HomeMy WebLinkAboutCAG2021-174 - Original - A & M Consulting - Utility Coordination - 03/30/2021ApprovalOriginator:Department:
Date Sent:Date Required:
Authorized to Sign:
Director or Designee Mayor
Date of Council Approval:
Grant? Yes 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? Yes No*
Business License Verification: Yes In-Process Exempt (KCC 5.01.045)
If meets requirements per KCC 3.70.100, please complete “Vendor Purchase-Local Exceptions” form on Cityspace.
Notice required prior to disclosure?
Yes 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
Budget Account Number:
Budget? Yes No
Dir Asst:
Sup/Mgr:
Dir/Dep:
rev. 200821
FOR CITY OF KENT OFFICIAL USE ONLY
(Optional)
* Memo to Mayor must be attached
CONSULTANT SERVICES AGREEMENT - 1
($20,000 or Less)
CONSULTANT SERVICES AGREEMENT
between the City of Kent and
A & M Consulting
THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation
(hereinafter the "City"), and A & M Consulting organized under the laws of the State of Washington,
located and doing business at 18119 NE 30th Street, Redmond, WA 98052, Phone: (206) 276-3635,
Contact: Arnie Tomac (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 public and private utility coordination for multiple 2021
projects. 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
Nine Thousand, Two Hundred Forty Dollars ($9,240), 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
($20,000 or Less)
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
($20,000 or Less)
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
($20,000 or Less)
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
($20,000 or Less)
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
numberofcounterffishallconstituteanori9inal,andallofwhichwillto9etherconstitute
this one Agreement. Further, upon executing this Agreement, either party may deliver the signature page
to the oth6r 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.
IN WITI{ESS, the parties below execute this Agreement, which shall become effective on
the last date entered below. All acts consistent with the authority of this Agreement and prior
to its effective date are ratified and affirmed, and the terms of the Agreement shall be deemed
to have applied.
CONSULTANT:
By:AThAf-
hlnPrint Name:tt 8C
Its f arn el
DATE:/,c-z-(zt
CITY OF KENT:
By:E,;
Chad Bieren, P.E.
Public Works Director
Print Name:
Its:
DATE:
NOTICES TO BE SENT TO:
CONSULTANT:
Arnie Tomac
A & M Consulting
18119 NE 30th Street
Redmond, WA 98052
(206) 27 6-3635 (telephone)
A facsimile
NOTICES TO BE SENT TO:
CITY OF KENT:
Chad Bieien, P.E.
City of Kent
220 Fourth Avenue South
Kent, WA 98032
(
(
253) 856-5500 (telePhone)
2s3) 8s6-6soo (mile
ATTEST:
Kent Clerk
A & M Consultlng - Utility Consultlng & Coordlnatlon/Leyr€r
CONSULTANT SERVICES AGREEMENT - 6
($20,000 or Less)
DECLARATION
GITY OF KENT EQUAL EMPLOYMENT OPPORTUNIW 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 compiy with the regulations of the City's equal employment oppoftunity
policies.
The following questions specifically identify the requirements the City deems necessary for any
contractor, Jubcontractor or" suppiier on fhis 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 Frime Contractor complied with the requirements as set forth
above.
By signing below, I agree to fulfill the five requirements referenced above.
By:
For:PAC (/t4
Title:/v^o(
Date i lln-l vt
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: _________________________________________
Scope of Work
A&M Consulting-202 I Miscellaneous Improvement Projects
Scope of Work
The consultant shall provide consultant services to the City of Kent for multipie miscelianeous public and
private utility City Improvement Projects. Routinely, A&M is asked to provide minor support on small City
projects ( of say 3-10 hows) for which the creation of an individual project contract would be burdensome.
Therefore, A&M suggests that the City consider using one contract for the year 7027 for these multiple small
projects. These services shall include the following:
a
o
Evaluate impacted of the City's projects on private utilities equipment.
Coordinate with Puget Sound Energy, COMCAST and Centrylink (Lumen).for overhead to
underground conversions.
Coordinate with Puget Sound Energy, COMCAST and Centrylink (Lumen) design construction
agreements and cost estimates for utility relocations.
Provide construction coordination and provide advice on resolution of conflicts related to private
utilities during construction for the City public projects.
Projects currently planned or underway (but not limited to) which could be included within this contract
include the following:
o Linda Heights Sewer Pump Station (11-3002)
o Skyline Park Sewer Pump Station (11-3003)
o Transits Access- SE Kent-Kangley @ 150th Ave SE QA4026.4). 132"d & Kent-Kangley Pedestrian Improvements (20-3027)
o Mill Creek @76yh Flood Prevention Improvements (30-2038.1)
o 2021 Watermain replacements (21-3002)
Note: Work will only be preformed on those projects with project numbers provided and as authorized by the
City Contract Manger. Contract will be billed monthly by project and project YTD.
Budget 59240
o
$66/hour
EXHIBIT A
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. The City shall be named as an
Additional 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.
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.
EXHIBIT B (Continued)
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 Consultant 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.
DATE {MM/DD¡YYYY}
020Tl{lS CERTIFICATE ls ISSUED AS A MATTER oF tt¡¡FoRffATtoN ONLY AND CONFERS NO RIGI{TS UPON THE CERTIFIC,ATE IIOLDER"TII¡S GERTIFICATE DOES NOT AFFIRMATIVELY OR NEG/TTVEI-Y AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY TIIE
POLICIES BELOW- TII¡$ GERTIFIGATE OF ¡NSURANCE ÐOE$ NOT CONST¡TUTE A CONTRACÍ BETWEEN THE tsstjtl,lc tNsuRER(S),
AUT!{OR,IZED REFRE5ENTATIVE OR PRODUCER, AND THE CERTIFICATE I{OLDER.
IMPORTANT:tf the certificate holder ls an ADDITIONAL INSURED,the policy(ies)must be endorsed.tf SUBR,OGA TloNts WAIVËD,
sub¡ect Éo the terms and condiúions of the policy,cerüair¡policies mãy reqr.lire an endorsement A statement on th!s cerÉificaúe does notconfer rights to the centificate holder in lieu of such endoreernent(s).
PRODUCER
AJ GALLAGHER & CO INS BRKRS CÄ/PHS
72255202
The Hartford Business Service Center
3600 Wiseman Blvcl
San Antonio, TX78251
CONTACT
NAMT-
PHONE {BBB) e20-6259
(Á/C, Nc, Exi):
FAx (888)443_6112
{,4/Ç, No):
E-MAIL
ADDRESS:
INSURER{S) AFFORDING COVERAGE NAIC#
INSURED
ARNOLD TOMAC DBA A & ÍIJI CONSULTING
181 19 NE 3OTH ST
REDMOND WA 98052-5902
INSURERA: Hartford CasualtylnsuranceCompany 29424
INSURER B
INSURER C
INSURER D
INSURER E
INSURER F
COVERAGES
CERTIFICATE OF LIABILITY INSURANGE
CERTIFICATE Nt,!MBER:REVISIOIII NLIMBE${:
GELLA
@ 1988-2015 ACORI) CORPORAT'ION. At¡ rights reserved.
ïhe ACORÐ name and logo are reg¡stered rnarks of ACORD
IND ICATEÐ.NOTWITHSTAND ING
MAY
ISTHIS CERTIFYTO THETHAT OFPOLTCtES LISTEDiNSURANCE HAVEBELOW ENBE TOISSUED INSUREDTHE ABOVENAMED THEFOR POLICY PERIOD
REQUANY TERMIREMENT OR CONDITION ANYOF CONTRACT OR DOCUMENTOTHER WITH RESPECT WHICHTÕ THiSCERTIFICATEBEDISSUEMAORTHEPERTAIN,INSURANCE BYAFFORDED THE POLICIES HEREINDESCRIBED SUBJECT ALLTO THETERMù,ANDEXCLUSIONS oCONDITIONS F SUCH LIMITSPOLtCtES.SHOWN MAY BEENHAVE BYREDUCED CLAIMS.PAID
TYPE OF INSURANCE POLICY NUMBER LtMlfs
EACH OCCURRENCE ,000,000
$300,000
X
COMMERCIAL GENERAL LIABILITY
OCCUR
l\JlÉD EXP (Any one person)$10,000
& ADV
GENERAL AGGREGATE
PRODUCTS - COMP|AP AGG $4,000,000
A
GEN'L AGGREGATE LIMITAPPLIES PER:
OTHER:
LOCPRO.
JF.(j.-|
X 72 SBM llK5025 11tO1t2020 1'1t0112021
$2,000,000
BODILY INJURY {P"r personJ
BODILY INJURY (Per aæídanl)
X X
acc¡dent)
,AUTOHOBILË LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED
AUTOS
SCHEDULED
AUTOS
NON..OWNED
AUTOS
72 SBM UK5O25 11/O1t2020 1'l1o1t2021
EACHUMBRELLA LIAS
EX6ESS LIAB CLAIMS-
MADE AGGREGATE
REIENTON $
E,L. EACH ACCIDENT $1,000,000
E,L. DISEASE,EA EMPLOYEE $1,000,000
A
ÂND EIIPLOYERS' UÄBILITY
ANY
PROPRIETORIPARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandaiory in NH)
lf yes, decribe under
Y/ñt
WORKERS
N¡,4,72 SBM UK5O25 11tO1t202A 11|t1t2021
E,L. DISEASE - POLICY LIMIT $1,000,000
A EMPLOYMENT PRACTICES
LIABILITY 72 SBM UK5025 11t01t2A20 111A1/2021 Each Claim Limit
Aggregate Limif
Those usual to the lnsured's Operations. Certificate Holder is an Additional Insured per the Business Liabilíty Çoverage Form SS000B attached to thispolícy.
ÐE$CR,FTION OF OPERATIONS / LOCAT'ONS / WHICLES (ACORD 101, Add¡t¡onäl Rêmarl(s $chedule,máy bs atiached if mors spacê is rsquired)
ABOVE DESCRIBED POLICIES BE CANCELLËD
BEFORE THE EXPIRATION DATE THEREOF, NOTICE wlLL tsE DËLIVERED
It'¡ ACCORDANCE W|TH THE POLICY PROVTSIONS.
SHOULD ANY OF THEThe City of Kent
Public Works Engineering
222 4TH AVE S
KENT WA 98032
lft"a-attã /a¿ât-,¿^-
AUTHORIZED REPRESENTIITIVE
ACORÐ 25 (2016103)
POLICYHOLDER NOTICE . WASHINGTON
tlate:09/15/20
Policy Number: 72 sBM UK5025
Renewa! Date: 11/01/20
Your Hartford Agent: Ãdf GÀI¡.¡\(ffiR & CO ffS BRInS g,À/pES "Hr#
o
0o
(BB8) 920-6259
.ÊR¡ÚOIiD TOHAC DBA À E il
goNsuf,ìFr¡[e
18i"19 ¡E"r- 30|118 SIIREET
RTIËTGüID PÛã. 9805?
Dear Valued Hartford lnsured,
Your current policy provided by The Hartford will expire shortly. The purpose of this notice is to advise you of certain
changes to your policy upon renewal"
A. Folicv Fremium
The new premium for your policy for the upcoming term is indicated below. This premium amount is based on
current information known to us and may be subject to change based on any additional information we may
receive from you or your Hartford agent or broker. More information on your premium determination can be
obtained from your agent or broker, or from The Hartford-
RenewalPremium - $
Amount of lncrease = $
425.ÐA
The reason(s) for the increase in premium is due to one or more of the following:
1. A change in rates or the method of calculating premium.
2. A change in your exposures, loss experience, or other risk characteristics.
B- Goveraqe Ghanges (if applicable)
Your policy for the upcoming term will include certain reductions or additional restrlctions in coverage, as
indicated by an (x) below" lf your state requires a notice of nonrenewal as a result of the indicated change(s), this
is our notice to you in compliance with the applicable law"
( ) lncrcase in Deductibleto:
( ) Reduction in Limits to
( ) Reductions in Coverage:
( ) Other Changes or Restrictions in Coverage:
ïhe coverage change is due to the following indicated reason(s):
( ) Your exposures, loss experience, or other risk characteristics indicate a need for the change"
( ) A change in our rules, forms or underwriting guidelines for yourtype of policy,
Fonn lH 70 501210 Page f
Further information regarding the reason for the coverage change(s) is available from the company or
your agent or broker. You may receive other notices of coverage changes for the upcoming policy term
under separate cover. Those other changes will apply in addition to the changes described above.
This is not a bill. You will receive a separate bill for all or part of the premium due for your renewal policy. lf
you do not pay the amount shown by the due date as stated in the bill, your insurance coverage will expire or
be cancelled for non-payment of premium. lf you have any questions about your policy or about your overall
ilrsura¡ruç ¡reecis, piease corúaci your äarüorci ageni or broker.
Fonn lH 7{150 t2 l0 Page2
25
50
UK
SBM
This Spectrum Policy consists of the Declarations, Coverage Forms, Common Policy Conditions and any
other Forms and Endorsements issued to be a part of the Policy. This insurance is provided bythe stock
insurance company of The Hartford lnsurance Group shown below.
INSURER: HARTFORD CASUALTY ]NSURANCE COMPANY
ONE HARTFORD PLAZA, HARTFORD, CT 061-55
COMPANYCODE: 3
Policy Number: 72 SBM UK5025 DX
SPECTRUM POLICY DECLARATIONS
@
ò
Named lnsured and Mailing Address:
(No., Street, Town, State, Zip Code)
ORIGINAL
ARNOLD TOMAC DBA A & M
CONSULTTNG
181]-9 N.E. 3OTH STREET
REDMOND üIA 98052
Poficy Period: From 1J/AI/20 To L1"/0L/2L 1 YEAR
12:01 a.m., Standard time at your mailing address shown above. Exception: 12 noon in New Hampshire
Nameof Agent/Broker: AJ GALLAGHER & CO rNS BRKRS CA/PHS
Code: 255202
Previous Policy Number: 72 SBM UK5025
Named Insured is: TNDTVTDUAL
Audit Period: NON-AUDITABLE
Type of Property Goverage: NONE
lnsurance Provided: ln return for the payment of the premium and subject to all of the terms of this policy, we
agree with you to provide insurance as stated in this policy.
TOTAL ANNUAL PREMIUM lS: ç42s Mp
rN RECOGNTTION OF THE MULTIPLE COVERAGES TNSURED II'TTH THE HARTFORD, YOUR
POLTCY PREMIUM TNCLUDES AN ACCOU\]T CREDTT.
Countersigned by
L**-an-f /a¿â**-*r---
Authorized Representative
09 /1,5 /20
Date
Page 001- (CoNTINUED ON NEXT PAGE)
Policy Expiration Date: t1-/ 01-/2L
Form SS 00 021206
Process Date: 09 /L5/2A
TNSURED COPY
SPECTRUM POLICY DECLARATIONS (Continued)
POLICYNUMBER: 72 SBM UK5025
Location(s), Building(s), Business of Named lnsured and Schedule of Coverages for Premises as designated by
Number below
Location: 001 Building: 001
4 ôl I ^ ar ñ a^ñ1" ññññEñIO1IJ ¡T.!. JVI¡¡ 9¡IlgUI
RF:DMC)ND ht¿, 98052
Description of Business:
REÀL ESTATE APPRAISER
Deductible: NO COVERAGE
BUILDING AND BUSINESS PERSONAL PROPERTY LIMITS OF INSURANCE
BUILDING
NO CO\rERAGE
BUSINESS PERSONAL PROPERTY
REPLACEMENT COST
PERSONAL PROPERTY OF OTHERS
REPLACEMENT COST
NO COVERAGE
NO COVERAGE
MONEY AIVD SECURITIES
INSIDE THE PREMISES
OUTSTDE THE PREMISES
Form SS 00 02 12 06
Process Date: 09 /L5/2A
NO COVERAGE
NO COVER.A,GE
Page 002 (CONTINUED ON NEXT PAGE)
Policy Expiration Date: LI/0I/2L
SPECTRUM POLICY DECLARATTONS (Continued)
POLICYNUMBER: 72 SBM UK5O25
BUSINESS LIABILITY
LIABILITY AND MEDICAL EXPENSES
MEDICAL EXPENSES - ANY ONE PERSON
PERSONAL AND ADVERTISING INJURY
LIMITS OF INSURANCE
$2, 000, 000
$ 10, 000
$2,000,000
DAMAGES TO PREMISES RENTED TO YOU
ANY ONE PREMISES
$ 300,000
AGGREGATE LIMITS
PRODUCTS-COMPLETED OPERATIONS $4, 000, 000
$4, 000, 000GENERAL AGGREGATE
EMPLOYMENT PRACTICES LIABILITY
COVERAGE¡ FORM SS 09 0t-
EACH CLAIM LIMIT $ S, OOO
DEDUCTIBLE - EACH CLAIM LIMIT
NOT APPLICABLE
AGGREGATE LIMIT $ 5, OOO
RETROACTIVE DATE: l_1_0L2 005
This Employment Practices Liability Coverage contains claims made coverage. Except as may be othenviseprovided herein, specified coverages of this insurance are limited generally to liability for injuries for w-hich claims arefirst made against the insured while the insurance is in force. Please read and review tlre insurance carefully and
discuss the coverage with your Hartford Agent or Broker.
