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HomeMy WebLinkAboutCAG2023-513 - Change Order - #1 - Petersen Brothers, Inc. - Veteran's Drive Guardrail Repair - 12/01/2023 FOR CITY OF KENT OFFICIAL USE ONLY Sup/Mgr: Agreement Routing Form Dir Asst: • For Approvals,Signatures and Records Management Dir/Dep: KE N T This form combines&replaces the Request for Mayor's Signature and Contract Cover (Optional) WASHINGTON Sheet forms. Originator: Department: Dani Hodgins for Ryan Carroll Public Works Date Sent: Date Required: 0 12/04/2023 12/7/2023 CL Director or Designee to Sign. Date of Council Approval: CL Q Budget Account Number: Grant?[:]YesZNo 11115530.64110.7495 Budget?:Yes:No Type: N/A Vendor Name: Category: Petersen Brothers, Inc. Contract Vendor Number: Sub-Category: = Change Order 0 Project Name: Veteran's Drive Guardrail Repair -Change Order #1 E Y as project c Pro)ectDetails:Additional time and funds are necessary ect required extra � p J G = parts and labor to complete. c 40 E Agreement Amount: $1,494.99 additional Basis for Selection of Contractor: Bid 47 `Memo to Mayor must be attached 11- Start Date: 12/1/2023 Termination Date: 12/31/2023 Q Local Business?F--]YesF--]No* If meets req uiremen ts per KCC 3.70.100,please complete"Vendor Purchase-Local Exceptions'form on Cityspace. Business License Verification:Yes:ln-Process:Exempt(KCC 5.01.045) Notice required prior to disclosure? Contract Number: F1Yes�✓ No CAG2023-513 Comments: a1 G 3 4) H •� i N 3 f0 C V1 Date Routed to the City Clerk's Office: 12/4/23 Interlocal Agreement has been uploaded to website: adccW22313_1_20 Visit Documents.KentWA.gov to obtain copies of all agreements rev.20210513 • KENT W A S H I N G T O N CHANGE ORDER NO. 1 NAME OF CONTRACTOR: Petersen Brothers, Inc. ("Contractor") CONTRACT NAME & PROJECT NUMBER: Veteran's Drive Guardrail Repair ORIGINAL CONTRACT DATE: Ocotber 2, 2023 This Change Order amends the above-referenced contract; all other provisions of the contract that are not inconsistent with this Change Order shall remain in effect. For valuable consideration and by mutual consent of the parties, the project contract is modified as follows: 1. Section I of the Agreement, entitled "Description of Work," is hereby modified to add additional work or revise existing work as follows: In addition to work required under the original Agreement and any prior Amendments, Contractor shall provide all labor, materials, and equipment necessary to: Additional time and funds are necessary as project required extra parts and labor to complete. 2. The contract amount and time for performance provisions of Section II "Time of Completion," and Section III, "Compensation," are hereby modified as follows: Original Contract Sum, $10,785.70 (including applicable alternates and WSST) Net Change by Previous Change Orders $0 (incl. applicable WSST) Current Contract Amount $10,785.70 (incl. Previous Change Orders) Current Change Order $1,494.99 Applicable WSST Tax on this Change $ Order Revised Contract Sum $12,280.69 CHANGE ORDER - 1 OF 3 Original Time for Completion 12/1/23 (insert date) Revised Time for Completion under N/A prior Change Orders (insert date) Days Required (f) for this Change Order 30 calendar days Revised Time for Completion 12/31/23 (insert date) In accordance with Sections 1-04.4 and 1-04.5 of the Kent and WSDOT Standard Specifications, and Section VII of the Agreement, the Contractor accepts all requirements of this Change Order by signing below. Also, pursuant to the above-referenced contract, Contractor agrees to waive any protest it may have regarding this Change Order and acknowledges and accepts that this Change Order constitutes final settlement of all claims of any kind or nature arising from or connected with any work either covered or affected by this Change Order, including, without limitation, claims related to contract time, contract acceleration, onsite or home office overhead, or lost profits. This Change Order, unless otherwise provided, does not relieve the Contractor from strict compliance with the guarantee and warranty provisions of the original contract, particularly those pertaining to substantial completion date. All acts consistent with the authority of the Agreement, previous Change Orders (if any), and this Change Order, prior to the effective date of this Change Order, are hereby ratified and affirmed, and the terms of the Agreement, previous Change Orders (if any), and this Change Order shall be deemed to have applied. The parties whose names appear below swear under penalty of perjury that they are authorized to enter into this contract modification, which is binding on the parties of this contract. 3. The Contractor will adjust the amount of its performance bond (if any) for this project to be consistent with the revised contract sum shown in section 2, above. IN WITNESS, the parties below have executed this Agreement, which will become effective on the last date written below. CONTRACTOR: CITY OF KENT: By: By: IX! &'�� Print Name: Ronald G. Petersen Print Name: 04A0 13SCUW Its President Its: P061.1c. wDpxs U1REcTv DATE: 12/1/2023 DATE: 11 11-13 CHANGE ORDER - 2 OF 3 ATTEST: APPROVED AS TO FORM: (applicable if Mayor's signature required) W41A Kent City Clerk Kent Law Department P:\Ad min I Contracts\Dani CHANGE ORDER - 3 OF 3 A�" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 10/25/2023 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 Sue Martin NAME: HENTSCHELL&ASSOC INC aCC Ext: (253)272-1151 A/XC,No): (253)272-1225 1436 S.Union Ave. E-MAIL SueM@hentschell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Tacoma WA 98405-1925 INSURERA: Charter Oak Fire Insurance 25615 INSURED INSURER B: Travelers Ind Cc Of CT 25682 Petersen Brothers,Inc. INSURERC: Travelers Prop Cas Co of Amer 25674 2008 East Valley Hwy INSURER D: Great American Ins.Co. INSURER E: Sumner WA 98390 INSURER F COVERAGES CERTIFICATE NUMBER: 2023 GLAU UMB XS 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 INSURANCEADDLSUBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PRIM SES Ea oNcE ence $ 300,000 X Employers Liability(Stop Gap) 10,000 MED EXP(Any one person) $ A X Limited Job Site Pollution Y Y DT-CO-526D9518-COF-23 11/01/2023 11/01/2024 PERSONAL&ADV INJURY $ 1,000,000 MOTHER LAGGREGATE LIMIT APPLIES PERGENERAL AGGREGATE $ 2,000,000 POLICY � PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT: PD Deductible$5,000 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED Y Y 810-OL622021-23-26G 11/01/2023 11/01/2024 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY /� AUTOS ONLY Per accident PD Deductible$2,500 $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 C EXCESS LAB CLAIMS-MADE Y Y CUP-4R705623-23-26 11/01/2023 11/01/2024 AGGREGATE $ 1,000,000 DED I X1 RETENTION $ 10,000 $ WORKERS COMPENSATION X STATUTE ER WA Stop Gap Limits AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? NIA DT-CO-526D9518-COF-23 11/01/2023 11/01/2024 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Limits: D Excess Liability P/no retention Form) TUE0196246-13 11/01/2023 11/01/2024 Occurrence $5,000,000 Occurrence Form/no retention Aggregate $5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) [Job#:PBI 23-129 Job Type:] RE:Veteran's Drive Guardrail Repair. City of Kent is included as additional insureds. Certificate Holder is included in Blanket Additional Insured as required by written contract or agreement as attached forms listed below: General Liability:CGD 246(04/19)Blanket Additional Insured including Completed Operations.CGT100(02/19) Primary Non-Contributory.;CGD 316(02/19)Blanket Waiver of Subrogation CGD211((01/04)Per Project Aggregate.;Automobile:CAT353(02/15) Additional Insured&Waiver.Auto Extension CAT499(02/16)Additional Insured Primary Non Contributory. Umbrella:E00001 (7/16) Excess Liability Following Form. