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Home My WebLink AboutCAG2020-256 - Amendment - #3 - A & M Consulting - GRNR Area North Pump Station - 11/30/2022Ap p r o v a l Originator:Department: Date Sent:Date Required: Director or Designee to Sign. Interlocal Agreement Uploaded to Website Date of Council Approval: Grant? Yes No Type: Re v i e w / Si g n a t u r e s / R o u t i n g Comments: Date Routed to the City Clerk’s Office: Ag r e e m e n t I n f o r m a t i o n Vendor 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 AMENDMENT - 1 OF 2 AMENDMENT NO. 3 NAME OF CONSULTANT OR VENDOR: A & M Consulting CONTRACT NAME & PROJECT NUMBER: Green River Natural Resources Area North Pump Station ORIGINAL AGREEMENT DATE: August 6, 2020 This Amendment is made between the City and the above-referenced Consultant or Vendor and amends the original Agreement and all prior Amendments. All other provisions of the original Agreement or prior Amendments not inconsistent with this Amendment shall remain in full force and effect. For valuable consideration and by mutual consent of the parties, Consultant or Vendor’s work is modified as follows: 1. Section I of the Agreement, entitled “Description of Work,” is hereby modified to add additional work or revise existing work as follows: In addition to work required under the original Agreement and any prior Amendments, the Consultant or Vendor shall: No change to the scope of work, however an amendment is needed to extend the time of completion to December 31, 2023 due to shift in project priority, an extension is needed to complete the project. 2. The contract amount and time for performance provisions of Section II “Time of Completion,” and Section III, “Compensation,” are modified as follows: Original Contract Sum, including applicable WSST $1,980 Net Change by Previous Amendments including applicable WSST $0 Current Contract Amount including all previous amendments $1,980 Current Amendment Sum $0 Applicable WSST Tax on this Amendment $0 Revised Contract Sum $1,980 original Time for Completion 12/31/20 (insert date) Revised Time for Completion under 12/31/22 prior Amendments (insert date) Add'I Days Required (f) for this 365 calendar days Amendment Revised Time for Completion 12/31/23 (insert date) The Consultant or Vendor accepts all requirements of this Amendment by signing below, by its signature waives any protest or claim it may have regarding this Amendment, and acknowledges and accepts that this Amendment constitutes full payment and final settlement of all claims of any kind or nature arising from or connected with any work either covered or affected by this Amendment, including, without limitation, claims related to contract time, contract acceleration, onsite or home office overhead, or lost profits. This Amendment, unless otherwise provided, does not relieve the Consultant or Vendor from strict compliance with the guarantee and warranty provisions of the original Agreement. All acts consistent with the authority of the Agreement, previous Amendments (if any), and this Amendment, prior to the effective date of this Amendment, are hereby ratified and affirmed, and the terms of the Agreement, previous Amendments (if any), and this Amendment shall be deemed to have applied. The parties whose names appear below swear under penalty of perjury that they are authorized to enter into this Amendment, which is binding on the parties of this contract. IN WITNESS, the parties below have executed this Amendment, which will become effective on the last date written below. CONSULTANT/VENDOR: CITY OF KENT: r By: /t� By: LOU!= [sig atuEe (signature Print Name: !