HomeMy WebLinkAboutCAG2021-300 - Amendment - #1 - Consor North America, Inc. dba Murraysmith, Inc. - 2021 Storm Sewer CIPP Lining - 03/31/2022ApprovalOriginator:Department:
Date Sent:Date Required:
Authorized to Sign:
Director or Designee
Date of Council Approval:
Grant? Yes No
Type:Review/Signatures/RoutingComments:
Date Routed to the City Clerk’s Office:Agreement InformationVendor Name:Category:
Vendor Number:Sub-Category:
Project Name:
Project Details:
Agreement Amount:
Start Date:
Basis for Selection of Contractor:
Termination Date:
Local Business? Yes No*
Business License Verification: Yes In-Process Exempt (KCC 5.01.045)
If meets requirements per KCC 3.70.100, please complete “Vendor Purchase-Local Exceptions” form on Cityspace.
Notice required prior to disclosure?
Yes No
Contract Number:
Agreement Routing Form
For Approvals, Signatures and Records Management
This form combines & replaces the Request for Mayor’s Signature and Contract Cover
Sheet forms.
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
(Optional)
* Memo to Mayor must be attached
KENT
WA=� .T.�
FIRST AMENDMENT TO
CONSULTANT SERVICES AGREEMENT
BETWEEN THE CITY OF KENT, MURRAYSMITH, INC.
AND CONSOR NORTH AMERICA, INC. DBA MURRAYSMITH, INC.
This First Amendment ("First Amendment"), to the Consultant Services Agreement,
dated June 28, 2021, ("Agreement") is between MurraySmith, Inc., an Oregon profit
corporation ("MurraySmith"), and Consor North America, Inc. DBA MurraySmith, Inc., an
Oregon profit corporation ("Consor"), (together "Consultant"), and the City of Kent, a
Washington municipal corporation ("City"), collectively the ("Parties").
RECITALS
A. The Agreement was originally between the City and MurraySmith.
B. After entering into the Agreement, MurraySmith was acquired by Consor,
effective December 31, 2020.
C. The Parties enter into this Amendment to formally assign the Agreement to
Consor who will assume all Consultant responsibilities in place of MurraySmith.
D. Due to unanticipated events and delays, Section I of the Agreement, entitled
"Description of Work" must be revised to incorporate the additional work required. Some of
these project impacts include: a delay to the start of construction activities that require
additional coordination of schedule changes; weather delays and contractor equipment
malfunction; and the determination that four locations did not meet City CIPP design
standards and now require additional planning and coordination.
E. Section III of the Agreement entitled "Compensation" must be revised to
increase the original contract amount of $76,688.00 by an additional $18,968.00 for a new
total contract amount of $95,656.00. This increase in compensation is a direct result of the
additional work needed.
AMENDMENT
NOW THEREFORE, the City, MurraySmith, and Consor, each agree as follows:
1. Assicinment: Effective immediately, the Agreement is assigned to Consor, who
will assume all Consultant duties and responsibilities under the Agreement. Given its
acquisition of MurraySmith, Consor agrees to assume all responsibility and liability for any
work performed by MurraySmith prior to the effective date of the assignment.
2. Consultant Name: Wherever in the Agreement the term "MurraySmith, Inc."
appears, such term shall be replaced with "Consor North America, Inc. DBA MurraySmith,
Inc."
3. Description of Work. In addition to the work already outlined in Section I of
the original Agreement, entitled "Description of Work," and detailed further in the original
Exhibit A, the Consultant shall complete the following:
• Additional inspection and coordination due to weather and contractor
equipment and malfunction
• Pre -Lining CCTV review and evaluate existing storm system condition
FIRST AMENDMENT TO CONSULTANT SERVICES AGREEMENT Page 1
(between City of Kent and Consort North America, Inc. DBA MurraySmith, Inc.)
• Submittal review and response
• Coordination with City to remove catch basin obstructions (ladder & stand pipe)
• Meeting with the City to review four (4) locations not meeting City CIPP design
standards
• Meeting with the City to discuss project CIPP design methods and contractor
proposed alternatives
• Additional site inspection due to implementation of Kevlar liner
• Increased sample testing coordination due to implementation of Kevlar line
• Additional coordination with City and Contractor beyond on -site inspector
support
• Unanticipated coordination with water districts
• Final contractor pay estimate and project closeout support
4. Compensation. The agreement amount provision of Section III,
"Compensation," is modified to increase the original Agreement amount of $76,688.00 by an
additional $18,968.00 for a new total contract amount of $95,656.00. The Consultant's billing
rates for the additional $18,938.00 are outlined below, and are in addition to those billing
rates already delineated in Exhibit A to the Agreement.
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5. Insurance. Consor agrees to obtain and maintain insurance of the types and in
the amounts required by Exhibit B to the Agreement.
6. Waiver of Claims Prior to Amendment. Consor and MurraySmith accept all
requirements of this Amendment by signing below, and by their signatures waive any protest
or claim they may have regarding this Amendment, and acknowledge and accept 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 Consor and MurraySmith from strict compliance with the guarantee and warranty
provisions of the original Agreement.
7. Ratification. All acts consistent with the authority of this Amendment and prior
to its effective date are ratified and affirmed and the terms of the Agreement and this
Amendment shall be deemed to have applied.
8. Remaining Provisions. Except as specifically amended by this Amendment, all
remaining provisions of the Agreement shall remain in full force and effect.
The parties whose names appear below swear and affirm that they are authorized to
enter into this Amendment, which is binding on the parties of the Agreement.
