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CAG2022-213 - Supplement - #1 - KBA, Inc. - S. 212th St. Preservation (Green River Bridge to Orillia Rd./Kent City Limits) - 08/03/2022
Nancy Yoshitake for Eric Connor Public Works 08/04/2022 08/08/2022 N/A R90122 N/A KBA, Inc.Contract Amendment S. 212th St. Preservation (Green River Bridge to Orillia Rd./Kent City Limits) Revised Exhibits D and E. Other 06/30/2023 $0 CAG2022-213 Supplement_______ Supplemental Agreement Number Organization and Address Phone: Original Agreement Number Project Number Execution Date Completion Date Project Title New Maximum Amount Payable Description of Work The Local Agency of desires to supplement the agreement entered in to with and executed on The changes to the agreement are described as follows: I Section 1, SCOPE OF WORK, is hereby changed to read: II for completion of the work to read: III If you concur with this supplement and agree to the changes as stated above, please sign in the Appropriate By: By: Consultant Signature Approving Authority Signature Date DOT Form 140-063 Revised 09/2005 S. 212th St. Preservation r (Green River Bridge to Orillia Rd / Kent City Limits) City of Kent KBA Job No. Cost + Net fee (on DSC Only) Prepared On: 4/19/2022 Prepared by: Cameron Bloomer Annual Escalation on DSC S% ESTIMATE OF COSTS CONFIDENTIAL & PROPRIETARY TO KBA, INC. 21 21 22 20 23 21 21 168 168 176 160 184 168 168 6% 6% 6% 6% 6% 6% 6% 178 178 187 170 195 178 178 KBA Hours Task 2022 Rate Total Agreement Hours APR Total 2022 MAY JUN JUL AUG SEP OCT 2022 2022 2022 2022 2022 2022 LSubtotal - KBA Labor Ho 1,101 1,101 - 87 287 261 299 167 - Project Expenses Tax Total Agreemen Costs Total N PR MAY JUN JUL AUG SEP OCT 022 2022 2022 2022 2022 2022 2022 Subtotal - Direct Expenses 7,029 - 702 1,753 1,691 1,780 1,104 Jimale Technical Services, LLC. Materials Testing HWA Geosciences GeoTech 5,297 6,738 6,125 7,044 1,225 12,601 H Sam Schuyler M2 Manager II 01.00 $229.31 2,752 2,752 - 688 459 459 459 688 - H Jill Carter A4 Administrator IV 01.00 $125.65 2,513 2,513 - 503 503 503 503 503 - F Cameron Bloomer ES Engineer/ Professional V 02.00 $171.02 67,895 67,895 - 6,B41 16,076 14,537 16,760 13,682 - F Inspector E3 E3 Engineer/ Professional III 02.00 $124.37 68,652 68,652 - 4,975 23,257 21,143 9,328 9,950 - F Inspector E3 (Night) E3 Engineer/ Professional 111 03.00 $143.02 17,162 17,162 - - - - 17,162 - - Direct 2022 158,974 - 13,006 40,294 36,641 44,211 24,822 - Direct Expenses (No Markup) 7,029 7,029 - 702 1,753 1,691 11780 1,104 - Subconsultant(s) 39,029 39,029 - 5,297 6,738 6,125 19,645 1,225 - Agreement: City of Kent Agreement No. 169284 - 212th GRB to Orillia Rd. Rates are effective through 12/31/22 All Inclusive 2022 Home Direct Labor Hourly Billing Office Fee NTE Job Classifications Hourly Billing Rate Effective Overhead Rate 30% DSC + OH Rate NTE Through 155.78% 12/31/22 Manager II 1 $ 80.24 1 155.78% 30% $ 229.31 Administrator IV 1 $ 44.00 1 155.78% 30% $ 125.65 Agreement: City of Kent Agreement No. 169284 - 212th GRB to Orillia Rd. Rates are effective through 12/31/22 All Inclusive 2022 Home Direct Labor Hourly Billing Field Fee NTE Job Classifications Hourly Billing Rate Effective Overhead Rate 30% DSC + OH Rate NTE Through 146.37% 12/31/22 Engineer/ Professional V $ 61.88 146.37% 30% $ 171.02 Inspector E3 $ 45.00 146.37% 30% $ 124.37 Inspector E3 (Night) $ 51.75 146.37% 30% $ 143.02 Project Cost Estimate HWA Ref: 2022-065 Construction Inspection and Testing S 212th St Preservation - Green River Bridge to Orillia Rd Date: 15-Jul-22 Kent, WA Prepared By: BKH/BS Prepared For: Cameron Bloomer, KBA PROPOSED WORK SCOPE: This cost estimate is based on plans and information provided by the Client. 1. Sampling of HMA aggregate for acceptance testing (3 samples). Sampling of HMA aggregate and oil at the plant for ignition oven correction factor testing (1 sample). 2. Sampling and testing HMA during paving for Rice density, extraction and gradation (minimum: one test sample per 1000 tons). 3. Inspection and testing of HMA placement and compaction (minimum: one test per 100 tons). 