�41A Print Name: Carla Maloney, P.E. Its Its De si n En ineerin Manager {tide DATE: l �— DATE: } ATTEST' APPROVED AS TO FORM: (applicable if Mayor's signature required) L;u Kent City Clerk Kent Law Department A & M - GRNRA H PS Amd 3/HaWodc AMENDMENT - 2 OF 2 25 50 UK SBM ThisSpectrumPolicyconsistsoltneLleclarallon$'L/ovsritgururrl other Forms and Enclorsements issued to ou . prrt'of ttie Pilicy. This rnsurance is provided bythe stock iniurance company of The Hartford lnsurance Group shown below' INSURER: HARTFORD CASUAI,TY INSUNANCE COMPANY ONE HARTFORD PLAZA, HARTFORD, CT 06].55 COMPANYCODH: 3 PolicyNumber: ?2 SBM UKs025 DX SPECTRUM POLICY DECLARATIONS oRTGTNAL ,sx*# a Narned lnsured and Mailing Address: ARNOLD TOMAC DBA A & M (No,, Street, Town, State, Zip Code) CONSULTING 1.81.19 N.E, 3OTH STREET REDMONP WA 98052 Policy Pericd: From LL / AL /22 To LL / AL / 23 1 YnAR 12:01 a.rn., $tandard time at your mailing address shown above' Exceptisn: 12 noon in New Hanrpsltire Nameof Agent/Broker: AJ GALLAGHER & CO TNS BRKRS CA/pHS Code: 255202 Previous Policy Number: 72 SBM UKs025 Named lnsured is: TNDIVIDUAL Audit PETiOd: NON*AUDITABI,E Type of ProPertY Coverage: N0NE ln*urarrce Frovided: ln return for the payment of the premium and subject to all of the terms of this policy' we agree with yor-r to provide insurance as stated in this poliey' TOTAL ANNUAL PREMIUM l$r *425 MP IN RECOGNI?ION OF TFIH MUT'TIPLE COVERAGES INSURED WITH THE HARTFORD' YOUR POLTCY PA"EMIUM INCLUDES AN ACCOUNT CREDIT' Countersigned bY lfo-a-r, C" fftur /i{-"7.4aN/r.t*} Authorized RePresentative 09 /L9 /22 Date i{ri Form SS 00 0? 12 06 Process Oate: 09 /L9 /22 TNSURHD COPY Page 001 (CONTINUED CII\t t{aXT PAGE) PolicY HxPiratinn Aate: 1I /AL / 23 SPECTRUM POLTCY DECLARATTONS {Continued)POLICYNUMBER: ?2 sBM UKS02S :'1 Location(s), Building(s), Business of Named lnsured and $chedule of Coverages for premises as designated byNumber below. Locaticn: 001 Building: 001_ 18].19 N.E. 3OTH STRAETREDMONN WA 98052 Oescription of Business : REATJ ESTA?E APFRAISER Deductible: NO COirsRAcE BUILDING AND BU$INE$$ PER$ONAL PROPERTY LIMITS OF INSURANCE EUILDING NO COVERAGE BUSINE$S PERSCINAL PRCIPERTY REPLACEMENT CO$T PERSONAL PRCIPERTY OF OTHERS REPLACEMENT COST MONEY AND SECURITIES INSIDE THE PREMISES OUT$IDE THE PRSMTSES Form $S 00 02 t2 06 Process Aar'e: Ag /L9 /22 PAgC OO2 (CONTINUED ON NEXT PAGE} Pcticy Expiration Daft: j,I / AI /23 NO COVERAGE NO CO\ISNAGE NO CO\rERAGE NO CO1rSRAGE d SPECTRUM POLICY DECLARATTONS {Continued} POLICY NUMBER: 72 SBM UKs025 BUSINEE$ LIABILITY LIABILITY AND MEDICAL EXPENSES MEDICAL EXPENSI$ - ANY ONE PER$OftI PERSONAL AND ADVERTI$ING INJURY AGGREGATE LIMIT$ PRODUCTS.COMPLETED OPERATIONS LIMITS OF INSURANCE $2,000, oo0 $ l-0, 000 $2, 000, 000 q DAMAGES TO PREMISES RENTED TO YOU ANY CINE PREMISES $ 300,000 $4,000,000 $4, 000, 000 GENERAL AGGREGATE EMPLCIYMEFIT PRACTICES LIAEILITY C0VERAGEI FORM $S 09 01 EACH CLAIM LIMIT DEDI.,CTIBLE - EASH CLAIM LIMIT NOT APPI,ICA3I,E AGGREGATE LIMIT RETROACTIVE DATE: 1"10120 05 This Employment practice$ Liability c*verage c*ntsins clairns fnade cov*mge' Except a$ mffy be otherwise provided herein, $pecifi;;;;uerages of t'i* lnuui*nce ffre limitecl 0enerully to lialrility.for iniuries for which cl*ims are first rnacle against the insureci wtrite tne inuiiiunc* iu in for**. piease read anri review the insurunee carefrrlly *nd discu*s the coverage with your l'lartforrJ Agent or Brsk*r' The Limits of lnsurance statecl in this Declarati$ns will be recluced, anrl may he etrnpletcly exl'lau*t*d, by the paynxent of ,.deferrse expens€,' anrl. irr such eve*t, The company will not be *bligat*d t* pay any f[l*h*r ,,def$ilse expsnse,, or sums which the insurecl is or nray beccnte legally otrligated to pay a$ "damsge$"' BUSINESS LlABlI,lTY OPTTONAL COVERAGES HIRED/NON_OWNED AUfO LIABII,TTY FOF-l4r $S 0L 70 $2,000,000 $ 5,000 $ 5, ooo rr.ti. r Form $$ 00 02 1 2 06 Process Date: 09 /19 /22 (COT{TINUED ON NEXT TXAGE} Policy Expiration Oale: LL/0L/23,l Fage 003 SPECTRUM POLICY DECLARATTONS {Continued}POLICYNUMBER: 72 sBM UKS0AS BUSINE$S LIABILITY OPTIONAL COVERAGES {Continued} d ISdFITOYS&S f,XtBIIrIft tilD glsr0p Ct&B8ouxLt rHfl'ltY BY ICSTDENT!