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HomeMy WebLinkAboutCAG2022-373 - Supplement - #2 - KBA, Inc. - 76th Ave South: North Segment - 08/22/2023 FOR CITY OF KENT OFFICIAL USE ONLY Sup/Mgr: Agreement Routing Form DirAsst: • For Approvals,Signatures and Records Management Dir/Dep: KENT This form combines&replaces the Request for Mayor's Signature and Contract Cover (Optional) WASHINGTON Sheet forms. (Print on pink or cherry colored paper) Originator: Department: Dani Hodgins for Eric Connor Public Works Date Sent: Date Required: c 08/10/2023 8/15/2023 QAuthorized to Sign: Date of Council Approval: Q �✓ Mayor or Designee Budget Account Number: Grant? Yes No�✓ R90125 Budget?❑✓ Yes E]No Type: N/A Vendor Name: Category: KBA, Inc. Contract Vendor Number: Sub-Category: Supplement 0 Project Name: 76th Avenue South - North Segment 3- Project Details: 0 Increase in amount to cover costs of added working days. c c Basis for Selection of Contractor: Agreement Amount: $24,543 Bid E _ *Memo to Mayor must be attached i Start Date: Date of Mayors signature Termination Date: 12/31/23 a Local Business? Yes F—]No*If meets requirements per KCC 3.70.100,please complete"Vendor Purchase-Local Exceptions"form on Cityspace. Business License Verification: ❑Yes In-Process F1 Exempt(KCC 5.01.045) FlAuthorized Signer Verified Notice required prior to disclosure? Contract Number: Yes❑No CAG2022-373 Comments: IM C C 3 0 N a Date Received:City Attorney: 8/10/23 Date Routed:Mayor's Offic 8/16/23 6ity Clerk's Office 8/22/23 adccW22' V'si Documents.KentWA.gov to obtain copies of all agreements rev.20221201 Washington State To Department of Transportation Supplemental Agreement Organization and Address Number 2 KBA,Inc. Original Agreement Number 11201 SE 8th Street, Suite 160 Bellevue,WA 98004 LA 10342 Phone: 425 455-9720 Project Number Execution Date Completion Date 21-3012 9/13/22 12/31/23 Project Title New Maximum Amount Payable 76th Avenue South-North Segment $526,400 Description of Work Provide remaining work needed to complete the project. For a description, see Exhibit A which is attached and incorporated by this reference. The Local Agency of City of Kent desires to supplement the agreement entered in to with KBA, Inc. and executed on 9/13/22 and identified as Agreement No. LA10342 All provisions in the basic agreement remain in effect except as expressly modified by this supplement. The changes to the agreement are described as follows: I Section 1, SCOPE OF WORK, is hereby changed to read: No change. I I Section IV, TIME FOR BEGINNING AND COMPLETION, is amended to change the number of calendar days for completion of the work to read: No change. III Section V, PAYMENT, shall be amended as follows: Increase of$24,543 to cover costs from added working days on project. as set forth in the attached Exhibit A, and by this reference made a part of this supplement. If you concur with this supplement and agree to the changes as stated above, please sign in the Appropriate spaces below and return to this office for final action. By: Kristen M. Overleese By: Dana Ralph O". R- L� - Consultant Signature Approving Au0ority Agnature 08/22/2023 Date DOT Form 140-063 Revised 09/2005 Exhibit A From: Connor,Eric To: Peterson,Kelly Subject: FW: 76th Ave S-Supplement 2 Request Date: Thursday,July 6,2023 10:40:00 AM Attachments: 022013-01 Sur mlement 2 Draft CTC CRB.mdf FYI... Please let me know if you have any questions. Eric Connor, Construction Engineering Manager Phone 253-856-5533 1 Cell 253-797-0693 CITY OF KENT, WASHINGTON PLEASE CONSIDER THE ENVIRONMENT BEFORE PRINTING THIS E-MAIL From: Cameron Bloomer<cbloomer@kbacm.com> Sent:Thursday,July 6, 2023 10:09 AM To: Connor, Eric<EConnor@kentwa.gov>; Barry,Jason <JBarry@kentwa.gov> Cc: Paul Garrett<PGarrett@kbacm.com> Subject: 76th Ave S-Supplement 2 Request EXTERNAL EMAIL Hello Eric and Jason, I am requesting a supplement to our agreement for the 76th Ave project. My estimated Cost to Complete is 526,400, the current agreement is for 501,857, resulting in a supplement request of $24,543. The largest reason for this supplement request is the extended time on the project.The original agreement was for the 75 working days in the contract, Supplement 1 anticipated 25.5 added working days with the CO 5's addition to the PCCP work. Currently the project has counted 121 working days and substantial completion has not been granted. To manage costs as we work toward project completion, KBA has reduced its presence on the project to a part time RE only, we anticipate the RE will work 25-30%on 76th through July and August, and closeout in September. Thank you for considering this. I am around to discuss. Thanks, Cameron Bloomer, PE C 206.819.7148 1 cbloomerftbacm.com KBA, Inc. 1 Construction Management Specialists I www.kbacm.com DETERMINATION . OCTAUG SEP MONTH 2022 20221 122 2022 20231 123 2023 20231 123 2023 20231 25YERR5 City of Kent Days/Mo 22 21 21 20 21 21 20 23 21 21 22 20 23 21 21 76th Ave S.