FIRST AMENDMENT TO CONSULTANT SERVICES AGREEMENT Page 2
(between City of Kent and Consor North America, Inc. DBA MurraySmith, Inc.)
IN WITNESS, the parties below have executed this Amendment, which will
become effective on the last date written below.
CONSULTANT:
Consor North America, Inc. DBA
MurraySmith, Inc.
BY
(si nature)
Print Name: Ian Mgachan
Its Vice President
(title)
DATE: 3/31/2022
MurraySmith, Inc.
(signature)
Print Name: Ian Machan
Its Vice President
(title)
DATE: 3/31/2022
CITY:
City of Kent
Dgkely signed by Chad Bieren
DN: C=US, E=cbleren@kenlwa.gov,
Chad Bieren CCN=Chad BiereOU=Public Works,
By: Date: 2022,03,31 14'.44:50-07'00'
(signature)
Print Name: Chad Bieren, P.E.
Its Public Works Director
(title)
DATE:
FIRST AMENDMENT TO CONSULTANT SERVICES AGREEMENT Page 3
(between City of Kent and Consor North America, Inc. DBA MurraySmith, Inc.)
R CERTIFICATE OF LIABILIry INSURANCE 12131t2022
DATE (MMTDDIYYYY}
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS^IRTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLIC]ESlovv. THls CERTIFIGATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE |SSU|NG TNSURER(S), AUTHORTZED
RCPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
If SUBROGATION IS WAIVED,
this certificate does not confer
subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
must ADDITIONAL INSURED provisions or be
to the certificate holder in lieu of such
lf an ADDITIONAL INSURED,
NAME:
INSURER(S} AFFORDING COVERAGE NAIC #
Pnooucen Lockton Companies
Three City Place Drive, Suite 900
St. Louis MO 63141-7081
(3 14) 432-0500
lNsuRER A : *'r'l' SEE ATTACHMFNT *'**
INSURER B :
INSURER C :
INSTJRER D :
INSURER E :
INSURED
t4oTtrs itffi1fT,lii:lue, suite r r7o
Portland OF'97204-2025
INSURER F :
COVERAGES NU BER:NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR
BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE IVAY 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.
TYPE OF INSUMNCE LIMITS
EACH OCCURRENCE
MED EXP one
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
COMMERCIAL GENERAL LIABILITY
.LATMS-MADE lTl o""u^
GEN'L AGGREGATE LIIII,IIT APPLIES PER;
'o.,." lTliF8; E
OTHERI
LOC
Y N 6004-1073 12/31/202r 12/31/2022
$
$
BODILY INJURY (Per person)
BODILY INJURY (P6r accident)$
$ XXXXXXX
SCHEDULED
AUTOS
NON.OWNED
AUTOS ONLY
LIABILITY
ANY AUTO
OWNED
AUTOS ONLY
HIRED
AUTOS ONLY
Y N 84 rJEN OL5490 (AOS)
84 AB OLs683 (IIr)
P-001 -000788094-01 (xs)
12/31/2021
t2/31/2021
12t31/2021
12/31t2022
12/3112022
12/3r/2022
$l
EACH OCCURRENCEUMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS.MADE AGGREGATE
A N N TLJE3274463 02 12/3t/2021 t2/31/2022
X
E.L. EACH ACCIDENT
E.L. DISEASE. EA $1
A AND EMPLOYERS' LIABILITY
ANY PROPRIETORYPARTNEFUEXECUTIVE
OFFICEF|,/I\4EMBER EXCLUDED?
(Mandatory ln NH)
N
lf dBscrlbe under
WORKERS
OF
N/A
N 0468405Y (AOS)
046840s8 0lr) 'l2/31/2021
12/31/2021
t2/3u2022
12/3112022
E.L. DISEASE -
Professional &
Environmental Liability
N N 88263487610U2027 r2/31/2021 12/31/2022 $ I 0,000,000 per Claim
$ I 0,000,000 Aggregate
Deductible: $150,000
DESCRIPTION OF OPEMTIONS I LOCATIONS / VEHICLES (AGORD 101, Addltlonal Romsrks Schsdule, may
RE: 2 I -3 I 43 -202 1 Storm Sewer GIPP Lining. city of Kent is included as additional insured on
respect to General Liability and Automobile -Liability per the terms and conditions of the policy.
respect to General Liability and Automobile Liability per the terrns and conditions ofthe i:otic!.
bo attachsd lf morc apace ls requlrod)
a Primary and Non-conkibutory basis if required by written contract with
A 30-day notice ofcancellatiori is included-ifrequired by written conhact with
TE HOLDER CAN
@1
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
'|'765'1404
City of Kent
400 W Gowe Street
KentWA 98032
:AUTHORIZED
.2
ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD
CORPORA All rights reserved.
Miscellaneous Attachment: M602380 Master ID: 1407115, Certificate lD: 17651404
lnsurers
A. Allied World lnsurance Company - 6004-1073
B. Hartford Fire lnsurance Company - 84 UEN 015490 (AOS)
C. Hartford Underwriters lnsurance Company - 84 AB 015683 (Hl)
D. AXIS Surplus lnsurance Company - P-001-000788084-01 (XS Layer)
E. Great American lnsurance Company - TUE 3274463 02
F. Manufactures Alliance lnsurance Company - 0468405Y (AOS)
G. Pennsylvania Manufacturers Association - 04684058 (Hl)
H. AXIS Surplus lnsurance Company - E82634816/01/2021
l. Aspen American lnsurance Company - OM00PUX21
J. Federal lnsurance Company- 8250-1945
c
Attachment Code: D545910 Master ID: 1407115, Certificate ID:17651404
City of Kent
400 W Gowe Street
Kent WA 98032
To whom it may concern:
ln our continuing effort to provide timely certificate delivery, Lockton Companies is transitioning
to paperless delivery of Certificates of lnsurance.