4. Written field reports will be prepared for all inspections and reviewed for QC. Material Testing - ESTIMATED HWA LABOR: Engr VIII Geol VI Inspector Clerical TOTAL TOTAL $229.24 $142.54 $82.29 $74.94 HOURS AMOUNT Asphalt Inspection and Testing, including: Inspection and Testing during HMA Placement for Roadway (up to 8 visits) 64 64 $5,267 HMA Oven Ignition Correction Sampling of Aggregate and Oil (1 mix) 4 4 $329 HMA/Aggregate Sampling at Batch Plant during placement (5 samples) 20 20 $1,646 Project Management Preconstruction Meeting 1 1 $143 QA Review, Reporting, Submittal Reviews, and Report Distribution 4 2 6 $1,202 TOTAL LABOR COST 4 3 88 0 95 $8,586 Material Testing - LABORATORY TESTING ESTIMATE: LABORATORY EXPENSE DESCRIPTION Est No. Unit Test TOTAL Asphalt Ignition Oven Correction (1 mix, 3 burns) 3 $140 $420 HMA Aggregate Acceptance (Voids, FF, SE) (1 mix) at WSDOT intervals 3 $310 $930 Bitumen Content by Extraction with Gradation of Aggregate (1 mix design) at WSDOT intervals 5 $185 $925 Maximum Theoretical Specific Gravity of HMA (Rice Density) (1 mix design) at WSDOT intervals 5 $140 $700 LABORATORY TOTAL:$2,975 Scope of Services 2022 PERSONNEL & BILLING RATES S 212th St Preservation - Green River Bridge to Orillia Rd 1 of 2 HWA GeoSciences Inc. EXPENSES: $480 $320 $240 EXPENSE TOTAL:$1,040 ESTIMATED PROJECT TOTALS AND SUMMARY: Total Labor Cost $8,586 Laboratory Testing $2,975 Direct Expenses $1,040 ESTIMATED PROJECT TOTAL:$12,601 Assumptions: 1. These estimates may require adjustment due to the Contractor's rate of construction, weather delays, source changes and/or other factors beyond our control. 2. The HWA PM reserves the right to shift hours between the various subtasks as required. 3. The HWA work scope does not include safety assessment nor work pertaining to any environmental issues. 4. This cost estimate was prepared with the understanding that the Client will schedule inspection as needed. 5. All night work is charged at an 8 hour minimum segment. Night work cancelled within 12 hrs of scheduled time will be charged 4 hrs. 6. All weekend work is charged at an 4 hour minimum segment. Weekend work cancelled within 12 hrs of scheduled time will be charged 4 hrs. 7. Per Client, all concrete used will be 3000psi Commercial mix, and therefore will not be tested. 8. This cost estimate assumes temporary HMA will not be tested. 9. Per Client, aggregates will not be sampled. Compacted aggregates for ADA Ramps and Sidewalk will not be tested. Mileage to and from the job site for all inspections at IRS mileage rate (8 trips) Mileage for HMA and HMA aggregate sampling, assuming 6 trips EXPENSE DESCRIPTION Total Cost Thin Lift (HMA Testing) Nuclear Gauge Rental ($60/day), assuming 8 days S 212th St Preservation - Green River Bridge to Orillia Rd 2 of 2 HWA GeoSciences Inc. HWA Geosciences Subconsultant Agreement: City of Kent Agreement No. 169284 - 212th GRB to Orillia Rd. Rates are effective through 12/31/22 All Inclusive Direct Labor 2022 Hourly Billing Fee NTE Job Classifications Hourly Billing Overhead Rate Rate Effective 30% DSC Rate NTE 163.90% Through 12/31/22 Engineer VII $ 78.00 163.90% 30% $ 229.24 Geol V $ 48.50 163.90% 30% $ 142.54 Inspector $ 28.00 163.90% 30% $ 82.29 Clerical $ 25.50 163.90% 30% $ 74.94 Arnale Technical Services S 212th St. Preservation Green River Bridge to Orillia Rd. / Kent City Limits KBA Job No. 022011-01 KBA PM: Cameron Bloomer Exhibit B Estimate Neactiated Hourly Rates Effective Throuah December 31st 2022 Mary Lynum Mary Shelton JTS Project Admin JTS Sr. Project Admin/Quality Controls Working Days Per/Month 22 20 23 21 21 20 21 Hours Per/Month 176 160 184 168 168 160 168 Estimated Over -Time 12% 12% 12% 12% 11% 10% 4% otal Regular and Over -Time Hou 197 179 206 188 186 176 175 3,369 6,738 6,125 7,044 1,225 1,928 - - - - Jimale Techincals Services Subconsultant Agreement: City of Kent Agreement No. 169284 - 212th GRB to Orillia Rd. Rates are effective through 12/31/22 All Inclusive Direct Labor 2022 Fee NTE Hourly Billing Job Classifications Hourly Billing Overhead Rate 10% of DSC + Rate Effective Rate NTE 113.57% OH Through 12/31/22 Project Admin 1 $ 32.59 1 113.57% 10% $ 76.56 Sr. Project Admin/Quality Controls 1 $ 41.03 1 113.57% 10% $ 96.39 S. 212th St. Preservation r (Green River Bridge to Orillia Rd / Kent City Limits) City of Kent KBA Job No. Cost + Net fee (on DSC Only) Prepared On: 4/19/2022 Prepared by: Cameron Bloomer Annual Escalation on DSC S% ESTIMATE OF COSTS CONFIDENTIAL & PROPRIETARY TO KBA, INC. 21 21 22 20 23 21 21 168 168 176 160 184 168 168 6% 6% 6% 6% 6% 6% 6% 178 178 187 170 195 