HomeMy WebLinkAboutCAG2021-333 - Original - Apply-A-Line, LLC - Off Duty Officers Flaging & Traffic Control - 06/10/2021ApprovalOriginator: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:
KENT POLICE SERVICES AGREEMENT
THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation
(hereinafter "Kent"), and Applv-A-Line, LLC , organized under the laws of
the State of wasnington, tocated and doing business at 175 Roy Rd SW Bldg C' Pacific WA
(hereinafter the "Contractor").
I. TERM *AGREEMENT" FURTHER DEFINED - INCORPORATION OF ATTACHMENTS
AND INSURANCE EXHIBIT. The term "Agreement" as used throughout this document shall
mean this document, and any and all Scope of Services Attachments (hereinafter
"Attachments") which describe the scope of services to be performed. The Attachments are
hereby incorporated into this Agreement by this reference. It is recognized that the Contractor
may request police services on several occasions, and therefore, while this main Agreement will
only be signed one time, there may be multiple Attachments to this Agreement. This Agreement
shall be lnforceable with regard to each instance of work performed pursuant to each
Attachment. In the event of a conflict between the terms of this Agreement and any
Attachment, the terms of this Agreement shall prevail.
The Insurance exhibit as required by Section IX of this Agreement shall also be incorporated into
this Agreement as if set forth herein in full.
II. SCOPE OF SERVICES. Contractor desires to utilize the services of a commissioned Kent
police officer who will be dedicated to performing the services described in the Attachment(s) to
this Agreement.
police officers shall only be permitted to provide police-related services during the performance
of the work called for herein, and Contractor shall not ask or solicit such police officers to
perform work that is not police-related.
III. COST OF SERVICES AND PAYMENT
A. Hourly Rate. Contractor shall pay to the Kent Police Department a sum for each
hour of worked performed by a commissioned police officer. The Chief of Police or his or her
designee shall have the authority to determine the hourly rate that will be specified in the
Attachment.
B. Four Hour Minimum Payment Requirement. There shall be a four (4) hour
minimum payment required for each instance that a police officer performs services under this
Agreement. Therefore, Contractor shall be required to pay to Kent the greater sum of four (4)
h6urs of work or the actual number of hours worked during each instance that a police officer
performs services. For example, if Contractor needs two (2) police officers to work on the same
day and at the same time for two (2) hours of work each, Contractor will be required to pay Kent
for four (4) hours for each police officer, for a total of eight (8) hours. If Contractor needs two
(2) police officers for six (6) hours each, Contractor shall pay for six (6) hours for each police
officer for a total of twelve (12) hours.
C. Holiday Shifts and Shifts in Excess of Ten Hours. Shifts performed on holidays
shall be subject to an increased hourly rate that will be specified in the Attachment. Shifts that
POLICE SERVICES AGREEMENT - 1 (Form version: t/2o16)
last in excess of ten (10) hours will be subject to a higher hourly rate for all work performed in
excess of ten (10) hours. The hourly rate for work performed in excess of ten (10) hours may
not be specified in the Attachment, but will be approximately at a rate of one and one-half (1.5)
times the regular hourly rate charged on that day. The Contractor will be billed and shall pay
the rate for work over ten (10) hours even if not specified in the Attachment.
D. Method and Time of Payment. Kent shall, within a reasonable time, submit a bill
to Contractor for amounts owing for services performed. Contractor shall, within fourteen (14)
calendar days of receipt of such bill, pay the amount owing to Kent. All payments shall be made
to the "City of Kent" and shall be delivered to:
City of Kent
Attn : Customer Services
220 Foufth Avenue South
Kent, WA 98032
E. Late Payment Penalties. If Contractor fails or neglects to pay any invoice within
thirty (30) calendar days from the date shown on the invoice as the "invoice date," a service
charge of one percent (Lo/o) of the amount of the unpaid balance on the account or two dollars
(92.00), whichever sum is greater, will be imposed one (1) month from the date payment was
due, and at the end of each succeeding monthly period, until all past due amounts are paid in
fu ll.
Any invoice or service charge due under this Agreement and unpaid shall constitute a debt
owed to Kent. Kent may, pursuant to Chapter 3.10 of the Kent City Code and Chapter 19'16 of
the Revised Code of Washington, use a collection agency to collect outstanding debts, or it may
seek collection by court proceedings, which remedies shall be in addition to all other remedies.
At the discretion of the Chief of Police or his or her designee, services may not be
provided to Contractors who have delinquent payments.
IV. EMERGENCY INTERRUPTIONS IN SERVICE. Police officers performing services called
for in this Agreement shall at all times be subject to the rules, regulations, and policies of Kent
and its Police Depaftment, and shall be required to follow the orders of supervisors and
command staff. Contractor understands that police officers performing services pursuant to this
Agreement may, from time to time, be required to pefform traditional police duties for the
benefit of the greater public. Therefore, from time to time, police officers performing services
for Contractor may be required to respond to emergencies and abandon the services being called
for under this Agreement. In the event of this occurrence, Contractor shall not be relieved of
providing full payment; provided, that in the event the interruption lasts longer that one half of
one hour (i.e., more than thirty (30) continuous minutes), Kent and Contractor will agree to an
amount of a reduction in the costs of services to account for the police officer's time not
pedorming services under this Agreement.
V. INDEMNIFICATION.
A. General. Contractor shall defend, indemnify, and hold Kent, 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 Kent's
performance of this Agreement, except for that portion of the injuries and damages caused by
the sole negligence of Kent or its officers or employees'
POLICE SERVICES AGREEMENT - 2 (Form Version: L/20I6)
IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE
INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE CONTRACTOR'S WAIVER OF
IMMUNIry UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF
THIS INDEMNIFICATION. THE PARTIES FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY
NEGOTIATED THIS WAIVER.
