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Home My WebLink AboutCAG2020-336 - Original - HWA Geosciences, Inc. - Washington Ave Pump Station Relocation Geotechnical Engineering Services - 10/27/2020ApprovalOriginator: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 CONSULTANT SERVICES AGREEMENT - 1 (Over $20,000) CONSULTANT SERVICES AGREEMENT between the City of Kent and HWA Geosciences, Inc. THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and HWA Geosciences, Inc. organized under the laws of the State of Washington, located and doing business at 21312 30th Drive SE, Suite 110, Bothell, WA 98021, Phone: (206) 794- 3122, Contact: Jolyn Gillie (hereinafter the "Consultant"). I. DESCRIPTION OF WORK. The Consultant shall perform the following services for the City in accordance with the following described plans and/or specifications: The Consultant shall provide geotechnical engineering services for the Washington Avenue South Stormwater Pump Station Project. For a description, see the Consultant's Scope of Work which is attached as Exhibit A and incorporated by this reference. The Consultant further represents that the services furnished under this Agreement will be performed in accordance with generally accepted professional practices within the Puget Sound region in effect at the time those services are performed. II.TIME OF COMPLETION. The parties agree that work will begin on the tasks described in Section I above immediately upon the effective date of this Agreement. The Consultant shall complete the work described in Section I by December 31, 2021. III. COMPENSATION. A. The City shall pay the Consultant, based on time and materials, an amount not to exceed Thirty Two Thousand, Two Hundred Twenty Three Dollars ($32,223), for the services described in this Agreement. This is the maximum amount to be paid under this Agreement for the work described in Section I above, and shall not be exceeded without the prior written authorization of the City in the form of a negotiated and executed amendment to this agreement. The Consultant agrees that the hourly or flat rate charged by it for its services contracted for herein shall remain locked at the negotiated rate(s) for a period of one (1) year from the effective date of this Agreement. The Consultant's billing rates shall be as delineated in Exhibit A. B. The Consultant shall submit monthly payment invoices to the City for work performed, and a final bill upon completion of all services described in this Agreement. The City shall provide payment within forty-five (45) days of receipt of an invoice. If the City objects to all or any portion of an invoice, it shall notify the Consultant and reserves the option to only pay that portion of the invoice not in dispute. In that event, the parties will immediately make every effort to settle the disputed portion. C. Card Payment Program. The Consultant may elect to participate in automated credit card payments provided for by the City and its financial institution. This Program is provided as an alternative to payment by check and is available for the convenience of the Consultant. If CONSULTANT SERVICES AGREEMENT - 2 (Over $20,000) the Consultant voluntarily participates in this Program, the Consultant will be solely responsible for any fees imposed by financial institutions or credit card companies. The Consultant shall not charge those fees back to the City. IV.INDEPENDENT CONTRACTOR. The parties intend that an Independent Contractor- Employer Relationship will be created by this Agreement. By their execution of this Agreement, and in accordance with Ch. 51.08 RCW, the parties make the following representations: A. The Consultant has the ability to control and direct the performance and details of its work, the City being interested only in the results obtained under this Agreement. B. The Consultant maintains and pays for its own place of business from which the Consultant’s services under this Agreement will be performed. C. The Consultant has an established and independent business that is eligible for a business deduction for federal income tax purposes that existed before the City retained the Consultant’s services, or the Consultant is engaged in an independently established trade, occupation, profession, or business of the same nature as that involved under this Agreement. D. The Consultant is responsible for filing as they become due all necessary tax documents with appropriate federal and state agencies, including the Internal Revenue Service and the state Department of Revenue. E. The Consultant has registered its business and established an account with the state Department of Revenue and other state agencies as may be required by the Consultant’s business, and has obtained a Unified Business Identifier (UBI) number from the State of Washington. F. The Consultant maintains a set of books dedicated to the expenses and earnings of its business. V. TERMINATION. Either party may terminate this Agreement, with or without cause, upon providing the other party thirty (30) days written notice at its address set forth on the signature block of this Agreement. After termination, the City may take possession of all records and data within the Consultant’s possession pertaining to this project, which may be used by the City without restriction. If the City’s use of the Consultant’s records or data is not related to this project, it shall be without liability or legal exposure to the Consultant. VI.FORCE MAJEURE. Neither party shall be liable to the other for breach due to delay or failure in performance resulting from acts of God, acts of war or of the public enemy, riots, pandemic, fire, flood, or other natural disaster or acts of government (“force majeure event”). Performance that is prevented or delayed due to a force majeure event shall not result in liability to the delayed party. Both parties represent to the other that at the time of signing this Agreement, they are able to perform as required and their performance will not be prevented, hindered, or delayed by the current COVID-19 pandemic, any existing state or national declarations of emergency, or any current social distancing restrictions or personal protective equipment requirements that may be required under federal, state, or local law in response to the current pandemic. If any future performance is prevented or delayed by a force majeure event, the party whose performance is prevented or delayed shall promptly notify the other party of the existence and nature of the force majeure event causing the prevention or delay in performance. Any excuse from liability shall be effective only to the extent and duration of the force majeure event causing the prevention or delay in performance and, provided, that the party prevented or delayed has not caused such event to occur and continues to use diligent, good faith efforts to avoid the effects of such event and to perform the obligation. CONSULTANT SERVICES AGREEMENT - 3 (Over $20,000) Notwithstanding other provisions of this section, the Consultant shall not be entitled to, and the City shall not be liable for, the payment of any part of the contract price during a force majeure event, or any costs, losses, expenses, damages, or delay costs incurred by the Consultant due to a force majeure event. Performance that is more costly due to a force majeure event is not included within the scope of this Force Majeure provision. If a force majeure event occurs, the City may direct the Consultant to restart any work or performance that may have ceased, to change the work, or to take other action to secure the work or the project site during the force majeure event. The cost to restart, change, or secure the work or project site arising from a direction by the City under this clause will be dealt with as a change order, except to the extent that the loss or damage has been caused or exacerbated by the failure of the Consultant to fulfill its obligations under this Agreement. Except as expressly contemplated by this section, all other costs will be borne by the Consultant. VII. DISCRIMINATION. In the hiring of employees for the performance of work under this Agreement or any subcontract, the Consultant, its subcontractors, or any person acting on behalf of the Consultant or subcontractor shall not, by reason of race, religion, color, sex, age, sexual orientation, national origin, or the presence of any sensory, mental, or physical disability, discriminate against any person who is qualified and available to perform the work to which the employment relates. The Consultant shall execute the attached City of Kent Equal Employment Opportunity Policy Declaration, Comply with City Administrative Policy 1.2, and upon completion of the contract work, file the attached Compliance Statement. VIII. INDEMNIFICATION. The Consultant shall defend, indemnify and hold the City, its officers, officials, employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or suits, including all legal costs and attorney fees, arising out of or in connection with the Consultant's performance of this Agreement, except for that portion of the injuries and damages caused by the City's negligence. The City's inspection or acceptance of any of the Consultant's work when completed shall not