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14-106.00 GeoEngineers: 2014 Street PreservationAGREEMENT FOR PROFESSIONAL SERVICES GeoEngineers 2014 FWD Study SVPW Contract 14-040 THIS AGREEMENT is made by and between the City of Spokane Valley, a code City of the State of Washington, hereinafter "City" and GeoEngineers, hereinafter "Consultant," jointly referred to as "Parties." IN CONSIDERATION of the terms and conditions contained herein, the Parties agree as follows: 1. Work to Be Performed. Consultant shall provide all labor, services and material to satisfactorily complete the scope of work identified in the attached Exhibit 1: GeoEngineers June 20, 2014 Revised Proposal. A. Administration. The City Manager or designee shall administer and be the primary contact for Consultant. Prior to commencement of work, Consultant shall contact the City Manager or designee to review the Scope of Services, schedule and date of completion. The Scope of Services is attached hereto as Exhibit 1. Upon notice from the City Manager or designee, Consultant shall commence work, perform the requested tasks in the Scope of Services, stop work and promptly cure any failure in performance under this Agreement, B. Representations. City has relied upon the qualifications of Consultant in entering into this Agreement. By execution of this Agreement, Consultant represents it possesses the ability, skill and resources necessary to perform the work and is familiar with all current laws, rules and regulations which reasonably relate to the Scope of Services. No substitutions of agreed-upon personnel shall be made without the prior written consent of City. Consultant represents that the compensation as stated in paragraph 3 is adequate and sufficient compensation for its timely provision of all professional services required to complete the Scope of Services under this Agreement. Consultant shall be responsible for the technical accuracy of its services and documents resulting therefrom, and City shall not be responsible for discovering deficiencies therein. Consultant shall correct such deficiencies without additional compensation except to the extent such action is directly attributable to deficiencies in City furnished information. C. Standard of Care. Consultant shall exercise the degree of skill and diligence normally employed by professional consultants engaged in the same profession, and performing the same or similar services at the time such services are performed. D. Modifications. City may modify this Agreement and order changes in the work whenever necessary or advisable. Consultant will accept modifications when ordered in writing by the City Manager or designee. Compensation for such modifications or changes shall be as mutually agreed between the Parties. Consultant shall make such revisions in the work as are necessary to correct errors or omissions appearing therein when required to do so by City without additional compensation. 2. Terin of Contract, This Agreement shall be in full force and effect upon execution and shall remain in effect until completion of all contractual requirements have been met as determined by City. Consultant shall complete its work by $eptember 1, 2014, unless the time for performance is extended in writing by the Parties. Either Party may terminate this Agreement for material breach after providing the other Party with at least ten Agreement for Professional Services Page 1 of 6 days' prior notice and an opportunity to cure the breach. City may, in addition, terminate this Agreement for any reason by ten days' written notice to Consultant. In the event of termination without breach, City shall pay Consultant for all work previously authorized and satisfactorily performed prior to the termination date. 3. Compensation. City agrees to pay Consultant up to a maximum of $59,000, including all taxes on a time and materials basis as full compensation for everything done under this Agreement. Consultant shall not perform any extra, further or additional services for which it will request additional compensation from City without a prior written agreement for such services and payment therefore. 4. Payment. Consultant shall be paid monthly upon presentation of an invoice to City. Applications for payment shall be sent to the City Finance Deparhnent at the below stated address. City reserves the right to withhold payment under this Agreement which is determined in the reasonable judgment of the City Manager or designee to be noncompliant with the Scope of Services, City standards, City Code, and federal or state standards. 5. Notice. Notices other than applications for payment shall be given in writing as follows: TO THE CITY: Name: Christine Bainbridge, City Clerk Phone: (509) 921-1000 Address: 11707 East Sprague Ave, Suite 106 Spokane Valley, WA 99206 TO THE CONSULTANT: Name: James Harakas, PE, LEG Phone: (509) 363-3125 Address: 523 East Second Avenue Spokane, WA 99202 6. Applicable Laws and Standards. The Parties, in the performance of this Agreement, agree to comply with all applicable federal, state, and local laws and regulations. Consultant warrants that its designs, construction documents, and services shall confnin to all federal, state and local statutes and regulations. 7. Certification Regarding Debarment, Suspension, and Other Responsibility Matters — Primary Covered Transactions. A. By executing this Agreement, the Consultant certifies to the best of its knowledge and belief, that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; 2. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission or fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; 3. