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HomeMy WebLinkAboutPW17-137 - Amendment - #5 - A & M Consulting - Lower Russell Road Levee - 12/09/2021Nancy Y. for Toby Hallock Public Works 12/08/2021 12/10/2021 N/A D20079 N/A A & M Consulting Contract Amendment Lower Russell Levee Extend the time of completion to December 31, 2022 Other 12/31/2022 $0 PW17-137 12/8/2021 AMENDMENT - 1 OF 2 AMENDMENT NO. 5 NAME OF CONSULTANT OR VENDOR: A & M Consulting CONTRACT NAME & PROJECT NUMBER: Lower Russell Road Levee ORIGINAL AGREEMENT DATE: March 23, 2017 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: An amendment is needed to extend the time of completion to December 31, 2022 due to the Consultant will help to provide assistance to other areas impacted by this project that were not originally included. 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 $ Net Change by Previous Amendments including applicable WSST $ Current Contract Amount including all previous amendments $ Current Amendment Sum $ Applicable WSST Tax on this Amendment $ Revised Contract Sum $ Original Time for Completion 12/31/17 (insert date) Revised Time for Completion under 12/31/21 prior Amendments (insert date) Add'I Days Required (f) for this 365 calendar days Amendment Revised Time for Completion 12/31/22 (insert date) 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: 7 By: (sig a ure) A (d CITY OF KENT: By: 04 A�� (signature) Print Name: ri � t! m lot Print Name: Carla Malone P.E. Its ()W n...e_r Its Design Engineering Manager ( itle) (ti IN DATE: DATE: ATTEST: APPROVED AS TO FORM: (applicable if Mayors signature required) Kent City Clerk L;ie eM4 Kent Law Department A & M - Lower Russell Amd 5/Hllock AMENDMENT - 2 OF 2 ��`''� CERTIFICATE OF LIABILITY INSURANCE DATE(MMI/DDIYYYY) 10/0M2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed If SUBROGATIONIS WAIVED, subject to the teens and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT AJ GALLAGHER & CO INS BRKRS CAIPHS 72255202 The Hartford Business Service Center NAME: PHONE (888) 920-6259 (AIC, No. Ett). FAX (888)443-6112 (A/C, No): 3600 Wiseman Blvd E-MAIL San Antonio, TX 78251 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIL# INSURED INSURERA: Hartford Casualty Insurance Company 29424 ARNOLD TOMAC DBA A & M CONSULTING INSURER B : 18119 NE 30TH ST INSURERC: REDMOND WA 98052-5902 INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER. REVISION NUMBER - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED -NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS LTR TYPE OF INSURANCE AD➢L INS SUBR POLICY NUMBER POLICY EFF D POLICY EXP DD LIMITS COMMERCIAL GENERAL UA131UTY EACH OCCURRENCE $2,000.000 CLAIMS -MADE OCCUR DAMAGETO RENTED P I a $300,000 X General Liability MED EXP (Arty one parson) $10.000 A X 72 SBM UK5025 11/01/2021 11/01/2022 PERSONAL & A➢V INJURY $2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4.000,000 POUCY ❑ PRO- LOC JE PRODUCTS -COMP/OPAGG $4,000,000 OTHER' AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT tEa accident) $2,000.000 ANY AUTO BODILY INJURY (Per person) A AUTOS ALLOWNEDSCHEDULED AUTOS 72SBM UK5025 11/0112021 11/01/2022 BODILY INJURY (Per accident) PROPERTY DAMAGE (Peraccidenl) HIRED NON -OWNED x AUTOS x AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAB CLAIMS - MADE ED RETENTION $ WORKERS COMPENSATION PER OTFI- AND EMPLOYERS' LIABILITY STATUTE E.L.ACH ACCIDENT $1.000.000 ANY YIN A PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBEREXCLUDED? NIA 72SBM UK5025 11/01/2021 11/01/2022 SEASE-EAEMPLOYEE $1,000,000 (Mlandatory in NH) If yes, describe under ISEASE-POLICY LIMIT $1,000.000 DESCRIPTION OF OPERATIONS below A EMPLOYMENT PRACTICES LIABILITY 72SBM UK5025 11/0112021 11/01/2022 Each Claim Limit Aggregate A re ate Limit $5.000 $5,000 DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Certificate Holder is an Additional Insured per the Business Liability Coverage Form SS0008 attached to this policy. CERTIFICATE HOLDER CANCELLATION The City of Kent SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Public Works Engineering BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 