be grounds to avoid any of these covenants of indemnification. Should a court of competent jurisdiction determine that this Agreement is subject to RCW 4.24.115, then, in the event of liability for damages arising out of bodily injury to persons or damages to property caused by or resulting from the concurrent negligence of the Consultant and the City, its officers, officials, employees, agents and volunteers, the Consultant's duty to defend, indemnify, and hold the City harmless, and the Consultant’s liability accruing from that obligation shall be only to the extent of the Consultant's negligence. IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE CONSULTANT'S WAIVER OF IMMUNITY UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF THIS INDEMNIFICATION. THE PARTIES FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY NEGOTIATED THIS WAIVER. In the event the Consultant refuses tender of defense in any suit or any claim, if that tender was made pursuant to this indemnification clause, and if that refusal is subsequently determined by a court having jurisdiction (or other agreed tribunal) to have been a wrongful refusal on the Consultant’s part, then the Consultant shall pay all the City’s costs for defense, including all reasonable expert witness fees and reasonable attorneys’ fees, plus the City’s legal costs and fees incurred because there was a wrongful refusal on the Consultant’s part. The provisions of this section shall survive the expiration or termination of this Agreement. IX.INSURANCE. The Consultant shall procure and maintain for the duration of the Agreement, insurance of the types and in the amounts described in Exhibit B attached and incorporated by this reference. CONSULTANT SERVICES AGREEMENT - 4 (Over $20,000) X. EXCHANGE OF INFORMATION. The City will provide its best efforts to provide reasonable accuracy of any information supplied by it to the Consultant for the purpose of completion of the work under this Agreement. XI. OWNERSHIP AND USE OF RECORDS AND DOCUMENTS. Original documents, drawings, designs, reports, or any other records developed or created under this Agreement shall belong to and become the property of the City. All records submitted by the City to the Consultant will be safeguarded by the Consultant. The Consultant shall make such data, documents, and files available to the City upon the City’s request. The Consultant acknowledges that the City is a public agency subject to the Public Records Act codified in Chapter 42.56 of the Revised Code of Washington. As such, the Consultant agrees to cooperate fully with the City in satisfying the City’s duties and obligations under the Public Records Act. The City’s use or reuse of any of the documents, data, and files created by the Consultant for this project by anyone other than the Consultant on any other project shall be without liability or legal exposure to the Consultant. XII. CITY'S RIGHT OF INSPECTION. Even though the Consultant is an independent contractor with the authority to control and direct the performance and details of the work authorized under this Agreement, the work must meet the approval of the City and shall be subject to the City's general right of inspection to secure satisfactory completion. XIII. WORK PERFORMED AT CONSULTANT'S RISK. The Consultant shall take all necessary precautions and shall be responsible for the safety of its employees, agents, and subcontractors in the performance of the contract work and shall utilize all protection necessary for that purpose. All work shall be done at the Consultant's own risk, and the Consultant shall be responsible for any loss of or damage to materials, tools, or other articles used or held for use in connection with the work. XIV. MISCELLANEOUS PROVISIONS. A. Recyclable Materials. Pursuant to Chapter 3.80 of the Kent City Code, the City requires its contractors and consultants to use recycled and recyclable products whenever practicable. A price preference may be available for any designated recycled product. B. Non-Waiver of Breach. The failure of the City to insist upon strict performance of any of the covenants and agreements contained in this Agreement, or to exercise any option conferred by this Agreement in one or more instances shall not be construed to be a waiver or relinquishment of those covenants, agreements or options, and the same shall be and remain in full force and effect. C. Resolution of Disputes and Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Washington. If the parties are unable to settle any dispute, difference or claim arising from the parties’ performance of this Agreement, the exclusive means of resolving that dispute, difference or claim, shall only be by filing suit exclusively under the venue, rules and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in writing to an alternative dispute resolution process. In any claim or lawsuit for damages arising from the parties' performance of this Agreement, each party shall pay all its legal costs and attorney's fees incurred in defending or bringing such claim or lawsuit, including all appeals, in addition to any other recovery or award provided by law; provided, however, nothing in this paragraph shall be construed to limit the City's right to indemnification under Section VIII of this Agreement. D. Written Notice. All communications regarding this Agreement shall be sent to the parties at the addresses listed on the signature page of the Agreement, unless notified to the contrary. Any written notice hereunder shall become effective three (3) business days after the date of mailing by registered or certified mail, and shall be deemed sufficiently given if sent to the addressee at the address stated in this Agreement or such other address as may be hereafter specified in writing. E. Assignment. Any assignment of this Agreement by either party without the written consent of the non-assigning party shall be void. If the non-assigning party gives its consent to any assignment, the terms of this Agreement shall continue in full force and effect and no further assignment shall be made without additional written consent. CONSULTANT SERVICES AGREEMENT - 5 (Over $20,000) F. Modification. No waiver, alteration, or modification of any of the provisions of this Agreement shall be binding unless in writing and signed by a duly authorized representative of the City and the Consultant. G. Entire Agreement. The written provisions and terms of this Agreement, together with any Exhibits attached hereto, shall supersede all prior verbal statements of any officer or other representative of the City, and such statements shall not be effective or be construed as entering into or forming a part of or altering in any manner this Agreement. All of the above documents are hereby made a part of this Agreement. However, should any language in any of the Exhibits to this Agreement conflict with any language contained in this Agreement, the terms of this Agreement shall prevail. H. Compliance with Laws. The Consultant agrees to comply with all federal, state, and municipal laws, rules, and regulations that are now effective or in the future become applicable to the Consultant's business, equipment, and personnel engaged in operations covered by this Agreement or accruing out of the performance of those operations. I. Public Records Act. The Consultant acknowledges that the City is a public agency subject to the Public Records Act codified in Chapter 42.56 of the Revised Code of Washington and documents, notes, emails, and other records prepared or gathered by the Consultant in its performance of this Agreement may be subject to public review and disclosure, even if those records are not produced to or possessed by the City of Kent. As such, the Consultant agrees to cooperate fully with the City in satisfying the City’s duties and obligations under the Public Records Act. J. City Business License Required. Prior to commencing the tasks described in Section I, Contractor agrees to provide proof of a current city of Kent business license pursuant to Chapter 5.01 of the Kent City Code. / / / / / / / / / / / / / / / / / / / / / / / / K. Counterparts and Signatures by Fax or Email. This Agreement may be executed in any number of counterparts, each of which shall constitute an original, and all of which will together constitute this one Agreement. Further, upon executing this Agreement, either party may deliver the signature page to the other by fax or email and that signature shall have the same force and effect as if the Agreement bearing the original signature was received in person. 10/27/2020 DECLARATION CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY The City of Kent is committed to conform to Federal and State laws regarding equal opportunity. As such all contractors, subcontractors and suppliers who perform work with relation to this Agreement shall comply with the regulations of the City's equal employment opportunity policies. The following questions specifically identify the requirements the City deems necessary for any contractor, subcontractor or supplier on this specific Agreement to adhere to. An affirmative response is required on all of the following questions for this Agreement to be valid and binding. If any contractor, subcontractor or supplier willfully misrepresents themselves with regard to the directives outlines, it will be considered a breach of contract and it will be at the City's sole determination regarding suspension or termination for all or part of the Agreement; The questions are as follows: 1. I have read the attached City of Kent administrative policy number 1.2. 