The Limits of lnsurance stated in this Declarations will be reduced, and may be completely exhausted, by thepayment of "defense expense" and, in such event, The Company will not be obligated to pay any further"defense expense" or sums which the insured is or may become legally obligated to pay as "damages".
BUSINESS LIABILTTY OPTIONAL
COVERAGES
HTRED/NON-OWNED AUTO LTABTLITY
FORM: SS 01 70
$2,000,000
Form SS A0021206
Process Date: 09 /L5/2A
Page OO3 (CONTINUED ON NEXT PAGE)
Policy Expiration Date: L1" / 0L / 21,
SPECTRUM POLICY DECLARATIONS (Continued)
POLICY NUMBER: 72 SBM UK5025
BUSINESS LIABILITY OPTIONAL COVERAGES
(Gontinued)
lllPI¡CrYERg I¡IÀBII¡IT]I åND STOP CIAP
BODII.Y IN'N'RT !T ASCIDE¡IT
ETCE ÀCCIDE¡IT+NíGU ËÚ ñTd'IClEE\,lJItr¡ tll rñ¡ D¡ v¡9se5
EACE EOIPLOTEE
BODIITT INit{tRÏ BY DIgEÀgE
POLXCI I¡MIfl
APPLICABLE |t!O LOCATIONS IN llEE
FOLI¡OWI¡IG¡ SIÍÀEE(S) ¡
W.ASHITi¡G¡IION
WAI\TER OF SUBROGTÀTION:
FOnil flg 12 15
IOCÀTION: 001 BUILDXI{GI: 001
NA!G: If ã¡ÍI
Form SS 00 02 12 06
process Date: 09 /L5/20
LIMITS OF INSURANCE
sl, 000, 000
s1, 000, 000
$l-, 000, 000
PagE OO4 (CONTTNUED ON NEXT PAGE)
PolicY ExPiration Ðalet IL/ 0L/2t
SPECTRUM POLICY DECLARATTONS (Conrinued)
POLICYNUMBER: 12 SBNI UK5025
ADDITIONAL INSUREDS: THE FOLLOWING ARE ADDITIONAL INsUREDs FoR BUsINEss
LIABILITY COVERAGE IN THIS POLICY.
@
oo
LOCATION
TCPE
NÀME
OO1 BUII.DIIIG¡ OO1
!ÛÀ¡TAC¡ER LESSOR
sEE roR![ XE 12 00
Form SS A0 021206
Process Date: 09/L5/20
Page 005 (CONTTNUED ON NEXT PAGE)
Policy Expiration Datei TL/0L/2L
ıı ^n AÊ, 1) nÁÚJ VV AJ LZ
SS 89 93 07 L6ss 0s 03 03 00ss 09 aI 12 L4ss 09 ]L L2 L4
rH 99 4l- 04 09
05
09
l_ 1_
L7
L4
09
09
06
03
L2
04
^ot/o
70
63
1_0
7A
40
SPECTRUM POLICY DECLARATIONS (Continued)
POL¡CYNUMBER: 72 SBM UK5025
Form Numbers of Forms and Endorsements that apply:
L2 85 ADD]TIONAI, INSURED - MANAGER/LESSOR
Form SS 00 02 1 2 06
Process Date: 09 /L5 /20
00
01-
4L
5l_
09
99
ÞÐ
S5
SS
ss
ss
IH
UU
L7
05
l_5t4
00
^^ ^- l1vv v) L¿
01 28 05
4L 02 04
50 l-9 01-
09 67 09
r_2 l_5 03
ùÞ
ss
SS
ì)Þ
ss
ss
I+t6
L5
1-5
L4
9B
L5
1- l-
03
09
09
09!2
09
01_
00
55 UU Ufss 00 64ss 00 60ss 05 47ss 09 2sss 1-0 04ss 83 76
IH
Policy Expiration Date: TL/ 0L/2L
Page 006
BUSINESS LIABILITY COVERAGE FORM
EE
E
--EEGEtEt-
-
d
rfl
C\t
r'1
oit
orr{do
rJ)c\oro
M
c\lr*
oiloo
r-{
(v1
l.
----g
-E
GG
-*IEE
-----------Gt
-ryE
-t
-EE
O 2005, The Hartford
Form SS 00 0E 04 05
QUICK REFERENCE
BUSINESS LIABILITY COVERAGE FORM
READ YOUR POLICY CAREFULLY
BUSINESS LIABILITY COVERAGE FORM
A. COVERAGES
Business Liability
Medical Expenses
Coverage Extension - Supplementary Payments
B. EXCLUSIONS
C. WHO IS AN INSURED
LIABILITY AND MEDICAL EXPENSES
LIMITS OF INSURANCE
E. LIABILITY AND MEDICAL EXPENSES GENER.AL CONDITIONS
1. Bankruptcy
2. Duties ln The Event Of Occurrence, Offense, Claim Or Suit
3. Financial Responsibility Laws
4. LegalAction Against Us
5. Separation Of lnsureds
6. Representations
7. Other lnsurance
8. Transfer Of Rights Of Recovery Against Others To Us
F. OPTIONAL ADDITIONAL INSURED COVERAGES
Additional lnsureds
G. LIABILITY AND MEDICAL EXPENSES DEFINITIONS
Beginning on Page
14
15
15
15
16
16
16
16
16
17
18
18
20
,l
1
2
2
3
10
D
Form SS 00 08 04 05
BUSINESS LIABILITY COVERAGE FORM
Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what
is and is not covered.
Throughout this policy the words 'you" and "youl'' refer to the Named lnsured shown in the Declarations. The wordsnwe", "us" and "out" refer to the stock insurance company member of The Hartford providing this insurance.
The word "insured" means any person or organization qualiffing as such under Section C. - \Mlo ls An lnsured.
Other words and phrases that appear in quotation marks have special meaning. Refer to Section G. - Liability And
Medical Expenses Defi nitions.
c\
rr1c\
rr-)c\
Ol
dt+o
1r)c\olft
M!)ft
F-c\oorl
F1
J.
A. COVERAGES
1. BUSTNESS LtABtLtTy COVERAGE (BODtLy
INJURY, PROPERTY DAMAGE, PERSONAL
AND ADVERTTSTNG TNJURY)
lnsuring Agreement
a. V\le will pay those sums that the insured
becomes legally obligated to pay as
damages because of 'bodily injury",
"property damage' or 'personal and
advertising in.iury' to which this insurance
applies. \Ale will have the right and duty to
defend the insured against any nsuit"
seeking those damages. However, we will
have no duty to defend the insured against
any "suito seeking damages for "bodily
injury", "property damage" or "personal and
advertising injury" to which this insurance
does not apply.
We may, at our discretion, investigate any
"occurrence" or offense and setile any claim
or "suit" that may result. But:
(1) The amount we will pay for damages is
limited as described in Section D. -
Liability And Medicat Expenses Limits
Of lnsurance; and
(21 otr right and duty to defend ends when
we have used up the applicable limit of
insurance in the payment of judgnrents,
setlements or rnedlcal e;penses to wtrich
this insur:ance applles.
No other oHigation or liability to pay suns or
perbrm ads or services is covered unless
exfliciUy povided br under Coverage
Extension - Supplennntary Paynents.
b. This insurance applies:
(1) To "bodily injury' and .property
damage" only if:
(a) The "bodily injury" or "property
damage" is caused by an
"occurrence" that takes place in the
"coverage territory";
(b) The "bodily injury" or 'property
darnage' occurs during the policy
period; and
(c) Prior to the policy period, no insured
listed under Paragraph 1. of Section
C. - \Mro ls An lnsured and no
'employee" authorized by you to give
or receive notice of an "occunence"
or claim, knew that the 'bodily injury"
or'property damage" had occuned,
in whole or in part. lf such a listed
insured or authorized "employee"
knew, prior to the policy period, that
the "boclily iniury" or "property
damage' occurred, then any
continuation, change or resumption
of such 'bodily injury' or 'property
damage' during or after the policy
period will be deemed to have been
known prior to the policy period.
l2l To "personal and advertising injury"
caused by an offense arising out ofyour
business, but only if the offense was
committed in the ncoverage tenitory.
during the policy period.
c. .Bodily injury" or "property damage" will be
deemed to have been known to have
occuned at the earliest time when any
insured listed under Paragraph 1. of Section
C. - Who ls An lnsured or any *employee"
authorized by you to give or receive notice
of an "occurrence' or claim:
(1) Reports all, or any part, of the "bodily
injury' or "property damage' to us or
any other insurer;
ltttlt:&
-G
EIGI
!!!Er
--
@
-*
-
--:
-ttE
*
G
EtlG
--G
GG
-E-
--E*
-tlErGE-
-
Form SS 00 08 04 05
@ 2005, The Hartford
Page 1 of24
BUSINESS LIABILIry COVERAGE FORM
l2l Receives a written or verlcal demand or
claim for damages because of the "bodily
injury" or "property damage"; or
(3) Becomes aware by any other means that
"bodily injury" or "property damage" has
occuned or has begun to occur.
d. Damages because of "bodily injury" include
damages claimed by any person or
organization for care, loss of services or
death resulting at any time from the "bodily
injury".
e. lncidental Medical Malpractice
(1) "Bodily injury" arising out of the
rendering of or failure to render
professional health care services as a
physician, dentist, nurse, emergency
medical technician or paramedic shall
be deemed to be caused by an
"occurrence", but only if:
(a) The physician, dentist, nurse,
emergency medical technician or
paramedic is employed by you to
provide such services; and
(b) You are not engaged in the
business or occupation of providing
such services.
(2) For the purpose of determining the
limits of insurance for incidental medical
malpractice, any act or omission
together with all related acts or
omissions in the furnishing of these
services to any one person will be
considered one "occurrence".
2. MEDICAL EXPENSES
lnsuring Agreement
a. We will pay medical expenses as described
below for "bodily injury" caused by an
accident:
(1) On premises you own or rent;
(2) On ways next to premises you own or
rent; or
(3) Because of your operations;
provided that:
(f) The accident takes place in the
"coverage territory" and during the
policy period;
(21 The expenses are incuned and reported
to us within three years of the date of
the accident; and
(3) The injured person submits to
examination, at our expense, by
physicians of our choice as often as we
reasonably require.
b. We will make these payments regardless of
fault. These payments will not exceed the
applicable limit of insurance. We will pay
reasonable expenses for:
(f ) First aid administered at the time of an
accident;
l2l Necessary medical, surgical, x-ray and
dental services, including prosthetic
devices; and
(3) Necessary ambulance, hosPital,
professional nursing and funeral
services.
3. COVERAGE EXTENSION -
SUPPLEMENTARY PAYMENTS
a. We will pay, with respect to any claim or
"suit" we investigate or settle, or any "suit"
against an insured we defend:
(1) Allexpenses we incur.
l2l Up to $1,000 for the cost of bail bonds
required because of accidents or traffic
law violations arising out of the use of
any vehicle to which Business Liability
Coverage for "bodily injury" applies. We
do not have to furnish these bonds.
(3) The cost of appeal bonds or bonds to
release attachments, but only for bond
amounts within the applicable limit of
insurance. We do not have to furnish
these bonds.
(4) All reasonable expenses incurred by the
insured at our request to assist us in the
investigation or defense of the claim or
"suit", including actual loss of earnings
uP to $500 a daY because of time off
from work.
(5) All costs taxed against the insured in
the "suit".
(6) Prejudgment interest awarded against
the insured on that part of the judgment
we pay. lf we make an offer to PaY the
applicable limit of insurance, we will not
pay any prejudgment interest based on
that period of time after the offer.
(71 All interest on the full amount of any
judgment that accrues after entry of the
judgment and before we have Paid,
offered to pay, or deposited in court the
part of the judgment that is within the
applicable limit of insurance.
Any amounts paid under (1) through (7)
above will not reduce the limits of insurance.
Page 2 of 24 Form SS 00 08 04 05
B
b. lf we defend an insured against a "suit"
and an indemnitee of the insured is also
named as a party to the "suit", we will
defend that indemnitee if all of the
following conditions are met:
(1) The'suit" against the indemnitee
.seeks damages for which the insured
has assumed the liability of the
indemnitee in a contract or agreement
that is an "insured contract";
(21 This insurance applies to such liability
assumed by the insured;
(3) The obligation to defend, or the cost of
the defense of, that indemnitee, has
also been assumed by the insured in
the same'insured contract";
(4) The allegations in the "suit" and the
information we know about the
'occurrence" are such that no conflict
appears to exist between the interests
of the insured and the interest of the
indemnitee;
(5) The indemnitee and the insured ask
us to conduct and control the defense
of that indemnitee against such "suit"
and agree that we can assign the
same counsel to defend the insured
and the indemnitee; and
(6) The indemnitee:
(a) Agrees in writing to:
(i) Cooperate wilh us in the
investigation, settlement or
defense of the "suit";
(ii) lmmediately send us copies ofany demands, notices,
summonses or legal papers
received in connection with
the'suit';
(iii) Notiff any other insurer whose
coverage is available to the
indemnitee;and
(iv) Cooperate with us with
respect to coordinating other' applicable insurance available
to the indemnitee; and
(b) Provides us with written
authorization to:
(0 Obtain records and other
information related to the
'suit"; and
(ii) Conduct and control the
defense of the indemnitee in
such nsuit".
BUSINESS LIABILITY COVERAGE FORM
So long as the above conditions are rnet,
attomeys' fees incuned by us in the
defense of that indemnitee, necessary
litigation expenses incuned by us and
necessary litpation elpenses incuned
by the indemnitee at our request will be
paid as Supplementary Payments.
Notwithstanding the provisions of
Paragraph l.b.(b) of Section B. -
Exclusions, such payments will not be
deemed to be damages for "bodily
injury" and 'property damage" and will
not reduce the Limits of lnsurance.
Our obligation to defend an insured's
indemnitee and to pay for aftorneys' fees
and necessary litigation expenses as
Supplementary Payments ends when:
(1) We have used up the applicable limitof insurance in the payment of
judgments or settlements; or
(21 The conditions set forth above, or the
terms of the agreement described in
Paragraph (6) above, are no longer met.
B. EXCLUSIONS
1. Applicable To Business Liability Goverage
This insurance does not apply to:
a. Expected Or lntended lnjury
(1) "Bodily injury' or 'property damage'
expected or intended from the
standpoint of the insured. This
exclusion does not apply to "bodily
injury" or "property damage" resulting
ftom the use of reasonable force to
protecl persons or property; or
(21 "Personal and advertising in!ry" arising
out of an oftnse committed by, at the
direction of or with the consent or
aoquiescence of the insured with the
expectation of infliding "personal and
adrrertising inirry'.
b. Contractual Liability
(11 "Bodily inirry" or"property damage'; or
(21 'Personal and advertising injury"
for which the insured is obligated to pay
damages by reason of the assumption of
liability in a contract or agreement.