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (A)(2) of this certification; and 4. Have not within a three-year period preceding this application/proposal had one or more public transactions (federal, state, or local) terminated for cause or default. Agreement for Professional Services Page 2 of 6 B. Where the prospective pritnary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach mi explanation to this Agreement. 8. Relationship of the Parties. It is understood, agreed and declared that Consultant shall be an independent contractor, and not the agent or employee of City, that City is interested in only the results to be achieved, and that the right to control the particular manner, method and means in which the services are performed is solely within the discretion of Consultant. Any and all employees who provide services to City under this Agreement shall be deemed employees solely of Consultant. The Consultant shall be solely responsible for the conduct and actions of all its employees under this Agreement and any liability that may attach thereto. 9. Ownership of Documents. All drawings, plans, specifications, and other related documents prepared by Consultant under this Agreement are and shall be the property of City, and may be subject to disclosure pursuant to RCW 42.56 or other applicable public record laws. The written, graphic, mapped, photographic, or visual documents prepared by Consultant under this Agreement shall, unless otherwise provided, be deemed the property of City. City shall be permitted to retain these documents, including reproducible camera-ready originals of reports, reproduction quality mylars of maps, and copies in the form of computer files, for the City's use. City shall have unrestricted authority to publish, disclose, distribute and otherwise use, in whole or in part, any reports, data, drawings, images or other material prepared under this Agreement, provided that Consultant shall have no liability for the use of Consultant's work product outside ofthe scope of its intended purpose. 10. Records. The City or State Auditor or any of their representatives shall have full access to and the right to examine during normal business hours all of Consultant's records with respect to all matters covered in this Agreement. Such representatives shall be permitted to audit, examine and make excerpts or transcripts from such records and to make audits of all contracts, invoices, materials, payrolls and record of matters covered by this Agreement for a period of three years from the date fmal payment is made hereunder. 11. Insurance. Consultant shall procure and maintain for the duration of the Agreement, insurance against claims for injuries to persons or damage to property which may arise from or in connection with the performance of the work hereunder by Consultant, its agents, representatives, employees or subcontractors. A. Minimum Scope of Insurance. Consultant shall obtain insurance of the types described below: 1. Automobile liability insurance covering all owned, non -owned, hired and leased vehicles. Coverage shall be written on Insurance Services Office (ISO) form CA 00 01 or a substitute form providing equivalent liability coverage. If necessary, the policy shall be endorsed to provide contractual liability coverage. 2. Commercial general liability insurance shall be written on ISO occurrence forrn CG 00 01 and shall cover liability arising from premises, operations, independent contractors and personal injury and advertising injury. City shall be named as an insured under Consultant's corntnercial general liability insurance policy with respect to the work performed for the City. 3. Workers' compensation coverage as required by the industrial insurance laws of the State of Washington. 4. Professional liability insurance appropriate to Consultant's profession. B. Minimum Amounts of Insurance. Consultant shall maintain the following insurance limits: Agreement for Professional Services Page 3 of 6 1. Automobile Liability insurance with a minimum combined single limit for bodily injury and property damage of $1,000,000 per accident. 2. Commercial general liability insurance shall be written with limits no less than $1,000,000 each occurrence, $2,000,000 general aggregate. 3. Professional liability insurance shall be written with limits no less than $1,000,000 per claim and $1,000,000 policy aggregate limit. C. Other Insurance Provisions. The insurance policies are to contain, or be endorsed to contain, the following provisions for automobile liability, professional liability and commercial general liability insurance: 1. Consultant's insurance coverage shall be primary insurance with respect to City except for professional liability insurance. Any insurance, self-insurance, or insurance pool coverage maintained by City shall be in excess of Consultant's insurance and shall not contribute with it. 2. Consultant shall fax or send electronically in .pdf format a copy of insurer's cancellation notice within two business days of receipt by Consultant. D. ,Acceptability of Insurers. Insurance is to be placed with insurers with a current A.M. Best rating of not less than A:VII, except for professional liability insurance which shall have a current A.M. Best rating of not less than A:V. E. Evidence of Coverage. As evidence of the insurance coverages required by this Agreement, Consultant shall furnish acceptable insurance certificates to the City Clerk at the time Consultant returns the signed Agreement. The certificate shall specify all of the parties who are additional insureds, and will include applicable policy endorsements, and the deduction or retention level. Insuring companies or entities are subject to City acceptance. If requested, complete copies of insurance policies shall be provided to City. Consultant shall be financially responsible for all pertinent deductibles, self-insured retentions, and/or self-insurance. 