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CAG2023-453 - Supplement - #1 - KBA, Inc. - 108th Ave SE and SE 264th Street Compact Roundabout - 12/01/2023
FOR CITY OF KENT OFFICIAL USE ONLY Sup/Mgr: Agreement Routing Form DirAsst: • For Approvals,Signatures and Records Management Dlr/Dep: KE N T This form combines&replaces the Request for Mayor's Signature and Contract Cover (optional) W ASH INGTGN Sheet forms. Originator: Department: Karin Bayes for Eric Connor Public Works Date Sent: Date Required: 0 12/01/2023 12/5/2023 Q Director or Designee to Sign. Date of Council Approval: Q 8/1/2023 Budqet Account Number: Grant?:Yes:No R20098 Budget?❑YesDNo Type: N/A Vendor Name: Category: KBA, Inc. Contract Vendor Number: Sub-Category: = Supplement 0 Project Name: 108th Ave SE & SE 264th St Compact Roundabout E Project Details:Amended to bring KBA's subconsultant's (HWA) ICR current in our contract Agreement Amount: —$1 073 Basis for Selection of Contractor: Other *Memo to Mayor must be attached i� Start Date: Upon Execution Termination Date: 6/30/2024 Q Local Business?0YesF--]No* If meets requirements per KCC3.70.100,please complete'Vendor Purchase-Local Exceptions"formonCityspoce. Business License Verification:YesElln-ProcessElExempt(KCC 5.01.045) Notice required prior to disclosure? Contract Number: F_IYesF�No CAG2023-453 Comments: _ 3 GJ y •� i GJ 3 M _ N Date Routed to the City Clerk's Office: 12/1/23 Interlocal Agreement has been uploaded to website: ad«W22373_1_20 Visit Documents.KentWA.gov to obtain copies of all agreements rev.20210513 Adft Washington State Department of Transportation Supplemental Agreement Organization and Address Number I KBA,1nc. 11201 SE Sth Street,Suite 160 Original Agreement Number Bellevue,WA 98004 LA-10197 Phone: 425-455-9720 Project Number Execution Date Completion Date R200098 08/24/2023 6/30/2024 Project Title New Maximum Amount Payable 108th Ave SE&SE 264th Street Compact Roundabout $251,772 Description of Work Amended to bring KBA's subconsultant's(HWA) ICR current in our contract. The Local Agency of City of Kent desires to supplement the agreement entered in to with KBA, Inc. and executed on 08/24/2023 and identified as Agreement No. LA-10197 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: Decrease of$1,073 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 , President By: Eric Connor, Construction Manager 74e. Consultant Signature Approving Authority Signature 12/1/2023 Date ❑OT Form 140-063 Revised 09/2005 Washington State Development Division •. Department of Transportation Contract Services Off ice PQ Box 47408 Olympia,WA 98504-7408 7345 Underson Way SW Tumwater,WA 96501-6504 TTY: 1-800-833-6388 www.wsdot.wa.gov August 29, 2023 HWA GeoSciences, Inc. 21312 30th Drive SE, Suite 110 Bothell, WA 98021 Subject: Acceptance FYE 2022 ICR—CPA Report Dear Vasiliy P. Babko: We have accepted your firms FYE 2022 Indirect Cost Rate(ICR)of 190.07%of direct labor (rate includes 0.60% Facilities Capital. Cost of Money) based on the "Independent CPA Report," prepared by T-Max CPA. This rate will be applicable for WSDOT Agreements and Local Agency Contracts in Washington only. This rate may be subject to additional review if considered necessary by WSDOT. Your ICR must be updated on an annual basis. Costs billed to agreements/contracts will still be subject to audit of actual costs, based on the terms and conditions of the respective agreement/contract. This was not a cognizant review. Any other entity contracting with the firm is responsible for determining the acceptability of the ICR. If you have any questions, feel free to contact our office at (360) 704-6397 or via email consu lta n tra tes Awsd