The URL can be used to link to this page

Home My WebLink AboutCAG2020-154 - Amendment - #2 - JECB, LLC - 2020 Overlay - 1/21/2021ApprovalOriginator: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 CAG2020-154 AMENDMENT - 1 OF 2 AMENDMENT NO. 2 NAME OF CONSULTANT OR VENDOR: JECB, LLC CONTRACT NAME & PROJECT NUMBER: 2020 Overlay ORIGINAL AGREEMENT DATE: June 2, 2020 This Amendment is made between the City and the above-referenced Consultant or Vendor and amends the original Agreement and all prior Amendments. All other provisions of the original Agreement or prior Amendments not inconsistent with this Amendment shall remain in full force and effect. For valuable consideration and by mutual consent of the parties, Consultant or Vendor’s work is modified as follows: 1. Section I of the Agreement, entitled “Description of Work,” is hereby modified to add additional work or revise existing work as follows: In addition to work required under the original Agreement and any prior Amendments, the Consultant or Vendor shall: Provide additional materials testing and construction inspection/quality assurance services for the project due to a plan revision. 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 modified as follows: Original Contract Sum, including applicable WSST $52,490 Net Change by Previous Amendments including applicable WSST $25,250 Current Contract Amount including all previous amendments $77,740 Current Amendment Sum $12,000 Applicable WSST Tax on this Amendment $0 Revised Contract Sum $89,740 Original Time for Com (inseft date){r I etion I l3u2l Revised Time for Com prior Amendments (insert date) d l I l l letion under nt I Add'l Days Requi Amendment ."q I (*) for this 0 calendar days Revised Time for Com (insert date) flleti I i on II t3u2t coNSULTANT/VENDOR: By (titte) J¡.^l¿- 4-q/r' 'tzÅ**"-\ (signature) Prin ïts DATE: I v{u^u, DATE: crTY Print By: (signature) me: Chad Bieren, P.E. F KENTI al (title) ) ATTEST: Kent City Clerk APPRQVED AS TO FORM¡ (anOticab!1 if Mayor's signature required) , Kent Department its signature waives any protest acknowledges and accepts that this and the terms of the Agreement, deemed to have applied. full payment and final settlement of all claims of any kind or nature arisi by this Amendment, including, w acceleration, onsite or home office from or connected ith any work either covered or affected ut limitation, cla d, or lost p provided, does not relieve the Con nt or Vendor from ct compliance with the guarantee and warranty provisions of the original reement. All acts consistent with the rity of the Agreentent, of this Amendme Amendments (if previous Amendments (if any), and this Amendment, prior to the nt, are hereby ratified and arfirmed, any), and this Amendment shall be The paÊies whose names a authorized to enter into this Amend pear below swear nder penalty of perjury that they are t, which is bindi on the parties of this contract IN WITNESS, the parties low have this Amendment, which will become effective on the last d written below, JECB - tverlays 2020 Amd 2lconnor The Consultant or Vendor a pts all