12. Indemnification and Hold Harmless. Consultant shall, at its sole expense, defend, indemnify and hold harmless City and its officers, agents, and employees, from any and all claims, actions, suits, liability, loss, costs, attorney's fees and costs of litigation, expenses, injuries, and damages of any nature whatsoever relating to or arising out of the wrongful or negligent acts, errors or omissions in the services provided by Consultant, Consultant's agents, subcontractors, subconsultants and employees to the fullest extent permitted by law, subject only to the limitations provided below. Consultant's duty to defend, indemnify and hold harmless City shall not apply to liability for damages arising out of such services caused by or resulting from the sole negligence of City or City's agents or employees. Consultant's duty to defend, indemnify and hold harmless City against liability for damages arising out of such services caused by the concurrent negligence of (a) City or City's agents or employees, and (b) Consultant, Consultant's agents, subcontractors, subconsultants and employees, shall apply only to the extent of the negligence of Consultant, Consultant's agents, subcontractors, subconsultants and employees. Consultant's duty to defend, indemnify and hold City harmless shall include, as to all claims, demands, Losses and liability to which it applies, City's personnel -related costs, reasonable attorneys' fees, and the reasonable Agreement for Professional Services Page 4 of 6 value of any services rendered by the office of the City Attorney, outside consultant costs, court costs, fees for collection, and all other claim -related expenses. Consultant specifically and expressly waives any immunity that may be granted it under the Washington State Industrial Insurance Act, Title 51 RCW. These indemnification obligations shall not be limited in anyway by any limitation on the amount or type of damages, compensation or benefits payable to or for any third party under workers' compensation acts, disability benefit acts, or other employee benefits acts. Provided, that Consultant's waiver of immunity under this provision extends only to claims against Consultant by City, and does not include, or extend to, any claims by Consultant's employees directly against Consultant. Consultant hereby certifies that this indemnification provision was mutually negotiated. 13. Waiver. No officer, employee, agent or other individual acting on behalf of either Party has the power, right or authority to waive any of the conditions or provisions of this Agreement. No waiver in one instance shall be held to be a waiver of any other subsequent breach or nonperformance. All remedies afforded in this Agreement or by law, shall be taken and construed as cumulative, and in addition to every other remedy provided herein or by law. Failure of either Party to enforce at any time any of the provisions of this Agreement or to require at any time performance by the other Party of any provision hereof shall in no way be construed to be a waiver of such provisions nor shall it affect the validity ofthis Agreement or any part thereof. 14. Assignment and Delegation. Neither Party shall assign, transfer, or delegate any or all of the responsibilities ofthis Agreement or the benefits received hereunder without first obtaining the written consent of the other Party. 15. Subcontracts. Except as otherwise provided herein, Consultant shall not enter into subcontracts for any of the work contemplated under this Agreement without obtaining prior written approval of City. 16. Confidentiality. Consultant may, from time to time, receive information which is deemed by City to be confidential. Consultant shall not disclose such information without the prior express written consent of City or upon order of a court of competent jurisdiction. 17. Jurisdiction and Venue. This Agreement is entered into in Spokane County, Washington. Disputes between City and Consultant shall be resolved in the Superior Court of the State of Washington in Spokane County. Notwithstanding the foregoing, Consultant agrees that it may, at City's request, be joined as a party in any arbitration proceeding between City and any third party that includes a claim or claitns that arise out of, or that are related to Consultant's services under this Agreement. Consultant Thrther agrees that the Arbitrator(s) decision therein shall be final and binding on Consultant and that judgment may be entered upon it in any court having jurisdiction. thereof. 18. Cost and Attorney's Fees. The prevailing party in any Iitigation or arbitration arising out of this Agreement shall be entitled to its attorney's fees and costs of such litigation (including expert witness fees). 19. Entire Agreement. This written Agreement constitutes the entire and complete agreement between the Parties and supersedes any prior oral or written agreements. This Agreement may not be changed, modified or altered except in writing signed by the Parties hereto. 20. ,Anti -kickback. No officer or employee of City, having the power or duty to perform an official act or action related to this Agreement shall have or acquire any interest in this Agreement, or have solicited, accepted or granted a present or future gift, favor, service or other thing of value from any person with an interest in this Agreement. Agreement for Professional Services Page 5 of 6 21. Dusiness Registration. Prior to commencement of work under this Agreement, Consultant shall register with the City as a business. 22. Severability. If any section, sentence, clause or phrase of this Agreement should be held to be invalid for any reason by a court of competent jurisdiction, such invalidity shall not affect the validity ofany other section, sentence, clause or phrase of this Agreement. 