ot.wa.gov. Regards, scha�zl`e 1fakvetl Schatzie Harvey(Aug 30,2023 15:27 P ) SCHATZIE HARVEY, CPA Contract Services Manager SH:Ieg IIWA GEOSCIENCIES,INC. STATEMENT OF DIRECT LABOR,FRINGE BENEFITS,AND GENERAL OVERHEAD FOR THE YEAR ENDED DECEMRER 31,2022 GL Account Unallowable Total %of Direct Description Balance Custs FAR Rer Proposed Labor Direct Labor 5 1,990,039 S - $ 1,990,039 Fringe Benefits: Bonuses $ iW790 $ - $ 190.790 PTO 327,769 - 327,769 401 k 128,260 (10.511) (1) 117,749 Employee group insurance 262,317 - 262,317 Workers'comp 9,603 (125) (1) 9,478 Payroll taxes 275,867 (1,406) (2) 274,461 Other employee benefits 15,951 (3,095) (3)(4) 12,856 Total Fringe Benefits $ 1,210,557 S (15,137i $ 1,195.420 60.07% General Overhead: Indirect labor $ 1,065,565 $ (18.383) (5} $ 1,047,182 Bid and proposals W4,278 - 104,278 Automobile expense 22,606 - 22,606 Advertising and marketing 15,128 (15,128) (5) - Bank service charges 2,814 - 2,814 Contributions 2,231 (2,231) (6)(7) - Computer and software expenses 136,202 - 136,202 Depreciation and amortization 108,591 - 108,59I Dues and subscriptions 9,714 - 8,714 Insurance 290,200 - 290,200 Interest 3,597 (3,597) (9)(9) - Maintenance and repairs 9,295 - 9,295 Meals and entertainment 5,460 - 5,460 Office supplies and poslage 21,994 (2,573) (5)(10) 19,311 Printing 25,999 - 25,889 Professional fees 88,308 (1,340) (11) 86,968 Seminars and professional education 23,964 (2,361) (4)(5)(6)(12) 21,603 Supplies 89,786 - $9,786 Rent and utilities 410,076 - 410,076 Taxes and licenses 228,760 (84,503) (2)(13) 144,257 Telecommunications 71,060 - 71,060 Travel 5,654 - 5,654 Recovery (34,797) (34,797) Total General Overhead $ 2,705,265 $ [330,Z 16) $ 2,575,149 129.40% To Fringe Benefits and General Overhead $ 3,915,822 S (145,253) $ 3,770,569 189.47% Facilities Capital Cost of Money(FCCM) S 11,983 0.60% See notes to the indirect cost statement. Page 14 HWA GEOSCIENCES,INC. DESCRIPTION OF FAR REFERENCES FOR THE YEAR ENDED DECI MBER 31,2022 (1) 31.201-2(d)Determining allowability-Costs not supported with documentation are unallowable. (2) 31.201-6(a)Accounting for unallowable costs-When an timallowable cost is incurred,its directly associated costs are also unallowable. (3) 31.205-14 Entertainment costs—Costs ofarnuseruent,diversions,social activities,and any directly associated costs such as tickets to shows or sports events,meals,lodging,rentals,transportation,and gratuities are unallowable. (4) 31.205-51 Costs of alcoholic beverages-Costs of alcoholic beverages are unallowable. (5) 31205-1(f)(1)Public relations and advertising costs-All public relations and advertising costs whose primary purpose is to promotc the sale of products or services by stimulating interest in a product or product line,or by disseminating messages calling favorable attention to the contractor for purposes of enhancing the company image to sell the company's products or services arc unallowable. (6) 31.205-8 Contributions or donations-Contributions or donations,including cash,property and services,regardless of recipient,are unallowable- (7) 31.205-22(a)(1)Lobbying and political activity costs-Attempts to influence the outcomes of any Federal,State,or local election, referendum,initiative,or similar procedure,through in kind or cash contributions,endorsements,publicity,or similar actvitics are unallowable. (9) 31.205-20 Interest and other financial costs-Interest on borrowing.