tree Removal - 10/07/2020ApprovalOriginator: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
CHANGE ORDER - 1 OF 3
CHANGE ORDER NO. 1
NAME OF CONTRACTOR: A Plus Tree, Inc. (“Contractor”)
CONTRACT NAME & PROJECT NUMBER: Hycroft Pond Tree Removal
ORIGINAL CONTRACT DATE: October 1, 2020
This Change Order amends the above-referenced contract; all other provisions of the
contract that are not inconsistent with this Change Order shall remain in effect. For valuable
consideration and by mutual consent of the parties, the project contract is modified as follows:
1. Section I of the Agreement, entitled “Description of Work,” is hereby modified to
add additional work or revise existing work as follows:
In addition to work required under the original Agreement and any
prior Amendments, Contractor shall provide all labor, materials, and
equipment necessary to:
No change to the description of work, however a change order is
necessary to revise the time of completion to November 6, 2020.
2. The contract amount and time for performance provisions of Section II “Time of
Completion,” and Section III, “Compensation,” are hereby modified as follows:
Original Contract Sum,
(including applicable alternates and
WSST)
$10,285
Net Change by Previous Change Orders
(incl. applicable WSST)
$0
Current Contract Amount
(incl. Previous Change Orders)
$10,285
Current Change Order $0
Applicable WSST Tax on this Change
Order
$0
Revised Contract Sum $10,285
DocuSign Envelope ID: 12A8E49C-6D54-4DAB-B359-863AA81EA1B0
DocuSign Envelope lD: 1 2A8E49C-6D54-4DAB-8359-863AA81 EA1 B0
Original Time for Completion
(insert date)
tot9t20
Revised Time for Completion under
prior Change Orders
(insert date)
nla
Days Required (*) for this Change
Order
28 calendar days
Revised Time for Completion
(insert date)
lu6t20
Pursuant to the above-referenced contract, Contractor agrees to waive any protest it may
have regarding this Change Order and acknowledges and accepts that this Change Order
constitutes final settlement of all claims of any kind or nature arising from or connected with any
work either covered or affected by this Change Order, including, without limitation, claims
related to contract time, contract acceleration, onsite or home office overhead, or lost profits.
This Change Order, unless otherwise provided, does not relieve the Contractor from strict
compliance with the guarantee and warranty provisions of the original contract, particularly
those pertaining to substantial completion date.
All acts consistent with the authority of the Agreement, previous Change Orders (if any),
and this Change Order, prior to the effective date of this Change Order, are hereby ratified and
affirmed, and the terms of the Agreement, previous Change Orders (if any), and this Change
Order shall be deemed to have applied.
The parties whose names appear below swear under penalty of perjury that they are
authorized to enter into this contract modification, which is binding on the parties of this
contract.
3. The Contractor will adjust the amount of its performance bond (if any) for this
project to be consistent with the revised contract sum shown in section 2, above.
IN WITNESS, the parties below have executed this Agreement, which will
become effective on the last date written below.
CONTRACTOR:
By
--DocuSigned by:
] (^n" (ils^at,
U- ss6eE3566is saas... ( sig qt4tu re )pfint Name. carrle E] osmoe
I tc VP of Urb an Forest Sales
DATE: to/6/2020 t(t'fidz PM PDT
CITY OF KENT:
By:
(signature)
Print Name: David A. Brock. P,E.
Its
DATE
CHANGE ORDER - 2OF 3
DocuSign Envelope lD: 12A8E49C-6D54-4DAB-8359-863AA81 EA1 B0
ATTEST:
Kent City Clerk
APPROVED AS TO FORM:
(applicable if Mayor's signature required)
Kent Law Department
A Plus Tree - Hycroft CO l/Araucto
CHANGE ORDER - 3 OF 3
Docus¡gn Envelope lD: ECC09F88-0FAA-4492-8632-EF2E6B48C37A
-
.ACORD"
APLUSTR-OI
CERTIFICATE OF LIABILITV INSURANGE
@ t988-2015 ACORD CORPORATION. All rlghte rtcerved.
Tho ACORD nôme ¡nd logo erE rcgl3tero{, marks ol ACORD
ÞAlE (ilH1DO/'fYYYl
31612020
THIS CERT|FICATE IS ISSUED A8 A TATTER OF II¡FORTATION OI{LYAT¡DCOT{FERSrloRIGHTSUPOI¡THECERÎIFICAIEHOLDER.I}IIS
CERTIFICATE DOES I¡OT AFFIR¡IAÎVELY OR NEGANVELY AtrETID, EXTEIID OR ALTER lHE COVERAGE AFFORDED EYTHEFOLICIES
BELow. THIS GERT|F|CATE OF titSURA¡CE oOÊS IOT COilSnTúre n COWn¡CT BETWEEN THE lssull¡G INSURER(s), AUTHORIZÉD
R€PRESET¡TAÎIVE OR PROOUCER, A¡¡D THE CERTIFICAÎE HOLDER
of endot¡ed,bothemutth¡vcthelroldercerlific¡te lnl!ADDMONALtfITPORTAilT:rtguRED,pollcy(le¡)
A atatement onc¡rtalnth¡rndterm¡ol thecondlllon¡tortssuERoGAIt0t{WAIVED,polhy
tho holdcrcertlllcatr lntothL
tNSUREi(!¡l 4rFgEglNC COITERAGË ilAlc I
rf{3r¡RER^:G¡eðnwich lntuEnce com¡nny .22322
nsunERB:XLSpeclrltY In¡ur¡nceComplny .37886
NsuRËRc:Arch lnrunnce Company f 1150
¡¡¡g¡¡¡ ¡ , Travele rr Ciluslty & Surety Comprny ol Amerlcå 311 94
NsuRÊRe:Fsder¡l lnturencs Compeny 20281
PNOOUCER
ftsrrREo
F:
832ô581(8061ilol:
Barbrrr, CA 93130-3t10
CA - HUB lntemltlonal lnli¡rance Sorv¡cet lnc,
A P¡u¡ TroÊ lnc
$90 Bu¡klrk Ave.