This exclusion does not apply to liability
for damages because of:
(a) 'Bodily inln/, 'property damage" or
"personal and adwrtising injury" that
the insured rnrculd have in the
absence of the contrad or
agreennnt;or
c?|
cac{
c.l
c\il
o\dr-lo
rnc\otrl
M5
c\tr\Noo
d
ca*
-
;G
---
:
G
-iET
it
-=aEr
G!
G
--
-E
-n
Form SS 00 08 04 05 Page 3 of 24
BUSINESS LIABILITY COVERAGE FORM
(b) "Bodily injury" or "property damage"
assumed in a contract or agreement
that is an "insured contract",
provi<led the "bodily injury" or
'property damage" occur':s
subsequent to the execution of the
contract or agreernent. Solely for
the purpose of liability assumed in
an "insured contract", reasonable
attomeys' fees and ne@ssary
litigation expenses incuned by or for
a party other than an insured are
deemed to be damages because of
"bodily injury" or "property damage"
provided:
(i) Liability to such party for, or for
the cost of, that party's defense
has also been assumed in the
same "insured contract", and
(ii) Such attorneys' fees and
litigation expenses are for
defense of that party against a
civil or alternative dispute
resolution proceeding in which
damages to which this
insurance applies are alleged.
c. Liquor Liability
"Bodily injury" or "property damage" for
which any insured-may be held liable by
reason of:
(1) Causing or contributing to the
intoxication of any person;
l2'l The fumishing of alcoholic beverages to
a person under the legal drinking age or
underthe influence of alcohol;or
(3) Any statute, ordinance or regulation
relating to the sale, gift, distribution or
use of alcoholic beverages.
This exclusion applies only if you are in the
business of manufacturing, distributing,
selling, serving or fumishing alcoholic
beverages.
d. Workers' Compensation And Similar
l-aws
Any obligation of the insured under a
workers' compensation, disability benefits
or unemployment compensation law or
any similar law.
e. Employer's Liability
"Bodily injury" to:
(1) An "employee" of the insured arising
out ofand in the course ot
(a) Employment by the insured; or
(b) Performing duties related to the
conduct of the insured's business, or
(21 The spouse, child, parent, brother or
sister of that "employee" as a
consequence of (1) above.
This exclusion applies:
(1) Wrether the insured may be liable as
an employer or in any other capacity;
and
l2l To any obligation to share damages
with or repay someone else who must
pay damages because of the injury.
This exclusion does not apply to liability
assumed by the insured under an "insured
contract".
f. Pollution
(1) "Bodily injury", "property damage" or
"personal and advertising injury"
arising out of the actual, alleged or
threatened discharge, dispersal,
seepage, migration, release or escape
of "pollutants":
(a) At or from any premises, site or
location which is or was at any
time owned or occupied by, or
rented or loaned to any insured.
However, this subparagraph does
not apply to:
(i) "Bodily injury" if sustained within
a building and caused by
smoke, fumes, vapor or soot
produced by or originating from
equipment that is used to heat,
cool or dehumldiff the building,
or equipment that is used to
heat water for personal use, by
the building's occupants or their
guests;
(ii) "Bodily injury" or "property
damage" for which you may be
heb liable, if you are a
contrador and the owner or
lessee of such premises, site or
location has been added to your
policy as an additional insured
with respect to your ongoing
operations perfonred for that
additional insured at that
premises, site or location and
such premises, site or location
is not and never was owned or
occupied by, or rented or
loaned to, any insured, other
than that additional insured; or
Page 4 of 24 Form SS 00 08 04 05
<l
l-.t
C\f
cac\
o\r{rlorn
c|ilolr)
MDc\r\c\oo
f{('1
:}
(iii) "Bodily injury" or "property
damage' arising out of heat,
smoke or fumes from a
"hostile fire";
(b) At or from any premises, site or
location which is or was at any
time used by or for any insured or
others for the handling, storage,
disposal, processing or treatment
of waste;
(c) \Mtich are or were at any time
transported, handled, stored,
treated, disposed of, or processed
as waste by or for:
(i) Any insured; or
(ii) Any person or organization for
whom you may be legally
responsible;
(d) At or from any premises, site or
location on which any insured or
any contractors or subcontractors
working directly or indirectly onany insured's behalf are
performing operations if the
'pollutants' are brought on or to
the premises, site or location in
connection with such operations
by such insured, contractor or
subcontrac{or. However, this
subparagraph does not apply to:
(a) 'Bodily injury" or 'property
damage' arising out of the
escape of fuels, lubricants or
other operating fluids which are
needed to perform the normal
el€ctrical, hydraulic ornechanical functions
necessary for the operation of
"rnobile equipment" or its parts,
if sucfr fuels, lubricants or other
operating fluids escape ftom a
whicle part designed to hold,
store or receiw them. This
exce$ion does not apply if the
'boclily injury" or 'property
damage" arises out of the
intentional discha rge, dispersalor release of the fuels,
lubricants or other operating
fluiCs, or if such fuels,
luhicants or other operating
flukJs are brought on or to the
premises, site or location withthe intent that they be
discharged, dispersed or
BUSINESS LIABILITY COVERAGE FORM
released as part of the
operations being performed
by such insured, contractor or
subcontractor;
(ii) "Bodily injury" or "property
damage" sustained within a
building and caused by the
release of gases, funes or
vapors from materials brought
into that building in connedion
wtth operations being perfornnd
by you or on your behalf by a
contrador or subcontractor; or
(iii) "Bodily injury" or "property
damage" arising out of heat,
smoke or fumes from a
"hostile fire"; or
(e) At or fom any premises, site or
location on which any insured or any
contractors or subcontractors
working diredly or indirectly on any
insured's behalf are performing
operations if the operations are to
test fur, nnnitor, clean up, remove,
contain, treat, detoiff or neutralize,
or in any way respond to, or assess
the efiects of, "pollutanls'.
(21 Any loss, cost or expense arising out
of any:
(a) Request, dernand, order or statutory
or regulatory requirement that any
insured or others test ficr, monitor,
clean up, remove, contain, treat,
detoxiff or neutralize, or in any way
respond to, orassess the efiects of,
"pollutants";or
(b) Claim or suit by or on behalf of a
governnental authority for
damages because of testing for,
monitoring, cleaning up, rernoving,
containing, treating, detoxiffing or
neutralizing, or in any way
responding to, or assessing the
effects of, "pollutants".
However, this paragraph does not
apply to liability for damages because
of .property damage" that the insured
wouh have in the absence of such
request, demand, order or statutory or
regulatory requirement, or such claim
or nsuitn by or on behalf of a
govemmental authority.
!E
-
!E
-G
-G
Gt
-=t
@
-,-
-
-=:
:
-E
G:
-
-G
-GEG
--
Form SS 00 08 04 05 Page 5 of 24
BUSINESS LIABILITY COVERAGE FORM
g. Aircraft, Auto Or Watercraft
"Bodily injury" or "property damage" arising
out of the ownership, maintenance, use or
entrustment to othes of any aircraft, "auto"
or watercraft owned or operated by or rented
or loaned to any insured. Use includes
operation and "loading or unloading".
This exclusion applies even if the claims
against any insured allege negligence or
other wrongdoing in the supeMsion, hiring,
employrnent, training or monitoring of otherc
by that insured, if the "occunence" which
caused the "bodily injury" or "property
darnage" involved the ownership,
maintenance, use or entrustment to others of
any aircraft, "auto" or watercraft that is
owned or operated by or rented or loaned to
any insured.
This exclusion does not apply to:
(1) A watercraft while ashore on premises
you own or rent;
(21 A watercraft you do not own that is:
(a) Less than 51 feet long; and
(b) Not being used to carry persons
for a charge;
(3) Parking an "auto" on, or on the ways
next to, premises you own or rent,
provided the "auto" is not owned by or
rented or loaned to you or the insured;
(4) Liability assumed under any "insured
contract" for the ownership,
maintenance or use of aircraft or
watercraft;
(51 "Bodily injury" or "property damage"
arising out of the operation of any of
the equipment listed in Paragraph f.(2)
or f.(3) of the definition of "mobile
equipment"; or
(61 An aircraft that is not owned by any
insured and is hired, chartered or loaned
with a pald crew. However, this
exception does not apply if the insured
has any other insurance for such "bodily
injury" or "property damage", whether
the other insurance is primary, excess,
contingent or on any other basis.
h. Mobile Equipment
"Bodily injury" or "property damage"
arising out of:
(1) The transportation of "rnobile equipment"
by an "auto" owned or operated by or
rented or loaned to any insured; or
(2) The use of "mobile equipment" in, or
while in practice or preparation for, a
preananged racing, speed or
demolition contest or in any stunting
activity.
i. War
"Bodily injury", "property damage" or
"personal and advertising injury", however
caused, arising, directly or indirectly, out of:
(1) War, including undeclared or civil war;
(21 Warlike action by a military force,
including action in hindering or
defending against an actual or
expected attack, by any government,
sovereign or other authority using
military personnel or other agents; or
(3) lnsurrection, rebellion, revolution,
usurped power, or action taken by
governmental authority in hindering or
defending against any of these.
j. ProfessionalServices
"Bodily injury", "property damage" or
"personal and advertising injury" arising
out of the rendering of or failure to render
any professional service. This includes
but is not limited to:
(1) Legal, accounting or advertising
seMces;
l2l Preparing, approving, or failing to
prepare or approve maps, shop
drawings, opinions, reports, surveys,
fieb oders, change ordem, designs or
drawings and specifi cations;
(3) Supervisory, inspection, architectural
or engineering activities;
(4) Medical, surgical, dental, x-ray or
nursing services treatment, advice or
instruction;
(5) Any health or therapeutic service
treatment, advice or instruction;
(6) Any service, treatment, advice or
instruction for the purpose of
appearance or skin enhancement, hair
removal or replacement or personal
grooming;
(71 Optical or hearing aid services
including the prescribing, preparation,
fitting, demonstration or distribution of
ophthalmic lenses and similar
products or hearing aid devices;
Page 6 of 24 Form SS 00 08 04 05
LOrac\
r'1c!
Or
t-{rlo
lf)c\orft
D4Doilr\
C\iloo
f{ra.t
(8) Optometry or optometric services
including but not limited to examinationof the eyes and the prescribing,
preparation, ffting,demonstration or
dbtribution of ophthalmic lenses and
similar products;
(e) Any:
(a) Body piercing (not including ear
piercing);
(b) Tattooing, including but not limited
to the insertion of pigments into or
under the skin; and
(c) Similar services;
(10) Services in the practice of pharmacy;
and
(11) Computer consulting, design or
programming seMces, including web
site design.
Paragraphs (4) and (5) of this exclusion do
not apply to the lncidental Medical
Malpractice coverage afforded under
Paragraph 1.e. in Section A. - Coverages.
k. Damage To Property
"Property damage" to:
(1) Property you own, rent or occupy,
including any costs or expenses
incuned by you, or any other person,
organization or entity, for repair,replacement, enhancement,
restoration or maintenance of such
property for any reason, including
prevention of injury to a person or
damage to anothefs property;
(21 Prenilses you sell, give away or
abandon, if the "property damage" arises
out of any part of those premises;
(3) Property loaned to you;
(4) Personal property in the care, custody
or control of the insured;
(5) That particular part of real property on
which you or any contradors or
subcnntractors workiry diredly or
indiredly on your behalf are performing
operations, if the "property damage"
arises out of those operations; or
(6) That particular part of any property
that must be restored, repaired or
replaced because 'your work" was
inconectly performed on it.
BUSINESS LIABILITY COVERAGE FORM
Paragraphs (1), (3) and (4) of this
exclusion do not apply to "property
damage" (other than damage by fire) to
premises, including the contents of such
premises, rented to you for a period of 7 or
fewer consecutive days. A separate Limitof lnsurance applies to Damage To
Premises Rented To You as described in
Section D. - Limits Of lnsurance.
Paragraph (2) of this exclusion does not
apply if the premises are 'your work" and
were never occupied, rented or held for
rental by you.
Paragraphs (3) and (41of this exclusion do
not apply to the use of elevators.
Paragraphs (3), (4), (5) and (6) of this
exclusion do not appty to liability assumed
under a sidetrack agreement.
Paragraphs (3) and (4) of this exclusion do
not apply to "property damage" to
bonowed equipment while not being used
to perform operations at a job site.
Paragraph (6) of this exclusion does not
apply to "property damage" included in the
'products-completed operations hazard".
l. Damage To Your Product
'Property damage" to "your product"
arising out of it or any part of it.
m. Damage To Your Work
"Property damage' to 'your work" arising
out of it or any part of it and included in the
"products-completed operations hazard".
This exclusion does not apply if the
damaged work or the work out of which
the damage arises was performed on your
behalf by a subcontractor.
n. Damage To knpaired Property Or
Property Not Physically lnjured
"Property damage' to 'impaired property"
or property that has not been physically
injured, arising out of:
(1) A defect, deficiency, inadequacy or
dangerous condition in 'your product"
or "your work"; or
(21 A delay or failure by you or anyone
ac*ing on your behalf to perform a
contract or agreement in accordance
with its terms.
This exclusion does not apply to the loss
of use of other property arising out of
sudden and accidental physical in!ry to
'your product' or 'your work" afier it has
been put to its intended use.
:
@
GT*
-i
!!t
G
-E
-ry
GG
-a
-s
@
E
4G!
-G
-=Eg
-!G
Form SS 00 08 04 05 PageT oI 24
BUSINESS LIABILITY COVERAGE FORM
o. Recall Of Products, Work Or lmpaired
Property
Damages claimed for any loss, cost or
expense incurred by you or others for the
loss of use, withdrawal, recall, inspection,
repair, replacement, adjustment, removal
or disposal of:
(1) "Your product";
(21 "Your work"; or
(3) "lmpaired property";
if such product, work or property is
withdrawn or recalled from the market or
fom use by any person or organization
because of a known or suspected defect,
deficiency, inadequacy or dangerous
condition in it.
p. PersonalAnd Advertising lnjury
"Personal and advertising injury":
(1) Arising out of oral, written or electronic
publication of material, if done by or at
the direction of the insured with
knowledge of its falsity;
(21 Arising out of oral, wriften or electronic
publication of material whose first
publication took place before the
beginning of the policy period;
(3) Arising out of a criminal act commilted
by or at the direction of the insured;
(4) Arising out of any breach of contract,
except an implied contract to use
another's "advertising idea" in your
"advertisement";
(5) Arising out of the failure of goods,
products or services to conform withany statement of quality or
performance made in your
"advertisement";
(6) Arising out of the wrong description of
the price of goods, products orservices;
(7) Arising out of any violation of any
intellectual property rights such as
copyright, patent, trademark, trade
name, trade secret, service mark or
other designation of origin or
authenticity.
However, this exclusion does not
apply to infringement, in your
"advertisement", of
(a) Copyright;
(b) Slogan, unless the slogan is also
a trademark, trade name, service
mark or other designation of origin
or authenticity; or
(c) Title of any literary or artistic work;
(8) Arising out of an offense committed by
an insured whose business is:
(a) Advertising, broadcasting,
publishing or telecasting ;
(b) Designing or determining content
of web sites for others; or
(c) An lnternet search, access,
content or service provider.
However, this exclusion does not
apply to Paragraphs a., b. and c.
under the definition of "personal and
advertising injury" in Section G.
Liability And Medical Expenses
Definitions.