2. During the time of this Agreement I will not discriminate in employment on the basis of sex, race, color, national origin, age, or the presence of all sensory, mental or physical disability. 3. During the time of this Agreement the prime contractor will provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 4. During the time of the Agreement I, the prime contractor, will actively consider hiring and promotion of women and minorities. 5. Before acceptance of this Agreement, an adherence statement will be signed by me, the Prime Contractor, that the Prime Contractor complied with the requirements as set forth above. By signing below, I agree to fulfill the five requirements referenced above. By: L� ForForrV p e, 11 s' Title: Date: EEO COMPLIANCE DOCUMENTS - 1 EEO COMPLIANCE DOCUMENTS - 2 CITY OF KENT ADMINISTRATIVE POLICY NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998 SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996 CONTRACTORS APPROVED BY Jim White, Mayor POLICY: Equal employment opportunity requirements for the City of Kent will conform to federal and state laws. All contractors, subcontractors, consultants and suppliers of the City must guarantee equal employment opportunity within their organization and, if holding Agreements with the City amounting to $10,000 or more within any given year, must take the following affirmative steps: 1.Provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 2.Actively consider for promotion and advancement available minorities and women. Any contractor, subcontractor, consultant or supplier who willfully disregards the City’s nondiscrimination and equal opportunity requirements shall be considered in breach of contract and subject to suspension or termination for all or part of the Agreement. Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public Works Departments to assume the following duties for their respective departments. 1.Ensuring that contractors, subcontractors, consultants, and suppliers subject to these regulations are familiar with the regulations and the City’s equal employment opportunity policy. 2.Monitoring to assure adherence to federal, state and local laws, policies and guidelines. EEO COMPLIANCE DOCUMENTS - 3 CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded the Agreement. I, the undersigned, a duly represented agent of Company, hereby acknowledge and declare that the before-mentioned company was the prime contractor for the Agreement known as that was entered into on the (date), between the firm I represent and the City of Kent. I declare that I complied fully with all of the requirements and obligations as outlined in the City of Kent Administrative Policy 1.2 and the Declaration City of Kent Equal Employment Opportunity Policy that was part of the before-mentioned Agreement. By: ___________________________________________ For: __________________________________________ Title: _________________________________________ Date: _________________________________________ Eün I GTOSCIENCES INc. D8E/MWBE September 10,2020 HWA Project No. 2019-P168-21 City of Kent 220 Fourth Avenue South Kent, Washington 98032 Attention: Subject: Stephen Lincoln, P.E. Geotechnical Engineering Services Washington Avenue South Stormwater Pump Station Kent, Washington Dear Steve: As requested, HWA GeoSciences Inc. (HWA) is pleased to present this scope of work to provide geotechnical engineering services for the Washington Avenue South Stormwater Pump Station Project in Kent, Washington. PROJECT UNDERSTANDING It is our understanding that the City of Kent is proposing to relocate, improve, and expand the capacity and service area of the existing pump station, which will be moved from its existing location just north of the Green River and west of Washington Avenue South to the grassy area within the existing right-of-way (ROW) at the southeast comer of Washington Avenue South's intersection with South 251't Street. The proposed wet well will extend on the order of l5 feet below the ground surface. Two auxiliary shelter structures will also be constructed at the new pump station location, along with a flow meter vault and installation of piping improvements within the new location. To complete the geotechnical portions of this work, HWA proposes the following scope of work. GEOTECHNICAL ENGINEERINGS SERVICES SCOPE The proposed scope of work is divided into two separate phases including Phase I - Geotechnical Explorations and Phase 2 - Geotechnical Engineering and Reporting. Details of the two phases and their various subtasks are provided below. Phase I - Geotechnical Explorations This work will include the following subtasks. o Review Existing Soil and Ground Water Information: HWA will review readily available existing site information including geologic and existing geotechnical zr3r2 3otr' Dr. 5E, STE. Ío, Bothell, WA 98o2r l4?s.774.o1o61 hwogeo.com EXHIBIT A September 10,2020 HWA Project No. 201 9-P 168-21 a o o exploration information to evaluate the general geology of the site and surrounding area. Conduct Site Reconnaissance and Utility Locates: Prior to conducting our field exploration program, HWA will conduct a reconnaissance of the site. This reconnaissance will be focused on identifying critical surface features of the site and identifying the best exploration locations. During our site reconnaissance, HWA will mark a proposed boring location and call for utility locates. HWA will make an additional site visit to verify that the proposed boring location is clear of utilities prior to frnalizing the exploration plan/location and mobilizing equipment. Conduct Geotechnical Bxploration: HWA will conduct an exploration that will consist of one (1) 40-foot boring at the new pump station location within the City right-of-way on the east side of Washington Avenue South. The boring will be completed as a ground water monitoring well. A ground water monitoring transducer will be installed within the well to monitor ground water over a period of up to 12 months. The exploration activity will be monitored fulltime by an HWA geotechnical engineer or geologist. We expect that drilling of the one (l) proposed boring and one (l) well installation willtake approximately one (1) working day. Generate a Boring Log and Conduct Laboratory Testing: All soil samples retrieved from our exploration will be sealed in plastic bags and taken to our Bothell, Washington laboratory for further examination and testing. Selected soil samples will be tested to determine relevant engineering and index properties for our engineering analyses. Soil and laboratory test information will be presented on a summary boring log that will be generated upon completion of our exploration program. Ground Water Monitoring: HWA will make up to 3 site visits to collect ground water readings from the transducer installed in the proposed monitoring well. The ground water readings will be used to evaluate the fluctuation of the ground water at the site to provide design recommendations as they relate to evaluation of potential for onsite infiltration, wet well design and construction, uplift (buoyancy) evaluations, foundation design for the auxiliary shelter structures, and construction dewatering. Ground water monitoring will be conducted for a period of l2 months from the installation of the well. Phase 2 - Geotechnical Engineering and Reporting o Engineering Analysis: HWA will evaluate the data derived from our field investigation and laboratory testing to complete our engineering analysis. Our a WA Ave S Stormwater PS Scope 9-10-20 2 HWA GeoSciences Inc. September 10,2020 HWA Project No. 2019-P168-21 engineering analysis will include development of seismic design parameters, foundation design, uplift (buoyancy) evaluations, potential for onsite infiltration, temporary shoring earth pressures, pernanent earth pressures, dewatering considerations, earthwork and trench backfi ll recommendations. Pavement Design Recommendations: HWA willperform analyses to provide a pavement design section with recommendations for possible access improvements for the new pump station location. Conduct Screening for Infiltration Potential: HWA will utilize boring and ground water data to evaluate the feasibility of using infiltration for stormwater management at the site. Feasibility will be determined based on the provisions of the 2016 King County Stormwater Design Manual. If inflrltration is considered feasible, we will utilize grain size data to estimate possible design infiltration rates for preliminary evaluation of infiltration facilities; howevero the20l6 King County Stormwater Manual requires that infiltration rates be measured by performing a small or large- scale pilot inhltration test (PIT) if infiltration is used in design of the project. As there is a possibility that infiltration may not be feasible, completion of a pilot infiltration test is not part of this proposal and can be provided as a supplemental