To ensure electronic delivery for future renewals of this certificate, we need your email address
Please contact us via one of the methods below, referencing Certificate lD 17651404.
€mai l: STL-edelivery@lockton.com
Phone: (866) 728-5657 (toll-free)
lf you received this certificate through an internet link where the current certificate is viewable,
we have your email and no further action is needed.
ln the event your mailing address has changed, will change in the future, or you no longer
require this certificate, please let us know using one of the methods above.
The above inbox is for providing e-Delivery email addresses for next year's renewol
certificates ONLY. Your information will be input within 90 days.
Thank you for your cooperation and willingness in reducing our environmental footprint.
Lockton Companies
Lockton Companies
''i'is,r;x, {.'.j:.v!.t\t,:'.. fji', -rtii'-: :ir;* irt.. j..t:tsi:,. ,i";i1': l:,1",,",'t-'j;i:::i::.
3 1 4-432-0580 r' I*chroi:.corn
@r(xKTolf
POLICYNUMBER: 6004-1073
A. Section ll - Who ls An lnsured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but 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 for
the additional insured(s) at the location(s) desig-
nated above.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and
2. lf coverage provided to the additional insured
is required by a contract or agreement, the
insurance afforded to such additional insured will
not be broader than that which you are required
by the contract or agreement to provide for such
additional insured.
COMMERCIAL GENERAL LIABILITY
cG 20 10 04 13
B. With respect to the insurance afforded to these
additional insureds, the following additional exclu-
sions apply:
This insurance does not apply to "bodily injury" or
"property damage" occurring after:
1. All work, including materials, parts or
equipment furnished in connection with such
work, on the project (other than service,
maintenance or repairs) to be performed by or
on behalf of the additional insured(s) at the
location of the covered operations has been
completed; or
2. That portion of "your work" out of which the
injury or damage arises has been put to its
intended use by any person or organization
other than another contractor or subcontractor
engaged in performing operations for a principal
as a part of the same project.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SGHEDULE
@ lnsurance Services Office, lnc.,2O12
Insured Copy
Name Of Additional Insured Person(s)
Or Oroanizationlsl:
Location(s) Of Covered Operations
Any owner, lessee, or contractor whom you have
agreed to include as an additional insured under a fully
executed wriften contract or written agreement,
provided that such was executed prior to an
"occurrence", loss, injury or damage.
All Locations of the Named lnsured.
lnformation required to complete this Schedule. if not shown above, will be shown in the Declarations.
cG 20 {0 04 13 Page I of2
C. With respect to the insurance afforded to these
additional insureds, the following is added to
Section lll- Limits Of lnsurance:
lf coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; 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.
cG 20 10 04 13 @ lnsurance Services Office, lnc.,2012 Page2 ol2
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILIry COVERAGE PART
SCHEDULE
POLICY NUMBER: 6004-1 073
A. Section ll - Who ls An lnsured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury" or
"property damage" caused, in whole or in part, by
"your work" at the location designated and
described in the Schedule of this endorsement
performed for that additional insured and
included in the "products-completed operations
hazard".
However:
1. The insurance afforded to such additional
insured only applies to the extent permifted
by law;and
2. lf coverage provided to the additional insured
is required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
COMMERCIAL GENERAL LIABILITY
cG 20 37 04 13
B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section lll- Limits Of lnsurance:
lf coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; 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.
Name Of Additional lnsured Person(s)
Or Orqanization(s)Location And Description Of Completed Operations
Any owner, lessee, or contractor whom you have agreed to
include as an additional insured under a fully executed written
contract or written agreement, provided that such was
executed prior to an "occurrence", loss, injury or damage.
All locations and operations included in the "products-
completed operations hazard" of the Named lnsured.
lnformation required to complete this Schedule, if not shown above, will be shown in the Declarations.
cG 20 37 0413 @ lnsurance Services Office, !nc.,2012 Page 1 of 1
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY -
OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
PROD UCTS/COM PLETE D O P ERATIONS LIAB I LITY COVE RAGE PART
The following is added to the Other Insurance
Condition and supersedes any provision to the
contrary:
Primary And Noncontributory lnsurance
This insurance is primary to and will not seek
contribution from any other insurance available to
an additional insured under your policy provided
that:
({) The additional insured is a Named lnsured
under such other insurance; and
COMMERCIAL GENERAL LIABILITY
cG 20 01 12 19
(2) You have agreed in writing in a contract or
agreement that this insurance would be
primary and would not seek contribution
from any other insurance available to the
additional insured.
GG 20 01 12 19 @ lnsurance Services Office, lnc., 2018 Page I of 1
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF REGOVERY
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of
Section lV - Conditions:
lf, prior to the time of an "occurrence", you waive any right of recovery against a specific person
or organization for injury or damage as required under an "insured contract", we will also waive
any rights we may have against such person or organization
GL 00024 00 (06/09)
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY-
ADDITIONAL NOTICE OF CANCELLATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILIry COVERAGE PART
SECTION lV. COMMERCIAL GENERAL LIABILITY CONDITIONS is amended to include the following
additional provision:
Additional Notice of Cancellation
lf we cancel this policy for any reason, other than for the non-payment of premium, we will
endeavor to provide advance notice of such cancellation to the person(s) or organization(s)
shown in the Schedule below. We will send notice to the email or mailing address listed on such
Schedule at least thirty (30) days, or the number of days listed on such Schedule (if any), before
the cancellation becomes effective. A notice shall be sent only when a valid address is provided.
ln no event shall the notice to such person or entity exceed the notice to the Named lnsured.