requirements of this Amendment by signing below, by ave regarding this Amendment, and related to contract time, contract This Amendment, unless otherwise or claim ¡t may mendment date tous AMENDMEN'T. 2 OF 2 KENTPUBLIC WORKS DESIGN ENGINEERINGCarla Maloney, P.E.Design Eng¡neering Manager400 West GoweKent, WA 98032Fax: 253-856-6500PHONE: 253-856-5500WasH'ilcroNccDateTo:FromNovember 25,2O2OEric Connor, Construction Engineering ManagerPaul Kuehne, Construction SupervisorMazin Ghanim, Construction InspectorRob Brown, Transportation ManagerWilliam Thomas, Street and Vegetation ManagerAbdulnaser Almaroof, Project Engineer anMark Nagamatsu, Engineering Designer IThroughDerek Hawkes, P.E., Design Engineering Supervisor DNHCarla Maloney, P.E., Design Engineering ManagerRegarding:. 2O2O Asphalt Overlay - Speed Cushions and Raised Crosswalk on g8th Ave,"BUMP" legends to existing speed cushions on 42nd Ave S, and Traffic Loops onMisc. StreetsProject No. 20-3001,1Revision No. 3ADD Work 98th Ave S:New four (4) Speed Cushions (3.5") as shown on the attached plan sheets # (1, & 2) for"98th Ave S - Speed Cushions" and in conformance with standard plans 6-29 (a, & b).New One (1) Raised Crosswalk (3") as shown on the attached plan sheet (#3) for "ggtt'Ave S - Raised Crosswalk" and the detailed sheet "Raised Crosswalk- g8th Ave S" and inconformance with standard plans 6-29 (c, d, & e).AnticiuantitiesCity of Kent Public Works DepartmentChad J. Bieren, Interim Public Works DirectorOuantiW41401015157010120151770BO1UnitsEAEALFSYSYLFSYSYEASFLFEAHRHRLSDescription3.5" speed cushion, Including All PavementMarkinqs and "BUMP" leqends.3u raised crosswalk, Including All PavementMarkinqs and "BUMP" leqends.Sawcut Exitino Asohalt Concrete PavementRemove Existinq Asphalt Concrete PavementRemove Cement Concrete SidewalkRemove Cement Concrete Curb and CutterPlaninq Bituminous Pavement, 2 Inch ThickCement Concrete SidewalkCement Concrete Sidewalk Ramp Type Parallel BDetectable Warninq SurfaceCement Concrete Curb and GutterAdiust Existinq Catch Basin Frame and GrateTraffic Control LaborTraffic Control SupervisorTemporary Traffic Control DevicesBid ItemNewNew100510201025103010501065to75New10901 120150015051510EXHIBIT A ADD Work Traffic Loops Misc. Streets: (See attached "Traffic Signal Loop Replacement List" forlocations).Anticipated QuantitiesQuantitv35130601UnitsEAHRHRLSDescriptionTraffic Loops (Misc. Streets, See Attached)Traffic Control LaborTraffic Control Su pervisorTemporary Traffic Control DevicesBid Item2800150015051510ADD Work: "BUMP" legends for existing speed cushions on 42d Ave S:New six (6) "BUMP" legends paint marks to be installed for the existing three speedcushions on 42nd Ave S (Green Valley Heights Neighborhood), as shown on the attachedrevisions for sheets (39,4o, and 41) of the 2020 overlay project design plans.Anticipated QuantitiesAdd itiona I Support InformationConstruction Note: Street signs to be installed by Public Works Operations and they needabout 2 weeks advanced notice on the speed cushions installation so the signs can beinstalled at the same time or before the