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Kent Public Works Department ACCORDANCE WITH THE POLICY PROVISIONS. 400 West Gowe AUTHORIZED REPRESENTATIVE Kent WA 98032 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY DESIGNATED PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Project Designated Project(s): General Aggregate(s): EACH "PROJECT" FOR WHICH YOU HAVE AGREED, GENERAL AGGREGATE IN A WRITTEN CONTRACT WHICH IS IN EFFECT LIMIT SHOWN ON THE DURING THIS POLICY PERIOD, TO PROVIDE A DECLARATIONS. SEPARATE--GENERAL—AGGREGATE -LIMIT -PROVIDED THAT THE CONTRACT IS SIGNED AND EXECUTED BY YOU BEFORE THE "BODILY INJURY" OR "PROPERTY DAMAGE" OCCURS, A. For all sums which the insured becomes legally 3. Any payments made under COVERAGE A. obligated to pay as damages caused by "occur- for damages or under COVERAGE C. for rences" under COVERAGE A. (SECTION 1), and medical expenses shall reduce the Desig- _for all-medical expenses-caused-by accidents_un- nafed_Project-_General-A-ggregate__Limit_Tar __ der COVERAGE C (SECTION I), which can be that designated g "project". Such payments attributed only to operations at a single desig- shall not reduce the General Aggregate Limit nated "project"shown in the Schedule above: shown in the Declarations nor shall they re- f. A separate Designated Project General Ag- duce any other Designated Project General gregate Limit applies to each designated "pro- Aggregate Limit for any other designated ject", and that limit is equal to the amount of "project"shown in the Schedule above. the General Aggregate Limit shown in the 4. The limits shown in the Declarations for Each Declarations;-unless- separate Designated Occurrence,-Damage To-Premises-Rented -- -- Project General Aggregate(s) are sched- To You and Medical Expense continue to uled above. apply. However, instead of being subject to 2. The Designated Project General Aggregate the General Aggregate Limit shown in the Limit is the most we will pay for the sum of all Declarations, such limits will be subject to the damages under COVERAGE A., except applicable Designated Project General Ag- damages because of "bodily injury" or "prop- gregate Lit-nit. erty damage" included in the "products- B. For all sums which the insured becomes legally completed operations hazard", and for medi- obligated to pay as damages caused by "occur- cal expenses under COVERAGE C, regard- rences" under COVERAGE A. (SECTION 1), and less of the number of: for all medical expenses caused by accidents un- a. Insureds; der COVERAGE C. (SECTION 1), which cannot b. Claims made or"suits" brought; or be attributed only to operations at a single desig- nated "project"shown in the Schedule above: c. Persons or organizations making claims or bringing"suits". CG D2 11 01 04 Copyright, The Travelers Indemnity Company, 2004 Page 1 of 2 COMMERCIAL GENERAL LIABILITY 1. Any payments made under COVERAGE A. vided, any payments for damages because of for damages ar under COVERAGE C. for "bodily injury" or "property damage" included in medical expenses shall reduce the amount the "products-completed operations hazard" will available under the General Aggregate Limit reduce the Products-Completed Operations Ag- or the Products-Completed Operations Ag- gregate Limit, and not reduce the General Aggre- gregate Limit, whichever is applicable; and gate Limit nor the Designated Project General 2. Such payments shall not reduce any Desig- Aggregate Limit. nated Project General Aggregate Limit. E. For the purposes of this endorsement the Defini- C. Part 2. of SECTION III—LIMITS OF INSURANCE tions Section is amended by the addition of the is deleted and replaced by the following: following definition: 2. The General Aggregate Limit is the most we "Project' means an area away from premises will pay for the sum of: owned by or rented to you at which you are per- forming operations pursuant to a contract or a. Damages under Coverage B; and agreement. For the purposes of determining the b. Damages from "occurrences" under applicable aggregate limit of insurance, each COVERAGE A (SECTION 1) and for all "project" that includes premises involving the medical expenses caused by accidents same or connecting lots, or premises whose con- under COVERAGE C (SECTION 1) which nection is interrupted only by a street, roadway; cannot be attributed only to operations at waterway or right-of-way of a railroad shall be a single designated "project"shown in the considered a single "project". SCHEDULE above. F. The -provisions_ of SEC TION-_III—LIMITS OF D. When coverage for liability arising out of the INSURANCE not otherwise modified by this en- "products-completed operations hazard" is pro- dorsement shall continue to apply as stipulated. m� m= d� o m� m= R� n� Oa Oo V� Page 2 of 2 Copyright, The Travelers Indemnity Company, 2004 CG D2 11 01 04 014E 18 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 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 this Coverage Part, and these coverage broadening provisions d❑ not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Who Is An Insured—Unnamed Subsidiaries C. Incidental Medical Malpractice B. Blanket Additional Insured — Governmental D. Blanket Waiver Of Subrogation Entities — Permits Or Authorizations Relating To E. Contractual Liability—Railroads Operations F. Damage To Premises Rented To You PROVISIONS a. An organization other than a partnership,joint A. WHO IS AN INSURED — UNNAMED venture or limited liability company; or SUBSIDIARIES b. A trust; The following is added to SECTION II —WHO IS as indicated in its name or the documents that AN INSURED: govern its structure. Any of your subsidiaries, other than a partnership, B. BLANKET ADDITIONAL INSURED — joint venture or limited liability company, that is GOVERNMENTAL ENTITIES — PERMITS OR not shown as a Named Insured in the AUTHORIZATIONS RELATING TO OPERATIONS Declarations is a Named Insured if: a. You are the sole owner of, or maintain an The following is added to SECTION II — WHO IS ownership interest of more than 50% in, such AN INSURED: subsidiary on the first day of the policy period; Any governmental entity that has issued a permit and or authorization with respect to operations b. Such subsidiary is not an insured under performed by you or on your behalf and that you similar other insurance. are required by any ordinance, law, building code or written contract or agreement to include as an No such subsidiary is an insured for"bodily injury' additional insured on this Coverage Part is an or "property damage" that occurred, or "personal insured, but only with respect to Iiabi Iity for"bodily and advertising injury" caused by an offense injury", "property damage" or "personal and committed: advertising injury" arising out of such operations. a. Before you maintained an ownership interest The insurance provided to such governmental of more than 50% in such subsidiary; or entity does not apply to: b. After the date, if any, during the policy period a. Any "bodily injury", "property damage" or that you no longer maintain an ownership "personal and advertising injury" arising out of interest of more than 50% in such subsidiary. operations performed for the governmental For purposes of Paragraph 1. of Section II —Who entity; or Is An Insured, each such subsidiary will be b. Any "bodily injury" or "property damage" deemed to be designated in the Declarations as: included in the "products-completed operations hazard CG D3 16 02 19 02017 The Travelers Indemnity Company.All rights reserved. Page 1 ❑f 3 Includes copyrighted material ofInsurance Services Office,Inc.,with its permission. COMMERCIAL GENERAL LIABILITY C. INCIDENTAL MEDICAL MALPRACTICE pharmaceuticals committed by, or with the 1. The following replaces Paragraph b. of the knowledge or consent of, the insured. definition of "occurrence" in the 5. The following is added to the DEFINITIONS DEFINITIONS Section: Section: b. An act or omission committed in providing "Incidental medical services" means: or failing to provide "incidental medical services", first aid or "Good Samaritan a. Medical, surgical, dental, laboratory, x-ray services" to a person, unless you are in or nursing service or treatment, advice or the business or occupation of providing instruction, or the related furnishing of professional health care services. food or beverages; or 2. The following replaces the last paragraph of b. The furnishing or dispensing of drugs or Paragraph 2.a.