Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
14-039.00 Max J. Kuney: Sullivan West Bridge Ph 2
. , . ILI-etto Contract , la/ THIS AGREEMENT, made and entered into this Fday of , 2014, between the City of Spokane Valley under and by virtue of Title 47 RCW, as amended and Max J. Kunev Company Hereinafter called the Contractor. WITNESSETH: That in consideration of the terms and conditions contained herein and attached and made a part of this agreement,the parties hereto covenant and agree as follows: I. The Contractor shall do all work and furnish all tools, materials, and equipment for: Phase 2 - Sullivan Road West Bridge Replacement Project#0155 SVPW Contract 14-039 In accordance with and as described in the project plans and specification, and the standard specification of the Washington State of Department of Transportation which are by this reference incorporated herein and made part hereof and, shall perform any changes in the work in accord with the Contract Documents. The Contractor shall provide and bear the expense of all equipment, work and labor, of any sort whatsoever that may be required for the transfer of materials and for constructing and completing the work provided for in these Contract Documents except those items mentioned therein to be furnished by the City of Spokane Valley. II. The City of Spokane Valley hereby promises and agrees with the Contractor to employ, and does employ the Contractor to provide the materials and to do and cause to be done the above described work and to complete and finish the same in accord with the attached plans and specification and the terms and conditions herein contained and hereby contracts to pay for the same according to the attached specifications and the schedule of unit or itemized prices at the time and in the manner and upon the conditions provided for in this contract. III. The Contractor for himself/herself, and for his/hers heirs, executors, administrators, successors, and assigns, does hereby agree to full performance of all covenants required of the Contractor in the contract. IV. It is further provided that no liability shall attach to the City of Spokane Valley by reason of entering onto this contract, except as provided herein. V. The project was awarded for the bid amount of$12,307,560.31. 3-1 CITY OF SPOKANE VALLEY CONTRACT FORMS PHASE 2-SULLIVAN ROAD WEST BRIDGE REPLACEMENT PROJECT BID NO: 14-039 IN WITNESS WHEREOF, the Contractor has executed this instrument, on the day and year first below written and the City of Spokane Valley has caused this instrument to be executed by and in the name of the said City of Spokane Valley the day and year first above written. Executed by Contractor 71U l f , 2014. / Date :e / 614, i c -t4 Printed Name V'ce Title Signature City of Spokane Valley I Le +I2dZ&7M Printed Name 47klitij a 'tl= Signature 3-2 CITY OF SPOKANE VALLEY CONTRACT FORMS PHASE 2 - SULLIVAN ROAD WEST BRIDGE REPLACEMENT PROJECT BID NO: 14-039 Spokane 1Valley 23028945 BOND NO: CONTRACTOR'S PERFORMANCE BOND to City of Spokane Valley, Washington The City of Spokane Valley, Washington, in Spokane County, has awarded to Max J. Kunev Company (Contractor), as Principal, a contract for the construction of the project designated as Phase 2 - Sullivan Road West Bridge Replacement Project #0155 , Contract No. 14-039 in Spokane Valley, Washington, and said Principal is required under the terms of the Contract to furnish a performance bond in accordance with chapter 39.08 Revised Code of Washington (RCW). The Principal, and Liberty Mutual Insurance Company (Surety), a corporation, organized under the laws of MA and licensed to do business in the State of Washington as surety and named in the current list of "Surety Companies Acceptable in Federal Bonds" as published in the Federal Register by the Audit Staff Bureau of Accounts, U.S. Treasury Dept., are jointly and severally held and firmly bound to the City of Spokane Valley, as Obligee, in the sum of $12,307,560.31 total Contract amount (including Washington State sales tax), subject to the provisions herein. This performance bond shall become null and void, if and when the Principal, its heirs, executors, administrators, successors, or assigns shall well and faithfully perform all of the Principal's obligations under the Contract and fulfill all the terms and conditions of all duly authorized modifications, additions, and changes to said Contract that may hereafter be made, at the time and in the manner therein specified; shall warranty the work as provided in the Contract and shall indemnify and hold harmless the Obligee from any defects in the workmanship and materials incorporated into the work for the period identified in the Contract; and if such performance obligations have not been fulfilled, this bond shall remain in full force and effect. The Surety for value received agrees that no change, extension of time, alteration or addition to the terms of the Contract, the specifications accompanying the Contract, or to the work to be performed under the Contract shall in any way affect its obligation on this bond, and waives notice of any change, extension of time, alteration or addition to the terms of the Contract or the work performed. The Surety agrees that modifications and changes to the terms and conditions of the Contract that increase the total amount to be paid the Principal shall automatically increase the obligation of the Surety on this bond and notice to Surety is not required for such increased obligation. This bond may be executed in two original counterparts, and shall be signed by the parties' duly authorized officers. This bond will only be accepted if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf of the surety. PRINCIPAL (CONTRACTOR) Max J. Kuney Company Principal Signature Date Daniel R. Kuney Printed Name Vice President al Insurance Company Heather Anderson 7/28/2014 Date Printed Name Attorney -in -Fact Title Title Name, address, and telephone of local office/agent of Surety Company is: Wells Fargo Insurance Services USA, Inc. 601 W. Main, Suite 1400, Spokane, WA 99201 (509)358-3800 3-3 CITY OF SPOKANE VALLEY PHASE 2 - SULLIVAN ROAD WEST BRIDGE REPLACEMENT PROJECT BID NO: 14-039 CONTRACT FORMS Spokane ....Valley - BOND NO: 23028945 CONTRACTOR'S PAYMENT BOND (FEDERALLY FUNDED PROJECT) to City of Spokane Valley, Washington The City of Spokane Valley, Washington, in Spokane County, has awarded to Max J. Kunev Company (Contractor), as Principal, a contract for the construction of the project designated as Phase 2 - Sullivan Road West Bridee Replacement Project #0155 , Contract No. 14-039 in Spokane Valley, Washington, and said Principal is required under the terms of the Contract to furnish a payment bond in accordance with chapter 39.08 Revised Code of Washington (RCW) and chapter 60.28 RCW. Liberty Mutual Insurance Company Sure a corporation organized The Principal, and (Surety), g under the laws of MA and licensed to do business in the State of Washington as surety and named in the current list of "Surety Companies Acceptable in Federal Bonds" as published in the Federal Register by the Audit Staff Bureau of Accounts, U.S. Treasury Dept., are jointly and severally held and firmly bound to the City of Spokane Valley, as Obligee, in the sum of $12,307,560.31 total Contract amount, subject to the provisions herein. This payment bond shall cover any and all taxes incurred pursuant to Titles 50 and 51 RCW, taxes imposed on the Principal pursuant to Title 82 RCW, and any additional sales taxes. This payment bond shall become null and void, if and when the Principal, its heirs, executors, administrators, successors, or assigns shall pay all persons in accordance with chapters 39.08, 39.12, and 60.28 RCW, including all workers, laborers, mechanics, subcontractors, and materialmen, and all persons who shall supply such contractor or subcontractor with provisions and supplies for the carrying on of such work; shall pay all taxes due pursuant to Titles 50, 51, and 82 RCW; and shall indemnify and hold harmless the Obligee from all loss, cost or damage which Obligee may suffer by reason of the failure of Principal to make such required payments; and if such payment obligations have not been fulfilled, this bond shall remain in full force and effect. The Surety for value received agrees that no change, extension of time, alteration or addition to the terms of the Contract, the specifications accompanying the Contract, or to the work to be performed under the Contract shall in any way affect its obligation on this bond, except as provided herein, and waives notice of any change, extension of time, alteration or addition to the terms of the Contract or the work performed. The Surety agrees that modifications and changes to the terms and conditions of the Contract that increase the total amount to be paid the Principal shall automatically increase the obligation of the Surety on this bond and notice to Surety is not required for such increased