This advance notice of a pending cancellation of coverage is intended as a courtesy only. Our
failure to provide such advance notice will not extend the policy cancellation date nor negate
cancellation of the policy.
SCHEDULE
Person or OrEanization E-mailAddress or Mailinq Address
Number of Days
Advance Written
Notice of
Gancellation (Other
Than Nonpayment
of Premium)
Person{s) and oroanization(s)cer the schedule on file with the insurer or broker 30
GL 00578 00 (07/18)
Page 1 of 1
COMMERCIAL AUTOMOBILE
HA 99 16 03 12
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL AUTOMOBILE BROAD FORM
ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
To the extent that the provisions of this endorsement provide broader benefits to the "insured" than other
provisions of the Coverage Form, the provisions of this endorsement apply.
1. BROAD FORM INSURED
A. Subsidiaries and Newly Acquired or
Formed Organizations
The Named lnsured shown in the
Declarations is amended to include:
(1) Any legal business entity other than a
partnership or joint venture, formed as a
subsidiary in which you have an
ownership interest of more than 50% on
the effective date of the Coverage Form.
However, the Named lnsured does not
include any subsidiary that is an
"insured" under any other automobile
policy or would be an "insured" under
such a policy but for its termination or
the exhaustion of its Limit of lnsurance.
(2) Any organization that is acquired or
formed by you and over which you
maintain majority ownership. However,
the Named lnsured does not include any
newly formed or acquired organization:
(a) That is a partnership or joint
venture,
(b) That is an "insured" under any other
policy,
(c) That has exhausted its Limit of
lnsurance under any other policy, or
(d) 180 days or more after its
acquisition or formation by you,
unless you have given us notice of
the acquisition or formation.
Coverage does not apply to "bodily
injury" or "property damage" that results
from an "accident" that occurred before
you formed or acquired the organization.
B. Employees as lnsureds
Paragraph A.1. - WHO lS AN INSURED - of
SECTION ll - LIABILITY COVERAGE is
amended to add:
d. Any "employee" of yours whiie using a
covered "auto" you don't own, hire or
borrow in your business or your
personal affairs.
C, Lessors as lnsureds
Paragraph A.1. - WHO lS AN INSURED - of
Section ll- Liabitity Coverage is amended to
add:
e. The lessor of a covered "auto" while the
"auto" is leased to you under a written
agreement if:
(1) The agreement requires you to
provide direct primary insurance for
the lessor and
(2) The "auto" is leased without a driver.
Such a leased "auto" will be considered a
covered "auto" you own and not a covered
"auto" you hire.
D. Additional lnsured if Required by Contract
(1) Paragraph A.1. - WHO lS AN INSURED
- of Section ll - Liability Coverage is
amended to add:
f. When you have agreed, in a written
contract or written agreement, that a
person or organization be added as
an additional insured on your
business auto policy, such person or
organization is an "insured", but only
to the extent such person or
organization is liable for "bodily
injury" or "property damage" caused
by the conduct of an "insured" under
paragraphs a. or b. of Who ls An
lnsured with regard to the
ownership, maintenance or use of a
covered "auto."
@2011, The Hartford (lncludes copyrighted material
of ISO Properties, lnc., with its permission.)Form HA 99 16 03 12 Page 1 of 5
The insurance afforded to any such
additional insured applies only if the
"bodily injury" or "property damage"
occurs:
(1) During the policy period, and
(2) Subsequent to the execution of such
written contract, and
(3) Prior to the expiration of the period
of time that the written contract
requires such insurance be provided
to the additional insured.
(2) How Limits Apply
lf you have agreed in a written contract
or written agreement that another
person or organization be added as an
additional insured on your policy, the
most we will pay on behalf of such
additional insured is the lesser of:
(a) The limits of insurance specified in
the written contract or written
agreement; or
(b) The Limits of lnsurance shown in
the Declarations.
Such amount shall be a part of and not
in addition to Limits of lnsurance shown
in the Declarations and described in this
Section.
(3) Additional lnsureds Other lnsurance
lf we cover a claim or "suit" under this
Coverage Part that may also be covered
by other insurance available to an
additional insured, such additional
insured must submit such claim or "suit"
to the other insurer for defense and
indemnity.
However, this provision does not apply
to the extent that you have agreed in a
written contract or written agreement
that this insurance is primary and non-
contributory with the additional insured's
own insurance.
(4) Duties in The Event Of Accident, Claim,
Suit or Loss
lf you have agreed in a written contract
or written agreement that another
person or organization be added as an
additional insured on your policy, the
additional insured shall be required to
comply with the provisions in LOS$
CONDITIONS 2. . DUTIES IN THE
EVENT OF ACCIDENT, CLAIM , SUIT
OR LOSS OF SECTION IV
BUSINESS AUTO CONDITIONS, in the
same manner as the Named lnsured,
E. Primary and Non-Contributory if
Required by Contract
Only with respect to insurance provided to
an additional insured in '1.D. - Additional
lnsured lf Required by Contract, the
following provisions apply:
(3) Primary lnsurance When Required By
Contract
This insurance is primary if you have
agreed in a written contract or written
agreement that this insurance be
primary. lf other insurance is also
primary, we will share with all that other
insurance by the method described in
Other lnsurance 5.d.
