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CAG2020-288 - Change Order - Dickson Company - Signature Pointe Levee Wagner Property Demolition - 10/26/2020
ApprovalOriginator: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: Dickson Company (“Contractor”) CONTRACT NAME & PROJECT NUMBER: Wagers Property Demolition ORIGINAL CONTRACT DATE: September 4, 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: Hydroseed the site and dispose of tires from the Wagers Property. For a description, see Exhibit A which is attached and incorporated by this reference. 2. The contract amount and time for performance provisions of Section II “Time of Completion,” and Section III, “Compensation,” are hereby modified as follows: Original Contract Sum, (including applicable alternates and WSST) $87,835 Net Change by Previous Change Orders (incl. applicable WSST) $0 Current Contract Amount (incl. Previous Change Orders) $87,835 Current Change Order $4,600 Applicable WSST Tax on this Change Order $460 Revised Contract Sum $92,895 Original Time for Completion (insert date) 12t3u20 Revised Time for Completion under prior Change Orders (insert date) nla Days Required (*) for this Change Order 0 calendar days Revised Tíme for Completion (insert date) l2t3lt20 Pursuant to the above-referenced contract, Contractor agrees to waive any protest it mayhave regarding this Change order and acknowledges and áccepts that this' Change orderconstitutes final settlement of all claims of any kind or nature arising from or connected with anywork either covered or affected by this Change Order, including, without limitation, claimsrelated to contract time, contract acceleration, onsite or home offrce overhead, or lost profits.This Change Order, unless otherwise provided, does not relieve the Contractor from strictcompliance with the guarantee and warranty provisions of the original contract, particularly those pertaining to substantíal completíon date, All acts consistent with the auth,ority of the Agreement, previous Change Orders (if any),and this Change order', prior to the effective date of this Change order, are ñereby ratiiied andaffirmed, and the terms of the Agreement, prevíous Change Orders (if any), and this ChangeOrder shall be deemed to have applied. The parties whose names appear below swear under penalty of perjury that they areauthorized to enter into this contract modification, which is bindíng on ihe'parties of tnitcontract. 3. The Contractor will adjust the amount of its performance bond (if any) for thisproject to be consistent wíth the revised contract sum shown ín section 2, above. IN WITNESS' the parties below have executed this Agreement, which willbecome effective on the last date written below. R: By Print Name David Dickson President (t¡tle) DATE 10t22t2020 CITY OF KENT: By ãt E-t^ (signature) Print Name:Chad Bieren. P.E.Its Interim Public Wor DATE: CHANGE ORDER. 2 OF 3 CHANGE ORDER - 3 OF 3 ATTEST: ___________________________ Kent City Clerk APPROVED AS TO FORM: (applicable if Mayor’s signature required) Kent Law Department Dickson Co. - Signature Pointe CO1/Holcomb 'tot19t2020 Mail - Holcomb, Drew - Outlook Fw:Wagers Property - Unforeseen Items t Download cÞ Save to OneDrive Fw: Wagers Propefty - Unforeseen ltems g Holcomb, Drew Thu 9/24/2020 2:27 PM To: Jason Roosa <Jason@dickson.net> Cc: Bryant Jason; Hawkes, Derek; Connor, Eric; Maloney, Carla Hello Jason, b <1+ The email is sufficient. The City agrees to process a change order for disposal of the tires in the amount requested below, SflSg,Jotalfor disposal of both tires. Please proceed with disposal, I request that we wa¡t to process this change order until after the UST and septic removaljust in case something comes up so we can keep it all in one change or;t+O:pes this work for you? Drew Holcomb, DesisnEnsineerrr ,á 1116ç -* loÍb*+ 'ú ¿ %*çw Design Engineering I Public Works Department 400 West Gowe, Kent, WA 98032 Main 253-856-5561 Cell 253-561-15A7 dholcomb@kentwa.gov CITY OF KENT, WASHINGTON KentWA.gov Facebook j,.,r¡r¡ir,;¡ YouTube PLEASE CONSIDER THE ENVIRONMENT BEFORÊ PRINTING THIS E-MAIL From: Jason Roosa <Jason@dickson.net> Sent: Thursday, September 24,2020 12:49 PM To: Holcomb, Drew <DHolcomb@ kentwa,gov> Subject: RE: Wagers Property - Unforeseen ltems EXTERNAL EMAIL Drew, The disposal cost is $550.00 per each tire, so $1,100.00 (plus tax). I'd like to cover my trucking at approx.. $300.00 and some profit on top of that. ls there room for $1,750.00? Do you need me to put this on letterhead? Thanks, Jason Roosa Project Manager / Estimator (253) 219-2324 ulHffifft https:i/outlook.ofüce365.com/ma¡l/deeplink 1t1 EXHIBIT A 