&cE lccxpp{l!IODIIY fK.yUltY Dt OIgltgE&rcE n|PIl*XA& IODIIrY INdfirRt BE DIgSlgU POI.XCry IJIilX'l!rFPLICllLtl |lO LOCAtrXO$g III ftrsF0LLOWIHC S$ruE(6) Iwl.gtrMflro!{ $rtrlrER Or $mnocasroN:roru{ ss 1} 15 IaoeA,fXO!(r 001 tSILDIt[Glr 001t{ltiEr Ir }!{y Form $$ 00 02 1A 06 Process Date: 0 I /Lg /22 LIMITS OF INSURANCH $1, 000, 000 $1, 000, 000 $l_, 000, 0oo Page 004 (CONTINUED ON NEXT PAGE) Policy Expiration Date: l'L/ 0L/23 t: SPECTRUM POLICY DECLARATION$ {Continued} POLICY NUMtsER: 72 SEM uK5025 ADDITIONAL IN$UREDS & a THEFoLLotvINGAREADDITI0NALIN$uREpsFoRBU$lNEss LIABILITYCOVERAGE IN THIS POLICY. T"OCATXOB lryPE al![E 001. Bnr[DrMl 001 e[$3ISgAR LESSOB gEe rox$ xs 13 00 a Form$$ AA021206 Process Date: 09 lLg/22 PaEe 005 (CONTINUSD 0I$ NEXT PAGE) PolicY gxpiration Aa|r: LL/AL/23 SPECTRUM FOLICY DECLARATTON$ {Continued}POLICYNUMBER: 72 s8ld UK5025 Form Numbers of Forms and Endorsements that apply: OO 11 85 ADDTTTONAIJ INSURED * MAT{AGAR/LSSSOR Form $$ 00 02 1? 06 Process Da&i Ag /Lg l22 ss 00 0l-ss 00 64ss 00 60ss 05 47ss 09 25ss 10 04ss 83 76rr{ 12 16 14 YU 20 03no 09 09 L2 09 T2 L4 ils (:c 05 04 n1 09 03 05 2B v4 l*0 67 1c, 00 n1 41 09 IZ ss 00ss s95s s5ss 09s5 09rH 99 o? 03 0l_ 7L 4L 05 09 11 !r. I L4 09 04 a9 UO vt1n 04 OB 70 63 07 ?0 40 00 01- 4L 1') no 99 45gs ss |iti IH 1H LZ ut) L7 05 71 t4 00 1_2 0607 L6 03 00L2 L4 t2 L4 04 09 d E Fage 005 Policy Expiration Date: i_1 /0t/23 $PECTRUM POLICY DECLARATIONS (Continued) POLICYNUMBER: 72 ssM UK5025 SUPPLEMENTAL OECLARATION$: Form S$ 00 45 12 06 Process Date: 09 / L9 /22 r ,3 A service fee of g 6.00 is charged for eaclr instailment when your pfemiurn is paid in installments. The service tee is $ -' 5 ' 00 p*r withdrawal when you select an electronic fund transfer payment plan. The service fee wilt be added to the premium amount shown on your premium billing staternent' a Policy Expiration gate: 1-Ll0Ll23 ft coMMO${ pOLtcY coh$ DITIOruS Form $$ 00 05 f2 S6 (O 2006, The Hartford QUICK REFERENCE . SPECTRUM POLICY DECLARATION$ and COMMON POLICY CONDITICINS I. DECLARATION$ Named lnsured and Mailing Address Policy Period Description and Business Location Coverages and Limits of lnsurance II. COMMON POLICY CONDITIONS A. Cencellation B. Changes C. Concealment, Misrepresentation Or Fraud D. Examination Of your Books And Records E. lnspeciions And $urveys F. lnsurance Under Two Or More Coverages G. Liberalizaiion H. Other lnsurance - property Coverage l. Premiums J. Transfer Of Rights Of Recovery Against Others To Us K. Transfer Of your Rights And Duties Under This Folicy L. Premium Audit Eeginning on Page I 1t 4 2 4t 2 rt& 2 2 4A J ,d d Form $S 00 05 1t 06 # coMeJION pCLICY CSrumnTr*rus All coverages of this policy are subject to the following conditions' A. Cancellation 1. The first Namecl lnsured shown in the Declarations may cancel this policy by ntailing or delivering to us advance written notice of cancellation. 