Pleæül Hlll, CA 04523
IYPE
CERT|FICAT€
EXCLUSIONS CLÂIMS.
POLICYÎHË PERIODrssuEf)EEEN ÏHETO NÁMEOINSURED FORAEOVETOTHATCERTIFYPOLTCTESTHEINSURANCEOFBELOWHAVELISTEOrsfHrs
RESPECTWTH ffircHTO lHrsORTËRMOFCONDITlONCOI{TRACTANY OTHEROR DOCUMENTANYNOÍWITHSIANDINGREOUIREME¡TINDICATED.
HEREIN TOSUEJECT THEALL8YAFFOROEOPOLICTESTHEOESCRIBËDrs TERMS,BEMIAY EOrssu MAYOR TI{EPER'TÀN,INSURANCE
BY PAIDLIMITSPOL¡CIES.MAYSHOWN BEE}IHAVEco¡rDtroNsAND SUCHOF
E^CHOCCURRËNCÊ $
DAMAGE IO RÊMTEO
PREMISES (Eä ocâ¡n¡rìc.) s
HÊD EXP [Any one ptrsdr] - S
PERSOML TAOr, IÑJURY . 9
GENÉRALAGGR€GAÌE , S
PRODIJCIS.COiTPIOPAGG S
1
X t1PC100305300 31il2020 3nno21
X . corÍERcr L cei¿ËRAL LlrBlt.rrY
clArils.rAor' X occun
GEI{'L AGGFEGAT€ LIMIl APPLIE.S P€R
eor-rcv X !fi$ !oÇ
X *'ly¡wo
Ol/\il{ED
AUTOSONLY
llfi&o*,-'
3nn06 Bootly tNJURy tpå.p€Gonl
BOOILY INJURY (P8. åct¡deril)
PROPERIY DÀMAGE(P€rsrrtsnD
^uTotoB{..C
LttB¡Lllv
3nt202aX llBAl00305¡100
SCHÊDIJLED
AUTOS
TB+*Hñ9
utBRÊLr¡ LIAE X occun
X exce¡sueg cLAtttS-MAoE
DÊD REIENÍIONT
EÀCH OCCURRÉNCE
AGGREGATE
s
IitEc6tt0t062û0{t,m20 3nno21
Y' f{
xr{oR(ERl coilPEr{3^nd{
^fi
o €f PtoYERt' Ll^ä¡ufr ZAWCI9¿t3780tAl{Y PROPRIEÍo'R PARTNER/EX€CI llvE
OFNCER/ìTÊMBER EXCLUDEO?lflßdrtoty ln ilHl
at1t2020 1t1t2021Y t{rA EL ÉACHACCIOENT , S
E,L DIS€ASE - EA EMPLOYEE T
D cflme
E tlrc. Tool¡
t06ı8653+
¡lı47latO
gE 20tg
tnftî,20
9tu2020
3nn02t
¡1,000 Dod
¡1,000 Dod
1,000,o00
200,000
¡rËSCRlPROf{ * OPERAnollS , LoG Ìxtilf , vÉHlcLEE lAcoRD l0l, Addlüoill R]nrttr sch.r¡¡b' íllv b. lürcllll lf ûotl ¡Þ¡q¡ lt t qulndl
úırkli,t ıdmireniãUoã Fon-cy *ZÀWC19137600; Eff.Erp: il13r20.tllll20, lsulng C¡rfsr: Arch lnrurancb Gompàny, Limitr: E.L. Elch Accid€nt ¡1,000,0(X1 ,
E.LDircase - Each Enployoe ¡1,000,000 / E.L. Dlseaee - Pollcy Llnit ¡1,üt0,0{Xl'
Cêrtiftcåt€ holder l! n¡med Addition¡l ln¡ured fo¡ Gonêrrl Lirbllity psr form tCG20l0 0at3 t #CG20¡7 0¿t13, General Lhblllty Primary rnd l.lonContributory
*ordlngperform#XlL¡f38 1208;Addltlonalln¡urodforAutoL¡tb¡¡ittp€rfofm*XlC121 l0l3 a¡nquimdbywrlttencontnct.
Glty of Kent
220 Fourth AYe. South
Kent, WA 98032
EHOULD A}IY OF IHË ABOì/E DESCRIBËÛ POLICIES BE CAI{C€LLED AEFORE
THE EJTPIRATIOII OATE THËRËOF, Ì{OIICE IYILL ðE DELNÆRED IN
ACCORDAI|CE WltH TltE POLTCY PROVlSlOlilS.
AUIHORUI D REFREIEIIÎAIIVE
&,,W-,^^
ACORD 25 (2o18ro3l
DocuSign Envelope lD: ECC09F88-0F444492-8632-EF2E6B48C37A
POLICY NUMBER: NPC10030s3O0
THIS ENDORSEMENT CHANGES THE POLICV. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
Thís endorsement modifies insurance prov¡ded under the following
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
COMMERCIAL GENERAL LIABILITY
cG 20 10 04 13
:,h
Name Of Addilional lneured Person(s)
Or Oroanizatlon(s)Loc¡tion(s) Of Govered Ooerations
Blankee as required by wrÍcten çonEracÈ.BlankeE as required by writuen
contract.
lnformation reouired to comolete this Schedule. if not shown above. will be shown in the Declaralions.
A. Sectlon ll - ltVho ls An lnsured is amended to
include as an additional insured thê person(s) or
organization(s) shown in the Schedule, bul only
with respect to liability lor "bodily injury", "property
damage' or npersonal and adverlising iniury"
caused, in whole or in parl, by:
l. Your acts or omíssions: or
2. The acts or omissions of those actíng on your
behall;
in the performance of your ongoing operalions for
the additional insured(s) at lhe location(s)
designated above.
However:
l. The insurance aflorded to such additional
insured only applies to the extent permitted by
law;and
2. lf coverage provided to the addilional insured is
required by a contract or agreement, the
insurance afforded to such addilional insured
will not be broader than thal which you are
required by the contract or agreemenl to
provide for such addilional insured.