(1) of SECTION II — WHO IS medical, dental, or surgical supplies or AN INSURED: appliances. Unless you are in the business or occupation 6. The following is added to Paragraph 4.b., of providing professional health care services, Excess Insurance, of SECTION IV — Paragraphs (1)(a), (b), (c) and (d) above do COMMERCIAL GENERAL LIABILITY not apply to "bodily injury" arising out of CONDITIONS: providing or failing to provide: This insurance is excess over any valid and (a) "Incidental medical services" by any of collectible other insurance, whether primary, your "employees" who is a nurse, nurse excess, contingent or on any other basis, that assistant, emergency medical technician is available to any of your "employees" for or paramedic; or "bodily injury" that arises out of providing or (b) First aid or "Good Samaritan services" by failing to provide "incidental medical services" any of your "employees" or "volunteer to any person to the extent not subject to workers", other than an employed or Paragraph 2.a.(1) of Section II — Who Is An volunteer doctor. Any such "employees" Insured. or "volunteer workers" providing or failing D. BLANKET WAIVER OF SUBROGATION to provide first aid or "Good Samaritan services" during their work hours for you The following is added to Paragraph 8., Transfer will be deemed to be acting within the Of Rights Of Recovery Against Others To Us, scope of their employment by you or of SECTION IV — COMMERCIAL GENERAL performing duties related to the conduct LIABILITY CONDITIONS: of your business. If the insured has agreed in a contract or 3. The following replaces the last sentence of agreement to waive that insured's right of Paragraph 5. of SECTION III — LIMITS OF recovery against any person or organization, we INSURANCE: waive our right o f recovery against such person or For the purposes of determining the organization, but only for payments we make applicable Each Occurrence Limit, all related because of: acts or omissions committed in providing or a. "Bodily injury" or "property damage" that failing to provide "incidental medical occurs; or services", first aid or "Good Samaritan services" to any one person will be deemed to b. "Personal and advertising injury" caused by be one"occurrence"_ an offense that is committed; 4. The following exclusion is added to subsequent to the execution of the contract or Paragraph 2., Exclusions, of SECTION I — agreement. COVERAGES — COVERAGE A — BODILY E. CONTRACTUAL LIABILITY—RAILROADS INJURY AND PROPERTY DAMAGE LIABILITY: 1. The following replaces Paragraph c. of the Sale Of Pharmaceuticals definition of "insured contract' in the "Bodily injury' or "property damage" arising DEFINITIONS Section: out of the violation of a penal statute or c. Any easement or license agreement; ordinance relating to the sale of Page 2 of 3 ®2017 The Travelers Indemnity Company.All rights reserved. CG D3 16 02 19 Includes copyrighted material of Insurance Services 0ffice,Inc.,with its permission. COMMERCIAL GENERAL LIABILITY 2. Paragraph f.(1) of the definition of "insured a. Any premises while rented to you or contract' in the DEFINITIONS Section is temporarily occupied by you with permission del eted. of the owner; or F. DAMAGE TO PREMISES RENTED TO YOU b. The contents of any premises while such The following replaces the definition of"premises premises is rented to you, if you rent such damage" in the DEFINITIONS Section: premises for a period of seven or fewer "Premises damage" means"property damage" to: consecutive days. CG D3 16 02 19 ®2017 The Travelers Indemnity Company.All rights reserved. Page 3 of 3 Includes copyrighted material of Insurance Services 0ffice,Inc.,with its permission. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (Includes Products-Completed Operations If Required By Contract) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS (1) Any "bodily injury", "property damage" or The following is added to SECTION II — WHO IS AN "personal injury" arising out of the providing, INSURED: or failure to provide, any professional Any person or organization that you agree in a architectural, engineering or surveying written contract or agreement to include as an services, including: additional insured on this Coverage Part is an (a) The preparing, approving, or failing to insured, but only: prepare or approve, maps, shop a. With respect to liability for "bodily injury" or drawings, opinions, reports, surveys, "property damage" that occurs, or for "personal field orders or change orders, or the injury" caused by an offense that is committed, preparing, approving, or failing to subsequent to the signing of that contract or prepare or approve, drawings and agreement and while that part of the contract or specifications; and agreement is in effect; and (b) Supervisory, inspection, architectural or b. If, and only to the extent that, such injury or engineering activities. damage is caused by acts or omissions of you or your subcontractor in the performance of "your (2) Any "bodily injury' or "property damage" work" to which the written contract or agreement caused by "your work" and included in the applies. Such person or organization does not "products-completed operations hazard" qualify as an additional insured with respect to unless the written contract or agreement the independent acts or omissions of such specifically requires you to provide such person or organization. coverage for that additional insured during The insurance provided to such additional insured is the policy period. subject to the following provisions: c. The additional insured must comply with the a. If the Limits of Insurance of this Coverage Part following duties: shown in the Declarations exceed the minimum (1) Give us written notice as soon as practicable limits required by the written contract or agreement, the insurance provided to the of an "occurrence" or an offense which may additional insured will be limited to such result in a claim. To the extent possible, such minimum required limits. For the purposes of notice should include: determining whether this limitation applies, the (a) How, when and where the "occurrence" minimum limits required by the written contract or or offense took place; agreement will be considered to include the minimum limits of any Umbrella or Excess (b) The names and addresses of any injured liability coverage required for the additional persons and witnesses; and insured by that written contract or agreement. (c) The nature and location of any injury or This provision will not increase the limits of damage arising out of the "occurrence" insurance described in Section III — Limits Of or offense. Insurance. b. The insurance provided to such additional (2) If a claim is made or "suit" is brought against insured does not apply to: the additional insured: CG D2 46 