23. Exhibits. Exhibits attached and incorporated into this Agreement are: 1. Scope of Services 2. Insurance Certificates d The Parties have executed this Agreement thi1�_ day of CITY OF SPOI ..; VALLEY M' Jackson, Ci / `anager it/ istine Bainbridge, City Cler: Consultant: Authorized Representative 20/./ APPROVED AS TO FORM: r4i, Office of City AI Agreement for Professional Services Page 6 of 6 June 20, 2014 City of Spokane Valley 11707 East Sprague Avenue, Suite 106 Spokane Valley, Washington 99206 Attention: CraigAldworth, PE, Senior Engineer/Project Manager Subject: Revised Proposal Geotechnical Services Proposed 2014 Street Preservation Project Spokane Valley, Washington Fife No. 11264-034-00 INTRODUCTION AND PROJECT UNDERSTANDING GEOENGINEERS_ 523 East Second Avenue Spokane, Washington 99202 509.363.3125 This letter presents our revised proposal for geotechnical engineering services associated with the City of Spokane Valley (City) 2014 Street Preservation Project. This project includes providing Falling Weight Deflectometer (FWD) testing, road section coring and pavement design services for 10 street projects within the City limits, A summary of the street segments Is provided In Table 1. TABLE 1. PROJECT STREETS AND LIMITS Project Name Evergreen Road Argonne Road Ira ue,Avenue Start Sulllan _Roa Sullivan Road Sullivan Road Dishrnan-Mica Road. Oad` uclid_Avefiue' <. th Avenin Appleway Boulevard Sprague Avenue- Flora Road Indiana Avenue `' =:Indiana Avenue Gorbin :Road. Dishman-Mlca-Road. Misslon'Av"e"'n`ue': „=' - -- .:,:rte:..• -,__ 24th Avenue Saltese Avenue =16 Avenue., ;. Indiana' Avenue. Limits :No. Lanes Ap•prox 'Length_ (fee City of Spokane Valley 'June 20, 2014 Page 2 METHODOLOGY Our proposed services include FWD testing and coring of existing asphalt concrete pavement to measure existing hot -mix asphalt (HMA) and base course thicknesses. The FWD testing will be completed using a KUAB FWD to measure deflection for use in back -calculating the elastic moduli of the pavement, base and subgrade. As requested, we propose to complete the FWD testing and pavement coring In the outside lanes of the above referenced road alignments. FWD tests will be completed at approximate 250 -foot intervals. Pavement cores will be completed at an approximate 2,000 -foot spacing within the outer lanes, staggered for an effective spacing of approximately 1,000 feet on -center. A minimum of two pavement cores will be completed per street segment. We assume that traffic control will be required during all field activities. For estimating purposes, we assume that signs and an arrow board mounted onto a traffic control vehicle will be used at each FWD and pavement core location where there are at least two lanes for each direction of traffic. Where field testing is completed on streets with one lane of traffic in each direction, we propose to retain flaggers to direct the flow of traffic. SCOPE OF SERVICES The purpose of our base scope of services is to provide geotechnical engineering -related recommendations for rehabilitation of the subject streets presented in Table 1 based on site reconnaissance, subsurface exploration, FWD testing, laboratory testing and engineering analyses. Our specific scope of services will include the following: 1. Coordinating clearance of existing utilities with proposed core locations by contacting the local One -Call Service before beginning our explorations. 2. Traffic control services provided under subcontract to GeoEngineers, Inc. We assume traffic control will include closing one lane of traffic, and requiring flaggers and signage during coring operations. An arrow board and signage will be provided during the non-destructive deflection testing (NDT) operations for streets with multiple lanes in each direction. Flaggers and signage will be used during NOT operations on streets with a single lane in each direction. We also assume that two traffic control laborers will be present during both coring and FWD activities to allow for quick transitions and set-ups during coring, and between project locations during FWD testing, to reduce standby time during field operations. 3. Coring pavements in order to measure the thickness of existing asphalt concrete pavement and underlying crushed rock base course and subbase, if present. For estimating purposes, we have assumed that the maximum pavement thickness will not exceed 6 inches and base course thickness will not exceed 8 inches, and about 60 cores will be collected. Following coring and measurement of pavement layer thicknesses, base course and subbase will be tamped to a firm condition and cores will be backfilled with portland cement concrete (PCC). Pavement core measurements and base course and subbase thickness measurements will be utilized for back - calculating modulus values from NDT. GEOENGiNEERj Ale No. 112^04034-00 City of Spokane Valley June 20, 2014 Page 3 4. NDT along the project alignment using a FWD to develop data for back -calculating modulus values for design of pavement overlays. This element of our services will be completed under an agreement between GeoEngineers and one of our subconsultants, who specializes in NDT testing. 