(4) Primary And Non-Contributory To Other
lnsurance When Required By Contract
lf you have agreed in a written contract
or written agreement that this insurance
is primary and non-contributory with the
additional insured's own insurance, this
insurance is primary and we will not
seek contribution from that other
insurance.
Paragraphs {3) and (4) do not apply to other
insurance to which the additional insured
has been added as an additional insured.
When this insurance is excess, we will have no
duty to defend the insured against any "suit" if
any other insurer has a duty to defend the
insured against that "suit". lf no other insurer
defends, we will undertake to do so, but we will
be entitled to the insured's rights against all
those other insurers.
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, by the
method described in Other lnsurance 5.d.
2. AUTOS RENTEDBYEMPLOYEES
Any "auto" hired or rented by your "employee"
on your behalf and at your direction will be
considered an "auto" you hire.
The OTHER INSURANCE Condition is amended
by adding the following:
O 2011, The Hartford (lncludes copyrighted material
of ISO Properties, lnc., with its permission.)Form HA 99 16 03 12 Page 2 of 5
lf an "employee's" personal insurance also
applies on an excess basis to a covered "auto"
hired or rented by your "employee" on your
behalf and at your direction, this insurance will
be primary to the "employee's" personal
insurance.
3. AMENDED FELLOW EMPLOYEE EXCLUSION
EXCLUSION 5. - FELLOW EMPLOYEE - of
SECTION ll - LlABlLlry COVERAGE does not
apply if you have workers' compensation
insurance in-force covering all of your
"employees".
Coverage is excess over any other collectible
insurance.
4. HIRED AUTO PHYSICAL DAMAGE COVERAGE
lf hired "autos" are covered "autos" for Liability
Coverage and if Comprehensive, Specified
Causes of Loss, or Collision coverages are
provided under this Coverage Form for any
"auto" you own, then the Physical Damage
Coverages provided are extended to "autos" you
hire or borrow, subject to the following limit.
The most we will pay for "loss" to any hired
"auto" is:
(1) $100,000;
(2) The actual cash value of the damaged or
stolen property at the time of the "loss"; or
(3) The cost of repairing or replacing the
damaged or stolen property,
whichever is smallesi, minus a deductible. The
deductible will be equal to the largest deductible
applicable to any owned "auto" for that
coverage. No deductible applies to "loss" caused
by fire or lightning. Hired Auto Physical Damage
coverage is excess over any other collectible
insurance. Subject to the above limit, deductible
and excess provisions, we will provide coverage
equal to the broadest coverage applicable to any
covered "auto" you own.
We will also cover loss of use of the hired "auto"
if it results from an "accident", you are legally
liable and the lessor incurs an actual financial
loss, subject to a maximum of $1000 per
"accidenf'.
This extension of coverage does not apply to
any "auto" you hire or borrow from any of your
"employees", partners (if you are a partnership),
members (if you are a limited liability company),
or members of their households.
5. PHYSICAL DAMAGE . ADDITIONAL
TEMPORARY TRANSPORTATION EXPENSE
COVERAGE
Paragraph A.4.a. of SECTION lll - PHYSICAL
DAMAGE COVERAGE is amended to provide a
limit of $50 per day and a maximum timit of
$1,000.
6. LOAN/LEASEGAPCOVERAGE
Under SECTION III . PHYSICAL DAMAGE
COVERAGE, in the event of a total "loss" to a
covered "auto", we will pay yot.tr additional legal
obligation for any difference between the actual
cash value of the "auto" at the time of the "loss"
and the "outstanding balance" of the loanllease.
"Outstanding balance" means the amount you
owe on the loan/lease at the time of "loss" less
any amounts representing taxes; overdue
payments; penalties, interest or charges
resulting from overdue payments; additional
mileage charges; excess wear and tear charges;
lease termination fees; security deposits not
returned by the lessor; costs for extended
warranties, credit life lnsurance, health, accident
or disability insurance purchased with the loan or
lease; and carry-over balances from previous
loans or leases.
7. AIRBAG COVERAGE
Under Paragraph B. EXCLUSIONS - of
SECTION III - PHYSICAL DAMAGE
COVERAGE, the following is added:
The exclusion relating to mechanical breakdown
does not apply to the accidental discharge of an
airbag.
8. ELECTRONIC EQUIPMENT . BROADENED
COVERAGE
a. The exceptions to Paragraphs 8.4
EXCLUSIONS - of SECTION lll - PHYSICAL
DAMAGE COVERAGE are replaced by the
following:
Exclusions 4.c. and 4.d. do not apply to
equipment designed to be operated solely
by use of the power from the "auto's"
electrical system that, at the time of "loss",
is:
(1) Permanently installed in or upon
the covered'nauto";
(2\ Removable from a housing unit
which is permanently installed in
or upon the covered "auto";
(3) An integral part of the same unit
housing any electronic
equipment described in
Paragraphs (1) and (2) above; or
@2011, The Hartford (lncludes copyrighted material
of ISO Properties, lnc., with its permission.)Form HA 99 16 03 12 Page 3 of 5
(4) Necessary for the normal
operation of the covered "auto" or
the monitoring of the covered
"auto's" operating system.