asphalt work is done$100,000 is in the traffic calming budget for the speed cushions and raised crosswalk. Thiswork should be charged to 11145530.64110,7500$50,000 is available within the budget for the construction of the Traffic Loops andconstruction should do a many of these 35 loops within the budget allowed. Charged to11115530.647LO.7499AttachmentsSheet 39 of 43Sheet 40 of 43Sheet 4L of 43Traffic Signal Loop Replacement Listg8th Ave S- Speed Cushions/ Raised Crosswalk (3 sheets)Raised Crosswalk - 98th Ave S (1 Page)Kent Standard Plan 6-29aKent Standard Plan 6-29bKent Standard Plan 6-29cKent Standard Plan 6-29dKent Standard Plan 6-29eOuantitv6UnitsEADescription"BUMP" Paint MarkBid ItemNew $0.00C. Hicks$0.00C. Hicks$s00.00$11shour100$11,s00.00cStaff$thour0$0.00& GradationD21$17s.00each0$0.00$0.00$0.00$0.00$0.00$0.00$0.00s0.00$0.00$12,000.00***Overtime rates (1.5) apply for all work-over 8 hrs per shift, before 7am, after 5 pm, holidays, or weekend0010000000TOTALper hourper hourper houreacheacheacheacheacheachNO CHARGENO CHARGE$9s.00$9s.00$50.00$105.00$25.00$180.00$7s.00$125.00$7s.00PROFESSIONAL SERVICESAsphalt/Soils WDensometert< * *<Reinforced Concrete{<**Administrative ServicesAsphalt, Rice Specific Gravity (ASTM D2041)Concrete, Cylinders Compression (ASTM C39)Soil, Moisture-Density Relation (ASTM D1557)Soil, Sand Equivalent Test (ASTM D2419)Soil, Sieve Analysis includes 200 V/ash (Cl36)Soil, Fracture Count (ASTM D5821)MileageSample Pick UpESTIMATED PROJECT TOTAL ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTR INSD WVD PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: 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) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY 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 LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) 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 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.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 6/23/2020 (425) 822-1368 (425) 822-2737 24082 JECB, LLC Jamie Hicks PO BOX 832 Auburn, WA 98092 A 2,000,000 X BZS56778701 6/26/2020 6/26/2021 1,000,000 15,000 2,000,000 4,000,000 4,000,000 1,000,000A BZS56778701 6/26/2020 6/26/2021 City of Kent Public Works Department 220 Fourth Avenue South Kent, WA 98032 JECBLLC-02 ELIZABETH Griffin MacLean Inc2340 130th Ave NE D150 Bellevue, WA 98005 info@griffinmaclean.com Ohio Security Insurance Co X X XX AC"R0 CERTIFICATE OF LIABILITY INSURANCE i...r-�1 DATE(MM/DD/YYYY) 12/30/2020 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER STANFORD INSURANCE INC PO Box 189 Gig Harbor, HbWA 98335 _ NAME_, Crystal Wells —_ PHONE Ex(�:_253-874-9200 FAX No): E-MAILADDRESS:rY c stal stanfordinsurance.co_m INSURERS AFFORDING COVERAGE NAIC N INSURERA: CONTINENTAL CASUALTY INSURED JECB Inc JECB Engineering & Consulting P O BOX 832 Auburn WA 98071 INSURERS: INSURERC.