For the purposes of this exclusion,
placing an "advertisement" for or
linking to others on your web site, by
itself, is not considered the business
of advertising, broadcasting,
publishing or telecasting ;
tg) Arising out of an electronic chat room
or bulletin board the insured hosts,
owns, or over which the insured
exercises control;
(10) Arising out of the unauthorjzed use of
anothefs name or product in your e-mail
address, domain name or metatags, or
any other similar tactics to mislead
anothe/s potential customers ;
(11) Arising out of the violation of a
person's right of privacy created by
any state or federal act.
However, this exclusion does not
apply to liability for damages that the
insured would have in the absence of
such state orfederal act;
(12) Arising out of:
(a) An "advertisement" for others on
your web site;
(b) Placing a link to a web site of
others on your web site;
(c) Content from a web site of others
displayed within a frame or border
on your web site. Content includes
information, code, sounds, text,
graphics or images; or
(d) Computer code, software or
programming used to enable:
(i) Your web site; or
(ii) The presentation or tunctionalily
of an "advertisement' or other
content on your web site;
Page I of 24 Form SS 00 08 04 05
\ofnc\
aac\
orr{riort)
GIo
trat
M5c\r\
C!oo
f{
fr-).I
(13) Arising out of a violation of any anti-
trust law;
(14) Arising out of the fluctuation in price or
value of any stocks, bonds or other
securities; or
(15) Arising out of discrimination or
humiliation committed by or at the
direction of any "executive officef',
director, stockholder, partner or
member of the insured.
q. Electronic Data
Damages arising out of the loss of, loss of
use of, damage to, corruption of, inabilityto access, or inabilily to manipulate
"electronic data".
r. Employment-Related Practices
'Bodily injury" or "personal and advertising
injury" to:
(1) A person arising out of any:
(a) Refusalto employ that person;
(b) Termination of that person's
employment;or
(c) Employnrent-related practices,
policies, ads or omissions, such as
coercion, demotion, evaluation,reassi;nment, discipline,
def;amation, harassnrent, humiliation
or discrimination directed at that
person; or
(21 The spouse, child, parent, brother orsister of that person as a
consequence of 'bodily injury" or
"personal and advertising injury" to the
person at whom any of the
employment-related practices
described in Paragraphs (a), (b), or (c)
above is directed.
This exclusion applies:
(1) \Mrether the insured may be liable as
. an employer or in any other capacity;
and
(21 To any obligation to share damages
with or repay someone else who must
pay damages because of the injury.
s. Asbestos
(1) "Bodily injury', 'property damage' or
'personal and advertising injury"
arising out of the "asbestos hazard".
l2l Any damages, irdgments, settlernents,
bss, costs or expenses that:
BUSINESS LIABILITY COVERAGE FORM
(a) May be awarded or incuned by
reason of any claim or suit
alleging actual or threatened injury
or damage of any nature or kind to
persons or property which would
not have occuned in whole or in
part but for the "asbestos hazard";
(b) Arise out of any request, demand,
order or statutory or regulatory
requirement that any insured or
others test for, monitor, clean up,
remove, encapsulate, contain,
treat, detoxiff or neutralize or in
any way respond to or assess the
effects of an "asbestos hazard"; or
(c) Arise out of any daim or suit for
damages because of testing for,
mnitoring, cleaning up, removing,
encapsulating, containing, treating,
detoxifring or neutralizing or in any
way responding to or assessing the
efieds ofan "asbestos hazard".
t. Violation Of Statutes That Govern E-
Mails, Fax, Phone Galls Or Other
Methods Of Sending Material Or
lnformation
"Bodily injury', "property damage", or
'personal and advertising injury" arising
directly or indirectly out of any action or
omission that violates or is alleged to
violate:
(1) The Telephone Consumer Protection
Act CICPA), including any amendment
of or addition to such law;
(2) The CAN-SPAM Act of 2003, including
any amendment of or addition to such
law; or
(3) Any statute, ordinance or regulation,
other than the TCPA or CAN-SPAM Ad
of 2003, that prohibits or limits the
sending, transmitting, communicating or
distribution of rnaterial or information.
Damage To Premises Rented To You -
Exception For Damage By Fire, Lightning
or Explosion
Exclusions c. through h. and k. through o. do
not apply to damage by fire, lightning or
explosion to premises rented to you or
temporarily occupied by you with permission of
the owner. A separate Limit of lnsurance
applies to this coverage as described in
Section D. - Liability And Medical Expenses
Limits Of lnsurance.
:
-E
G
-
G
-G
-G
=3G
!E
E
G
@
!G!
--!E
-E==
Form SS 00 08 04 05 Page 9 of 24
BUSINESS LIABILIry COVERAGE FORM
2. Applicable To Medical Expenses Coverage
We will not pay expenses for "bodily injury":
a. Any lnsured
To any insured, except "volunteer workers".
b. Hired Person
To a person hired to do work for or on behalf
of any insured or a tenant of any insured.
c. lnjury On Normally Occupied Premises
To a person injured on that part of
premises you own or rent that the person
normally occupies.
d. Workers' Compensation And Similar
[aws
To a person, whether or not an
"employee" of any insured, if benefits for
the "bodily injury" are payable or must be
provided under a workers' compensation
or disability benefits law or a similar law.
e. AthleticsActivities
To a person injured while practicing,
instructing or participating in any physical
exercises or games, sports or athletic
contests.
f. Products-Completed Operations Hazard
lncluded with the "products-completed
operations hazard".
g. Business Liability Exclusions
Excluded under Business Liability Coverage.
C. WHO IS AN INSURED
1. lf you are designated in the Declarations as:
a. An individual, you and your spouse are
insureds, but only with respect to the
conduct of a business of which you are the
sole owner.
b. A partnership or pint venture, you are an
insured. Your nrembers, your partners, and
their spouses are also insureds, but only with
respecf to the condud ofyour business.
c. A limited liability company, you are an
insured. Your members are also insureds,
but only with respect to the conduct of your
business. Your managers are insureds, but
only with resped to their duties as your
rn€rnagers.
d. An organization other than a partnership,
irint venture or limited liability company, you
are an insured. Your "executirre officers" and
direc{ors are insureds, but only with respect
to their duties as your officers or diredors.
Your stockholders are also insureds, but only
with respect to their liability as stockholders.
e. A trust, you are an insured. Your trustees
are also insureds, but only with respect to
their duties as trustees.
2. Each of the following is also an insured:
a. Employees And Volunteer Workers
Your "volunteer workers" only while
performing duties related to the conduct of
your business, or your "employees", other
than either your "executive officers" (if you
are an organization other than a
partnership, joint venture or limited liability
company) or your managers (if you are a
limited liability company), but only for acts
within the scope of their employment by
you or while performing duties related to
the conduct of your business.
However, none of these "employees" or
"volunteer workers" are insureds for:
(1) "Bodily injury" or "personal and
advertising injury":
(a) To you, to your partners or
members (if you are a partnership
or joint venture), to your members
(if you are a limited liability
company), or to a co-"emPloyee"
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 co-
"employee" or that "volunteer
worker" 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 Paragraphs (1)(a) or
(b) above; or
(d) Arising out of his or her providing
or failing to provide professional
health care seryices.
lf you are not in the business of
providing professional health care
seMces, Paragraph (d) does not apply
to any nurse, emergency medical
technician or paramedic employed by
you to provide such services.
(21 "Property damage" to property:
(a) Owned, occupied or used by,
Page 10 of 24 Form SS 00 08 04 05
r\
afic!rn
C\
cnr{rtolftc\o
LO
M5c\r\c\oo
r-tr.l.*
(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
"employees", "volunteer workers",
any partner or member (if you are
a partnership or joint venture), or
any member (if you are a limited
liability company).
b. Real Estate Manager
Any person (other than your "employee" or
"volunteer workef'), or any organization
while acting as your real estate manager.
c. Temporary Gustodians Of Your
Property
Any person or organization having proper
temporary custody of your property if you
die, but only:
(1) \Mth resped to liability arising out of the
maintenance or use of that property; and
(21 Until your legal representative has
been appointed.
d. Legal Representative lf You Die
Your legal representative if you die, but
only with respect to duties as such. That
representative will have all your rights and
duties under this insurance.
e. Unnamed Subsidiary
Any subsidiary and subsidiary thereof, of
yours which is a legally incorporated entity
of which you own a financial interest of
more than 50olo of the voting stock on the
effective date of this Coverage Part.
The insurance afforded herein for any
subsidiary not shown in the Declarations
as a named insured does not apply to
injury or damage with respect to which an
insured under this insurance is also an
insured under another policy or would be
an insured under such policy but for its
termination or upon the exhaustion of its
limits of insurance.
3. Newly Acquired Or Formed Organization
Any organization you newly acquire or form,
other than a partnership, joint venture or
limited liability company, and over which you
maintain financial interest of more than 50o/o of
the voting stock, will qualiff as a Nanred
lnsured if there is no other similar insurance
available to that organization. However:
a. Coverage under this provision is afforded
only until the 180th day after you acquire
or form the oryanization or the end of the
policy period, whichever is earlier; and
BUSINESS LIABILITY COVERAGE FORM
b. Coverage under this provision does not
apply to:
(1) "Bodily injury" or "property damage"
that occuned; or
(21 .Personal and advertising injury"
arising out of an offense committed
before you acquired or formed the
organization.
4. Operator Of Mobile Equipment
lr1/lth respect to 'npbile equipment' registered in
your name under any motor vehicle registration
law, any person 's an insured while driving such
equipment along a public hQhway with your
permission. Any other person or organization
responsible for the condud of such person is
also an insured, but only with respect to liability
arising out of the operation of the equipment, and
only if no other insurance of any kind is available
to that person or organization for this liability.
However, no person or organization is an insured
with respedto:
a. "Bodily injury' to a co-'employee" of the
person driving the equipment; or
b. "Property damage' to property owned by,
rented to, in the charge of or occupied by
you or the employer of any person who is
an insured underthis provision.
5. Operator of Nonowned Watercraft
\Mth respect to watercraft you do not own that
is less than 51 feet long and is not being used
to carry persons for a charge, any person is an
insured while operating such watercraft with
your permission. Any other person or
organization responsible for the conduct of
such person is also an insured, but only with
respect to liability arising out of the operation
of the watercraft, and only if no other
insurance of any kind is available to that
peron or organization for this liability.
However, no person or organization is an
insured with respect to:
a. "Bodily injury' to a co-"employee" of the
person operating the watercraft; or
b. "Property damagel to property owned by,
rented to, in the charge of or occupied by
you or the employer of any person who is
an insured under this provision.
6. Additional lnsureds When Required By
Written Contract, Written Agreement Or
Permit
The person(s) or organization(s) identified in
Paragraphs a. through f. below are additional
insureds when you have agreed, in a wriften
-=_!=!=
!@
i*
G
i-
-E
-@EE
IE
re
G
!G
--:
-@
-!t!!!E
Form SS 00 08 04 05 Page 11 ot 24
BUSINESS LIABILITY COVERAGE FORM
contract, written agreement or because of a
permit issued by a state or political
suMivision, that such person or organization
be added as an additional insured on your
policy, provided the injury or damage occurs
subsequent to the execution of the contract or
agreement, orthe issuance of the permit.
A person or organization is an additional
insured under this provision only for that
period of time required by the contract,
agreement or permit.
However, no such person or organization is an
additional insured under this provision if such
person or organization is included as an
additional insured by an endorsement issued
by us and made a part of this Coverage Part,
including all persons or organizations added
as additional insureds under the specific
additional insured coverage grants in Section
F. - OptionalAdditional lnsured Coverages.
a. Vendors
Any person(s) or organization(s) (efened to
below as vendor), but only with respect to
"bodily injury" or "property damage" arising
out of "your products" which are distributed
or sold in the regular course of the vendofs
business and only if this Coverage Part
provides coverage for "bodily injury" or
"property damage" included within the
"produd.s-completed operations hazard".
(1) The insurance afforded to the vendor
is subject to the following additional
exclusions:
This insurance does not apply to:
(a) "Bodily injury" or "property
damage" for which the vendor is
obligated to pay damages by
reason of the assumption of
liability in a contract or agreement.
This exclusion does not apply to
liability for damages that the
vendor would have in the absence
of the contracl or agreement;
(b) Any express warranty
unauthorized by you;
(c) Any physical or chemical change
in the product made intentionally
by the vendor;
(d) Repackaging, except when
unpacked solely ficr the purpose of
inspection, demonstration, testing,
or the substitution of parts under
instructions f'om the manufadurer,
and then repackaged in the
original container;
(e) Any failure to make such
inspections, adjustments, tests or
servicing as the vendor has
agreed to make or normally
undertakes to make in the usual
course of business, in connection
with the distribution or sale of the
products;
(f) Demonstration, installation,
servicing or repair operations,
except such operations performed
at the vendods premises in
connection with the sale of the
product;
(g) Products which, after distribution
or sale by you, have been labeledor relabeled or used as a
container, part or ingredient of any
other thing or substance by or for
the vendor; or
(h) "Bodily injury" or "property
damage" arising out of the sole
negligence of the vendor for its
own acts or omissions or those of
its employees or anyone else
acting on its behalf. However, this
exclusion does not apply to:
(i) The exceptions contained in
Subparagraphs (d) or (f); or
(ai) Such inspections, ad.lustments,
tests or seMcing as the vendor
has agreed to make or normally
undertakes to rnake in the usual
course of business, in
connection with the distribution
or sale of the products.
l2l This insurance does not apply to any
insured person or organization from
whom you have acquired such producls,
or any ingredient, part or container,
entering into, accompanying or
containing such products.
b. Lessors Of Equipment
(1) Any person or organization from
whom you lease equipment; but only
with respect to their liability for "bodily
injury", "property damage" or
"personal and advertising injury"
caused, in whole or in part, by your
maintenance, operation or use of
equipment leased to you by such
person or organization.
Page 12 ol 24 Form SS 00 08 04 05
6
cf)c\rrl
c\l
ol
t{r{o
rrrtc\oro
!dD(\tr\c\oorJfa.}
(21 \Mth respect to the insurance affordedto these additional insureds, this
insurance does not apply to any
"occurrence' which takes place after
you cease to lease that equipment.
c. Lessors Of Land Or Premises
(1) Any person or organization from
whom you lease land or premises, but
only with respect to liability arising out
of the ownership, maintenance or use
of that part of the land or premises
leased to you.
l2l V\rlth respect to the insurance affordedto these additional insureds, this
insurance does not apply to:
(a) Any "occurrence' which takes
place after you cease to lease that
land or be a tenant in that
premises; or
(b) Structural alterations, new
construction or demolition
operations performed by or on
behalf of such person or
organization.
d. Architects, Engineers Or Surveyors
(1) Any architec{, engineer, or surveyor, but
only with respecd to liability for "bodily
in.iury", "property dannge' or "personal
and advertbing injury" caused, in whole
or in part, by your ads or omissions or
the ads or omissions of those acting on
your behalf
(a) ln connection with your premises;
or
(b) ln the performance of your
ongoing operations performed by
you or on your behatf.
(21 Wth respect to the insurance affordedto these additional insureds, the
following additional exclusion applies:
This insurance does not apply to
'bodily injury", "property damage" or
'personal and advertising injury"
arising out of the rendering of or the
failure to render any professional
services by or for you, including:
(a) The preparing, approving, or
failure to prepare or approve,
maps, shop drawings, opinions,
reports, surveys, field orders,
change orders, deslgns or
drawings and specifications; or
(b) SupeMsory, inspection,
architectural or engineering
activities.
BUSINESS LIABILITY COVERAGE FORM
e. Permits lssued By State Or Political
Subdivisions
(1) Any state or political subdivision, but
only with respect to operations
performed by you or on your behalf for
which the state or political subdivision
has issued a permit.