222 4TH AVE S IN ACCORDANCE WITH THE POLICY PROVISIONS. KENT WA 98032 AAU{T�HORF7 D REPRESENTATIVE U ueA,-) r�ad� O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 72 SBMUK5025 y it THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK s INSURANCE ACT. DISCLOSUREXAP ON LOSSES - TERRORISM RISK INSURANCE ACT SCHEDULE Terrorism Premium: $ $5.00 A. Disclosure Of Premium In accordance with the federal Terrorism Risk Insurance Act, as amended (TRIA), we are required to provide you with a notice disclosing the portion of your premium, if any, attributable to coverage for "certified acts of terrorism" under TRIA. The portion of your premium attributable to terrorism coverage is shown in the above Schedule of this endorsement. B. The following definition is added with respect to the provisions of this endorsement: 1. A "certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in accordance with the provisions of TRIA, to be an act of terrorism under TRIA. The criteria contained in TRIA for a "certified act of terrorism" include the following: a. The act results in insured losses in excess of $5 million in the aggregate, attributable to all types of insurance subject to TRIA; and b. The act results in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of an United States mission; and c. The act is a violent act or an act that is dangerous to human life, property or infrastructure and is committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion C. Disclosure Of Federal Share Of Terrorism Losses The United States Department of the Treasury will reimburse insurers for 80% of insured losses attributable to "certified acts of terrorism" under; TRIA that exceeds the applicable insurer deductible. l.: However, if aggregate industry insured losses,'.: attributable to "certified acts of terrorism" under 11; TRIA exceed $100 billion in a calendar year, the Treasury shall not make any payment for any portion of the amount of such losses that exceeds $100 billion. The United States government has not charged any premium for their participation in covering terrorism losses. D. Cap On Insurer Liability for Terrorism Losses If aggregate industry insured losses attributable to "certified acts of terrorism" under TRIA exceed $100 billion in a calendar year and we have met, or will meet, our insurer deductible under TRIA, we shall not be liable for the payment of any portion of the amount of such losses that exceed $100 billion. In such case, your coverage for terrorism losses may be reduced on a pro-rata basis in accordance with procedures established by the Treasury, based on its estimates of aggregate industry losses and our estimate that we will exceed our insurer deductible. Form SS 83 76 12 20 Page 1 of 2 0 2020, The Hartford (Includes coovriahted material of Insurance Services Office, Inc., with its permission) In - accordance with the Treasury's procedures, amounts paid for losses may be subject to further adjustments based on differences between actual losses and estimates. E. Application of Other Exclusions The terms and limitations of any terrorism exclusion, the inapplicability or omission of a terrorism exclusion, or the inclusion of terrorism coverage, do not serve to create coverage for any loss which would otherwise be excluded under this Coverag Form, Coverage Part or Policy, such as losses excluded by any pollution, pathogenic, nuclear hazard or war exclusions which may be included on this Policy. F. All other terms and conditions remain the same Page 2 of 2 Form SS 83 7612 20 s s IMPORTANT NOTICE TO POLICYHOLDERS To help your Insurance keep pace with increasing costs, we have increased your amount of insurance ... giving you better protection in case of either a partial, or total loss to your property. If you feel the new amount is not the proper one, please contact your agent or broker. 