-North Segement Hr/Mo 176 168 168 160 168 168 160 184 168 168 176 160 184 168 168 KBA Project No.:B22-058-01 Extra Work 12% 25% 25% 25% 25% 25% 8% 10% 11% 12% 12% 12% 12% 12% 11% Prepared On:8/2/2022 Adj Hr/Mo 197 210 210 200 210 210 173 202 186 188 197 179 206 188 186 Prepared by:Cameron Bloomer Annual Escalation on DSC 5% r. ESTIMATE OF COSTS ' CONFIDENTIAL&PROPRIETARY TO KBA,INC. 3007096 3007176 3007207 3007305 3007378 3007435 3007517 3007634 3007685 Thru 6/16/23 OCT • DECOCT KB/ Hours 2022 20221 122 2023 20231 123 2023 21111 H Sam Schuyler M2 Manager II 1 14 2 4 3 3 - 2 H Elmin Kovac A2 Administrator II 1 21 2 2 2 3 2 2 2 2 5 3 2 2 2 H Jill Carter A4 Administrator IV 1 - - - - H Cameron Bloomer E5 Engineer/Professional V 1 7 - 1 - 2 4 1 1 1 1 F Cameron Bloomer E5 Engineer/Professional V 2 917 22 81 72 109 107 134 128 117 96 54 54 50 30 F Gary Paxton T6 Technical Representative A 2 22 17 5 -IF Jamie Masters T2 Technical Representative II 2 805 24 2 10 117 111 169 173 168 13 20 F Ryan Winchell T3 Technical Representative III 2 28 28 F Justin Clements T4 Technical Representative IV 2 517 54 132 64 109 57 101 F Justin Clements(night) T4 Technical Representative IV 2 15 7 5 3 1 OCTProject Expenses Rate Tax I AUG SEP • . •CT 1 1 1 1 1MIEB 23 2023 20231 123 2023 202312023 Vehicle Lease DE 10.1% 17,559 479 627 627 2,330 2,832 2,871 2,663 2,784 1,697 650 432 400 240 Vehicle Rental DE 10.1% - - - Misc DE Subtotal-Direct Expenses 17,559 479 627 627 2,330JJJJPJNNEF�� 1 432 400 240 Total AUG SEP • NOVDECOCT • • Costs 2022 20221 122 2022 2023 2023 20231 123 2023 20231 12023 Sub1 HWA Geosciences Sub1 47,135 - - 10,253 4,912 3,357 12,012 10,084 6,267 250 Sub2 Jimale Technical Services Sub2 55,112 6,112 7,077 8,471 6,755 6,648 10,401 6,433 2,359 858 Subtotal-Subconsultant Costs 1 /1 08 1 1 OCTDECOCT Combined Costs Rate Rate DSC 2022 1 123 2023 20231 123 2023 20231 H Sam Schuyler M2 Manager II 1 $228.40 $237.62 3,244 - 457 914 685 713 - 475 - - - - - - - H Elmin Kovac A2 Administrator II $85.39 $92.00 1,840 128 128 128 213 138 138 138 184 414 230 184 184 184 - H Jill Carter A4 Administrator IV 1 $133.78 $140.47 - - - - - - - - - - - - - - - - H Cameron Bloomer E5 Engineer/Professional V 1 $216.33 $216.33 1,406 - - - 216 - 324 - - 757 108 - 216 216 216 - F Cameron Bloomer E5 Engineer/Professional V 2 $193.46 $208.45 186,914 - 4,256 15,574 13,832 20,990 22,200 27,932 26,577 24,389 20,011 11,152 11,256 10,423 6,254 - F Gary Paxton T6 Technical Representative VI 2 $164.56 $186.50 3,620 - 2,798 823 - - - - - - - - - - - - F Jamie Masters T2 Technical Representative II 2 $95.99 $109.71 86,224 - 2,304 192 960 11,183 12,178 18,486 18,925 18,376 1,426 2,194 - - - - F Ryan Winchell T3 Technical Representative III 2 $106.97 $137.14 2,968 2,968 - - - - - - - - - - F Justin Clements T4 Technical Representative IV 2 $159.08 $170.05 87,238 8,590 22,362 10,883 18,535 9,693 17,175 - - - - - F Justin Clements(night) T4 Technical Representative IV 2 $0.00 $195.56 2,933 - 1,369 978 587 - - - - - - Loaded Salary Costs 7102,748 9,485 17,173 16,050 44,631 57,915 58,809 65,629 53,986 Project Expenses - 479 627 627 2,330 2,832 2,871 2,663 2,7B4 1,697 650 432 400 240 - Subconsultant(s) - - 6,112 7,077 18,723 11,666 10,005 22,413 16,517 8,626 1,108 - - -TOTAL - CTC 11 90,704 400 41 Current Agreement $501,857 $9,964 $23,911 $23,737 $65,684 $72,414 $71,685 $90,705 $73,287 $49,458 Supplement 2 Request DATE IY(MM/DDYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 5/10/2023 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 CONTACT NAME: Nancy Ferrick AssuredPartners Design Professionals Insurance Services, LLC PHONE FAX 3697 Mt. Diablo Blvd., Suite 230 A/C No Ext: 510-272-1400 A/c No), Lafayette CA 94549 ADDRESS: nanc .ferrick@assuredpartners.com INSURER(S)AFFORDING COVERAGE NAIC# License#:6003745 INSURER A:The Travelers Indemnity Company 25658 INSURED KBAINCO-03 INSURER B:The Travelers Indemnity Company of America 25666 KBA, Inc.11201 