5. Overlay thickness design of all 10 projects listed in Table 1 using the computer program WinPAS and traffic data provided by the City. 6. Presentation of our results in a letter report. Our report will include an excel spreadsheet listing each street name, termini, core location, HMA thickness, crushed surfacing thickness, FWD testing locations, subgrade resilient modulus values and overlay thicknesses based on the results of our analyses. We also will provide hard copies of computer input/output files and electronic version of our report. TERMS, FEE ESTIMATE AND SCHEDULE Our services will be completed in accordance with the terms, conditions and billing rates described in the Agreement for Professional Services currently under negotiation. between GeoEngineers and the City of Spokane Valley. .For the scope of services described above, we estimate that our fee will be $59,000. This includes: ® Approximately $14,000 for four days of FWD testing and processing of data files; Approximately $5,500 for 60 pavement cores; is Approximately $11,500 for traffic control services. This includes 5 days for pavement coring and 4 days of FWD testing; and Approximately $28,000 for field labor, project management, analysis, report preparation and support. Our fee will be determined on a time -and -expense basis using the rates contained in our Schedule of Charges, which are attached to and form a part of this proposal. We appreciate the opportunity to submit this proposal. If you have any questions, please call. We look forward to working with you on this project and appreciate your confidence in our firm. Sincerely, GeoEngineers, Inc. avid R. Lauder, PE Senior Engineer DRL:JBH:tjh Attachments: Schedule of Charges - Spokane 2014 ?.6440 es B. Harakas, PE, LEG enior Principal Disclaimer. My electronic form, facsimile or hard copy of the original document (email, text, table, and/or figure), if provided, and any attachments are only a copy of the original document.The original document is stored by GeoEngineers, Inc. and will serve as the official document of record. Copyright© 2014 by GeoEngineers,Inc. Ni rights reserved. Fte t1o,11284.O34-00 DOCUMENTS EXEMPT FROM PUBLIC DISCLOSURE The three page(s) entitled “Schedule of Charges - 2014” contain(s) confidential cost and rate data and is(are) withheld from public disclosure pursuant to 23 USC 112(2)(E). Prenotification; confidentiality of data. A recipient of funds requesting or using the cost and rate data shall notify any affected firm before such request or use. Such data shall be confidential and shall not be accessible or provided, in whole or in part, to another firm or to any government agency which is not part of the group of agencies sharing cost data under this paragraph, except by written permission of the audited firm. If prohibited by law, such cost and rate data shall not be disclosed under any circumstances. You may petition for a review of our findings pertaining to any redacted or withheld documents pursuant to Spokane Valley Municipal Code (SVMC) 2.75.080; and obtain judicial review pursuant to RCW 42.56.550. Terra Insurance Company (A Risk Retention Group) Two Fifer Avenue, Suite 100 Corte Madera, CA 94925 CERTIFICATE OF INSURANCE DATE 06/24/14 TERRA INSURANCE COMPANY NAME AND ADDRESS OF INSURED GeoEngineers, Inc. 523 East Second Avenue Spokane, WA 99202 This certifies that the "claims made" insurance policy (described below by policy number) written on forms in use by the Company has been issued. This certificate is not a policy or a binder of insurance and is issued as a matter of information only, and confers no rights upon the certificate holder. This certificate does not alter, amend or extend the coverage afforded by this policy. The policy of insurance listed below has 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 policy described herein is subject to all the terms, exclusions and conditions of such policy. Aggregate limits shown may have been reduced by paid claims. TYPE OF INSURANCE Professional Liability POLICY NUMBER 214019 EFFECTIVE DATE EXPIRATION DATE 01/01/14 12/31/14 LIMITS OF LIABILITY $1,000,000 EACH CLAIM $1,000,000 ANNUAL AGGREGATE PROJECT DESCRIPTION 11264-034-00 City of Spokane Valley / 2014 St Preserve CANCELLATION: If the described policy is cancelled by the Company before its expiration date, the Company will mail written notice to the certificate holder thirty (30) days in advance, or ten (10) days in advance for non-payment of premium. If the described policy is cancelled by the insured before its expiration date, the Company will mail written notice to the certificate holder within thirty (30) days of the notice to the Company from the insured. CERTIFICATE HOLDER City of Spokane Valley Attn: Craig Aldworth 11707 East Sprague Avenue, Suite 106 Spokane Valley, Washington 99206 ISSUING COMPANY: TERRA INSURANCE COMPANY (A Risk Retention Group) rresiaent GEOEINC-01 POOLEKI '4� be CERTIFICATE OF LIABILITY INSURANCE DAT/24/2D/YYYY) 6/24/2014 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(les) must 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 Willis of Seattle, Inc. do 26 Century Blvd P.O. Box 305191 Nashville, TN 37230-5191 CONTACT NAME: certificates@willis.com (877)PHONE945-7378 FAX (888)467-2378 INC. No, Ext): (AIC, No): E-MAIL. ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Travelers Property Casualty Company of America 25674 INSURED GeoEngineers, Inc. 8410 154th Ave. NE Redmond, WA 98052 INSURER B : Travelers Indemnity Company 25658 INSURER c : Liberty Mutual Fire Insurance Company 23035 INSURER D : $ 1,000,000 INSURER E: $ 100,000 INSURER F : CERTIFICATE NUMBER. REVISION NUMBER: v• THISIS 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 POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL (NSD SUER WVD POLICY NUMBER EFF (MM/DPOUDIYYYY) LICY EXP (Y MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X P -660 -533D1564 -TIL -14 3/31/2014 3/31/2015 EACH OCCURRENCE $ 1,000,000 pREM SES (EaEoccurrence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE POLICY OTHER: X LIMIT APPLIES JEC PER: LOC PRODUCTS - COMP/OP AGG $ 2,000,000 B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS OT EED AUS P -810 -532D8375 -IND -14 3/31/2014 3/31/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA UAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WC2-Z91-451667-014 3/31/2014 3/31/2015 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Re: Project Number 11264-034-00 City of Spokane Va ley/ 2014 St Preserve City of Spokane Valley is included as an Additional Insured as respects to General Liability as required by written contract. WA Stop Gap, USL&H and Maritime Employers Liability coverage is included under Workers' Compensation coverage evidenced above. V LI\„I ,VII 1 L 1 1,,...11.0•—• s City of Spokane Valley 11707 East Sprague Avenue, Suite 106 (Spokane, WA 99206 --------------- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. EPRESENTATIVE AUTHORIZED /� REPRESENTATIVE ce-- %i ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reseryed. The ACORD name and logo are registered marks of ACORD ,�p� GEOEINC-01 WRIGHTDU ACC:RO" DATE(MM/DDmYY) 16.