2. We may cancel this policy by mailing 0r delivering to the firsl Named lnsured wtitten notice of cancellation at least; a. 5 days before the effective date of cancellation if any one of the foltowing condiiions exists at any building that is Covered Property in this PolicY: (1) The building has been vacant or unoccuPied 60 or more consecutive daYs. This does not aPPIY to: {a) Seasonal unoccuPancY; or (b) Birilclings in the course of construction, renovation or addition. Buildings with 650/o or more of the rental units or floor area vacanl or unoccupied ar<: considerecl unoccupied under this provision. (2) After damage by a Covered Cause of Los$, permanent repairs to the ltuilelittg: (a) Have not staded; attd (b) Have ttct been contracted for, within 30 days of initial payment of loss. {3) The building has: {ai An outstanding order to vacate; (b) An outstanding dernolition order; or tc) Been declared unsafe bY governmental authoritY (4) FixeeJ and salvageable ilems have beett or are treirrg; removed frorn the building and are not being replaced' This does not aPPIY to such removal that is necessary or incidental to any renovation or remodeling' {5} Faiture to: (a) Furnish necessary heat, water, sewer service or electricity fot 30 conseculive daYs or more, except during a Period of seasonal unoccupancy; or (bl Pay property taxes that are owing and have been outstanding for more than one Year following the clate due, except ihat this provision will not aPPIY where You are in a bona fide disPute with the taxing authoritY regarding PaYment of such taxes. b. 10 clays before the effective date of cancellation if we cancel for nonpayment of premium. c. 30 days before the effective date of cancellation if we cancel for any oiher reason' 3. We will mail or deliver our notice to the first Named lnsured's last mailing address known to us. 4. Notice of cancellation will stale the effeclive date of cancellation. The policy period will end on that date. 5. lf this policy is canceled, we will send the first Named lnsured any premium refund due Such refund will be pro rata. The cancellation will be effective even if we have not made or offered a refund. 6. lf notice is mailed, proof of nrailing will be sufficient Proof of notice. 7. lf the first Named lnsured cancels this policy, we will retain no less than $100 of the premtum. B. Changes This policy contains all the agreements between you and us concerning the insurance afforded' fne first Named lnsured shown in the Declarations is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us and made a Parl of this PoticY' Form SS 00 05 12 06 @ 2006, The Hartford FaEe 1 af 3 * coMMoN POt_tCY CONDtTtOAtS C. Concealment, Misrepresentation Or Fraud This policy is voicl in any case of fraucl lry you as it relates to this palicy at any tinre" lt is also void ifyou 0r any other insured, at any time, interrti*nally conceal or rnisrepresenl a material fact concerning: 1. "Ihis policy; 2. The Covered proper"ty; 3. Your interest in the Covered Froperty; or 4, A claim under this policy. D, Examination Of your Books And Records We may examine and audii your books and records as they relerte to the policy at any time during thepolicy peiiocl and up to three years afterward. E. lnspections And $urveys We have the right but are not obligated to: 1. Make inspections and surveys at any tirne; 2. Give you reports on the conditions we find; and 3" Recommend changes. Any inspections, srJrveys, repoft$ ot recornrnenclatiorrs relatr; only to insur.ability anc.i tlre ;:rerniurns to t:e t:ha,rgr:rl. Wel clo not rnake safetyin$pection$. \iVe clo noi unclert*ke to perfornr the cluty of any Betsolj ar etrganizatir:n to piovicle fr.rr the health nr safety of ilny flet$ort. /\rrcJ vue clo nol represent or warrant that conditions: 1. Are safe or healthful; or 2. Comply vuith laws, regulations, codes or slandards. T'tris conclition applies nct only to us, i:ul alsu lo anyrating, aclvi*ory, raie *ervice or