178 178 KBA Hours Task 2022 Rate Total Agreement Hours APR Total 2022 MAY JUN JUL AUG SEP OCT 2022 2022 2022 2022 2022 2022 LSubtotal - KBA Labor Ho 1,101 1,101 - 87 287 261 299 167 - Project Expenses Tax Total Agreemen Costs Total N PR MAY JUN JUL AUG SEP OCT 022 2022 2022 2022 2022 2022 2022 Subtotal - Direct Expenses 7,029 - 702 1,753 1,691 1,780 1,104 Jimale Technical Services, LLC. Materials Testing HWA Geosciences GeoTech 5,297 6,738 6,125 7,044 1,225 12,601 H Sam Schuyler M2 Manager II 01.00 $229.31 2,752 2,752 - 688 459 459 459 688 - H Jill Carter A4 Administrator IV 01.00 $125.65 2,513 2,513 - 503 503 503 503 503 - F Cameron Bloomer ES Engineer/ Professional V 02.00 $171.02 67,895 67,895 - 6,B41 16,076 14,537 16,760 13,682 - F Inspector E3 E3 Engineer/ Professional III 02.00 $124.37 68,652 68,652 - 4,975 23,257 21,143 9,328 9,950 - F Inspector E3 (Night) E3 Engineer/ Professional 111 03.00 $143.02 17,162 17,162 - - - - 17,162 - - Direct 2022 158,974 - 13,006 40,294 36,641 44,211 24,822 - Direct Expenses (No Markup) 7,029 7,029 - 702 1,753 1,691 11780 1,104 - Subconsultant(s) 39,029 39,029 - 5,297 6,738 6,125 19,645 1,225 - Agreement: City of Kent Agreement No. 169284 - 212th GRB to Orillia Rd. Rates are effective through 12/31/22 All Inclusive 2022 Home Direct Labor Hourly Billing Office Fee NTE Job Classifications Hourly Billing Rate Effective Overhead Rate 30% DSC + OH Rate NTE Through 155.78% 12/31/22 Manager II 1 $ 80.24 1 155.78% 30% $ 229.31 Administrator IV 1 $ 44.00 1 155.78% 30% $ 125.65 Agreement: City of Kent Agreement No. 169284 - 212th GRB to Orillia Rd. Rates are effective through 12/31/22 All Inclusive 2022 Home Direct Labor Hourly Billing Field Fee NTE Job Classifications Hourly Billing Rate Effective Overhead Rate 30% DSC + OH Rate NTE Through 146.37% 12/31/22 Engineer/ Professional V $ 61.88 146.37% 30% $ 171.02 Inspector E3 $ 45.00 146.37% 30% $ 124.37 Inspector E3 (Night) $ 51.75 146.37% 30% $ 143.02 Project Cost Estimate HWA Ref: 2022-065 Construction Inspection and Testing S 212th St Preservation - Green River Bridge to Orillia Rd Date: 15-Jul-22 Kent, WA Prepared By: BKH/BS Prepared For: Cameron Bloomer, KBA PROPOSED WORK SCOPE: This cost estimate is based on plans and information provided by the Client. 1. Sampling of HMA aggregate for acceptance testing (3 samples). Sampling of HMA aggregate and oil at the plant for ignition oven correction factor testing (1 sample). 2. Sampling and testing HMA during paving for Rice density, extraction and gradation (minimum: one test sample per 1000 tons). 3. Inspection and testing of HMA placement and compaction (minimum: one test per 100 tons). 4. Written field reports will be prepared for all inspections and reviewed for QC. Material Testing - ESTIMATED HWA LABOR: Engr VIII Geol VI Inspector Clerical TOTAL TOTAL $229.24 $142.54 $82.29 $74.94 HOURS AMOUNT Asphalt Inspection and Testing, including: Inspection and Testing during HMA Placement for Roadway (up to 8 visits) 64 64 $5,267 HMA Oven Ignition Correction Sampling of Aggregate and Oil (1 mix) 4 4 $329 HMA/Aggregate Sampling at Batch Plant during placement (5 samples) 20 20 $1,646 Project Management Preconstruction Meeting 1 1 $143 QA Review, Reporting, Submittal Reviews, and Report Distribution 4 2 6 $1,202 TOTAL LABOR COST 4 3 88 0 95 $8,586 Material Testing - LABORATORY TESTING ESTIMATE: LABORATORY EXPENSE DESCRIPTION Est No. Unit Test TOTAL Asphalt Ignition Oven Correction (1 mix, 3 burns) 3 $140 $420 HMA Aggregate Acceptance (Voids, FF, SE) (1 mix) at WSDOT intervals 3 $310 $930 Bitumen Content by Extraction with Gradation of Aggregate (1 mix design) at WSDOT intervals 5 $185 $925 Maximum Theoretical Specific Gravity of HMA (Rice Density) (1 mix design) at WSDOT intervals 5 $140 $700 LABORATORY TOTAL:$2,975 Scope of Services 2022 PERSONNEL & BILLING RATES S 212th St Preservation - Green River Bridge to Orillia Rd 1 of 2 HWA GeoSciences Inc. EXPENSES: $480 $320 $240 EXPENSE TOTAL:$1,040 ESTIMATED PROJECT TOTALS AND SUMMARY: Total Labor Cost $8,586 Laboratory Testing $2,975 Direct Expenses $1,040 ESTIMATED PROJECT TOTAL:$12,601 Assumptions: 1. These estimates may require adjustment due to the Contractor's rate of construction, weather delays, source changes and/or other factors beyond our control. 2. The HWA PM reserves the right to shift hours between the various subtasks as required. 