task if infiltration is selected for the project. Internal QA/QC: HWA will have all design calculations and recommendations reviewed by a senior principal prior to distribution to the design team or the City Project Coordination Meeting: HWA will attend up to one (l) project coordination meeting via teleconference. This meeting will be to convey the geotechnical considerations of the site to the City and the design team. Prepare Draft Geotechnical Engineering Report: HWA willgenerate a draft geotechnical engineering report that will contain the results of the geotechnical engineering investigation, including description of surface and subsurface conditions; a site plan showing the exploration location and other pertinent features; summary boring log; and laboratory test results. The report will provide a narrative and geotechnical recommendations for each of the above described geotechnical aspects ofthe project. Miscellaneous Engineering Support: Additional time will be allotted to account for any design aspects introduced to the project later that were not initially provided to HWA in this scope of work. a a a a a WA Ave S Stormwater PS Scope 9-10-20 3 HWA GeoSciences Inc. September 10,2020 HWA Project No. 20 I 9-P 168-21 a a Conduct Plan and Specification Review: HWA will conduct a plan review at the 60 and 90 percent milestones to ensure that the geotechnical aspects of the project have been properly incorporated into the project plans. Prepare a Final Geotechnical Engineering Report: HWA will prepare a final geotechnical report for this project. This report will develop HWA's draft geotechnical engineering report with any comments provided by other design team members or the City during the 60 and 90 percent plans. Assumptíons: . Any required street use, and other permit fees will be paid by others. o Non-contaminated drilling spoils will be collected and disposed of offsite by the driller. If soil contamination is identiflred, drilling spoils will be drummed and left within the grassy area until such time as analyticaltesting is completed to determine an appropriate disposal site. Coordination associated with contaminated spoil removal, if required, is not included in this scope and budget. r No analytical testing will be conducted to identify potential soil contamination. . Ground water monitoring well abandonment will be completed by the contractor during construction and not as part ofthe design phase ofthis project. . All drilling will be completed during the weekday daylight hours between 7AM and 6 PM. . Utility locates, via the One-Call Utility Locate Center, will be comprehensive and accurate enough to allow reliable and safe location of borings. Private utility locating and/or vacuum extraction of borings is not included. o HWA will be responsible for all post drilling clean up. ¡ No Phase 1 or Phase 2 Environmental Site Assessment report will be required. . The boring will be inside City righrof-way. o The boring location will be field located using handheld GPS and measurement from existing known features. Surveying of actual exploration location willbe performed by others. o Relatively disturbed subsurface soil samples will be collected from the boring using the Standard Penetration Test (SPT) at intervals of 2.5 feet in the upper 20 feet and at intervals of5 feet below 20 feet. ¡ Traffic control andlor flagging will not be required during drilling activities. o Base CAD files for the project will be provided to HV/A for use in the geotechnical report. WA Ave S Stormwater PS Scope 9-10-20 4 HWA GeoSciences Inc. September 10,2020 HWA Project No. 2019-P168-21 a Following finalization of the geotechnical report, all soil samples will be disposed of, unless otherwise mutually agreed upon. Long-term storage of soil samples by the Consultant is not included. Deliverøbles: o Draft and final geotechnical report SCHEDULE We propose the following schedule based on time relative to the notice to proceed (NTP). Phase 1 Schedule . Project setup and scheduling of drilling to occur within two weeks of NTP. o Drilling of boring is anticipated to occur six to eight weeks from NTP, provided approval of any permits associated with conducting the boring are in hand and drillers are available. o Following drilling, lab testing and draft logs will be generated and would be seven to ten weeks relative to NTP following completion of drilling. . Ground water monitoring will continue over a period of up to l2 months from to NTP. Phase 2 Schedule Phase 2 would begin after Phase I is completed, or relative to NTP for this task, whichever comes later. Engineering and reporting will begin relative to NTPiEnd of Phase I and continue for approximately four weeks following the start of this phase. During this time, HWA will coordinate with the City to address the key aspects of the project. The draft geotechnical report would be delivered approximately 4 to 6 weeks relative to NTP/End of Phase I for the City to review. This time assumes that all design alternatives and information regarding options for the pump station are provided within four weeks of the start of Phase 2. Following receipt of review comments HWA will update the geotechnical report for delivery within two weeks of receiving comments, and delivery of frnalreport depends on review time of City. Once the final geotechnical report is delivered, HWA will provide review of Contract Documents as they are provided to HWA by the City. a a a a a WA Ave S Stormwater PS Scope 9-10-20 5 HWA GeoSciences Inc. September 10,2020 HWA Project No. 20 I 9-P168-21 COST ESTIMATE Based on our understanding of the project and assumed site conditions, we propose to provide the above geotechnical engineering scope of services on a time and materials basis that is divided into two phases. Budget for Phase I work estimated to be $12,258 and Phase 2 work is estimated to be $19,965 for a total of 532p23 for both tasks together. However, if during the project unexpected conditions are revealed that require alteration of our work scope, or the Client or Owner request analyses and evaluations which would require a level of effort beyond the scope of our proposed study and budget, we will contact you immediately to discuss any necessary modifications to our scope of services and/or budget estimate. A summary of our estimated cost is presented on the attached spreadsheet. Our scope of services does not include evaluation of the potentialpresence and/or concentrations of contaminated and/or hazardous materials on site, nor within the ground water at the site location. Our scope of work also excludes construction inspection services. We appreciate the opportunity to provide geotechnical engineering services on this project Please feel free to call if you have any questions or need additional information. Sincerely, HWA GnoScrnNCEs INC. Jolyn Gillie, P.E. Geotechnical Engineer, Principal Encl: Geotechnical Cost Estimate List of Key Staff Proposed for Project Laboratory Fee Schedule WA Ave S Stormwater PS Scope 9-10-20 6 HWA GeoSciences Inc. PROJECT COST ESTIMATf,,GEOTECHNICAL SERVICESWashington Avenue South Stormwater Pump StåtionKen! WashingtonPROPOSED SCOPE: See attached Scope DocumentIIIYA LABOR:DIRECTLABOR: 4245766LABORATORY TESTTNG ESTIMATE:Assumptions:I . All hours and items are estimated, and may be increased or decreased within the limits of the total budget at the discretion of HWA'sproject manager. The HWA project nurnager may also transfer funds allocated for direct costs to professional/technical hours, and vice-vers4 as needed 1o meet the demands ofthe project.2. Drill cuttings generated during our explorations will be drumed and exported.3. Applicable permils/approval for drilling the proposed boring will be provided by City ofKent al no cost 10 HWA.4. The scope ofwork is related solely to geotechnical engineering evaluation ofsite soil and ground water, as they relate to geotechnicaldesign for the pump station relocatíon. Neilher identification nor evaluation ofcontaminants that my be present in the soil or groundwaTer is included ín this scope ofwork.5. Ground water monitoring well abandonment will be completed by the contractor during construction md not as part ofthe designphase ofthis project.HWA Budget Est¡mate_SB562HWA Ref.: 2019-P168-21Date: I'tAug-2020Prepared By: SB/JLG172$26,815I 380I 0402260,940E,290i530I 620il 500s700TOTALLABORs580$1.0ó0s570$810$1.060$810st-270s 1.150$350$4. l 40$ l.s 10$1.365$l.8804TOTALHOURS4t294t26E2848468I622681l8t2ClericalFisks80.00EContractsAdminBabko$120.00E224CADÆechMenzs12s.00ET2I21Geolosist VlThurbers140.00EI22ongGeotechnicalEnsineer Isl15.00288I12E642446IGeotechnicalEnsineer VBrodahls 175.002414E1222I222I6648GeotechnicalEngineer VIIGillie2s230.00EE22244242PERSONNEL AND 2O2O HOURLY RATESPrincipal IXBoirums290.0021IMiscellaneous Engineering Support (Assumed 8 hous)SiteProject Management - Phase IÐvaluate Field a¡d Laboratory DataDevelop Foundation Design for PumD StationConduct Plan and Specification Review (60yo and 90/o)Conduct Geotechnical Explorations (assume I borins)WORKTASKDESCRIPTIONReview Existing Soil and Groundwater InformationGenerate Borins Loe and Assien Laboraloru TestinsGround Water Monitoring and Data Reduction (3 siie visits)Develoo Seismic Desim ParametersDevelop Temporary Shoring