B. With respect to the insurance alforded to these
addilional insureds, the lollowing additional
exclusions apply:
This insurance does not apply to "bodily injury" or
"properly damage" occurring alter:
1. All work, including materials, parts or
equipmenl furnished in conneclion with such
work, on the pro¡ect (olhêr than service,
maintenance or repairs) to be performed by or
on behall of the additional insured(s) al lhe
localion of the covered operations has been
completed;or
2. That portlon of 'your work" out of which the
injury or damage arises has been pul to ¡ts
intended use by any p€rson or organization
other than another contractor or subcontractor
engaged in performing operal¡ons for a
principal as a part ol the same project.
cG 20 10 04 13 o lnsüËncã Sþndcès ûffloè, líc,, 201â P¡Ío t ol 2
DocuSign Envelope lD: ECC09F88-0F444492-8632-EF2E6B48C37 A
C. With respecl to lhê insurance afforded lo these
additional insureds, the following is added to
Sectlon lll - Llmlt¡ (X lnsur¡nce:
lf coverago provided to the additional insured is
required by a contract or agregment, lhe mosl we
will pay on behalf of lhe additional insured is the
amount of insurance:
l. Re{uired by the contract or âgreêmenl: or
2. Available under lhe applicable Limits of
lnsurance shown in the Declarations;
whichavor is less.
This andorsemenl shall not increase lhe
applicable Limits ol lnsurance shown in lhe
Declaralions.
Pagc 2 ol 2 Ê'|ffi ruwüffi üıü[.@m,ffi;*Ðf*;" .:ì:, -.d..r'l! -:4ÌÐ14¡Ff,itß:Ð; .:; \,.f;.
DocuSign Envelope lD: ECC09F88-0FAA-4492-8632-EFZE6B48C37 A
pOLlCy NUMBER: NPcl-00305300 COiIMERCIAL GENERAL LIABILITY
cG 20 37 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
a
This endorsement modif¡es insurance prov¡ded under lhe following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULË
Name Ol Additional lnaured Person(s)
Or Oroanlzatlon(s)Location And Desc¡iotion Of Comoleted Ooeratlons
Blankeu as required by wrítten concract BlankeE as reguired by written contracc
lnformation required to complete this Schsdule, if not shown above, will be shown in the Declarat¡ons.
A. Seclion ll - t{ho ls An lnsured is amended lo
include as an addilional insured the person(s) or
organization(s) shown in the Schedule, but only
with respgct to liab¡lily for "bodily iniury" or
"propeny damage" caused, in whole or in parl, by
"your work" al lhe location designated and
described in the Schedule of this endorsement
performed for that addilional insured and
included in the "producls-completed operations
hazard".
However:
1. The insurance afforded to such additional
ínsured only applies to lhe exlent permitted
by law;and
2. lf coverage provided to the additional insured
is required by a contract or agreement, lhe
insurance afforded lo such addílional insured
will not be broader lhan that which you are
B. W¡th respect to the insurance afforded to these
additional insureds, lhe lollowing is added to
Sectlon lll- Llmlt¡ Of lnsurance:
lf coverage provided 10 the additional ínsured is
required by a contract or agreemenl, the most we
will pay on behalf of the additional insured is the
amount ol insurance:
1. Required by the conlracl or agreement; or
2. Available under the applicable Limits of
lnsurance shown in the Declarâtions;
whichever is less.
This endorsEment shall nol increase the applicable
Limils of lnsurance shown in the Declarations.
required by the conlract
provide for such additional
or agreemenl
insured.
to
cG 20 37 04 13 s lnsurånco Sårvlces Ofllce, lnc.r 20f2 Prgr 'l ol I
DocuSign Enùelope lD: ECC09F88-0FM-4492-8632-EF2E6B48C37A
POLICY NUMBER: NBAI OO3O54OO
THIS ENDORSEMENT CHAIIGES THE POLICY. PLEASE READ IT CAREFULLY.
XL PLUS BUSINESS AUTO EXTEI{SION ENDORSEIIENT
This endorsement modifies insurence provided underthe folloring:
BUSINESS AUTO COVERAGE FORM
COVERAGE DESCRIPTION
Temporary Substitute Auto Phyrical Damage
Who ls An lnsured
1. Brcad Form lneurod
2. Employees As lnsureds
3. Additional lnsured By Conttact, Agreement or Fermlt
4. Employee Hired Autos
Supplementary Payments
Amended Fellow Employee Excluslon
Physical Damage Coverage
t. RentalReimbusement
2. Extra Expense- Broadened Coverage
3. Personal Effects Goverage
4. LeaseGap
5. Glass Repair - Waiver Of [Þductible
Physical Damage Coverage Extensions
l. AdditionalTraneportationExpente
2. Hired Auto PhyslcalDamage
Businees Auto Conditiong
'1. Notice Of Occurrence
2. Waiver Of Subrogation
3. Unintent¡onal Failure To Di¡cloas H¿zards
4. Primary lnsurance
Bodily lnjury Redellned
Extended Cancellation Condition
@ 2013 X.L. America, lnc. Alt Rights Reserved,
May not be copied without permission.
lncludes copyrighted material of lnsurancs services office, lnc., with its permission
A.
B.
c.
D.
E.
xtc 421 1013
F
G.
H.