3. The HWA work scope does not include safety assessment nor work pertaining to any environmental issues. 4. This cost estimate was prepared with the understanding that the Client will schedule inspection as needed. 5. All night work is charged at an 8 hour minimum segment. Night work cancelled within 12 hrs of scheduled time will be charged 4 hrs. 6. All weekend work is charged at an 4 hour minimum segment. Weekend work cancelled within 12 hrs of scheduled time will be charged 4 hrs. 7. Per Client, all concrete used will be 3000psi Commercial mix, and therefore will not be tested. 8. This cost estimate assumes temporary HMA will not be tested. 9. Per Client, aggregates will not be sampled. Compacted aggregates for ADA Ramps and Sidewalk will not be tested. Mileage to and from the job site for all inspections at IRS mileage rate (8 trips) Mileage for HMA and HMA aggregate sampling, assuming 6 trips EXPENSE DESCRIPTION Total Cost Thin Lift (HMA Testing) Nuclear Gauge Rental ($60/day), assuming 8 days S 212th St Preservation - Green River Bridge to Orillia Rd 2 of 2 HWA GeoSciences Inc. HWA Geosciences Subconsultant Agreement: City of Kent Agreement No. 169284 - 212th GRB to Orillia Rd. Rates are effective through 12/31/22 All Inclusive Direct Labor 2022 Hourly Billing Fee NTE Job Classifications Hourly Billing Overhead Rate Rate Effective 30% DSC Rate NTE 163.90% Through 12/31/22 Engineer VII $ 78.00 163.90% 30% $ 229.24 Geol V $ 48.50 163.90% 30% $ 142.54 Inspector $ 28.00 163.90% 30% $ 82.29 Clerical $ 25.50 163.90% 30% $ 74.94 Arnale Technical Services S 212th St. Preservation Green River Bridge to Orillia Rd. / Kent City Limits KBA Job No. 022011-01 KBA PM: Cameron Bloomer Exhibit B Estimate Neactiated Hourly Rates Effective Throuah December 31st 2022 Mary Lynum Mary Shelton JTS Project Admin JTS Sr. Project Admin/Quality Controls Working Days Per/Month 22 20 23 21 21 20 21 Hours Per/Month 176 160 184 168 168 160 168 Estimated Over -Time 12% 12% 12% 12% 11% 10% 4% otal Regular and Over -Time Hou 197 179 206 188 186 176 175 3,369 6,738 6,125 7,044 1,225 1,928 - - - - Jimale Techincals Services Subconsultant Agreement: City of Kent Agreement No. 169284 - 212th GRB to Orillia Rd. Rates are effective through 12/31/22 All Inclusive Direct Labor 2022 Fee NTE Hourly Billing Job Classifications Hourly Billing Overhead Rate 10% of DSC + Rate Effective Rate NTE 113.57% OH Through 12/31/22 Project Admin 1 $ 32.59 1 113.57% 10% $ 76.56 Sr. Project Admin/Quality Controls 1 $ 41.03 1 113.57% 10% $ 96.39 A RDA CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 5/11/2022 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER AssuredPartners Design Professionals Insurance Services, LLC 3697 Mt. Diablo Blvd Suite 230 Lafayette CA 94549 CONTACT NAME: Brlttlnl Alberty PHONE FAX A/c No Ext : A/C No): ADDRESS: brittini.alberty@assuredpartners.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: The Travelers Indemnity Company 25658 License#: 6003745 INSURED KBAINCO-03 INSURER B : Travelers Casualty and Surety Co of America 31194 KBA, Inc. 11201 SE 8th Street, Ste 160 INSURER C : INSURER D : Bellevue WA 98004 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:253801276 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 6806NO33449 5/10/2022 5/10/2023 EACH OCCURRENCE $1,000,000 CLAIMS -MADE � OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $1,000,000 X MED EXP (Any one person) $ 10,000 Contractual Liab Included PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY � PRO- � LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY Y Y BA7R748905 5/10/2022 5/10/2023 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ HIRED LNON-OWNED AUTOS ONLY AUTOS ONLY UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N 6806NO33449 5/10/2022 5/10/2023 X STATUTE ER WA STOP GAP ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 B Professional Liability & 107633573 5/10/2022 5/10/2023 Per Claim $1,000,000 Contractor's Pollution Annual Aggregate $1,000,000 Legal Liability DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Project Name: 212th St. Preservation (GRB to Orillia Rd) / Project Number: 022011-01 the STATE and AGENCY, their officers, employees, and agents are named as Additional Insured as respects General and Auto Liability as required per written contract or agreement. The General Liability and Automobile Liability policies include an automatic Additional Insured endorsement that provides Additional Insured status to the Certificate Holder, only when there is a written contract that requires such status, and only with regard to work performed on behalf of the named insured. The General Liability policy contains a special endorsement with Primary and Noncontributory wording, when required by written contract. The Automobile Liability policy contains a special endorsement with Primary wording, when required by written contract. 