------ CERTIFICATE OF LIABILITY INSURANCE 4/1/2015 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 be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Willis of Seattle,Inc. PHONE 877 945-7378 FAX 888 467-2378 c/o 26 Century Blvd (Ala No,Ext):( ) (NC,No): (888) P.O.Box 305191 E-MAIL ADDRESS: Nashville,TN 37230-5191 INSURER(S)AFFORDING COVERAGE NAIC 0 INSURER A:Travelers Property Casualty Company of America 25674 INSURED INSURER B:Travelers Indemnity Company 25658 GeoEngineers,Inc. INSURER C:Liberty Insurance Corporation 42404 8410 154th Ave.NE INSURER D:Liberty Mutual Fire Insurance Company 23035 Redmond,WA 98052 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. 18R TYPE OF INSURANCE ADSL SUER POLICY NUMBER (MM/LDICY EFF POLICY D/YYYY) ( 'NSD WYD DD/YYYY) LIMITS LTR A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X P-660-533D1564-TIL-15 03/31/2015 03/31/2016 PREM SES Ea occurrrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) B X ANY AUTO X P-810-532D8375-IND-15 03/31/2015 03/31/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNEDO PROPERTY DAMAGE $ Per accident) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 C EXCESS LIAB CLAIMS-MADE TH7-661-066735-015 03/31/2015 03/31/2016 AGGREGATE $ 1,000,000 DED X RETENTION$ 0 - $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N D ANY PROPRIETOR/PARTNER/EXECUTIVE WC2-Z91-451667-015 03/31/2015 03/31/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1 000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) WA Stop Gap,USL&H and Maritime Employers Liability coverage is Included under Workers'Compensation coverage evidenced above. City of Spokane Valley is included as an Additional Insured as respects to General Liability and Auto Liability policies. CERTIFICATE HOLDER 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. AUTHORIZED REPRESENTATIVE City o7 Spokane ,Sley it -----�, _/ 11707 E Sprague,Suite 106 j� 'Spokane Valley,WA 99206 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: P-660-533D1564-TIL-15 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - WRITTEN CONTRACTS (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II –WHO IS plies only to such "bodily injury" or "property AN INSURED: damage"that occurs before the end of the pe- riod of time for which the "written contract re- Any person or organization that you agree in a "written contract requiring insurance"to include as quiring insurance" requires you to provide an additional insured on this Coverage Part, but: such coverage or the end of the policy period, whichever is earlier. a. Only with respect to liability for"bodily injury", "property damage" or"personal injury"; and 2. The following is added to Paragraph 4.a. of SEC- TION IV – COMMERCIAL GENERAL LIABILITY b. If, and only to the extent that, the injury or CONDITIONS: damage is caused by acts or omissions of you or your subcontractor in the performance The insurance provided to the additional insured is excess over any valid and collectible "other in of "your work" to which the "written contract surance", whether primary, excess, contingent or requiring insurance" applies. The person or organization does not qualify as an additional on any other basis, that is available to the addi insured with respect to the independent acts tional insured for a loss we cover. However, if you or omissions of such person or organization. specifically agree in the "written contract requiring insurance" that this insurance provided to the ad- The insurance provided to such additional insured ditional insured under this Coverage Part must is limited as follows: apply on a primary basis or a primary and non- .— c. In the event that the Limits of Insurance of contributory basis, this insurance is primary to this Coverage Part shown in the Declarations "other insurance" available to the additional in- „,— exceed n-exceed the limits of liability required by the sured which covers that person or organization as "written contract requiring insurance", the in- a named insured for such loss, and we will not surance provided to the additional insured share with that "other insurance". But this insur- shall be limited to the limits of liability required ance provided to the additional insured still is ex- by that "written contract requiring insurance". cess over any valid and collectible "other insur- This endorsement shall not increase the limits ance", whether primary, excess, contingent or on of insurance described in Section III – Limits any other basis, that is available to the additional Of Insurance. insured when that person or organization is an d. This insurance does not apply to the render- additional insured under any"other insurance". ing of or failure to render any "professional 3. The following is added to SECTION IV – COM- services" or construction management errors MERCIAL GENERAL LIABILITY CONDITIONS: or omissions. Duties Of An Additional Insured e. This insurance does not apply to "bodily in- - As a condition of coverage provided to the addi jury" or "property damage" caused