%(however represented)are unallowable. (4) 31.205-15(a)Fines,penalties,and mischarging costs-Costs of fines and penalties resulting from violations of,or failure of the contractor to comply with,Federal.Slate,local,or foreign laws and regulations,are unallowable. (10) 31.205-13(b)Employee morale,health,welfare,food service,and dormitory costs and credits-Costs of gifts arc unallowable. (11)31.202(a)Direct costs-Direct costs of the contract shall be charged directly to the contract. (12)31.201-2(c)Determining allowability-Costs for other accounting periods are unallowab[c. (13)31.205-41(b)(7)Taxes-Income tax accruals designed to account for the tax effects of differences between taxable income and pretax income as reflected by the books of account and financial statements are unallowable. Page 15 M' =W% ORIGINAi AGREEMENT 108th Aye SE and SE 254th St JUN JUL AUG SEP Ocy NOV DE(Compact Roundabout r Supplement t-Estimate of Costs Working Days 1 Month 22 21 2Z 21 Z1 20 21 City of Kent Hours/Month 176 168 176 168 168 160 168 KBA lob No,-TBD Overtime Utilization 12% 12% 12% 12% 11% 10% 4% Prepared On:10/24/2023 Reg Hrs+07 Hrs/Month 197 168 197 188 186 176 175 KBA Hours 10-1, Acireemerr r23 Oct NOV DEC H Cameron Bloomer 65 Engineer V 01,00 S 16.00 27 27 6 5 5 5 6 H Jill Carter AA Administrator IV 0190 S 51.00 13 13 4 2 2 2 3 H Erica Dougherty E4 Engineer 1V 02-W S 66.00 12 12 - 6 - 6 F Sean Flint 7`6 Technical Representative VI 02,00 S 65.00 760 7W 168 176 165 166 40 H Jason cuwey P6 P 'act Contrors Vi o2-00 S 65.00 400 400 54 88 B4 B4 6o Original OCT • DEC cost Total r r 023 KBA Field Velude Monthly 4-Door SUV DE a 416 4.41 6 1,104 1,104 1,104 1,10d KBA Field Veh¢le Hourly 4-POo*SUV DE s52 557. 552 r1,10404 1,104 1,104 Total JUN JUL AUG SEP• . OCT • DEC Subconsultants r nZ3 2023r 1 023 Total Sub 1 Narne HWA GeoSeiences 23.792 23792 5,143 6,216 6.216 6,216 Original OCT • VEC Combined Costs T.i�k Rate DS( Agreement 2023 2023 2023r r2023 Total H Cameron Bloomer ES Engineer 0190 $76.00 2A52 2,052 4i6 380 380 380 456 H All Carter Ara Administrator IV 01.00 S51,00 663 663 2&: 102 102 102 153 H Erica Dougherty E4 Engineer IV 02.00 566.00 792 792 3% - 396 - F Sean Flint T6 Technical Bepresernative VI 02-W $65.00 49A00 49,4W 10.920 11.440 10.920 10,920 512M H Jazon Cundey P6 Project CorRrols VI 02.90 $65.00 25,000 26,OD0 - 5,460 5.720 5.460 5,460 3,900 �I KBA Raw Labo - 7&907 - - 17,0a0 18,038 16,862 17,258 9,709 Home Overhead 46.Km 46,807 - - y,708 10466 9.426 10,054 7.153 Field 0ve 1—d 73.626 73,626 - - 16.27S 17,050 16.275 16.275 7.750 KEA OH 120,433 - 25,963 274517 25,701 26,329 14,903 Subrotal Fee 23.672 23.672 5.112 5.411 5.059 5,177 2 913 KBA Loaded Labor Cost 223,012 - 48,135 50,966 47,622 48,765 27,524 Subtotal Direct Expenses 4.968 4.%8 - - 1,104 1,104 1,104 1,104 i52. SYbtOtal Su bconmultaM Casts 23.792 23.792 - - 5.143 6216 6.216 6.216 ESTIMATED TOTALr Project Cost Estimate HWA Ref-- 2023-089 Construction Inspection and Testing 108th Ave SE and SE 264th GEOSCIENCES INC.St Compact Roundabout , Date: 20-Oct-23 Kent,Washington DBEIMWBE Prepared By: BKHIBS Prepared for Cameron Bloomer,P.E-,KBA PROPOSED WORK SCOPE: This cost estimate is based on plans and specifications provided by the Client. 1.Sampling and acceptance/proctor testing of CSTC,Gravel Borrow,and Foundation Material for use in trench backfill,wall base,and roadway/sidewalk construction. 2.blspecuon and testing of compacted aggregates for roadway/sidewalk,utility trenches,vaults,walls,and ADA ramp construction- 3.Sampling of HMA aggregate for acceptance testing and oil/cold feed at the plant for ignition oven correction factor. 4.Inspection and testing of 14MA placement and compaction(minimum:one test per 100 tons). 5.Sampling and testing HMA during paving for Rice density,extraction and gradation(minimum:one test sample per day or 1000 tons). 6.Sampling and acceptance testing of concrete aggregates for assorted mix designs_ 7.Concrete sampling for retaining wall,roundabout components,pole foundation,and driveway.Includes next-day pickups. 