0419 ©2018 The Travelers Indemnity Company. All rights reserved. Page 1 of 2 COMMERCIAL GENERAL LIABILITY (a) Immediately record the specifics of the (4) Tender the defense and indemnity of any claim or"suit" and the date received; and claim or "suit" to any provider of other (b) Notify us as soon as practicable and see insurance which would cover such additional to it that we receive written notice of the insured for a loss we cover. However, this claim or"suit" as soon as practicable. condition does not affect whether the insurance provided to such additional (3) Immediately send us copies of all legal insured is primary to other insurance papers received in connection with the claim available to such additional insured which or "suit", cooperate with us in the covers that person or organization as a investigation or settlement of the claim or named insured as described in Paragraph 4., defense against the "suit', and otherwise Other Insurance, of Section IV — Commercial comply with all policy conditions. General Liability Conditions. Page 2 of 2 ©2018 The Travelers Indemnity Company. All rights reserved. CG D2 46 04 19 UMBRELLA EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE THIS POLICY, IN PART, PROVIDES FOLLOW-FORM LIABILITY COVERAGE. COVERAGE WILL APPLY ON A CLAIMS-MADE BASIS WHEN FOLLOWING rLAiwq_ anE i INnERLvINr- INCI IQelurE. COVERAGE WILL APPLY ON A DEFENSE-WITHIN-LIMITS BASIS WHEN FOLLOWING UNDERLYING INSURANCE UNDER WHICH DEFENSE EXPENSES ARE PAYABLE WITHIN, AND NOT IN ADDITION TO, THE LIMITS OF INSURANCE. WHEN FOLLOWING SUCH UNDERLYING INSURANCE, PAYMENT OF DEFENSE EXPENSES UNDER THIS POLICY WILL REDUCE, AND MAY EXHAUST, THE LIMITS OF INSURANCE OF THIS POLICY. PLEASE READ THE ENTIRE POLICY CAREFULLY. Various provisions in this policy restrict coverage_ Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy, the words "you" and "your" refer to the Named Insured shown in the Declarations and any other person or organization qualifying as a Named Insured under this policy. The words "we", "us" and "our" refer to the company providing this insurance. The word "insured" means any person or organization qualifying as such under SECTION II — WHO IS AN INSURED. Other words and phrases that appear in quotation marks have special meaning. Refer to SECTION VI — DEFINITIONS. SECTION I—COVERAGES provisions to the contrary contained in this A_ COVERAGE A — EXCESS FOLLOW-FORM insurance. LIABILITY T--_ _--_-- 3. The amount we will pay for damages is limited as described in SECTION III — LIMITS OF 1. We will pay on behalf of the insured those INSURANCE, sums, in excess of the "applicable underlying 4. For the purposes of Paragraph 1.above: limit", that the insured becomes legally obligated to pay as damages to which a. The applicable limit of insurance stated Coverage A of this insurance applies, for the policies of "underlying insurance" provided that the "underlying insurance" would in the Schedule Of Underlying Insurance apply to such damages but for the exhaustion will be considered to be reduced or of its applicable limits of insurance. If a exhausted only by the following sublimit is specified in any "underlying payments: insurance", Coverage A of this insurance (1) Payments of judgments or applies to damages that are in excess of that settlements for damages that are sublimit only if such sublimit is shown for that covered by that "underlying "underlying insurance" in the Schedule Of insurance". However, if such Underlying Insurance. "underlying insurance" has a policy Z. Coverage A of this insurance is subject to the period which differs from the policy same terms, conditions, agreements, period of this Excess Follow-Form exclusions and definitions as the "underlying And Umbrella Liability Insurance, any insurance", except with respect to any such payments for damages that would not be covered by this Excess EU 00 01 07 16 (c)2016 The Tr-,we.lers Inr.emni-y Company.All rights reserver.. Page 1 of 22 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" An Insured, of SECTION II—COVERED AUTOS under the Who Is An Insured provision contained LIABILITY COVERAGE: in Section II. 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 a� 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 "insured" will make any settlement ing a covered"auto"you don't own, hire or borrow without our consent. in your business or your personal affairs. (iii)We may, at our discretion, participate E. SUPPLEMENTARY PAYMENTS — INCREASED in defending the "insured" against, or LIMITS in the settlement of, any claim or 1. The following replaces Paragraph A.2.a.(2), "suit". of SECTION II—COVERED AUTOS LIABIL- (iv)We will reimburse the "insured" for ITY COVERAGE: 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 jurisdiction while any trade sanction, em- have used up the applicable limit of bargo, or similar regulation imposed by the insurance in payments for damages, United States of America applies to and pro- settlements or defense expenses. 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, "a uto" that you lease, hire, rent or borrow contingent or on any other basis. without a driver for a period of 30 days or less and that is not an "auto" you lease, hire, rent (c) This insurance is not a substitute for re- or borrow from any of your "employees", quired or compulsory insurance in any 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 No deductibles apply to this Personal Property compulsory insurance requirements will coverage. not invalidate the coverage afforded by 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 AA., Cover- 5. 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 0215 ©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- lest 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 Company.All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL AUTO h THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE - CONTRACTORS 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 c. in A.1., Insurance of SECTION IV — BUSINESS AUTO Who 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 5. Other Insurance, this are required under a written contract or insurance is primary to and non-contributory with agreement, that is signed by you before the applicable other insurance under which an "bodily injury" or "property damage" occurs and additional insured person or organization is a that is in effect during the policy period, to name named insured when a written contract or as an additional insured for Covered Autos agreement with you, that is signed by you before Liability Coverage, but only for damages to which the "bodily injury" or "property damage" occurs this insurance applies and only to the extent of and that is in effect during the policy period, that person's or organization's liability for the requires this insurance to be primary and non- conduct of another"insured". contributory. CA T4 99 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. UMBRELLA T. WAIVER OR TRANSFER OF RIGHTS OF provision does not affect our right to collect RECOVERY AGAINST OTHERS TO US additional premium or to exercise our rights of 1. If the insured has rights to recover all or part cancellation or nonrenewal in accordance with of any payment we have made under this applicable insurance laws or regulations. insurance, those rights are transferred to us W. WHEN LOSS IS PAYABLE and the insured must do nothing after loss to If we are liable under this insurance, we will pay impair them. At our request, the insured will for injury, damage or loss after: bring suit or transfer those rights to us and help us, and with respect to Coverage A, the 1. The insured's liability is established by: "underlying insurer'', enforce them. a. A court decision; or If the insured has agreed in a contract or b. A written agreement between the agreement to waive that insured's right of claimant, the insured, any "underlying recovery against any person or organization, insurer" and us; and we waive our right of recovery against that person or organization, but only for payments 2. The amount of the "applicable underlying we make because of an "event" that takes limit" or "self-insured retention" is paid by or place or is committed subsequent to the on behalf of the insured. execution of that contract or agreement by SECTION VI—DEFINITIONS such insured. 