25 50 UK SBM This Spectrum Policy consists of the Declarations, Coverage Forms, Common Policy Conditions and any other Forms and Endorsements issued to be a part of the Policy. This insurance is provided by the stock insurance company of The Hartford Insurance Group shown below. INSURER: HARTFORD CASUALTY INSURANCE COMPANY ONE HARTFORD PLAZA, HARTFORD, CT 06155 COMPANY CODE: 3 Policy Number: 72 SBM UK5025 DX SPECTRUM POLICY DECLARATIONS ORIGINAL Named Insured and Mailing Address: ARNOLD TOMAC DBA A & M (No., Street, Town, State, Zip Code) CONSULTING 18119 N.E. 30TH STREET REDMOND WA 98052 a 0 w THElf$ HARTFORD Policy Period: From 11/01/21 To 11/01/22 1 YEAR 12:01 a.m., Standard time at your mailing address shown above. Exception: 12 noon in New Hampshire. Name of Agent/Broker: AJ GALLAGHER & CO INS BRKRS CA/PHS Code: 255202 Previous Policy Number: 72 SBM UK5025 Named Insured is: INDIVIDUAL Audit Period: NON-AUDITABLE Type of Property Coverage: NONE Insurance Provided: In return for the payment of the premium and subject to all of the terms of this policy, we agree with you to provide insurance as stated in this policy. TOTAL ANNUAL PREMIUM IS: $425 MP IN RECOGNITION OF THE MULTIPLE COVERAGES INSURED WITH THE HARTFORD, YOUR POLICY PREMIUM INCLUDES AN ACCOUNT CREDIT. Countersigned by �ic@2�7 � ��.�dl�rre•.G��.� Authorized Representative 09/20/21 Date Form SS 00 02 12 06 Process Date: 09/20/21 Page 001(CONTINUED ON NEXT PAGE) Policy Expiration Date: 11/01/22 SPECTRUM POLICY DECLARATIONS (Continued) POLICYNUMBER: 72 SBM UK5025 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 001 Building: 001 18119 N.E. 30TH STREET REDMOND WA 98052 Description of Business: REAL ESTATE APPRAISER Deductible: NO COVERAGE BUILDING AND BUSINESS PERSONAL PROPERTY LIMITS OF INSURANCE BUILDING BUSINESS PERSONAL PROPERTY REPLACEMENT COST PERSONAL PROPERTY OF OTHERS REPLACEMENT COST MONEY AND SECURITIES INSIDE THE PREMISES OUTSIDE THE PREMISES NO COVERAGE NO COVERAGE NO COVERAGE NO COVERAGE NO COVERAGE Form SS 00 02 12 06 Process Date: 0 9 / 2 0 / 21 Page 002 (CONTINUED ON NEXT PAGE) Policy Expiration Date: 11/01/22 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 72 SBM UK5025 BUSINESS LIABILITY LIMITS OF INSURANCE LIABILITY AND MEDICAL EXPENSES $2, 000, 000 MEDICAL EXPENSES - ANY ONE PERSON $ 10, 000 PERSONAL AND ADVERTISING INJURY $2, 000, 000 DAMAGES TO PREMISES RENTED TO YOU $ 300,000 ANY ONE PREMISES AGGREGATE LIMITS PRODUCTS -COMPLETED OPERATIONS $4, 000, 000 GENERAL AGGREGATE $4, 000, 000 EMPLOYMENT PRACTICES LIABILITY COVERAGE: FORM SS 09 01 EACH CLAIM LIMIT $ 5,000 DEDUCTIBLE - EACH CLAIM LIMIT NOT APPLICABLE AGGREGATE LIMIT $ 5,000 RETROACTIVE DATE: 11012005 This Employment Practices Liability Coverage contains claims made coverage. Except as may be otherwise provided herein, specified coverages of this insurance are limited generally to liability for injuries for which claims are first made against the insured while the insurance is in force. Please read and review the insurance carefully and discuss the coverage with your Hartford Agent or Broker. The Limits of Insurance stated in this Declarations will be reduced, and may be completely exhausted, by the payment of "defense expense" and, in such event, The Company will not be obligated to pay any further "defense expense" or sums which the insured is or may become legally obligated to pay as "damages". BUSINESS LIABILITY OPTIONAL COVERAGES HIRED/NON-OWNED AUTO LIABILITY FORM: SS 01 70 $2,000,000 Form SS 00 02 12 06 Process Date: 0 9 / 2 0 / 21 Page 003 (CONTINUED ON NEXT PAGE) Policy Expiration Date: 11/01/22 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 72 SBM UK5025 BUSINESS LIABILITY OPTIONAL COVERAGES LIMITS OF INSURANCE (Continued) EMPLOYERS LIABILITY AND STOP GAP BODILY INJURY BY ACCIDENT EACH ACCIDENT $1,000,000 BODILY INJURY BY DISEASE EACH EMPLOYEE $1,000,000 BODILY INJURY BY DISEASE POLICY LIMIT $1,000,000 APPLICABLE TO LOCATIONS IN THE FOLLOWING STATE(S): WASHINGTON WAIVER OF SUBROGATION: FORM SS 12 15 LOCATION: 001 BUILDING: 001 NAME: IF ANY Form SS 00 02 12 06 Page 004 (CONTINUED ON NEXT PAGE) Process Date: 09/20/21 Policy Expiration Date: 11/01/22 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 72 SBM UK5025 ADDITIONAL INSUREDS: THE FOLLOWING ARE ADDITIONAL INSUREDS FOR BUSINESS LIABILITY COVERAGE IN THIS POLICY. LOCATION 001 BUILDING 001 TYPE }.I.MAGER LESSOR NAM SEE