10hst2020 Mail - Holcomb, Drew - Outlook Re: Decommissioning Certificate Holcomb, Drew < DHolcomb@kentwa.gov> Mon L0/5/2020 2:40 PM To: Hawkes, Derek <DHawkes@kentwa.gov> Cc: Bryant, Jason <JBryant@kentwa.gov> Derek, I spoke with Jason Bryant and he said this price is a little high, couple hundred high, but this is likely due to the demand given the wet season is fast approaching. Jason recommended we do it as a few hundred isn't worth the time of getting another contract together. Can I tell the contractor to proceed and wrap this into the tire removal change order? Drew Holcomb, Design Eng¡neer II Design Engineering I Public Works Department 400 West Gowe, Kent, WA 98032 Main 253-856-5561 Cell 253-561-'-587 dholcomb@kentwa.gov crTY oF KENT, WASHTNGTON KentwA.gov Facebook l-r¡;;itt;rr YouTube PLÉASE CONSIDER THE ENVTRONMENT BEFORE PRINTING THIS E.MAIL ,Øz,gSú * lvfc:wssr è93'/ßÉæ From: Jason Roosa <Jason@dickson.net> Sent: Monday, October 5, 2020 12:24 PM To: Holcomb, Drew <DHolcomb@ kentwa.gov> Cc: Hawkes, Derek <DHawkes@kentwa.gov>; Bryant, Jason <JBryant@kentwa.gov> Subject: RE: Decommissioning Certifi cate EXTERNAL EMAIL Jason Roosa Project Manager / Estimator (253) 219-2324 irqlli.) I j Drew, I haven't called on the final inspections yet, but will soon. The price to hydro-seed the site is $2,850.00,. Please let me know your thoughts on this and I can get it scheduled accordingly. - Thanks, https://outlook.office36S.com/mail/search/id/AAMkADRkOTRINDEwLTNkNzQtNGQyNC0SOGNhL\^lfzODY4MzA't NWFkZABGAAAAAAAbI4a'tlAo/o2F... 1t3 INSR ADDL SUBR LTR INSR WVD DATE (MM/DD/YYYY) PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE INSURER(S) AFFORDING COVERAGE NAIC # Y / N N / A (Mandatory in NH) ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? EACH OCCURRENCE $ DAMAGE TO RENTED $PREMISES (Ea occurrence)CLAIMS-MADE OCCUR MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ $ PRO- OTHER: LOCJECT COMBINED SINGLE LIMIT $(Ea accident) BODILY INJURY (Per person)$ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS AUTOS ONLY HIRED PROPERTY DAMAGE $AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below POLICY NON-OWNED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) ACORDTM CERTIFICATE OF LIABILITY INSURANCE Axis Surplus Insurance Company SAIF Corporation Zurich American Insurance Company Axis Insurance Company 9/02/2020 Propel Insurance Tacoma Commercial Insurance 1201 Pacific Ave, Suite 1000 Tacoma, WA 98402 Casondra Mossuto 800 499-0933 866 577-1326 casondra.mossuto@propelinsurance.com Dickson Company 3315 S Pine St. Tacoma, WA 98409 26620 36196 16535 37273 A X X X BI/PD Ded: $25,000 X SP002316042020 04/01/2020 04/01/2021 1,000,000 300,000 25,000 1,000,000 2,000,000 2,000,000 D X X HA Comp $100 X X X HA Coll $1000 AXSAT0087201 04/01/2020 04/01/2021 1,000,000 A X X X 0 SX002334042020 04/01/2020 04/01/2021 10,000,000 10,000,000 A B SP002316042020 WA Stop Gap OR WC - 760390 04/01/2020 10/01/2020 04/01/2021 10/01/2021 X 1,000,000 1,000,000 1,000,000 A A C Pollution Professional Leased Equip. SP002316042020 SP002316042020 027659504 04/01/2020 04/01/2020 04/01/2020 04/01/2021 04/01/2021 04/01/2021 $1M/$2M Ded: $25k $1M/$2M Ded: $25k $375k Ded: $5k RE: Wagers Property, 6804 South 251st Street, Kent WA. Additional Insured Status applies per attached form(s). City of Kent 220 Fourth Avenue South Kent, WA 98032 1 of 1 #S4259647/M4255307 DICKWILL4Client#: 132978 KTR00 1 of 1 #S4259647/M4255307 This page has been left blank intentionally. Includes copyrighted material of Insurance Services Office, Inc with its permission SPP 2010 01 (Ed. 11 16) Page 1 of 1 Endorsement No. Effective Date: 04/01/2020 @12:01 a.m. Standard Time at the address of the Named Insured Policy Number: SP002316-04-2020 Insured Name: Dickson Company Issuing Company: AXIS Surplus Insurance Company Additional (Return) Premium: $0 If the Endorsement Effective Date is blank, then the effective date of this Endorsement is the Inception Date of the Policy. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: SPECIALTY PACKAGE POLICY SCHEDULE Name Of Additional Insured Person(s) Or Organization(s)Location(s) Of Covered Operations As required by written contract in effect prior to any related ůĂŝŵ As required by written contract in effect prior to any related ůĂŝŵ Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A.Section III – Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to Bodily Injury or Property Damage occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the addi- tional insured(s) at the site of the Cov- ered Operations has been completed; or (2) That portion of Your Work out of which the injury or damage arises has been put to its intended use by any person or organization other than another con- tractor or subcontractor engaged in performing operations for a principal as a part of the same project. Includes copyrighted material of Insurance Services Office, Inc with its permission SPP 2037 01 (Ed. 11 16)Page 1 of 1 Endorsement No. Effective Date: 04/01/2020@12:01 a.m. Standard Time at the address of the Named Insured Policy Number: SP002316-04-2020 Insured Name: Dickson Company Issuing Company: AXIS Surplus Insurance Company Additional (Return) Premium: $0 If the Endorsement Effective Date is blank, then the effective date of this Endorsement is the Inception Date of the Policy. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: SPECIALTY PACKAGE POLICY SCHEDULE Name Of Additional Insured Person(s) Or Organization(s)Location And Description Of Completed Operations As required by written contract in effect prior to any related ůĂŝŵ As required by written contract in effect prior to any related ůĂŝŵ Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section III – Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of Your Work at the location designated and described in the schedule of this endorsement performed for that insured and included in the Products-Completed Operations Hazard. Includes copyrighted material of Insurance Services Office, Inc with its permission CG 20 12 04 13 SPP 2012 13 (04 14)Page 1 of 1 Endorsement No. Effective Date: 04/01/2020 @12:01 a.m. Standard Time at the address of the Named Insured Policy Number: SP002316-04-2020 Insured Name: Dickson Company Issuing Company: AXIS Surplus Insurance Company Additional (Return) Premium: $0 If the Endorsement Effective Date is blank, then the effective date of this Endorsement is the Inception Date of the Policy. ADDITIONAL INSURED – STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION – PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: SPECIALTY PACKAGE POLICY SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: As required by written contract in effect prior to any related ůĂŝŵ Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section III – Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1.This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a.The insurance afforded to such additional insured only applies to the extent permitted by law; and b.If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 2.This insurance does not apply to: a. Bodily Injury, Property Damage or Personal and Advertising Injury arising out of operations performed for the federal government, state or municipality; or b. Bodily Injury or Property Damage included within the Products-Completed Operations Hazard. B.With respect to the insurance afforded to these additional insureds, the following is added to Section IV – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement; or 2.Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. SPP 0107 (Ed. 05 16)Page 1 of 2 Endorsement No. Effective Date: 04/01/2020 @12:01 a.m. Standard Time at the address of the Named Insured Policy Number: SP002316-04-2020 Insured Name: Dickson Company Issuing Company: AXIS Surplus Insurance Company Additional (Return) Premium: $0 If the Endorsement Effective Date is blank, then the effective date of this Endorsement is the Inception Date of the Policy. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT ENDORSEMENT (GENERAL LIABILITY COVERAGE) THIS ENDORSEMENT MODIFIES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies the Specialty Package Policy. Schedule of Designated Projects: As required by written contract in effect prior to any related Claim A.Subject to paragraph E. below, for all damages under Coverage A, except damages because of Bodily Injury or Property Damage included in the Products-Completed Operations Hazard, to which this insurance applies and which can be attributed only to a single designated project shown in the Schedule above (“Designated Project”): 1.A separate Designated Project General Aggregate Limit applies to each Designated Project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. This Designated Project General Aggregate Limit applies on a primary non- contributory basis where required by written contract in effect prior to any associated claim. 2.The Designated Project General Aggregate Limit is the most we will pay for the sum of all such damages and Loss, regardless of the number of: a.Insureds; b. Claims made or Suits brought; or c.Persons or organizations making Claims or bringing Suits. 