L
xtc 421 't013 Page 1 of6
DocuSign Envelope lD: ECC09F88-0FM-4492-8632-EF2E6B48C37A
A.Temporary Subatitute Auto Phytical Damage
SECTION I - COVERED AUTOS, C. Gertain Trailers, Mobile Ëquipment And Temporary Subst¡tute
Autos ís changed by adding the follnving:
lf Physical Damage coverege is provided by this Coverage Form, the following types of vehicles are also
covered .autos'for Physical Damage coverage:
1. Any'auto'you dotrot orrn while used with the permission of its owner as a temporary substitute for
a covered "auto'you own that is out of service because of its:
Breakdown;
Repa¡r;
Servicing;
'Loss"; or
Destruction
B. Who le An lnsured
SECTION ll - COVERED AUTOS LIABILIW COVERAGE, A. Coverage, l. Who ls An lnsured is
changed by adding the following:
Brcad Form lnsured
For any covered 'auto', any subsidiary, affiliate or organization, other than a partnership or joint
venture, as may now exist or hereafter be constituted over which you assume aciive management
or maíntaín orvnership or majority ínterest, provided that you notify us within ninety (90) days from
the date that any such subsidiary or affiliate is acquired or formed and that there is no similar
insurance available to that organization. However, coverage does not apply to'bodily injury' or
"property damage'that occurred before you acquired or formed the organization.
2. Employees As lnsureds
Any "employee' of yours is an 'insured'while using a covered 'auto' you don't own, hire or borrow,
in your business or your personal affairs.
3. Additional lnsu¡ed By Gontract, Agreement Or Permit
Any person or organization with whom you have agreed in writing in a contract, agreement or
permit, to provide insurance such as is provided under this policy, provided that the "bodily injury"
or 'property damage" occurs subsequent to the execution of the written contract, agreement or
permit.
4. Employee Hlred Autoe
An -employee' of yours is an 'insured' while operaling an "auto" hired or rented under a contract or
agreement in that'employee's' name, wilh your permission, while performing duties related to lhe
conduct of your business.
O 2013 X.L. America, lnc. All Rights Reserved.
May not be copied without permission.
lncludes copyrighted material of lnsurancs Services Office, lnc., with its permiss¡on.
a.
b.
c.
d.
e.
xtc 421 1013 Page 2 of 6
DocuSign Envelope lD: ECC09FB8-0FAA-4492-8632-EF2E6B48C37A
SECTION lV - BUSINESS AUTO COtlDlTlOttlS, B. General Conditlons, 5. Other lnsurance, b.
is replaced wÍth the following:
For Hired Auto Physical Damage Coverage, the following are deemed to be covered
"autos'you own:
(f l Any covered'auto'you lease, hire, rent or borrow; and
l2l Any covered "auto" hired or rented by your "employee' under a contract in that
individual 'employee's' name, with your permission, while performing duties
related to the conduct of your business.
However, any 'auto'that is leased, hired, rented or borrored with a driver is not a covered
"auto'.
C. Supplementary Payments
SECTION ll - COVERED AUTOS LIABILITY COVERAGE, A. Goveraga, 2. Covårage Extensions, a.
Supplementary Payments is changed as follors:
Item (2| is deleted and replaced by the folloring:
(2) Up to $3,500 for cost of bail bonds (including bonds for related traffic law violations) required
because of an "accidenf'we cover. We do notrhave to furnish these bonds.
Item (4) is deleted and replaced by the follouring:
(4) All reasonable expenses incuned by the 'insured' at our requ6st, including actual loss of eamings
up to $500 a day because of time off from work.
D. Amended Fallow Employee Exclusion
SËCTION ll- COVERED AUTOS UABILITY COVERAGE, 8. Exclusions, 5. Fellow Employee does not
apply.
The insurance provided under this Provision D. is excess ovsr any olher collectible insurance.
E. Physical Damage Coverage
SECTION lll - PHYSICAL DAilAGE COVERAGE, A. Coverage is changed by adding the fotlowing:
1. RentalReimbursement
a. We wíll pay for rental reimbursement expenses incurred by you for the rental of an 'auto"
because of *loss' lo a covered "auto". Payment appliei in addition to the othenrise
applicable amount of each coverage you have on a covered 'auto". No deductibles apply
to this coverage.
b. We will pay only for those expenses incurred during the policy period beginning twenty-four
(24) hours afier the "loss" and ending, regardless of the policy's expiratlon, wäh ttre lesser
of the following number of days:
b.
@ 2013 X.L. America, lnc. Afl Rights Reserved.
May not be copied without permission.
lncludes copyrighted material of lnsurance services office, lnc., with its permission
xlc 421 1013 Page 3 of 6
Docusign Envelope lD: ECC09F88-0FAA-4492-8632-EF2E6B48C37 A
(rl The number of days reasonably required to repair or replace the covered "auto'. lf
"losso is cåused by thefr, this number of days is added to the number of days it
takes to locate the covered nauto' and retum it to you.
c-
(21 Thirty (30) days.
Our payment is limited to the lesser of the following amounts:
(*l Necessary and ac{ual expenses incurred.
(21 $50 any one day per private passenger'auto";
$100 any one day per truck;
$1,500 any one period per private passenger'auto';
$3,000 any one period per truck; or
Higher limits if shown elsewhere in this policy.
d.This coverage does not apply while there are spare or reserve'autos'available to you for
your operations.
e. lf "loss' results from the total thefr of a covered 'auto" of the private passenger 9pe, we will
pay under this coverage only that amount of your rental reimbursement expenses which is
not already provided for under the Physical Damage eoverage Extension.
Extra Expense - Broadened Coverage
We will pay for the expense of retuming a stolen covered "auto'to you.
3. Personal Effects Coverage
lf you have purchased Comprehensíve Coverage on this policy for an "auto' you onn and that
"auto' is stolen, we will pay, without application of a deductible, up to $500 for'personal effects"
stolen from the'auto".
As used in lhis endorsement, "personaleffects' means tangible property that is worn or carrÍed by
an'insured"" "Personaleffects'does not include tools, jewelry, money or securities.
4. LeaseGap
ln the event of a total .loss" to a covered "auto" shown in the Declarations. we will pay any unpaíd
amount due on the lease or loan for a covered "auto', lessl
a.The amount paid under the Physical Damage Coverage Section of the policy: and
Any:
(f l Overdue lease/loan payments at the lime of the "loss";
Financial penalties imposed under a lease for excessive use, abnormal wear and
tear or high mileage;
Security deposits not returned by the lessor;
Costs for extended wananties, Credit Life lnsurance, Health, Accident or Disability
lnsurance purchases with the loan or lease; and
Carry-over balances from previous loans or leases.