Ea¡th PressuresDevelop Permanent Structute Earth Pressu¡esEvaluate Feasibility ofUsing Infiltration for Stormwater ManagementDevelop Recommendations for Earthwork and DewateringDevelop Pavement Desim Recommendationstntemai OA/OCParticipate in One Team Meetins (assume I teleconference meetins)Generate Drâft Geotechnical ReDortSenerale Final Geotechnical ReDortProiecl Manasement - Phase 2TotalCosts220s88$500$230$l,oJtUnil Test CostS/eachs220s22$250sl t5EsÎ. No.TestsI422TESTAtterbers LimitsNatual Moisture ContentGrain Size Analysis (Conbined Analysis)Jrain Size Anâlysis (Sieve A¡alysis Wet)s2s0s250$ó00s50$15Water Level lndicator: S I 5/day, I dayGPS; $50/dav. I davMilease IRS RateGround Water Transducer Rental: S600/each, Is6 850s l.038$4.000$l 20$250{r, t<¡LaboratoR TesfinsDrilling subcontractor CostDrrect ExpensesDriller B&O Exoense (3%)l otal Labor Cost1ESTIMATED GRAND TOTAL: HWA GEOSCIENCES INC. 2O2O BILLING RATES Washington Avenue South Stormwater Pump Station Key Staff EMPLOYEE TITLE BILLING RATE Szgo.oo * s230.00 Szgo.oo s230.00 s21s.00 Srzs.oo s16s.00 Srso.oo 5r¿o.oo s140.00 Srzo.oo Srrs.oo s140.00 Si.3o.oo S8o.oo Srzs.oo Sgz.oo S12o.oo s80.00 Sos.oo Ralph Boirum Principal lX Steve Greene Geologist Vlll Jolyn Gillie Geotechnical Engineer Vll Bryan Hawkins Geotechnical Engineer Vll Michael Place Geotechnical Engineer Vl Sandybell Brodahl Geotechnical Engineer V Dila Saidin Geotechnical Engineer V Zakeyo Ngoma Geotechnical Engineer V Ali Sirjani Geotechnical Engineer lll Sean Schlitt Geotechnical Engineer lll Shane Miller Geotechnical Engineer ll Amanda Ong Geotechnical Engineer I Brad Thurber Geologist Vl Nicole Kapise Geologist V Mary Alice Benson Geologist ll Brian Menz CAD Catherine Fry CAD Vasiliy Babko Contracts Administrator Christiana Fisk Administrative Support Anna Ataman Administrative Support Notes: * Represents Capped Billing Rate \ì:-,fu:r;*:GToScIENCES INC. DBE/MWBE STANDARD SCHEDULE OF FEES AND CHARGES AII prices are et'fective Jdnudry 1,2020 - December 31,2020 and are subject to change without notice. H.WA GeoSciences Inc. is accredited by the American Association of State Highway and Transportatíon Officials (AASHTO R-18) for Aggregate, Asphalt Mixture, Concrete and Soil. We participate in the sample proficiency program from AMRL for soil classification and compaction, coarse and fine aggregates, Hot Mix Asphalt, California Bearing Ratio, and CCRL for concrete. PROFESSIONAL SERVICES Request Labor Rate Schedule EXPENSES Alt Outside Expenses (i.e., airfare, subsistence, equipment rental, materíals, reproduction, efc.)........ Cost plus 15% Dritting & Chemicat Laboratory Subcontractors....Cost ptus 15% pH Onty s40.00 Mileage (per míle) Resistivity On1y........... 5110.00 Specific GravityTest (ASTM D854)......... .5120.00 Strength Testing li\EN I LABORATORY TESTS (Continuedl Permeability Tests (Con' t) Estimate of Effective Porosity Retative Density (ASTM 04253 I D4254)........ Shetby Tube Extrusion and Sampte Description Soil Resistivity & pH (AASHTO T 288/1 289) ... S54s.oo 5375.00 s1 00.00 s140.00 Current IRS Rate Tests Conducted on Contaminated Soils........... 20% surcharge AII contaminated soils will be returned to client for disposal Speciat Sample Prep (including sample remolding, rock crushing, etc.).......... 580/Hour All Samples will be disposed of within 30 days of Final Report unless arrangements are made to return to the client. LABORATORY TESTS SoiI Laboratory Tests Atterberg Limits Liquid Limit and Plastic Limit (ASTM D4318) Three Point 5220.00 California Bearing Ratio (ASTM D1883) (Requíres hloisture I Density Relatîonship Test) One Point 5250.00 Three Point.. .......5S2S.00 Consolidation Test lncrementat Loading (ASTM D2435) 9 Loads, 0.125 KSF to 32 KSF, 4 Unloads 5800.00 24 hour loads for Secondary Compression 51000.00 Each Additional Load 5100.00 Grainsize Analysis Combined Analysis (ASTM D691 3/ D7928)............. 5250. 00 Passing #200 Sieve (ASTM D1140) .......... 580.00 SieveAnalysis-Wet (ASTM D6913) .....5115.00 Moisture/ Density Relationship Proctor - Cohesive (ASTM D698, D1 557).............. 5280.00 Proctor - Granular (ASTM Dó98, D1557) 5255.00 Moisture Content w/Description............... 522.00 One-Dimensional Swetl (ASTM D4546) ..................... 5700.00 Organic Content Test (ASTM Ð2974)........ 570.00 Permeabitity Tests Permeabitity of Granular Soits (ASTM D2434) ....... 5320.00 Fatting Head Test (WSDOT 605)........... 5250.00 Triaxiat with Back Pressure (ASTM D5084) 5485.00 (6-in diameter) ............. 5525.00 Direct Shear Strength (3 points) (ASTM D3080) 1ntact......... .....5600.00 Remolded.... .....5650.00 Triaxial (c-u) (3 points) (ASTM D4767) 51 500.00 Triaxial (u-u) (ASTM D2850) 5230.00 Compressive Strength (ASTM 02166) . 5140,00 Unit Weight Percent of Sotids Catcutation 522.00 Porosity (includes specific gravity/unit weight) .... 5160.00 Soit in Ring (ASTM D 2937').......... .... 550.00 Soit in Shetby Tube (ASTM D 2937') . .. . 555.00 Visual Soil Ctassification ..... 517.50 Aggregate Quality Tests Clay Lumps and Friable Partictes (ASTM C142)....... Degradation Test (WSDOT T 1 13) ........ Fracture Face Count (ASTM 05821 ) (Requires Sieve) Flat and Elongated (ASTM D 4791) (Requires Sieve). Butk Grain Size (ASTM C136) ......... LAAbrasion (ASTM C131, C535).... Organic lmpurities (ASTM C40)..... Percentage of Material Passing #200 Sieve (ASTM C1 17). 580.00 Sand Equivatent (ASTM D24191........ ......5105.00 Specific Gravity Test CoarseAggregate (ASTMC127) ........5115.00 Fine Aggregate (minus #4 mesh) (ASTM C128) ......5125.00 Unit Weight by Dry Rodding (ASTM C 29) .......... 575.00 Uncompacted Voids Content of FA (ASTM C1252)........$145.00 Concrete and Masonry Tests Compression Testing of Concrete Cores (includes trimming) (ASTM C42, C513) ................ S95.00 Compression Testing of Concrete Cylinders (ASTM C39) . 5:O.OO Compression Testing of Lightweight Concrete Cylinders 580.00 Concrete Beam Flexural Strength Test (ASTM C 78)...... S90.00 51 1 s.00 5300.00 , 5ss.oo , sss.oo 51 80.00 s24s.00 , S9o.oo Rush Testing avaitabte subject to avaitability for a 50% additionaI surcharge. Contact the Lab regarding scope of testing and availabitity. STANDARD SCHEDULE OF FEES AND CHARGES (Continued) All prices are et't'ective lanudry 1,2020 - December 31,2020 and are subiect to change without notice. Ûün ! GEoSctENCEs INC. i oBE/Mwæ Flow Monitoring Set Per day 51 05.00 Per week 5400.00 Geomembrane Tensiometer (per day) .... S100.00 Grundfos Redi Flow ll Pump and Generator Per day .. 5100.00 Per week 5300.00 lnclinometer...550.00 (hourty rental)or up to 5200.00 (per day) lnfiltration/Fatting Head Meters (per day, per set up) ... 525.00 Landfitt Gas Monitoring Equipment (GEM 500) Per day ... 595.00 Per week 5300.00 Level and Stadia Set.... ..... 525.00 Nuclear Density Gauge (per day)........... 540.00 Per month.... 5400.00 Thin Lift Gauge (per day)........... ..........560.00 Per month.... ...........5600.00 Peristaltic Samp[ìng Pump Per day ss0.00 Per week pH-Conductivity Temperature Meter ........590.00 Concrete Cytinder Molds......... ..............52.50 Concrete Cytinders Sampted and Cured (not tested)..... S30.00 Density Test Concrete Cylinders ...... 535.00 Light Weight Concrete Cytinders ...... 580.00 End Trimming of Samples (per specimen).................. 520.00 Sptitting Tensite Strength Test (ASTM C496) ............... 590.00 Shotcrete Panel (cut three cores & compression test)..5350.00 Asphattic Concrete Têsts Bitumen Content by lgnition lgnition onty (ASTM D6307)........ ....5140.00 with Gradation (ASTM D5444, Dó307) 5180.00 Oven Correction Factor (per point) ..5140.00 Butk Specific Gravity and Density - SSD Method (per specimen) (ASTM D2726) 555.00 Butk Specific Gravity and Density - Wax Method (per specimen) (ASTM 01188) ........5100.00 MarshatI Stabitity & Flow Determination (3specimens)(ASTMD6927)............... $500.00 Percent Air Voids in Compacted or Open Bituminous Mixtures (ASTM D3203) 51 s0.00 Rice Density (ASTM D2041)............... ..5140.00 EQUIPMENT CHARGES Labor will be charged in addition to equipment charges Air Filters for Development (per day) .......... 550.00 BK Development Pump/Surge Block (per day) 520.00 Bolt Tension Catibrator (per day)..... ...... 550.00 Carbon Filter (per day) .......... 550.00 Celtular Concrete (4 cytinders) .s30.00 525.00Coating Thickness Gauges (per day) Combustibte Gas Tech Meter (GT 302 I 3220) Per day .. 5100.00 Per week ..5300.00 Coring Equipment Charge ....... Reguest Schedule Data Logger and Transducers (Piezometer Rentat.......5600.00) Up to a year .......... ...5500.00 Dissolved Oxygen Meter Per day ... 595.00 Per week ..5300.00 Falling Weight Deflectometer (Per Hour).. 5250.00 Double Ring lnfittrometer........... 550.00 Dropweight Cone Penetrometer (per day) ................. 575.00 GPS Unit Rentetal (per day) . 550.00 Water Level lndicator (per day) 515.00 Per day Per week Photoionization Detector (Mini Rae / HNU i Microtip) Per day Per week QED Btadder Pump Controller Per day Per week Traffic Controt Signs & Cones (per day) Torque Wrench (per day) Turbidity Meter (per day)................ Turbidity Meter (per week).............. UT Thickness Gauge (per day) . Wetl Probe (per day).. Wett Probe (per week) Safety Equipment Level D (solvex gtoves, disposabte suit)52s.00 5s0.00 59s.oo Levet C2 (above plus respirator) Level C1 (above plus chemical suit) Level B (above plus SCBA)... 