obligation. This bond may be executed in two original counterparts, and shall be signed by the parties' duly authorized officers. This bond will only be accepted if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf of the surety. PRINCIPAL (CONTRACTOR) Max J. Kuney Company Principal Signature Daniel R. Kuney 7/28/2014 Date Printed Name Vice President t .I Insurance Company 7/28/2014 Date Heather Anderson Printed Name Attorney -in -Fact Title Title Name, address, and telephone of local office/agent of Surety Company is: Wells Fargo Insurance Services USA, Inc. 601 W. Main, Suite 1400, Spokane, WA 99201 (509)358-3800 3-4 CITY OF SPOKANE VALLEY PHASE 2 - SULLIVAN ROAD WEST BRIDGE REPLACEMENT PROJECT BID NO: 14-039 CONTRACT FORMS THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. ;ThY^ Por of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Certificate No. 8354947 American Fire and Casualty Company Liberty Mutual Insurance Company The Ohio Casualty Insurance Company _ _ _ West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That American Fire & Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the "Companies'), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Chris Larson; Diana R. Williams,'ErrnL. Repp;`Georcte C..Schroeder; H: Keith McNally; Heather. Anderson; Kathy Gurley; W. W_ Weller; Wm Dinneen all of the city of Spokane state of WA - - - each -individually if there be more than one named, its true and lawful attomey-in-fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed; any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons.-- - , _ - _ IN WITNESS WHEREOF, this Power of Attomey has' been subscribed by an uthorized officeEor official of the Companies and the corporate seals of the Companies have been affixed. thereto this 19th day of November' m , 2 3 _--..."7:J:-:';'..,.-: - - !', - ' ' _ _ STATE OF PENNSYLVANIA _ COUNTY OF MONTGOMERY ss By: American Fire and Casualty Company The Ohio Casualty lnsurance_Company Liberty Mutual Insurance Company - West American Insurance Company - David M. Carey, Assistant Secretary On this 19th day of November 2013 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary_ of American Fire and Casualty Company, Liberty Mutual Insurance. Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do,. execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. - IN WITNESS WHEREOF, have hereunto subscribed ntyyname and affixed my notarial seal at Plymouth Meeting, Pennsylvania, on the day and year first above written. - - ci1;;i»,c r/Et.:''�-f L:; t-1 NNS'et.VANrA 1/14--646 ry.C,auni•y By: Teresa Pastella , Notary Public ` This Power of Attomey is made and execu etpdrsuantloanoby Othority of the following By-laws and Authorizations OfAmerican Fire and Casualty Company, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company,'andigst Minoan -Insurance C,ompany which resolutions are now in full force and effect reading as follows: _ : . ARTICLE OFFICERS- Section 12. Power of Attorney. Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the President may prescribe, shall appoint such attomeys-in-fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obhgations. Such attomeys-in-fact, subject to the limitations set forth in their respective powers of attorney, snail have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation.- VVhen so executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attomey-in-fact. under ffie provisions of this article may be revoked at any tithe by the Board, the Chairman, the President or by the officer or officers granting such power or authority. - _ - _ = ARTICLE XIII - Execution of Contracts - SECTION 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, shall appoint such attomeys-in-fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their. respective powers of attomey, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company.. When so executed such instruments -shall be as binding as if signed by the president and attested by the secretary. - `. - . _ - _.- Certificate of Designation - The President -of the Company; acting pursuant to -the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys -in - fact as may be necessary to act on behalf of the Company to make, execute; seal, acknowledge and deliver,as surety thy and all undertakings, bonds, recognizances and other surety . obligations. . - - - Authorization - By unanimous consent of the Company's Board of Directors; the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copyof any power of attorney issued by the Company in connection with surety bonds, shall be valid 'and binding upon the Company with the same force and effect as though manually -affixed:- ; _ 1, Gregory W. Davenport, the undersigned, Assistant Secretary, of American Fire and Casualty Company, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attomey executed by said Companies, is in full force and effect and has not been revoked. }, - IN TESTIMONY WHEREOF, 1 have hereunto set my hand and affixed the seals of said Companiesthis - 28 t` tlay of - July - By: Gregory W. Davenport, Assistant Secretary _ 194133 ��CERTIFICATE OF LIABILITY INSURANCE A`VCcR�® DATE (MM/DD/YYYY) 7/31/2014 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(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 Commercial Lines - (509) 358-3800 Wells Fargo Insurance Services USA, Inc. - CA Lic#: OD08408 601 West Main Street, Suite 1400 Spokane, WA 99201-0635 CONTACT NAME: Kristy Bremer PHONE 509-358-3983 FAX 866-510-9588 (A/C. No. Ext): (A1C, No): E-MAIL o.comf ll t kris.bremer wesar ADDRESS: Y @ 9 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Valley Forge Insurance Company 20508 INSURED Max J. Kuney Company PO Box 4008 Spokane, WA 99220 INSURER B: Continental Insurance Company 35289 INSURER C : Navigators Insurance Company 42307 INSURER D : Columbia Casualty Company 31127 INSURER E : Berkley National Insurance Company 38911 INSURER F : Travelers Property Casualty Co of America 25674 • 8020038 REVISION NUMBER: See below 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MM/DDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X 2081227280 12/31/2013 12/31/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE RENTE PREM SESO(Ea occurrence) $ 300,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 15,000 X WA STOP GAP $1,000,000 PERSONAL & ADV INJURY $ 1,000,000 X LIMITED JOBSITE POLLUTION GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE POLICY OTHER: X LIMIT APPLIES JECT PER: LOC PRODUCTS - COMP/OP AGG $ 2,000,000 Ded Per Occurrence $ 5,000 B AUTOMOBILE X X x LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS $0 Liab.Dedu X SCHEDULED AUTOS NON -OWNED AUTOS X X 2081227294 12/31/2013 12/31/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ C X UMBRELLA UAB EXCESS LIAB X OCCUR CLAIMS -MADE SE13EXC5553291V 12/31/2013 12/31/2014 EACH OCCURRENCE $ 11,000,000 AGGREGATE $ 11,000,000 $ DED X RETENTION $ 10,000 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICE /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N I A 2081227280 WA STOP GAP ONLY 12/31/2013 12/31/2014 STATUTE OERH E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 $ D CONTRACTORS ERRORS AND OMMISSION 4033056237 07/01/2014 07/01/2015 $2,000,000 CONTRACTORS ERRORS & OMMISSIONS EACH CLAIM AND AGGREGATE $25,000 RETENTON DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) CG 25 04 05 09,CA 04 44 03 10,G18652J,G140331 D,SCA 23 500D 10/11 AS RESPECTS PHASE 2 - SULLIVAN RAOD WEST BRIDGE REPLACEMENT PROJECT #0155, FEDERAL AID #BRM4103(007) ADDITIONAL INSURED STATUS AND WAIVER OF SUBROGATION IF REQUIRED BY WRITTEN CONTRACT TO THE CITY OF SPOKANE VALLEY ITS OFFICERS, ELECTED OFFICIALS, EMPLOYEES, AND AGENTS; CH2M HILL INC ITS OFFICERS, ELECTED OFFICIALS, EMPLOYEES AND AGENTS; MARKET POINTE II, LLC; HANSON INDUSTRIES INC; THE STATE OF WASHINGTON DEPT OF NATURAL RESOURCES AND DEPT OF PARKS AND RECREATION THEIR ELECTED AND APPOINTED OFFICALS, AGENTS AND EMPLOYEES AS GRANTED BY THE ACTUAL POLICY FORMS ATTACHED TO THIS CERTIFICATE. ATION CITY OF SPOKANE VALLEY PUBLIC WORKS DEPARTMENT 11707 E SPRAGUE AVE, SUITE 106 SPOKANE VALLEY WA 99206 I 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 g«— The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01) (This certificate replaces certlfi1ate# 8020000 Issued on 7/31/2014) © 1988-2014 ACORD CORPORATION. All rights reserved. CID: 194133 SID: 8020038 Certificate of Insurance (Con't) OTHER Coverage INSR TYPE OF INSURANCE ADDL WVD POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE LIMIT LTR INSR SUBR (MM/DD/YY) (MM/DD/YY) E EXCESS LIABILITY OVER TO FOLLOW 8/11/2014 08/11/2015 $9,000,000 EACH OCCURRENCE PRIMARY NAVIGATORS POLICY $9,000,000 AGGREGATE LIMIT F SULLIVAN ROAD BRIDGE PROJECT TO FOLLOW 08/11/2014 07/01/2016 ALL RISK $12,310,000 LIMIT SUBJECT TO $5,000 DED. INCLS QUAKE AND FLOOD WITH 2% DED. ($50,000 MINIMUM DED) Certificate of Insurance-Con't POLICY NUMBER: 2081227280 COMMERCIAL GENERAL LIABILITY CG 25 04 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED LOCATION(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Location(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which can be attributed only to operations at a single designated "loca- tion" shown in the Schedule above: 1. A separate Designated Location General Aggregate Limit applies to each designated "location", and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Location General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except dam- ages because of "bodily injury" or "property damage" included in the "products -completed operations hazard", and for medical expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Loca- tion General Aggregate Limit for that desig- nated "location". Such payments shall not re- duce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Location General Aggre- gate Limit for any other designated "location" shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Decla- rations, such limits will be subject to the appli- cable Designated Location General Aggre- gate Limit. CG 25 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 2 0 B. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under Section 1— Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which cannot be attrib- uted only to operations at a single designated "location" shown in the Schedule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products -completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Location General Aggregate Limit. Page 2 of 2 C. When coverage for liability arising out of the "products -completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -completed Operations Ag- gregate Limit, and not reduce the General Ag- gregate Limit nor the Designated Location Gen- eral Aggregate Limit. D. For the purposes of this endorsement, the Defi- nitions Section is amended by the addition of the following definition: "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. E. The provisions of Section 111 — Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. © Insurance Services Office, Inc., 2008 CG 25 04 05 09 0 POLICY NUMBER: 2081227294 COMMERCIAL AUTO CA 04 44 0310 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE 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 the endorsement' This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Max J. Kuney Company Endorsement Effective Date: 12/31/2013 SCHEDULE Name(s) Of Person(s) Or Organization(s): .Any Person or organization with whore you are obligated by valid written contract to provide insurance such as is afforded under this Coverage Form. Information required to complete this Schedule, if not shown above, will be shown in the Declarations, The Transfer Of Rights Of Recovery Against Oth- ers To Us Condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "ac- cident" or the "loss" under a contract with that person or organization. CA 04 44 0310 ©Insurance Services Office, Inc., 2009 Page 1 of 1 11 CNA G -18652-J (Ed. 07-12) CONTRACTORS' GENERAL LIABILITY EXTENSION ENDORSEMENT It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART as follows. The changes this endorsement makes do not apply with respect to any coverage that has been excluded or amended by another endorsement attached to this policy. SCHEDULE Coverage is summarized below. For particulars and limitations affecting each coverage, please refer to the corresponding policy provisions in the body of this endorsement. 1. Additional Insureds Seven additional insured extensions. 2. Bodily Injury— Expanded Definition 3. Broad Knowledge of Occurrence/ Notice of Occurrence 4. Broad Named Insured 5. Broadened Liability Coverage For Damage To "Your Product" And "Your Work" Limit: $100,000. 6. Contractual Liability — Railroads Expanded definition of "insured contract." 7. Contractual Liability For Personal And Advertising Injury 8. Electronic Data Liability Loss of Electronic Data Limit: $100,000. 9. Expanded Personal And Advertising Injury - Discrimination Or Humiliation 10. Expected Or Intended Injury Reasonable force — "bodily injury" or "property damage." 11. General Aggregate Limits Of Insurance - Per Project 12. In Rem Actions 13. Incidental Health Care Malpractice Coverage 14. Joint Ventures/Partnership/Limited Liability Companies Coverage for your interest in such terminated or ended organizations. 15. Legal Liability/Alienated Premises/Borrowed Equipment Coverage Extended perils. Default limit increased to $500,000 for Damage to Premises Rented To You. $25,000 limit for "property damage" to borrowed tools or equipment at a jobsite. 16. Liberalization Clause 17. Liquor Liability Coverage Extension 18. Medical Payments Limits increased to $15,000. Reporting increased to three years from the date of accident. 19. Non -owned Aircraft Coverage 20. Non -owned Watercraft increased to 75 feet. 21. Primary And Non -Contributory To Other Insurance 22. Property Damage - Elevators 23. Supplementary Payments Cost of bail bonds increased to $5,000. Daily loss of earnings increased to $1,000. 24. Unintentional Failure To Disclose Hazards 25. Waiver of Subrogation - Blanket Waiver of subrogation where required by written contract or written agreement. 26. Wrap -Up Extension G -18652-J (Ed. 07-12) Page 1 of 12 Copyright, CNA All Rights Reserved. CNA 1. ADDITIONAL INSURED SECTION II — WHO IS AN INSURED is amended to include as an insured any person or organization (called additional insured) described in paragraphs A. through G. below whom you are required to add as an additional insured on this policy under a written contract or written agreement, provided the written contract or written agreement: i. Is currently in effect or becomes effective during the term of this policy; and II. Was executed prior to the "bodily injury," "property damage" or 'personal injury and advertising injury" for which the additional insured seeks coverage. However, we will not provide the additional insured any broader coverage or any higher limit of insurance than the least that is: a. The maximum permitted by law; b. Required in the written contract or written agreement; c. Afforded to you under this policy; or d. Described in the applicable paragraphs A. through G. below. A. Controlling Interest Any persons or organizations with a controlling interest in you but only with respect to their liability arising out of: t Their financial control of you; or 2. Premises they own, maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for such additional insured. B. Co-owner of Insured Premises A co-owner of a premises co -owned by you and covered under this insurance but only with respect to the co -owner's liability as co-owner of such premises. C. Lessor - Equipment 1. Any person or organization from whom you lease equipment, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person or organization. G -18652-J (Ed. 07-12) 2. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any "occurrence" which takes place after the equipment lease expires. D. Lessor - Land An owner or other interest from whom land has been leased by you but only with respect to liability arising out of the ownership, maintenance or use of that specific part of the land leased to you and subject to the following additional exclusions: This insurance does not apply to: 1. Any "occurrence" which takes place after you cease to lease that land; or 2. Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. E. Lessor - Premises A manager or lessor of premises but only with respect to liability arising out of the ownership, maintenance or use of that specific part of the premises leased to you and subject to the following additional exclusions: This insurance does not apply to: 1. Any "occurrence" which takes place after you cease to be a tenant in that premises; or 2. Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. F. Mortgagee, Assignee or Receiver A mortgagee, assignee or receiver but only with respect to their liability as mortgagee, assignee, or receiver and arising out of the ownership, maintenance, or use of a premises by you. This insurance does not apply to structural alterations, new construction or demolition operations performed by or for such additional insured. G. State or Governmental Agency or Subdivision or Political Subdivisions A state or governmental agency or subdivision or political subdivision subject to the following provisions: 1. This insurance applies only with respect to the following hazards for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization in connection with premises G -18652-J (Ed. 07-12) Page 2 of 12 Copyright, CNA All Rights Reserved. CNA you own, rent, or control and to which this insurance applies: a. The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk vaults, street banners, or decorations and similar exposures; or b. The construction, erection, or removal of elevators; or c. The ownership, maintenance or use of any elevators covered by this insurance. 2. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. 