2. Reimbursement of any amount recovered will A. With respect to all coverages of this insurance: be made in the following order: 1. "Applicable underlying limit" means the sum of: a. First, to any person or organization a. The applicable limit of insurance stated (including us or the insured) who has paid for the policies of "underlying insurance" any amount in excess of the applicable in the Schedule Of Underlying Insurance limit of insurance; subject to the provisions in Paragraphs b. Next, to us; and 4.a.(1), (2) and (3) of COVERAGE A — c. Then, to any person or organization EXCESS FOLLOW-FORM LIABILITY of (including the insured and with respect to SECTION I—COVERAGES; and Coverage A, the "underlying insurer") that b. The applicable limit of insurance of any is entitled to claim the remainder, if any, "other insurance"that applies. 3. Expenses incurred in the process of recovery The limits of insurance in any policy of will be divided among all persons or "underlying insurance" will apply even if: organizations receiving amounts recovered according to the ratio of their respective a. The "underlying insurer" claims the recoveries. insured failed to comply with any term or U. TRANSFER OF YOUR RIGHTS AND DUTIES condition of the policy; or UNDER THIS INSURANCE b. The "underlying insurer" becomes 1. Your rights and duties under this insurance bankrupt or insolvent. may not be transferred without our written 2. "Auto hazard" means all "bodily injury" and consent except in the case of death of an "property damage" to which liability insurance individual Named Insured. afforded under an auto policy of "underlying 2. If you die, your rights and duties will be insurance" would apply but for the exhaustion transferred to your legal representative but of its applicable limits of insurance. only while acting within the scope of duties as 3. "Electronic data" means information, facts or your legal representative. Until your legal programs stored as or on, created or used on, representative is appointed, anyone having or transmitted to or from computer software proper temporary custody of your property will (including systems and applications software), have your rights and duties but only with hard or floppy disks, CD-ROMs, tapes, drives, respect to that property. cells, data processing devices or any other V. UNINTENTIONAL OMISSION OR ERROR media which are used with electronically The unintentional omission of, or unintentional controlled equipment. error in, any information provided by you which we 4. "Event" means an "occurrence", offense, relied upon in issuing this policy will not prejudice accident, act, error, omission, wrongful act or your rights under this insurance. However, this loss. Page 16 of 22 Chi 2016 The Travelers Incemni:y Company.All rights reservec. EU 00 01 07 16 UMBRELLA POLICY NUMBER: CUP-8J818962-17-26 ISSUE DATE: 10/17/2017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT - OTHER INSURANCE - DESIGNATED PERSONS OR ORGANIZATIONS FOR WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT TO PROVIDE INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL EXCESS LIABILITY (UMBRELLA) INSURANCE SCHEDULE OF DESIGNATED PERSONS OR ORGANIZATIONS Person or Organization: ANY PERSON OR ORGANIZATION THAT QUALIFIES AS AN INSURED UNDER PARAGRAPH 2.F. OF SECTION II - WHO IS AN INSURED. Project or Location: ANY PROJECT FOR A PERSON OR ORGANIZATION THAT IS SHOWN IN THE PERSON OR ORGANIZATION SECTION OF THIS SCHEDULE, IF THE WRITTEN CONTRACT IN WHICH YOU HAVE AGREED TO PROVIDE INSURANCE FOR THAT PERSON OR ORGANIZATION FOR THAT PROJECT SPECIFICALLY REQUIRES THAT THE INSURANCE PROVIDED BY THIS POLICY TO SUCH PERSON OR ORGANIZATION APPLY ON A PRIMARY BASIS OR A PRIMARY AND NON-CONTRIBUTORY BASIS. PROVISIONS or location shown in that schedule, if the written con- The following is added to Paragraph 10., OTHER IN- tract in which you have agreed to provide insurance SURANCE., of SECTION IV—CONDITIONS.: for that person or organization specifically requires that this insurance apply on a primary basis or a pri- However, for any person or organization shown in the mary and non-contributory basis, this insurance will Schedule Of Designated Persons Or Organizations apply as if other insurance available to that person or that qualifies as an insured under Paragraph 2.f. of organization under which that person or organization SECTION II — WHO IS AN INSURED for the project qualifies as a named insured does not exist, and we UM 06 39 02 14 ©2013 The Travelers Indemnity Company.All rights reserved. Page 1 Of 2 UMBRELLA will not share with that other insurance. But this insur- which covers that person or organization as an addi- ance still is excess over any valid and collectible other tional insured or as any other insured that does not insurance, whether such insurance is stated to be qualify as a named insured. primary, contributing, excess, contingent or otherwise, Page 2 of 2 ©2013 The Travelers Indemnity Company.All rights reserved. UM 06 39 02 14 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT - POLLUTION EXCLUSION - INCLUDING LIMITED COVERAGE FOR POLLUTION COSTS - CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS respect to your ongoing operations 1. The following replaces Paragraph 1.a.(2) of performed for that additional insured SECTION I — COVERAGES — COVERAGE A — at that premises, site or location and BODILY INJURY AND PROPERTY DAMAGE such premises, site or location is not LIABILITY and of SECTION I — COVERAGES — and never was owned, occupied or COVERAGE B — PERSONAL AND managed by, or rented or loaned to, ADVERTISING INJURY LIABILITY: any insured, other than that additional (2) Our right and duty to defend end when we insured; or have used up the applicable limit of insurance (iii) "Bodily injury" or "property damage" in the payment of judgments or settlements arising out of heat, smoke or fumes under Coverages A or B, medical expenses from a "hostile fire"; under Coverage C or "limited covered (b) At or from any premises, site or location pollution costs" under Coverage D. which is or was at any time used by or for 2. The following replaces Paragraph (1) of Exclusion any insured or others for the handling, f., Pollution, in Paragraph 2. of SECTION I — storage, disposal, processing or COVERAGES — COVERAGE A — BODILY treatment of waste; INJURY AND PROPERTY DAMAGE LIABILITY: (c) If such "pollutants" are or were at any (1) "Bodily injury" or "property damage" arising time transported, handled, stored, out of the actual, alleged or threatened treated, disposed of, or processed as discharge, dispersal, seepage, migration, waste by or for: release or escape of"pollutants": (i) Any insured; or (a) At or from any premises, site or location (ii) Any person or organization for whom which is or was at any time owned, you may be legally responsible; occupied or managed by, or rented or (d) At or from any premises, site or location loaned to, any insured. However, this on which any insured or any contractors subparagraph d oes not apply to: or subcontractors working