8.Written field reports will be prepared for all inspections and reviewed for QC. Material Testing-ESTIMATED HWA LABOR: 2023 1i11.I.ING ILA]ES Scope of Scrviccs GeQBgvlll (ieol Vl G-1 III 6eo11 Contracts "1"0TAL TOTAL $284.86 S176,04 $129.63 $99.22 $105,62 IIOl]RS AMOUNT —gm, and Tc•..tirtg,i—l.dh g: Sam lin of CSW.(4-4 I3urmn�,and I om,dation Maredal a single source) 4 4 $397 Ins cetim and Testing of Co acicd Road Con—le Base A ssatcs 20 20 $1,984 lns eetiai and Testin of('om acted Trench:Sl—i—Ma kfill 20 20 $1984 Inscclim and Testing o1'Wall 11cklill 10 la S992 phalt Ins ctian and Testing,including: lns ectiai and Te.,ting daring I R-d,ay!MerJy 20 20 $1 984 Ii:'NA Oven lgrnLion Co Tim-Sarnplinj4 of Aegysgalc and Oil(1 mix x I source) 4 4 5397 ILMA Sam lm at Batch Plant 2 trips x 4 1— 8 8 S794 Concrete Ins—non and Tessin,-dadmg: C'on—tc A ssegate S—ling and Tessin 3 mixes x 2 a c ates x l source 4 4 5397 Ddreivu 1 visit, lus pick 9 9 S893 Yiomented�sram ed—mtc (I visit,pl., icku 9 9 $893 1111alu atim Pole Foundations I visit V1wpickup) 9 9 5893 Reinforced Conerctc Walff—lotion 1 visit,pls iclat s 9 9 5893 Pmjecf Mann emew Preconstmctian Meoling Schedulin¢:PM a 4 S704 (:-technical('nnsultation S.PpcTt 4 I.I?`l InV07Cttl A RevlelL',R rtip,Submittal Reviews,R m Distrih.6- e 4 12 TOTAL O Y COST -I n I M 4 146 ',1'1)47 108th Ave SE and SE 264th St Compact Roundabout 1 of 2 HWA GeoSciences Inc. Material Tesdii -LABORATORY TESTING ESTIMATE: LABORATORY EXPENSE DESCRIP DON I:��\ri, Vnit Tc•I 101:1I_ CS fC'Acce tance-fes[in (Gl.Sli.GS)at WSU(]'f In[enzIs(assume sin Le source} 1 S3b5 �345 Grav�i Botruw and Foundation Mal-nut Ater tansy T<stin GS SE assume sin Ic soured S305 S61 u Proctor Tests on All Materials to be Compacted 2 S285 5570 As halt Iknitinn Ovzn(.'orrectinn 1 mix x l lant,3 brans 3 5150 S450 HM k A¢ c tc Accc tancc Voids,FF,SE I mix Gam mug].suurrc L S320 S320 Bitumen Content by Extraction with Cnadatiun o]'A cg'ate sin Ic ample) 2 S205 $410 Maximum theoretical Specific(;.,ilv ofHMA(Rice Ik—i ,) 2 5150 S300 Concrctc A¢2rc ate Accc lance 3 mixes x 2 a re ales x I smrccc Gradation 6 $195 $1,170 Concrctc Com ressivc Mr nulh Testin (4 sets x 4 per set) 16 S35 5560 LABORATORY TOTAL: I $4 755 EXPENSES: EXPENSE Total DESCRIPTION Cast Nuclear Gauge Rental($401da —mininp 8 da_ S320 thin Lift{PIMA-1-tin Nuclear Gauge R-1.1(5fWd ,--inp 2da, $120 Miles c to and It—the ob site far all ins -ctions+icku sat IRS mules,rate 281d s $I,i00 Mil..for PIMA,mrd.ggrgal.sampling,assuming 5 Iris S250 EXPENSE TOTAL: $t,v90 ESTIMATED PROJECT TOTALS AND STIMFL4RY: Total Labor Cost S 17,047 Labortilory T.sting, S4 755 Direct E.x crises 51.990 ESTIMATED PROJECT TOTAL: $23 792 Assamnticus- 1.These estimates may require adjustment due to thefontractors rate of ewtstruclim,weatherdelays,source changes andiorothcr factors beyond our mrrlml. 2.1he I IWA PM reserves the right to shift hours between the various subtasks as required 3-The HWA work scope does not include safety assessment nor work Pertaining to any cnvimnmenW issues- 4.This cast esuraale assumes that the saWit dllested aggregate will be the sarrre that is used between all Schedules 5.This cost estimate was prepared with the understanding that the Client will schedule inspection as needed. 6.All night work is charged at-8 hour mutununt segrtmnr.Night work cvtccllad within.L2 h.of scheduled titre will be cbarged 41us. 7.All weekend work k charged as an 4 hotrr minimum segment.Weekend work canccllcd within 12 hrs of seheduled time will be charg,1 4 hm g-3000psi,Commeacial,and concrete far sidewalks and thrust blocks will not he tested, 9.This cast estimate assumes temporary HMA(trench patching,etc)will notbe tested. 