3. This insurance does not apply to: a. "Bodily injury," "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or "property damage" included within the "products -completed operations hazard." A governmental permit which requires you to add the governmental entity as an additional insured will trigger this Provision 1. as if the permit were a written contract. 2. BODILY INJURY — EXPANDED DEFINITION SECTION V — DEFINITIONS, the definition of "bodily injury" is changed to read: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including death, humiliation, shock, mental anguish or mental injury by that person at any time which results as a consequence of the bodily injury, sickness or disease. 3. BROAD KNOWLEDGE OF OCCURRENCE/ NOTICE OF OCCURRENCE Condition 2. Duties in The Event of Occurrence, Offense, Claim or Suit of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is amended to add the following provisions: A. BROAD KNOWLEDGE OF OCCURRENCE G -18652-J (Ed. 07-12) You must give us or our authorized representative notice of an "occurrence," offense, claim, or "suit" only when the "occurrence," offense, claim or "suit" is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) An executive officer or the employee designated by you to give such notice, if you are a corporation; or (4) A manager, if you are a limited liability company. B. NOTICE OF OCCURRENCE Your rights under this Coverage Part will not be prejudiced if you fail to give us notice of an "occurrence," offense, claim or "suit" and that failure is solely due to your reasonable belief that the "bodily injury" or "property damage" is not covered under this Coverage Part. However, you shall give written notice of this "occurrence," offense, claim or "suit" to us as soon as you are aware that this insurance may apply to such "occurrence," offense claim or "suit." 4. BROAD NAMED INSURED A. Any subsidiary or affiliate organization, other than a partnership, joint venture or limited liability company, in which a Named Insured specifically shown in the Declarations has management control, directly or through one or more subsidiary organizations, at the time of loss will qualify as a Named Insured but only if there is no other similar insurance available to such organization, nor similar insurance which would be available but for exhaustion of its limits. For the purpose of this provision, similar insurance means general liability or equivalent insurance, no matter whether its coverage is broader or narrower than that provided by this insurance. But if the only other similar insurance is for a "consolidated (wrap-up) program," then a subsidiary that qualifies as a Named Insured on such project -specific insurance can still qualify as a Named Insured on this insurance, but not for projects covered by the "consolidated (wrap-up) program." [Please see Item 26.C. of this endorsement for the definition of "consolidated (wrap-up) program."j B. This endorsement does not apply to any organization for which coverage is excluded by another endorsement attached to this policy. C. Only for the purpose of this endorsement: G -18652-J (Ed. 07-12) Page 3 of 12 Copyright, CNA All Rights Reserved. CNA 1. Management control means: a. Ownership interest representing more than 50% of the voting, appointment, or designation power for the subsidiary organization's governing body; or b. Having the right, pursuant to a written contract, or pursuant to the by-laws, charter, operating agreement, or similar document of a specifically shown Named Insured or controlled subsidiary organization to select, appoint, or designate a majority of the subsidiary organization's governing body. Such contract or document must have been created prior to the time of Toss; or c. Having the right, pursuant to a written trust agreement, to protect, control the use of, encumber or transfer and sell property held by a trust. 2. Governing body means the Board of Directors of a corporation. 3. Loss means: a. The occurring of the "bodily injury" or "property damage"; or b. The committing of the offense that caused the "personal and advertising injury." D. The insurance provided by this policy applies to Named Insureds when trading under their own names, or under such trading names or doing - business -as (DBA) names as any should choose to employ. 5. BROADENED LIABILITY COVERAGE FOR DAMAGE TO "YOUR PRODUCT" AND "YOUR WORK" A. Under SECTION 1 — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Paragraph 2. Exclusions is amended to delete exclusions k. and 1. and replace them with the following: [This insurance does not apply to:] k. Damage to Your Product "Property damage" to "your product' arising out of it, or any part of it except when caused by or resulting from: (1) Fire; (2) Smoke; (3) Collapse; or (4) Explosion. G -18652-J (Ed. 07-12) 1. Damage to Your Work "Property damage" to "your work" arising out of it, or any part of it and included in the "products - completed operations hazard." This exclusion does not apply: (1) If the damaged work or the work out of which the damage arises was performed on your behalf by a subcontractor; or (2) If the cause of loss to the damaged work arises as a result of: (a) Fire; (b) Smoke; (c) Collapse; or (d) Explosion. B. The following paragraph is added to SECTION III — LIMITS OF INSURANCE: Subject to 5. above, $100,000 is the most we will pay under Coverage A for the sum of damages arising out of any one "occurrence" because of "property damage" to "your product" and "your work" that is caused by fire, smoke, collapse or explosion and is included within the "product -completed operations hazard." This sublimit does not apply to "property damage" to "your work" if the damaged work or the work out of which the damage arises was performed on your behalf by a subcontractor. C. This Provision 5. Broadened Liability Coverage For Damage To "Your Product" And "Your Work" does not apply if an endorsement of the same name is attached to this policy. 6. CONTRACTUAL LIABILITY — RAILROADS With respect to operations performed within 50 feet of railroad property, the definition of "insured contract" in SECTION V — DEFINITIONS is replaced by the following: "Insured Contract" means: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; b. A sidetrack agreement; c. Any easement or license agreement; G -18652-J (Ed. 07-12) Page 4 of 12 Copyright, CNA All Rights Reserved. CNA d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; (2) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in (1) above and supervisory, inspection, architectural or engineering activities. 7. CONTRACTUAL LIABILITY FOR PERSONAL AND ADVERTISING INJURY Under SECTION I— COVERAGE B —PERSONAL AND ADVERTISING INJURY LIABILITY, Paragraph 2. Exclusions is amended to delete exclusion e. Contractual Liability. This provision 7. does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part. 8. ELECTRONIC DATA LIABILITY A. Under SECTION 1 — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions is amended to delete exclusion p. Electronic Data and replace it with the following: [This insurance does not apply to:] p. Electronic Data G -18652-J (Ed. 07-12) Damages arising out of the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate "electronic data" that does not result from physical injury to tangible property. However, this exclusion does not apply to liability for damages because of "bodily injury." B. . The following paragraph is added to SECTION III - LIMITS OF INSURANCE: Subject to 5. above, $100,000 is the most we will pay under Coverage A for all damages arising out of any one "occurrence" because of "property damage" that results from physical injury to tangible property and arises out of "electronic data." C. The following definition is added to the SECTION V — DEFINITIONS: "Electronic data" means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software (including systems and applications software), hard or floppy disks, CD-ROMS, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. D. For the purposes of the coverage provided by this endorsement, the definition of "property damage" in SECTION V — DEFINITIONS is replaced by the following: 17. "Property damage" means: a. Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; b. Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of the "occurrence" that caused it; or c. Loss of, loss of use of, damage to, corruption of, inability to access, or inability to properly manipulate "electronic data," resulting from physical injury to tangible property. All such Toss of "electronic data" shall be deemed to occur at the time of the "occurrence" that caused It. For the purposes of this insurance, "electronic data is not tangible property. E. If Electronic Data Liability is provided at a higher limit by another endorsement attached to G -18652-J (Ed. 07-12) Page 5 of 12 Copyright, CNA All Rights Reserved. CNA this policy, then the $100,000 limit provided by this Provision 8. Electronic Data Liability is part of, and not in addition to, that higher limit. 