FORM IN 12 00 Form SS 00 02 12 06 Drn�u¢¢ i19tn• ria %i n �%1 Page 005 (CONTINUED ON NEXT PAGE) Policv Expiration Date: 11/01/22 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 72 SBM UK5025 Form Numbers of Forms and Endorsements that apply: SS 00 01 03 14 SS 00 05 12 06 SS 00 08 04 05 SS 00 45 12 06 SS 00 64 09 16 SS 01 28 05 17 SS 01 70 09 09 SS 89 93 07 16 SS 00 60 09 15 SS 41 02 04 05 SS 41 63 06 11 SS 05 03 03 00 SS 05 47 09 15 SS 51 10 03 17 SS 09 01 12 14 SS 09 25 12 14 SS 09 67 09 14 SS 09 70 12 14 SS 09 71 12 14 SS 10 04 09 98 SS 12 15 03 00 IH 99 40 04 09 IH 99 41 04 09 SS 83 76 12 20 IH 12 00 11 85 ADDITIONAL INSURED - MANAGER/LESSOR Form SS 00 02 12 06 Page 006 Process Date: 09/20/21 Policy Expiration Date: 11/01/22 COMMON POLICY CONDITIONS Form SS 00 06 12 06 QUICK REFERENCE - SPECTRUM POLICY DECLARATIONS and COMMON POLICY CONDITIONS I. DECLARATIONS Named Insured and Mailing Address Policy Period Description and Business Location Coverages and Limits of Insurance II. COMMON POLICY CONDITIONS Beginning on Page A. Cancellation 1 B. Changes 1 C. Concealment, Misrepresentation Or Fraud 2 D. Examination Of Your Books And Records 2 E. Inspections And Surveys 2 F. Insurance Under Two Or More Coverages 2 G. Liberalization 2 H. Other Insurance - Property Coverage 2 1. Premiums 2 J. Transfer Of Rights Of Recovery Against Others To Us 2 K. Transfer Of Your Rights And Duties Under This Policy 3 L. Premium Audit 3 i Form SS 00 05 12 06 COMMON POLICY CONDITIONS All coverages of this policy are subject to the following conditions. A. Cancellation 1. The first Named Insured shown in the Declarations may cancel this policy by mailing or delivering to us advance written notice of cancellation. 2. We may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least: a. 5 days before the effective date of cancellation if any one of the following conditions exists at any building that is Covered Property in this policy: (1) The building has been vacant or unoccupied 60 or more consecutive days. This does not apply to: (a) Seasonal unoccupancy; or (b) Buildings in the course of construction, renovation or addition. Buildings with 65% or more of the rental units or floor area vacant or unoccupied are considered unoccupied under this provision. (2) After damage by a Covered Cause of Loss, permanent repairs to the building: (a) Have not started; and (b) Have not been contracted for, within 30 days of initial payment of loss. (3) The building has: (a) An outstanding order to vacate; (b) An outstanding demolition order; or (c) Been declared unsafe by governmental authority. (4) Fixed and salvageable items have been or are being removed from the building and are not being replaced. This does not apply to such removal that is necessary or incidental to any renovation or remodeling. (5) Failure to: (a) Furnish necessary heat, water, sewer service or electricity for 30 consecutive days or more, except during a period of seasonal unoccupancy; or (b) Pay property taxes that are owing and have been outstanding for more than one year following the date due, except that this provision will not apply where you are in a bona fide dispute with the taxing authority regarding payment of such taxes. b. 10 days before the effective date of cancellation if we cancel for nonpayment of premium. c. 30 days before the effective date of cancellation if we cancel for any other reason. 3. We will mail or deliver our notice to the first Named Insured's last mailing address known to us. 4. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 5. If this policy is canceled, we will send the first Named Insured any premium refund due. Such refund will be pro rats. The cancellation will be effective even if we have not made or offered a refund. 6. If notice is mailed, proof of mailing will be sufficient proof of notice. 