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Home My WebLink AboutCAG2019-359 - Amendment - #2 - KBA, Inc. - S 228th St UPRR Grade Separation Bridge & Roadway Phase 5 - 06/07/2021ApprovalOriginator:Department: Date Sent:Date Required: Mayor or Designee Date of Council Approval: Grant? Yes No Type:Review/Signatures/RoutingDate Received: City Attorney: Comments: Date Routed: Mayor’s Office City Clerk’s OfficeAgreement InformationVendor Name:Category: Vendor Number:Sub-Category: Project Name: Project Details: Agreement Amount: Start Date: Local Business? Yes No* Business License Verification: If meets requirements per KCC 3.70.100, please complete “Vendor Purchase-Local Exceptions” form on Cityspace. Yes In-Process Exempt (KCC 5.01.045) Notice required prior to disclosure? Yes No Contract Number: 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. 20210513 FOR CITY OF KENT OFFICIAL USE ONLY Agreement Routing Form For Approvals, Signatures and Records Management (Optional) Basis for Selection of Contractor: * Memo to Mayor must be attached Termination Date: Authorized to Sign: CAG2019-359 #2 AMENDMENT - 1 OF 2 AMENDMENT NO. 2 NAME OF CONSULTANT OR VENDOR: KBA, Inc. CONTRACT NAME & PROJECT NUMBER: S. 228th Street Union Pacific Railroad Grade Separation Bridge and Roadway - Phase 5 ORIGINAL AGREEMENT DATE: July 3, 2019 This Amendment is made between the City and the above-referenced Consultant or Vendor and amends the original Agreement and all prior Amendments. All other provisions of the original Agreement or prior Amendments not inconsistent with this Amendment shall remain in full force and effect. For valuable consideration and by mutual consent of the parties, Consultant or Vendor’s work is modified as follows: 1.Section I of the Agreement, entitled “Description of Work,” is hereby modified to add additional work or revise existing work as follows: In addition to work required under the original Agreement and any prior Amendments, the Consultant or Vendor shall: Continue to provide additional construction management services for the project. For an estimate, see Exhibit A which is attached and incorporated by this reference. 2.The contract amount and time for performance provisions of Section II “Time of Completion,” and Section III, “Compensation,” are modified as follows: Original Contract Sum, including applicable WSST $717,000 Net Change by Previous Amendments including applicable WSST $80,400 Current Contract Amount including all previous amendments $797,400 Current Amendment Sum $43,100 Applicable WSST Tax on this Amendment $0 Revised Contract Sum $840,500 AMENDMENT - 2 OF 2 Original Time for Completion (insert date) 6/30/21 Revised Time for Completion under prior Amendments (insert date) 12/31/21 Add’l Days Required (±) for this Amendment 0 calendar days Revised Time for Completion (insert date) 12/31/21 The Consultant or Vendor accepts all requirements of this Amendment by signing below, by its signature waives any protest or claim it may have regarding this Amendment, and acknowledges and accepts that this Amendment constitutes full payment and final settlement of all claims of any kind or