similar org;lnization which makes insurance irrspections, survey$, re;lortsct r*commondations. F. lnsurance Under Two Or More Ccverages lf two or rnore of this policy,s oilverages apply to the sitnre loss or damage, r,rr* will nr:rl pily more than ihe actual arnount of the loss or damage. G. Liberalization lf we adopl any revision that would broaden thecoverage under this policy without additionalpremiurn within 4S clays prior to or during the poticy periocl, the broadeleel coverage will immerjialely apply to this poticy. H. Other lnsurance - property Coverage lf lhere is other insurance covering the sanre loss or clarnag*, we will pny only for llte amourtt of covered Ioss or damage in excess of the amount due from that other insurance, whether you can collect on it ornot. Birt we rarill not pay more than the applicable Limii of lrrsnrarnce. Fremiums 1. The first Named lnsured shown in the Declarations: a. ls responsible for lhe payment of all premiums; and b. Will be the payee for any return premiums vve p8y. 2. The premium shown in the Declarations was computed based on rates in effect at the time the poticy was issued. lf applicable, on eachrenewal, continuation or anniversary of the effective date of this policy, we wilt compute thepremiurn in accordance with our rales and rules then in effect, 3. With our consent, you may continue this policy in force by paying a conlinuation premium for each successive one-year period. The premium must be: a. Paid to us prior to the anniversary date; and b. Determined in accordance with paragraph 2. abcve. Our forms then in effect wiil apply. lf you donct pay the continuation premium, lhis policy will expire on the first anniversary date that vue have not received the premium. 4. Changes in exposures or changes in your business operaticn, acquisition or use of locations that are not shown in the Declaralions may occur during ihe palicy period. lf so, wemay require an additional prernium. Thatpremium will be determined in accordance witlr our rates and rules then in effect. Transfer Of Rights Of Recovery Against Othens To Us Applicable to Property Coverage: lf any person or organization to or for whom uremake payment under this policy has rights torecover damages from anolher, those rights are transferred to us to the extent of our payrnent. ttratper$on or organization musl do everything necessary to secure our rights and must do nothing after loss t0 impait them. But you may waive your rights against another party in writing: 1. Prior to a loss to your Covered properiy. 2. After a loss to your Covered property only if, at time of loss, that party is one of the fottowing; a. Someone insured by lhis insnrance; b. A business firm: {1} Owned or controlleeJ by you; or (2) That owns or controls you; or J. ti'ii Fag* I *f 3 Form SS 00 05 1A 06 c. Your tenant. You may also accept the usual bills of lading or shipping receipts limiting the liability of carriers' This will not restrict your insutance. K. Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transfeired without our written consent except in the case of death of an individual Named lnsured' lf you die, your rights and duties will be transferred to your legal representative but ottly while acting within the scope of duties 8s your legal representative. Until your legal representative is appointed, anyone having proper temporary custody oi'yort prope*y will have your rights and duties but only with respect to that ProPedY' COMMON POLICY CCINDITICINS Premium Audit a. We will compute all premiums for ihis policy in accordance with our rules and rates' I b, The pronriuttt amcrint shcwn in the Declaratiorts : is a ieposii plemi$ln only. Al