b.Section lll - Version CA 00 01 03 10 of the
Business Auto Coverage Form, Physical
Damage Coverage, Limit af lnsurance,
Paragraph C.2 and Version CA 00 01 10 01 of
the Business Auto Coverage Form, Physical
Damage Coverage, Limit of lnsurance,
Paragraph C are each amended to add the
following:
$1,500 is the most we will pay for "loss" in
any one "accident" to all electronic
equipment (other than equipment designed
solely for the reproduction of sound, and
accessories used with such equipment)
that reproduces, receives or transmits
audio, visual or data signals which, at the
time of "loss", is:
{1) Permanently installed in or upon
the covered "auto" in a housing,
opening or other location that is not
normally used by the "auto"
manufacturer for the instaltation of
such equipment;
(2) Removable from a permanently
installed housing unit as described
in Paragraph 2.a. above or is an
integral part of that equipment; or
(3) An integral part of such equipment.
c. For each covered "auto", should loss be limited
to electronic equipment only, our obligation to
pay for, repair, return or replace damaged or
stolen electronic equipment will be reduced by
the applicable deductible shown in the
Declarations, or $250, whichever deductible is
less.
9. EXTRA EXPENSE . BROADENED
COVERAGE
Under Paragraph A. - COVERAGE - of SECTION
lll - PHYSICAL DAMAGE COVERAGE, we will
pay for the expense of returning a stolen covered
"auto" to you.
10. GLASS REPAIR . WAIVER OF DEDUCTIBLE
Under Paragraph D. - DEDUCTIBLE - of SECTION
III - PHYSICAL DAMAGE COVERAGE, hE
following is added:
No deductible applies to glass damage if the
glass is repaired rather than replaced.
11. TWO OR MORE DEDUGTIBLES
Under Paragraph D. - DEDUCTIBLE - of SECTION
III - PHYSICAL DAMAGE COVERAGE, thE
following is added:
lf another Hartford Financial Services Group,
lnc. company policy or coverage form that is not
an automobile policy or coverage form applies to
the same "accident", the following applies:
(1) lf the deductible under this Business Auto
Coverage Form is the smaller (or smallest)
deductible, it will be waived;
(2i lf the deductible under this Business Auto
Coverage Form is not the smaller (or
smallest) deductible, it will be reduced by
the amount of the smaller (or smallest)
deductible.
12. AMENDED DUTIES IN THE EVENT OF
ACC|DENT, CLA|M, SUlr OR LOSS
The requirement in LOSS CONDITIONS 2.a. -
DUTIES IN THE EVENT OF ACCIDENT,CLAIM,
SUIT OR LOSS - ol SECTION lV - BUSINESS
AUTO CONDITIONS that you must notify us of
an "accident" applies only when the "accident" is
known to:
(1) You, if you are an individual;
{2) A partner, il you are a partnership;
{3) A member, if you are a limited liability
company; or
(4) An executive officer or insurance manager, if
you are a corporation.
13. UNINTENTIONAL FAILURE TO DISCLOSE
HAZARDS
lf you unintentionally fail to disclose any hazards
existing at the inception date of your policy, we
will not deny coverage under this Coverage
Form because of such failure.
14. HIRED AUTO . COVERAGE TERRITORY
Paragraph e. of GENERAL CONDITIONS 7. -
POLICY PERIOD, COVERAGE TERRITORY -
of SECTION lV - BUSINESS AUTO
CONDITIONS is replaced by the following:
e. For short-term hired "autos", the coverage
territory with respect to Liability Coverage is
anywhere in the world provided that if the
"insured's" responsibility to pay damages for
"bodily injury" or "proper$r damage" is
determined in a "suit," ths "suit" is brought in
the United States of America, the territories
and possessions of the United States of
America, Puerto Rico or Canada or in a
seftlement we agree to.
15. WAIVER OF SUBROGATION
TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US - Of SECTION IV.
BUSINESS AUTO CONDITIONS is amended by
adding the following:
@2O11, The Hartford (lncludes copyrighted material
of ISO Properties, lnc., with its permission.)Form HA 99 16 03 12 Page 4 of 5
We waive any right of recovery we may have
against any person or organization with whom
you have a written contract that requires such
waiver because of payments we make for
damages under this Coverage Form.
16. RESULTANT MENTAL ANGUISH COVERAGE
The definition of "bodily injury" in SECTION V-
DEFINITIONS is replaced by the following:
"Bodily injury" means bodily injury, sickness or
disease sustained by any person, including
mental anguish or death resulting from any of
these.
1 7. EXTENDED CANCELLATION CONDITION
Paragraph 2. of the COMMON POLICY
CONDITIONS - CANCELLATION - applies
except as follows:
lf we cancel for any reason other than
nonpayment of premium, we will mail or deliver
to the first Named lnsured written notice of
cancellation at least 60 days before the effective
date of cancellation.
18. HYBRIO, ELECTRIC, OR NATURAL GAS
VEHICLE PAYMENT COVER.AGE
ln the event of a total loss to a "non-hybrid" auto
for which Comprehensive, Specified Causes of
Loss, or Collision coverages are provided under
this Coverage Form, then such Physical
Damage Coverages are amended as follows:
a.lf the auto is replaced with a "hybrid" auto or
an auto powered solely by electricity or natural
gas, we will pay an additional 10%, to a
maximum of $2,500, of the "non-hybrid" auto's
actual cash value or replacement cost,
whichever is less,
b.The auto must be replaced and a copy of a bill
of sale or new lease agreement received by us
within 60 calendar days of the date of "loss,"
c.Regardless of the number of autos deemed a
total loss, the most we will pay under this
Hybrid, Electric, or Natural Gas Vehicle
Payment Coverage provision for any one
"loss" is $10,000.