by "your tional insured: work" and included in the "products- _ a. The additional insured must give us written completed operations hazard" unless the "written contract requiring insurance” specifi notice as soon as practicable of an "occur cally requires you to provide such coverage rence" or an offense which may result in a for that additional insured, and then the insur- claim. To the extent possible, such notice ance provided to the additional insured ap- should include: CG D4 14 04 08 ©2008 The Travelers Companies,Inc. Page 1 of 2 005906 • COMMERCIAL GENERAL LIABILITY i. How, when and where the "occurrence" any provider of other insurance which would or offense took place; cover the additional insured for a loss we ii. The names and addresses of any injured cover. However, this condition does not affect persons and witnesses; and whether this insurance provided to the addi- iii. The nature and location of any injury or tional insured is primary to that other insur- damage arising out of the "occurrence" or ance available to the additional insured which offense. covers that person or organization as a named insured. b. If a claim is made or "suit" is brought against the additional insured, the additional insured 4. The following is added to the DEFINITIONS Sec- must: tion: i. Immediately record the specifics of the "Written contract requiring insurance" means that claim or"suit"and the date received; and part of any written contract or agreement under which you are required to include a person or or- ii.• Notify us as soon as practicable. ganization as an additional insured on this Cover- The additional insured must see to it that we age Part, provided that the "bodily injury" and receive written notice of the claim or"suit" as "property damage" occurs and the "personal in- soon as practicable. jury" is caused by an offense committed: c. The additional insured must immediately send a. After the signing and execution of the contract us copies of all legal papers received in con- or agreement by you; vection with the claim or"suit", cooperate with b. While that part of the contract or agreement is us in the investigation or settlement of the in effect; and claim or defense against the "suit", and oth- erwise comply with all policy conditions. c. Before the end of the policy period. d. The additional insured must tender the de- fense and indemnity of any claim or "suit" to Page 2 of 2 ©2008 The Travelers Companies, Inc. CG D4 14 04 08 COMMERCIAL AUTO POLICY NUMBER: P-810-532D8375-IND-15 ISSUE DATE: -3/3112015 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi- sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. SCHEDULE Name of Person(s) or Organization(s): ANY PERSON OR ORGANIZATION THAT YOU ARE REQUIRED TO INCLUDE AS AN ADDITIONAL INSURED ON THIS COVERAGE FORM IN A WRITTEN CONTRACT OR AGREEMENT THAT IS SIGNED AND EXECUTED BY YOU BEFORE THE "BODILY INJURY" OR "PROPERTY DAMAGE " OCCURS AND THAT IS IN EFFECT DURING THE POLICY PERIOD. wicmgemiM - (If no entry appears above, information required to complete this endorsement will be shown in the Declarations • - as applicable to the endorsement.) twaiONIN Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. 0 0 0 CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 000859 w-1 GEOEINC-01 WRIGHTDU ACt7RC," DATE(MWDD/YYYY) 4.1.....------ CERTIFICATE OF LIABILITY INSURANCE 4/1/2015 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 be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Willis of Seattle,Inc. PHONE877 945-7378 FAX 888 467-2378 c/o 26 Century Blvd (A/C,No,Ext):I ) (AIC No): ) P.O.Box 305191 E-MAIL ADDRESS: Nashville,TN 37230-5191 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Travelers Property Casualty Company of America 25674 INSURED INSURER B:Travelers Indemnity Company 25658 GeoEngineers,Inc. INSURER C:Liberty Insurance Corporation 42404 8410 154th Ave.NE INSURER D:Liberty Mutual Fire Insurance Company 23035 Redmond,WA 98052 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. 18R ADDL SUBR POLICPOLICY NUMBER (MM/DDYEFF/YYYY) (M LTROLICY EXP TYPE OF INSURANCE (NSD WVD M/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X P-660-533D1564-TIL-15 03/31/2015 03/31/2016 DAMAGE TO RENTED 100,000 PREMISES{Ea occurrence) $ � MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X jgCOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) B X ANY AUTO X P-810-532D8375-IND-15 03/31/2015 03/31/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 C EXCESS LIAB CLAIMS-MADE TH7-661-066735-015 03/31/2015 03/31/2016 AGGREGATE $ 1,000,000 DED X RETENTION$ 0 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N D ANY PROPRIETOR/PARTNER/EXECUTIVE WC2-Z91-451667-015 03/31/2015 03/31/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N IA (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 $ , DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached N more space Is required) WA Stop Gap,USL&H and Maritime Employers Liability coverage is Included under Workers'Compensation coverage evidenced above. City of Spokane Valley is included as an Additional Insured as respects to General Liability and Auto Liability policies. CERTIFICATE HOLDER 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. AUTHORIZED IREEPRESENTATIVE City o7 Spokane ,Sley it i!