@ 2013 X.L. America, lnc. All Rights Reserved.
May not be copied without permission.
lncludes copyrighted matÊrial of lnsurance SeMces Office, lnc., with its permission.
2.
b.
(2)
(3)
(41
(5'
xlc 421 1013 Page 4 of6
Docusign Envelope lD: ECC09F88-0FAA-4492-8632-EF2E6B48C37A
5. Glass Repalr - We¡ver Of Deductible
No deductible applies to glass damage if the glass is repaired rather than replaced.
Physical Damage Coverage Extensions
SECTION lll- PHYSICAL DAMAGE COVERAGE, A. Coverago,4. Govcrage Extensions is amended by
the folloring:
,l. AdditionalTraneportationExpense
Sectlons a. and b. are amended to provide a limil of $50 per day and a maximum limit of $1,000.
2. Hired Auto PhyeicalÐamage
The folloring section is added:
Any *auto'you lease, hire, rent or borrow is deemed to be a covered "auto" for physical damage
coverage. The most we will pay for each covered'auto' is the lesser of:
(f) the actual cash value;
(21 the cost for repair or replacemen( or
(31 $50,000, or higher limit if shown on the Declarations for Hired Auto Physical Damage
Coverage.
For each covered "auto'a deduclible of $100 for Comprehensive Coverage and $1,000 for
Collision Goveraga will apply-
Business Auto Conditions
SECTION lV- BUSINESS AUTO CONDlTlOilS, A. Locs Conditions is changed by the following:
t, Notice Of Occurrence
Section 2. - Duties ln The Event Of Accident, Claim, Suit Or, Los, a. is changed by adding the
follovring:
lf you report an injury to an "employee' to your workers' compensation carrier and if it is
subsequently determined that the injury is one to which this insurance may apply, any failure to
comply with this condition will be waived if you provide us with the required notice as soon
thereafter as practicable after you knou or reasonably should have known that this insurance may
apply.
2. Waiver Of Subrogation
I
OtheetTo Us is changed by addlng the
However, this Condition does not apply to any person(s) or organization(s) with whom you have a
written contract, but only to the extent that subrogation is waived prior to the .accident" or the *loss'
under such contract with that person or organization.
@ 2013 X.L. America, lnc. All Rights Reserved.
May not be copied without permission.
lncludee copyrighted material of lnsuranca Services Offica, lnc., wlth its permission
F
G
$ection 5. Tranefer Of Rights Of Reeovery Against
following:
xrc 421 1013 Page 5 of 6
DocuSign Envelope lD: ECC09F88-0FAA-4492-8632-EF2E6B48C37A
H.
SECTION lV- BUSII{ESS AUTO COt{DlnONS, B. General Conditiong is changed by the follorving:
3. Unintentional Failure To Disclose Hazards
The follorving condition is added:
Your unintentional failure to disclose all hazards as of the inception dale of the policy shall not
prejudice any insured with respect to the coverage afforded by this policy.
4. Primary lnrurance
Gondition 5. Other lnsurance is changed by adding the folloñ,ing:
For any covered -auto' this insurance shall apply as primary and not contribute with any other
insurance where such requirement is agreed in a written contract executed prior to a .loss'.
Bodily lnjury Redefined
SECTIOi{ V - DEFINITIONS, C. .Bodily injury' is æplaced by the following:
"Bodily injury' means bodily injury, sickness or disease sustained by a parson including mental anguish,
mental injr"rry, shock, fright or death resulling from any of these at any lime.
Extended Cancellation Condition
COMI|ON POLICY CONDITIONS (Form lL 00 t7l, A. Cancellatlon, 2.b. is replaced by the following:
The greater of sixty (60) days or the time required by any applicable state amendatory endorsement before
the effectiræ date of cancellation if we cancel for any other reason.
All other terms and conditions of this policy remain unchanged.
@2013 X.L. America, lnc. AllRights Reeorved.
May not be copied without permission.
lncludes copyrighted material of lnsurance Services Office, lnc., with its permission.
xlc 421 1013 Page 6 of6
DocuSign Envelope lD: ECC09F88-0FM-4492-8632-EF2E6B48C37A
ENDORSEMENT #
This endonsement, effect¡ve f 2:01 a.m. , forms a part of
Policy No. NPC100305300 issued to A Plus Tree lnc
by Grcenwich Insurance Company
THIS ENDORSEIT,IENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
XL Plus Endorsement
This endorsement modifies insurance provided under the folloiving:
COMMERCIAL GENERAL LIAEILITY COVERAGE PART
GEiIERAL DESCRIPTIOI{ OF COVERAGE - This endorsement broadens coverage. The
folloraÍng listing is a generalcoverage desøiption only. Limitations and exclusions may apply
to these coverages. Read this endorsement carefully to determine rights, duties, and what is
and is not covered.
A. Reasonable Force - Bodily lnjury or Property Damage
B. Damage To Premises Rented To You Extension
o Perils of fire, lightning, explosion, smoke, aircraft or vehicles, riot or civil commotion,
vandalism, leakage from fire extinguishing equipment or water damage
r Limit increased to $300,000
G. Aírcraft Chartered with Crew
D. Non-orrned Watercrafi
E. Personal and Adverlising lnjury - Assumed by lnsured Contracl
F. lncreased Supplementary Paymenls
¡ Cost for bail bonds increased to $5,000
r Loss of eamings increased to $1,000 per day
G. Broadened Named lnsured
H. Blanket Additíonal lnsured - Managers or Lessors of Premises
l. Blanket Additional lnsured - Lessor of Leased Equipment
J. lnjury to Co-Employees and Co-Volunteer Workers
K. Knowledge and Notice of Occunence or Offense
L. Unintentional Omission
M. Liberalization
N. Blanket Waiver of Subrogalion
O. lncidental Medical Malpractice lnjury
P. Extension of Coverage - Bodily lnjury
Q. Coverage Territory
Form XIL 436 1208 @ 2008, XL America, lnc. Page 1 of I
lndrdes mpyrighted materitl of ln¡ursncê Services Oñice, |rrc., wilh its pemisoion.
