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HomeMy WebLinkAboutCAG2022-148 - Change Order - #1 - Hokkaido Drilling, Inc. - Kent Springs Well #3 - 05/25/2022Nancy Yoshitake for Bryan Bond Public Works 05/25/2022 05/27/2022 N/A W20112 N/A Hokkaido Drilling, Inc.Contract Change Order Kent Springs Well #3 Cleaning and Redevelopment Extend the time of completion to July 29, 2022 in case an unexpected delay occurs. Other 07/29/2022 $0 CAG2022-148 5/27/22 CHANGE ORDER - 1 OF 3 CHANGE ORDER NO. 1 NAME OF CONTRACTOR: Hokkaido Drilling, Inc. (“Contractor”) CONTRACT NAME & PROJECT NUMBER: Kent Springs Well #3 ORIGINAL CONTRACT DATE: April 19, 2022 This Change Order amends the above-referenced contract; all other provisions of the contract that are not inconsistent with this Change Order shall remain in effect. For valuable consideration and by mutual consent of the parties, the project contract 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, Contractor shall provide all labor, materials, and equipment necessary to: Work is scheduled to be completed on time, however in case of unexpected delays, the time of completion is being extended to July 29, 2022. 2. The contract amount and time for performance provisions of Section II “Time of Completion,” and Section III, “Compensation,” are hereby modified as follows: Original Contract Sum, (including applicable alternates and WSST) $ Net Change by Previous Change Orders (incl. applicable WSST) $ Current Contract Amount (incl. Previous Change Orders) $ Current Change Order $ Applicable WSST Tax on this Change Order $ Revised Contract Sum $ Original Time for Completion 6/30/22 (insert date) Revised Time for Completion under nla prior Change Orders (insert date) Days Required (f) for this Change i 29 calendar days Order Revised Time for Completion (insert date) 7/29/22 Pursuant to the above -referenced contract, Contractor agrees to waive any protest it may have regarding this Change Order and acknowledges and accepts that this Change Order constitutes final settlement of all claims of any kind or nature arising from or connected with any work either covered or affected by this Change Order, including, without limitation, claims related to contract time, contract acceleration, onsite or home office overhead, or lost profits. This Change Order, unless otherwise provided, does not relieve the Contractor from strict compliance with the guarantee and warranty provisions of the original contract, particularly those pertaining to substantial completion date. All acts consistent with the authority of the Agreement, previous Change Orders (if any), and this Change Order, prior to the effective date of this Change Order, are hereby ratified and affirmed, and the terms of the Agreement, previous Change Orders (if any), and this Change Order 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 contract modification, which is binding on the parties of this contract. 3. The Contractor will adjust the amount of its performance bond (if any) for this project to be consistent with the revised contract sum shown in section 2, above. IN WITNESS, the parties below have executed this Agreement, which will become effective on the last date written below. CONTRACTOR: By: f ` {slgnatu Print Name: .. f Its DATE: CITY OF KENT: Digitally Signed by DIVid A. Brpck David A. Brock ❑N. cn=pavId efat'0 Sr ee fl=dbr ck@kentwa_9 u llc Warky Operations, email=d6rock�kentwa.gov, [=U5 By: Date 2022.05 25 0559:14 -07W (signature) Print Name: David A. Brock P.E. Its Deputy Director O erations (title) DATE: CHANGE ORDER - 2 OF 3 CHANGE ORDER - 3 OF 3 ATTEST: ___________________________ Kent City Clerk APPROVED AS TO FORM: (applicable if Mayor’s signature required) Kent Law Department Hokkaido Drilling - Kent Spring Well #3 CO 1/Bond Client#: 68158 HOKKDRIL3 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1 4/18/2022 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER Propel Insurance Tacoma Commercial Insurance 1201 Pacific Ave, Suite 1000 Tacoma, WA 98402 NAME:Teressa Swiberg PHONE g00 499-0933 FAX 866 577-1326 A/C No Ext : A/c, No E-MAIL ADDRESS: teressa.swiberg@propelinsurance.com p INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Ohio Security Insurance Company 24082 INSURED INSURER B : The Ohio Casualty Insurance Company 24074 Hokkaido Drilling Inc. West American Insurance Company INSURER C : p Y 44393 PO Box 100 Graham, WA 98338 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 CONTRACTOR 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. LT R LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR BKS56049215 6/01/2021 06/01/2022 EACH OCCURRENCE $1000000 PREMISES ERENTED nce $1,000,000 MED EXP (Anyone person) $15 000 PERSONAL & ADV INJURY $1,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY F] JECOT LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ C AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY BAW56049215 6/01/2021 06/01/2022 Ea MINED accidentSINGLE LIMIT $1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE US056049215 6/01/2021 06/01/2022 EACH OCCURRENCE $4000000 AGGREGATE s4,000,000 DED I X RETENTION $10000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A BKS56049215 WA STOP GAP 6/01/2021 06/01/2022 PER OTH- TAT TE ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE- POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) RE: Kent Springs Well #3 City of Kent. Additional Insured Status applies per attached form(s). Waiver of Subrogation applies per attached form(s). IL" a Gi In a Pf_\ I a• i IVJ A.J aC AL\C Nf AAAGU Lai City of Kent 220 Fourth Avenue South Kent, WA 98032 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) 1 of 1 #S5151456/M4789076 © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD C LJ 02 This page has been left blank intentionally. '0� MutualLiberty . INSURANCE Coverage Is Provided In: Ohio Security Insurance Company Policy Change Endorsement Policy Number: BKS (22) 56 04 9215 Policy Period: From 06/01/2021 To 06/01/2022 Endorsement Period: From 03/13/2022 to 06/01/2022 12:01 am Standard Time at Insured Mailing Location Named Insured & Mailing Address Agent Mailing Address & Phone No. HOKKAIDO DRILLING INC. (206) 676-4200 PO Box 100 PROPEL INSURANCE Graham, WA 98338 PO BOX 2940 TACOMA, WA 98401-2940 CHANGES TO POLICY - TRANSACTION 4 3 This Policy Change Endorsement Results In A Change In The Charges As Follows: No Change in Premium Description of Change(s) Additional Interested Parties City of Kent is added as an additional insured per form CG8061. See The Revised Declarations and Declarations Schedule Issue Date To report a claim, call your Agent or 1-844-325-2467 Authorized Representative DS 70 27 01 08 56049215 POLSVCS 235 INSURED COPY 001295 PAGE 1 OF 32 Liberty Mutual. INSURANCE Coverage Is Provided In: Ohio Security Insurance Company Policy Change Endorsement Named Insured Agent HOKKAIDO DRILLING INC. SUMMARY OF LOCATIONS 0001 24511 104th Avenue Ct E Bldg 1, Graham, WA 98338-8929 0002 24511 104th Avenue Ct E Bldg 2, Graham, WA 98338-8929 0003 24511 104th Avenue Ct E Bldg 3, Graham, WA 98338-8929 0004 24511 104th Avenue Ct E Bldg 4, Graham, WA 98338-8929 0005 24511 104th Avenue Ct E Bldg 5, Graham, WA 98338-8929 POLICY FORMS AND ENDORSEMENTS (206) 676-4200 PROPEL INSURANCE Policy Number: BKS (22) 56 04 9215 Policy Period: From 06/01/2021 To 06/01/2022 Endorsement Period: From 03/13/2022 to 06/01/2022 12:01 am Standard Time at Insured Mailing Location This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CG 00 01 04 13 Commercial General Liability Coverage Form - Occurrence CG 01 81 05 08 Washington Changes CG 01 97 1207 Washington Changes - Employment -Related Practices Exclusion CG 04 42 11 03 Stop Gap - Employers Liability Coverage Endorsement - Washington CG 04 50 05 08 Washington Changes - Who Is An Insured CG 20 01 04 13 Primary And Noncontributory - Other Insurance Condition CG 21 06 05 14 Exclusion - Access Or Disclosure Of Confidential Or Personal Information And Data -Related Liability - With Limited Bodily Injury Exception CG 21 70 01 15 Cap on Losses from Certified Acts of Terrorism Issue Date To report a claim, call your Agent or 1-844-325-2467 Authorized Representative DS 70 27 01 08 56049215 POLSVCS 235 INSURED COPY 001295 PAGE 2 OF 32 Liberty Mutual. INSURANCE Coverage Is Provided In: Ohio Security Insurance Company Policy Change Endorsement Named Insured Agent HOKKAIDO DRILLING INC. (206) 676-4200 PROPEL INSURANCE POLICY FORMS AND ENDORSEMENTS - CONTINUED Policy Number: BKS (22) 56 04 9215 Policy Period: From 06/01/2021 To 06/01/2022 Endorsement Period: From 03/13/2022 to 06/01/2022 12:01 am Standard Time at Insured Mailing Location This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CG 21 76 01 15 Exclusion of Punitive Damages Related to a Certified Act of Terrorism CG 21 86 1204 Exclusion - Exterior Insulation and Finish Systems CG 21 96 03 05 Silica or Silica -Related Dust Exclusion CG 22 79 04 13 Exclusion - Contractors - Professional Liability CG 24 26 04 13 Amendment of Insured Contract Definition CG 26 77 1204 Washington - Fungi or Bacteria Exclusion CG 32 21 01 15 Washington Conditional Exclusion of Terrorism Involving Nuclear, Biological or Chemical Terrorism (Relating to Disposition of Federal Terrorism Risk Insurance Act) CG 80 61 05 11 Amendment of Cancellation Provisions CG 84 94 12 08 Exclusion - Consolidated Insurance Programs Wrap -Up CG 84 99 08 09 Non -Cumulation Liability Limits Same Occurrence CG 85 84 04 13 Additional Insured - Designated Owners, Lessees or Contractors - Completed Operations CG 88 10 04 13 Commercial General Liability Extension CG 88 77 12 08 Medical Expense At Your Request Endorsement Issue Date To report a claim, call your Agent or 1-844-325-2467 Authorized Representative DS 70 27 01 08 56049215 POLSVCS 235 INSURED COPY 001295 PAGE 3 OF 32 Liberty Mutual. INSURANCE Coverage Is Provided In: Ohio Security Insurance Company Policy Change Endorsement Named Insured Agent HOKKAIDO DRILLING INC. (206) 676-4200 PROPEL INSURANCE POLICY FORMS AND ENDORSEMENTS - CONTINUED Policy Number: BKS (22) 56 04 9215 Policy Period: From 06/01/2021 To 06/01/2022 Endorsement Period: From 03/13/2022 to 06/01/2022 12:01 am Standard Time at Insured Mailing Location This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CG 88 87 12 08 Exclusion - Lead Liability CG 8927 10 09 Washington Exclusion - Asbestos CG 91 98 06 15 Disclosure and Notice Concerning Fully Earned and Minimun Premium Endorsements CL 01 03 03 10 Common Policy Conditions - Washington CL 06 00 01 15 Certified Terrorism Loss CL 07 00 1006 Virus or Bacteria Exclusion CL 08 11 09 18 Cannabis Items and Activities Exclusion CL 16 50 08 06 Conditional Nuclear, Biological, and Chemical Terrorism Exclusion CM 76 13 07 13 Waiver of Theft Deductible CM 89 15 06 20 Variable Deductible Endorsement CM 89 19 0620 Valuation Of Equipment Leased Or Rented From Others CM 89 21 08 20 Replacement Cost Removed On Equipment Older Than Six (6) Years Of Age CP 00 10 10 12 Building and Personal Property Coverage Form CP 00 50 10 12 Extra Expense Coverage Form CP 00 90 07 88 Commercial Property Conditions CP 01 26 10 12 Washington Changes Issue Date To report a claim, call your Agent or 1-844-325-2467 Authorized Representative DS 70 27 01 08 56049215 POLSVCS 235 INSURED COPY 001295 PAGE 4 OF 32 Liberty Mutual. INSURANCE Coverage Is Provided In: Ohio Security Insurance Company Policy Change Endorsement Named Insured Agent HOKKAIDO DRILLING INC. (206) 676-4200 PROPEL INSURANCE POLICY FORMS AND ENDORSEMENTS - CONTINUED Policy Number: BKS (22) 56 04 9215 Policy Period: From 06/01/2021 To 06/01/2022 Endorsement Period: From 03/13/2022 to 06/01/2022 12:01 am Standard Time at Insured Mailing Location This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CP 01 40 07 06 Exclusion of Loss Due to Virus or Bacteria CP 01 60 03 21 Washington Changes - Domestic Abuse CP 01 79 10 12 Washington Changes - Excluded Causes of Loss CP 10 30 10 12 Causes of Loss - Special Form CP 1220 10 12 Loss Payable Provisions - Washington Endorsement CP 88 00 02 15 Property Extension Endorsement CP 88 04 03 10 Removal Permit CP 88 44 02 15 Equipment Breakdown Coverage Endorsement CP 9201 05 17 Property Anti -Stacking Endorsement CP 92 12 1220 Cyber Incident Exclusion IL 01 23 11 13 Washington Changes - Defense Costs IL 01 46 08 10 Washington Common Policy Conditions IL 01 98 09 08 Nuclear Energy Liability Exclusion Endorsement (Broad Form) IL 09 35 07 02 Exclusion of Certain Computer -Related Losses IL 09 52 01 15 Cap On Losses From Certified Acts Of Terrorism Issue Date To report a claim, call your Agent or 1-844-325-2467 Authorized Representative DS 70 27 01 08 56049215 POLSVCS 235 INSURED COPY 001295 PAGE 5 OF 32 Liberty Mutual. INSURANCE Coverage Is Provided In: Ohio Security Insurance Company Policy Change Endorsement Named Insured Agent HOKKAIDO DRILLING INC. (206) 676-4200 PROPEL INSURANCE POLICY FORMS AND ENDORSEMENTS - CONTINUED Policy Number: BKS (22) 56 04 9215 Policy Period: From 06/01/2021 To 06/01/2022 Endorsement Period: From 03/13/2022 to 06/01/2022 12:01 am Standard Time at Insured Mailing Location This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE IL 09 96 01 07 Conditional Exclusion of Terrorism Involving Nuclear, Biological or Chemical Terrorism (Relating to Dispostion of Federal Terrorism Risk Insurance Act) IL 88 56 11 20 Actual Cash Value - Washington IM 20 97 04 04 Amendatory Endorsement - Washington IM 70 00 04 04 Contractors' Equipment Coverage 3721 15 0 Mortgagee Clause Issue Date To report a claim, call your Agent or 1-844-325-2467 Authorized Representative DS 70 27 01 08 56049215 POLSVCS 235 INSURED COPY 001295 PAGE 6 OF 32 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 01 04 13 Page 1 of 1 PRIMARY AND NONCONTRIBUTORY – OTHER INSURANCE CONDITION Other Insurance Primary And Noncontributory Insurance (1) (2) This page has been left blank intentionally. COMMERCIAL GENERAL LIABILITY CG 88 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY EXTENSION INDEX SUBJECT PAGE NON-OWNED AIRCRAFT 2 NON-OWNED WATERCRAFT 2 PROPERTY DAMAGE LIABILITY ELEVATORS 2 2 MEDICAL PAYMENTS EXTENSION 3 EXTENSION OF SUPPLEMENTARY PAYMENTS COVERAGES A AND B 3 ADDITIONAL INSUREDS BY CONTRACT, AGREEMENT OR PERMIT 3 PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED EXTENSION 5 ADDITIONAL INSUREDS 6 WHO IS AN INSURED INCIDENTAL MEDICAL ERRORS/MALPRACTICE AND WHO IS AN INSURED FELLOW EMPLOYEE EXTENSION MANAGEMENT EMPLOYEES 6 NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES 7 FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES 7 KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT 7 LIBERALIZATION CLAUSE 7 BODILY INJURY REDEFINED 7 EXTENDED PROPERTY DAMAGE 8 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US 8 WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU CG 88 10 04 13 Page 1 of 8 A. NON-OWNED AIRCRAFT 2. Exclusions Section I Coverage A - Bodily Injury And Property Damage Liability, g. Aircraft, Auto Or Watercraft 1. 