7. If the first Named Insured cancels this policy, we will retain no less than $100 of the premium. B. Changes This policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declarations is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us and made a part of this policy. Form SS 00 05 12 06 Page 1 of 3 COMMON POLICY CONDITIONS C. Concealment, Misrepresentation Or Fraud I. Premiums This policy is void in any case of fraud by you as it relates to this policy at any time. It is also void if you or any other insured, at any time, intentionally conceal or misrepresent a material fact concerning: 1. This policy; 2. The Covered Property; 3. Your interest in the Covered Property; or 4. A claim under this policy. D. Examination Of Your Books And Records We may examine and audit your books and records as they relate to the policy at any time during the policy period and up to three years afterward. E. Inspections And Surveys We have the right but are not obligated to: 1. Make inspections and surveys at any time; 2. Give you reports on the conditions we find; and 3. Recommend changes. Any inspections, surveys, reports or recommendations relate only to insurability and the premiums to be charged. We do not make safety inspections. We do not undertake to perform the duty of any person or organization to provide for the health or safety of any person. And we do not represent or warrant that conditions: 1. Are safe or healthful; or 2. Comply with laws, regulations, codes or standards. This condition applies not only to us, but also to any rating, advisory, rate service or similar organization which makes insurance inspections, surveys, reports or recommendations. F. Insurance Under Two Or More Coverages If two or more of this policy's coverages apply to the same loss or damage, we will not pay more than the actual amount of the loss or damage. G. Liberalization If we adopt any revision that would broaden the coverage under this policy without additional premium within 45 days prior to or during the policy period, the broadened coverage will immediately apply to this policy. H. Other Insurance - Property Coverage If there is other insurance covering the same loss or damage, we will pay only for the amount of covered loss or damage in excess of the amount due from that other insurance, whether you can collect on it or not. But we will not pay more than the applicable Limit of Insurance. 1. The first Named Insured shown in the Declarations: a. Is responsible for the payment of all premiums; and b. Will be the payee for any return premiums we pay. 2. The premium shown in the Declarations was computed based on rates in effect at the time the policy was issued. If applicable, on each renewal, continuation or anniversary of the effective date of this policy, we will compute the premium in accordance with our rates and rules then in effect. 3. With our consent, you may continue this policy in force by paying a continuation premium for each successive one-year period. The premium must be: a. Paid to us prior to the anniversary date; and b. Determined in accordance with Paragraph 2. above. Our forms then in effect will apply. If you do not pay the continuation premium, this policy will expire on the first anniversary date that we have not received the premium. 4. Changes in exposures or changes in your business operation, acquisition or use of locations that are not shown in the Declarations may occur during the policy period. If so, we may require an additional premium. That premium will be determined in accordance with our rates and rules then in effect. J. Transfer Of Rights Of Recovery Against Others To Us Applicable to Property Coverage: If any person or organization to or for whom we make payment under this policy has rights to recover damages from another, those rights are transferred to us to the extent of our payment. That person or organization must do everything necessary to secure our rights and must do nothing after loss to impair them. But you may waive your rights against another party in writing: 1. Prior to a loss to your Covered Property. 2. After a loss to your Covered Property only if, at time of loss, that party is one of the following: a. Someone insured by this insurance; b. A business firm: (1) Owned or controlled by you; or (2) That owns or controls you; or 9 Page 2 of 3 Form SS 00 0512 06 ow COMMON POLICY CONDITIONS c. Your tenant. You may also accept the usual bills of lading or shipping receipts limiting the liability of carriers. This will not restrict your insurance. K. Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual Named Insured. If you die, your rights and duties will be transferred to your legal representative but only while acting within the scope of duties as your legal representative. Until your legal representative is appointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. L. Premium Audit a. We will compute all premiums for this policy in accordance with our rules and rates. b. The premium amount shown in the Declarations is a deposit premium only. At the close of each audit period we will compute the earned premium for that period. Any additional premium found to be due as a result of the audit are due and payable on notice to the first Named Insured. If the deposit premium paid for the policy term is greater than the earned premium, we will return the excess to the first Named Insured. c. The first Named Insured must maintain all records related to the coverage provided by this policy and necessary to finalize the premium audit, and send us copies of the same upon our request. Our President and Secretary have signed this policy. Where required by law, the Declarations page has also been countersigned by our duly authorized representative. i` Kevin Barnett, Secretary czo t Douglas Elliot, President Form SS 00 05 12 06 Page 3 of 3 POLICY NUMBER: 72 SBM UK5025 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGER/LESSOR THE CITY OF KENT PUBLIC WORKS ENGINEERING 222 FOURTH AVE. SO. KENT WA 99032 Form IH 12 00 1185 T SEG. NO. 0 02 Process Date: 0 9 / 2 0 / 21 Printed in U.S.A. Page 0 017 INSURED COPY Expiration Date: 11 / 01 / 2 2 a 0 N THE HARTFOR D 0 0 Named Insured: ARNOLD TOMAC DSA A & N Policy Number: 72 SHM UK5025 Effective Date: 11/01/21 Expiration Date: 11/01/22 Company Name: HARTFORD CASUALTY INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. TRADE OR ECONOMIC SANCTIONS ENDORSEMENT This insurance does not apply to the extent that trade or economic sanctions or other laws or regulations prohibit us from providing insurance, including, but not limited to, the payment of claims. All other terms and conditions remain unchanged. Form IH 99 41 04 09 Page 1 of 1 f"OLICY NUMBER: 72 SBM UK5025 THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK INSURANCE ACT. CISCLOSUREXAR ON LOSSES - TERRORISM RISK INSURANCE ACT $5.00 Disclosure Of Premium In accordance with the federal Terrorism Risk Insurance Act, as amended (TRIA), we are required to provide you with a notice disclosing the portion of your premium, if any, attributable to coverage for "certified acts of terrorism" under TRIA. The portion of your premium attributable to terrorism coverage is shown in the above Schedule of this endorsement. The following definition is added with respect to the provisions of this endorsement: 1. A "certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in accordance with the provisions of TRIA, to be an act of terrorism under TRIA. The criteria contained in TRIA for a "certified act of terrorism" include the following: a. The act results in insured losses in excess of $5 million in the aggregate, attributable to all types of insurance subject to TRIA; and b. The act results in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of an United States mission; and c. The act is a violent act or an act that is dangerous to human life, property or infrastructure and is committed by an individual or individuals as part of an effort to coerce the civilian population of the Form SS 83 80 12 20 Process Date: 09/20/21 United States or to influence the policy or affect the conduct of the United States Government by coercion C. Disclosure Of Federal Share Of Terrorism Losses The United States Department of the Treasury will reimburse insurers for 80% of insured losses attributable to "certified acts of terrorism" under TRIA that exceeds the applicable insurer deductible. However, if aggregate industry insured losses attributable to "certified acts of terrorism" under TRIA exceed $100 billion in a calendar year, the'•�� Treasury