10.This cost estimate dots not include spenal inspection(minfmcing steel,shoring,or other structural elomenls) 108th Ave SE and SE 264th St Compact Roundabout 2 of 2 HWA GeoSciences Inc. Project Cost Estimate HWA Ref: 2023-089 Construction Inspection and Testing GEOSCIENCES INC. 108th Ave SE and SE 264th St Compact Roundabout V ' Date: 1,lun•23 Kent,Washington DBEIMWBE Prepared By: BKHIBS Prepared for Cameron Bloomer,P.E.,KBA PROPOSED WORK SCOPE: This cast estirnata is based on plans and specifications provided by the Client. 1.Sampling and acceptancelProctor testing of CSTC,Grave]Borrow,and Foundation Material for use in trench backfill,wall bast:,and roadway/sidewalk construction. 2.Inspection and testing of conrpactcd aggregates for ruadwaylsidcwatk,utility trenches,vaults,walls,and ADA rarlgr construction. 3.Sampling of HMA aggregate for acceptance testing and oil/cold feed at the plant for ignition oven correction factor. 4.Inspection and testing of HMA placement and compaction(mm mum one test per 100 tons). 5.Sampling and testing HMA during paving for Rice density,extraction and gradation(minimum:one test sample per day or 1000 tons). 6.Sampling and acceptance testing of concrete aggregates for assorted mix designs. 7.Concrete sampling for retaining wall,roundabout components,pole foundation,and driveway.Includes next-day pickups. S_Written field reports will he prepared for all inspections and reviewed for QC. Material Testing-ESTIMATED HWA LABOR: 2023 RILIING RATES Scope of Services GeoF�rg VIII Geol VI Geol III Geol 11 Contacts TOTAL TOTAL $246.02 S186.07 S137.02 S104.88 S152.24 HOURS AMOUNT ,ft,qdle lns Mina and Tessin,includin Sa tin of CSTC,Grmc1 Boaoty,and Foundation Martina] assume sin a sotnce 4 4 5420 Ins cctim and Tessin of Co acted Road'Concrete Basn A •ates 20 20 $2 098 Ins eetion and Tcstin of Coin acted Tamla'Sir cturc Backlill 20 20 52,098 Ins ectim and Tcstin of Wall Backfill 10 10 S1,049 As hall Ins tfim aad Tesdi ,imladia hts ectimt and'res6i d—p,uMA Rad—y10-Ttay 20 20 s2.09$ I-MA Own Ignition Commien-Sanpfing of Aggcgate and Oil(I mix x 1 source) 4 4 $420 1 IMA Sam line at Batch plain 7 trip,x 41— 8 8 $939 Cancreie Les ticeion and Tessin,indadin Concrete A re ate Sam fin and Testin mixes x 2 a arcs z 1 source q q $420 Dricesat�[I�isir, bus ricku 1 9 9 $944 Pio rented'stam edetmerete I%isk,pluspickup) 9 9 $944 lllutninarinn Ya]c T'oundarinus I risit itos kku 9 9 $944 Rc R,—dC'oncrcic Wall;Foundation I visit lus xku s 9 9 S944 Pro'ecs kfana rmnri f'rccomtntclion Mcctin 'SchWusin .PM 4 4 $744 Gcolcdurica1 Consultation Support 4 4 S1,184 Imoicin,QA Review,R nin,Sufimittal Reviews,Re on Oistxi-bon 1 4 12 S1,977 TOTAL HOURLY COST 12 J r.i 126 4 146 $18 120 108th Ave SE and SE 264th St Compact Roundabout 1 of 2 HWA GeoSciences Inc. Material Testing-LABORATORY TESTING ESTIMATE: LABORATORY EXPENSE DESCRIPTION frail 1,,l TOTAL CSI C Acc lance Testine rF,Sl'.GS at WSDO f Irate w4s assume sin to source 1 Si65 $365 Gravel Barrmv and Foundation Material Acc,trance Testing(GS SE assume sin .source 5305 S610 Tractor Tests on All Mill—Is to be Co clad 2 S285 $570 Asphalt Igiudon Ovcn f—action I mix x l plant,3 bums SIM S450 TIMA,V,r.!ate Accc Lance Voids,FF,SE t mix&am sin le source 1 $320 $320 Bitumen Content by Extraction with Gradation ol'Ae ceatc sinelc sant lc S205 $410 \Maximum Thmrctical S ecift Gmvil ofHMA Ricc Density)sin lc source S15U $300 Con,,e,2 Aonre are Acce Lance 3 mixes x 2 a e Les x I source Gradation (i ti195 $1,170 ConcrxYc{'om ressivc Strength Testing(4 sets x A per set) 16 Si5 $560 LABOKAIUKY MIA11, $4,755 FXPENSES: EXPENSE Total DESCRIPTION Cost Nuclear Gauge Rental($401da ,assuming 8 days S320 lYtin Lift PIMA 7estin¢)Nuclear Gau eRenlal SGO.