DocuSign Envelope lD: ECC09F8B-0FAA-4492-8632-EF2E6B4BC37A
A. REASOT{ABLE FORCE - BODILY INJURY OR PROPERTY DAMAGE
ExcJusion a. Expected O.r lntended lnjr¡ry of Part 2., Exclusions of Coverage A. Bodily lnjury
And Prcperty Damage Liability of Section I - Coverages is deleted in its eñtirety ano ieptäcéO
by the follorving:
fihis insurance does not apply to;)
Expacted or lntended lniury or Damage
"Bodily injury" or'property damage' expec{ed or intended from the standpoint of the insured.
This exclusion does not apply to'bodily injury" or "property damage" resulting from the use of
reasonable force to protect pêrsons or propefi.
B. DAMAGE TO PREMISES RENTED TO VOU EXTENSION
l. Ilt:.lltt qlagraph of 2. Exclusions of Coverage A. Bodily lnjury And Property Damage
Liability of Sec{ion | - Coverages is deleted in its entirety ariO réptäceO by the foítowing:
Exclusions c. through n. do not apply to damages to premises while rented to you, or
temporarily occupied by, you with permission of the owner, caused by fire, lig'htning,
explosion. smoke, aircrafr or vehicles, riot or civíl commotion, vandalism, leakage ñom f¡ie', extinguishing equipment or water damage. A separate limit <¡f insurance appties to this
coverage as described in Section lll- Limits of lnsurance.
2. This insurance does..not apply to damage to premises while rented to you, or temporarily
occupied by you with permission of the ou'ner, caused by:
a. Rupture, bursting, or operation of pressure relief devices;
b. Rupture or bursting due to expansion or swelling of the contents of any building or
struc{ure, caused by or resultíng from water; or
c. Explosion of steam boilers, steam pipes, steam engines, or steam turbines.
3. faragraph 6. of Section lll- Limits of lnsurance is deleted in ils entirety and replaced by the
following:
6.a' Subjec{ to Paragraph 5. above, the Damage To Premises Rented To you Limit is the
most we will pay- u.nder Coverage A for damages because of "property damage" to any
one premises while renled to you, or temporarily occupied by you with penñission oflhe owner, caused by fire, explosion, lightning, smoke, aircrafror vehicie, riot or civil
commot¡on, vandalism, leakage froqr lire extinguishing equipment or water damage.
The Damage To Premises Rented To You Limit wiltaþply tó alt damage proximatãy
c-aused by the same uoccurrence", whether such damagaresults from ñre, explosion,
líghtning, smoke, aircrafl or vehicle or riot or civil commıtion, vandaliem, leakaþe from
fire extinguishing equipment or water damage or any combination of any of the-se.
b. The Damage to Premises Rented to you Limit wiil be the higher of:
(1) $300,000; or
(2) The amount shown on the Declarations for Damage to Premises Rênted to you
Limit.
Form XIL 436 1208 @ 200S, XL America, lnc.
lndudes copyrighted mate.ial of lnsurance Services Oñìce, |rrc., with its permission.
Page 2 of I
DocuSign Envelope lD: ECC09F88-0FM-4492-8632-EF2EOB48C37A
4, Paragraph 9.a. of the definition of insured contracl" under Section V- Definitions, is deleted
in its entire$ and replaced by the following:
l"lnsured contract" means:]
a. A contract for a lease of premises. Hor#ever, that portion of the contract for a lease of
premises that indemnifies any person or organization for damage by fire, lightning,
explosion, smoke, aircrafr or vehicle, riot or civil commotion, vandalism, leakage from
fire extinguishing equipment or water damage to premises while renled to you, or
temporarily occupied by you with the permission of the owner is not an -insured
contract'.
5. This Article B. does not apply if coverage for Damage to Premises Rented to You of
Coverage A. Bodily lnjury And Property Damage Liability of Section I - Coverages is
excluded by endorsemenl.
C. AIRCRÀFT CHARTERED WITH CREW
t. The following is added to the exceplions contained in Exclusion 9., Aircrafr, Auto or
Watercraft in Part 2., Exclusions of Coverage A. Bodily lnjury And Proper$ Damage of
Section l- Coverages:
[This exclusion does not apply to:)
Aircrafr chartered with crew to any insured.
2. This Article C. does not apply if the chartered aircrafr is owned by any insured,
3. The insurance provided by thís Article C. shall be excess over ãny valid and collectible
ínsurance available to the insured, whether primary, excêss, contingent or on any other
basis, except for insurance purchased specifically by you to be excess of this policy.
D. NON.oWNEDWATERCRAFT
1. The exception conlained in Subparagraph (2) of Exclusion g. Aircrafl. Aulo orWatercrafl
in Part 2., Exclusions of Coverage A. Bodily lnjury And Property Damage Liability of
Sec.tion I - Coverages is deleted in its entirety and replaced by the following:
(2) A watercraft you do not own that is:
(a) 50 feet long or lessi and
(bl Not being used to carry persons or property for a charge;
2. This Article D. applies to any person who, with your expressed or implied consent, either
uses or is responsible for the use of the watercraft.
3. This insurance províded by this Article D. shall be excess over any other valid and
collectible insurance available to the insured, whether primary, êxcess, contingent or on
any other basis, except for insurance purchased specifically by you to be excess of lhis
Policy,
E. PERSONAL AND ADVERTIS¡NG INJURY - ASSUMED BY INSURED COI{TRACT
l. Exclusion e. Contractual Liability in Part 2., Ëxclusions of Coverage B. PersonalAnd
Advertising lnjury Liability of Section I - Coverages is deleted in its entirety and replaced
by the following:
Form XIL 436 1208 @ 2008, XL America, lnc.
lndudes copyrþhted material of lnsurance Servioe¡ Ofüce, |rrc., with its permission.