3.Any payments made for such damages shall reduce the Designated Project General Aggregate Limit for that designated project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Project General Aggregate Limit for any other Designated Project shown in the Schedule above. 4.The limits shown in the Declarations for Each Occurrence and for Damage to Premises Rented to You continue to apply to a Designated Project. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Project General Aggregate Limit. SPP 0107 (Ed. 05 16)Page 2 of 2 B.For all sums which the insured becomes legally obligated to pay as damages under Coverage A to which this insurance applies and which cannot be attributed only to a single Designated Project shown in the Schedule above: 1.Any payments made for such damages shall reduce the amount available under the General Aggregate Limit or the Products-Completed Operations Aggregate Limit, whichever is applicable; and 2.Such payments shall not reduce any Designated Project General Aggregate Limit. C.When coverage for liability arising out of the Products-Completed Operations Hazard is provided, any payments for damages because of Bodily Injury or Property Damage included in the Products-Completed Operations Hazard will reduce the Products-Completed Operations Aggregate Limit, and shall not reduce the General Aggregate Limit or the Designated Project General Aggregate Limit. D.The provisions of SECTION IV – LIMITS OF INSURANCE AND DEDUCTIBLE not otherwise modified by this endorsement shall continue to apply as stipulated. E.Regardless of the number of locations or projects and any other circumstance or payments made under this Policy, including payments made for Claims covered under the General Aggregate, the Products Completed Operations Aggregate or any Pollution Aggregate as applicable, the total amount we will pay under this insurance policy for any and all project(s) designated within this endorsement shall be no more than the Designated Construction Project General Aggregate Limit shown below: Designated Construction Project General Aggregate Limit: $10,000,000 In the event that no dollar amount is shown next to the Designated Construction Project General Aggregate Limit above, the Designated Construction Project General Aggregate Limit shall be $10,000,000. All other terms and conditions of this Policy remain unchanged. Includes copyrighted material of Insurance Services Office, Inc with its permission CG 20 01 04 13 SPP 2001 04 (04 14) Page 1 of 1 Endorsement No. Effective Date: 04/01/2020 @12:01 a.m. Standard Time at the address of the Named Insured Policy Number: SP002316-04-2020 Insured Name: Dickson Company Issuing Company: AXIS Surplus Insurance Company Additional (Return) Premium: $0 If the Endorsement Effective Date is blank, then the effective date of this Endorsement is the Inception Date of the Policy. PRIMARY AND NONCONTRIBUTORY OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: SPECIALTY PACKAGE POLICY The following is added to SECTION VI, COMMON CONDITIONS, Paragraph 9, Other Insurance. It supersedes any provision to the contrary: Primary and Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your Policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. Includes copyrighted material of Insurance Services Office, Inc with its permission CG 24 04 05 09 SPP 2404(Ě͘04 14)Page 1 of 1 Endorsement No. Effective Date: 04/01/2020@12:01 a.m. Standard Time at the address of the Named Insured Policy Number: SP002316-04-2020 Insured Name: Dickson Company Issuing Company: AXIS Surplus Insurance Company Additional (Return) Premium: $0 If the Endorsement Effective Date is blank, then the effective date of this Endorsement is the Inception Date of the Policy. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: SPECIALTY PACKAGE POLICY SCHEDULE Name Of Person Or Organization: As required by written contract in effect prior to any related ůĂŝŵ Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 12. Subrogation of Section VI – Common Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or Your Work done under a contract with that person or organization and included in the Products- Completed Operations Hazard. This waiver applies only to the person or organization shown in the Schedule above. Includes copyrighted material of Insurance Services Office, Inc., with its permission KDCXA-0003 (01-17)Page 1 of 4 Endorsement No.Effective Date of Endorsement Policy Number Additional/Return Premium 4/1/2020 12:01 a.m. on If the above date is blank, then this endorsement is effective on the effective date of the policy. AXSAT-00872-01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTOMOBILE COVERAGE EXTENSION ENDORSEMENT This endorsement modifies insurance provide under the following: BUSINESS AUTO COVERAGE FORM Unless specifically stated in this endorsement, all other terms, conditions and exclusions of the policy remain unchanged. Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy the words "you" and "your" refer to the Named Insured shown in the Declarations, and any other person or organization qualifying as a Named Insured under this policy. The words "we", "us" and "our" refer to the Company providing this insurance. The word "insured" means any person or organization qualifying as such under Section II - Who Is An Insured. Other words and phrases that appear in quotation marks have special meaning. Refer to Section V - Definitions. The following is a summary of the limits, additional coverages and extensions provided by this endorsement. For complete details on specific coverages, consult the policy contract wording. Schedule Blanket Waiver of Transfer of Rights of Recovery Included Broadened Definition of Who Is An Insured Included Loss of Use Expenses Up to $50 a day / $750 Maximum Revised Deductible for Glass Damage Included Supplementary Payments Bail Bonds Loss of Earnings Up to $2,500 Up to $300 a day Transportation Expenses Up to $50 a day / $1,500 Maximum Unintentional Failure to Disclose Included Auto Loan/Lease Gap Coverage Included Includes copyrighted material of Insurance Services Office, Inc., with its permission KDCXA-0003 (01-17)Page 2 of 4 I. Changes to SECTION II – LIABILITY COVERAGE A.Coverage, 1. Who Is An Insured is amended to add the following: d. Any organization you newly acquire or form during the policy period provided you own 50% or more of the business entity. However, coverage under this provision: (1) Does not apply if the organization you acquire or form is an “insured” under another liability policy or would be an insured under such a policy but for its termination or the exhaustion of its limits of insurance; (2) Does not apply to “bodily injury” or “property damage” that occurred before you acquired or formed the organization; and (3) Is afforded only for the first 90 days after you acquire or form the organization or until the end of the policy period, whichever comes first. e. Any person or organization to whom you become obligated to include as an additional insured under this policy, as a result of a written contract or written agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered “auto”. However, the insurance provided will not exceed the lesser of: (1)The coverage and/or limits of this policy, or (2)The coverage and/or limits required by said contract or agreement. f. An 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. A. Coverage, 2. Coverage Extensions, a. Supplementary Payments, (2) and (4) are deleted in their entirety and replaced with the following: (2) Up to $2,500 for cost of bail bonds (including bonds for related traffic law violations) required because of an “accident” we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the “insured” at our request, including actual loss of earnings up to $300 a day because of time off from work. II. SECTION III – PHYSICAL DAMAGE COVERAGE is amended to add the following: A.Coverage, 4. Coverage Extensions, a. Transportation Expenses is deleted in its entirety and replaced with the following: a.Transportation Expenses We will pay up to $50 per day, to a maximum of $1,500, for temporary transportation expense incurred by you because of the total theft of a covered “auto” of the private passenger type. We will pay only for those covered “autos” for which you carry either Comprehensive or Specified Causes of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy’s expiration, when the covered “auto” is returned to use or we pay for its “loss”. Includes copyrighted material of Insurance Services Office, Inc., with its permission KDCXA-0003 (01-17)Page 3 of 4 A.Coverage, 4. Coverage Extensions, b. Loss Of Use Expenses is deleted in its entirety and replaced with the following: b.Loss Of Use Expenses For Hired Auto Physical Damage, we will pay expenses for which an "insured" becomes legally responsible to pay for loss of use of a vehicle rented or hired without a driver, under a written rental contract or agreement. We will pay for loss of use expenses if caused by: (1)Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for any covered "auto"; (2)Specified Causes Of Loss only if the Declarations indicate that Specified Causes Of Loss Coverage is provided for any covered "auto"; or (3)Collision only if the Declarations indicate that Collision Coverage is provided for any covered "auto". However, the most we will pay for any expenses for loss of use is $50 per day, to a maximum of $750. D. Deductible is deleted in its entirety and replaced with the following: For each covered "auto", our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by the applicable deductible shown in the Declarations. Any Comprehensive Coverage deductible shown in the Declarations does not apply to "loss" caused by fire or lightning and no deductible applies to glass damage if the glass is repaired rather than replaced. III. SECTION IV – BUSINESS AUTO CONDITIONS is amended as follows: A. Loss Conditions, 5. Transfer Of Rights Of Recovery Against Others To Us is deleted in its entirety and replaced with the following: 5. Transfer Of Rights Of Recovery Against Others 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”, provided that the “accident” arises out of operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. A. General Conditions, 2. Concealment, Misrepresentation Or Fraud is amended by adding the following: 2. Concealment, Misrepresentation Or Fraud The unintentional omission of, or unintentional error in, any information given by you shall not prejudice your rights under this insurance. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal. IV. Auto Loan/Lease Gap Coverage is added as follows: For those businesses not listed as “auto” dealerships in the Declarations, the following provisions apply: If a long term leased “auto”, under an original lease agreement, is a covered “auto” under this Coverage Form and the lessor of the covered “auto” is named as an additional insured under this policy, in the event of a total loss to Includes copyrighted material of Insurance Services Office, Inc., with its permission KDCXA-0003 (01-17)Page 4 of 4 the leased covered “auto”, we will pay any unpaid amount due on the lease or loan, less the amount paid under the Physical Damage Coverage Section of the policy; and less any: a.Overdue lease/loan payments at the time of the “loss”; b.Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; c.Security deposits not returned by the lessor; d.Costs for extended warranties, credit Life Insurance, Health Accident or Disability Insurance purchased with the loan or lease; and e.Carry-over balances from previous loans or leases. POLICY NUMBER: AXSAT-00872-01 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Dickson Company; Drain-Pro, Inc. ; Drain-Pro, Inc. dba Affordable Septic Endorsement Effective Date: 4/1/2020 SCHEDULE Name(s) Of Person(s) Or Organization(s): Blanket as Required by Written Contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. KDCXA-0005 (01-17)Page 1 of 1 Endorsement No.Effective Date of Endorsement Policy Number Additional/Return Premium 4/1/2020 12:01 a.m. on If the above date is blank, then this endorsement is effective on the effective date of the policy. AXSAT-00872-01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – PRIMARY AND NONCONTRIBUTORY This endorsement modifies coverage provided under the following: COMMERCIAL COVERAGE FORM CA 00 01 It is agreed that: Blanket as Required by Written Contract This policy provides any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. The insurance provided by this policy to the person or organization shown in the Schedule and named as an additional insured is primary insurance. We will not seek contribution from any other insurance available to that additional insured. All other provisions of the Policy remain unchanged. SPX 0005 (Ed. 04 11)Page 3 of 9 Claims, conditions or circumstances that prior to the inception of this Policy, the Named Insured knew or should have reasonably known could give rise to a Claim under this Policy; I. Any Medical Payments coverage provided by Underlying Insurance. III. DEFINITIONS In addition to any applicable definitions in the Underlying Insurance, the following definitions apply to this Policy: A.Controlling Underlying Policy means the Policy designated in Item 5.a. of the Declarations and any renewal or replacement of said Policy. C.Named Insured means the individual, partnership or corporation designated in Item 1 of the Declarations; and any entity added by endorsement as a Named Insured. D.Insured means the Named Insured and those persons qualifying as Insureds under Underlying Insurance. E.Policy Period means the period designated in Item 2 of the Declarations or any shorter period arising as the result of the cancellation of this Policy. F.Underlying Insurance means the insurance policies shown on the Schedule of Underlying Insurance to this Policy, including but not limited to the Controlling Underlying Policy and any renewals or replacements of such policies. G.Underlying Insurer(s) means any