9. EXPANDED PERSONAL AND ADVERTISING INJURY - DISCRIMINATION OR HUMILIATION A. SECTION V — DEFINITIONS is amended to add the following to the definition of "Personal and advertising injury": h. Discrimination or humiliation that results in injury to the feelings or reputation of a natural person, but only if such discrimination or humiliation is: (1) Not done intentionally by or at the direction of: (a) The insured; or (b) Any "executive officer," director, stockholder, partner, member or manager (if you are a limited liability company) of the insured; and (2) Not directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person or persons by any insured. B. Under SECTION I — COVERAGE B — PERSONAL AND ADVERTISING INJURY LIABILITY, Paragraph 2. Exclusions is amended to add the following additional exclusions: [This insurance does not apply to:] Discrimination Relating To Room, Dwelling or Premises "Personal or advertising injury" caused by discrimination directly or indirectly related to the sale, rental, lease or sub -lease or prospective sale, rental, lease or sub -lease of any room, dwelling or premises by or at the direction of any insured. Fines Or Penalties Fines or penalties levied or imposed by a governmental entity because of discrimination. This provision 9. does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part. 10. EXPECTED OR INTENDED INJURY Under SECTION 1— COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Paragraph 2. Exclusions is G -18652-J (Ed. 07-12) amended to delete exclusion a. Expected or Intended Injury and replace it with the following: [This insurance does not apply to:] a. Expected or Intended Injury "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. 11. GENERAL AGGREGATE LIMITS OF INSURANCE - PER PROJECT A. For each construction project away from premises you own or rent, a separate Construction Project General Aggregate Limit, equal to the amount of the General Aggregate Limit, is the most we will pay for the sum of: 1. All damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard"; and 2. All medical expenses under Coverage C, that arise from "occurrences" or accidents which can be attributed solely to ongoing operations at that construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations, nor the Construction Project Aggregate Limit of any other construction project. B. All: 1. Damages under Coverage B, regardless of the number of locations or construction projects involved; 2. Damages under Coverage A, caused by "occurrences" which cannot be attributed solely to ongoing operations at a single construction project, except damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard"; and 3. Medical expenses under Coverage C caused by accidents which cannot be attributed solely to ongoing operations at a single construction project, will reduce the General Aggregate Limit shown in the Declarations. G -18652-J (Ed. 07-12) Page 6 of 12 Copyright, CNA All Rights Reserved. CNA C. The limits shown in the Declarations for Each Occurrence, for Damage To Premises Rented To You and for Medical Expense continue to apply, but will be subject to either the Construction Project Aggregate Limit or the General Aggregate Limit, depending on whether the "occurrence" can be attributed solely to ongoing operations at a particular construction project. D. When coverage for liability arising out of the "products -completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard," regardless of the number of locations involved will reduce the Products -Completed Operations Aggregate Limit shown in the Declarations. E. If a single construction project away from premises owned by or rented to the insured has been abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. F. The provisions of SECTION 1I1 — LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue to apply as stipulated. 12. IN REM ACTIONS Any action in rem against any vessel owned or operated by or for you, or chartered by or for you will be treated in the same manner as though the action were in personam against you. In rem is a term used to designate actions instituted against the thing, as distinct from actions against the person, which are said to be in personam. 13. INCIDENTAL HEALTH CARE MALPRACTICE COVERAGE A. With respect only to "bodily injury" that arises out of a "health care incident," COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY OF SECTION I — COVERAGES is amended to replace Insuring Agreement Paragraphs 1.b.(1) and 1.b.(2) with the following: b. This insurance applies to "bodily injury" only if you are not in the business of providing professional health care services, and only if: (1) The "bodily injury" is caused by an "occurrence" that takes place in the "coverage territory." For the purpose of this insurance: G -18652-J (Ed. 07-12) (a) "Bodily injury" caused by a "health care incident" will be considered caused by an "occurrence"; and (b) All acts, errors or omissions that are logically connected by any common fact, circumstance, situation, transaction, event, advice or decision will be considered to constitute a single "occurrence"; (2) The "bodily injury" occurs during the policy period. All "bodily injury" arising from an "occurrence" will be deemed to have occurred at the time of the first act, error, or omission that is part of the "occurrence"; and B. With respect only to the insurance provided by this Provision 13., Exclusion 2.e. Employer's Liability of SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE, is amended to append the following: Only for "bodily injury" not covered by other liability insurance (including state -sanctioned self insurance) available to the insured (or which would be available but for exhaustion of its limits), this exclusion does not apply to "bodily injury" that arises out of a "health care incident." C. SECTION V — DEFINITIONS is amended to add the following new definition: "Health care incident" means a negligent act, error or omission by your "employees" or "volunteer workers" working on your behalf in the rendering of or failure to render professional health care services in any of the following capacities, or the related furnishing of food, beverages, medical supplies or appliances: a. Physician; b. Nurse; c. Emergency medical technician; d. Paramedic; e. Chiropractor; f. Dentist; g. Athletic trainer; h. Audiologist; I. Physical therapist; j. Psychologist; k. Speech therapist; I. Other allied health professional; or G -18652-J (Ed. 07-12) Page 7 of 12 Copyright, CNA All Rights Reserved. CNA m. Provider of first aid or Good Samaritan services rendered in an emergency and for which no payment is demanded or received. D. SECTION 1 — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions is amended to add the following additional exclusions. These new exclusions apply only to this Incidental Health Care Malpractice Coverage: [This insurance does not apply to:] Dishonesty or Crime Any dishonest, criminal or malicious act, error or omission. Clinical Trials / Product Testing Acts, errors or omissions that occur in the course of human clinical trials or product testing. Medicare/Medicaid Fraud IVledicare or Medicaid fraud or abuse. Services Excluded by Endorsement Any "health care incident" for which coverage is excluded by endorsement. E. SECTION V — DEFINITIONS is amended to add the following subparagraph to Paragraph f. of the definition of "insured contract": Paragraph 1. does not include that part of any contract or agreement: (4) Under which you assume another's tort liability for "bodily injury" arising out of the rendering of or failure to render professional health care services. F. SECTION I1 — WHO IS AN INSURED is amended to add the following provisions: 1. Your "employees" are insureds with respect to: a. "bodily injury" to a co -"employee" while in the course of the co -"employee's" employment by you or while performing duties related to the conduct of your business; and b. "bodily injury" to a "volunteer worker" while performing duties related to the conduct of your business; when such "bodily injury" arises out of a "health care incident." 2. Your "volunteer workers" are insureds with respect to: G. G -18652-J (Ed. 07-12) a. "bodily injury" to a co -"volunteer worker while performing duties related to the conduct of your business; and b. "bodily injury" to an "employee" while in the course of the "employee's" employment by you or while performing duties related to the conduct of your business; when such "bodily injury" arises out of a "health care incident." 3. Paragraphs 2.a. (1)(a), (b) and (c) of SECTION II — WHO IS AN INSURED do not apply to "bodily injuryfor which insurance is provided this Provision 13. 4. Paragraph 2.a.(1)(d) of SECTION II — WHO IS AN INSURED is deleted. With respect to the insurance provided by this Provision 13., the following is added to Paragraph 4.b.