directly or (i) "Bodily injury" if sustained within a indirectly on any insured's behalf are or building and caused by smoke, were at anytime performing operations to fumes, vapor or soot produced by or test for, monitor, clean up, remove, originating from equipment that is contain, treat, detoxify or neutralize, or in used to heat, cool or dehumidify the any way respond to, or assess the effects building, or produced by or originating of, "pollutants"; or from equipment that is used to heat (e) If any of such discharge, dispersal, water for personal use by the seepage, migration, release or escape of building's occupants ortheir guests; "pollutants" resulted in "bodily injury" or (i i) "Bodily injury" or "property damage" "property damage" that occurred, in for which you may be held liable, if whole or in part, prior to the policy period. you are a contractor and the owner or Any continuation, change or resumption lessee of such premises, site or of such "bodily injury" or "property location has been added to your damage" during or after the policy period policy as an additional insured with will be deemed to have occurred prior to CG D1 73 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 1 of 5 Includes copyrighted material of Insurance Services Office, Inc.with its permission. COMMERCIAL GENERAL LIABILITY the policy period. However, this n. Pollution Costs subparagraph does not apply to "bodily "Pollution costs". injury" or "property damage" included in the "products-completed operations S. The following is added to SECTION I — hazard". COVERAGES: Paragraphs (1)(a), (b) and (c) of this COVERAGE D — LIMITED COVERAGE FOR exclusion do not apply to "bodily injury" or POLLUTION COSTS "property damage" arising only out of the 1. Insuring Agreement discharge, release or escape of any a. We will pay those sums that you become "pollutant" if such discharge, release or legally obligated to pay as "limited escape: covered pollution costs" to which this (1) Is either: insurance applies. We will have the right (a) At or from any premises, site or and duty to defend you against any "suit" location (other than at or from an seeking those "limited covered pollution "underground tank") which is owned, costs". However, we will have no duty to occupied or managed by, or rented or defend you against any "suit" seeking loaned to, you during the policy "limited covered pollution costs" to which period; or this insurance does not apply. We may at our discretion investigate any discharge, (b) From a pipe containing sewage; release or escape of "pollutants" and (2) Commences abruptly during the policy settle any claim or "suit" that may result. period and after the effective date of the But: Amendment — Pollution Exclusion — (1) The amount we will pay for "limited Including Limited Coverage For Pollution covered pollution costs" will be Costs—Contractors endorsement; included within, and not in addition to, (3) Ends within seven consecutive days after the limits of insurance that apply to its abrupt commencement; Coverage A; and (4) Becomes known to an insured listed (2) Our right and duty to defend end under Paragraph 1. of Section II —Who Is when we have used up the applicable An Insured, or to an "employee" limit of insurance in the payment of authorized by you to give or receive judgments or settlements under notice of any "occurrence" or claim, and Coverages A or B, medical expenses is reported to us, within 30 days after its under Coverage C or"limited covered abrupt commencement; and pollution costs" under Coverage D. (5) Does not arise out of any intentional No other obligation or liability to pay sums violation of any governmental law, or perform acts or services is covered regulation or rule by you or anyone acting unless explicitly provided for under on your behalf. Supplementary Payments. All "bodily injury" or "property damage" b. This insurance applies to "limited covered described in this exception will be deemed to pollution costs" only if the "pollutants" for occur at the time such discharge, release or which the limited covered pollution costs escape abruptly commences. are incurred also cause "bodily injury" or property damage covered under 3. The following replaces Paragraph (2) of Exclusion Coverage A that: f., Pollution, in Paragraph 2. of SECTION I — (1) Arises out of a dispersal, seepage, COVERAGES — COVERAGE A — BODILY migration, release or escape of INJURY AND PROPERTY DAMAGE LIABILITY: "pollutants" at or from any premises, (2) "Pollution costs". site or location on which any insured or any contractors or subcontractors 4. The following replaces Exclusion n., Pollution- working directly or indirectly on any Related, in Paragraph 2. of SECTION I — insured's behalf are performing COVERAGES — COVERAGE B — PERSONAL operations if the "pollutants" are AND ADVERTISING INJURY LIABILITY: brought on or to the premises, site or Page 2 of 5 ©2017 The Travelers Indemnity Company.All rights reserved. CG D1 73 02 19 Includes copyrighted material of Insurance Services Office, Inc.with its permission. COMMERCIAL GENERAL LIABILITY location in connection with such 6. The following is added to SECTION II —WHO IS operations by such insured, AN INSURED: contractor or subcontractor; or Paragraph 3. is the only part of this section that (2) Is within the exception to exclusion f. applies to Section I — Coverage D. For the of Coverage A that requires the purposes of Coverage D, similar coverage as discharge, release or escape of used in Paragraph 3. of this section includes any "pollutants"to: pollution liability coverage. (a) Be either: 7. The following is added to SECTION III — LIMITS (i) At or from any premises, site OF INSURANCE: or location (other than at or For the purposes of any aggregate limit and the from an "underground tank") Each Occurrence Limit, "limited covered pollution which is owned, occupied or costs" under Coverage D will be deemed to be managed by, or rented or damages because of "property damage" under loaned to, you during the Coverage A. policy period; or 8. The following is added to Paragraph 3., Legal (ii) From a pipe containing Action Against Us, of SECTION IV — sewage; COMMERCIAL GENERAL LIABILITY (b) Commence abruptly during the CONDITIONS: policy period and after the With respect to "limited covered pollution costs", effective date of the Amendment no person or organization has a right under this — Pollution Exclusion — Including Coverage Part: Limited Coverage For Pollution a. To join us as a party or otherwise bring us Costs — Contractors into a "suit" asking for "limited covered endorsement; pollution costs"from you; or (c) End within seven consecutive b. To sue us on this Coverage Part unless all of days after its abrupt its terms have been fully complied with. commencement; With respect to"limited covered pollution costs", a (d) Become known to an insured person or organization may sue us to recover on listed under Paragraph 1. of an agreed settlement or on a final judgment Section II—Who Is An Insured, or against you, but we will not be liable for "limited to an "employee" authorized by covered pollution costs that are not payable under the terms of this Coverage Part or that are you to give or receive notice of in excess of the applicable limit of insurance. As any"occurrence"or claim, and be used in this provision, an agreed settlement reported to us, within 30 days means a settlement and release of liability signed after its abrupt commencement; by us, by you and by the claimant or the and claimant's legal representative. (e) Not arise out of any intentional 9. The following is added to Paragraph 4., Other violation of any governmental Insurance, of SECTION IV — COMMERCIAL