5300.00 Sensidyne Monitoring Equipment (does not include tubes/.51 5.00 Sediment Coring or Soit Sampting Kit (does not include shelby fubes) (per day)5s0.00 .. S4o.oo . Sloo.oo . 51 00.00 . s300.00 .. sso.00 .. s90.00 , 57s.00 , 525.00 , S4o.oo s1 s0.00 5s0.00 51s.00 5s0.00 For additional information: Please contact 425.77 4.0106 www.hwageo.com Sandy Brodahl, PE, for Geotechnical Services (Ext 251, sbrodaht@hwageo.com) Nicole Kapise, for GeoEnvironmental & Hydrogeology Services (Ext 254, nkapise@hwageo. com ) Steve Wright for Laboratory Services (Ext 240, swright@hwageo.com) EXHIBIT B INSURANCE REQUIREMENTS FOR CONSULTANT SERVICES AGREEMENTS Insurance The Consultant shall procure and maintain for the duration of the Agreement, insurance against claims for injuries to persons or damage to property which may arise from or in connection with the performance of the work hereunder by the Consultant, their agents, representatives, employees or subcontractors. A. Minimum Scope of Insurance Consultant shall obtain insurance of the types described below: 1. Automobile Liability insurance covering all owned, non-owned, hired and leased vehicles. Coverage shall be written on Insurance Services Office (ISO) form CA 00 01 or a substitute form providing equivalent liability coverage. If necessary, the policy shall be endorsed to provide contractual liability coverage. 2. Commercial General Liability insurance shall be written on ISO occurrence form CG 00 01 and shall cover liability arising from premises, operations, independent contractors, products-completed operations, personal injury and advertising injury, and liability assumed under an insured contract. The City shall be named as an insured under the Consultant’s Commercial General Liability insurance policy with respect to the work performed for the City using ISO additional insured endorsement CG 20 10 11 85 or a substitute endorsement providing equivalent coverage. 3. Workers’ Compensation coverage as required by the Industrial Insurance laws of the State of Washington. 4. Professional Liability insurance appropriate to the Consultant’s profession. B. Minimum Amounts of Insurance Consultant shall maintain the following insurance limits: 1. Automobile Liability insurance with a minimum combined single limit for bodily injury and property damage of $1,000,000 per accident. 2. Commercial General Liability insurance shall be written with limits no less than $1,000,000 each occurrence, $2,000,000 general aggregate and a $1,000,000 products-completed operations aggregate limit. EXHIBIT B (Continued) 3. Professional Liability insurance shall be written with limits no less than $1,000,000 per claim and $1,000,000 policy aggregate limit. C. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions for Automobile Liability and Commercial General Liability insurance: 1. The Consultant’s insurance coverage shall be primary insurance as respect the City. Any Insurance, self-insurance, or insurance pool coverage maintained by the City shall be excess of the Consultant’s insurance and shall not contribute with it. 2. The Consultant’s insurance shall be endorsed to state that coverage shall not be cancelled by either party, except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City. 3. The City of Kent shall be named as an additional insured on all policies (except Professional Liability) as respects work performed by or on behalf of the Consultant and a copy of the endorsement naming the City as additional insured shall be attached to the Certificate of Insurance. The City reserves the right to receive a certified copy of all required insurance policies. The Consultant’s Commercial General Liability insurance shall also contain a clause stating that coverage shall apply separately to each insured against whom claim is made or suit is brought, except with respects to the limits of the insurer’s liability. D. Acceptability of Insurers Insurance is to be placed with insurers with a current A.M. Best rating of not less than A:VII. E. Verification of Coverage Consultant shall furnish the City with original certificates and a copy of the amendatory endorsements, including but not necessarily limited to the additional insured endorsement, evidencing the insurance requirements of the Contractor before commencement of the work. F. Subcontractors Consultant shall include all subcontractors as insureds under its policies or shall furnish separate certificates and endorsements for each subcontractor. All coverages for subcontractors shall be subject to all of the same insurance requirements as stated herein for the Consultant. 10/20/2020 Orion Insurance Group 10634 E. Riverside Dr. Suite #300 Bothell WA 98011 Orion Insurance / Ralph Taylor (425) 771-5197 (425) 673-4427 rtaylor@orioninsgroup.com HWA GeoSciences Inc. 21312 30th Drive SE, Suite 110 Bothell WA 98021-7010 Travelers Insurance Company 36137 SWETT - Admiral Insurance Company 24856 CL19112604262 A Y Y 680–009N931138-19 47 12/01/2019 12/01/2020 1,000,000 1,000,000 10,000 1,000,000 2,000,000 2,000,000 A Y Y BA-3P900632-19-GRP 12/01/2019 12/01/2020 1,000,000 A Y Y CUP-003P901597-19-47 12/01/2019 12/01/2020 5,000,000 5,000,000 A Y 680–009N931138 STOP GAP 12/01/2019 12/01/2020 1,000,000 1,000,000 1,000,000 B Professional Liability Claims Made Including Pollution Liability EO00003589302 12/01/2019 12/01/2020 $3,000,000 Each Claim $50,000 $3,000,000 Aggregate Deductible Full prior acts for 2m/2m limits and 3/7/2018 for 3m/3m limits. Project Name: Washington Avenue South Stormwater Pump Station Project. City of Kent is listed as additional insureds with primary non-contributory wording except with respect to professional liability and worker's compensation. 30-days notice of cancellation modification applies to certificate holder. A blanket waiver of subrogation applies in favor of additional insureds for all policies including the worker's compensation and professional liability. City of Kent 220 Forth Ave S Kent WA 98032 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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 rights to the certificate holder in lieu of such endorsement(s). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR ARCHITECTS, ENGINEERS AND SURVEYORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Non -Owned Watercraft — 75 Feet Long Or Less B. Who Is An Insured — Unnamed Subsidiaries C. Who Is An Insured — Retired Partners, Members, Directors And Employees D. Who Is An Insured — Employees And Volunteer Workers — Bodily Injury To Co -Employees, Co - Volunteer Workers And Retired Partners, Members, Directors And Employees E. Who Is An Insured — Newly Acquired Or Formed Limited Liability Companies F. Blanket Additional Insured — Controlling Interest G. Blanket Additional Insured — Mortgagees, Assignees, Successors Or Receivers PROVISIONS A. NON -OWNED WATERCRAFT — 75 FEET LONG OR LESS 1. The following replaces Paragraph (2) of Exclusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION I — COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY: (2) A watercraft you do not own that is: (a) 75 feet long or less; and (b) Not being used to carry any person or property for a charge; 2. The following replaces Paragraph 2.e. of SECTION II — WHO IS AN INSURED: e. Any person or organization that, with your express or implied consent, either H. Blanket Additional Insured — Governmental Entities — Permits Or Authorizations Relating To Premises I. Blanket Additional Insured — Governmental Entities — Permits Or Authorizations Relating To Operations J. Incidental Medical Malpractice K. Medical Payments — Increased Limit L. Amendment Of Excess Insurance Condition — Professional Liability M. Blanket Waiver Of Subrogation — When Required By Written Contract Or Agreement N. Contractual Liability —Railroads uses or is responsible for the use of a watercraft that you do not own that is: (1) 75 feet long or less; and (2) Not being used to carry any person or property for a charge; B. WHO IS AN INSURED — UNNAMED SUBSIDIARIES The following is added to SECTION II — WHO IS AN INSURED: Any of your subsidiaries, other than a partnership or joint venture, that is not shown as a Named Insured in the Declarations is a Named Insured if: a. You are the sole owner of, or maintain an ownership interest of more than 50% in, such subsidiary on the first day of the policy period; and CG D3 79 02 19 © 2017 The Travelers Indemnity Company. All rights reserved. Page 1 of 6 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY b. Such subsidiary is not an insured under similar other insurance. No such subsidiary is an insured for "bodily injury" or "property damage" that occurred, or "personal and advertising injury" caused by an offense committed: a. Before you maintained an ownership interest of more than 50% in such subsidiary; or b. After the date, if any, during the policy period that you no longer maintain an ownership interest of more than 50% in such subsidiary. For purposes of Paragraph 1. of Section II — Who Is An Insured, each such subsidiary will be deemed to be designated in the Declarations as: a. A limited liability company; b. An organization other than a