B. Indemnification and the Public Duty Doctrine. Contractor understands that,
pursuant to the legal doctrine in Washington called the "public duty doctrine," Kent, its Police
Department, and its officers and employees of the Kent Police Department, owe a general duty
to the public and not a specific duty of protection or care to the Contractor. Contractor
understands that by entering into this Agreement, the Police Department's and the police
officer's duties remain to the public in general, and neither Kent, its Police Department, nor any
of its officers or employees have a specific duty of protection or care to the Contractor, its
employees, subcontractors, and agents, or any of its guests, or other people on the premises of
the Contractor. Moreover, neither Kent, its Police Department, nor any officer or employee of
Kent guarantees, in any way, the safety of any person or property as a result of the work
performed under this Agreement. In the event of injury to any person or property, Contractor
shall not assert that Kent, its Police Department, or its police officer owed any special duty to
protect persons or property or provide care for such persons or property or had any special
relationship with the owner or any other person to protect persons or property. This Agreement
shall in no way create a duty for Kent, its Police Department, or any of its officers or employees
where none previously existed. In the event Kent is sued, and a court determines that the
public duty doctrine does not apply, or an exception to the public duty doctrine exists with
relation to an injury to the person or property of any employee, subcontractor, guest, or other
person on the premises of Contractor, Contractor shall specifically indemnify, hold harmless, and
defend Kent, its Police Department, and each and every officer and employee thereof to the full
extent permitted by law.
C. Survival. The provisions of this Section V shall survive the expiration or
termination of this Agreement and the obligations contained therein will continue to apply
beyond the provision of services called for in any Attachment.
VI. PARTIES ARE INDEPENDENT. The parties agree that neither shall be considered an
employee or agent of the other.
VII. TERMINATION, ALTERATION, OR RESCHEDULING. In the event Kent is unable to
obtain the services of a Kent Police Officer to perform the services called for in the Agreement,
Kent will contact Contractor, and advise Contractor that Kent is unable to perform the services
called for herein. Notice by way of telephone, email, writing, or in-person shall be adequate
notice of such cancellation of services, and Kent shall not be liable for the cost of Contractor
obtaining replacement services.
In the event Contractor must cancel, alter, or reschedule the services called for by this
Agreement, Contractor must provide at least ten and one-half (10.5) hours advance notice to
the Police Department by contacting its on-duty sergeant line at (253) 856-5840. A failure to
cancel, alter, or reschedule at least ten and one-half (10.5) hours before the services are called
for shall result in the Contractor paying the minimum four (4) hours of service provided for in
Section III.B. above, regardless of whether such services are provided at a later or rescheduled
date and time.
VIII. CONTRACTOR SHALL ABIDE BY LAWS AND SHALL NOT DISCRIMINATE. At AII
times during Kent's performance of this Agreement, Contractor shall abide by all laws and
POLICE SERVICES AGREEMENT - 3 (Formversion: r/2016)
regulations applicable to Contractor's business. Moreover, Contractor 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 in violation of any laws of the
State of Washington or the United States.
IX. INSURANCE. Contractor shall at all times during Kent's performance of the services
called for in this Agreement procure and maintain insurance of the types and in the amounts
described in Exhibit A attached and incorporated by this reference.
X. CONTRACTOR'S BUSINESS PERFORMED AT ITS OWN RISK. Contractor shall take all
necessary precautions and shall be responsible for the safety of its employees, agents, guests,
and all persons on Contractor's property and invitees at all times when a police officer is
performing services pursuant to this Agreement.
XI. MISCELLANEOUS PROVISIONS.
A. Non-Waiver of Breach. The failure of Kent 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.
B. Resotution 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
Kent's right to indemnification under Section V.B. of this Agreement.
C. 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.
D. 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.
E. 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
Kent and Contractor.
F. Entire Agreement. The written provisions and terms of this Agreement, together
with any Exhibits or Attachments attached hereto or referenced herein, shall supersede all prior
POLICE SERVICES AGREEMENT - 4 (Form version: t/20r6)
verbal statements of any officer or other representative of Kent, 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 or Attachments to this Agreement conflict with any
language contained in this Agreement, the terms of this Agreement shall prevail. Further, the
representative signing this Agreement on behalf of Contractor swears and affirms that he or she
is authorized to enter into this Agreement on behalf of Contractor and that action is binding on
the Contractor.
G. Compliance with Laws. Contractor agrees to comply with all federal, state, and
municipal laws, rules, and regulations that are now effective or in the future become applicable
to Contractor's business, equipment, and personnel engaged in operations covered by this
Agreement or accruing out of the performance of those operations.
H. Counterparts. This Agreement may be executed in any number of counterparts,
each of which shall constitute an original, and all of which will together constitute this one
Agreement.
IN WITNESS, the parties below execute this Agreement, which shall become
effective on the last date entered below.
CONTRACTOR:
By
(signature)
Ron ReillyPrint Name:
Assistant Vice President
(titte)
DATE: 05/UL2ozt
KENT:
By:Eal
(signature)
Print Nam e: Rafael Padilla-
Its Police Chief
DATE:0b. l()- >t
NOTICES TO BE SENT TO:
CONTRACTOR:
Attn Dave Bennett
175 Roy Rd SW BIdo C
Pacific WA 98047
253.299-L200
253.299-t250
(telephone)
(facsimile)
NOTICES TO BE SENT TO:
CITY OF KENT:
sqt.SGT Matt Stansfiel .l
City of Kent
220 Fourth Avenue South
Kent, WA 98032
(253) 856- 5809 (telephone)
(253) 856-6802 (facsimile)
E\ClviI.El6OFn FiE l tll.-hl'.6r DuryOv.'6m?,tolic ltrdq kvtq at'Gddl f.r af Duly *brkd.q
POLICE SERVICES AGREEMENT - 5 (Form Version: 1/2016)
KENT SCOPE OF SERVICES ATTACHMENT
To Police Services AgreementWasHrNctoN
Thi
by
I
II
s Scope of Services Attachment shall be incorporated into the Police
Apdy-A:!ns, LLC - (hereinafter "Contractor")
Services reement signed
on 05/2 202L
DESCRIPTION OF SERVICES. Contractor requests the services of a commissioned police
officer who will be dedicated to performing the following services (check box that applies):
tr Flagging/Traffic Control
tr Security for Entertainment Venue or Event
n Security for Retail Establishment
n Guarding of Property, Buildings, Possessions, or Equipment
Other
Police officers shall only be permitted to provide police-related services during the
performance of the work called for herein, and Contractor shall not ask or solicit such police
officers to perform work that is not police-related.
HOURLY RATE & NUMBER OF OFFICERS REQUIRED. The work called for herein shall be
paid by Contractor at the following hourly rates and the Contractor requests the following
number of officers:
n
A
Extra-Duty Work: Supervisor
Up to $100 per hour.x Number of Supervisors Required:-
* Note: Hourly rates are quoted "up to" a specified amount, Officers are paid different rates
based on factors such as time in service, assignment, education, etc, The rate quoted is the
maximum rate that will be billed subject to overtime holiday rates specified below'
Contractor's rate may be lower.