(21 \Mth respect to the insurance afforded
to these additional insureds, this
insurance does not apply to:
(a) "Bodily injury", "property damage"or 'personal and advertising
injury" arising out of operations
performed for the state or
municipality; or
(b) "Bodily in.fury" or "property damage"
included within the 'products-
cornpleted operations hazard".
f. Any Other Party
(1) Any other person or organization who
is not an insured under Paragraphs a.
through e. above, but only with
respect to liability for "bodily injury",
"property damage" or "porsonal and
advertising injury" caused, in whole or
in part, by your acts or omissions or
the acis or omissions of those acting
on your behalf:
(a) ln the performance of your
ongoing operations;
(b) ln connection with your premises
owned by or rented to you; or
(c) ln connection with "your work" and
included within the 'products-
completed operations hazard', but
only if
(i) The written contract or written
agreement requires you to
provide such coverage to
such additional insured; and
(ii) This Coverage Part provides
coverage for "bodily injury" or
"property damage" includedwithin the "products-
completed operations hazard".
(21 \A/lth respect to the insurance affordedto these additional insureds, this
insurance does not apply to:
"Bodily injury", 'property damage' or
"personal end advertising inirry"
arising out of the rendering ol or the
failure to render, any professional
architectural, engineering or surveying
services, including:
=!!!!
--ta
;G;
i---.
-El&.
t
-G
E:
-t
-:e
G
G
---4
G
--!!tG
Form SS 00 08 04 05 Page 13 of 24
BUSINESS LIABILITY COVERAGE FORM
(a) The preparing, approving, or
failure to prepare or approve,
maps, shop drawings, opinions,
reports, surveys, field orders,
change orders, designs or
drawings and specifications; or
(b) Supervisory, inspection,
architectural or engineering
activities.
The limits of insurance that apply to additional
insureds are described in Section D. - Limits
Of lnsurance.
How this insurance applies when other
insurance is available to an additional insured
is described in the Other lnsurance Condition
in Section E. - Liability And Medical Expenses
General Conditions.
No person or organization is an insured with
respect to the conduct of any current or past
partnership, joint venture or limited liability
company that is not shown as a Named lnsured in
the Declarations.
D. LIABILITY AND MEDICAL EXPENSES
LIMITS OF INSURANCE
1. The Most We Will Pay
The Limits of lnsurance shown in the
Declarations and the rules below fix the most
we will pay regardless of the number of:
a. lnsureds;
b. Claims made or "suits" brought; or
c. Persons or organizations making claims or
bringing "suits".
2. Aggregate Limits
The most we will pay for:
a. Damages because of "bodily injury" and
"property damage" included in the
'products-completed operations hazard" isthe Products-Completed Operations
Aggregate Limit shown in the
Declarations.
b. Damages because of all other "bodily
injury", "property damage" or "personal
and advertising injury", including medical
expenses, is the General Aggregate Limit
shown in the Declarations.
This General Aggregate Limit applies
separately to each of your "locations"
owned by or rented to you.
"Location" means premises involving the
same or connecting lots, or premises
whose connection is interrupted only by a
street, roadway or right-of-way of a
railroad.
This General Aggregate limit does not
apply to "property damage" to premises
while rented to you or temporarily
occupied by you with permission of the
owner, arising out of fire, lightning or
explosion.
3. Each Occurrence Limit
Subject to 2.a. or 2.b above, whichever
applies, the most we will pay for the sum of all
damages because of all "bodily injury",
"property damage" and medical expenses
arising out of any one "occurrence" is the
Liability and Medical Expenses Limit shown in
the Declarations.
The most we will pay for all medical expenses
because of "bodily injury" sustained by any
one person is the Medical Expenses Limit
shown in the Declarations.
4. PersonalAnd Advertising lnjury Limit
Subject to 2.b. above, the most we will pay for
the sum of all damages because of all
"personal and advertising injury" sustained by
any one person or organization is the Personal
and Advertising lnjury Limit shown in the
Declarations.
5. Damage To Premises Rented To You Limit
The Damage To Premises Rented To You
Limit is the most we will pay under Business
Liability Coverage for damages because of
"property damage" to any one premises, while
rented to you, or in the case of damage by fire,
lightning or explosion, while rented to you or
temporarily occupied by you with permission of
the owner.
ln the case of damage by fire, lightning or
explosion, the Damage to Premises Rented To
You Limit applies to all damage proximately
caused by the same event, whether such
damage results from fire, lightning or explosion
or any combination of these.
6. How Limits Apply To Additional lnsureds
The most we will pay on behalf of a person or
organization who is an additional insured
under this Coverage Part is the lesser of:
a. The limits of insurance specified in a
written contract, written agreement or
permit issued by a state or political
suMivision; or
b. The Limits of lnsurance shown in the
Declarations.
Such amount shall be a part of and not in
addition to the Limits of lnsurance shown in
the Declarations and described in this Section.
Page 14 of 24 Form SS 00 08 04 05
Orr.l
N
ca
cril
c
t-Jrtolrt
oitoro
M!)c\
F\
oitoor{
c.llr
lf more than one limit of insurance under this
policy and any endorsements aftached thereto
applies to any claim or "suit", the most we will pay- under this policy and the endorsements is the
single highest limit of tiability of ail coverages
applicable to such claim or "suit". However, this
paragraph does not apply to the Medical Expenses
limit set forth in Paragraph 3. above.
The Limits of lnsurance of this Coverage Part apply
separately to each consecutive annual period and to
any remaining period of less than 12 months, starting
with the beginning of the policy period shown in the
Declarations, unless the policy peri,od is extended
afier issuance for an additional period of less than 12
months. ln that case, the additional period will be
deerned part of the last preceding period for purposes
of determining the Limits of lnsurance.
E. LIABILITY AND MEDICAL EXPENSES
GENERAL GONDITIONS
1. Bankruptcy
Bankruptcy or insolvency of the insured or of
the insured's estate will not relieve us of our
obligations under this Coverage part.
2. Duties ln The Event Of Occurrence,
Offense, Claim Or Suit
a. Notice Of Occurrence Or Offense
You or any additional insured must see toit that we are notified as soon as
practicable of an "occurrenceo or an
offense which may result in a claim. To
the eXent possible, notice should include:
(1) How, when and where the "occurrence"
or offense took place;
(21 The names and addresses of any
injured persons and witnesses; and
(3) The nature and location of any injuryor damage arising out of the*occurronce" or offense.
b. Notice Of Claim
lf a claim is made or "suit' is brought
against any insured, you or any additional
insured must:
(1) lmmediately record the specifics of the
claim or "suit" and the date received;
and
(21 Notiff us as soon as practicabte.
You or any additional insured must see to
it that we receive a wriften notice of the
claim or nsuit' as soon as practicable.
c. Assistance And Gooperation Of The
lnsured
You and any other involved insured must:
BUSINESS LIABILITY COVERAGE FORM
(1) lmmediately send us copies of any
demands, notices, summonses or
legal papers received in connection
with the claim or'suit";
(21 Authorize us to obtain records and
other information;
(3) Cooperate with us in the investigation,
settlement of the claim or defense
against the 'suit"; and
(4) Assist us, upon our request, in the
enforcement of any right against any
percon or organization that may be
liable to the insured because of injury
or damage to which this insurance
may also apply.
d. Obligations At The lnsured's Own Gost
No insured will, except at that insured's own
cost, voluntarily nnke a payment, assurre
any oblpation, or incur any expense, other
than ficr first aid, without our consent.
e. Additional lnsured's Other lnsurance
lf we cover a claim or nsuit" under this
Coverage Part that may also be coveredby other insurance available to an
additional insured, such additional insured
must submit such claim or 'suit" to the
other insurer for defense and indemnity.
However, this provision does not apply to
the extent that you have agreed in a
written contract, written agreement or
permit that this insurance is primary and
non-contributory with the additional
insured's own insurance.
f. Knowledge Of An Occurrence, Offense,
Claim Or Suit
Paragraphs a. and b. apply to you or to
any additional insured only when such
"occurrence', offense, claim or 'suit" is
known to:
(1) You or any additional insured that is
an individual;
(21 Any partner, if you or an additional
insured is a partnership;
(3) Any manager, if you or an additional
insured is a limited liability company;
(4) Any nexecutive officel,' or insurance
manager, if you or an additional
insured is a corporation;
(5) Any trustee, if you or an additional
insured is a trust; or
(S) Any elecled or appointed official, if you
or an additional insured is a political
suMivision or public entity.
!EE!
=*
G
!E
--
G
4
E
tlE
-FG
-
-GiE
E
-G
G
-!EE
----'G
-
-rllilll
Form SS 00 08 04 05 Pago 15 of 24
BUSINESS LIABILITY COVERAGE FORM
This Paragraph f. applies separately to
you and any additional insured.
3. Financial Responsibility Laws
a. When this policy is certified as proof of
financial responsibility for the future under
the provisions of any motor vehicle
financial responsibility law, the insurance
provided by the policy for "bodily injury"
liability and "property damage" liability will
comply with the provisions of the law to
the extent of the coverage and limits of
insurance required by that law.
b. Wth respect to "mobile equipment" to
which this insurance applies, we will
provide any liability, uninsured motorists,
underinsured motorists, no-fault or other
coverage required by any motor vehicle
law. We will provide the required limits for
those coverages.
4. LegalAction Against Us
No person or organization has a right under
this Coverage Form:
a. To join us as a party or otherwise bring us
into a "suit" asking for damages from an
insured; or
b. To sue us on this Coverage Form unless
all of its terms have been fully complied
with.
A person or opanization may sue us to recover
on an agreed settlement or on a final fudgment
against an insured; but we will not be liable for
damages that are not payable under the terms of
this insurance or that are in excess of the
applicable limit of insurance. An agreed
settlement means a settlement and release of
liability sQned by us, the insured and the
cla i mant or the cla i ma nt's lega I representative.
5. Separation Of lnsureds
Except with respect to the Limits of lnsurance,
and any rights or duties specifically assigned
in this policy to the first Named lnsured, this
insurance applies:
a. As if each Named lnsured were the only
Named lnsured; and
b. Separately to each insured against whom
a claim is made or "suit" is brought.
6. Representations
a. When You Accept This Policy
By accepting this policy, you agree:
(1) The statements in the Declarations
are accurate and complete;
(21 Those statements are based upon
representations you made to us; and
(3) We have issued this policy in reliance
upon your representations.
b. Unintentional Failure To Disclose
Hazards
lf unintentionally you should fail to disclose
all hazards relating to the conduct of your
business at the inception date of this
Coverage Part, we shall not deny any
coverage under this Coverage Part
because of such failure.
7. Other lnsurance
lf other valid and collectible insurance is
available for a loss we cover under this
Coverage Part, our obligations are limited as
follows:
a. Primary lnsurance
This insurance is primary except when b.
below applies. lf other insurance is also
primary, we will share with all that other
insurance by the method described in c.
below.
b. Excess lnsurance
This insurance is excess over any of the
other insurance, whether primary, excess,
contingent or on any other basis:
(1) YourWork
That is Fire, Extended Coverage,
Builder's Risk, lnstallation Risk or
similar coverage for *your work";
l2l Premises Rented To You
That is fire, lightning or explosion
insurance for premises rented to you
or temporarily occupied by you with
permission of the owner;
(3) Tenant Liability
That is insurance purchased by you to
cover your liability as a tenant for
"property damage" to premises rented
to you or temporarily occupied by you
with permission of the owner;
(4) Aircraft, Auto Or Watercraft
lf the loss arises out of the maintenance
or use of aircraft, "autos" or watercraft to
the extent not subject to Exclusion g. of
Section A. - Coverages.
(5) Property Damage To Borrowed
Equipment Or Use Of Elevators
lf the loss arises out of "property
damage" to borrowed equipment or
the use of elevators to the extent not
subject to Exclusion k. of Section A. -
Coverages.
Page l6 of 24 Fomr SS 00 08 04 05
oslc\r.lc\
Orrlr{o
Lrtc\orrt
!4
C\t\c\oo
t{(.t
.L
(6) When You
Additional
lnsurance
Are Added As An
lnsured To Other
That is other insurance available to
you covering liability for damages
arising out of the premises or
operations, or products and completed
operations, for which you have been
added as an additional insured by that
insurance; or
(71 When You Add Others As AnAdditional lnsured To This
lnsurance
That is other insurance available to an
additional insured.
However, the following provisions
apply to other insurance available to
any person or organization who is an
additional insured under this Coverage
Part:
(a) Primary lnsurance When
Required By Contract
This insurance is primary if you
have agreed in a written contract,
written agreement or permit that
this insurance be primary. lf other
insurance is also primary, we will
share with all that other insurance
by the method described in c.
below.
(b) Primary And Non€ontributoryTo Other lnsurance When
Required By Contract
lf you have agreed in a written
contraci, written agreement or
permit that this insurance is
primary and non-contributory withthe additional insured's own
insurance, this insurance is
primary and we will not seek
contribution fom that other
insurance.
Paragraphs (a) and (b) do not apply to
other insurance to which the additional
insured has been added as an
additional insured.
When this insurance is excess, we will
have no duty under this Coverage Part to
defend the insured against any 'suit" if any
other insurer has a duty to defend the
insured against that 'suit". lf no other
insurer defends, we will undertake to do
so, but we will be entitled to the insured's
rights against all those other insurers.
BUSINESS LIABILITY COVERAGE FORM
\Mren this insurance is excess over other
insurance, we will pay only our share of
the amount of the loss, if any, that
exceeds the sum of:
(1) The total amount that all such other
insurance would pay for the loss in the
absence of this insurance; and
(21 The total of all deductible and self-
insured amounts under all that other
insurance.
We will share the remaining loss, if any, with
any other insurance that is not described in
this Excess lnsuranec provision and was not
bought specifically to apply in excess of the
Limits of lnsurance shown in the
Declarations of this Coverage Part.
c. Method of sharing
lf all the other insurance permits
contribution by equal shares, we will follow
this method also. Under this approach,
each insurer contributes equal amounts
until it has paid its applicable limit of
insurance or none of the loss remains,
whichever comes first.
lf any of the other insurance does not permit
contribution by equal shares, we will
contribute by limits. Underthis method, each
insurefs share is based on the ratio of its
applicable limit of insurance to the total
applicable limits of insurance of all insurers.
8. Transfer Of Rights Of Recovery Against
Others To Us
a. Transfer Of Rights Of Recovery
lf the insured has r(lhts to recover all orpart of any payment, including
Supplementary Payments, we have made
under this Coverage Part, those rphts are
transfened to us. The insured must do
nothing after loss to impair them. At our
request, the insured will bring "suit" or
transfer those rights to us and help us
enforce them. This condition does not
apply to Medical Expenses Coverage.
b. Waiver Of Rights:Of Recovery (Waiver
Of Subrogation|
lf the insured has waived any rights of
recovery against any peron or
organization for all or part of any payment,
including Supplementary Payments, we
have made under this Coverage Part, we
also waive that right, provided the insured
waived their rights of recovery against
such person or organization in a contract,
agreement or permit that was executed
prior to the injury or damage.
G
-*E
-t
--
-#
*
!!ltE:
G
G
:
-E
-tEE=
Form SS 00 08 04 05 Page 17 ot 24
BUSINESS LIABILITY COVERAGE FORM
F. OPTIONAL ADDITIONAL INSURED
COVERAGES
lf listed or shown as applicable in the Declarations,
one or more of the following Optional Additional
lnsured Coverages also apply. \Men any of these
Optional Additional lnsured Coverages apply,
Paragraph 6. (Additional lnsureds When Required
by Written Contract, Written Agreement or Permit)
of Section G., \y'Vho ls An lnsured, does not apply
to the person or organization shown in the
Declarations. These coverages are subject to the
terms and conditions applicable to Business
Liability Coverage in this policy, except as
provided below:
1. Additional lnsured - Designated Person Or
Organization
\A/tlO lS AN INSURED under Section C. is
amended to include as an additional insured
the person(s) or organization(s) shown in the
Declarations, but only with respect to liability
for "bodily injury", "property damage" or
"personal and advertising injury" caused, in
whole or in part, by your acts or omissions or
the acts or omissions of those acting on your
behalf:
a. ln the performance of your ongoing
operations; or
b. ln connection with your premises owned
by or rented to you.