��--� 11707 E Sprague,Suite 106 Spokane Valley.WA 99206 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ILI - 1©G POLICY NUMBER: P-660-533D1564-TIL-15 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - WRITTEN CONTRACTS (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II –WHO IS plies only to such "bodily injury" or "property AN INSURED: damage"that occurs before the end of the pe- Any person or organization that you agree in a riod of time for which the "written contract re "written contract requiring insurance"to include as quiring insurance" requires you to provide an additional insured on this Coverage Part, but: such coverage or the end of the policy period, whichever is earlier. a. Only with respect to liability for"bodily injury", "property damage" or"personal injury"; and 2. The following is added to Paragraph 4.a. of SEC- TION IV – COMMERCIAL GENERAL LIABILITY b. If, and only to the extent that, the injury or CONDITIONS: damage is caused by acts or omissions of you or your subcontractor in the performance The insurance provided to the additional insured of "your work" to which the "written contract is excess over any valid and collectible "other in- requiring insurance" applies. The person or surance", whether primary, excess, contingent or organization does not qualify as an additional on any other basis, that is available to the addi- insured with respect to the independent acts tional insured for a loss we cover. However, if you or omissions of such person or organization. specifically agree in the "written contract requiring B insurance" that this insurance provided to the ad- The insurance provided to such additional insured ditional insured under this Coverage Part must is limited as follows: apply on a primary basis or a primary and non- c. In the event that the Limits of Insurance of contributory basis, this insurance is primary to this Coverage Part shown in the Declarations "other insurance" available to the additional in- exceed the limits of liability required by the sured which covers that person or organization as — "written contract requiring insurance", the in- a named insured for such loss, and we will not surance provided to the additional insured share with that "other insurance". But this insur- shall be limited to the limits of liability required ance provided to the additional insured still is ex- by that "written contract requiring insurance". cess over any valid and collectible "other insur- This endorsement shall not increase the limits ance", whether primary, excess, contingent or on of insurance described in Section III – Limits any other basis, that is available to the additional Of Insurance. insured when that person or organization is an d. This insurance does not apply to the render- additional insured under any "other insurance". ing of or failure to render any "professional 3. The following is added to SECTION IV – COM- services" or construction management errors MERCIAL GENERAL LIABILITY CONDITIONS: or omissions. Duties Of An Additional Insured 0— e. This insurance does not apply to "bodily in- As a condition of coverage provided to the addi- jury" or "property damage" caused by "your tional insured: work" and included in the "products- . completed operations hazard" unless the a. The additional insured must give us written "written contract requiring insurance" specifi notice as soon as practicable of an "occur _ cally requires you to provide such coverage rence" or an offense which may result in a for that additional insured, and then the insur- claim. To the extent possible, such notice ance provided to the additional insured ap- CG include: CG D4 14 04 08 ©2008 The Travelers Companies,Inc. Page 1 of 2 005906 COMMERCIAL GENERAL LIABILITY i. How, when and where the "occurrence" any provider of other insurance which would or offense took place; cover the additional insured for a loss we ii. The names and addresses of any injured cover. However, this condition does not affect persons and witnesses; and whether this insurance provided to the addi- iii. The nature and location of any injury or tional insured is primary to that other insur- damage arising out of the "occurrence" or ance available to the additional insured which offense. covers that person or organization as a named insured. b. If a claim is made or "suit" is brought against the additional insured, the additional insured 4.. The following is added to the DEFINITIONS Sec- must: tion: i. Immediately record the specifics of the "Written contract requiring insurance" means that claim or"suit"and the date received; and part of any written contract or agreement under which you are required to include a person or or- ii. Notify us as soon as practicable. ganization as an additional insured on this Cover- The additional insured must see to it that we age Part, provided that the "bodily injury" and receive written notice of the claim or "suit" as "property damage" occurs and the "personal in- soon as practicable. jury" is caused by an offense committed: c. The additional insured must immediately send a. After the signing and execution of the contract us copies of all legal papers received in con- or agreement by you; nection with the claim or"suit", cooperate with b. While that part of the contract or agreement is us in the investigation or settlement of the in effect; and claim or defense against the "suit", and oth- erwise comply with all policy conditions. c. Before the end of the policy period. d. The additional insured must tender the de- fense and indemnity of any claim or "suit" to Page 2 of 2 ©2008 The Travelers Companies, Inc. CG D4 14 04 08 COMMERCIAL AUTO POLICY NUMBER: P-810-532D8375-IND-15 ISSUE DATE: ,3/3112015 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi- sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. SCHEDULE Name of Person(s) or Organization(s): ANY PERSON OR ORGANIZATION THAT YOU ARE REQUIRED TO INCLUDE AS AN ADDITIONAL INSURED ON THIS COVERAGE FORM IN A WRITTEN CONTRACT OR AGREEMENT THAT IS SIGNED AND EXECUTED BY YOU BEFORE THE "BODILY INJURY" OR "PROPERTY DAMAGE " OCCURS AND THAT IS IN EFFECT DURING THE POLICY PERIOD. m (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section 0 II of the Coverage Form. 0- 0- 0_0 CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 000859