Four Hour Minimum. There shall be a four (4) hour minimum payment required for
each instance that a police officer performs services under the Agreement. Therefore,
Contractor shall be required to pay to Kent the greater sum of four (4) hours of work
or the actual number of hours worked during each instance that a police officer
performs services, For example, if Contractor needs two (2) officers to work on the
same day and at the same time for two (2) hours of work each, Contractor will be
required to pay Kent for four (4) hours for each police officer, for a total of eight (8)
hours. If Contractor needs two (2) officers for six (6) hours each, Contractor shall pay
for six (6) hours for each police officer for a total of twelve (12) hours.
Extra-Duty Work: Officer
Up to $80 per hour.x Number of Officers Required ' 2
SCOPE OF SERVICES ATTACHMENT TO POLICE SERVICES AGREEMENT
Page 1 of 2 (Form Version: I2/2OI7
Overtime Rate. Contractor shall be required to pay the rate of one and one half (1,5)
times the rate specified above for any time worked by a police officer in excess of ten
(10) hours in a shift, Therefore, if a police officer works ten (10) hours, he or she
shall be paid at the rate specified above. If the officer works twelve (12) hours, he or
she shall be paid at the rate specified above for the first ten (10) hours, and at a rate
of one and one half (1.5) times the rate specified above for the remaining two (2)
hours,
Hotidav Rate. The following holidays are observed by Kent police officers: New Year's
Day, Martin Luther King Day, President's Day, Memorial Day, Independence Day,
Labor Day, Veteran's Day, Thanksgiving DaY, Day after Thanksgiving, and Christmas.
Except as otherwise provided in this section, all hours worked during an observed
holiday, or during 15;00 hours to 23:59 hours on Christmas Eve or New Year's Eve,
will be billed at one and a half (1.5) times the rate specified above. All hours worked
on Thanksgiving Day or Christmas Day will be billed at a rate of two (2.0) times the
rate specified above.
D Contractor's Termination Alteration or Reschedulina of Services. Cancellation,
alteration, or rescheduling of police officer services by the Contractor for a specific
date must be made at least ten and a one-half (10.5) hours prior to the scheduled
staft time for that date. If Contractor fails to provide ten and one-half (10.5) hours
advance notice from the scheduled stat time, Contractor will be billed for a minimum
payment of four (4) hours per officer scheduled for that date in accordance with
Section ILA. above. Cancellation, alteration, or rescheduling notification can be made
by phone or email,
In. LOCATION OF SERVICES. The services called for herein shall be performed at the following
location:
Please see attached list.
A police officer will arrive at the above location on the date and time specified below'
IV. DATE AND R SERVICES. Contractor a Kent police officer provide services
from 8:00 , _L02.@L to rt,2o2_L
By signing below, I understand that I am entering a contract to hire police officers to perform the
work described above, I agree to the terms of this Scope of Services Attachment and all of the terms
contained within the Police Services Agreement referenced herein, and finally if I am signing this
Scope of Services Attachment on behalf of an organization, I swear and affirm that I am authorized
to do behalf of the organization and that action is binding on the Contractor
l os/27/202t
Signature Date
Ron Reilly, Assistant Vice President
B
c
Print Name
175 Roy Rd SW Bldg C
Address
Pacific WA 98047
SCOPE OF SERVICES ATTACHMENT TO POLiCE SERVICES AGREEMENT
Page 2 of 2
Approved by
Kent ce Department
(Form Version : t2l2ot7)
Locations of Services:
lntersection of 68th Ave S / S 2t2th St (N)
lntersection of 58th Ave S / S 2t2th St (S)
lntersection of 4th Ave N / W James St (S)
lntersection of Central Ave N / E James St (N)
lntersection of 116th Ave SE / SE Kent Kangley Rd (E)
DATE (MM/DDTYYYY}
3t412021
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFTCATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: lf the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed'
lf SUBROGATION lS 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).
PRoDUGER LoCKI'ON CoMPANIES
3657 BRIARPARK DRIVE, SUITE 7OO
HOUSTON TX77Q42
866-260-3538
PHONE
lAlC. No. Exi):
INSIIRFRTSI AFFORDING COVERAGE NAIC f
tNsuRERA: Zurich Anerican Insurance Cotnpany 1 6535
INSURED Frontline Road Safety Holdings, LLC
Aoolv-A-Line. LLC
175 Rov Road SW, Blds C
Pacific WA 98047
r485069
rNsr.rRER B , American Guarantee and Liab. Ins. Co.).o.47
INSURER C
INSIIPFR D :
INCI IDFE F
INSIIPFR F.
A,CORE'"\--'CERTIFIGATE OF LIABILITY INSURANCE
See
@1988-2015 ACORD
The ACORD name and logo are registered marks of ACORD
ilt/2022
sTEDBELoWHAVEBEENlSsUEDToTHElNSUREDNAMEDABoVEFoRTHEPoLlcYPERloD
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.
LIMITSPOLICY NUMBERTYPE OF INSURANCE
=ACH OCCIJRRFNCF s 2.000.000
n 300.000
MFn FXP aAnv oha oerson)q 10.000
PERSONAL & ADV INJURY s 2.000.000
NFNFRAI AGGRFGATF s 4-000.000
PRODUCTS. COMP/OP AGG s 4.000.000
$
1/1/2021 v1/2022YYcl-o 3002387 00ACOMMERCIAL GENERAL LIABILITY
::::Jtr58; nLo"
ECLAIMS-MADE OCCUR
s 1.000.000
$ XXXXXXXBoDILY INJURY (Per person)
$ XXXXXXXBODILY INJURY (Per accidenl
$ XXXXXXX
$ XXXXXXX
11112021 1/t/2022YYBAP 3088737 00AAUTOMOBILE LIABILITY
ANY AUTO
OWNED
AUTOS ONLY
HIRED
AUTOS ONLY
SCHEDULED
AUTOS
NON-OWNED
AUTOS ONLY
:ACH OCCURRENCE $ 5.000.000XX
\GGREGATE $ 5.000"000
UMBRELLA LIAB
EXCESS LIAE
$ 5_000-000
t/11202r 1/t/2022
Pro-Com Ops Agg
Y Y AIJC 3 109785 00B
DED RETENTION $
PER
STATI ITF X IOJ#
:,1. EACH ACCIDENT s 1.000.000
:.1. DISEASE - EA EI\4PLOYEE s 1.000.000. 1.000 000
t/1/202r |1t2022
: I DISFASF . POI ICY I IMIT
N/A
Y wc 3002388 00AWORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOFYPARTNEFYEXECUTIVE
OFFICER'MEMBER EXCLUDED?