2. Additional lnsured - Managers Or Lessors
Of Premises
a. \ tslO lS AN INSURED under Section C. is
amended to include as an additional insured
the person(s) or organization(s) shown in the
Declarations as an Additional lnsured -
Designated Person Or Organization; but only
with respect to liability arising out of the
ownership, maintenance or use of that part of
the premises leased to you and shown in the
Declarations.
b. Vvith respect to the insurance afforded to
these additional insureds, the following
additional exclusions apply:
This insurance does not apply to:
(1) Any "occurrence" which takes place
after you cease to be a tenant in that
premises; or
(21 Structural afterations, new
construction or demolition operations
performed by or on behalf of such
person or organization.
3. Additional lnsured - Grantor Of Franchise
\ IiO lS AN INSURED under Section G. is
amended to include as an additional insured
the person(s) or organization(s) shown in the
Declarations as an Additional lnsured
Grantor Of Franchise, but only with respect to
their liability as grantor of franchise to you.
4. Additional lnsured - Lessor Of Leased
Equipment
a. \ /FlO lS AN INSURED under Section C. is
amended to include as an additional
insured the person(s) or organization(s)
shown in the Declarations as an Additional
lnsured - Lessor of Leased Equipment,
but only with respect to liability for "bodily
injury", "property damage" or "personal
and advertising injury" caused, in whole or
in part, by your maintenance, operation or
use of equipment leased to you by such
person(s) or organization(s).
b. With respect to the insurance afforded to
these additional insureds, this insurance
does not apply to any "occurrence" which
takes place after you cease to lease that
equipment.
5. Additional lnsured - Owners Or Other
lnterests From Whom Land Has Been
Leased
a. \ /FlO lS AN INSURED under Section G. is
amended to include as an additional
insured the person(s) or organization(s)
shown in the Declarations as an Additional
lnsured - Owners Or Other lnterests From
Whom Land Has Been Leased, but only
with respect to liability arising out of the
ownership, maintenance or use of that part
of the land leased to you and shown in the
Declarations.
b. With respect to the insurance afforded to
these additional insureds, the following
additional exclusions aPPly:
This insurance does not apply to:
(1) Any "occurrence" that takes place
after you cease to lease that land; or
(2) Structural alterations, new
construction or demolition operations
performed by or on behalf of such
person or organization.
6. Additional lnsured - State Or Political
Subdivision - Permits
a. \ /l-lo lS AN INSURED under Section G. is
amended to include as an additional
insured the state or political suMivision
shown in the Declaralions as an Additional
Page 18 of 24 Form SS 00 08 04 05
r{stlc\
rr)c\
orrlrlo!o
c\|o
LO
!4bc\c\
oitoor{fa.x
lnsured - State Or Political Subdivision -
Permits, but only with respect to
operations performed by you or on your
behalf for which the state or political
suMivision has issued a permit.
b. M/ith respect to the insurance afforded to
these additional insureds, the following
additional exclusions apply:
This insurance does not apply to:
(1) "Bodily injury", 'property damage" or
"personal and advertising injury"
arising out of operations performed for
the state or municipality; or
(21 "Bodily injury" or 'property damage"
included in the "product-completed
operations" hazard.
7. Additional lnsured - Vendors
a. \ /FlO lS AN INSURED under Section G. is
amended to include as an additional
insured the person(s) or organization(s)
(refered to below as vendor) shown in the
Declarations as an Additional lnsured -
Vendor, but only with respect to "bodily
injury" or "property damage" arising out of
"your products" which are distributed or
sold in the regular course of the vendo/s
business and only if this Coverage Part
provides co\€rage for 'bodily injury" or
"property damage" included within the
"products-completed operations hazard".
b. The insurance afforded to the nendor is
subjec;t to the following additional exclusions:
(1) This insurance does not apply to:
(a) "Bodily injury" or "property
damage" for which the vendor is
obligated to pay damages by
reason of the assumption of
liability in a contract or agreement.
This exclusion does not apply to
liability tor damages that the
vendor would have in the absence
of the contract or agreement;
(b) Any express warranty
unauthorized by you;
(c) Any physical or chemical change
in the product made intentionally
by the vendor;
(d) Repackaging, unless unpacked
solely for the purpose of inspection,
demonstration, testing, or the
substitution of parts under
instructions fom the manufadurer,
and then repackaged in the original
containeI
BUSINESS LIABILITY COVERAGE FORM
(e) Any failure to nrake such
inspections, adjustments, tests or
seMcing as the rendor has agreed
to make or normally undertakes to
make in the usual course of
business, in connection with the
distribution orsale of the products;
(0 Demonstration, installation,
servicing or repair operations,
except such operations performed
at the vendods premises in
connection with the sale of the
product;
(g) Products which, after distribution
or sale by you, have been labeledor relabeled or used as a
container, part or ingredient of any
other thing or substance by or for
the vendor; or
(h) 'Bodily injury" or "property
damage" arising out of the sole
negligence of the vendor for its
own acts or omissions or those of
its employees or anyone else
acting on its behalf. However, this
exclusion does not apply to:
(i) The exceptions contained in
Subparagraphs {d) or (f); or
(ii) Such inspections,
adpstments, tests or servicing
as the vendor has agreed to
make or normally undertakes
to make in the usual course of
business, in connection with
the. distribution or sale of the
products.
(21 This insurance does not apply to any
insured person or organization from
whom you have acquired such
products, or any ingredient, part orcontainer, entering into,
accompanying or containing such
products.
E. Additional lnsured - Controlling lnterest
\A/l-lO lS AN INSURED under Section C. is
amended to include as an additional insured
the person(s) or organization(s) shown in the
Declarations as an Additional lnsured
Controlling lnterest, but only with respect to
their liability arising out of:
a. Their financial control of you; or
b. Premises they own, maintain or control
while you lease or occupy these premises.
-GG!
G
*
-!!!!t!!
-t
G
---GT
=
---EE
G
=
--
---TEE
Form SS 00 08 04 05 Page 19 of 24
BUSINESS LIABILITY COVERAGE FORM
This insurance does not apply to structural
afterations, new construction and demolition
operations performed by or for that person or
organization.
9. Additional lnsured - Owners, Lessees Or
Contractors Scheduled Person Or
Organization
a. \A/l-lO lS AN INSURED under Section G. is
amended to include as an additional
insured the person(s) or organization(s)
shown in the Declarations as an Additional
lnsured - Owner, Lessees Or Contractors,
but only with respect to liability for "bodily
injury", "property damage" or "personal
and advertising injury" caused, in whole or
in part, by your acts or omissions or the
acts or omissions of those acting on your
behalf:
(1) ln the performance of your ongoing
operations for the additional
insured(s); or
(21 ln connection with "your work"
performed for that additional insured
and included within the "products-
completed operations hazard'f , but
only if this Coverage Part provides
coverage for "bodily injury" or
"property damage" included within the
"products-completed operations
hazafd".
b. \Mth respect to the insurance afforded to
these additional insureds, this insurance
does not apply to "bodily injury", "property
damage" or "personal an advertising
injury" arising out of the rendering of, or
the failure to render, any professional
architectural, engineering or surveying
services, including:
(1) The preparing, approving, or failure to
prepare or approve, maps, shop
drawings, opinions, reports, surveys,
field orders, change orders, designs or
drawings and specifications; or
l2l Supervisory, inspection, architectural
or engineering activities.
10. Additional lnsured - Co-Owner Of lnsured
Premises
\ lFlO lS AN INSURED under Section G. is
amended to include as an additional insured
the person(s) or Organization(s) shown in the
Declarations as an Additional lnsured - Co-
Owner Of lnsured Premises, but only with
respect to their liability as co-owner of the
premises shown in the Declarations.
The limits of insurance that apply to additional
insureds are described in Section D. - Limits Of
lnsurance.
How this insurance applies when other insurance
is available to an additional insured is described in
the Other lnsurance Condition in Section E. -
Liability And Medical Expenses General
Conditions.
G. LIABILITY AND MEDICAL EXPENSES
DEFINITIONS
1. "Advertisement" means the widespread public
dissemination of information or images that
has the purpose of inducing the sale of goods,
products or services through:
a.(1) Radio;
(21 Television;
(3) Billboard;
(4) Magazine;
(5) Newspaper;
b. The lnternet, but only that part of a web
site that is about goods, products or
services for the purposes of inducing the
sale of goods, products orservices; or
c. Any other publication that is given
widespread public distribution.
However, "advertisement" does not include:
a. The design, printed material, information
or images contained in, on or upon the
packaging or labeling of any goods or
products; or
b. An interactive conversation between or
arnong persons through a computer network.
2. "Advertising idea" means any idea for an
"advertisement".
3. "Asbestos hazard" means an exposure or
threat of exposure to the actual or alleged
properties of asbestos and includes the mere
presence of asbestos in any form.
4. "Auto" means a land motor vehicle, trailer or
semi-trailer designed for travel on public
roads, including any attached machinery or
equipment. But "auto" does not include
"mobile equipment".
5. "Bodily injury" means physical:
a. lnjury;
b. Sickness; or
c. Disease
sustained by a person and, if arising out of the
above, mental anguish or death at any time.
6. "Coverage territory" means:
Page 20 of 24 Form SS 00 08 04 05
c\<l
oilfa
o(l
orr{-{olrtc\oro
Mb
c.{
F\Nooilfat
a. The United States of America (including its
territories and possessions), Puerto Rico
and Canada;
b. lnternational waters or airspace, but only if
the injury or damage occurs in the course
of travel or transportation between any
places included in a. above;
c. All other parts of the world if the injury or
damage arises out of:
(1) Goods or produds made or sold by you
in the tenitory described in a. above;
(21 The activities of a person whose home
is in the territory described in a.
above, but is away for a short time on
your business; or
(3) "Personal and advertising injury"
offenses that take place through the
lnternet or similar electronic means of
communication
provided the insured's responsibility to pay
damages is determined in the United States of
America (including its territories and
possessions), Puerto Rico or Canada, in a
"suit" on the merits according lo the
substantive law in such tenitory, or in a
settlement we agree to.
7. "Electronic data" means information, facts or
prograrns:
a. Stored as or on;
b. Created or used on; or
c. Transmifted to or from
computer software, including systems and
applications software, hard or floppy disks,
CD-ROMS, tapes, drives, cells, data
processing devices or any other media whichare used with electronically controlled
equipment.
8. "Employee' includes a 'leased workef .
"Employee' does not include a "temporary
workef.
9. "Executive ofiicef' means a person holding
any of the officer positions created by your
charter, constitution, byJaws or any other
similar governing document.
10. "Hostile fire" means one which becomes
uncontrollable or breaks out from where it was
intended to be.
11. 'lmpaired property" means tangible property,
other than "your product" or "your wort', that
cannot be used or is less useful because:
a. ft incorporates "your produd' or "your work"
that is known or thought to be defectiw,
deficient, inadequate or dargerous; or
BUSINESS LIABILITY GOVERAGE FORM
b. You have failed to tulfill the terms of a
contract or agreement;
if such property can be restored to use by:
a. The repair, replacement, adjustment or
removal of "your product" or "your work";
or
b. Your fulfilling the terms of the contract or
agreement.
12. "lnsured contract" means:
a. A contract for a lease of premises.
However, that portion of the contract for a
lease of premises that indemnifies any
person or organization for damage by fire,
lightning or explosion to premises while
rented to you or temporarily occupied by
you with permission of the owner is
subpct to the Damage To Premises
Rented To You limit described in Section
D. - Liability and Medical Expenses Limits
of lnsurance
b. A sidetrack agreement;
c. Any easement or license agreement,
including an easement or license
agreement in connection with construction
or demolition operations on or within 50
feet of a railroad;
d. Any obligation, as required by ordinance,to indemniff a municipality, except in
connection with work for a municipality;
€. An elevator maintenance agreement; or
f. That part of any other contract or
agreement pertaining to your business
(including an indemnification of a
municipality in connection with work
performed for a municipality) under which
you assume the tort liability of another
party to pay for "bodily injury" or "property
damage'to a third person or organization,
provftled the "bodily infury' or 'property
damage" is caused, in whole or in part, by
you or by those acting on your behalf.
Tort liability means a liability that would be
imposed by law in the absence of any
contract or agreement.
Paragraph f. includes that part of any
contract or agreement that indemnifies a
railroad for "bodily injury" or *property
damage" arising out of construction or
demolition operations within 50 feet of any
railroad property and affecting any railroad
bridge or trestle, tracks, road-beds, tunnel,
underpass or crossing.
However, Paragraph f. does not include
that part of any contract or agreement:
_G
G
!G
r
GE
-
&
--iE
@
--s
-G
!l'!tt
@!G
tr
-G
-IE
-
Form SS 00 08 04 05 Page 21 ot 24
BUSINESS LIABILITY COVERAGE FORM
(1) That indemnifies an architect,
engineer or surveyor for injury or
damage arising out of:
(a) Preparing, approving or failing to
prepare or approve maps, shop
drawings, opinions, reports,
surveys, field orders, change
orders, designs or drawings and
specifications; or
(b) Giving directions or instructions,
or failing to give them, if that is the
primary cause of the injury or
damage; or
l2l Under which the insured, if an
architect, engineer or surveyor,
assumes liability for an injury or
damage arising out of the insured's
rendering or failure to render
professional services, including those
listed in (1) above and supervisory,
inspection, architectural or
engineering activities.
13. "Leased worker" means a person leased to
you by a labor leasing firm under an
agreement between you and the labor leasing
firm, to perform duties related to the conduct of
your business. "Leased worker" does not
include a "temporary worke/'.
14. "Loading or unloading" means the handling of
property:
a. After it is moved from the place where it is
accepted for movement into or onto an
aircraft, watercraft or "auto";
b. \Mrile it is in or on an aircraft, watercraft or
"auto"; or
c. \Mrile it is being moved from an aircraft,
watercraft or "auto" to the place where it is
finally delivered;
but "loading or unloading" does not include the
movement of property by means of a mechanical
device, other than a hand truck, that is not
attached to the aircraft, watercraft or "auto".
15. "Mobile equipment" means any of the following
types of land vehicles, including any attached
machinery or equipment:
a. Bulldozers, farm machinery, forklifts and
other vehicles designed for use principally
ofi public roads;
b. Vehicles maintained for use solely on or
next to premises you own or rent;
c. Vehicles that travel on crawler treads;
d. Vehicles, whether self-propelled or not, on
which are permanently mounted:
(1) Power cranes, shovels, loaders,
diggers or drills; or
(21 Road construction or resurfacing
equipment such as graders, scrapers
or rollers;
e. Vehicles not described in a., b., c., or d.
above that are not self-propelled and are
maintained primarily to provide mobility to
permanently attached equipment of the
following types:
(1) Air compressors, pumps and
generators, including sPraying,
welding, building cleaning,
geophysical exploration, lighting and
well servicing equipment; or
(21 Gherry pickers and similar devices
used to raise or lower workers;
f. Vehicles not described in a., b., c., or d.
above maintained primarily for purposes
other than the transportation of persons or
cargo.
However, self-propelled vehicles with the
following types of permanently attached
equipment are not "mobile equipment" but
will be considered "autos":
(1) Equipment, of at least 1,000 pounds
gross vehicle weight, designed
primarily for:
(a) Snow removal;
(b) Road maintenance, but not
construction or resurfacing; or
(c) Street cleaning;
(21 Cherry pickers and similar devices
mounted on automobile or truck
chassis and used to raise or lower
workers; and
(3) Air compressors, pumps and
generators, including spraying,
welding, building cleaning,
geophysical exploration, lighting and
well servicing equipment.
{6. "Occurrence" rneans an accident, including
continuous or repeated exposure to substantially
the same general harmful conditions.