nature arising from or connected with any work either covered or affected by this Amendment, including, without limitation, claims related to contract time, contract acceleration, onsite or home office overhead, or lost profits. This Amendment, unless otherwise provided, does not relieve the Consultant or Vendor from strict compliance with the guarantee and warranty provisions of the original Agreement. All acts consistent with the authority of the Agreement, previous Amendments (if any), and this Amendment, prior to the effective date of this Amendment, are hereby ratified and affirmed, and the terms of the Agreement, previous Amendments (if any), and this Amendment shall be deemed to have applied. The parties whose names appear below swear under penalty of perjury that they are authorized to enter into this Amendment, which is binding on the parties of this contract. IN WITNESS, the parties below have executed this Amendment, which will become effective on the last date written below. CONSULTANT/VENDOR: By: (signature) Print Name: Its (title) DATE: CITY OF KENT: By: (signature) Print Name: Dana Ralph Its Mayor (title) DATE: ATTEST: ___________________________ Kent City Clerk APPROVED AS TO FORM: (applicable if Mayor’s signature required) Kent Law Department KBA - 228th Ph 5 Amd 2/Barry Kristen M. Overleese President 6/3/21 06/07/2021 Project Name: 228th St. Union Pacific RR Grade Sep Ph VMonthJul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Apr-21 May-21 Jun-21 Jul-21 Aug-21Client Project No.: N/ADays/Mo 22 21 21 22 19 22 20 20 23 22 20 22 21 22KBA Project No.: 0190020-01Hr/Mo 176 168 168 176 152 176 160 160 184 176 160 176 168 176Contract Type: Cost + Net Fee (on DSC only) Extra Work13% 13% 13% 13% 13% 13% 6% 8% 12% 12% 12% 12% 12% 12%Date Prepared:Adj Hr/Mo 198 189 189 198 171 198 170 173 206 197 179 197 188 197Prepared by: Sam SchuylerSalary Escalation 5%KBA Labor HoursEmployeeTitle2019Rate2020 Rate2021 RateTotal Hours2019 Total 2020 Total 2021 TotalJul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Apr-21 May-21 Jun-21 Jul-21 Aug-21Sam Schuyler (M2) Project Manager $72.50 $75.24 $77.52 102 5 69 29 5 3 3 8 8 7 8 7 8 6 Jill Carter(A4) Contract Admin $38.00 $39.48 $42.00 26 1 24 1 2 1 1 1 1 1 1 - - Wendy Blackwood (A3) Subconsultant CA $33.00 $0.01 $0.01- - - - - - - Jen Payne(A5) Contract Admin $34.60 $44.40 $0.015 5 - - - - - Paige Barnes (A4) Contract Admin $0.01 $0.01 $42.442 - - 2 - 1 1 1 Cameron Bloomer (E4) FE/OE$52.00 $54.00 $56.00 2,441 266 1,518 658 60 138 145 146 120 113 140 129 60 29 40 92 88 80 Gary Paxton(T5) Inspector$51.00 $54.00 $55.68 879 247 633 - - - Gary Paxton(T5) Inspector- NS$58.65 $62.10 $64.03- - - - - - - Nsharra Key(P3) Project Assistant$34.00 $35.56 $0.01 389 89 300 - - - - Dane Setzer(E3) Eng. Prof. III$38.00 $38.00 $39.00 1,615 - 1,087 528 160 152 114 145 93 153 126 126 167 109 Subtotal - KBA Labor Hours5,458 611 3,630 1,217 227 294 262 300 221 274 275 262 235 144 40 92 89 80 KBA Inv KBA InvDirect ExpensesInv Status StatusItemTotal Costs2019 Total 2020 Total 2021 TotalJul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Apr-21 May-21 Jun-21 Jul-21 Aug-21Vehicles @ $950/month (plus tax) 29,445$ 2,568 20,742 6,135 1,445 1,919 1,621 1,926 1,406 1,572 1,762 1,686 1,446 1,241 Vehicles @ $6/hour (plus tax)2,802$ 814 - 1,988 - 265 609 583 531 Misc: Supplies, Equipment, Copies, Postage218$ 124 - 94 - 94 Subtotal - Direct Expenses32,465 3,505 20,742 8,217 1,445 1,919 1,621 1,926 1,406 1,572 1,762 1,686 1,446 1,241 265 609 583 625 Subconsultant(s)Inv Status StatusSubconsultantsTotal Costs2019 Total 2020 Total 2021 TotalJul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Apr-21 May-21 Jun-21 Jul-21 Aug-21Terracon Consultants, Inc. 80,052$ 2,043 47,923 30,086 - 10,692 8,508 6,582 6,435 - 6,410 16,226 - 7,450 Subtotal - Subconsultant Costs80,052 2,043 47,923 30,086 - 10,692 8,508 6,582 6,435 - 6,410 16,226 - 7,450 - - - - KBA Inv KBA InvCombined CostsInv Status StatusEmployee Title2019Rate2020 Rate2021 RateTotal DSC2019 Total 2020 Total 2021 TotalJul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Apr-21 May-21 Jun-21 Jul-21 Aug-21Sam Schuyler (M2) Project Manager $72.50 $75.24 $77.52 7,726$ 363 5,154 2,209 - 376 226 226 602 564 527 620 543 620 426 - - - - Jill Carter(A4) Contract Admin $38.00 $39.48 $42.00 1,028$ 38 948 42 - 79 39 39 39 39 39 42 - - - - - - - Wendy Blackwood (A3) Subconsultant CA $33.00 $0.01 $0.01-$ - - - - - - - - - - - - - - - - - - Jen Payne(A5) Contract Admin $34.60 $44.40 $0.01 156$ 156 - - - - - - - - - - - - - - - - - Paige Barnes (A4) Contract Admin $0.01 $0.01 $42.44 85$ - - 85 - - - - - - - - 21 - 21 - - 42 Cameron Bloomer (E4) FE/OE$52.00 $54.00 $56.00 132,598$ 13,806 81,972 36,820 - 3,240 7,452 7,803 7,884 6,453 6,075 7,840 7,196 3,360 1,624 2,240 5,152 4,928 4,480 Gary Paxton(T5) Inspector$51.00 $54.00 $55.68 46,727$ 12,572 34,155 - - - - - - - - - - - - - - - - Gary Paxton(T5) Inspector- NS$58.65 $62.10 $64.03-$ - - - - - - - - - - - - - - - - - - Nsharra Key(P3) Project Assistant$34.00 $35.56 $0.01 13,677$ 3,009 10,668 - - - - - - - - - - - - - - - - Dane Setzer(E3) Eng. Prof. III$38.00 $38.00 $39.00 61,879$ - 41,287 20,592 - 6,080 5,776 4,313 5,510 3,534 5,814 4,914 4,914 6,513 4,251 - - - - Subtotal Direct Salary Costs263,874$ 29,943 174,183 59,748 9,775 13,493 12,381 14,035 10,591 12,455 13,416 12,674 10,493 6,323 2,240 5,152 4,970 4,480 Overhead (Home) @165.72% 167.65% 156.16%14,803$ 922 10,229 3,652 763 445 445 1,075 1,012 949 1,034 881 968 699 - - 70 - Overhead (Field) @ 146.88% 144.90% 144.89%370,143$ 43,163 243,551 83,429 13,505 19,167 17,556 19,408 14,471 17,227 18,479 17,546 14,305 8,512 3,290 7,567 7,238 6,491 Subtotal Overhead Costs384,946$ 44,085 253,780 87,082 14,268 19,612 18,001 20,483 15,483 18,176 19,513 18,427 15,273 9,211 5,530 12,719 12,279 10,971 Fee (on DSC only) @79,162$ 8,983 52,255 17,924 2,933 4,048 3,714 4,211 3,177 3,737 4,025 3,802 3,148 1,897 672 1,546 1,491 1,344 Subtotal Burdened Labor (DSC+OH+Fee)727,983$ 83,010 480,218 164,754 26,975 37,153 34,096 38,729 29,251 34,368 36,954 34,903 28,915 17,431 6,202 14,265 13,770 12,315 Direct Expenses (No Markup)32,465$ 3,505 20,742 8,217 1,445 1,919 1,621 1,926 1,406 1,572 1,762 1,686 1,446 1,241 265 609 583 625 Subconsultant(s)80,052$ 2,043 47,923 30,086 - 10,692 