Page 3 of I
Docusign Envelope lD: ECC09F88-0FM-4492-8632-ÉF286B,48C37 A
|Ihis insurancê does not apply to:)
e. Contractual Liablllty
"Personal and Advertising Injury'for which the insured has assumed liability in a contract
or agreement. This exclusion does not apply to liability for damages:
.. t. That the insured would have in the absence of the contract or agreemenl or
2. Assumed in a written contract or agreement that is an "ir{sured contract"; provided the
'personal and advertising injury'is cauaed by an offense which occurs subsequent to
the execution of the contracl or agreement.
2. Subparagraph f. of the definition of "insured contract' Section V.- Definitions ís deleted in its
entirety and replaced by the following:
f. That part of any other contract or agreement pertaining lo your business, including an
indemnification of a municipality in connection for work performed for a municipalþ,
under which you assume the tort liability of anther party to pay for "bodily injury",
'property damage" or "personal and advertising injury'to a lhird party or organization.
Tort liabilþ means a liability that would be imposed by law in the absence of any
contract or agreement.
2. This Article E. does not apply if Coverage B. Pemonal A¡d Advertísing lnjury Liability is
excluded by endorsement.
F. II{CREASED SUPPLEMENTARY PAYII'IENTS
Subparagraphs l. b. and d. of Supplementary Paymenls - Coverages A And B of Section I -
Coverages are amended as follo¡s:
L ln Subparagraph b., the amount we will pay for the æst of bail bonds ís increased up to
$5,000.
2, ln Subparagraph d., the amount we will pay for a loss of earnings is increased up to
$1.000 a day.
G. BROADEIIED Î{Ai/lED INSURED
1. The Named lnsured in ¡tem 1. of the Declarations is as follows:
The person or organizations named ín ltem l. of the Declarations and any organization,
other than a partnership or joint venture, over which you maintain ornershíp or majority
interesl on lhe effec{ive date of the policy. Honever, coverage for any such organization
will cease as of the date that you no longer maintain ownership ol or majarity interest in,
such organization.
2. This Article G. does not apply to any person or organization for which coverage is excluded
by endorsement.
Form XIL 436 1208 @ 2008, XL America, lnc.
lndudes copyrþhted material of lßurance Services oftce, lnc., with its p€m¡ssíon.
Page 4 of I
DocuSign Envelope lD: ECC09F88-0FAA-4492-8632-EF2E6B48C37A
H. BLANKET ADDITIONAL INSURED - iIAiIAGERS OR LESSORS OF PREMISES
l. Sec-lion ll-Wro ls An lnsured is amended to include as an insured any person or
organization with whom you have agreêd in a writlen contract executed prior to loss (an
"additional insured'), but only with respect to liabilþ arising out of the ownership,
maintenance or use of that part of any premises leased to you, subject to the foltofling
provisions:
a. Limits of lnsuranee. The Limits of lnsurance afforded to the'additional insured" shall
be the limits you agreed to provide, or the limits shown on the Declarations, whichever
is less.
b. The insurance afforded to the'additional insured' does not apply to:
(f I Any'occurrence'that takes plæe after you oease to be a tenant in that premises;
(2) Any premises for which coveftìge is excluded by endorsement: or
(3f Structural alterations, new construc{ion or demolition operations performed by or
on behalf of such "additíonal insured".
2. The insurance afforded to the .additional insured" is excess over any valid and collectible
insurance available to such "additional insuæd', unless you have agreed in a written
contract for this insurance to apply on a primary or contributory basis.
I. BLANKET ADDITIONAL INSURED - LESSOR OF LEASED EOUIP¡IIENT
l. Section ll-Wlro ls An lnsured is amended to include an 'additional insured' (as defined in
Article H, above), but only with respect to their liability arising out of maintenance, operation
or use by you of equipment leased to you by such 'additional insured", subject to the
following provisions:
a. Limits of lnsurance. The Limits of lnsurance afiorded to the "additional insured" shall
be the limits which you agreed to provide, or the limits shown on the Declarations,
whichever is less.
b. The insurance afforded to the'additional insured'does not apply to:
(f ) Any'occurrenceo that takes place afrerthe equipment lease expíres; or
(2) 'Bodily injury' or "properÇ damage' arising out of the sole negligence of such
additional insured.
2. The insurance provided to the 'additional insured' is excess over any valíd and collectible
insurance available to such "additional insured", unless you have a written contract for thís
insurance lo apply on a primary or contdbutory basis.
J. INJURY TO CO.EMPLOYËES AND CO.VOLUNTEERWORKERS
1. Seclion ll- Who ls An lnsured is amended to include your.employees' as insureds with
respect to'bodily injury" to a co--employee' in the course of the co-'employee's"
employment by you, or to your'volunteer workers" while performing duties related to the
conduc{ of your business, provided thal this coverage for your -employees' does not
apply to ac{s outside the scope of thair employment by you or while performing duties
unrelated to the conduct of your business.
Form XIL 436 '1208 @ 2008, XL America, lnc.
lnducles copyrighled material of lnsurance Services Office, lnc., wr'lh ils permission.
Page 5 of I
DocuS ig n E nvelope I D: ECC09F88-0F444492-8632-EF 286B48C37 A
2. Section ll - Who ls An lnsured is amended to include your'volunteer workers" as
insureds with respect to'bodily injury'to a co-"volunteer worke/ while performing duties
related to the conduct of your business, or to your'employæs" employment by you,
provided that this ooverage for your 'volunteer workers' does not apply while performing
duties unrehted to the conduct of your business.
K. KNOWLEOGE AND NOTICE OF OCCURRENCE OR OFFET{SE
The following is added to Paragraph 2., Duties ln The Event of Occurrence, Offense, Claim or
Suit of the Section lV - Commercial General Liability Conditions:
Notice of an "occunence" or of an offense which may result in a claim under this insurance
shall be given as soon as practicable after knowledge of the uoccunence' or offense has
been reported to any insured lísted under Paragraph l. of Sestion ll-\lVho ls An lnsured or
any'employee'(such as insurance, loss control, risk manager or adminislrator) desígnated
by you to giræ such notice.