- INSURER D : INSURERE: INSURER F : U0VI=KAGt5 CERTIFICATE NUMBER: REVISION NUMBER - 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. INSR LTR TYPE OF INSURANCE ADD UBR POLICY NUMBER POLICY EFF _JMM/DI1NY1YJ POLICY EXP AMMALDIMLYJ LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR 11 EACH OCCURRENCE $ DAA A �� RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ AGGREGATE LIMIT APPLIES PER POLICY ❑ PRO- JECT LOC GENERAL AGGREGATE $ GEN'L PRODUCTS - COMP/OP AGG $ $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- ANDEMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? NIA STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below M C H 591896631 12/31 /2020 12/31 /2021 $2,000, 000/$2,000,000 A ERRORS & OMISISONS LIABILITY E&O LIABILITY DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) k AIVI.CLLA I IVIV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF KENT PUBLIC WORKS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2200 4TH AVE S ACCORDANCE WITH THE POLICY PROVISIONS. KENT, WA 98032 AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD RI%86,1(662:1(56 %3 7+,6 (1'256(0(17 &+$1*(6 7+( 32/,&< 3/($6(5($' ,7 &$5()8//< %86,1(662:1(56 /,$%,/,7< (;7(16,21 (1'256(0(17 /LEHUW\ 0XWXDO ,QVXUDQFH %3 3DJH RI ,QFOXGHV FRS\ULJKWHG PDWHULDO RI ,QVXUDQFH 6HUYLFHV 2IILFH ,QFZLWK LWV SHUPLVVLRQ 7KLV HQGRUVHPHQW PRGLILHV LQVXUDQFH SURYLGHG XQGHU WKH IROORZLQJ %86,1(662:1(56 &29(5$*()250 %HORZ LV D VXPPDUL]DWLRQ RI WKH FRYHUDJHV SURYLGHG E\ WKLV HQGRUVHPHQW 1R FRYHUDJHV DUH JLYHQ E\ WKLV VXPPDU\ $FWXDO FRYHUDJH GHVFULSWLRQV DUH ZLWKLQ WKLV HQGRUVHPHQW 6(&7,21 68%-(&7 $6XSSOHPHQWDU\ 3D\PHQWV %DLO %RQGV /RVV 2I (DUQLQJV %%URDGHQHG &RYHUDJH )RU 'DPDJH 7R 3UHPLVHV 5HQWHG 7R <RX &,QFLGHQWDO 0HGLFDO 0DOSUDFWLFH ,QMXU\ '0RELOH (TXLSPHQW (%ODQNHW $GGLWLRQDO ,QVXUHG 2ZQHUV &RQWUDFWRUV 2U /HVVRUV )1HZO\ )RUPHG 2U $FTXLUHG 2UJDQL]DWLRQV *$JJUHJDWH /LPLWV +'XWLHV ,Q 7KH (YHQW 2I 2FFXUUHQFH 2IIHQVH &ODLP 2U 6XLW ,/LDELOLW\ $QG 0HGLFDO ([SHQVHV 'HILQLWLRQV %RGLO\ ,QMXU\ ,QVXUHG &RQWUDFW 3HUVRQDO $QG $GYHUWLVLQJ ,QMXU\ 6HFWLRQ ,, /LDELOLW\LV DPHQGHG DV IROORZV $ 6XSSOHPHQWDU\ 3D\PHQWV 6HFWLRQ $ %XVLQHVV /LDELOLW\LV PRGLILHG DV IROORZV 7KH OLPLW VKRZQ LQ 3DUDJUDSK $IE &RYHUDJH ([WHQVLRQ 6XSSOHPHQWDU\ 3D\PHQWV IRU WKH FRVW RI EDLO ERQGV LV UHSODFHG E\ D OLPLW 7KH OLPLW VKRZQ LQ 3DUDJUDSK $IG &RYHUDJH ([WHQVLRQ 6XSSOHPHQWDU\ 3D\PHQWV IRU UHDVRQDEOH H[SHQVHV DQG ORVV RI HDUQLQJV LV UHSODFHG E\ D OLPLW % %URDGHQHG &RYHUDJH )RU 'DPDJH 7R 3UHPLVHV 5HQWHG 7R <RX 7KH ODVW SDUDJUDSK RI 6HFWLRQ % ([FOXVLRQV $SSOLFDEOH 7R %XVLQHVV /LDELOLW\ &RYHUDJH LV UHSODFHG E\ WKH IROORZLQJ :LWK UHVSHFW WR WKH SUHPLVHV ZKLFK DUH UHQWHG WR \RX RU WHPSRUDULO\ RFFXSLHG E\ \RX ZLWK WKH SHUPLV VLRQ RI WKH RZQHU ([FOXVLRQV F G H J K N O P QDQG RGR QRW DSSO\ WR SURSHUW\ GDPDJH RI/LEHUW\ 0XWXDO ,QVXUDQFH %3 3DJH RI ,QFOXGHV FRS\ULJKWHG PDWHULDO RI ,QVXUDQFH 6HUYLFHV 2IILFH ,QFZLWK LWV SHUPLVVLRQ 3DUDJUDSK ' /LDELOLW\ $QG 0HGLFDO ([SHQVHV /LPLWV 2I ,QVXUDQFH LV UHSODFHG E\ WKH IROORZLQJ 7KH PRVW ZH ZLOO SD\ XQGHU WKLV HQGRUVHPHQW IRU WKH VXP RI DOO GDPDJHV EHFDXVH RI DOO SURSHUW\ GDPDJH WR SUHPLVHV ZKLOH UHQWHG WR \RX RU WHPSRUDULO\ RFFXSLHG E\ \RX ZLWK WKH SHUPLVVLRQ RI WKH RZQHU LV WKH /LPLW RI ,QVXUDQFH VKRZQ LQ WKH 'HFODUDWLRQV 3DUDJUDSK ' /LDELOLW\ $QG 0HGLFDO ([SHQVHV /LPLWV 2I ,QVXUDQFH GRHV