(Mandatory ln NH)
lf ves. doscdbs undgr
DEscRtPTtoN oF oPERATtoNS betow
N
DESCRIPT|ON OF OpERATTONS / LOCATTONS / VEHICLES (ACORD lOl, Additional Remarks schedule, may be aftached if moro spacs is
RE: PROJECT: AAL#145A6254 - 2021 PLASTIC MARKINGS PROJECT NO. 21-3011.2.
required)
AUTHORlzED
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THEEXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
17400549
CITY OF KENT
4OO W GOWE
KENT WA 98032
ACORD 25 (2016/03)rights reserved
All policies include a blanket notice of cancellation to certificate holders endorsementn providing for 30 days'.
advance notice if the policy is cancelled by the company other than for no4payment-of premium,.l0 days'notice if
the policy is cancelled for honpayment of premium. Notice is sent to certificate holders with mailing addresses on
nte wittr ihe agent or the company. The endorsement does not provide for notice of cancellation if the named
insured requests cancellation.
coNTtNUAT|ON DESCRtpflON OF OPERATTONS/LOCATTONS/VEHtCLES/EXCLUSTONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS (Uss only if more space is requlred)
ACORD 25 (2016/03)Certificate Holder ID: 17400549
Attachment Code : D581632 Master ID: 1485069, Certificate ID:17400549
All policies (except Workers'Compensation/El) include a blanket automatic additional insured fprovision]
that confers additional insured status to the certificate holder only if there is a written contract between
the named insured and the certificate holder that requires the named insured to name the certificate
holder as an additional insured. In the absence of such a contractual obligation on the part of the named
insured, the certificate holder is not an additional insured under the policy.
All policies include a blanket automatic waiver of subrogation endorsement fprovision] that provides this
feature only when there is a written contract between the named insured and the certificate holder that
requires it. In the absence of such a contractual obligation on the part of the named insured, the waiver
of subrogation feature does not apply.
Attachment Code : D585637 Master ID: 1485069, Certificate lD: 17400549
a
oAdditional Insured - Automatic - Owners, Lessees Or
Contractors
ZURICH
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Named lnsured: Frontline Road Safety Holdings, LLC; Stripe-A-Zone,lnc.;Apply-A-Line, LLC; Griffin Pavement Services
Address (including ZIP Gode): 9 Greenway Plaza, Suite 2400, Houston, TX 77046
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
A. Section ll - Who ls An Insured is amended to include as an additional insured any person or organization whom you
are required to add as an additional insured on this policy under a written contract or written agreement. Such
person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or
"personal and advertising injury" caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf,
in the performance of your ongoing operations or "your work" as included in the "products-completed operations
hazard", which is the subject of the written contract or written agreement.
However, the insurance afforded to such additional insured:
1. Only applies to the extent permitted by law; and
2. Will not be broader than that which you are required by the written contract or written agreement to provide for
such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following additionalexclusion applies:
This insurance does not aPPIY to:
"Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to
render, any professional architectural, engineering or surveying services including:
a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys,
field orders, change orders or drawings and specifications; or
b. Supervisory,inspection, architecturalorengineeringactivities.
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the
supervision, hiring,'employment, training or monitoring of others by that insured,_ if the "occurrence" which caused the
,,bodily injury" or-"property damage", oithe offense which caused the "personal and advertising injury", involved the
rendering of or the faiiure to render any professional architectural, engineering or surveying services.
u-GL-1175-F CW (04/13)
Page 1 of 2
Policy No.Eff. Date of Pol.Exp. Date of Pol.Efi. Date of End Producer No.Add'1. Prem Return Prem.
G1O3002387 00 11112021 1t1t2022 1t1t2021
lncludes copyrighted material of lnsurance services office, lnc., with its permission.
Attachment Code : D585637 Master ID: 1485069, Certificate lD: 17400549
C. The following is added to Paragraph 2. Duties ln The Event Of Occurrence, Offense, Claim Or Suit of Section lV -
Commercial General Liability Conditions:
The additional insured must see to it that:
i. We are notified as soon as practicable of an "occurrence" or offense that may result in a claim;
2, We receive written notice of a claim or "suit" as soon as practicable; and
3. A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by
another insurer under which the additional insured may be an insured in any capacity. This provision does not
apply to insurance on which the additional insured is a Named lnsured if the written contract or written agreement
requires that this coverage be primary and non-contributory.
D. For the purposes of the coverage provided by this endorsement:
1. The following is added to the Other lnsurance Condition of Section lV - Commercial General Liability
Conditions:
Primary and Noncontributory insurance
This insurance is primary to and will not seek contribution from any other insurance available to an additional
insured provided that:
a. The additional insured is a Named lnsured under such other insurance; and
b. You are required by written contract or written agreement that this insurance be primary and not seek
contribution from any other insurance available to the additional insured.
2. The following paragraph is added to Paragraph 4.b. of the Other lnsurance Condition of Section lV - Commercial
General Liability Conditions:
This insurance is excess over:
Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional
insured, in which the additional insured on our policy is also covered as an additional insured on another policy
providing coverage for the same "occurrence", offense, claim or "suit". This provision does not apply to any
'poticy
in wnich the additional insured is a Named lnsured on such other policy and where our policy is required by
a written contract or written agreement to provide coverage to the additional insured on a primary and
non-contributory basis.
E. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement
showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to
that identified additional insured.
F. With respect to the insurance afforded to the additional insureds under this endorsement, the following is added to
Section lll- Limits Of lnsurance:
The most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the written contract or written agreement referenced in Paragraph A. of this endorsement; or
2. Available under the applicable Limits of lnsurance shown in the Declarations,
whichever is less.
This endorsement shall not increase the applicable Limits of lnsurance shown in the Declarations.
All other terms and conditions of this policy remain unchanged
u-GL-1175-F CW (04/13)
Page 2 ot 2
lncludes copyrighted material of lnsurance services office, lnc., with its permission.