law, regulation or rule by you or GENERAL LIABILITY CONDITIONS: anyone acting on your behalf. If valid and collectible other insurance is available 2. Exclusion to you for a loss we cover under Coverage D of this Coverage Part, this insurance is excess over This insurance does not apply to "limited any of the other insurance, whether primary, covered pollution costs" which you are excess, contingentor on any other basis. obligated to pay by reason of the assumption We will have no duty under Coverage D to defend of liability in a contract or agreement. This you against any "suit" if any other insurer has a exclusion does not apply to liability that you duty to defend you against that "suit". If no other would have to pay "limited covered pollution insurer defends, we will undertake to do so, but costs" in the absence of the contract or we will be entitled to your rights against all those agreement. other insurers. CG D1 73 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 3 of 5 Includes copyrighted material of Insurance Services Office, Inc.with its permission. COMMERCIAL GENERAL LIABILITY We will pay only our share of the amount of the detoxify or neutralize, or assess the effects of, loss, if any,that exceeds the sum of: "pollutants". (1) The total amount that all such other insurance b. Does not include: would pay for the loss in the absence of this (1) Any punitive or exemplary damages or insurance; and the portion of any multiplied damage (2) The total of all deductible and self-insured award that exceeds the amount amounts under all such other insurance. multiplied; 10. The following is added to Paragraph 8., Transfer (2) Any statutory or administrative fine or Of Rights Of Recovery Against Others To Us, penalty; of SECTION IV — COMMERCIAL GENERAL (3) Any salary of, or benefit for, any of your LIABILITY CONDITIONS: "employees", any of your partners or With respect to"limited covered pollution costs", if members (if you area partnership or jo int you have agreed in a contract or agreement to venture), any of your managers (if you waive your rights of recovery against any person are a limited liability company), any of or organization, we waive our right of recovery your trustees(if you are a trust), or any of against such person or organization, but only for your "executive officers" or directors (if payments we make because of "limited covered you are an organization other than a pollution costs" incurred for a discharge, release partnership, joint venture, limited liability or escape of "pollutants" that commences company or trust); abruptly after the execution of the contract or agreement. (4) Any cost or expense for: (a) The repair, replacement, 11. The following replaces the definition of "suit" in enhancement, restoration or the DEFINITIONS Section: maintenance of any premises, site or "Suit" means a civil proceeding in which damages location which is or was at any time because of "bodily injury", "property damage", owned, occupied or managed by, or "personal injury" or "advertising injury" to which rented or loaned to, you; or this insurance applies, or in which "limited covered pollution costs" to which this insurance (b) The prevention of injury to a person or damage to another s property; applies, are alleged."Suit" includes: (5) Any cost or expense to test for, monitor, a. An arbitration proceeding in which such clean up, remove, contain, treat, detoxify damages are claimed and to which the or neutralize, or assess the effects of, insured must submit or does submit with our "pollutants", if such work or operations consent; began while such "pollutants" are or b. Any other alternative dispute resolution were: proceeding in which such damages are (a) At any premises, site or location claimed and to which the insured submits with which is or was at any time owned, our consent; occupied or managed by, or rented or c. An arbitration proceeding in which such loaned to, you; or "limited covered pollution costs" are claimed (b) On or in personal property in your and to which you must submit or do submit care, custody or control; or with our consent; and d. Any other alternative dispute resolution (c) At that particular part of any property proceeding in which such "limited covered that must be restored, repaired or pollution costs" are claimed and to which you replaced because "your work" was incorrectly performed on it; or submit with our consent. 12. The following is added to the DEFINITIONS (6) Any cost or expense to test for, monitor, Section: clean up, remove, contain, treat, detoxify or neutralize, or assess the effects of, "Limited covered pollution costs": "pollutants" on or in any of your a. Means any cost or expense to test for, "employees", after the actual, alleged or monitor, clean up, remove, contain, treat, threatened absorption, ingestion or inhalation of such "pollutants" by any of Page 4 of 5 ©2017 The Travelers Indemnity Company.All rights reserved. CG D1 73 02 19 Includes copyrighted material of Insurance Services Office, Inc.with its permission. COMMERCIAL GENERAL LIABILITY your"employees" arising out of and in the "Underground tank" means any one or course of: combination of tanks (including any connected (a) Employment by you; or pipe or pump), the volume of which (including the volume of all connected underground pipes or (b) Performing duties related to the pumps) is 10% or more: conduct of your business. a. Beneath the surface of the ground outside of "Pollution costs" means any loss, cost or expense a building or structure; arising out of any: b. Beneath the lowest basement floor of a a. Request, demand, order or statutory or building or structure; regulatory requirement that any insured or c. Otherwise covered with earthen materials; or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any d. Beneath the surface of the water. way respond to or assess the effects of, Underground pipes or pumps means all "pollutants"; or underground piping or pumps, including valves, b. Claim or suit by or on behalf of any elbows, joints, flanges and flexible connectors governmental authority or any other person or attached to any one or a combination of tanks. organization because of testing for, However, "underground tank" does not include monitoring, cleaning up, removing, the part of any tank (including the part of any containing, treating, detoxifying or connected pipe or pump) containing sewage. neutralizing, or in any way responding to, or assessing the effects of,"pollutants". CG D1 73 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 5 of 5 Includes copyrighted material of Insurance Services Office, Inc.with its permission. 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 lass 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 insuranceof all insurers. non renewal in accordance with applicable insurance d. Primary And Non-Contributory Insurance If laws or regulations. Required By Written Contract 7. 