QRW DSSO\ & ,QFLGHQWDO 0HGLFDO 0DOSUDFWLFH ,QMXU\ 3DUDJUDSK XQGHU 3DUDJUDSK %M ([FOXVLRQV $SSOLFDEOH 7R %XVLQHVV /LDELOLW\ &RYHUDJH 3URIHV VLRQDO 6HUYLFHV GRHV QRW DSSO\ WR ,QFLGHQWDO 0HGLFDO 0DOSUDFWLFH ,QMXU\ FRYHUDJH :LWK UHVSHFW WR WKLV HQGRUVHPHQW WKH IROORZLQJ LV DGGHG WR 6HFWLRQ ) /LDELOLW\ $QG 0HGLFDO ([SHQVHV 'HILQLWLRQV D,QFLGHQWDO 0HGLFDO 0DOSUDFWLFH ,QMXU\ PHDQV ERGLO\ LQMXU\ DULVLQJ RXW RI WKH UHQGHULQJ RI RU IDLOXUH WR UHQGHU GXULQJ WKH SROLF\ SHULRG WKH IROORZLQJ VHUYLFHV 0HGLFDO VXUJLFDO GHQWDO [UD\ RU QXUVLQJ VHUYLFH RU WUHDWPHQW RU WKH IXUQLVKLQJ RI IRRG RU EHYHUDJHV LQ FRQQHFWLRQ WKHUHZLWK RU 7KH IXUQLVKLQJ RU GLVSHQVLQJ RI GUXJV RU PHGLFDO GHQWDO RU VXUJLFDO VXSSOLHV RU DSSOLDQFHV E7KLV FRYHUDJH GRHV QRW DSSO\ WR ([SHQVHV LQFXUUHG E\ WKH LQVXUHG IRU ILUVWDLG WR RWKHUV DW WKH WLPH RI DQ DFFLGHQW DQG WKH 'XWLHV LQ WKH (YHQW RI 2FFXUUHQFH 2IIHQVH &ODLP RU 6XLW &RQGLWLRQ LV DPHQGHG DFFRUGLQJO\ $Q\ LQVXUHG HQJDJHG LQ WKH EXVLQHVV RU RFFXSDWLRQ RI SURYLGLQJ DQ\ RI WKH VHUYLFHV GHVFULEHG XQGHU DDERYH ,QMXU\ FDXVHG E\ DQ\ LQGHPQLWHH LI VXFK LQGHPQLWHH LV HQJDJHG LQ WKH EXVLQHVV RU RFFXSDWLRQ RI SURYLGLQJ DQ\ RI WKH VHUYLFHV GHVFULEHG XQGHU DDERYH ' 0RELOH (TXLSPHQW 6HFWLRQ & :KR ,V $Q ,QVXUHG LV DPHQGHG WR LQFOXGH DQ\ SHUVRQ GULYLQJ PRELOH HTXLSPHQW ZLWK \RXU SHUPLVVLRQ ( %ODQNHW $GGLWLRQDO ,QVXUHG 2ZQHUV &RQWUDFWRUV 2U /HVVRUV 6HFWLRQ & :KR ,V $Q ,QVXUHG LV DPHQGHG WR LQFOXGH DV DQ LQVXUHG DQ\ SHUVRQ RU RUJDQL]DWLRQ ZKRP \RX DUH UHTXLUHG WR QDPH DV DQ DGGLWLRQDO LQVXUHG RQ WKLV SROLF\ XQGHU D ZULWWHQ FRQWUDFW RU ZULWWHQ DJUHHPHQW 7KH ZULWWHQ FRQWUDFW RU DJUHHPHQW PXVW EH D&XUUHQWO\ LQ HIIHFW RU EHFRPLQJ HIIHFWLYH GXULQJ WKH WHUP RI WKLV SROLF\ DQG E([HFXWHG SULRU WR WKH ERGLO\ LQMXU\ SURSHUW\ GDPDJH RU SHUVRQDO DQG DGYHUWLVLQJ LQMXU\ 7KH LQVXUDQFH DIIRUGHG WR WKH DGGLWLRQDO LQVXUHG LV OLPLWHG DV IROORZV D7KH SHUVRQ RU RUJDQL]DWLRQ LV RQO\ DQ DGGLWLRQDO LQVXUHG ZLWK UHVSHFW WR OLDELOLW\ DULVLQJ RXW RI 5HDO SURSHUW\ DV GHVFULEHG LQ D ZULWWHQ FRQWUDFW RU ZULWWHQ DJUHHPHQW \RX RZQ UHQW OHDVH PDLQWDLQ RU RFFXS\ DQG &DXVHG LQ ZKROH RU LQ SDUW E\ \RXU RQJRLQJ RSHUDWLRQV SHUIRUPHG IRU WKDW LQVXUHG E7KH /LPLW RI ,QVXUDQFH DSSOLFDEOH WR WKH DGGLWLRQDO LQVXUHG DUH WKRVH VSHFLILHG LQ WKH ZULWWHQ FRQWUDFW RU ZULWWHQ DJUHHPHQW RU WKH OLPLWV DYDLODEOH XQGHU WKLV SROLF\ DV VWDWHG LQ WKH 'HFODUD WLRQV ZKLFKHYHU DUH OHVV 7KHVH OLPLWV DUH LQFOXVLYH RI DQG QRW LQ DGGLWLRQ WR WKH /LPLW RI ,QVXUDQFH DYDLODEOH XQGHU WKLV SROLF\ F7KH LQVXUDQFH DIIRUGHG WR WKH DGGLWLRQDO LQVXUHG GRHV QRW DSSO\ WR /LDELOLW\ DULVLQJ RXW RI WKH VROH QHJOLJHQFH RI WKH DGGLWLRQDO LQVXUHG %RGLO\ LQMXU\ SURSHUW\ GDPDJH SHUVRQDO DQG DGYHUWLVLQJ LQMXU\RU GHIHQVH FRYHUDJH XQGHU WKH 6XSSOHPHQWDU\ 3D\PHQWV VHFWLRQ RI WKH SROLF\ DULVLQJ RXW RI DQ DUFKLWHFW¶V HQ JLQHHU¶V RU VXUYH\RU¶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¶V UHQGHULQJ RU IDLOXUH WR UHQGHU SURIHVVLRQDO VHUYLFHV LQFOXGLQJ WKRVH OLVWHG LQ DERYH DQG VXSHUYLVRU\ LQVSHFWLRQ DUFKLWHFWXUDO RU HQJLQHHULQJ DFWLYLWLHV 3DUDJUDSK )E 3HUVRQDO $QG $GYHUWLVLQJ ,QMXU\LV UHSODFHG E\ WKH IROORZLQJ E0DOLFLRXV SURVHFXWLRQ RU DEXVH RI SURFHVV