17. "Personal and advertising injury" means injury,
including consequential "bodily injury", arising
out of one or more of the following offenses:
a. False arrest, detention or imprisonment;
b. Malicious prosecution;
Page 22 ol 24 Form SS 00 08 04 05
cn<lc!
rrl
C\t
o'l
d
t{orof\to
lr)
M5c\lr\c!oor{
ca*
c. The wrongful eviction from, wrongful entry
into, or invasion of the right of private
occupancy of a room, dwelling or
premises that the person occupies,
committed by or on behalf of ils owner,
landlord or lessor;
d. Oral, written or electronic publication of
material that slanders or libels a person or
organization or disparages a p€rson's or
organization's goods, products or services ;
e. Oral, written or electronic publication of
material that violates a person's right of
privacy;
f. Copying, in your "advertisement", a
person's or organization's'advertising
idea" or style of "advertisement";
g. lnfringement of copyright, slogan, ortiile of
any literary or artistic work, in your
"advertisement"; or
h. Discrimination or humiliation that resutts in
injury to the feelings or reputation of a
natural person.
18. "Pollutants" rneans any solirJ, lQuid, gaseous or
thermal initant or contaminant, including smoke,
vapor, soot, ftrrnes, acids, alkalis, chemicals and
waste. \Ahste includes materials to be recycled,
reconditioned or redaimed.
1 9. "Products-completed operations hazard";
a. lncludes all .bodily injury" and .property
damage" occuning away from premises
you own or rent and arising out of "your
product" or "your worft" except:
(1) Products that are still in your physical
possession;or
l2l Work that has not yet been completed
or abandoned. However, "your work"
will be deemed to be compteted at the
earliest of the following times:
(a) \Men all of the work called for in
your contract has been completed.
(b) \Mren all of the work to be done at
the job site has been completed if
your contract calls for work at
npre than one job site.
(c) \Mren that part of the work done at
a |rb site has been put to its
intended use by any person or
oganization other than another
contractor or subcontractor
worting on the same prolect.
BUSINESS LIABILITY COVERAGE FORM
Work that may need service, maintenance,
correction, repair or replacement, but
which is otherwise complete, will be
treated as completed.
The "bodily injury" or "property damage"
must occur away from premises you own
or rent, unless your business includes the
selling, handling or distribution of "your
product" for consumption on premises you
own or rent.
b. Does not include 'bodily injury" or.property damage" arising out of:
(1) The transportation of property, unless
the injury or damage arises out of a
condition in or on a vehicle not owned
or operated by you, and that condition
was created by the "loading or
unloading" of that vehicle by any
insured; or
(21 The existence of tools, uninstalled
equipment or abandoned or unused
materials.
20. "Property damage" means:
a. Physical injury to tangibte property,
including all resulting loss of use of that
property. All such loss of use shall be
deemed to occur at the time of the
physical injury that caused it; or
b. Loss of use of tangible property that is not
physically in.lured. All such loss of use
shall be deemed to occur at the time of
"occurrence" that caused it.
As used in this definition, "electronic data" is
not tangible property.
21.'Suit" means a civil proceeding in which
damages because of "bodily injury', "property
damage' or "personal and advertising injury'
to which this insurance applies are alleged.
"Suit'includes:
a. An arbitration proceeding in which such
damages are claimed and to which the
insured must submit or does submit with
our consent; or
b. Any other altemative dispute resolution
proceeding in which such damages are
claimed and to which the insured submits
with our consent.
22. "Temporary workef means a person who is
fumished to you to substitute for a permanent
"employee" on leave or to meet seasonal or
short-term workload conditions.
23. "Volunteer worke/' means a person who:
a. ls not your "employee';
--t!-!=
4
G
Erlt
!!GG
TE
-EG
-i-
--G
lMt
--
-E
G
G
-:
4
-*r
GG
--r
-r
Form SS 00 08 04 05 Page 23 of 24
BUSINESS LIABILITY COVERAGE FORM
b. Donates his or her work;
c. Acts at the direction of and within the
scope of duties determined by you; and
d. ls not paid a fee, salary or other
compensation by you or anyone else for
their work performed for you.
24. "Your product":
a. Means:
(1) Any goods or products, other than real
property, manufactured, sold, handled,
distributed or disposed of by:
(a) You;
(b) Others trading under your name;
or
(c) A person or organization whose
business or assets you have
acquired; and
(21 Containers (other than vehicles),
materials, parts or equipment
furnished in connection with such
goods or products.
b. lncludes:
(1) Wananties or representations made at
any time with respect to the fitness,
quality, durability, performance or use
of"your product"; and
(21 The providing of or failure to provide
warnings or instructions.
c. Does not include vending machines or
other property rented to or located for the
use of others but not sold.
25. "Your work":
a. Means:
(1) Work or operations performed by you
or on your behalf; and
(2) Materials, parts or equipment
furnished in connection with such work
or operations.
b. lncludes:
(1) Warranties or representations made at
any time with respect to the fitness,
quality, durability, performance or use
of "your work"; and
l2l The providing of or failure to provide
wamings or instructions.
Page 24 ol 24 Form SS 00 08 04 05
SPECTRUM POLICY DECLARATIONS (Continued)
POLICYNUMBER: 72 sBM UK5025
SUPPLEMENTAL DECLARATIONS:
A service fee of $ 6.00 ¡s charged for each installment when your premium is paid in
installments. The service fee is $ 6. o0 per withdrawal when you select an electronic
fund transfer payment plan. The service fee will be added to the premium amount
shown on your premium billing statement.
Form SS 00 45 12 06
Process Date= 09/L5/20
@
Policy Expiration Ðate: Lt/0L/2L
o
@
COMMON POLICY CONDITIONS
Form SS 00 05 12 06
@ 2006, The Hartford
QUICK REFERENCE . SPECTRUM POL¡CY
DECLARATIONS
and
COMMON POLICY CONDITIONS
!. DECLARATIONS
Named lnsurecj anci Maiiing Address
Policy Period
Description and Business Location
Coverages and Limits of lnsurance
II. COMMON POLICY CONDIT¡ONS
á.
B. Changes
G. Concealment, Misrepresentation Or Fraud
D. Examination Of Your Books And Records
E. lnspections And Surveys
F. lnsurance Under Two Or More Coverages
G. !-ibe¡^alization
H. Other lnsurance - Property Coverage
l. Premiums
J. Transfer Of Rights Of Recovery Against Others To Us
K. Transfer Of Your Rights And Duties Under This Policy
L. Premium Audit
Beginning on Page
1_
1
z
2
2
2
z
2
2
2
3
.t
Form SS 00 05 12 06
tr
COMMON POLICY CONDIT¡ONS
All coverages of this policy are subject to the following conditions
A. Cancellation
1. The first Named lnsured shown in the
Declarations may cancel this policy by mailing
or delivering to us advance written notice of
cancellation.
2. We may cancel this policy by mailing or
delivering to the first Named lnsured written
notice of cancellation at least:
a. 5 days before the effective date of
cancellation if any one of the following
conditions exists at any building that is
Covered Property in this policy:
(1) The building has been vacant or
unoccupied 60 or more consecutive
days. This does not apply to:
(a) Seasonal unoccupancy; or
(b) Buildings in the course of
construction, renovation or
addition.
Buildings with 65% or more of the rental
units or floor area vacant or unoccupied
are considered unoccupied under this
provision.
(2) After damage by a Covered Cause of
Loss, permanent repairs to the
building:
(a) Have not started; and
(b) Have not been contracted for,
within 30 days of initial payment of
loss.
(3) The building has:
(a) An outstanding order to vacate;
(b) An outstanding demolition order;
or
(c) Been declared unsafe by
govern mental authority.
(4) Fixed and salvageable items have
been or are being removed from the
building and are not being replaced.
This does not apply to such removal
that is necessary or incidental to any
renovation or remodeling.
(5) Failure to:
(a) Furnish necessary heat, water,
sewer service or electricity for 30
consecutive days or more, except
during a period of seasonal
unoccupancy; or
(b) Pay property taxes that are owing
and have been outstanding for
more than one year following the
date due, except that this
provision will not apply where you
are in a bona fide dispute with the
taxing authority regarding payment
of such taxes.
b. 10 days before the effective date of
cancellation if we cancel for nonpayment
of premium.
c. 30 days before the effective date of
cancellation if we cancel for any other
reason.
3. We will mail or deliver our notice to the first
Named lnsured's last mailing address known
to us.
4. Notice of cancellation will state the effective
date of cancellation. The policy period will end
on that date.
5. lf this policy is canceled, we will send the first
Named lnsured any premium refund due.
Such refund will be pro rata. The cancellation
will be effective even if we have not made or
offered a refund.
6. lf notice is mailed, proof of mailing will be
sufficient proof of notice.
7. lf the first Named lnsured cancels this policy,
we will retain no less than $100 of the
premium.
B. Changes
This policy contains allthe agreements between you
and us concerning the insurance afforded. The first
Named lnsured shown in the Declarations is
authorized to make changes in the terms of this policy
with our consent. This policy's terms can be
amended or waived only by endorsement issued
by us and made a part of this policy.
@
Form SS 00 05 12 06
@ 2006, The Hartford
Page I of 3
COMMON POLICY CONDITIONS
C. Concealment, Misrepresentation Or Fraud
This policy is void in any case of fraud by you as Ít
relates to this policy at any time. lt is also void if you
or any other insured, at any time, intentionally conceal
or misrepresent a materialfact conceming:
1. This policy;
2. Tne uovereci Propeny;
3. Your interest ¡n the Covereci Properiy; or
Á A nlqim nnderlhic, nolimrr-"-t'
D. Examination Of Your Books And Records
We may examine and audit your books and
records as they relate to the policy at any t¡me
during the policy period and up to three years
afterward.
E. lnspections And SurveYs
We have the right but are not obligated to:
I Make insnecfions anci sttrvevs at anv time:
2. Give you reports on the conditions we find; and
3. Recommend changes.
Any inspections, surveys, reports or
recommendations relate only to insurability and the
premiums to be charged. We do not make safety
inspections. We do not undertake to perform the duty
of any person or organization to pror4do for the healr.h
or safety of any person. And we do not represent or
warrant that conditions:
1. Are safe or healthful; or
2. Comply with laws, regulations, codes or
standards.
This condition applies not only to us, but also to
any rating, advisory, rate service or similar
organization which makes insurance inspections,
surveys, reports or recommendations.
F. lnsurance Under Two Or More Goverages
lf two or more of this policy's coverages apply to
the same loss or damage, we will not pay more
than the actual amount of the loss or damage.
G. Liberalization
lf we adopt any revision that would broaden the
coverage under this policy without additional
premium within 45 days prior to or during the policy
period, the broadened coverage will immediately
apply to this policy.
H. Other lnsurance - Property Coverage
lf there is other insurance covering the same loss
or damage, we will pay only for the amount of
covered loss or damage in excess of the amount
due from that other insurance, whether you can
collect on it or not. But we will not pay more than
the applicable Limit of lnsurance.
l. Premiums
1. The first Named lnsured shown in the
Declarations:
a. ls responsible for the payment of all
premiums; and
b. Will be the payee for any return premiums
we pay.
2. The premium shown in ihe Deciarations was
computed based on rates in effect at the time
the policy was issued. lf applicable, on each
renewal, continuation or anniversary of the
effective date of this policy, we will compute
the premium in accordance with our rates and
rules then in effect.
-1. t¡Vith our consent, you ma!, continue this polic;t
in force by paying a continuation premium for
each successive one-year period. The
premium must be:
a. Pald to us pnorto tne annversary oate; ano
b. Determined in accordance with Paragraph
2. above.
Our forms then in effect will appl.v. lf you do
not pay the continuation premium, this policy
will expire on the first anniversary date that we
have not received the Premium.
¡ ^L^--^- :- ^- ^!-^-"4. Unanges in exposui^es Ûi cnanges in yoüí
business operation, acquisition or use of
locations that are not shown in the Declarations
may occur during the policy period. lf so, we may
require an additionalpremium. That premium will
be determined in accordance with our rates and
rules then in effect.
J. Transfer Of Rights Of Recovery Against Others
To Us
Applicable to Property Coverage:
lf any person or organization to or for whom we
make payment under this policy has rights to
recover damages from another, those rights are
transferred to us to the extent of our payment.
That person or organization must do everything
necessary to secure our rights and must do
nothing after loss to impair them. But you may
waive your rights against another party in writing:
1. Prior to a loss to your Covered Property.
2. Afrer a loss to your Covered Property only if, at
time of loss, that party is one of the following:
a. Someone insured by this insurance;
b. A business firm:
(1) Owned or controlled bY You; or
(2) That owns or controls You; or
Page 2 of 3 Form SS 00 05 12 06
c. Your tenant.
You may also accept the usual bills of lading or
shipping receipts limiting the liability of carriers.
This will not restrict your insurance.
K. Transfer Of Your Rights And Duties Under This
Policy
Your rights and duties under this policy may not be
transferred without our written consent except in
the case of death of an individual Named lnsured.
lf you die, your rights and duties will be transferred
to your legal representative but only while acting
within the scope of duties as your legal
representative. Until your legal representative is
appointed, anyone having proper temporary
custody of your property will have your rights and
duties but only with respect to that property.
*?'-
Lisa Levin, Secretary
COMMON POLICY CONDITIONS
L. Premium Audit
a. We will compute all premiums for this policy in
accordance with our rules and rates.
b. The premium amount shown in the
Declarations is a deposit premium only. At the
close of each audit period we will compute the
earned premium for that period. Any
additional premium found to be due as a result
of the audit are due and payable on notice to
the first Named lnsured. lf the deposit
premium paid for the policy term is greater
than the earned premium, we will return the
excess to the first Named lnsured.
c. The first Named lnsured must maintain all
records related to the coverage provided by
this policy and necessary to finalize the
premium audit, and send us copies of the
same upon our request.
@ì
o
Our President and Secretary have signed this policy. Where required by law, the Declarations page has also been
countersigned by our duly authorized representative.
qt^{r'UArÃb
Douglas Elliot, President
Form SS 00 05 12 06 Page 3 of 3
POLICY NUMBER: 72 SB.M UK5025
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
ADDTTIONAL TNSURED - MANAGER/LESSOR
THE CITY OF KENT
PUBLIC WORKS EATGINEERING
222 FOVP'IH AVE. SO.
KE}üT WA 98032
ffi
@
ooo
Form lH 12 ü, 1l 85 T SEQ. NO. 002
Process Date: 09 /75 /20
Printed in U.S.A. Page 001-
Expiration Ðalez It / 0t / 2t
INSURED COPY
@
@
ôo
Named lnsured:
Policy Number:
Effective Date:
Company Name
ÀR¡IOI.D TO!ûAC DBA À & M
72 SBM UK5O25
1,L/0L/20 Expiration Date
HARTFORD CASUALTY INSURANCE COMPAXIY
LL / OT/2I
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
TRADE OR ECONOMIC SANCTIONS ENDORSEMENT
This insurance does not apply to the extent that trade or economic sanctions or other laws or regulations
prohibit us from providing insurance, including, but not limited to, the payment of claims.
All other terms and conditions remain unchanged
Form lH 99 41 04 09 Page I of I
THE
THE HARTFORD
BUSINESS SERVICE CENTER
36TÛ WISEMAN BLVD
HARTFORD SAN ANTONIO TX 78251
HB 01 000517 88792 H 3 A
,tll,t,u,til¡tl,,l,ltttt¡ll¡,tll,ll!t,,!ilt,ilt¡1,,¡t,,otlt¡,olo
ARNOLDTOMACDBAA&MCO
181 19 N-E, 3OTH STREET
REDMOND WA SBO52_5902
Policy lnformation:
Policy N¡.¡mber:72 SBM UK5O25
October 3,202t
tP Contact Us
Business Service Center
Business Hours: Monday - Fríday
gAf\Í - 7PM CentralStandard Tíme)
Phone: (888) 920-6259
Fax: (888) 443-6112
Ernail: agency.services@thehartford.oom
Website: https://business.thehartford.com
Enclosed please find information pertaining to your policy. Please c,ontact us if you have any questions or æncerns.