2. 3. 4. B. NON-OWNED WATERCRAFT 2. Exclusions Section I Coverage A Bodily Injury And Property Damage Liability, (2)g. Aircraft, Auto Or Watercraft (2) (a) (b) C. PROPERTY DAMAGE LIABILITY ELEVATORS 1.2. Exclusions Section I Coverage A Bodily Injury And Property Damage Liability,(3), (4)(6)j. Damage To Property 2.Section IV Commercial General Liability Conditions, 4. Other Insurance, b. Excess Insurance: D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU 1.2. Exclusions of Section I - Coverage A - Bodily Injury and Property Damage Liability: a.j. Damage To Property (1),(3) (4) (i) (ii) (1),(3) (4) Section III Limits of Insurance CG 88 10 04 13 Page 2 of 8 b.2. Exclusions c.n. Section III Limits Of Insurance. 2.6.Section III Limits Of Insurance 6.5. A a. (1) (2) b. 3.D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) - 9.a.Definitions 9.a. E. MEDICAL PAYMENTS EXTENSION Coverage C Medical Payments 1.Insuring Agreement Section I Coverage C Medical Payments, (b)a. (b) F. EXTENSION OF SUPPLEMENTARY PAYMENTS COVERAGES A AND B 1.Supplementary Payments Coverages A B,1.b. b.$3,000 2.1.d d. $500 G. ADDITIONAL INSUREDS - BY CONTRACT, AGREEMENT OR PERMIT 1.2.Section II Who Is An Insured a. CG 88 10 04 13 Page 3 of 8 b. c. d. (1) (2) (3) a) (b) (c) 1. 2. 1.a. (1) (2) 1.b. 1.c. b.2. Duties In the Event Of Occurrence, Offense, Claim Or Suit Section IV Commercial General Liability Conditions. CG 88 10 04 13 Page 4 of 8 2. 2. Exclusions Section I - Coverage A - Bodily Injury And Property Damage Liability: a. b. c. (1) (2) d. (1) (2) e. ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS 3.Section III Limits Of Insurance: a. b. H. PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED EXTENSION 4. Other Insurance of SECTION IV COMMERCIAL GENERAL LIABILITY CONDITIONS a. a. Primary Insurance: CG 88 10 04 13 Page 5 of 8 b. b. Excess Insurance: I. ADDITIONAL INSUREDS - 1.2. Duties In The Event Of Occurrence, Offense, Claim or Suit: a. b. c. d. 2. Section III Limits of Insurance . J. WHO IS AN INSURED - INCIDENTAL MEDICAL ERRORS / MALPRACTICE WHO IS AN INSURED - FELLOW EMPLOYEE EXTENSION - MANAGEMENT EMPLOYEES 2.a.(1)Section II - Who Is An Insured (1) (a) (b) (1) (a) (c) (1) (a)(b) (d) (d) CG 88 10 04 13 Page 6 of 8 (a)(b) J. K. NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES 3.Section II Who Is An Insured 3. a. b.A c.B d. L. FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES Section IV Commercial General Liability Conditions,6. Representations: M. KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT Section IV Commercial General Liability Conditions,2. Duties In The Event of Occurrence, Offense, Claim Or Suit: 1. Section II Who Is An Insured N. LIBERALIZATION CLAUSE O. BODILY INJURY REDEFINED Section V Definitions,3. 3. CG 88 10 04 13 Page 7 of 8 P. EXTENDED PROPERTY DAMAGE Exclusion a. COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY a. Expected Or Intended Injury Q. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU Section IV Commercial General Liability Conditions,8.Transfer Of Rights Of Recovery Against Others To Us: 1. 2. CG 88 10 04 13 Page 8 of 8 COMMERCIAL AUTO AC 85 01 06 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. If the policy to which this endorsement is attached also contains a Business Auto Coverage Enhancement Endorsement with a specific state named in the title, this endorsement does not apply to vehicles garaged in that specified state. COVERAGEINDEX SUBJECT PROVISION NUMBER ACCIDENTAL AIRBAG DEPLOYMENT 13 ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT 4 AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS 21 AMENDED FELLOW EMPLOYEE EXCLUSION 6 AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE 15 BODILY INJURY REDEFINED 25 EMPLOYEES AS INSUREDS (Including Employee Hired Auto) 3 EXTRA EXPENSE -BROADENED COVERAGE 11 GLASS REPAIR -WAIVER OF DEDUCTIBLE 17 HIRED AUTO COVERAGE TERRITORY 23 HIRED AUTO PHYSICAL DAMAGE (Including Employee Hired Auto) 7 LOAN / LEASE GAP (Coverage Not Available In New York) 16 NEWLY FORMED OR ACQUIRED SUBSIDIARIES 2 PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) 18 PERSONAL EFFECTS COVERAGE 12 PHYSICAL DAMAGE - ADDITIONAL TRANSPORTATION EXPENSE COVERAGE 9 PHYSICAL DAMAGE DEDUCTIBLE -VEHICLE TRACKING SYSTEM 14 PRIMARY AND NON-CONTRIBUTORY - WRITTEN CONTRACT OR WRITTEN AGREEMENT 24 RENTAL REIMBURSEMENT 10 SUPPLEMENTARY PAYMENTS 5 TOWING AND LABOR 8 TRAILERS - INCREASED LOAD CAPACITY 1 TWO OR MORE DEDUCTIBLES 19 UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS 20 WAIVER OF TRANSFER OF RIGHTS OF RECOVERYAGAINST OTHERS TO US 22 SECTION I - COVERED AUTOS is amended as follows: 1. TRAILERS - INCREASED LOAD CAPACITY The following replaces Paragraph C.1. Certain Trailers, Mobile Equipment And Temporary Substitute Autos of SECTION I - COVERED AUTOS: "Trailers" with a load capacity of 3,000 pounds or less designed primarily for travel on public roads. © 2017 Liberty Mutual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 1 of 7 SECTION II - LIABILITY COVERAGE is amended as follows: 2. NEWLY FORMED OR ACQUIRED SUBSIDIARIES SECTION II - LIABILITY COVERAGE, Paragraph A.I. - Who Is An Insured is amended to include the following as an "insured": d. Any legally incorporated subsidiary of which you own more than 50 percent interest during the policy period. Coverage is afforded only for 90 days from the date of acquisition or formation. However, "insured" does not include any organization that: (1) Is a partnership or joint venture; or (2) Is an "insured" under any other automobile policy except a policy written specificall y to apply in excess of this policy; or (3) Has exhausted its Limit of Insurance or had its policy terminated under any other automobile policy. Coverage under this provision d. does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization. 3. EMPLOYEES AS INSUREDS SECTION II - LIABILITY COVERAGE, Paragraph A.I. Who Is An Insured is amended to include the following as an "insured": e. Any "employee" of yours while using a covered "auto" you do not own, hire or borrow but only for acts within the scope of their employment by you. Insurance provided by this endorsement is excess over any other insurance available to any "employee". f. Any "employee" of yours while operating an "auto" hired or borrowed under a written contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business and within the scope of their employment. Insurance provided by this endorsement is excess over any other insurance available to the "employee". 4. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT SECTION II - LIABILITY COVERAGE, Paragraph A.1. Who Is An Insured is amended to include the following as an "insured": g. Any person or organization with respect to the operation, maintenance or use of a covered "auto", provided that you and such person or organization have agreed in a written contract, written agreement, or permit issued to you by governmental or public authority, to add such person, or organization, or governmental or public authority to this policy as an "insured". However, such person or organization is an "insured": (1) Only with respect to the operation, maintenance or use of a covered "auto"; (2) Only for "bodily injury" or "property damage" caused by an "accident" which takes place after you executed the written contract or written agreement, or the permit has been issued to you; and (3) Only for the duration of that contract, agreement or permit. The "insured" is required to submit a claim to any other insurer to which coverage could apply for defense and indemnity. Unless the "insured" has agreed in writing to primary noncontributory wording per enhancement number 24, this policy is excess over any other collectible insurance. 5. SUPPLEMENTARY PAYMENTS SECTION II - LIABILITY COVERAGE, Coverage Extensions, 2.a. Supplementary Payments, Paragraphs (2) and (4) are replaced by the following: (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic 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. © 2017 Liberty Mutual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 2 of 7 6. AMENDED FELLOW EMPLOYEE EXCLUSION In those jurisdictions where, by law, fellow "employees" are not entitled to the protection afforded to the employer by the workers compensation exclusivity rule, or similar protection, the following provi- sion is added: SECTION II - LIABILITY, Exclusion B.5. Fellow Employee does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire if you have workers compensation insurance in force for all of your "employees" at the time of "loss". This coverage is excess over any other collectible insurance. SECTION III - PHYSICAL DAMAGE COVERAGE is amended as follows: 7. HIRED AUTO PHYSICAL DAMAGE Paragraph A.4. Coverage Extensions of SECTION III - PHYSICAL DAMAGE COVERAGE, is amended by adding the following: If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of Loss or Collision coverage are provided under the Business Auto Coverage Form for any "auto" you own, then the Physical Damage coverages provided are extended to "autos": a. You hire, rent or borrow; or b. Your "employee" hires or rents under a written contract or agreement in that "employee's" name, but only if the damage occurs while the vehicle is being used in the conduct of your business, subject to the following limit and deductible: a. The most we will pay for "loss" in any one "accident" or "loss" is the smallest of: (1) $50,000; or (2) The actual cash value of the damaged or stolen property as of the time of the "loss"; or (3) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality, minus a deductible. b. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. c. Subject to the limit, deductible and excess provisions described in this provision, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own. d. Subject to a maximum of $1,000 per "accident", we will also cover the actual 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. e. This coverage extension does not apply to: (1) Any "auto" that is hired, rented or borrowed with a driver; or (2) Any "auto" that is hired, rented or borrowed from your "employee" or any member of your "employee's" household. Coverage provided under this extension is excess over any other collectible insurance available at the time of "loss". 8. TOWING AND LABOR SECTION III - PHYSICAL DAMAGE COVERAGE, Paragraph A.2. Towing, is amended by the addition of the following: We will pay towing and labor costs incurred, up to the limits shown below, each time a covered "auto" classified and rated as a private passenger type, "light truck" or "medium truck" is disabled: a. For private passenger type vehicles, we will pay up to $75 per disablement. b. For "light trucks", we will pay up to $75 per disablement. "Light trucks" are trucks that have a gross vehicle weight (GVW) of 10,000 pounds or less. c. For "medium trucks" , we will pay up to $150 per disablement. "Medium trucks" are trucks that have a gross vehicle weight (GVW) of 10,001 - 20,000 pounds. However, the labor must be performed at the place of disablement. © 2017 Liberty Mutual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 3 of 7 9. PHYSICAL DAMAGE -ADDITIONAL TRANSPORTATION EXPENSE COVERAGE Paragraph A.4.a. Coverage Extensions, Transportation Expenses of SECTION III - PHYSICAL DAMAGE COVERAGE, is amended to provide a limit of $50 per day and a maximum limit of $1,500. 10. RENTAL REIMBURSEMENT SECTION III - PHYSICAL DAMAGE COVERAGE, A. Coverage, is amended by adding the following: a. We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of an "auto" because of "accident" or "loss", to an "auto" for which we also pay a "loss" under Comprehensive, Specified Causes of Loss or Collision Coverages. We will pay only for those ex- penses incurred after the first 24 hours following the "accident" or "loss" to the covered "auto." b. Rental Reimbursement requires the rental of a comparable or lessor vehicle, which in many cases may be substantially less than $75 per day, and will only be allowed for the period of time it should take to repair or replace the vehicle with reasonable speed and similar quality, up to a maximum of 30 days. c. We will also pay up to $500 for reasonable and necessary expenses incurred by you to remove and replace your tools and equipment from the covered "auto". This limit is excess over any other collectible insurance. d. This coverage does not apply unless you have a business necessity that other "autos" available for your use and operation cannot fill. e. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided under Paragraph 4. Coverage Extension. f. No deductible applies to this coverage. g. The insurance provided under this extension is excess over any other collectible insurance. If this policy also provides Rental Reimbursement Coverage you purchased, the coverage provided by this Enhancement Endorsement is in addition to the coverage you purchased. For the purposes of this endorsement provision, materials and equipment do not include "personal effects" as defined in provision 12.13. 11. EXTRA EXPENSE - BROADENED COVERAGE Under SECTION III - PHYSICAL DAMAGE COVERAGE, A. Coverage, we will pay for the expense of returning a stolen covered "auto" to you. The maximum amount we will pay is $1,000. 