SE 8th Street, Ste 160 INSURER C:Travelers Property Casualty Company of America 25674 Bellevue WA 98004 INSURER D:Travelers Casualty and Surety Co of America 31194 INSURER E: Underwriters at Lloyd's,London 32727 INSURER F: COVERAGES CERTIFICATE NUMBER:2120873190 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP IY LIMITS LTR INSD WVD POLICY NUMBER MM/DDYYY IY MM/DDYYY B X COMMERCIAL GENERAL LIABILITY Y Y 6806NO33449 5/10/2023 5/10/2024 EACH OCCURRENCE $1,000,000 CLAIMS-MADE OCCUR PREM SESOEa occur ence $1,000,000 X Contractual Liab MED EXP(Any one person) $10,000 Included PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY jE LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y Y BA7R748905 5/10/2023 5/10/2024 COMBINED SINGLE LIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident C X UMBRELLA LIAB X OCCUR Y Y CUP6N036187 5/10/2023 5/10/2024 EACH OCCURRENCE $9,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $9,000,000 DED RETENTION$ $ B WORKERS COMPENSATION 6806NO33449 5/10/2023 5/10/2024 PER X OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER WA STOP GAP ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 D Professional Liability(includes 107633573 5/10/2023 5/10/2024 Per Claim $2,000,000 E Pollution Liability) ESL0539659713 5/10/2023 5/10/2024 Annual Aggregate $4,000,000 Cyber Liability Per Claim $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Umbrella Liability policy is follow-form to underlying:General Liability/Auto Liability/Employer's Liability. RE:All Operations of the Named Insured. The State of Washington and City of Kent,their officers,employees,and agents are named as Additional Insured as respects General and Auto Liability as required per written contract or agreement.General Liability and Auto Liability are Primary/Non-Contributory per policy form wording.A Severability of Interest Clause applies to General Liability per policy form. Insurance coverage includes waiver of subrogation per the attached.30 Day Notice of Cancellation. CERTIFICATE HOLDER CANCELLATION 30 Day Notice of Cancellation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Kent 220 Fourth Avenue South AUTHORIZED REPRESENTATIVE Kent, WA 98032 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER 6806No33449 COMMERCIAL GENERAL LIABILITY 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 to include as an additional insured on this Coverage Part, provided that such written contract was signed 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 a written contract with the Additional Insured Person(s) or Organization(s) in the 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- This insurance does not apply to "bodily injury" or clude as an additional insured the person(s) or "property damage" occurring, or "personal injury" organization(s) shown in the Schedule, but only or "advertising injury" arising out of an offense with respect to liability for"bodily injury", "property committed, after: damage", "personal injury" or "advertising injury" 1. All work, including materials, parts or equip- caused, in whole or in part, by: ment furnished in connection with such work, 1. Your acts or omissions; or on the project (other than service, mainte- 2. The acts or omissions of those acting on your nance or repairs) to be performed by or on behalf; behalf of the additional insured(s) at the loca- tion of the covered operations has been com- in the performance of your ongoing operations for pleted; or the additional insured(s) at the location(s) desig- nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its in- B. With respect to the insurance afforded to these tended use by any person or organization additional insureds, the following additional exclu- other than another contractor or subcontrac- sions apply: for 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 CG T8 01 XX XX Includes copyrighted material of Insurance Services Office, Inc. with its permission. DATE OF ISSUE: 05/10/2023 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 6806NO33449 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- location designated and described in the schedule of clude as an additional insured the person(s) or or- this endorsement performed for that additional in- ganization(s) shown in the Schedule, but only with sured and included in the "products-completed opera- respect to liability for "bodily injury" or "property dam- tions hazard". age" caused, in whole or in part, by "your