8,508 6,582 6,435 - 6,410 16,226 - 7,450 - - - - Cost To Complete840,500 88,559 548,883 203,058 28,420 49,765 44,225 47,237 37,093 35,940 45,127 52,814 30,361 26,122 6,467 14,874 14,353 12,940 717,000$ 80,400$ 797,400$ 840,500$ (43,100)$ Determinationof Hours5/10/2021ScheduleOriginal BudgetSupplement 1Total30.00%ESTIMATEACTUALSActuals + EstimateSupplementEXHIBIT A SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 5/12/2021 Dealey,Renton &Associates 3697 Mt.Diablo Blvd,Suite 230 Lafayette CA 94549 Dani Schulze 510-465-3090 510-452-2193 DesignProCerts@AssuredPartners.com License#:0020739 XL Specialty Insurance Co.37885 KBAINC0-03 The Travelers Indemnity Company of America 25666KBA,Inc. 11201 SE 8th Street,Ste 160 Bellevue WA 98004 Travelers Property Casualty Company of America 25674 The Travelers Indemnity Company 25658 1999037470 B X 1,000,000 X 1,000,000 X Contractual Liab 10,000 Included 1,000,000 2,000,000 X Y Y 6806N033449 5/10/2021 5/10/2022 2,000,000 D 1,000,000 X X X Y Y BA6N034864 5/10/2021 5/10/2022 C X X 9,000,000YCUP6N0361875/10/2021Y 5/10/2022 9,000,000 X 10,000 B X6806N0334495/10/2021 5/10/2022 WA STOP GAP 1,000,000 1,000,000 1,000,000 A Professional Liability + Contractors Pollution Liability DPR9977632 5/10/2021 5/10/2022 Per Claim Annual Aggregate $2,000,000 $4,000,000 Umbrella Liability policy is a follow-form underlying General Liability/Auto Liability/Employers Liability. RE:Project No.B17057-03 -S 228th St Union Pacific Railroad Grade Separation –Phase 5 The City of Kent is named as an additional insured as respects general and auto liability as required per written contract or agreement.General and Auto Liability are Primary/Non-Contributory per policy form wording. Severability of Interest applies to General and Auto Liability.SEVERABILITY OF INTERESTS (Per CG 00 01 10 01)7.Separation of Insureds -Except with respect to the Limits of Insurance,and any rights or duties specifically assigned in this Coverage Part to the first Named Insured,this insurance applies:a.As if each Named Insured were the only Named Insured;and b.Separately to each insured against whom claim is made or suit is brought.30 Day Notice of Cancellation 30 Day Notice of Cancellation City of Kent Attn:Nancy Yoshitake 220 Fourth Avenue,South Kent WA 98032                                                                                         Policy #: BA7R748905                                                                                                                                                                                                                                   ÐÑÔ×ÝÇÒËÓÞÛÎ COMMERCIAL GENERAL LIABILITY ISSUED DATE: ÌØ×ÍÛÒÜÑÎÍÛÓÛÒÌÝØßÒÙÛÍÌØÛÐÑÔ×ÝÇòÐÔÛßÍÛÎÛßÜ×ÌÝßÎÛÚËÔÔÇò    Ì¸·»²¼±®»³»²¬³±¼·º·»·²«®¿²½»°®±ª·¼»¼«²¼»®¬¸»º±´´±©·²¹æ ÝÑÓÓÛÎÝ×ßÔÙÛÒÛÎßÔÔ×ßÞ×Ô×ÌÇÝÑÊÛÎßÙÛÐßÎÌ    ø×²º±®³¿¬·±²®»¯«·®»¼¬±½±³°´»¬»¬¸·Í½¸»¼«´»ô·º²±¬¸±©²¿¾±ª»ô©·´´¾»¸±©²·²¬¸»Ü»½´¿®¿¬·±²ò÷ Í»½¬·±²×× É¸±×ß²×²«®»¼·¿³»²¼»¼¬±·²ó Ì¸··²«®¿²½»¼±»²±¬¿°°´§¬±þ¾±¼·´§·²¶«®§þ±® ½´«¼»¿¿²¿¼¼·¬·±²¿´·²«®»¼¬¸»°»®±²ø÷±® þ°®±°»®¬§¼¿³¿¹»þ±½½«®®·²¹ô±®°»®±²¿´·²¶«®§Œ ±®¹¿²·¦¿¬·±²ø÷¸±©²·²¬¸»Í½¸»¼«´»ô¾«¬±²´§ ±®¿¼ª»®¬··²¹·²¶«®§Œ¿®··²¹±«¬±º¿²±ºº»²» ©·¬¸®»°»½¬¬±´·¿¾·´·¬§º±®þ¾±¼·´§·²¶«®§þôþ°®±°»®¬§ ½±³³·¬¬»¼ô¿º¬»®æ ¼¿³¿¹»þôþ°»®±²¿´·²¶«®§Œ±®¿¼ª»®¬··²¹·²¶«®§þ ß´´©±®µô·²½´«¼·²¹³¿¬»®·¿´ô°¿®¬±®»¯«·°ó½¿«»¼ô·²©¸±´»±®·²°¿®¬ô¾§æ ³»²¬º«®²·¸»¼·²½±²²»½¬·±²©·¬¸«½¸©±®µô Ç±«®¿½¬±®±³··±²å±®±²¬¸»°®±¶»½¬ø±¬¸»®¬¸¿²»®ª·½»ô³¿·²¬»ó ²¿²½»±®®»°¿·®÷¬±¾»°»®º±®³»¼¾§±®±²Ì¸»¿½¬±®±³··±²±º¬¸±»¿½¬·²¹±²§±«®¾»¸¿´º±º¬¸»¿¼¼·¬·±²¿´·²«®»¼ø÷¿¬¬¸»´±½¿ó¾»¸¿´ºå ¬·±²±º¬¸»½±ª»®»¼±°»®¿¬·±²¸¿¾»»²½±³ó·²¬¸»°»®º±®³¿²½»±º§±«®±²¹±·²¹±°»®¿¬·±²º±®°´»¬»¼å±®¬¸»¿¼¼·¬·±²¿´·²«®»¼ø÷¿¬¬¸»´±½¿¬·±²ø÷¼»·¹ó Ì¸¿¬°±®¬·±²±ºþ§±«®©±®µþ±«¬±º©¸·½¸¬¸»²¿¬»¼¿¾±ª»ò ·²¶«®§±®¼¿³¿¹»¿®·»¸¿¾»»²°«¬¬±·¬·²óÉ·¬¸®»°»½¬¬±¬¸»·²«®¿²½»¿ºº±®¼»¼¬±¬¸»»¬»²¼»¼«»¾§¿²§°»®±²±®±®¹¿²·¦¿¬·±²¿¼¼·¬·±²¿´·²«®»¼ô¬¸»º±´´±©·²¹¿¼¼·¬·±²¿´»¨½´«ó ±¬¸»®¬¸¿²¿²±¬¸»®½±²¬®¿½¬±®±®«¾½±²¬®¿½ó·±²¿°°´§æ ¬±®»²¹¿¹»¼·²°»®º±®³·²¹±°»®¿¬·±²º±®¿ °®·²½·°¿´¿¿°¿®¬±º¬¸»¿³»°®±¶»½¬ò Ý±°§®·¹¸¬îððëÌ¸»Í¬òÐ¿«´Ì®¿ª»´»®Ý±³°¿²·»ô×²½òß´´®·¹¸¬®»»®ª»¼ò Ð¿¹»ï±ºï ×²½´«¼»½±°§®·¹¸¬»¼³¿¬»®·¿´±º×²«®¿²½»Í»®ª·½»Ñºº·½»ô×²½ò©·¬¸·¬°»®³··±²ò Any person or organization that you agree in a written contract, on this Coverage Part, provided that such written contract was signed and executed by you before, and is in effect when the "bodily injury" or "property damage" occurs or the "personal injury" or "advertising injury" offense is committed. Any project to which an applicable written contract with the described in the Name of Additional Insured Person(s) or Organization(s) section of this Schedule applies. 6806N033449 5/12/2021 ÐÑÔ×ÝÇÒËÓÞÛÎæ COMMERCIAL GENERAL LIABILITY ISSUED DATE: ÌØ×ÍÛÒÜÑÎÍÛÓÛÒÌÝØßÒÙÛÍÌØÛÐÑÔ×ÝÇòÐÔÛßÍÛÎÛßÜ×ÌÝßÎÛÚËÔÔÇò   Ì¸·»²¼±®»³»²¬³±¼·º·»·²«®¿²½»°®±ª·¼»¼«²¼»®¬¸»º±´´±©·²¹æ ÝÑÓÓÛÎÝ×ßÔÙÛÒÛÎßÔÔ×ßÞ×Ô×ÌÇÝÑÊÛÎßÙÛÐßÎÌ    ×²º±®³¿¬·±²®»¯«·®»¼¬±½±³°´»¬»¬¸·Í½¸»¼«´»ô·º²±¬¸±©²¿¾±ª»ô©·´´¾»¸±©²·²¬¸»Ü»½´¿®¿¬·±²ò ·¿³»²¼»¼¬±·²ó ´±½¿¬·±²¼»·¹²¿¬»¼¿²¼¼»½®·¾»¼·²¬¸»½¸»¼«´»±º ½´«¼»¿¿²¿¼¼·¬·±²¿´·²«®»¼¬¸»°»®±²ø÷±®±®ó ¬¸·»²¼±®»³»²¬°»®º±®³»¼º±®¬¸¿¬¿¼¼·¬·±²¿´·²ó ¹¿²·¦¿¬·±²ø÷¸±©²·²¬¸»Í½¸»¼«´»ô¾«¬±²´§©·¬¸ «®»¼¿²¼·²½´«¼»¼·²¬¸»þ°®±¼«½¬ó½±³°´»¬»¼±°»®¿ó ®»°»½¬¬±´·¿¾·´·¬§º±®þ¾±¼·´§·²¶«®§þ±®þ°®±°»®¬§¼¿³ó ¬·±²¸¿¦¿®¼þò ¿¹»þ½¿«»¼ô·²©¸±´»±®·²°¿®¬ô¾§þ§±«®©±®µþ¿¬¬¸» ×ÍÑÐ®±°»®¬·»ô×²½òôîððì Ð¿¹»ï±ºï Any person or organization that you agree in a written contract to include as an additional insured on this Coverage Part for "bodily injury" or "property damage" included in the "products- completed operations hazard", provided that such contract was signed and executed by you before, and is in effect when, the bodily injury or property damage occurs. Any project to which an applicable contract described in the Name of Additional Insured Person(s) or Organization(s) section of this Schedule applies. 5/12/20216806N033449 COMMERCIAL GENERAL LIABILITY c. Method Of Sharing If all of 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. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this methoo, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. d. Primary And Non-Contributory Insurance If Required By Written Contract If you specifically agree in a written contract or agreement that the insurance afforded to an insured under this Coverage Part must apply on a primary basis, or a primary and non- contributory basis. this insurance is primary to other insurance that is available to such insured which covers such insured as a named insured, and we will not share with that other insurance, provided that: (1) The "bodily injury'' or "property damage" for which coverage is sought occurs; and (2) The "personal and advertising injury" for which coverage is sought is caused by an offense that is committed; subsequent to the signing of that contract or agreement by you. 5. Premium Audit a. We will compute all premiums for this Coverage Part in accordance with our rules and rates. b. Premium shown in this Coverage Part as advance premium is a deposit premium only. At the close of each audit perioo we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. c. The first Named Insured must keep records of the information we need for premium computation , and send us copies at such times as we may request. 6. Representations By accepting this policy, you agree: a. The statements in the Declarations are accurate and complete; b. Those statements are based upon representations you made to us; and c. We have issued this policy in reliance upon your representations. The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not prejudice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable insurance laws or regulations. 7. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or "suit" is brought. 8. Transfer Of Rights Of Recovery Against Others To Us If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred 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. 9. When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written not ice of the nonrenewal not less than 30 days before the expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice. SECTION V -DEFINITIONS 1. "Advertisement" means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. For the purposes of this definition: a. Notices that are published include material placed on the Internet or on similar electronic means of communication; and b. Regarding websites, only that part of a website that is about your goods, prooucts or services for the purposes of attracting customers or supporters is considered an advertisement. Page 16 of 21 © 2017 The Travelers Indemnity Company. All rights reserved. CG T1000219 Includes copyrighted material of Insurance Services Office, Inc. with its permiss ion. Policy #6806N033449 6806N0334496806N033449 COMMERCIAL GENERAL LIABILITY that is available to any of your "employees"occupational therapist or occupational for "bodily injury" that arises out of providingtherapy assistant, physical therapist or or failing to provide "incidental medicalspeech-language pathologist; or services" to any person to the extent not(b)First aid or "Good Samaritan services"subject to Paragraph 2.a.