(1) of SECTION IV — COMMERCIALGENERAL LIABILITY CONDITIONS: To the extent this insurance applies, it is excess over any of the other insurance (including qualified self insurance), whether primary, excess, contingent or on any other basis, except for insurance purchased specifically by you to be excess of this policy. 14. JOINT VENTURES / PARTNERSHIP / LIMITED LIABILITY COMPANIES A. The following is added to SECTION II — WHO IS AN INSURED: 4. You are an insured when you had an interest in a joint venture, partnership or limited liability company which terminated or ended prior to or during this policy period, but only to the extent of your interest in such joint venture, partnership or limited liability company. This coverage does not apply: a. Prior to the termination date of any joint venture, partnership or limited liability company; b. If there is other valid and collectible insurance purchased specifically to insure the partnership, joint venture or limited liability company; or c. To a joint venture, partnership or limited liability company which is or was insured under a "consolidated (wrap- up) insurance program." G -18652-J (Ed. 07-12) Page 8 of 12 Copyright, CNA All Rights Reserved. CNA [Please see Item 26.C. of this endorsement for the definition of "consolidated (wrap-up) program."] B. The last paragraph of SECTION 11 — WHO IS AN INSURED is deleted and replaced by the following: Except as provided under the Contractors' General Liability Extension Endorsement or by the attachment of another endorsement (if any), no person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured In the Declarations. 15. LEGAL LIABILITY/ALIENATED PREMISES/ BORROWED EQUIPMENT A. Under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions is amended to delete exclusion j. Damage to Property in its entirety and replace it with the following: [This insurance does not apply to:] j. Damage to Property "Property damage" to: (1) Property you own, rent, or occupy; (2) Premises you sell, give away or abandon, if the "property damage" arises out of any part of those premises; (3) Property loaned to you; (4) Personal property in the care, custody or control of the insured; That particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations, if the "property damage" arises out of those operations; or That particular part of any property that must be restored, repaired or replaced because "your work" was incorrectly performed on it. Paragraph (2) of this exclusion does not apply if the premises are "your work." Paragraphs (3) and (4) of this exclusion do not apply to "property damage" to tools or equipment loaned to you. A separate limit of insurance applies to such tools or equipment that are damaged while being used in your operations. (5) (6) G -18652-J (Ed. 07-12) Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire) to premises rented to you or temporarily occupied by you with the permission of the owner, or to the contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to Damage To Premises Rented To You as described In SECTION III -LIMITS OF INSURANCE. Paragraphs (3), (4), (5) and (6) of this exclusion do not apply to liability assumed under a sidetrack agreement. Paragraph (6) of this exclusion does not apply to "property damage" included in the "products -completed operations hazard." B. Under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE the last paragraph of Paragraph 2. Exclusions is deleted and replaced by the following. Exclusions c, through n. do not apply to damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner nor to the contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described in SECTION 111 — LIMITS OF INSURANCE. C. The following paragraph is added to SECTION III — LIMITS OF INSURANCE: Subject to 5. above, $25,000 is the most we will pay under Coverage A for damages arising out of any one "occurrence" because of "property damage" to tools or equipment loaned to you by others that occurs while the equipment is being used to perform operations. D. Paragraph 6. Damage To Premises Rented To You Limit of SECTION 111 — LIMITS OF INSURANCE is replaced by the following: 6. Subject to Paragraph 5. above, (the Each Occurrence Limit), the Damage To Premises Rented To You Limit is the most we will pay under SECTION — 1 — COVERAGE A for damages because of "property damage" to any one premises while rented to you or temporarily occupied by you with the permission of the owner, including contents of such premises rented to you for a period of 7 or fewer consecutive days. The Damage To Premises Rented To You Limit is the greater of: a. $500,000; or G -18652-J (Ed. 07-12) Page 9 of 12 Copyright, CNA All Rights Reserved. CNA b. The Damage To Premises Rented To You Limit shown in the Declarations. E. Paragraph 4.b.(1)(a)(ii) of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is deleted and replaced by the following: (ii) That is property insurance for premises rented to you, for premises temporarily occupied by you with the permission of the owner; or for personal property of others in your care, custody or control; F. This Provision 15. does not apply if Damage To Premises Rented To You Liability under SECTION — 1 — COVERAGE A is excluded by endorsement. 16. LIBERALIZATION CLAUSE If we adopt a change in our forms or rules which would broaden coverage for contractors under this endorsement without an additional premium charge, your policy will automatically provide the additional coverage as of the date the revision is effective in your state. 17. LIQUOR LIABILITY Under SECTION 1— COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions is amended to delete exclusion c. Liquor Liability. This provision 17. does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part. 18. MEDICAL PAYMENTS A. Paragraph 7. Medical Expense Limit, of SECTION III — LIMITS OF INSURANCE is deleted and replaced by the following: 7. Subject to Paragraph 5. above (the Each Occurrence Limit), the Medical Expense Limit is the most we will pay under SECTION — 1 — COVERAGE C for all medical expenses because of "bodily injury" sustained by any one person. The Medical Expense Limit is the greater of: (1) $15,000; or (2) The amount shown in the Declarations for Medical Expense Limit. B. Paragraph 1.a.(3)(b) of SECTION I — COVERAGE C MEDICAL PAYMENTS, is replaced by the following: (b) The expenses are incurred and reported to us within three years of the date of the accident; and G -18652-J (Ed. 07-12) This paragraph B. does not apply to medical expenses incurred in the state of Missouri. 19. NON -OWNED AIRCRAFT Under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY. Paragraph 2. Exclusions is amended such that exclusion g. Aircraft, Auto or Watercraft does not apply to an aircraft you do not own, provided that: 1. The pilot in command holds a currently effective certificate issued by the duly constituted authority of the United States of America or Canada, designating that person as a commercial or airline transport pilot; 2. The aircraft is rented to you with a trained, paid crew; and 3. The aircraft does not transport persons or cargo for a charge. 20. NON -OWNED WATERCRAFT Under SECTION 1— COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Paragraph 2. Exclusions is amended to delete subparagraph (2) of exclusion g. Aircraft, Auto or Watercraft and replace it with the following. [This exclusion does not apply to:] (2) A watercraft you do not own that is: (a) Less than 75 feet long; and (b) Not being used to carry persons or property for a charge. 21. PRIMARY AND NON-CONTRIBUTORY TO OTHER INSURANCE With respect to any person or organization that is an additional insured under this Coverage Part, the following is added to Paragraph 4. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If you have agreed in writing in a contract or agreement that this insurance is primary and non- contributory relative to an additional insured's own insurance, then this insurance is primary and we will not seek contribution from that other insurance. For the purpose of this Provision 21., the additional insured's own insurance means insurance on which the additional insured is a Named Insured. This Provision 21. does not apply in situations where the endorsement on this policy affording coverage to the additional insured specifies that this insurance is excess over any other insurance available to that additional insured. 22. PROPERTY DAMAGE — ELEVATORS G -18652-J (Ed. 07-12) Page 10 of 12 Copyright, CNA All Rights Reserved. CNA A. Under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions is amended such that exclusion k. Damage to Your Product, and subparagraph (3), (4) and (6) of exclusion j. Damage to Property do not apply "property damage" that results from the use of elevators. B. With respect only to the coverage provided by this enriorsement, C_nditinn 4, Other Insurance in SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is amended to add the following subparagraph b.(1)(a)(v): 4. Other Insurance b. Excess Insurance (1) This insurance is excess over: (a) Any of the other insurance, whether primary, excess, contingent or on any other basis: (v) That is Property insurance covering property of others damaged from the use of elevators. 