work" at the CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 CG T8 02 XX XX DATE OF ISSUE: 05/10/2023 Policy# 6806NO33449 COMMERCIAL GENERAL LIABILITY c. Method Of Sharing a. The statements in the Declarations are If all of the other insurance permits contribution accurate and complete; by equal shares, we will follow this method also. b. Those statements are based upon Under this approach each insurer contributes representations you made to us; and equal amounts until it has paid its applicable c. We have issued this policy in reliance upon limit of insurance or none of the loss remains, your representations. whichever comes first. The unintentional omission of, or unintentional error If any of the other insurance does not permit in, any information provided by you which we relied contribution by equal shares, we will contribute upon in issuing this policy will not prejudice your by limits. Under this method, each insurer's rights under this insurance. However, this provision share is based on the ratio of its applicable limit does not affect our right to collect additional of insurance to the total applicable limits of premium or to exercise our rights of cancellation or insurance of all insurers. nonrenewal in accordance with applicable insurance d. Primary And Non-Contributory Insurance If laws or regulations. Required By Written Contract 47. Separation Of Insureds If you specifically agree in a written contract or Except with respect to the Limits of Insurance, and agreement that the insurance afforded to an any rights or duties specifically assigned in this insured under this Coverage Part must apply on Coverage Part to the first Named Insured, this a primary basis, or a primary and non- insurance applies: contributory basis, this insurance is primary to a. As if each Named Insured were the only other insurance that is available to such insured Named Insured; and which covers such insured as a named insured, and we will not share with that other insurance, b. Separately to each insured against whom claim provided that: is made or"suit" is brought. (1) The "bodily injury' or"property damage" for 8. Transfer Of Rights Of Recovery Against Others which coverage is sought occurs; and To Us (2) The "personal and advertising injury" for If the insured has rights to recover all or part of any which coverage is sought is caused by an payment we have made under this Coverage Part, offense that is committed; those rights are transferred to us. The insured must subsequent to the signing of that contract or do nothing after loss to impair them. At our request, agreement by you. the insured will bring "suit" or transfer those rights to us and help us enforce them. 5. Premium Audit g. When We Do Not Renew a. We will compute all premiums for this Coverage If we decide not to renew this Coverage Part, we will Part in accordance with our rules and rates. mail or deliver to the first Named Insured shown in b. Premium shown in this Coverage Part as the Declarations written notice of the nonrenewal advance premium is a deposit premium only. At not less than 30 days before the expiration date. the close of each audit period we will compute If notice is mailed, proof of mailing will be sufficient the earned premium for that period and send notice to the first Named Insured. The due date proof of notice. for audit and retrospective premiums is the date SECTION V—DEFINITIONS shown as the due date on the bill. If the sum of 1. "Advertisement" means a notice that is broadcast or the advance and audit premiums paid for the published to the general public or specific market policy period is greater than the earned segments about your goods, products or services premium, we will return the excess to the first for the purpose of attracting customers or Named Insured. 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 18 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Policy#6806NO33449 COMMERCIAL GENERAL LIABILITY occupational therapist or occupational that is available to any of your "employees" therapy assistant, physical therapist or for "bodily injury" that arises out of providing speech-language pathologist; or or failing to provide "incidental medical (b) First aid or "Good Samaritan services" services" to any person to the extent not by any of your"employees" or"volunteer subject to Paragraph 2.a.