30 Days Notice of Cancellation CERTIFICATE HOLDER CANCELLATION 30 Dav Notice of Cancellation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Kent ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Nancy Yoshitake AUTHORIZED REPRESENTATIVE 220 Fourth Avenue S. Kent WA 98032 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policy #: BA7R748905 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BROAD FORM NAMED INSURED B. BLANKET ADDITIONAL INSURED C. EMPLOYEE HIRED AUTO D. EMPLOYEES AS INSURED E. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS F. HIRED AUTO — LIMITED WORLDWIDE COV- ERAGE — INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE — GLASS PROVISIONS A. BROAD FORM NAMED INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any organization you newly acquire or form dur- ing the policy period over which you maintain 50% or more ownership interest and that is not separately insured for Business Auto Coverage. Coverage under this provision is afforded only un- til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- ever is earlier. B. BLANKET ADDITIONAL INSURED The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT J. PERSONAL PROPERTY K. AIRBAGS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS M. BLANKET WAIVER OF SUBROGATION N. UNINTENTIONAL ERRORS OR OMISSIONS this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. C. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COV- ERED AUTOS LIABILITY COVERAGE: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your busi- ness. 2. The following replaces Paragraph b. in B.S., Other Insurance, of SECTION IV — BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your CA T3 53 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO permission, while performing duties related to the conduct of your busi- ness. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". D. EMPLOYEES AS INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. E. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS 1. The following replaces Paragraph A.2.a.(2), of SECTION II — COVERED AUTOS LIABIL- ITY COVERAGE: (2) Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4), of SECTION II — COVERED AUTOS LIABIL- ITY COVERAGE: (a) With respect to any claim made or "suit" brought outside the United States of America, the territories and possessions of the United States of America, Puerto Rico and Canada: (i) You must arrange to defend the "in- sured" against, and investigate or set- tle any such claim or "suit" and keep us advised of all proceedings and ac- tions. (ii) Neither you nor any other involved "insured" will make any settlement without our consent. (iii) We may, at our discretion, participate in defending the "insured" against, or in the settlement of, any claim or "suit". (iv) We will reimburse the "insured" for sums that the "insured" legally must pay as damages because of "bodily injury" or "property damage" to which this insurance applies, that the "in- sured" pays with our consent, but only up to the limit described in Para- graph C., Limits Of Insurance, of SECTION II — COVERED AUTOS LIABILITY COVERAGE. (4) All reasonable expenses incurred by the (v) We will reimburse the "insured" for "insured" at our request, including actual the reasonable expenses incurred loss of earnings up to $500 a day be- with our consent for your investiga- cause of time off from work. tion of such claims and your defense of the "insured" against any such F. HIRED AUTO — LIMITED WORLDWIDE COV- "suit", but only up to and included ERAGE — INDEMNITY BASIS within the limit described in Para - The following replaces Subparagraph (5) in Para- graph C., Limits Of Insurance, of graph B.7., Policy Period, Coverage Territory, SECTION II — COVERED AUTOS of SECTION IV — BUSINESS AUTO CONDI- LIABILITY COVERAGE, and not in