(1)of Section II –by any of your "employees" or "volunteer Who Is An Insured.workers", other than an employed or volunteer doctor. Any such "employees"K. MEDICAL PAYMENTS – INCREASED LIMIT or "volunteer workers" providing or failing The following replaces Paragraph 7.ofto provide first aid or "Good Samaritan SECTION III – LIMITS OF INSURANCE:services" during their work hours for you 7.Subject to Paragraph 5.above, the Medicalwill be deemed to be acting within the scope of their employment by you or Expense Limit is the most we will pay under performing duties related to the conduct Coverage C for all medical expenses of your business.because of "bodily injury" sustained by any one person, and will be the higher of:3.The following replaces the last sentence of Paragraph 5.of SECTION III – LIMITS OF a.$10,000; orINSURANCE: b.The amount shown in the Declarations ofFor the purposes of determining the this Coverage Part for Medical Expenseapplicable Each Occurrence Limit, all related Limit.acts or omissions committed in providing or failing to provide "incidental medical L. AMENDMENT OF EXCESS INSURANCE services", first aid or "Good Samaritan CONDITION – PROFESSIONAL LIABILITYservices" to any one person will be deemed The following is added to Paragraph 4.b.,to be one "occurrence".Excess Insurance, of SECTION IV –4.The following exclusion is added to COMMERCIAL GENERAL LIABILITYParagraph2.,Exclusions, of SECTION I –CONDITIONS: COVERAGES – COVERAGE A – BODILY This insurance is excess over any of the otherINJURY AND PROPERTY DAMAGE insurance, whether primary, excess, contingentLIABILITY:or on any other basis, that is ProfessionalSale Of Pharmaceuticals Liability or similar coverage, to the extent the "Bodily injury" or "property damage" arising loss is not subject to the professional services out of the violation of a penal statute or exclusion of Coverage A or Coverage B. ordinance relating to the sale of M. BLANKET WAIVER OF SUBROGATION –pharmaceuticals committed by, or with the WHEN REQUIRED BY WRITTEN CONTRACTknowledge or consent of the insured.OR AGREEMENT5.The following is added to the DEFINITIONS The following is added to Paragraph 8.,TransferSection: Of Rights Of Recovery Against Others To Us,"Incidental medical services" means:of SECTION IV – COMMERCIAL GENERAL a.Medical, surgical, dental, laboratory, x-LIABILITY CONDITIONS: ray or nursing service or treatment,If the insured has agreed in a written contract oradvice or instruction, or the related agreement to waive that insured's right offurnishing of food or beverages; or recovery against any person or organization, we b.The furnishing or dispensing of drugs or waive our right of recovery against such personmedical, dental, or surgical supplies or or organization, but only for payments we makeappliances.because of: 6.The following is added to Paragraph 4.b.,a."Bodily injury" or "property damage" thatExcess Insurance, of SECTION IV –occurs; orCOMMERCIAL GENERAL LIABILITY b."Personal and advertising injury" caused byCONDITIONS: an offense that is committed;This insurance is excess over any valid and subsequent to the signing of that contract orcollectible other insurance, whether primary, excess, contingent or on any other basis,agreement. CG D3 79 02 19 ú 2017 The Travelers Indemnity Company. All rights reserved.Page 5 of 6 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Policy #6806N033449                                                                                                                                            Policy #: BA7R748905