�da ,assumin 2da $120 Milca c to and frmu the job site for all ins -ctionsl icku s at IRS mileage rate 28 trips) $1,300 Mile..f HMA,sad agtgregal.sou lira,--mg 5 Ui s 5250 EXPENSE TOTAL: $1,990 ESTIMATED PROJECT TOTALS AND SIiM\LARY: Total Labor Cost S 18,120 Laboratory Telling $A 755 Direct Expenses $I,990 ESTIMATED PROJECT TOTAL: $24,865 Ass mntiuns- 1.These estimates may n:quue.dj-Lmunt due to the Contractors rate of construction,weatherdclays,suurve changes andiorother factors beyond our contrul. 2.The HWA PM reserves the right to shill hours between the variotu subtacks as required. 3.The HWA work scope does not include safety assessment nor work pertaining to any environments]issues. 4.This cost estimate assumes that the sampledrLested aggregate will be the same that is used between all Schedules 5.This oust a aiu.w wa,prepared with the widcraLandiug Ilwt dre Clia t will a x4edulc ials-pcutiusi as tLecJul. 6.All might work is charged at an 8 hour minico u t segment.Night work cancelled within 12 hrs of scheduled time will be charged 4 hrs. 7.All weekend work is charged at an 4 hour minimum segracnt.Weekend work cancelled within 12 hrs of scheduled time will be charged 4 Ins, 8.3000psi,Cnmmescial,and concrete for sidewalks and thrust blocks will not be tested, 9-This mat estitnatc assumes temporary HMA(trench patching,etc)will notbe tested_ 10.This cost estimate does not include special inspection(reinforcing steel,shoring,or other slruonnu)elentenls) 108th Ave SE and SE 264th St Compact Roundabout 2 of 2 HWA GeoSciences Inc. 75F/10/2023 (MMIDDIYYYY) acOR" CERTIFICATE QF LIABILITY INSURANCE�� 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 NAME, Nancy Ferrick AssuredPartners Design Professionals Insurance Services, LLC PHONE FAX 3697 Mt- Diablo Blvd Suite 230 AIc Nn Est: 510-272 140tJ (wc,No): Lafayette CA 94549 ADDREss, nanc -Ferrick assured artners-com INSURERS)AFFORDING COVERAGE NAIL R License#_B003745 INSURER A:The Travelers Indemnit+_Comps 25658 INSURED KBAiNCO-03 INSURER B:The Travelers Indemnity Company of America 25666 KBA, Inc. — --- - - - 11201 5E$th Street, Ste 160 INSURER c:Travelers Property Casualty Company of America 25674 Bellevue WA 98004 INSURER D:Travelers Casualty and Surety Cc 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' ADDL SUER MMLOD YYYY MMLDDIYYYY LTR TYPE of INSURANCE POLICY NUMBER LIMITS B }( COMMERCiAL GENE RAL LIABILITY Y Y 6806NO33449 5/1012023 5110/2024 EACH OCCURRENCE $1,000,000 CLAIMS-MADE x]OCCUR DAMAGE TO S(RENTED PREMISES[Ea occurrence] $1,Goo.OOD x Contractual Liab MED EXP(Any one person) $10,000 InC&xlgd PERSONAL&ADV INJURY $1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENE RAIL AGGREGATE $2,000,000 POLICY x PEO LOG _PRODUCTS-COMPIOP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y Y BA7R748905 5l1012023 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 LIAR q OCCUR Y Y CUP6NO36187 5/10/2023 511012024 EACH OCCURRENCE $9,000,000 E]CCESS LIAB CLAIMS-MADE AGGREGATE: .$9,000.000 DED RETENTION$ $ e WORKERS COMPENSATION 6806NO33449 5110/2023 5/10/2024 PER x OTH- .AND EMPLOYERS'LIABILITY YIN STATUTE ER WA STOP GAP ANYPR OPRIETORIPA}RTNEFU EX ECUT IVE E.L.EACH ACCIDENT $1,000,000 OFF ICERIMEMBEREXCLUDED7 NIA — (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 ❑ Professional Liability(includes 107633573 5110/2023 5/10/2024 Per Claim $2,000.000 E Pollution Liability) ESLO539659713 5/10/2023 511012024 Annual Aggregate $4,000,000 Cyber Liability Per Claim $500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Scheduv,may be attached if more space is required) Umbrella