TIONS: addition to such limit. Our duty to make such payments ends when we (5) Anywhere in the world, except any country or have used up the applicable limit of jurisdiction while any trade sanction, em- insurance in payments for damages, bargo, or similar regulation imposed by the settlements or defense expenses. United States of America applies to and pro- hibits the transaction of business with or (b) This insurance is excess over any valid within such country or jurisdiction, for Cov- and collectible other insurance available ered Autos Liability Coverage for any covered to the "insured" whether primary, excess, "auto" that you lease, hire, rent or borrow contingent or on any other basis. without a driver for a period of 30 days or less (c) This insurance is not a substitute for re - and that is not an "auto" you lease, hire, rent quired or compulsory insurance in any or borrow from any of your "employees", country outside the United States, its ter - partners (if you are a partnership), members ritories and possessions, Puerto Rico and (if you are a limited liability company) or Canada. members of their households. Page 2 of 4 © 2015 The Travelers Indemnity Company. All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc. with its permission. You agree to maintain all required or compulsory insurance in any such coun- try up to the minimum limits required by local law. Your failure to comply with compulsory insurance requirements will not invalidate the coverage afforded by this policy, but we will only be liable to the same extent we would have been liable had you complied with the compulsory in- surance requirements. (d) It is understood that we are not an admit- ted or authorized insurer outside the United States of America, its territories and possessions, Puerto Rico and Can- ada. We assume no responsibility for the furnishing of certificates of insurance, or for compliance in any way with the laws of other countries relating to insurance. G. WAIVER OF DEDUCTIBLE — GLASS The following is added to Paragraph D., Deducti- ble, of SECTION III — PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto' will apply to glass damage if the glass is repaired rather than replaced. H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT The following replaces the last sentence of Para- graph A.4.b., Loss Of Use Expenses, of SEC- TION III — PHYSICAL DAMAGE COVERAGE: However, the most we will pay for any expenses for loss of use is $65 per day, to a maximum of $750 for any one "accident". PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT The following replaces the first sentence in Para- graph A.4.a., Transportation Expenses, of SECTION III — PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto' of the private passenger type. J. PERSONAL PROPERTY The following is added to Paragraph AA., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Personal Property We will pay up to $400 for "loss" to wearing ap- parel and other personal property which is: (1) Owned by an "insured"; and COMMERCIAL AUTO (2) In or on your covered "auto" This coverage applies only in the event of a total theft of your covered "auto". No deductibles apply to this Personal Property coverage. K. AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A.1.c., but only: a. If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one "loss". L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS The following is added to Paragraph A.2.a., of SECTION IV — BUSINESS AUTO CONDITIONS: Your duty to give us or our authorized representa- tive prompt notice of the "accident" or "loss" ap- plies only when the "accident" or "loss" is known to: (a) You (if you are an individual); (b) A partner (if you are a partnership); (c) A member (if you are a limited liability com- pany); (d) An executive officer, director or insurance manager (if you are a corporation or other or- ganization); or (e) Any "employee" authorized by you to give no- tice of the "accident" or "loss". M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.S., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — BUSINESS AUTO CONDI- TIONS: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract signed and executed prior to any "accident" or "loss", provided that the "accident' or "loss" arises out of operations contemplated by CA T3 53 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO such contract. The waiver applies only to the person or organization designated in such contract. N. UNINTENTIONAL ERRORS OR OMISSIONS The following is added to Paragraph B.2., Con- cealment, Misrepresentation, Or Fraud, of SECTION IV — BUSINESS AUTO CONDITIONS: The unintentional omission of, or unintentional error in, any information given by you shall not prejudice your rights under this insurance. How- ever this provision does not affect our right to col- lect additional premium or exercise our right of cancellation or non -renewal. Page 4 of 4 © 2015 The Travelers Indemnity Compa ny. All rights reserved . CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc. with its permission. POLICY NUMBER 6806NO33449 COMMERCIAL GENERAL LIABILITY ISSUED DATE: 5/11/2022 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 SCHEDULE Names of Additional Insured Person(s) or Organization(s): Any person or organization that you agree in a written contract, on this Coverage Part, provided that such written contract was signed and executed by you before, and is in effect when the "bodily injury" or "property damage" occurs or the "personal injury" or "advertising injury" offense is committed. Location of Covered Operations: Any project to which an applicable written contract with the described in the Name of Additional Insured Person(s) or Organization(s) section of this Schedule applies. (Information required to complete this Schedule, if not shown above, will be shown in the Declarations.) A. Section II — Who Is An Insured is amended to in- clude 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", "personal injury" or "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. 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, or "personal injury" or "advertising injury" arising out of an offense committed, after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, mainte- nance or repairs) to be performed by or on behalf of the additional insured(s) at the loca- tion of the covered operations has been com- pleted; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontrac- tor engaged in performing operations for a principal as a part of the same project. CG D3 61 03 05 Copyright 2005 The St. Paul Travelers Companies, Inc. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. POLICY NUMBER: 6806NO33449 COMMERCIAL GENERAL LIABILITY ISSUED DATE: 5/11/2022 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 SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Any person or organization that you agree in a written contract to include as an additional insured on this Coverage Part for "bodily injury" or "property damage" included in the "products - completed operations hazard", provided that such contract was signed and executed by you before, and is in effect when, the bodily injury or property damage occurs. Location And Description Of Completed Operations Any project to which an applicable contract described in the Name of Additional Insured Person(s) or Organization(s) section of this Schedule applies. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or or- ganization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property dam- age" 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 in- sured and included in the "products -completed opera- tions hazard". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 Policy # 6806NO33449 COMMERCIAL GENERAL LIABILITY c. Method Of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. d. Primary And Non -Contributory Insurance If Required By Written Contract If you specifically agree in a written contract or agreement that the insurance afforded to an insured under this Coverage Part must apply on a primary basis, or a primary and non- contributory basis, this insurance is primary to other insurance that is available to such insured which covers such insured as a named insured, and we will not share with that other insurance, provided that: (1) The "bodily injury' or"property damage" for which coverage is sought occurs; and (2) The "personal and advertising injury" for which coverage is sought is caused by an offense that is committed; subsequent to the signing of that contract or agreement by you. a. We will compute all premiums for this Coverage Part in accordance with our rules and rates. b. Premium shown in this Coverage Part as advance premium is a deposit premium only. At the close of each audit period we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. a. The statements in the Declarations are accurate and complete; b. Those statements are based upon representations you made to us; and c. We have issued this policy in reliance upon your representations. The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not prejudice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable insurance 7. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or "suit" is brought. S. Transfer Of Rights Of Recovery Against Others To Us If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. 9. When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice. SECTION V — DEFINITIONS 1. "Advertisement" means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. For the purposes of this definition: c. The first Named Insured must keep records of a. Notices that are published include material the information we need for premium placed on the Internet or on similar electronic computation, and send us copies at such times means of communication; and as we may request. b. Regarding websites, only that part of a website 6. Representations that is about your goods, products or services By accepting this policy, you agree: for the purposes of attracting customers or supporters is considered an advertisement. Page 16 of 21 © 2017 The Travelers Indemnity Company. All rights reserved. CG T1 00 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Policy # 6806NO33449 COMMERCIAL GENERAL LIABILITY occupational therapist or occupational therapy assistant, physical therapist or speech -language pathologist; or (b) First aid or "Good Samaritan services" by any of your "employees" or "volunteer workers", other than an employed or volunteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first aid or "Good Samaritan services" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. 3. The following replaces the last sentence of Paragraph 5. of SECTION III — LIMITS OF INSURANCE: For the purposes of determining the applicable Each Occurrence Limit, all related acts or omissions committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to any one person will be deemed to be one "occurrence". 4. The following exclusion is added to Paragraph 2., Exclusions, of SECTION I — COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury" or "property damage" arising out of the violation of a penal statute or ordinance relating to the sale of pharmaceuticals committed by, or with the knowledge or consent of the insured. 5. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x- ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; or b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. 6. The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to any of your "employees" for "bodily injury" that arises out of providing or failing to provide "incidental medical services" to any person to the extent not subject to Paragraph 2.a.(1) of Section II — Who Is An Insured. K. MEDICAL PAYMENTS — INCREASED LIMIT The following replaces Paragraph 7. of SECTION III — LIMITS OF INSURANCE: 7. Subject to Paragraph 5. above, the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury" sustained by any one person, and will be the higher of: a. $10,000; or b. The amount shown in the Declarations of this Coverage Part for Medical Expense Limit. L. AMENDMENT OF EXCESS INSURANCE CONDITION — PROFESSIONAL LIABILITY The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any of the other insurance, whether primary, excess, contingent or on any other basis, that is Professional Liability or similar coverage, to the extent the loss is not subject to the professional services exclusion oT L;overaae A or uoveraae b. M. BLANKET WAIVER OF SUBROGATION — WHEN REQUIRED BY WRITTEN CONTRACT OR AGREEMENT The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If the insured has agreed in a written contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of: a. "Bodily injury" or "property damage" that occurs; or b. "Personal and advertising injury" caused by an offense that is committed; subsequent to the signing of that contract or agreement. CG D3 79 02 19 © 2017 The Travelers Indemnity Company. All rights reserved. Page 5 of 6 Includes copyrighted material of Insurance Services Office, Inc. with its permission.