Attachment Code : D585638 Master ID: 1485069, Certificate lD: 17400549
a
ZURICH
Limited Operations Coverage - Work
Excluded Under A Consolidated (Wrap-Up)
Insurance Program
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREF'ULLY.
Named Insured: Frontline Road Safety Holdings, LLC; Stripe-A-Zone, lnc.; Apply-A-Line, LLC; Griffin Pavement
Services
Address (including ZIP Code): 9 Greenway Plaza, Suite 2400, Houston, TX 77046
This endorsement modifies insurance provided under the
Commercial General Liability Coverage Part
SCHEDULE
Description and Location of Operation(s)
(lf no entrv above. information ired to comolete this endo rsement will be shown in the Declarations
Policy No.Exp. Date of Pol.Eff. Date of End.Agency No.Addl. Pretn.Retum Prem.
GLO 3002387 00 t/r/2022 Ul12021
as appl icable to this endorsement.)
A. The following exclusion is added to paragraph 2., Exclusions of Goverage A - Bodily lnjury and Property
Damage Liability (Section l- Coverages):
This insurance does not apply to "bodily injury" or "property damage" arising out of either your ongoing
operations or operations included within the "products-completed operations hazard" at the location described
in the SGHEDULE of this endorsement, as a consolidated (wrap-up) insurance program has been provided
by the prime contractor/project manager or owner of the construction project in which you are involved.
This exclusion applies whether or not the consolidated (wrap-up) insurance program
1. Provides coverage identical to that provided by this Coverage Part;
2. Has limits adequate to cover all claims; or
3. Remains in effect.
B. The exclusion in A. above shall not apply to your ongoing operations at the location shown in the
SCHEDULE - for your service, maintenance, correction, repair or replacement of the original work performed
and insured under the consolidated wrap-up insurance program'
\J-GL-12s4-Acw (10/06)
Page I of2
Attachment Code : D585638 Master ID: 1485069, Certificate lD: 17400549
However, this extension of coverage does not apply to damages because of "bodily injury" or "property
damage" due to any service, maintenance, correctiOn, repair or replacement work:
1. as respects the "products-completed operations hazard"; or
2. for which coverage is afforded under the consolidated (wrap-up) insurance program.
.G. For the application of the coverage provided by this endorsement in paragraph B. above, SECTION lV -
COMMERCIAL GENERAL LIABILITY CONDITIONS paragraph 4 Other Insurance is replaced by the
following:
This insurance is excess over any other insurance, whether primary, excess, contingent or on any. other
basis. lf any other insurance responds or can respond to this loss, we shall have the right but not the duty to
defend any "srJit".
When 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
2. 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 may apply and that was not bought
specifically to apply in excesl of the Limits of lnsurance shown in the Declarations of this Coverage Part.
Countersigned
Authorized Representative
U-GL-1294-A CW (10/06)
Page 2 of2
Attachment Code : D585639 Master ID: 1485069, Certificate ID: 17400549
WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY
wc 04 03 06 (Ed.4-84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
E N DORSEM ENT_CALI FORN IA
This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a
different date is indicated below.
(The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.)
at 12:01 A.M. standard time, forms a part ofThis endorsement, effective on
Policy No, WC 3002388 00
of the
issued to
Premium (if any) $
1111202'l
Endorsement No.
Zurlch American lnsurace Company
Authorized Representative
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not
enforce our right against the person or organization named in the Schedule. (This agreement applies only to the
extent that you perform work under a written contract that requires you to obtain this agreement from us.)
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in
the work described in the Schedule.
The additional premium for this endorsement shall be % of the California workers' compensation pre-
mium otherwise due on such remuneration.
Schedule
Person or Organization Job Description
ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR
AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF
SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT
PERSON AN D/OR ORGANIZATION.
wc 252 (4-84)
wc 04 03 06 (Ed.4-84)Page 1 of 1
Attachment Code : D585640 Master ID: 1485069, Certificate lD:17400549
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY wc4203048
(Ed.6-14)
TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
This endorsement applies only to the insurance provided by the policy because Texas is shown in ltem 3.A. of the
lnformation Page.
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce
our right againJt the person or organization named in the Schedule, but this waiver applies only with respect to bodily
injuryLrising out of the operationi described in the Schedule where you are required by a written contract to obtain
this waiver from us.
This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
The premium for this endorsement is shown in the Schedule.
Schedule
1. ( )Specific Waiver
Name of person or organization
( X )Blanket Waiver
Any person or organization for whom the Named lnsured has agreed by written contract to furnish this
waiver.
2. Operations:
3. Premium:
The premium charge for this endorsement shall be 2% percent of the premium developed on payroll
in connection with work performed for the above person(s) or organization(s) arising out of the operations
described.
4. Advance Premium:
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherurrise stated'
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective 11112021 Policy No. WC 3002388 00 Endorsement No.
lnsured Frontline Road Safety Holdings, LLC; Stripe-A-Zone, lnc.; Apply-A-Line, LLC; Griffin Pavement Services
lnsurance Company Countersigned by
Premium
wc4203048
(Ed. 06-14)
@ Copyright 2014 National Council on Compensation lnsurance, lnc. All Rights Reserved. Page 1 of 1
Wolters Kluwer Financial Services I Uniform FormsTM
Attachment Code : D585641 Master ID: 1485069, Certificate lD: 17400549
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY wc 00 0313
(Ed.04-84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not
enforce our riglit against the person ilr organization named in the Schedule. (This agreement applies only to the
extent that you perform work under a written contract that requires you to obtain this agreement from us.)
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule'
Schedule
ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR
AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF
SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT
PERSON AND/OR ORGANIZATION.
This endorsement changes the policy to which it is attached and is effective on the date issued unless othenivise stated'
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective Policy No. WC 3002388 00 Endorsement No.
lnsured Frontline Road Safety Holdings, LLC; Stripe-A-Zone,lnc.;Apply-A-Line, Premium $
LLC; Griffin Pavement Services
lnsurance company Zurich American lnsurance company countersigned by
wc124 (4-841
wc 00 0313
Page 1 of 1
Uniform FormsTMCopyright 1983 National Council on Compensation lnsurance, lnc.
Attachment Code : D585642 Master ID: 1485069, Certificate ID:17400549
Coverage Extension Endorsement
re
ZURICH
o
Policy No.Eff. Date of Pol Exp. Date of Pol.Eff. Date of End.Producer No.Add'|. Prem Return Prem.