partnership, joint venture or limited liability company; or c. A trust; as indicated in its name or the documents that govern its structure. C. WHO IS AN INSURED — RETIRED PARTNERS, MEMBERS, DIRECTORS AND EMPLOYEES The following is added to Paragraph 2. of SECTION II — WHO IS AN INSURED: Any person who is your retired partner, member, director or "employee" that is performing services for you under your direct supervision, but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. However, no such retired partner, member, director or "employee" is an insured for: (1) "Bodily injury": (a) To you, to your current partners or members (if you are a partnership or joint venture), to your current members (if you are a limited liability company) or to your current directors; (b) To the spouse, child, parent, brother or sister of that current partner, member or director as a consequence of Paragraph (1)(a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraph (1)(a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to "bodily injury' arising out of providing or failing to provide first aid or "Good Samaritan services" by any of your retired partners, members, directors or "employees", other than a doctor. Any such retired partners, members, directors or "employees" providing or failing to provide first aid or "Good Samaritan services" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. (2) "Personal injury": (a) To you, to your current or retired partners or members (if you are a partnership or joint venture), to your current or retired members (if you are a limited liability company), to your other current or retired directors or "employees" while in the course of his or her employment or performing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of that current or retired partner, member, director, "employee" or "volunteer worker" as a consequence of Paragraph (2)(a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraph (2)(a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. (3) "Property damage" to property: (a) Owned, occupied or used by; or (b) Rented to, in the care, custody or control of, or over which physical control is being exercised for any purpose by; you, any of your retired partners, members or directors, your current or retired "employees" or "volunteer workers", any current partner or member (if you are a partnership or joint venture), or any current member (if you are a limited liability company) or current director. Page 2 of 6 © 2017 The Travelers Indemnity Company. All rights reserved. CG D3 79 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY D. WHO IS AN INSURED — EMPLOYEES AND VOLUNTEER WORKERS — BODILY INJURY TO CO -EMPLOYEES, CO -VOLUNTEER WORKERS AND RETIRED PARTNERS, MEMBERS, DIRECTORS AND EMPLOYEES The following is added to Paragraph 2.a.(1) of SECTION II —WHO IS AN INSURED: Paragraphs (1)(a), (b) and (c) above do not apply to "bodily injury" to a current or retired co - "employee" while in the course of the co - "'employee's" employment by you or performing duties related to the conduct of your business, or to "bodily injury" to your other "volunteer workers" or retired partners, members or directors while performing duties related to the conduct of your business. E. WHO IS AN INSURED — NEWLY ACQUIRED OR FORMED LIMITED LIABILITY COMPANIES The following replaces Paragraph 3. of SECTION II —WHO IS AN INSURED: 3. Any organization you newly acquire or form, other than a partnership or joint venture, and of which you are the sole owner or in which you maintain an ownership interest of more than 50%, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a. Coverage under this provision is afforded only: (1) Until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier, if you do not report such organization in writing to us within 180 days after you acquire or form it; or (2) Until the end of the policy period, when that date is later than 180 days after you acquire or form such organization, if you report such organization in writing to us within 180 days after you acquire or form it; b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and c. Coverage B does not apply to "personal and advertising injury' arising out of an offense committed before you acquired or formed the organization. For the purposes of Paragraph 1. of Section 11 — Who Is An Insured, each such organization will be deemed to be designated in the Declarations as: a. A limited liability company; b. An organization other than a partnership, joint venture or limited liability company; or c. A trust; as indicated in its name or the documents that govern its structure. F. BLANKET ADDITIONAL INSURED — CONTROLLING INTEREST 1. The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that has financial control of you is an insured with respect to liability for "bodily injury", "property damage' or "personal and advertising injury" that arises out of: a. Such financial control; or b. Such person's or organization's ownership, maintenance or use of premises leased to or occupied by you. The insurance provided to such person or organization does not apply to structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. 2. The following is added to Paragraph 4. of SECTION II —WHO IS AN INSURED: This paragraph does not apply to any premises owner, manager or lessor that has financial control of you. G. BLANKET ADDITIONAL INSURED — MORTGAGEES, ASSIGNEES, SUCCESSORS OR RECEIVERS The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that is a mortgagee, assignee, successor or receiver and that you have agreed in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to its liability as mortgagee, assignee, successor or receiver for "bodily injury", "property damage" or "personal and advertising injury" that: a. Is "bodily injury" or "property damage" that occurs, or is "personal and advertising injury" caused by an offense that is committed, CG D3 79 02 19 © 2017 The Travelers Indemnity Company. All rights reserved. Page 3 of 6 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY subsequent to the signing of that contract or agreement; and b. Arises out of the ownership, maintenance or use of the premises for which that mortgagee, assignee, successor or receiver is required under that contract or agreement to be included as an additional insured on this Coverage Part. The insurance provided to such mortgagee, assignee, successor or receiver is subject to the following provisions: a. The limits of insurance provided to such mortgagee, assignee, successor or receiver will be the minimum limits that you agreed to provide in the written contract or agreement, or the limits shown in the Declarations, whichever are less. b. The insurance provided to such person or organization does not apply to: (1) Any "bodily injury" or "property damage" that occurs, or any "personal and advertising injury" caused by an offense that is committed, after such contract or agreement is no longer in effect; or (2) Any "bodily injury", "property damage" or "personal and advertising injury" arising out of any structural alterations, new construction or demolition operations performed by or on behalf of such mortgagee, assignee, successor or receiver. H. BLANKET ADDITIONAL INSURED — GOVERNMENTAL ENTITIES — PERMITS OR AUTHORIZATIONS RELATING TO PREMISES The following is added to SECTION II — WHO IS AN INSURED: Any governmental entity that has issued a permit or authorization with respect to premises owned or occupied by, or rented or loaned to, you and that you are required by any ordinance, law, building code or written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of the existence, ownership, use, maintenance, repair, construction, erection or removal of any of the following for which that governmental entity has issued such permit or authorization: advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, elevators, street banners or decorations. I. BLANKET ADDITIONAL INSURED — GOVERNMENTAL ENTITIES — PERMITS OR AUTHORIZATIONS RELATING TO OPERATIONS The following is added to SECTION II — WHO IS AN INSURED: Any governmental entity that has issued a permit or authorization with respect to operations performed by you or on your behalf and that you are required by any ordinance, law, building code or written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury' arising out of such operations. The insurance provided to such governmental entity does not apply to: a. Any "bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the governmental entity; or b. Any "bodily injury" or "property damage" included in the "products -completed operations hazard". J. INCIDENTAL MEDICAL MALPRACTICE 1. The following replaces Paragraph b. of the definition of "occurrence" in the DEFINITIONS Section: b. An act or omission committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to a person, unless you are in the business or occupation of providing professional health care services. 