(1) of Section II — workers", other than an employed or Who Is An Insured. volunteer doctor. Any such "employees" K. MEDICAL PAYMENTS— INCREASED LIMIT or"volunteer workers" providing or failing The following replaces Paragraph 7. of to provide first aid or "Good Samaritan services" during their work hours for you SECTION III — LIMITS OF INSURANCE will be deemed to be acting within the 7. Subject to Paragraph 5. above, the Medical scope of their employment by you or Expense Limit is the most we will pay under performing duties related to the conduct Coverage C for all medical expenses of your business. because of "bodily injury" sustained by any 3. The following replaces the last sentence of one person, and will be the higher of: Paragraph 5. of SECTION III — LIMITS OF a. $10,000; or INSURANCE: For the purposes of determining the b. The amount shown in the Declarations of applicable Each Occurrence Limit, all related this Coverage Part for Medical Expense acts or omissions committed in providing or Limit. failing to provide "incidental medical L. AMENDMENT OF EXCESS INSURANCE services", first aid or "Good Samaritan CONDITION — PROFESSIONAL LIABILITY services" to any one person will be deemed to be one "occurrence". The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — 4. The following exclusion is added to COMMERCIAL GENERAL LIABILITY Paragraph 2. Ent:lusions SECTION I — CONDITIONS: COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE This insurance is excess over any of the other LIABILITY insurance, whether primary, excess, contingent Sale Of Pharmaceuticals or on any other basis, that is Professional Liability or similar coverage, to the extent the "Bodily injury" or "property damage" arising loss is not subject to the professional services out of the violation of a penal statute or exclusion of Coverage A or Coverage B ordinance relating to the sale of M. BLANKET WAIVER OF SUBROGATION — pharmaceuticals committed by, or with the WHEN REQUIRED BY WRITTEN CONTRACT knowledge or consent of the insured. OR AGREEMENT 5. The following is added to the DEFINITIONS Section: The following is added to Paragraph 0. Transfer Of Rights Of Recovery Against Others To Us, "Incidental medical services" means: of SECTION IV — COMMERCIAL GENERAL a. Medical, surgical, dental, laboratory, x LIABILITY CONDITIONS ray or nursing service or treatment, If the insured has agreed in a written contract or advice or instruction, or the related agreement to waive that insured's right of furnishing of food or beverages; or recovery against any person or organization, we b. The furnishing or dispensing of drugs or waive our right of recovery against such person medical, dental, or surgical supplies or or organization, but only for payments we make appliances. because of: 6. The following is added to Paragraph 4.b., a. "Bodily injury" or "property damage" that Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY occurs; or CONDITIONS: b. "Personal and advertising injury" caused by This insurance is excess over any valid and an offense that is committed; collectible other insurance, whether primary, subsequent to the signing of that contract or excess, contingent or on any other basis, 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. 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 H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF B. BLANKET ADDITIONAL INSURED USE—INCREASED LIMIT C. EMPLOYEE HIRED AUTO I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES—INCREASED LIMIT D. EMPLOYEES AS INSURED J. PERSONAL PROPERTY E. SUPPLEMENTARY PAYMENTS — INCREASED K. AIRBAGS LIMITS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR F. HIRED AUTO — LIMITED WORLDWIDE COV- LOSS ERAGE—INDEMNITY BASIS M. BLANKET WAIVER OF SUBROGATION G. WAIVER OF DEDUCTIBLE—GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS PROVISIONS A. BROAD FORM NAMED INSURED this insurance applies and only to the extent that The following is added to Paragraph A.1., Who Is person or organization qualifies as an "insured" under the Who Is An Insured provision contained An Insured, of SECTION II —COVERED AUTOS in Section II. LIABILITY COVERAGE: Any organization you newly acquire or form dur- C. EMPLOYEE HIRED AUTO ing the policy period over which you maintain 1. The following is added to Paragraph A.1., 50% or more ownership interest and that is not Who Is An Insured, of SECTION II — COV- separately insured for Business Auto Coverage. ERED AUTOS LIABILITY COVERAGE: Coverage under this provision is afforded only un- An "employee" of yours is an "insured" while