Thank you for selecting The l-lartford for your business insurance needs.
Sincerely,
Your Hartford Service Tearn
WLTRI}OI
POLICYNUMBER: 72 SBM UK5O25
THIS ENDORSEMENT IS I\TTACHED TO ANÐ MADE PART OF YOUR POLICY IN
RESPONSE TO THE DISGLOSURE REQUIREMENTS OF THE TERRORISM RISK
INSURANCE ACT.
DISGLOSURE PURSUANT TO TERRORISM RISK
INSURANCE ACT
SGHEDULE
Terrorism Premi¡¡m:
$ $s. oo
o
I
A. Disclosure Of Premir¡m
ln accordance with the federal Terrorism Risk
lnsurance Act, as amended [fRA), we are required
to provide you with a notice disclosing the portion of
your premium, if any, attributable to coverage for
"certified acts of terrorism" under TRIA. The portion
of your premium attributable to such coverage is
shown in the Schedule of this endorsement.
B. The following definition is added with respect to the
provisions of this endorsement:
1. A "certified act of terrorism" means an act that is
certified by the Secretary of the Treasury, in
accordance with the provisions of TRIA, to be
an act of terorism under TRIA. The criteria
contained in TRIA for a "certified act of
terorism" include the following:
a. ïhe act results in insured losses in excess
of $5 million in the aggregate, attributabte to
all types of insurance subject to TRIA; and
b. The act results in damage within the United
States, or outside the United States in the
case of certain air caniers or vessels or the
premises of an United States mission; and
c. The act is a violent act or an act that is
dangerous to human life, property or
infrastructure and is committed by an
individual or individuals as part of an effortto coerce the civilian population of the
United States or to influence the policy or
affect the conduct of the United States
Government by coercion
G. Disclosure Of Federal Share Of Terrorism
Losses
The United States Department of the Treasury wíll
reimburse insurers for a portion of insured losses,
as indicated in the table below, attributable to
"certÍfied acts of tenorism" under TRIA that exceeds
the applicable insurer deductíble:
Galendar Year Federal Share of
Terrorism Losses
2015 85o/o
2016 844/o
2017 83o/o
2018 82o/o
2019 811/o
2020 or later 809/o
However, if aggregate industry insured losses under
TRIA exceed $100 biltion in a calendar year, the
Treasury shall not make any payment for any
port¡on of the amount of such losses that exceeds
$100 billion. The United States government has not
charged any premium for their participation in
covering terrorism losses"
Form SS 83 80 0l 15 Page 1 ot 2
@ 2015 , The Hartford
(lncludes copyrighted material of the lnsurance Services Office, lnc., with Íts permission.)
Process Datê: 09/15/20 policy Expiration Ðater 7L/OL/2L
*
D. Gap On lnsurer Liability for Tenorism Losses
lf aggregate industry insured losses attributable to
"certified acts of tenorism" under TRIA exceed $100
billion in a calendar year and we havè met, or will
meet, our insurer deductible under TRIA, we shall
not be liable for the payment of any portion of the
amount of such losses that exceçd $100 billion- ln
*--^L ^--^ ^^ Í^- t¡;a¡¡ir* l¡¡¡¡r øar¡JUUII WJgr yVUr WVEIqVV lvr Lvrlv¡¡J¡lr rvJrvr rrruJ
be reduced on a pro-rata basis in accordance with
procedures established by the Treasury, based on
its estimates of aggregate industry losses and our
estimate that we will exceed our insuror deductible.
ln accondance with the Treasury's procedures,
amounts paid for losses may be subjêct to further
adjustments based on differences between actual
iosses and estimates"
E- Application of Other Exclusions
The terms and limitations of any tenorism exclusion,
the inapplicability or omission of a terrorism
er¡nllrcinn. nr fhcr incluçion of telrrorism coveraoe, rlo
not serve to create coverage for any loss which
would otherwise be exclucied under this Goverage
Form, Coverage Part or PolicY.
F. All other terms and conclitions nemain the sarne"
FormSS 83 80 0l 15 Fage 2ot 2
åR¡IOI¡D TC'![AC DBA À & M
18119 N.E. 3OTH STREET
REDMOND lYA 98052 ***-#"
@
Policy Number: 72 SBM UK5025
Renewal Date: 1_L / 01_ / 20
Thank you for being a loyal customer of The Hartford.
# 1: Your Hartford Policy
Enclosed are renewal documents for your policy, which is scheduled to renew on tL/OL/20 . Along
with a new Declarations Page, which details the coverages provided by your policy, we are enclosing
important policy documents. Please be aware that you will receive an invoice separately for this new
policy term approximately 30 days prior to the renewal date; no action is required now.
To ensure the premium you paid for this past policy term was accurate, we may contact you by letter,
phone or email to conduct a premium audit. lf contacted, we will advise what information is needed to
complete the audit.
# 2: Your Business lnsurance Goverage Checkup
Now is a great time to complete a business insurance coverage checkup with a Hartford lnsurance
Professional. Because you wear so many hats each day, you may not be thinking about how changes to
your business can impact the type and amount of insurance coverage needed to protect ¡t.
Together we will evaluate how your needs may have changed over the past year. Examples include:- Has your mailing address and/or the physical location of your business changed?- Has there been any increase/decrease in the amount of business property/equipment you own?- Has there been any increase/decrease in your company's payroll or sales?- Have you added or eliminated any vehicles used in your business operations?- Are the bill plan and deductible on your policy right for your business?
During the review we may make coverage recommendations, provide peace of mind solutions,
and possibly reduce your costs. Here is all you need to do:- Call toll free (866) 467-8739, and select our renewal review service option any
weekday from 7 A.M. to 7 P.M. CST and request your business insurance check-up.- To best serve you, please have your Policy Number or Account Number and a Copy of
your current Renewal Policy in hand when you calt.
# 3: Servicing Your Needs
To login or register for our Online Business Service Center, go
where any time, day or night you can:- Pay your bill, view payment history and enroll in Auto Pay- Request Auto lD Cards and Certificates of lnsurance- View electronic copies of billing and policy documents and sign up for paperless delivery
# 4z ll You've Had A Loss or Accident... Report lt lmmediately
We want to help! Contact us as quickly as possible at 1-800-327-3636.- Representatives are available 24-7 to assist in helping you recover from your loss.
On behalf of A.r eÀr¡r¡AGEER & co xNs BRKRS ca/pus and The Hartford, we appreciate the
opportunity to have been of service to you this past year and look forward to serving your business
insurance needs forthe upcoming year.
Sincerely,
Your Hartford Team
to www.theh artford.com/servicecenter
tr
IMPORTANT NOTICE TO POLICYHOLDERS
THE HARTFORD CYBER CENTER WEBSITE ACCESS
Thank you for choosing The Hartford for your business insurance needs.
You are receiving this Notice because you purchased a business owner's policy from The Hartford, (your Policy
was issued by The Hartford writing company identified on your policy Declarations page) which includes access to
The Hartford Cyber Center. This portal was created because we recognize that businesses face a variety of
cyber-related exposures and need help managing the related risks. These exposures include data breaches,
computer virus attacks and cyber extortion threats.
Through The Hartford Cyber Center, you have access to:
o A panel of third party incident response service providers
o Third party cybersecurity pre-incident service providers and a list of approved services to help protect
your business before a cyber-threat occurs
o Risk management tools, including self-assessments, best practice guides, templates, sample incident
response plans, and data breach cost calculators
o White papers, blogs and webinars from leading privacy and security practitioners
o Up-to-date cyber-related news and events, including examples of privacy and security related events
Accessing The Hartford Cyber Center is easy
1. Visit www.thehartford.com/cybercenter
2. Enter policyholder information
3. Access code:952689
4. Login to The Hartford Cyber Center
This Notice does not amend or otherwise affect the provisions of your business owner's policy.
Coverage Options:
The Hartford offers a variety of endorsements to your busíness owner's policy that can help protect your business
from a broad range of cyber-related threats. Please review your coverage with your insurance agent or broker to
determine the most appropriate cyber coverages and limits for your business.
Claims Reporting:
lf you have a claim, you can report it by calling The Hartford's toll-free claims line at 1-800-327-3636.
Should you have any questions, please contact your insurance agent, broker or you may contact us directly.
We appreciate your business and look fon¡rard to being of continued service to you.
Please be aware that:
o The Hartford Cyber Center is a proprietary web portal exclusively provided to customers of The Hartford.
Please do not share the access code with anyone outside your organization.
o Registration is required to access the Cyber Center. You may register as many users as necessary.
o Contacting a service provider about any issue does not constitute providing The Hartford notice of a claim
as required under your insurance policy. Read your insurance policy and discuss any questions with your
agent or broker.
The Hartford Cyber Center provides third party service provider references and materials for educational
purposes only. The Hartford does not specifically endorse any such service provider within The Hartford Cyber
Center and hereby disclaims all liability with respect to use of or reliance on such service providers. All service
providers are independent contractors and not agents of The Hartford. The Hartford does not warrant the
performance of the service providers, even if such services are covered under your Business Owners Policy. We
strongly encourage you to conduct your own assessments of the service providers' services and the fitness or
adequacy of such services for your particular needs.
o
è
Form SS 89 93 07 16
@ 2016, The Hartford
Page I of I
lnsurance Policy Billing lnformation
Thank you for selecting The Hartford for your business insurance needs,
Shortly, you will receive your first bill from us. You are receiving this Notice so you know
what to expect as a valued customer of The Hartford. Should you have any questions after
reviewing this information, please contact us at 866-467-8730, and we will be happy to
assist you.
o Your total policy premium will appear on your policy's Declarations Page. You will be billed based on the payment
plan you selected.
o You may pay the "minimum due" as it appears on your insurance bill or pay the policy balance in full.
o An installment service fee is added to each installment. A late fee will also be applied if the "minimum due" is not
received by the due date shown on your bíll. Service and late payment fees do not apply in all states.
o lf you selected installment billing, any credit or additional premium due as the result of a change made to your
policy, wlll be spread over the remaining billing installments. Additional premium due as a result of an audit will be
billed in fullon your next billdate following the completion of the audit.
o lf you elected Electronic Funds Transfer (EFT), policy changes may result in changes to the amount automatically
withdrawn from your bank account. The invoice you receive following a policy change will include future withdrawal
amounts. lf you need to adjust or stop your next scheduled EFT withdrawal, please contact us at least 3 days
prior to the scheduled withdrawal date at the telephone number shown below.
lf you selected installment billing and pay the premiums for your first policy term on time, at renewal, your account
may qualify for our "Equal lnstallment" feature. This means that the percentage due for each installment, including
the initial renewal installment, will be the same throughout the policy term - helping you better manage cash flow.
Equal installments will continue as long as you pay your premiums on time and no cancellation notices are issued
for any policy on your account. lf you no longer qualify for Equal lnstallments, future renewals will be billed based
on the payment plan you selected, which includes a higher initial installment amount.
o
o
o
o lf your policy is eligible for renewal, your bill for the upcoming policy term will be sent to you approximately 30 days
prior to your policy's renewal date. lf your insurance needs change, please contact us at least 60 days prior to your
renewal date so we can properly address any adjustments needed.
o One bill convenience -- you have the option of combining all eligible Hartford policies on one single bill allowing
you to make one payment for all policies on your account as payments are due.
You're ln Control
ln addition to selecting a bill plan option that best meets your budget, you have the flexibility to decide how your
payments are made ...
o Repetitive EFT: Sign up for Repetitive EFT payments and have payments automatically withdrawn from your bank
account. This option saves you money by reducing the amount of the installment service fee.
o Pay Online: Register at www.thehartford.com/servicecenter. Online Bill Pay is Quick, Easy and Secure!
o Pay by Check: Send a check with your remittance stub in the envelope provided with your bill.
o Pay by Phone: Calltoll-free l-S66467-8730.
Should you have any questions about your bill, please call Customer Service toll-free number:
1-866-467-8730 - 7AM - 7PM CST. We look forward to being of service to you.
Fo¡m 10072211th Rev. Printed in U.S.A.
POLICYNUMBER: 72 sBI,Il UK5O25
THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN
RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK
INSURANCE ACT.
DISCLOSURE PURSUANT TO TERRORISM RISK
INSURANCE ACT
SCHEDULE
Terrorism Premium:
$ $s. oo
o
@
@
A. Disclosure Of Premium
ln accordance with the federal Terrorism Risk
lnsurance Act, as amended (TRIA), we are required
to provide you with a notice disclosing the portion of
your premium, if any, attributable to coverage for
"certified acts of terrorism" under TRIA. The portion
of your premium attributable to such coverage is
shown in the Schedule of this endorsement.
B. The following definition is added with respect to the
provisions of this endorsement:
1, A "certified act of terrorism" means an act that is
certified by the Secretary of the Treasury, in
accordance with the provisions of TRIA, to be
an act of terrorism under TRIA. The criteria
contained in TRIA for a "ceftifïed act of
terrorism" include the following:
a. The act results in insured losses in excess
of $5 million in the aggregate, attributable to
all types of insurance subject to TRIA; and
b. The act results in damage within the United
States, or outside the United States in the
case of certain air carriers or vessels or the
premises of an United States mission; and
c. The act is a violent act or an act that is
dangerous to human life, property or
infrastructure and is committed by an
individual or individuals as part of an effortto coerce the civilian population of the
United States or to influence the policy or
affect the conduct of the United States
Government by coercion
C. Disclosure Of Federal Share Of Terrorism
Losses
The United States Department of the Treasury will
reimburse insurers for a portion of insured losses,
as indicated in the table below, attributable to
"certified acts of terrorism" under TRIA that exceeds
the applicable insurer deductible:
Calendar Year Federal Share of
Terrorism Losses
2015 85%
2016 84%
2017 83%
2018 82o/o
2019 81%
2020 or later 80%
However, if aggregate industry insured losses under
TRIA exceed $100 billion in a calendar year, the
Treasury shall not make any payment for any
portion of the amount of such losses that exceeds
$100 billion. The United States government has not
charged any premium for their participation in
coveri ng terrorism losses.
Form SS 83 76 01 15
@ 2015 , The Hartford
(lncludes copyrighted material of the lnsurance Services Office, lnc., with its permission.)
Page 1 of 2
D. Cap On lnst¡rer Liability for Terrorism Losses
lf aggregate industry insured losses attributable to
"certified acts of terrorism" under TRIA exceecl $100
billion in a calendar year and we have met, or will
meet, our insurer deductible under TRIA, we shall
not be liable for the payment of any portion of the
amount of such losses that exceed $100 billion. ln
such case. vour cove[aqe for terrorism losses may
be reduced on a pro-rata basis in accordance with
procedures established by the Treasury, based on
its estimates of aggregate industry losses and our
estimate that we will exceed our insurer deductible.
ln accordance with the Treasury's procedures,
amounts paid for losses may be subject to further
adjustments based on differences between actual
losses and estimates.
E. Application uf Olltcr Exclusions
The terms and limitations of any terrorism exclusion,
the inapplicability or omission of a terrorism
exclusion, or the inclusion of terrorism coverage, do
not serve to create coverage for any loss wnlcn
would otherwise be excluded under this Coverage
Form, Coverage Part or PolicY.
F. All other terms and conditions rernain the same.
Form SS 83 76 01 15 Page 2 ol 2
tr
@
N
oIMPORTANT NOTICE TO POLICYHOLDERS
To help your insurance keep pace with increasing costs, we have increased your amount of insurance .
better protection in case of either a partial, or total loss to your property.
lf you feel the new amount is not the proper one, please contact your agent or broker.
. giving you
Form PC€7¡t-0 Printed in U.S.A,