BAP 3088737 00 1nt2a21 1t1t2022 1t1t2022
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Business Auto Coverage Form
Motor Garrier Goverage Form
A. Amended Who ls An lnsured
1. The following is added to the Who ls An lnsured Provision in Section ll - Covered Autos Liability Coverage:
The following are also "insureds":
a. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow for acts
performed within the scope of employment by you. Any "employee" of yours is also an "insured" while
operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your
permission, while performing duties related to the conduct of your business.
b. Anyone volunteering services to you is an "insured" while using a covered "auto" you don't own, hire or
borrow to transport your clients or other persons in activities necessary to your business.
c. Anyone else who furnishes an "auto" referenced in Paragraphs A.1.a. and A.1.b. in this endorsement.
d. Where and to the extent permitted by law, any person(s) or organization(s) where required by written contract
or written agreement with you executed prior to any "accident", including those person(s) or organization(s)
directing your work pursuant to such written contract or written agreement with you, provided the "accident"
arises out of operations governed by such contract or agreement and only up to the limits required in the
written contract or written agreement, or the Limits of lnsurance shown in the Declarations, whichever is less.
2. The following is added to the Other lnsurance Condition in the Business Auto Coverage Form and the Other
lnsurance - Primary and Excess lnsurance Provisions Condition in the Motor Carrier Coverage Form:
Coverage for any person(s) or organization(s), where required by written contract or written agreement with you
executed prior to any "accident", will apply on a primary and non-contributory basis and any insurance maintained
by the additional "insured" will apply on an excess basis. However, in no event will this coverage extend beyond
the terms and conditions of the Coverage Form.
B. Amendment - Supplementary Payments
Paragraphs a.(2) and a.(4) of the Goverage Extensions Provision in Section ll - Covered Autos Liability
Goverage are replaced by the following:
(2) Up to $5,000 for the cost of bail bonds (including bonds for related traffic law violations) required because of an
"accident" we cover. We do not have to furnish these bonds.
(4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a
day because of time off from work.
u-cA424-F CW (04/14)
Page 1 of6
lncludes copyrighted material of lnsurance Services Office, lnc., with its permission.
Attachment Code : D585642Masteu ID: 1485069, Certificate lD:17400549
C. Fellow Employee Goverage
The Fellow Employee Exclusion contained in Section ll- Covered Autos Liability Goverage does not apply.
D. Driver Safety Program Liability and Physical Damage Goverage
1. The following is added to the Racing Exclusion in Section ll - Govered Autos Liability Goverage:
This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not
limited to, auto or truck rodeos and other auto or truck agility demonstrations.
Z. The following is added to Paragraph 2. in the Exclusions of Section lll - Physical Damage Coverage of the
Business Auto Coverage Form and Paragraph 2.b. in the Exclusions of Section lV - Physical Damage
Coverage of the Motor Carrier Coverage Form:
This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not
limited to, auto or truck rodeos and other auto or truck agility demonstrations.
E. Lease or Loan Gap Coverage
The following is added to the Coverage Provision of the Physical Damage Coverage Section:
Lease Or Loan Gap Coverage
ln the event of a total "loss" to a covered "auto", we will pay any unpaid amount due on the lease or loan for a covered
"auto", less:
a. Any amount paid under the Physical Damage Coverage Section of the Coverage Form; and
b. Any:
(1) Overdue lease or loan payments at the time of the "loss";
(2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage;
(3) Security deposits not returned by the lessor;
(4) Costs for extended warranties, credit life insurance, health, accident or disability insurance purchased with the
loan or lease; and
(5) Carry-over balances from previous leases or loans.
F. Towing and Labor
Paragraph A.2. of the Physical Damage Coverage Section is replaced by the following:
We will pay up to $75 for towing and labor costs incurred each time a covered "auto" of the private passenger type is
disabled. However, the labor must be performed at the place of disablement.
G. Extended Glass Coverage
The following is added to Paragraph A.3.a. of the Physical Damage Coverage Section:
lf glass must be replaced, the deductible shown in the Declarations will apply. However, if glass can be repaired and
is lctually repaired rather than replaced, the deductible will be waived. You have the option of having the glass
repaired rather than replaced.
H. Hired Auto Physical Damage - lncreased Loss of Use Expenses
The Coverage Extension for Loss Of Use Expenses in the Physical Damage Coverage Section is replaced by the
following:
Lo6s Of Use Expenses
For Hired Auto Physical Damage, we will pay expenses for which an "insured" becomes legally responsible to pay for
loss of use of a vehicle rented or hired without a driver under a written rental contract or written rental agreement.
We will pay for loss of use expenses if caused by:
u-cA424-F CW (04/14)
Page 2 of 6
lncludes copyrighted material of lnsurance Services Office, lnc., with its permission'
Attachment Code : D585642 Master ID: 1485069, Certificate lD: 17400549
(1) Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for any covered
"auto";
(2) Specified Causes Of Loss only if the Declarations indicate that Specified Causes Of Loss Coverage is provided
for any covered "auto"; or
(3) Collision only if the Declarations indicate that Collision Coverage is provided for any covered "auto".
However, the most we will pay for any expenses for loss of use is $100 per day, to a maximum of $3000'
l. Personal Effects Coverage
The following is added to the Coverage Provision of the Physical Damage Coverage Section:
Personal Effects Coverage
a. We will pay up to $750 for "loss" to personal effects which are:
(1) Personal property owned by an "insured"; and
(2) ln or on a covered "auto".
b. Subject to Paragraph a. above, the amount to be paid for "loss" to personal effects will be based on the lesser of:
(1) The reasonable cost to replace; or
(2) The actual cash value.
c. The coverage provided in Paragraphs a. and b. above, only applies in the event of a total theft of a covered
"auto". No deductible applies to this coverage. However, we will not pay for "loss" to personal effects of any of
the following:
(1) Accounts, bills, currency, deeds, evidence of debt, money, notes, securities, or commercial paper or other
documents of value.
(2) Bullion, gold, silver, platinum, or other precious alloys or metals; furs or fur garments; jewelry, watches,
precious or semi-precious stones.
(3) Paintings, statuary and other works of art.
(4) Gontraband or property in the course of illegal transportation or trade.
(5) Tapes, records, discs or other similar devices used with audio, visual or data electronic equipment.