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 applyon 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 lass 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 9. When We Do Not Renew a. We will compute all premiums for this Coverage Part in arrnrrl2nra tenth ni it ri iIPc and ratac If we decide not to renew this Coverage Part, We WIII "" 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 0 2017 The Travelers Indemnity Company.All rights reserved. CG T1 00 02 19 Includes copyrighted material of Insurance Services Office, Inc.with its permission. od General Liabi l ity coverage form index Policy Number CO-526D9518 Coverage and amendments DESCRIPTION FORM NUMBER ADDL INSD-OWNERS/LESSEE/CONTRACTOR B CG 20 10 10 01 ADDITIONAL INSURED-OWNERS, LESSEES CG 20 37 07 04 EXCL-DESIG OPS CVRD BY A CONTROLLED IP CG 21 54 12 19 EXCLUSION-LEAD CG DO 76 06 93 EXCLUSION - DISCRIMINATION CG D1 42 02 19 AMEND-POLL EXCL-INCL LTD COV POLL COST CG D1 73 02 19 AMEND-NON CUMULATION OF EACH OCC CG D2 03 12 97 EXCL-EXTERIOR INSULATION & FINISH SYSTEM CG D2 04 12 17 DESIGNATED PROJECTS(S) GEN AGGR LIMIT CG D2 11 01 04 EXCLUSION -SILICA OR SILICA-RELATED DUST CG D2 40 09 15 BLANKET AI-W/COMP OPS IF REQ BY CONTRACT CG D2 46 04 19 ADD'L INS ENGS, ARCHITECTS, SURVEYORS CG D2 70 01 10 EXCL-CONSTR MAN ERRORS AND OMISSIONS CG D2 93 11 03 XTEND ENDORSEMENT FOR CONTRACTORS CG D3 16 02 19 EXCL-CLMS OR SUITS BY NAMED INSUREDS CG D3 22 10 20 ADDL INSD-OWNERS/LESSEE/CONTRACTOR B CG D3 61 03 05 ADDITIONAL INSURED-OWNERS LESSORS CONTR CG D3 73 11 05 EXCL-ARCH ITECT/ENG/SU RVEY PROF SERV CG D5 46 10 11 EXCL-VIOLATION OF CONSUMER FIN PROT LAWS CG D6 18 10 11 ELECTRONIC DATA LIABILITY COVERAGE CG D8 23 02 19 AMENDMENT OF INTELLECTUAL PROPERTY EXCL CG D9 10 09 21 WASHINGTON - FUNGI OR BACTERIA EXCLUSION CG F2 41 05 02 WA CHANGES EMPLOY RELATED PRACTICES EXCL CG F2 66 02 19 DEDUCTIBLE LIAB INSURANCE-WASHINGTON CG F3 07 11 08 WASHINGTON CHANGE-WHO IS AN INSURED CG F4 66 01 08 COMM'L GENERAL LIABILITY DEC CG TO 01 11 03 DECLARATIONS PREMIUM SCHEDULE CG TO 07 09 87 KEY TO DECLARATIONS PREMIUM SCHEDULE CG TO 08 11 03 EMPLOYEE BENEFITS LIAB COV PART DEC CG TO 09 09 93 TABLE OF CONTENTS - COM GEN LIAB COV CG TO 34 02 19 EMPLOYEE BENEFITS LIAB TABLE OF CONTENTS CG TO 43 01 16 GL DECLARATIONS COMPOSITE SCHEDULE CG TO 71 03 98 COMMERCIAL GENERAL LIABILITY COV FORM CG T1 00 02 19 EMPLOYEE BENEFITS LIABILITY COV FORM CG T1 01 01 16 EXC-HAZARD-CONNECTED DESIGNATED EXPOSURE CG T4 81 11 88 GENERAL PURPOSE ENDORSEMENT CG T8 00 01 00 GENERAL PURPOSE ENDORSEMENT CG T8 01 01 00 GENERAL PURPOSE ENDORSEMENT CG T8 02 01 00 GENERAL PURPOSE ENDORSEMENT CG T8 03 01 00 GENERAL PURPOSE ENDORSEMENT CG T8 04 01 00 GENERAL PURPOSE ENDORSEMENT CG T8 05 01 00 GENERAL PURPOSE ENDORSEMENT CG T8 06 01 00 GENERAL PURPOSE ENDORSEMENT CG T8 07 01 00 Proposed on 10/17/2023 for HENTSCHELL&ASSOC INC Refer to policy for actual terms and conditions PETERSEN BROTHERS, INC.-Policy Period 11/01/2023—11/01/2024 Page 119 GENERAL PURPOSE ENDORSEMENT CG T8 08 01 00 GENERAL PURPOSE ENDORSEMENT CG T8 09 01 00 GENERAL PURPOSE ENDORSEMENT CG T8 10 01 00 GENERAL PURPOSE ENDORSEMENT CG T8 12 01 00 EMPLOYERS OVERHEAD LIABILITY GN 01 13 11 03 Proposed on 10/17/2023 for HENTSCHELL&ASSOC INC Refer to policy for actual terms and conditions PETERSEN BROTHERS, INC.-Policy Period 11/01/2023—11/01/2024 Page 120 Package common coverage form index Policy Number CO-526D9518 CO Common coverage and amendments DESCRIPTION FORM NUMBER WASHINGTON CHANGES - DEFENSE COSTS IL 01 23 11 13 NUCLEAR ENERGY LIABILITY EXCLUSION ENDOR IL 01 98 09 08 AMENDMENT OF NAMED INSURED -WASHINGTON IL F1 18 10 13 COMMON DEC IL TO 02 11 89 LOCATION SCHEDULE IL TO 03 04 96 COMMON POLICY CONDITIONS -WASHINGTON IL TO 05 06 10 CALCULATION OF PREMIUM-COMPOSITE RATE(S) IL T3 02 07 86 FED TERRORISM RISK INS ACT DISCLOSURE IL T3 68 01 21 DESIG PERSON, ORG-NOTICE PROVIDED BY US IL T4 05 05 19 AMNDT COMMON POLICY COND-PROHIBITED COVG IL T4 12 03 15 CAP ON LOSSES FROM CERT ACTS OF TERRORIS IL T4 14 01 21 GENERAL PURPOSE ENDORSEMENT IL T8 03 01 00 NOT OF CHNG REDUC IN COVG FUNGI BACTERIA PN T3 35 11 21 NOTICE INDEPENDENT AGENT AND BROKER COMP PN T4 54 01 08 Proposed on 10/17/2023 for HENTSCHELL&ASSOC INC Refer to policy for actual terms and conditions PETERSEN BROTHERS, INC.-Policy Period 11/01/2023—11/01/2024 Page 121 .R Commercial Auto coverage form index Policy Number 81 O-OL622021 Coverage and amendments DESCRIPTION FORM NUMBER OVERPRINT PAGE AUNN1A16 POLICY COVER AUNN2116 BUSINESS AUTO COVERAGE FORM CA 00 01 10 13 WASHINGTON CHANGES CA 01 35 10 13 WASHINGTON UNDERINSURED MOTORISTS COVERAGE CA 21 34 10 13 AUTO MEDICAL PAYMENTS COVERAGE CA 99 03 10 13 DRIVE OTHER CAR COVERAGE - BROADENED COVERAGE FOR NAMED INDIVIDUALS CA 99 10 10 13 HIRED AUTOS SPECIFIED AS COVERED AUTOS YOU OWN CA 99 16 10 13 POLLUTION LIABILITY- BROADENED COVERAGE FOR COVERED AUTOS - BUSINESS CA 99 48 10 13 AUTO AND MOTOR CARRIER COVERAGE FORMS WASHINGTON INSURANCE IDENTIFICATION CARD CA ID WA 07 96 BUSINESS AUTO COVERAGE PART DECLARATIONS (ITEMS 1 AND 2) CA TO 01 02 15 BUSINESS AUTO COVERAGE PART DECLARATIONS (ITEMS 4 AND 5) CA TO 03 02 15 BUSINESS AUTO/AUTO DEALERS/MOTOR CARRIER COVERAGE PART SUPPLEMENTARY CA TO 30 02 16 SCHEDULE - ITEM TWO- UNINSURED MOTORISTS COVERAGE AND UNDERINSURED MOTORISTS COVERAGE TABLE OF CONTENTS BUSINESS AUTO COVERAGE FORM CA TO 31 02 15 BUSINESS AUTO EXTENSION ENDORSEMENT CA T3 53 02 15 DEDUCTIBLE COVERAGE CA T3 95 02 15 SHORT TERM HIRED AUTO-ADDITIONAL INSURED AND LOSS PAYEE CA T4 52 02 16 AMENDMENT OF EMPLOYEE DEFINITION CA T4 59 02 15 BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY WITH OTHER CA T4 99 02 16 INSURANCE- CONTRACTORS COVERAGE DESCRIPTION COVDESC WASHINGTON CHANGES - DEFENSE COSTS IL 01 23 11 13 NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (BROAD FORM) IL 01 98 09 08 AMENDMENT OF NAMED INSURED -WASHINGTON IL F1 18 10 13 COMMON POLICY DECLARATIONS IL TO 02 11 89 COMMON POLICY CONDITIONS -WASHINGTON IL TO 05 06 10 CALCULATION OF PREMIUM - COMPOSITE RATES IL T3 02 07 86 AMENDMENT OF COMMON POLICY CONDITIONS - PROHIBITED COVERAGE - IL T4 12 03 15 UNLICENSED INSURANCE AND TRADE OR ECONOMIC SANCTIONS FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS IL T8 01 01 01 CALCULATION OF PREMIUM - COMPOSITE RATES IL T8 25 11 23 IMPORTANT NOTICE - INDEPENDENT AGENT AND BROKER COMPENSATION PN T4 54 01 08 COMMERCIAL AUTO TAB PAGE ZZ TA BS CA 01 INTERLINE ENDORSEMENTS TAB PAGE ZZ TA BS IL 01 POLICYHOLDER NOTICES TAB PAGE ZZ TA BS PN 01 Proposed on 10/17/2023 for HENTSCHELL&ASSOC INC Refer to policy for actual terms and conditions PETERSEN BROTHERS, INC.-Policy Period 11/01/2023—11/01/2024 Page 122 1111 Umbrella coverage farm index Policy Number CUP-4R705623 Coverage and amendments DESCRIPTION FORM NUMBER EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE EU 00 01 07 16 POLICY DECLARATIONS EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE EU 00 02 09 20 POLICY SCHEDULE OF UNDERLYING INSURANCE EU 00 03 08 18 CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM AND EXCLUSION OF OTHER EU 00 07 07 16 ACTS OF TERRORISM COMMITTED OUTSIDE THE UNITED STATES WASHINGTON CHANGES EU 00 74 07 16 COVERAGE FOR FINANCIAL INTEREST IN FOREIGN INSURED ORGANIZATIONS EU 01 44 07 16 NUCLEAR ENERGY LIABILITY EXCLUSION (BROAD FORM) - COVERAGES A AND B EU 02 09 08 18 POLLUTION NOT RELATED TO AUTOS EXCLUSION WITH LIMITED EXCEPTIONS - EU 02 16 04 20 COVERAGE A AMENDMENT OF COVERAGE - DEFINITIONS EU 02 34 07 16 AIRCRAFT LIABILITY EXCLUSION INCLUDING SERVICE FOR HIRE WITH LIMITED EU 03 12 10 20 EXCEPTION FOR UNMANNED AIRCRAFT - COVERAGES A AND B AUTO POLLUTION EXCLUSION WITH LIMITED EXCEPTIONS - COVERAGE A EU 03 21 08 18 CONSTRUCTION IDENTIFIED HAZARDS EXCLUSIONS -COVERAGE B EU 03 22 08 18 DISCRIMINATION EXCLUSION - COVERAGE B EU 03 31 08 18 FUNGI OR BACTERIA EXCLUSION -COVERAGE B -WASHINGTON EU 03 38 08 18 LEAD EXCLUSION - COVERAGE B EU 03 44 08 18 NON CUMULATION OF OCCURRENCE LIMIT EU 03 46 08 18 SILICA OR SILICA-RELATED DUST EXCLUSION - COVERAGE B EU 03 63 08 18 INTELLECTUAL PROPERTY EXCLUSION - COVERAGE B EU 04 21 09 21 VIOLATION OF BIOMETRIC INFORMATION PRIVACY LAWS EXCLUSION - COVERAGE B EU T8 01 11 23 FEDERAL TERRORISM RISK INSURANCE ACT DISCLOSURE IL T3 68 01 21 IMPORTANT NOTICE - LEAD EXCLUSION PN T1 94 11 21 Proposed on 10/17/2023 for HENTSCHELL&ASSOC INC Refer to policy for actual terms and conditions PETERSEN BROTHERS, INC.-Policy Period 11/01/2023—11/01/2024 Page 123