th* close of each ; auelit periocl we will conrprrte the earneel E. i**luii iot ir'at periorl. Anv additicnal 8 prerniitrn founct to be due as i: result etf the auclit are due ancl payable on fiotice to the fitst Nsrnocl Insured. tf the deposit premiurn paid for the policy term is greater than the earned premium, we will reiurn the exce$s to the first Named lnsured' The first Named lnsured must maintain all records related to the coverage provided by this policy ancl necessary to finalize the premium audit, ancl send us copies of the same upon our request, Douglas Elliot, President L t" our President and secretary have signed this policy. where required by law' the Declarations page has also been countersigned by our duly authorized representative' r*j*'-tt Q^#^ tllteh () Kevin Barnett, SecretarY $ Form SS 00 05 12 06 Page 3 of 3 ffiPOLICYNUIUIBEB: ?2 SBM UK5O25 THI$ ENDOR$EMENT CHANGES THE POLICY' PLEA$E HEAD IT CAREFULLY' ADDITIONAI, INSURED' MANAGAR/I'ESSOR fHE CITY OF KNWT PUBLIC WORXS M{GI$EEITING 22? TOURTII AVE. so' KENT WA 98032 h; 6 i' -i l{l LTt Form lH 12 0011 05T SEA. NO' 002 procesa Dats: 09 lLg / 22 Printod in U.S.A. Page 00L ExPlration Dato: 1"1/0L /23 INSURSD COPY e TI{IS ENDOR$EMENT CHANGES TI'IF POLICY. PLEA$E READ IT CAREFULLY' GOODS AT\ND Sffi RVICES ENDORSHMESIT WASI{&NGTOru This endorsement modifies insurance provided under all Covelage Parts of this Policy' we nrny offer or make ,,goods or seruices" availai:le tr, you thrCIugh this ttnclerwriting company, a non-ittsurer sr"rrrsidiary, or unaffitiatecitnirct pafiics r;; ;;;i ;i ilris pbticy, The "goocis or $ervices" may be providecl for a charge, al a discount, 0n a subsiclized oi*iu, nr fr*e of inaloe ln some case$, we mffy rec*ive e fee from the urraffiliated thir.i palties that pr0vide "gooiu oi sorvices".- we do not wartant ot guatuntee the "goods or services,, providecl by thircl parlies, *n*iltcrr tnirrl pnrlies shall be sol*ly liable anel resFottsible for the "goods or services,'u.,uv priruiJ*.'rn*,,good$ oi services" offerecJ or rrrarle availatrle by us may be rnoelifiecl ar discontinued at anY time. This endorseffient is slrbject to RCW 48.30.150(1Xe), which prOhibitS insurance companies from-providing prizes, goocls, wales, gifl cards, gift ee{tiiicates, orinerctrandise of an aggregate value in excess of $100 per petso,i in the aggregate in any c*tlsecr*ive twelve'rlonth period' ,,Goods or seruices,, means goods, products or services, including but not limited to risk mitigation, safety' andlor loss prevention services or equipment !,-.' tH 12 A7 82 21 @ 2021, The Hartford Page 1 of 1 ,***#i1 Named lnsured: Policy Number: Effective Oate: Gompany Name: truilOIJD rOUeC DBr & & !l 72 SBM UK5025 tL / 0L l 22 Expiration Date: IL / AL / 23 HARTFORD CASUALTY INSURANCE COMPANY THIS ENDORSEMENT CHANGE$ THE POLICY' PLEASE READ tT CAREFULLY TRADEoREcoNoMIGSANCTI0NSEND0RSEMENT This insurance does not apply to the oxteilt that tracle or economic sanctiotrs or other laws or regulations piorriuii"* trom provioing i;,iui*n"*, includinq, but not limiterl to, the payment of claims' All other terms and conditions remain unchanged' Li', lri r ,t Form lH 99 4{ 04 09 Page 1 of 1 FOLICY NUMBER: ?2 SBMUK5025 THI$rNn0R$EnfigruTls&TTACrlguT*AL:FMAffrrAffi'TorYOuRP*tleYlhl RFSPON$tr TO THg MISELCISUKT RfiQUIfrrrdrNT$ *F TY4fr'Ta&ftGffi,86f1fi RI$K l}i'&\:&&'r{*g &'cT. mtsfrL0suffiffi/cAp #zu Ltgsffis - Yffiffiffi#ffis$$w ffissK frru$uffiAfi\$Cffi $-#? e it $e F{E*Ul-g Terrorism Premium $ $s ' oo A. Disclosure Of Fremium ln accofdatlr:e with the fecletill Terrorisrn Risk ln$ur.qnce Act. as atnencleci (-fRlA)' \'vc fire required to provicle yotl with a notice rlisclosirig the