Any coverage provided by this Provision is excess over any other insurance coverage available for the same "loss".
J. Tapes, Records and Discs Coverage
1. The Exclusion in Paragraph B.4.a. of Section lll - Physical Damage Goverage in the Business Auto Coverage
Form and the Exclusion in Paragraph 8.2.c. of Section lV - Physical Damage Coverage in the Motor Carrier
Coverage Form does not aPPlY.
2. The following is added to Paragraph 1.a. Comprehensive Coverage under the Coverage Provision of the
Physical Damage Coverage Section:
We will pay for "loss" to tapes, records, discs or other similar devices used with audio, visual or data electronic
equipment. We will pay only if the tapes, records, discs or other similar audio, visual or data electronic devices:
(a) Are the property of an "insured"; and
(b) Are in a covered "auto" at the time of "loss".
The most we will pay for such "loss" to tapes, records, discs or other similar devices is $500. The Physical
Damage Goverage Deductible Provision does not apply to such "loss".
u-cA-424-F CW (04t14)
Page 3 of 6
lncludes copyrighted material of lnsurance Services Office, lnc., with its permission.
Attachment Code ; D585642 Master ID: 1485069, Certificate lD: 17400549
K. Airbag Goverage
The Exclusion in Paragraph B.3.a. of Section lll - Physical Damage Coverage in the Business Auto Coverage Form
and the Exclusion in Paragraph 8.4.a. of Section lV - Physical Damage Coverage in the Motor Carrier Coverage
Form does not apply to the accidental discharge of an airbag'
L. Two or More Deductibles
The following is added to the Deductible Provision of the Physical Damage Coverage Section:
lf an accident is covered both by this policy or Coverage Form and by another policy or Coverage Form issued to you
by us, the following applies for each covered "auto" on a per vehicle basis:
1. lf the deductible on this policy or Coverage Form is the smaller (or smallest) deductible, it will be waived; or
2. lf the deductible on this policy or Coverage Form is not the smaller (or smallest) deductible, it will be reduced by
the amount of the smaller (or smallest) deductible.
M. Physical Damage - Gomprehensive Goverage - Deductible
The following is added to the Deductible Provision of the Physical Damage Coverage Section:
Regardless of the number of covered "autos" damaged or stolen, the maximum deductible that will be applied to
Comprehensive Coverage for all "loss" from any one cause is $5,000 or the deductible shown in the Declarations,
whichever is greater.
N. Temporary Substitute Autos - Physical Damage
1. The following is added to Section l- Covered Autos:
Temporary Substitute Autos - Physical Damage
lf Physical Damage Coverage is provided by this Coverage Form on your owned covered "autos", the following
types of vehicles are also covered "autos" for Physical Damage Coverage:
Any "auto" you do not own when used with the permission of its owner as a temporary substitute for a covered
"auto" you do own but is out of service because of its:
1. Breakdown;
2. Repair;
3. Servicing;
4. "Loss"; or
5. Destruction.
2. The following is added to the Paragraph A. Coverage Provision of the Physical Damage Coverage Section:
Temporary Substitute Autos - Physical Damage
We will pay the owner for "loss" to the temporary substitute "auto" unless the "loss" results from fraudulent acts or
omissions on your part. lf we make any payment to the owner, we will obtain the owner's rights against any other
party.
The deductible for the temporary substitute "auto" will be the same as the deductible for the covered "auto" it
replaces.
O. Amended Duties ln The Event Of Accident, Glaim, Suit Or Loss
paragraph a. of the Duties ln The Event Of Accident, Glaim, Suit Or Loss Condition is replaced by the following:
a. ln the event of "accident", claim, "suit" or "loss", you must give us or our authorized representative prompt notice
of the "accident", claim, "suit" or "loss". However, these duties only apply when the "accident", claim, "suit" or
"loss" is known to you (if you are an individual), a partner (if you are a partnership), a member (if you are a limited
liability company) or an executive officer or insurance manager (if you are a corporation). The failure of any
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lncludes copyrighted material of lnsurance services office, lnc., with its permission.
Attachment Code : D585642 Master ID: 1485069, Certihcate lD: 17400549
agent, servant or employee of the "insured" to notify us of any "accident", claim, "suit" or "loss" shall not invalidate
the insurance afforded by this policy.
lnclude, as soon as practicable:
(l) How, when and where the "accident" or "loss" occurred and if a claim is made or "suit" is brought, written
notice of the claim or "suit" including, but not limited to, the date and details of such claim or "suit";
(2) The "insured's" name and address; and
(3) To the extent possible, the names and addresses of any injured persons and witnesses.
lf you report an "accident", claim, "suit" or "loss" to another insurer when you should have reported to us, your
failure to report to us will not be seen as a violation of these amended duties provided you give us notice as soon
as practicable after the fact of the delay becomes known to you.
P. Waiver of Transfer Of Rights Of Recovery Against Others To Us
The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition:
This Condition does not apply to the extent required of you by a written contract, executed prior to any "accident" or
"loss", provided that the "accident" or "loss" arises out of operations contemplated by such contract. This waiver only
applies to the person or organization designated in the contract.
Q. Employee Hired Autos - Physical Damage
Paragraph b. of the Other lnsurance Condition in the Business Auto Coverage Form and Paragraph f. of the Other
lnsurance - Primary and Excess lnsurance Provisions Condition in the Motor Carrier Coverage Form are replaced
by the following:
For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own:
(1) Any covered "auto" you lease, hire, rent or borrow; and
(2) Any covered "auto" hired or rented under a written contract or written agreement entered into by an "employee" or' -
elected or appointed ofiicial with your permission while being operated within the course and scope of that
"employee's" emptoyment by you or that elected or appointed official's duties as respect their obligations to you.
However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto".
R. Unintentional Failure to Disclose Hazards
The following is added to the Concealment, Misrepresentation Or Fraud Condition:
However, we will not deny coverage under this Coverage Form if you unintentionally:
(1) Fail to disclose any hazards existing at the inception date of this Coverage Form; or
(2) Make an error, omission, improper description of "autos" or other misstatement of information.
You must notify us as soon as possible after the discovery of any hazards or any other information that was not
provided to us prior to the acceptance of this policy.