12. PERSONAL EFFECTS COVERAGE A. SECTION III - PHYSICAL DAMAGE COVERAGE, A. Coverage, is amended by adding the following: If you have purchased Comprehensive Coverage on this policy for an "auto" you own and that "auto" is stolen, we will pay, without application of a deductible, up to $600 for "personal effects" stolen with the "auto." The insurance provided under this provision is excess over any other collectible insurance. B. SECTION V - DEFINITIONS is amended by adding the following: For the purposes of this provision, "personal effects" mean tangible property that is worn or carried by an "insured." "Personal effects" does not include tools, equipment, jewelry, money or securi- ties. 13. ACCIDENTAL AIRBAG DEPLOYMENT SECTION III - PHYSICAL DAMAGE COVERAGE, B. Exclusions is amended by adding the following: If you have purchased Comprehensive or Collision Coverage under this policy, the exclusion for "loss" relating to mechanical breakdown does not apply to the accidental discharge of an airbag. Any insurance manufacturer's warranty. we provide shall be excess over any other collectible insurance or reimbursement by warranty. However, we agree to pay any deductible applicable to the other coverage or AC 85 01 06 18 © 2017 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 4 of 7 14. PHYSICAL DAMAGE DEDUCTIBLE -VEHICLE TRACKING SYSTEM SECTION III - PHYSICAL DAMAGE COVERAGE, D. Deductible, is amended by adding the following: Any Comprehensive Deductible shown in the Declarations will be reduced by 50% for any "loss" caused by theft if the vehicle is equipped with a vehicle tracking device such as a radio tracking device or a global position device and that device was the method of recovery of the vehicle. 15. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE SECTION III - PHYSICAL DAMAGE COVERAGE, B. Exclusions, Paragraph a. of the exception to exclu- sions 4.c. and 4.d. is deleted and replaced with the following: Exclusions 4.c. and 4.d. do not apply to: a. Electronic equipment that receives or transmits audio, visual or data signals, whether or not de- signed solely for the reproduction of sound, if the equipment is: (1) Permanently installed in the covered "auto" at the time of the "loss" or removable from a housing unit that is permanently installed in the covered "auto"; and (2) Designed to be solely operated by use from the power from the "auto's" electrical system; and (3) Physical damage coverages are provided for the covered "auto". If the "loss" occurs solely to audio, visual or data electronic equipment or accessories used with this equipment, then our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by a $100 deductible. 16. LOAN / LEASE GAP COVERAGE (Not Applicable In New York) A. Paragraph C. Limit Of Insurance of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by adding the following: The most we will pay for a "total loss" to a covered "auto" owned by or leased to you in any one "accident" is the greater of the: 1. Balance due under the terms of the loan or lease to which the damaged covered "auto" is subject at the time of the "loss" less the amount of: a. Overdue payments and financial penalties associated with those payments as of the date of the "loss"; b. Financial penalties imposed under a lease due to high mileage, excessive use or abnormal wear and tear; c. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insur- ance purchased with the loan or lease; d. Transfer or rollover balances from previous loans or leases; e. Final payment due under a "Balloon Loan"; f. The dollar amount of any unrepaired damage which occurred prior to the "total loss" of a covered "auto"; g. Security deposits not refunded by a lessor; h. All refunds payable or paid to you as a result of the early termination of a lease agreement or as a result of the early termination of any warranty or extended service agreement on a covered "auto"; I. Any amount representing taxes; j. Loan or lease termination fees; or 2. The actual cash value of the damage or stolen property as of the time of the "loss". An adjustment for depreciation and physical condition will be made in determining the actual cash value at the time of the "loss". This adjustment is not applicable in Texas. B. Additional Conditions This coverage applies only to the original loan for which the covered "auto" that incurred the "loss" serves as collateral, or lease written on the covered "auto" that incurred the "loss". © 2017 Liberty Mutual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 5 of 7 C. SECTION V - DEFINITIONS is changed by adding the following: As used in this endorsement provision, the following definitions apply: "Total loss" means a 'loss" in which the cost of repairs plus the salvage value exceeds the actual cash value. A "balloon loan" is one with periodic payments that are insufficient to repay the balance over the term of the loan, thereby requiring a large final payment. 17. GLASS REPAIR- WAIVER OF DEDUCTIBLE Paragraph D. Deductible of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: No deductible applies to glass damage if the glass is repaired rather than replaced. 18. PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) Paragraph D. Deductible of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: The deductible does not apply to "loss" caused by collision to such covered "auto" of the private passenger type or light weight truck with a gross vehicle weight of 10,000 lbs. or less as defined by the manufacturer as maximum loaded weight the "auto" is designed to carry while it is: a. In the charge of an "insured"; b. Legally parked; and c. Unoccupied. The 'loss" must be reported to the police authorities within 24 hours of known damage. The total amount of the damage to the covered "auto" must exceed the deductible shown in the Declarations. This provision does not apply to any 'loss" if the covered "auto" is in the charge of any person or organization engaged in the automobile business. 19. TWO OR MORE DEDUCTIBLES Under SECTION III - PHYSICAL DAMAGE COVERAGE, if two or more company policies or coverage forms apply to the same "accident", the following applies to Paragraph D. Deductible: a. If the applicable Business Auto deductible is the smaller (or smallest) deductible, it will be waived; or b. If the applicable Business Auto deductible is not the smaller (or smallest) deductible , it will be reduced by the amount of the smaller (or smallest) deductible; or c. If the "loss" involves two or more Business Auto coverage forms or policies, the smaller (or smallest) deductible will be waived. For the purpose of this endorsement, company means any company that is part of the Liberty Mutual Group. SECTION IV - BUSINESS AUTO CONDITIONS is amended as follows: 20. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS SECTION IV- BUSINESS AUTO CONDITIONS, Paragraph B.2. is amended by adding the following: If you unintentionally fail to disclose any hazards, exposures or material facts existing as of the incep- tion date or renewal date of the Business Auto Coverage Form, the coverage afforded by this policy will not be prejudiced. However, you must report the undisclosed hazard of exposure as soon as practicable after its discovery, and we have the right to collect additional premium for any such hazard or exposure. © 2017 Liberty Mutual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 6 of 7 21. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT, OR LOSS SECTION IV - BUSINESS AUTO CONDITIONS, Paragraph A.2.a. is replaced in its entirety by the follow- ing: a. In the event of "accident", claim, "suit" or "loss", you must promptly notify us when it is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) Member, if you are a limited liability company; (4) An executive officer or the "employee" designated by the Named Insured to give such notice, if you are a corporation. To the extent possible, notice to us should include: (a) How, when and where the "accident" or "loss" took place; (b) The "insureds" name and address; and (c) The names and addresses of any injured persons and witnesses. 22. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION IV - BUSINESS AUTO CONDITIONS, Paragraph A.5. Transfer Of Rights Of Recovery Against Others To Us, is amended by the addition of the following: If the person or organization has in a written agreement waived those rights before an "accident" or "loss", our rights are waived also. 23. HIRED AUTO COVERAGE TERRITORY SECTION IV - BUSINESS AUTO CONDITIONS, Paragraph B.7. Policy Period, Coverage Territory, is amended by the addition of the following: f. For "autos" hired 30 days or less, the coverage territory is anywhere in the world, provided that the "insured's" responsibility to pay for damages is determined in a "suit", on the merits, in the United States, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to. This extension of coverage does not apply to an "auto" hired, leased, rented or borrowed with a driver. 24. PRIMARY AND NON-CONTRIBUTING IF REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREE- MENT The following is added to SECTION IV - BUSINESS AUTO CONDITIONS, General Conditions, B.5. Other Insurance and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1. Such "insured" is a Named Insured under such other insurance; and 2. You have agreed in a written contract or written agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured". SECTION V - DEFINITIONS is amended as follows: 25. BODILY INJURY REDEFINED Under SECTION V - DEFINITIONS, Definition C. is replaced by the following: "Bodily injury" means physical injury, sickness or disease sustained by a person, including mental anguish, mental injury, shock, fright or death resulting from any of these at any time. © 2017 Liberty Mutual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 7 of 7 This page has been left blank intentionally.