til the 180th day after you acquire or form the or- operating an "auto" hired or rented under a ganization or the end of the policy period, which- contract or agreement in an "employee's" ever is earlier. name, with your permission, while performing duties related to the conduct of your busi- B. BLANKET ADDITIONAL INSURED ness. The following is added to Paragraph c. in A.1., 2. The following replaces Paragraph b. in B.5., Who Is An Insured, of SECTION II — COVERED Other Insurance, of SECTION IV — BUSI- AUTOS LIABILITY COVERAGE: NESS AUTO CONDITIONS: Any person or organization who is required under b. For Hired Auto Physical Damage Cover- a written contract or agreement between you and age, the following are deemed to be cov- that person or organization, that is signed and ered "autos"you own: executed by you before the "bodily injury" or (1) Any covered "auto" you lease, hire, "property damage" occurs and that is in effect rent or borrow; and during the policy period, to be named as an addi- (2) Any covered "auto" hired or rented by tional insured is an "insured" for Covered Autos your "employee" under a contract in Liability Coverage, but only for damages to which 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 (a) With respect to any claim made or "suit" related to the conduct of your busi- brought outside the United States of ness. America, the territories and possessions However, any "auto" that is leased, hired, of the United States of America, Puerto rented or borrowed with a driver is not a Rico and Canada: covered "auto". (i) You must arrange to defend the "in- D. EMPLOYEES AS INSURED sured" against, and investigate or set- tle any such claim or "suit" and keep The following is added to Paragraph A.1., Who Is us advised of all proceedings and ac- An Insured, of SECTION II — COVERED AUTOS tions. LIABILITY COVERAGE: Any "employee" of yours is an "insured" while us- (ii) Neither you nor any other involved ing a covered "auto"you don't own, hire or borrow "insured" will make any settlement in your business or your personal affairs. without our consent. E. SUPPLEMENTARY PAYMENTS — INCREASED (iii)We may, at our discretion, participate LIMITS in defending the "insured" against, or in the settlement of, any claim or 1. The following replaces Paragraph A.2.a.(2), "suit". of SECTION II — COVERED AUTOS LIABIL- ITY COVERAGE: (iv)We will reimburse the "insured" for sums that the "insured" legally must (2) Up to $3,000 for cost of bail bonds (in- pay as damages because of "bodily cluding bonds for related traffic law viola- injury" or "property damage" to which tions) required because of an "accident" this insurance applies, that the "in- we cover. We do not have to furnish sured" pays with our consent, but these bonds. only up to the limit described in Para- 2. The following replaces Paragraph A.2.a.(4), graph C., Limits Of Insurance, of of SECTION II — COVERED AUTOS LIABIL- SECTION II — COVERED AUTOS ITY COVERAGE: 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 (5) Anywhere in the world, except any country or make such payments ends when we 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. COMMERCIAL AUTO You agree to maintain all required or (2) In or on your covered "auto". compulsory insurance in any such coun- This coverage applies only in the event of a total try up to the minimum limits required by theft of your covered "auto". local law. Your failure to comply with compulsory insurance requirements will No deductibles apply to this Personal Property not invalidate the coverage afforded by coverage. this policy, but we will only be liable to the K. AIRBAGS same extent we would have been liable The following is added to Paragraph B.3., Exclu- had you complied with the compulsory in- sions, of SECTION III — PHYSICAL DAMAGE surance requirements. COVERAGE: (d) It is understood that we are not an admit- Exclusion 3.a. does not apply to 'loss" to one or ted or authorized insurer outside the more airbags in a covered "auto" you own that in- United States of America, its territories flate due to a cause other than a cause of "loss" and possessions, Puerto Rico and Can- set forth in Paragraphs A.1.b. and A.1.c., but ada. We assume no responsibility for the only: furnishing of certificates of insurance, or a. If that "auto" is a covered "auto" for Compre- for compliance in any way with the laws hensive Coverage under this policy; of other countries relating to insurance. b. The airbags