For the purposes of the coverage provision,
a.A "non-hybrid" auto is defined as an auto that
uses only an internal combustion engine to
move the auto but does not include autos
powered solely by electricity or natural gas.
b.A "hybrid" auto is defined as an auto with an
internal combustion engine and one or more
electric motors; and that uses the internal
combustion engine and one or more electric
motors to move the auto, or the internal
combustion engine to charge one or more
electric motors, which move the auto.
19. VEHICLE WRAP COVERAGE
ln the event of a total loss to an "auto" for which
Comprehensive, Specified Causes of Loss, or
Collision coverages are provided under this
Coverage Form, then such Physical Damage
Coverages are amended to add the following:
ln addition to the actual cash value of the "auto",
we will pay up to $1,000 for vinyl vehicle wraps
which are displayed on the covered "auto" at the
time of total loss. Regardless of the number of
autos deemed a total loss, the most we will pay
under this Vehicle Wrap Coverage provision for
any one "loss" is $5,000. For purposes of this
coverage provision, signs or other graphics
painted or magnetically afflxed to the vehicle are
not considered vehicle wraps.
@ 2011, The Hartford (lncludes copyrighted material
of ISO Properties, lnc., with its permission.)Form HA 99 16 03 12 Page 5 of 5
POLICYNUMBER: 84 UEN OI549O COMMERCIAL AUTO
cA 04 44 10 1s
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGATNST OTHERS TO US (WATVER OF SUBROGATTON)
This endorsement modifies insurance provided under the following
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified
by the endorsement.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated
below.
Endorsement Effective Date: 12 / 31, / 21
SCHEDULE
Name(s) Of Person(s) Or Organization(s):
AS REQUIRED BY WRITTEN AGREEMENT.
lnformation required to complete this Schedule. if not shown above, will be shown in the Declarations.
The Transfer Of Rights Of Recovery Against Others
To Us condition does not apply to the person(s) or
organization(s) shown in the Schedule, but only to the
extent that subrogation is waived prior to the "accident"
or the "loss" under a contract with that person or
organization.
cA 04 44 10 13 @ lnsurance Services Office, lnc., 2011 Page I of I
tr
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
NOTTCE OF CANGELLATTON TO CERTIFICATE HOLDER(S)
This policy is subject to the following additional
Conditions:
A. lf this policy is cancelled by the Company, other
than for nonpayment of premium, notice of such
cancellation will be provided at least thirty (30)
days in advance of the cancellation effective date
to the certificate holder(s) with mailing addresses
on file with the agent of record or the Company.
B. lf this policy is cancelled by the Company for
nonpayment of premium, or by the insured, notice
of such cancellation will be provided within (10)
days of the cancellation effective date to the
certificate holder(s) with mailing addresses on file
with the agent of record or the Company.
lf notice is mailed, proof of mailing to the last known
mailing address of the certificate holde(s) on file with
the agent of record or the Company will be sufficient
proof of notice.
Any notification rights provided by this endorsement
apply only to active certificate holde(s) who were
issued a certificate of insurance applicable to this
polic/s term.
Form lH 03 07 06 11
@ 2011, The Hartford
Page 1 of 1
WORKERS COMPENSANON AND EMPLOYERS LIABILITY INSURANCE POLICY wc 00 0313
(Ed.$M'
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
We have the right tc r€@v€r our peyments fiom anyone liable for an inJury covered by this policy. We will not
enbrce our rlght against the person or organlza0on narned ln the Schedule. (This agreemant applles only to
the extent that you perform work under a written contract that requires you to obtain lhis agreement fiom us.)
This agreement shell not operab directy or indirec-tly to benefit anyone not named in the $chedule.
Schedule
AITY PERSONS OR ORGAI{IZATIONS E'OR WHOM ltsE lIAl'tED INSURED
HAS AGREED BY IVRITTEN @NTR.rcT TO T'URNISH THIS WATI/ER
This endorsement ehanges the policy to which ft ls athched and is eftective on the date lssued unless olherwise stated.
(Tho lntormetlon bslow ir roquliud 6nly when thlr endorremrnt la lrcusd Eubsequont to praparetlon of the pollcy.)
Endorsement Effectlve 7213il21, Pollcy No. 0458405Y
Insurance Company FldA
,wcoooars
(Ed.4-841
O 19Ct lJllhnj Councll qt Cornpcmrllm lnturlnoe.
INSURED@Pf
WORKERS COMPENSANON AND EMPLOYER8 LIABILIW INSURANCE POLICY wc 00 03lt
(Ed.1-84)
WAIVER OF OUR RIGHT TO RECO\|ER FRolyl OTHERS ENDORBETTENT
We have the right to r€covor our payments from anyorre liable for an injury covered by thie poliry. We will not
enforce our right against the person or organization named ln the Schedule. (Thls egreem€nt applies only to
the o<tent that you p€rbrm wort under a written contract that requires you to obtraln his agreement from us.)
This agreement shall not operate directy or indirectly b benefit anyone not named in ths Schedule.
Schedule
ANY PERSONS OR ORGANIZATIONS FOR WHO!{ THE }.IAMED TNSURED
HAS AGREED BY !{RITTEN CONTRACT TO EURNISH THTS IVATVER
This cndorsern€nt chang* tha poliryto whlch ft ls attachod and lg clleclive on the date isruod unlcss olhorwire slcted.