poriir:n of yot,r pre'niittl, if alty, aitritrLrtable--tti covet'age fct' icertifiecl ncts of terrorism" trncier TRIA' Tlre portion of your premium attributable to terrorism coverage is shown in the above Scheclule of this endorsernent' B. The following definition is added with respect to the provisiotts of this endorsement: 1. A "certifiecl act oF terrori$tn" illeatl$ iill act ihat is certifiecl by the $ecreiary r:f the Treasttry' in atccorclanee with lhe provisions of TRIA' to be an act of tetrr:rism uttclsll Tttll\' -l-lre ctiteria contained in TRIA for a "certified act of terrorism" include the followittg : a. The act results in insured losses in excess of $5 million itt the aggregate, attributable to all types of insurance subject to TRIA; and b. The act results in damage within the United $iates, or r:Lrlside the United Siates in the case of cedain air carriers or vess*:ls or the premises of an United $tates mission; and c. The act is a violent act or an act that i$ dangerous io human life, pt'operty 0l infrastructure and is commiitecl by an indiviclual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduot of the United States Government bY coerciott C. Disclosure Of Federal Share Of Terrsrism Losses The United States Departmeni of the Treasury will reimbitlse insurers {or SToiq of insuted los*es attribLrtable to "cer"tificcl aets of terrolisltl" unrjsr l"RlA that exceerls tlre a1:plir:af-rle insurer rleciLtctible ' l"lowever, if agtlregate industry insured lo:;ses allribtllable to "certified acts of terrorism" uttcl+:r TRIA exceed $100 billion in a calendar year, the Tr*a*irry shall not make any payrrerli fr:r any poilion of the amount of such losses lhat exceeds S100 billion. The United States governmeni has ttot charged any premium for their pa*icipation in covering terrorism losses D. Cap On lnsLlrer Liability for Terrorism l-osses lf aggregatt: inclustry insurecl losses .attrilrtttable io "certfiect atls oi terlori$tn" Lrncler l-RlA cxceed $100 billion in a calencJat' year altcl we have trtet, or' vrill rfiost, ouf ittsttt'el rjecluctible Lrrtcler 'frllA' rve sltall rrol l'le liable for the payrnertt of arty lLorlictt r':f thtr $rnorrlt of sLtch l$nssli tht.rl excertr'l $'100 billion' ln such case, your coverage for terrorism losses rnay be reducecl on a pt-o'rata basis irr accordance v'/ith procedures established by the Treasury, based on its eslimates of aggregate industry losses and our estimate lhat we will exceed our insurer deductible' -ji ?age 1 of 2 Form $5 837612 2a ts 202a,The Hartford (lncludes copyrighted material of lnsurance Services Office, lnc., with its permission) ln accordance with the Treasury,s procedures, amounls paid for losses may be subject to further adjustments based on differences between actual losses and estimates. E. Application of Other Exclusions The terms and limitations of any terrorism exclusion,the inapplicability or omission of a terrorism exclusicn, or the inclusion of terorism coverage, do not sorvs to create coverage for any loss which would olhenrvise be excluded under this Coverage Form, Coverage Part or policy, such as losses excluded by any pollution, pathogenic, nilcloar hazard or war exclusions vrrhich nay be includecl on this Policy. F. All other terms and conditions remain the same *E Page 2 of 2 Form S$ 8376i22A # r tMpsffiTANT NOTIGE T0 pot-lsYl-lsLpER$ To help your lnsurance ksep pace with increasing costs, we have increased your amounl of insUrancs Uslter irotection ln case of sitl'isr a partial, or total loss lo your propo6y' lf you feel the nsvv amount is not the proper One, pl€ase contact your agent or broksr" . giving you I Form PG-07r1-0 Prinled in u.s.A.