S. Hired Auto - World Wide Coverage
Paragraph 7a.(5) of the Policy Period, Goverage Territory Condition is replaced by the following:
(5) Anywhere in the world if a covered "auto" is leased, hired, rented or borrowed for a period of 60 days or less,
T. Bodily lnjury Redefined
The definition of "bodily injury" in the Definitions Section is replaced by the following:
,'Bodily injury" means bodily injury, sickness or disease, sustained by a person including death or mental anguish,
resulting from any of these at any time. Mental anguish means any type of mental or emotional illness or disease.
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lncludes copyrighted material of lnsurance Services Office, lnc., with its permission.
Attachment Code : D585642 Master ID: 1485069, Certificate lD: 17400549
U. Expected Or lntended lnjury
The Expected Or lntended Injury Exclusion in Paragraph B. Exclusions under Section ll - Covered Auto Liability
Coverage is replaced by the following:
Expected Or lntended Injury
"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 from the use of reasonable force to protect persons or
property.
V. Physical Damage - Additional Temporary Transportation Expense Coverage
Paragraph A.4.a. of Section lll- Physical Damage Goverage is replaced by the following:
4. Coverage Extensions
a. Transportation ExPenses
We will pay up to $50 per day to a maximum of $1,000 for temporary transportation expense incurred by you
because of the total theft of a covered "auto" of the private passenger type. We will pay only for those
covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage. We will
pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and
ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its
"loss".
W. Replacement of a Private Passenger Auto with a Hybrid or Alternative Fuel Source Auto
The following is added to Paragraph A. Goverage of the Physical Damage Goverage Section:
ln the event of a total "loss" to a covered "auto" of the private passenger type that is replaced with a hybrid "auto" or
"auto" powered by an alternative fuel source of the private passenger type, we will pay an additional 10% of the cost
of the replacement "auto", excluding tax, title, license, other fees and any aftermarket vehicle upgrades, up to a
maximum of $2500. The covered "auto" must be replaced by a hybrid "auto" or an "auto" powered by an alternative
fuel source within 60 calendar days of the payment of the "loss" and evidenced by a bill of sale or new vehicle lease
agreement.
To qualify as a hybrid "auto", the "auto" must be powered by a conventional gasoline engine and another source of
propulsion power. The other source of propulsion power must be electric, hydrogen, propane, solar or natural gas,
either compressed or liquefied. To qualify as an "auto" powered by an alternative fuel source, the "auto" must be
powered by a source of propulsion power other than a conventional gasoline engine. An "auto" solely propelled by
biofuel, gasoline or diesel fuel or any blend thereof is not an "auto" powered by an alternative fuel source.
X. Return of Stolen Automobile
The following is added to the Goverage Extension Provision of the Physical Damage Coverage Section:
lf a covered "auto" is stolen and recovered, we will pay the cost of transport to return the "auto" to you' We will pay
only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage'
All other terms, conditions, provisions and exclusions of this policy remain the same.
u-cA-424-F CW (04t14)
Page 6 of 6
lncludes copyrighted material of lnsurance services office, lnc., with its permission
Attachment Code : D585643 Master ID: 1485069, Certificate lD:17400549
Waiver Of Subrogation (Blanket) Endorsement
o
ZURICH
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREF'ULLY
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition:
If you are required by a written contract or agreement, which is executed before a losso to waive your rights of recovery from
others, we agree to waive our rights of recovery. This waiver of rights shall not be construed to be a waiver with respect to any
other operations in which the insured has no contractual interest.
U-GL-925-B CW (12101)
Page I of I
Policy No.Eff. Date of Pol.Exp. Date of Pol.Eff. Date of End.Producer Add'I. Prem Retum Prem.
cl,o 3002387 00 t/t/2021 t/U2022 U1/2021 Lockton Companies $$
Attachment Code : D585644 Master ID: 1485069, Certificate lD: 17400549
a
Notification to Others of Cancellation ZURICH
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Gommercial Automobile Coverage Part
A. lf we cancel this Coverage Part by written notice to the first Named lnsured for any reason other than nonpayment of
premium, we will mail or deliver a copy of such written notice of cancellation:
1. To the name and address corresponding to each person or organization shown in the Schedule below; and
2. At least 10 days prior to the effective date of the cancellation, as advised in our notice to the first Named lnsured,
or the longer number of days notice if indicated in the schedule below.
B. lf we cancel this Coverage Part by written notice to the first Named lnsured for nonpayment of premium, we will mail
or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or
organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation.
C. lf notice as described in paragraphs A. or B. of this endorsement is mailed, proof of mailing will be sufficient proof of
such notice.
All other terms and conditions of this policy remain unchanged
u-cA-812-A CW (05/10)
Page 1 of 1
r)
Policy No.Eff. Date of Pol.Exp. Date of Pol.Eff. Date of End.Producer No Add'|. Prem Return Prem.
BAP 3088737 00 0110112021 0110112022 0110112021
SCHEDULE
Name and Address of Other Person(s) /
o an
Number of Days Notice:
To Be Determined, as required by written contract.30
lncludes copyrighted material of lnsurance services office, lnc., with its permission.
Attachment Code : D585645 Master ID: 1485069, Certificate ID: 17400549
@
Notification to Others of Cancellation ZURICH
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Commercial General Liability Goverage Part
Liquor Liability Coverage Part
Products/Completed Operations Liability Goverage Part
A. lf we cancel this Coverage Part(s) by written notice to the first Named lnsured for any reason other than nonpayment
of premium, we will mail or deliver a copy of such written notice of cancellation:
1. To the name and address corresponding to each person or organization shown in the Schedule below; and
2. At least 10 days prior to the effective date of the cancellation, as advised in our notice to the first Named lnsured,
or the longer number of days notice if indicated in the Schedule below.
B. lf we cancel this Coverage Part(s) by written notice to the first Named lnsured for nonpayment of premium, we will
mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or
organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation.
C. lf notice as described in Paragraphs A. or B. of this endorsement is mailed, proof of mailing will be sufficient proof of
such notice.
All other terms and conditions this policy remain unchanged
u-GL-1446-A CW (05i10)
Page 1 of 1
6
Policy No.Eff. Date of Pol Exp. Date of Pol.Eff. Date of End.Producer No.Add'1. Prem Return Prem.
GLO 3002387 0t 01t0112021 0110112022 01t0112021
SCHEDULE
Number of Days Notice:Name and Address of Other Person(s) /
Orqanization(s):
30 daysTo Be Determined, as required by written contract.
lncludes copyrighted material of lnsurance Services Office, lnc., with its permission.