{Thc lnformstlcn bdow ir roqul-nrd 6nlywtrcn thb cndomnrnt b lrrucd rubrcquantto proplretlon oltho pollcy.)
Endorsem€nl ElTecttue 12l3U2L Pollcy No. 04684058
lnsurance Company PttA
.wc 00 0313
(Ed.444)
O l9t8 llrllontl Councll dt CompcnrrtJon lnrunnc..
INSURED@ry
1213112021* TUE-3274463-02 GREAT AMERICAN INSURANCE CO
The inclusion or addition hereunder of more
than one lnsured shall not operate to increase
the Company's Limits of lnsurance beyond that
set forth in ltem 4. of the Declarations-
We will be furnished a complete copy of the
First Underlying lnsurance Policy described in
Item 5. of the Declarations.
II. LIMITS OF INSURANCE
A. The Limits of lnsurance shown in the Dec-
larations and the rules below describe the
most we will pay regardless of the num-
ber of:
1. lnsureds;
2. claims made or suits brought; or
3- Persons or organizations making
claims or bringing suits.
B- The Limits of lnsurance of this policy will
apply as follows:
410925
TAU 95OO
(Ed. 11 e7)
EXCESS LIABILITY POLICY
There are provisions in this policy that restrict coverage. Read the entire policy carefully to determine
rights, duties and what is and is not covered.
Words and phrases in quotation marks have special meaning and can be found in the Definitions Section
or the specific policy provision where they appear.
ln consideration of the payment of the premium and in reliance upon the statements in the Declarations
we agree with you to provide coverage as follows:
INSURING AGREEMENTS
I. COVERAGE 1. This policy applies only in excess of
the Underlying Limits of lnsurance
shown in ltem 5. of the Declarations.We will pay on behalf of the lnsured "loss" in
excess of the Underlying Limits of lnsurance
shown in ltem 5. of the Declarations, but only
up to an amount not exceeding the Company's
Limits of lnsurance as shown in ltem 4, of the
Declarations. Except for the terms, conditions,
definitions and exclusions of this policy, the
coverage provided by this policy will follow
the First Underlying lnsurance Policy, as
shown in ltem 5. of the Declarations.
2.The aggregate limit shown in ltem 4. of
the Declarations is the most we will
pay for all "loss" that is subject to an
aggregate limit provided by the First
Underlying lnsurance Policy. The ag-
gregate limit applies separately and in
the same manner as the aggregate lim-
its provided by the First Underlying ln-
surance Policy.
3. Subject lo 8.2., the occurrence limit
stated in ltem 4. of the Declarations is
the most we will pay for all "loss"
arising out of any one occurrence to
which this policy applies.
4. subject to Paragraphs B.2. and B.3.
above, if the underlying Limits of ln-
surance stated in ltem 5. of the Dec-
larations are reduced or exhausted
solely by payment of "loss," such in-
surance provided by this policy will
apply in excess of the reduced Under-
lying Limits or, if all Underlying Limits
are exhausted, will apply as underlying
insurance subject to the same terms,
conditions, defi nitions and exclusions
of the First Underlying lnsurance Poli-
cy, except for the terms, conditions,
definitions and exclusions of this poli-
cy.
5. The Limits of lnsurance of this policy
apply separately to each consecutive
annual period and to any remaining pe-
TAU 95OO (Ed. 11197) XS (Page 1 of 5)
t. Poliry Territory
Coverage under this Policy applies to Claims made in any jurisdiction in the world. lf a Claim is made outside
the United States of America and its territories and possessions, Puerto Rico or Canadar
1. We shall have the right but not the duty to investigate, defend or settle any such Claims brought against
you.
2. lf we do not exercise such right, you shall, under our supervision, arrange for such investigation and
defense of the Claim as is reasonably necessary, and subject to our prior authorization, shall effect such
settlement thereof as we and you deem expedient;
3. Subject to the terms of this Policy, we will reimburse the Named lnsured for the reasonable cost of such
investigation and defense and the amount of any such settlement or judgment.
4. Such reimbursement shall be made in United States currency at the conversion rate published in The Wall
Street Journol on the date the judgment is rendered or the date that the amount of the settlement is
agreed upon or the date expenditure is made.
M. Representations
By accepting this Policy, you agree that:
!. the statements made and information contained in the Application for this insurance furnished to us are
true, accurate and complete, and are representations that the Named lnsured made on behalf of all
lnsureds; and
2. we have issued this Policy in reliance upon those representations.
lf such representations or such information are not true, accurate and complete, this Policy shall be null and
void in its entirety and we shall have no liability hereunder.
N. Severability
Misrepresentations, concealment, breach of condition or violation of any duty under this Policy by one
lnsured shall not prejudice the interest or coverage of another lnsured under this Policy.
O. Subrogation and Recovery
ln the event of any payment under this Policy, we will be subrogated to all of your rights of recovery therefore
against any person or organization, and you shall execute and deliver instruments and papers and do whatever
else is necessary to secure such rights. You shall do nothing to prejudice such rights.
We will have no rights of subrogation against any lnsured hereunder, or against your clients if prior to the
Claim, a waiver of subrogation was so required and accepted under a specific contractual undertaking by you
for such client.
Any recoveries shall be applied first to us up to the amount we have paid for Damages and Claim Expense;
then, to you as recovery of Deductible amounts paid as Damages and Claim Expense.
DP 0001 (Ed. 02 11)Page 10 of 10