Liability policy is follow-form to underlying:General Liability/Auto Liabilty/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 PrimarylNon-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 Kent, WA 98032 AUTHORIZED REP RESENTATIVE I ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD COMMERCIAL GFNFRAL LIABILITY POLICY NUMBER 6806NO33449 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 Persons) or Organization(s) in the Schedule applies. (Information required to complete this Schedule, if not shown above, will be shown in the ❑ecfarations.) 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, I. 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 TS 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: 6806N033449 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# 6806N033449 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 -->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 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 9. 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- notice 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 19 Includes copyrighted material of Insurance Services Office, Inc.with its permission. Policy#6806NO3M49 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 SECTION III—LIMITS OF INSURANCE: services" during their work hours for you 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 S. 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., Exclusions, of 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 pharmaceuticals committed by, or with the M. BLANKET WAIVER OF SUBROGATION — knowledge or consent of the insured. WHEN REQUIRED BY WRITTEN CONTRACT OR AGREEMENT 5. The following is added to the DEFINITIONS Section: The following is added to Paragraph 8., Transfer "Incidental medical services" means: Of Rights Of Recovery Against Others To Us, 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 furnishing of food ❑r beverages; ❑r agreement to waive that insured's right of 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; ❑r 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 O 2017 The Travelers Indemnity Company. All rights reserved. Page 5 of 6 Includes copyrighted material of Insurance Services 0fFce, Inc.with its permission. Policy#:SA7R748905 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 Gov- 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 cured" against, and investigate or set- The following is added to Paragraph A.1., Who Is tle any such claim or "suit" and keep An Insured, of SECTION II — COVERED AUTOS us advised of all proceedings and ac- 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 (itt)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 11 — 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 11 — COVERED AUTOS LIABIL- SECTION 11 — 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 describes! 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 0 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- lions, 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.h. 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- e Of Rights Of Recovery Against Others To Us, red "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- 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 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.Z., 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 0 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 organizations liability for the this insurance to be primary and non-contributory. conduct of another"insured". CA T4 74 42 16 ©2016 The Travelers Indemnity Company.Ali rights reserved. Page 1 of 1 Includes copyrighted material of insurance Services Office,Inc.with its permission.