2. The following replaces the last paragraph of Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to "bodily injury' arising out of providing or failing to provide: (a) "Incidental medical services" by any of your "employees" who is a nurse, nurse assistant, emergency medical technician, paramedic, athletic trainer, audiologist, dietician, nutritionist, Page 4 of 6 © 2017 The Travelers Indemnity Company. All rights reserved. CG D3 79 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY occupational therapist or occupational therapy assistant, physical therapist or speech -language pathologist; or (b) First aid or "Good Samaritan services" by any of your "employees" or "volunteer workers", other than an employed or volunteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first aid or "Good Samaritan services" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. 3. The following replaces the last sentence of Paragraph 5. of SECTION III — LIMITS OF INSURANCE: For the purposes of determining the applicable Each Occurrence Limit, all related acts or omissions committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to any one person will be deemed to be one "occurrence". 4. The following exclusion is added to Paragraph 2., Exclusions, of SECTION I — COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury" or "property damage" arising out of the violation of a penal statute or ordinance relating to the sale of pharmaceuticals committed by, or with the knowledge or consent of the insured. 5. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x- ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; or b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. that is available to any of your "employees" for "bodily injury" that arises out of providing or failing to provide "incidental medical services" to any person to the extent not subject to Paragraph 2.a.(1 ) of Section II — Who Is 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 Coverage C for all medical expenses because of "bodily injury" sustained by any one person, and will be the higher of: a. $10,000; or b. The amount shown in the Declarations of this Coverage Part for Medical Expense Limit. L. AMENDMENT OF EXCESS INSURANCE CONDITION — PROFESSIONAL LIABILITY The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any of the other insurance, whether primary, excess, contingent or on any other basis, that is Professional Liability or similar coverage, to the extent the loss is not subject to the professional services exclusion of Coverage A or Coverage B. M. BLANKET WAIVER OF SUBROGATION — WHEN REQUIRED BY WRITTEN CONTRACT OR AGREEMENT The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If the insured has agreed in a written contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of: 6. The following is added to Paragraph 4.b., a. "Bodily injury" or "property damage" that Excess Insurance, of SECTION IV — occurs; or COMMERCIAL GENERAL LIABILITY CONDITIONS: b. "Personal and advertising injury" caused by This insurance is excess over any valid and an offense that is committed; collectible other insurance, whether primary, subsequent to the signing of that contract or excess, contingent or on any other basis, agreement. CG D3 79 02 19 © 2017 The Travelers indemnity Company. All rights reserved. Page 5 of 6 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY N. CONTRACTUAL LIABILITY — RAILROADS 1. The following replaces Paragraph c. of the definition of "insured contract" in the DEFINITIONS Section: c. Any easement or license agreement; 2. Paragraph f.(1) of the definition of "insured contract" in the DEFINITIONS Section is deleted. Page 6 of 6 © 2017 The Travelers Indemnity Company. All rights reserved. CG D3 79 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission. POLICY NUMBER: 680-9N931138-19-47 EFFECTIVE DATE: 12/01/2019 ISSUE DATE: 12/04/2019 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS IL TO 19 02 05 COMMON POLICY DECLARATIONS MP TO 01 02 05 BUSINESSOWNERS COVERAGE PART DECLARATIONS IL TS 01 01 01 FORMS ENDORSEMENTS AND SCHEDULE NUMBERS IL T3 16 05 12 COMMON POLICY CONDITIONS - WASHINGTON MP TO 33 04 09 MASTER PAC ACCOUNT EXPOSURE ENDORSEMENT BUSINESSOWNERS MP T1 30 02 05 TABLE OF CONTENTS - BUSINESSOWNERS COVERAGE PART - DELUXE PLAN MP PO 06 09 15 ARCHITECTS, ENGINEERS AND SURVEYORS PROPERTY ENHANCEMENT MP T1 02 02 05 BUSINESSOWNERS PROPERTY COVERAGE SPECIAL FORM MP TZ 05 02 05 AMENDATORY PROVISIONS - OFFICES MP T3 07 03 97 PROTECTIVE SAFEGUARDS ENDORSEMENT FOR SPRINKLERED LOCATIONS AND RESTAURANTS MP T3 25 01 15 FEDERAL TERRORISM RISK INSURANCE ACT DISCLOSURE MP T3 50 11 06 EQUIPMENT BREAKDOWN - SERVICE INTERRUPTION LIMITATION MP T3 56 02 08 AMENDATORY PROVISIONS - GREEN BUILDING AND BUSINESS PERSONAL PROP COV ENHANCEMENTS CP 01 60 12 98 WASHINGTON CHANGES - DOMESTIC ABUSE MP T4 31 07 16 WASHINGTON CHANGES COMMERCIAL GENERAL LIABILITY CG D4 69 02 19 TOT AGG LIMIT OTHER THAN PROJECTS CG TO 34 02 19 TABLE OF CONTENTS - COMMERCIAL GENERAL LIABILITY COVERAGE FORM CG T1 00 02 19 CG T1 00 02 19 COMMERCIAL GENERAL LIABILITY COVERAGE FORM CG D3 09 02 19 AMENDATORY ENDORSEMENT - PRODUCTS -COMPLETED OPERATIONS HAZARD CG D3 81 09 15 BLANKET ADDITIONAL, INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) CG D6 75 02 19 AMEND -WHO IS INS-ARCHIT/ENG/SURVEY ACTIV CG D2 03 12 97 AMEND - NON CUMULATION OF EACH OCC CG D3 79 02 19 XTEND ENDORSEMENT FOR ARCHITECTS, ENGINEERS AND SURVEYORS CG D3 80 10 11 EXCLUSION - ENGINEERS, ARCHITECTS OR SURVEYORS PROFESSIONAL LIABILITY CG D4 21 07 08 AMEND CONTRAL LIAR EXCL - EXC TO NAMED INS CG D6 1S 10 11 EXCLUSION - VIOLATION OF CONSUMER FINANCIAL PROTECTION LAWS CG DO 76 06 93 EXCLUSION - LEAD CG D1 42 02 19 EXCLUSION - DISCRIMINATION IL T8 0101 01 PAGE : 1 OF 2 POLICY NUMBER: 680-9N931138-19-47 EFFECTIVE DATE: 12/01/2019 ISSUE DATE: 12/04/2019 COMMERCIAL GENERAL LIABILITY (CONTINUED) CG F2 58 01 08 WASHINGTON CHANGES CG F2 66 02 19 WASHINGTON CHANGES - EMPLOYMENT -RELATED PRACTICES EXCLUSION EMPLOYMENT PRACTICES LIABILITY PR TO 07 02 15 EMPLOYMENT PRACTICES LIAB COVG PART DEC PR Tl 10 04 09 EMPLOYMENT PRACTICES LIABILITY COVERAGE FORM PR T5 23 03 15 COVG FOR FINANCIAL INTEREST IN FOREIGN ORGANIZATIONS -EMPLOYMENT PRACTICES LIABILITY PR Fl 55 04 09 WASHINGTON MANDATORY ENDORSEMENT MULTIPLE SUBLINE ENDORSEMENTS CG T3 33 11 03 INTERLINE ENDORSEMENTS IL T3 68 01 15 IL T4 12 03 15 IL T4 14 01 15 IL T3 82 05 13 IL 01 23 11 13 IL 01 57 07 02 IL 01 73 07 02 IL 01 98 09 08 POLICY HOLDER NOTICES LIMITATION WHEN TWO OR MORE POLICIES APPLY FEDERAL TERRORISM RISK INSURANCE ACT DISCLOSURE AMNDT COMMON POLICY COND-PROHIBITED COVG CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM EXCLUSION OF LOSS DUE TO VIRUS OR BACTERIA WASHINGTON CHANGES - DEFENSE COSTS WASHINGTON CHANGES - ACTUAL CASH VALUE WASHINGTON CHANGES - EXCLUDED CAUSES OF LOSS NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (BROAD FORM) PN T4 54 01 08 IMPORTANT NOTICE REGARDING INDEPENDENT AGENT AND BROKER COMPENSATION PN T5 86 04 09 EPL+ - RISK MANAGEMENT LETTER PN MP 57 04 17 IMP NOT PROT SAFEGUARDS SPRK AND REST PN T7 72 07 11 IMPORTANT NOTICE - EMPLOYMENT PRACTICES LIABILITY HOTLINE PN MP 38 01 11 IMPORTANT NOTICE - JURISDICTIONAL INSPECTIONS IL T8 01 01 01 PAGE: 2 OF 2 TRAVELERS POLICY NUMBER: BA-3P900632-19-GRP EFFECTIVE DATE: 12-01-19 ISSUE DATE: 12-04-19 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND BY LINE OF BUSINESS. IL TO 02 11 89 COMMON POLICY DECLARATIONS IL TS 01 10 93 FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS IL TO 05 06 10 COMMON POLICY CONDITIONS-WASHINGTON COMMERCIAL AUTOMOBILE CA TO 01 02 15 BA- COVERAGE PART DECS (ITEMS 1 & 2) CA TO 02 02 15 BA COVERAGE PART DECS (ITEM 3) CA TO 03 02 15 BA COVERAGE PART DECS (ITEMS 4 & 5) CA TO 30 02 16 BA/AD/MC COV PART SUPPL SCE - ITEM TWO CA TO 31 02 15 TABLE OF CONTENTS -BUSINESS AUTO COV FORM CA 00 01 10 13 BUSINESS AUTO COVERAGE FORM CA T4 59 02 15 AMENDMENT OF EMPLOYEE DEFINITION CA 01 35 10 13 WASHINGTON CHANGES CA 21 34 10 13 WA UNDERINSURED MOTORISTS COVERAGE CA 99 03 10 13 AUTO MEDICAL PAYMENTS COVERAGE CA T3 53 02 15 BUSINESS AUTO EXTENSION ENDORSEMENT INTERLINE ENDORSEMENTS IL T4 12 03 15 AMNDT COMMON POLICY COND-PROHIBITED COVG IL 00 21 09 08 NUCLEAR ENERGY LIAB EXCL END -BROAD FORM IL 01 23 11 13 WASHINGTON CHANGES - DEFENSE COSTS IL 01 98 09 08 NUCLEAR ENERGY LIABILITY EXCLUSION IL T8 0110 93 PAGE: 1 OF 1 POLICY NUMBER: CUP-3P901597-19-47 EFFECTIVE DATE: 12/01/2019 ISSUE DATE: 12/04/2019 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS IL T8 01 01 01 FORMS ENDORSEMENTS AND SCHEDULE NUMBERS UMBRELLA / EXCESS EU 00 02 07 16 POLICY DECLARATIONS EXCESS FOLLOW -FORM AND UMBRELLA LIABILITY INSURANCE POLICY EU 00 03 08 18 SCHEDULE OF UNDERLYING INSURANCE EU 00 01 07 16 EXCESS FOLLOW -FORM AND UMBRELLA LIABILITY INSURANCE EU 02 34 07 16 AMENDMENT OF COVERAGE - DEFINITIONS EU 03 46 08 18 NON CUMULATION OF OCCURRENCE LIMIT EU 01 44 07 16 COVERAGE FOR FINANCIAL INTEREST IN FOREIGN INSURED ORGANIZATIONS EU 03 15 08 18 AMENDMENT OF UNDERLYING INSURANCE DEFINITION EU 00 07 07 16 CAP LOSSES - CERT ACTS TERRORSM AND EXCL EU 01 30 08 18 ARCHITECT, ENGINEER OR SURVEYOR PROFESSIONAL SERVICES EXCLUSION - COVERAGE B EU 01 48 08 18 DAMAGE TO PROPERTY EXCLUSION - COVERAGE A EU 02 09 08 18 NUCLEAR ENERGY LIABILITY EXCLUSION (BROAD FORM) - COVERAGES A AND B EU 02 90 07 16 WATERCRAFT LIABILITY EXCLUSION - COVERAGE B EU 03 31 08 18 DISCRIMINATION EXCLUSION - COVERAGE B EU 03 44 08 18 LEAD EXCLUSION - COVERAGE B EU 00 74 07 16 WASHINGTON CHANGES INTERLINE ENDORSEMENTS IL T3 68 01 15 FEDERAL TERRORISM RISK INSURANCE ACT DISCLOSURE IL T8 01 01 01 PAGE: 1 of 1