Knowledge of any other'employee(s)' of an uoccunence' or of an offense does not imply that
you also have such knowledge.
Notice shall be deemed prompt if given in good faith as soon as practicable to your workers
compensation insurer. This applies only if you subsequently give notice to us as soon as
practicable after any insured listed under Paragraph l. of Section ll - Wlto ls An lnsured or
an 'employee' (such as an insumnce, loss control, or risk manager or administmtor)
designated by you to give such notice discovers that the "occurrence', offense or claim may
involve this policy.
L. Ut{tñrrEiriloNAL oitllssloN
The folloring is added to Paragraph 6., Representations, of Section lV- Commercial General
Liability Conditions:
The uninlentionalomission of, or unintentionalenor in, any information provided by you shall
not prejudice your rights underthis insurance. However, this Article L. does not affect our
right to collect addilional premium or to exercise our right of cancellation or nonrenewal in
accordance with applicable state insurance laws or regulations.
i'. LIBERALIZATION
The following is added to Sec'tion lV-Commercial General Liability Conditions:
Liberalization
Afier the issuance of this policy, if we adopt a change in our forms or rules which would
broaden the coverage provided by any form that is a part of this policy without a premium
charge, lhe broader coverage wíll apply to this policy, This extension is effective upon the
approval of such broader covera¡ge in your state.
Form XIL 436 1208 @ 2008, XL America, lnc.
lnduder copyríghled måterial of lnsurance Services Oliæ, lrp., with ¡ls permiss¡on.
Page 6 of I
DocuSign Envelope lÐ: ECC09F88-0FM-4492-8632-EF2E6B48C37A
N. BT.ANKET WAIVER OF SUBROGATION
The folloring is added to Sec'tion lV-Commercial General Liability Gonditions
Waiver of Subrogatlon
We waive any right of recovery we may have against any person or organization because of
payments we make ficr injury or damage arising out of premises owned or occupied or rented
or loaned to you; ongoing opeÉtions performed by you or on your behalf, done under a
,
contract with that pàrson or organizalion; Tour work", or'your produc-ts". We waive this right
where you have agreed lo do so as part of a written contra6:t, executed by you prior to loss.
O. INCIDENTAL iIEDICAL iIIALPRACTICÊ INJURY
l. For insurance applicable to this Article O, the definition of 'bodily injury' in Section V -
Definitions is amended to include, 'lncidentral{tledical Malpractice lnjury'.
2. The following definition is added to Section V- Definitions:
'lncidental medical malpractíce injury" means'botlily injury', mental anguish, sickness or
disease sustained by a person, including death resulting from any of these at any time,
arising out of th6 rendering of, or faílure to render, the following services:
a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or
instruc{ion, or the related furnishing of food or beverages;
b. The furnishing or dispensing of drugs or medical, dental or surgical supplies or
appliances;
c. First aid; or
d. .Good Samaritan Services". As used in this Article O., -Good Samaritan Services'are
those medical services rendered or provided in an emergency and for which no
remuneration is demanded or received.
3. Paragraph 2.a.(f )(d) of Sec'tion ll -Who ls An lnsured does not apply to any regístered
nurse, licensed practical nurse, emergency medicaltechnician or paramedic employed by
you, but only while performing the services desøibed in Paragraph 2. above and while
acting within the scope of their employment by you. Any'employees' rendering 'Good
Samaritan Services'will be deemed to be ac{ing wíthin the scope of their employment by
you.
4. The folfowing exclusion is added to Paragraph 2. Exclusions of Coverage A. * Bodily
lnjury And Property Damage Liability of Sec{ion I - Coverages:
[This insurance does not apply to)
Willful Violation of Penal Statute
Liability arising out of the willful violation of a penal statute or ordinance relating to the
sale of pharmaceuticals by or with the knorrrledge or consent of the insured.
5. For the purposes of determining the applicable Límits of lnsurance, any act or omission,
together with all related acts or omissions in the fumishing of services described in
Paragraph 2.a. through 2.d. above to any one person, will be considered one "occurrence".
6. This Article O, does not apply if you are in the business or occupatíon of providing any of
the services described in Paragraph 2. above.
Form XIL 436 1208 @ 2m8, XL America, lnc.
lndudes copyrigtrled matêrial of lnaurance SeMces Oñice, lnc., rt ith its permiasion.
Page 7 of I
DocuSign Envelope lD: ECC09F88-0FA44492-8632-EF2EOB48C37A
7. The insurance provided by this Arlicle O. shall be excess over any other valid and
collec'table insurance available to the ineured, whether primary, excess, contingent or on
any other basis, except for ingurance purchased specifically by you to be excess of this
policy.
P. EXTENSION OF COVERAGE - BODILY INJURY.
The definition of "bodily injury' Section V- Definitions is deleted in its entirc$ and replaced by
the following:
3. "Bodily injury' means bodily injury, mentalanguish, mental injury, shock, fiight, disability,
humiliation, sickness or disease sustained by a person, including death resulting from
any of these at any time.
c¡. COVERAGE TERRITORY
The definilion of 'coverage tenitory" Section V- Definitions is deleted in its entirety and
replaced by the follouring:
4, 'Coverage tenitory" means anyurhere in the world.
This insurance does not apply to: .
e. "bodily injury" or'property damage' that takes place; or
b. 'personal and advertising injury' caused by an offense committed
outside the United States of America (including its possessions and tenitories),
Canada and Puerto Rico, unless a'suitn on the merits (to determine the insured's
responsibility to pay damages to which thig insurance applies) is brought in the
United States of America (including its possessions and tenitories). Canada or
Puerto Rico.
This insurance does not apply to damage, loss, cost or expenses in connec{ion with any
'suit' brought outside the United Slates ol America (including its possessions and
tenitories), Canada or Puerto Rico.
Form XIL 436 1208 @ 2008, XL America, lnc.
lncludes copyrighted material of lnsurance SeMces O'lIice. |rrc., wilh its pemþsion.
Page I ofB