are not covered under any war- G. WAIVER OF DEDUCTIBLE—GLASS ranty; and The following is added to Paragraph D., Deducti- c. The airbags were not intentionally inflated. ble, of SECTION III — PHYSICAL DAMAGE We will pay up to a maximum of $1,000 for any COVERAGE: one 'loss". No deductible for a covered "auto" will apply to L. NOTICE AND KNOWLEDGE OF ACCIDENT OR glass damage if the glass is repaired rather than LOSS replaced. The following is added to Paragraph A.2.a., of H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF SECTION IV—BUSINESS AUTO CONDITIONS: USE—INCREASED LIMIT Your duty to give us or our authorized representa- The following replaces the last sentence of Para- tive prompt notice of the "accident" or 'loss" ap- graph A.4.b., Loss Of Use Expenses, of SEC- plies only when the "accident' or 'loss" is known TION III—PHYSICAL DAMAGE COVERAGE: to: However, the most we will pay for any expenses (a) You (if you are an individual); for loss of use is $65 per day, to a maximum of (b) A partner(if you are a partnership); $750 for any one"accident'. (c) A member (if you are a limited liability com- I. PHYSICAL DAMAGE — TRANSPORTATION pany); EXPENSES—INCREASED LIMIT (d) An executive officer, director or insurance The following replaces the first sentence in Para- manager (if you are a corporation or other or- graph A.4.a., Transportation Expenses, of ganization); or SECTION III — PHYSICAL DAMAGE COVER- (e) Any "employee" authorized by you to give no- AGE: tice of the "accident' or'loss". We will pay up to $50 per day to a maximum of M. BLANKET WAIVER OF SUBROGATION $1,500 for temporary transportation expense in- The following replaces Paragraph A.5., Transfer curred by you because of the total theft of a cov- Of Rights Of Recovery Against Others To Us, ered "auto" of the private passenger type. of SECTION IV — BUSINESS AUTO CONDI- J. PERSONAL PROPERTY TIONS : The following is added to Paragraph A.4., Cover- S. Transfer Of Rights Of Recovery Against age Extensions, of SECTION III — PHYSICAL Others To Us DAMAGE COVERAGE: We waive any right of recovery we may have Personal Property against any person or organization to the ex- tent required of you by a written contract We will pay up to $400 for "loss" to wearing ap- signed and executed prior to any "accident' parel and other personal property which is: or"loss", provided that the "accident' or"loss" (1) Owned by an "insured"; and 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 The unintentional omission of, or unintentional person or organization designated in such error in, any information given by you shall not contract. prejudice your rights under this insurance. How- N. UNINTENTIONAL ERRORS OR OMISSIONS ever this provision does not affect our right to col- The following is added to Paragraph B.2., Con- lect additional premium or exercise our right of cealment, Misrepresentation, Or Fraud, of cancellation or non-renewal. SECTION IV—BUSINESS AUTO CONDITIONS: 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#BA7R748905 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM PROVISIONS 2. The following is added to Paragraph B.S., Other 1. The following is added to Paragraph A.1.c., Who Insurance of SECTION IV — BUSINESS AUTO Is An Insured, of SECTION II — COVERED CONDITIONS: AUTOS LIABILITY COVERAGE: Regardless of the provisions of paragraph a. and This includes any person or organization who you paragraph d. of this part S. Other Insurance, this are required under a written contract or insurance is primary to and non-contributory with agreement between you and that person or applicable other insurance under which an organization, that is signed by you before the additional insured person or organization is the "bodily injury" or "property damage" occurs and first named insured when the written contract or that is in effect during the policy period, to name agreement between you and that person or as an additional insured for Covered Autos organization, that is signed by you before the Liability Coverage, but only for damages to which "bodily injury" or "property damage" occurs and this insurance applies and only to the extent of that is in effect during the policy period, requires that person's or organization's liability for the this insurance to be primary and non-contributory. conduct of another"insured". CA T4 74 02 16 ©2016 The Travelers Indemnity Company.All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.with its permission.