shall not make any payment for any portion of the amount of such losses that exceeds $100 billion. The United States government has not charged any premium for their participation in covering terrorism losses. D. Cap On Insurer Liability for Terrorism Losses If aggregate industry insured losses attributable to "certified acts of terrorism" under TRIA exceed $100 billion in a calendar year and we have met, or will meet, our insurer deductible under TRIA, we shall not be liable for the payment of any portion of the amount of such losses that exceed $100 billion. In such case, your coverage for terrorism losses may be reduced on a pro-rata basis in accordance with procedures established by the Treasury, based on its estimates of aggregate industry losses and our estimate that we will exceed our insurer deductible. © 2020, The Hartford Page 1 of 2 Policy Expiration Date:11/01/22 Further information regarding the reason for the coverage change(s) is available from the company or your agent or broker. You may receive other notices of coverage changes for the upcoming policy term under separate cover. Those other changes will apply in addition to the changes described above. This is not a bill. You will receive a separate bill for all or part of the premium due for your renewal policy. If you do not pay the amount shown by the due date as stated in the bill, your insurance coverage will expire or be cancelled for non-payment of premium. If you have any questions about your policy or about your overall insurance needs, please contact your Hartford agent or broker. Form IH 70 50 12 10 Page 2 "POLICYHOLDER NOTICE - WASHINGTON Date: 09/20/21 Policy Number: 72 SBM UK5025 Renewal Date: 11 / 01 / 21 Your Hartford Agent: AJ GALYZV,7U€'R & CO INS SRKRS CA/PRS ARNOLD TOXAC DBA A & M CONSULTING 18119 N.E. 30TH STREET REDMOND WA 98052 Dear Valued Hartford Insured, THE HARTFORD (888) 920-6259 Your current policy provided by The Hartford will expire shortly. The purpose of this notice is to advise you of certain changes to your policy upnn renewal. A. Policy Premium The new premium for your policy for the upcoming term is indicated below. This premium amount is based on current information known to us and may be subject to change based on any additional information we may receive from you or your Hartford agent or broker. More information on your premium determination can be obtained from your agent or broker, or from The Hartford. Renewal Premium = $ Amount of Increase = $ 425.00 The reason(s) for the increase in premium is due to one or more of the following: 1. A change in rates or the method of calculating premium. 2. A change in your exposures, loss experience, or other risk characteristics. B. Coverage Ghangg s if a _plicable) Your policy for the upcoming term will include certain reductions or additional restrictions in coverage, as indicated by an (x) below. If your state requires a notice of nonrenewal as a result of the indicated change(s), this is our notice to you in compliance with the applicable law. ( ) Increase in Deductible to: ( ) Reduction in Limits to: ( ) Reductions in Coverage: ( ) Other Changes or Restrictions in Coverage: The coverage change is due to the following indicated reason(s): O Your exposures, loss experience, or other risk characteristics indicate a need for the change. () A change in our rules, forms or underwriting guidelines for yourtype of policy. Form lH 70 50 12 10 Page 1 In accordance with the Treasury's procedures, amounts paid for losses may be subject to further adjustments based on differences between actual losses and estimates. E. Application of Other Exclusions The terms and limitations of any terrorism exclusion, the inapplicability or omission of a terrorism exclusion, or the inclusion of terrorism coverage, do not serve to create coverage for any loss which Page 2 of 2 would otherwise be excluded under this Coverage Form, Coverage Part or Policy, such as losse,, excluded by any pollution, pathogenic, nuclea hazard or war exclusions which may be included or this Policy. F. All other terms and conditions remain the same Form SS 83 80 12 20