Company issuing any Policy of Underlying Insurance. H.Ultimate Net Loss means: 1. The total sum that you become legally obligated to pay by reason of Bodily Injury, Property Damage, Personal And Advertising Injury, Loss or Claim Expenses for a covered Claim either by adjudication or in a settlement to which we agree in writing; and 2. With respect to Underlying Insurance, except any applicable Professional Liability or Pollution Legal Liability Coverages: a. Where Claim Expenses are subject to the Limits of Insurance of Underlying Insurance, the Claim Expenses payable for a Claim covered by this Policy are subject to the Limit of Insurance stated in the Declarations of this Policy and are included as part of Ultimate Net Loss; and b. Where Claim Expenses are payable in addition to the Limits of Insurance of Underlying Insurance, we will pay Claim Expenses payable for a Claim covered by this Policy in addition to the Limit of Insurance stated in the Declarations of this Policy, but only for Bodily Injury, Property Damage, Personal And Advertising Injury or Loss covered by this Policy. 3.With respect to Professional Liability or Pollution Legal Liability Coverage scheduled as Underlying Insurance, Claim Expenses payable under this Policy are subject to the Limit of Insurance of this Policy and are included as part of Ultimate Net Loss. 4.Ultimate Net Loss does not include your costs, charges or other expenses incurred by you for goods supplied or services performed by or on behalf of your staff or salaried Employees or your parent, subsidiary or affiliate, unless such charges or other expenses are incurred with our prior written approval at our sole discretion. Where used in this Policy, the following terms have the same meaning as provided in the Controlling Underlying Policy: Endorsement No. Effective Date: 04/01/2020 @12:01 a.m. Standard Time at the address of the Named Insured Policy Number: SX002334-04-2020 Insured Name: Dickson Company Issuing Company: AXIS Surplus Insurance Company Additional (Return) Premium: $0 If the Endorsement Effective Date is blank, then the effective date of this Endorsement is the Inception Date of the Policy. MANUSCRIPT ENDORSEMENT-GENERAL CONDITIONS AMENDATORY (MANU 2173) THIS ENDORSEMENT MODIFIES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies the SPECIALITY PACKAGE INSURANCE POLICY: In consideration of the premium charged, it is agreed that: Paragraphs E and F are deleted in their entirety and replaced by the following: E. TRANSFER OF RIGHTS OF RECOVERY AND SUBROGATION If any insured has rights to recover all or part of any payment we have made under this Policy, those rights are transferred to us. You shall do whatever is necessary to secure and enforce such rights, and you shall do nothing to prejudice such rights. Any amount recovered after payment under this Policy shall be apportioned net of the expense of recovery in the reverse order of the actual payment of Loss. Expenses necessary for the recovery of any amounts shall be apportioned among the interests concerned in the ratio of their respective recoveries as finally settled. However, we waive any right of subrogation we may have against any person or organization for whom the insured is required to waive its right of subrogation in a written contract or written agreement that is executed and effective prior to the act, event, error, or omission giving rise to a Claim under this Policy. F. OTHER INSURANCE 1. If other policies of insurance provide similar coverage for Claims covered by this Policy, in whole or in part, this Policy shall apply in excess of those policies and this Policy shall not contribute on a pro-rata or other basis with such other insurance; However, this provision shall not apply: a. With respect to any policies of insurance specifically purchased to be excess of this Policy and in which this Policy is scheduled in writing as Underlying Insurance; or b. When you have agreed in a written contract or agreement in effect prior to any related Claim that, with the exception of the Underlying Insurance, this Policy will apply on a primary and non-contributory basis before any other valid and collectible insurance. 2. Notwithstanding the foregoing, this Policy shall only apply when the Limit of Insurance of all applicable Underlying Insurance is exhausted upon the actual payment by the Underlying Insurers of Ultimate Net Loss and in no way shall this Policy contribute on a pro rata basis with the Underlying Insurance. All other terms and conditions of the Policy shall apply and remain unchanged. DE 0005 (Ed. 11 10) Page 1 of 1 This page has been left blank intentionally.