23. SUPPLEMENTARY PAYMENTS A. Linder Section I — Supplementary Payments — Coverages A and B, Paragraph 1.b., the limit of $250 shown for the cost of bail bonds is replaced by $5,000: B. In Paragraph 1.d., the limit of $250 shown for daily loss of earnings is replaced by $1,000. 24. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS If unintentionally you should fail to disclose all existing hazards at the inception date of your policy, we will not deny coverage under this Coverage Part because of such failure. 25. WAIVER OF SUBGROGATION - BLANKET Under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, The Transfer Of Rights Of Recovery Against Others To Us Condition is amended by the addition of the following: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of: 1. Your ongoing operations; or 2. "Your work" included in the "products completed operations hazard." G -18652-J (Ed. 07-12) However, this waiver applies only when you have agreed in writing to waive such rights of recovery in a contract or agreement, and only if the contract or agreement: 1. Is in effect or becomes effective during the term of this policy; and 2. Was executed prior to loss. 2F. WRAP -IID FXTFNSIr]N,_ OWNER CONTROLLED INSURANCE PROGRAM, CONTRACTOR CONTROLLED INSURANCE PROGRAM OR CONSOLIDATED (WRAP-UP) INSURANCE PROGRAMS Note: The following provision does not apply to any public construction project in the state of Oklahoma, nor to any construction project in the state of Alaska, that is not permitted to be insured under a "consolidated (wrap-up) insurance program" by applicable state statute or regulation: If the endorsement EXCLUSION — CONSTRUCTION WRAP-UP or another exclusionary endorsement pertaining to Owner Controlled Insurance Programs (O.0.I.P.) or Contractor Controlled Insurance Programs (C.C.I.P.) is attached to this policy, then the following changes apply: A. The following wording is added to the endorsement: With respect to a "consolidated (wrap-up) insurance program" project in which you are or were involved, this exclusion does not apply to those sums you become legally obligated to pay as damages because of: 1. "Bodily injury," "property damage," or "personal or advertising injury" that occurs during your ongoing operations at the project, or during such operations of anyone acting on your behalf; nor 2. "Bodily injury" or "property damage" included within the "products -completed operations hazard" that arises out of those portions of the project that are not "residential structures." B. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is amended to add the following subparagraph 4.b.(1)(c) to Condition 4. Other Insurance: [This insurance is excess over:] (c) Any of the other insurance whether primary, excess, contingent or any other basis that is insurance available to you as a result of your being a participant in a "consolidated (wrap-up) insurance program," but only as G -18652-J (Ed. 07-12) Page 11 of 12 Copyright, CNA All Rights Reserved. CNA respects your involvement in that "consolidated (wrap-up) insurance program." C. SECTION V — DEFINITIONS Is amended to add the following definition: "Consolidated (wrap-up) insurance program" means a construction, erection or demolition project for which the prime contractor/project manager or owner of the construction project has secured general liability insurance covering some or all of the contractors or subcontractors involved in the project, such as an Owner Controlled Insurance Program (O.C.I.P.) or Contractor Controlled Insurance Program (C.C.LP.). "Residential structure" means any structure where 30% or more of the square foot area is used or is intended to be used for human All other terms and conditions of the Policy remain unchanged. G -18652-J (Ed. 07-12) residency including but not limited to single or multifamily housing, apartments, condominiums, townhouses, co-operatives or planned unit developments and also includes their common areas and/or appurtenant structures (including pools, hot tubs, detached garages, guest houses or any similar structures). When there is no individual ownership of units, residential structure does not include military housing, college/university housing or dormitories, long term care facilities, hotels, or motels. Residential structure also does not include hospitals or prisons. This provision 26. does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. Material used with permission of ISO Properties, Inc G -18652-J (Ed. 07-12) Page 12 of 12 Copyright, CNA All Rights Reserved. CNA G -140331-D (Ed. 01/13) BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS — WITH PRODUCTS -COMPLETED OPERATIONS COVERAGE It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART as follows: SCHEDULE (OPTIONAL) Name of Additional Insured Persons Or Organizations (As required by "written contract" per Paragraph A. below.) Locations of Covered Operations (As per the "written contract," provided the location is within the "coverage territory" of this Coverage Part.) A. Section II - Who Is An Insured is amended to include as an additional insured: 1. Any person or organization whom you are required by "written contract" to add as an additional insured on this Coverage Part; and 2. The particular person or organization, if any, scheduled above. B. The insurance provided to the additional insured is limited as follows: 1. The person or organization is an additional insured only with respect to liability for "bodily injury," "property damage," or "personal and advertising injury" caused in whole or in part by: a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your ongoing operations specified in the "written contract"; or b. "Your work" that is specified in the "written contract" but only for "bodily injury" or "property damage" included in the "products -completed operations hazard," and only if: (1) The "written contract" requires you to provide the additional insured such coverage; and (2) This Coverage Part provides such coverage. 2. If the "written contract" specifically requires you to provide additional insurance coverage via the 10/01 edition of CG2010 (aka CG 20 10 10 01), or via the 10/01 edition of CG2037 (aka CG 20 37 10 01), or via the 11/85 edition of CG2010 (aka CG 20 10 11 85), then in paragraph B.1. above, the words 'caused in whole or in part by are replaced by the words 'arising out of. 3. We will not provide the additional insured any broader coverage or any higher limit of insurance than: a. The maximum permitted by law; b. That required by the "written contract"; c. That described in B.1. above; or d. That afforded to you under this policy, whichever is less. 4. Notwithstanding anything to the contrary in Condition 4. Other Insurance (Section IV), this insurance is excess of all other insurance available to the additional insured whether on a primary, excess, contingent or G -140331-D (Ed. 01/13) Page 1 of 2 Copyright, CNA All Rights Reserved. CNA G -140331-D (Ed. 01/13) any other basis. But if required by the "written contract" to be primary and non-contributory, this insurance will be primary and non-contributory relative to insurance on which the additional insured is a Named Insured. 5. The insurance provided to the additional insured does not apply to "bodily injury," "property damage," or "personal and advertising injury" arising out of: a. The rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: (1) The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and (2) Supervisory, inspection, architectural or engineering activities; or b. Any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this Coverage Part. C. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: 1. The Duties In The Event of Occurrence, Offense, Claim or Suit condition is amended to add the following additional conditions applicable to the additional insured: An additional insured under this endorsement will as soon as practicable: (1) Give us written notice of an "occurrence" or an offense which may result in a claim or "suit" under this insurance, and of any claim or "suit" that does result; (2) Except as provided in Paragraph B.4. of this endorsement, agree to make available any other insurance the additional insured has for a loss we cover under this Coverage Part; Send us copies of all legal papers received, and otherwise cooperate with us in the investigation, defense, or settlement of the claim or "suit"; and (4) Tender the defense and indemnity of any claim or "suit" to any other insurer or self insurer whose policy or program applies to a loss we cover under this Coverage Part. But if the "written contract" requires this insurance to_be primary and non-contributory, this provision (4) does not apply to insurance on which the additional insured is a Named Insured. We have no duty to defend or indemnify an additional insured under this endorsement until we receive from the additional insured written notice of a claim or "suit." D. Only for the purpose of the insurance provided by this endorsement, SECTION V — DEFINITIONS is amended to add the following definition: "Written contract" means a written contract or written agreement that requires you to make a person or organization an additional insured on this Coverage Part, provided the contract or agreement: 1. Is currently in effect or becomes effective during the term of this policy; and 2. Was executed prior to: a. The "bodily injury" or "property damage"; or b. The offense that caused the "personal and advertising injury," for which the additional insured seeks coverage under this Coverage Part. (3) All other terms and conditions of the Policy remain unchanged. Material used with permission of ISO Properties, Inc. G -140331-D (Ed. 01/13) Page 2 of 2 Copyright, CNA All Rights Reserved. CNA SCA 23 500D (Ed. 10/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXTENDED COVERAGE ENDORSEMENT - BA PLUS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM I. LIABILTY COVERAGE A. Who Is An Insured The following is added to Section II, Paragraph B. A.1., Who Is An Insured: 1. a. Any incorporated entity of which the Named Insured owns a majority of the voting stock on the date of inception of this Coverage Form; provided that, b. The insurance afforded by this provision A.1. does not apply to any such entity that is an "insured" under any other liability "policy" C. providing "auto" coverage. 2. Any organization you newly acquire or form, other than a limited liability company, partnership or joint venture, and over which you maintain majority ownership interest. The insurance afforded by this provision A.2.: a. Is effective on the acquisition or formation date, and is afforded only until the end of the policy period of this Coverage Form, or the next anniversary of its inception date, whichever is earlier. b. Does not apply to: (1) "Bodily injury" or "property damage" caused by an "accident" that occurred before you acquired or formed the organization; or (2) Any such organization that is an "insured" under any other liability "policy" providing "auto" coverage. 3. Any person or organization that you are obligated to provide Insurance where required by a written contract or agreement is an insured, but only with respect to legal responsibility for acts or omissions of a person for whom Liability Coverage is afforded under this policy. 4. An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business. "Policy," as used in this provision A. Who Is An Insured, includes those policies that were in force on the inception date of this Coverage Form but: SCA 23 500D (Ed. 10/11) 11. A. B. C. D. E. 1. Which are no longer in force; or 2. Whose limits have been exhausted. Bail Bonds and Loss of Earnings Section II, Paragraphs A.2.a.(2) and A.2.a.(4) are revised as follows: 1. In a.(2), the limit for the cost of bail bonds is increased from $2,000 to $5,000, and 2. In a.(4), the limit for the Toss of earnings is increased from $250 to $500 a day. Fellow Employee Section II, Paragraph B.5 does not apply. Such coverage as is afforded by this provision C. is excess over any other collectible insurance. PHYSICAL DAMAGE COVERAGE Towing Section 111. Paragraph A.2., is revised to include Light Trucks up to 10,000 pounds G.V.W. Glass Breakage — Hitting A Bird Or Animal — Falling Objects Or Missiles The following is added to Section III, Paragraph A.3.: With respect to any covered "auto," any deductible shown in the Declarations will not apply to glass breakage if such glass is repaired, in a manner acceptable to us, rather than replaced. Transportation Expenses Section III, Paragraph A.4.a. is revised, with respect to transportation expense incurred by you, to provide: a. $60 per day, in lieu of $20; subject to b. $1,800 maximum, in lieu of $600. Loss of Use Expenses Section III, Paragraph A.4.b. is revised, with respect to loss of use expenses incurred by you, to provide: a. $1,000 maximum, in lieu of $600. Personal Property The following is added to Section Ili, Paragraph A.4. Copyright, CNA Corporation, 2000. Includes copyrighted material of the Insurance Services Office used with its permission. Page 1 of 3 CNA c. We will pay up to $500 for loss to Personal Property which is: (1) Owned by an "insured"; and (2) In or on the covered "auto." This coverage applies only in the event of a total theft of your covered "auto." This insurance is excess over any other collectible insurance and no deductible applies. F. Rental Reimbursement The following is added to Section III, Paragraph A.4.. d. We will pay for rental reimbursement expenses incurred by you for the rental of an "auto" because of "loss" to a covered "auto." Payment applies in addition to the otherwise applicable amount of each coverage you have on a covered "auto." No deductibles apply to this coverage. 1. We will pay only for those expenses incurred during the policy period beginning 24 hours after the "loss" and ending, regardless of the policy's expiration, with the lesser of the following number of days: (a) The number of days reasonably required to repair or replace the covered "auto"; or, (b) 15 days. 2. Our payment is limited to the lesser of the following amounts: (a) Necessary and actual expenses incurred; or, (b) $25 per day subject to a maximum of $375. 3. This coverage does not apply while there are spare or reserve "autos" available to you for your operations. 4. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided for under the Physical Damage Coverage Extension. G. Hired "Autos" The following is added to Section III. Paragraph A.: 5. Hired "Autos" If Physical Damage coverage is provided under this policy, and such coverage does not extend to Hired Autos, then Physical Damage coverage is extended to: SCA 23 500D (Ed. 10/11) SCA 23 500D (Ed. 10/11) a. Any covered "auto" you lease, hire, rent or borrow without a driver; and b. Any covered "auto" hired or rented by your "employee" without a driver, under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. c. The most we will pay for any one "accident" or "loss" is the actual cash value, cost of repair, cost of replacement or $75,000 whichever is Tess minus a $500 deductible for each covered auto. No deductible applies to "loss" caused by fire or lightning. d. The physical damage coverage as is provided by this provision will be limited to the types of physical damage coverage(s) provided on your owned "autos." e. Such physical damage coverage for hired "autos" will: (1) Include loss of use, provided it is the consequence of an "accident" for which the Named Insured is legally liable, and as a result of which a monetary loss is sustained by the leasing or rental concern. (2) Such coverage as is provided by this provision G.e.(1) will be subject to a limit of $750 per "accident." H. Airbag Coverage The following is added to Section III, Paragraph B.3. The accidental discharge of an airbag shall not be considered mechanical breakdown. I. Electronic Equipment Section III, Paragraphs B.4.c and B.4.d. are deleted and replaced by the following: c. Physical Damage Coverage on a covered "auto" also applies to "loss" to any permanently installed electronic equipment including its antennas and other accessories d. A $100 per occurrence deductible applies to the coverage provided by this provision. Diminution In Value The following Is added to Section III, Paragraph B.6. Subject to the following, the "diminution in value" exclusion does not apply to: J. Copyright, CNA Corporation, 2000. Includes copyrighted material of the Insurance Services Office used with its permission. Page 2 of 3 CNA a. Any covered "auto" of the private passenger type you lease, hire, rent or borrow, without a driver for a period of 30 days or less, while performing duties related to the conduct of your business; and b. Any covered "auto" of the private passenger type hired or rented by your "employee" without a driver for a period of 30 days or less, under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. c. Such coverage as is provided by this provision is limited to a "diminution in value" loss arising directly out of accidental damage and not as a result of the failure to make repairs; faulty or incomplete maintenance or repairs; or the installation of substandard parts. d. The most we will pay for "loss" to a covered "auto" in any one accident is the lesser of: (1) $5,000; or (2) 20% of the "auto's" actual cash value (ACV) III. Drive Other Car Coverage — Executive Officers The following is added to Sections II and III: 1. Any "auto" you don't own, hire or borrow is a covered "auto" for Liability Coverage while being used by, and for Physical Damage Coverage while in the care, custody or control of, any of your "executive officers," except: a. An "auto" owned by that "executive officer" or a member of that person's household; or b. An "auto" used by that "executive officer" while working in a business of selling, servicing, repairing or parking "autos." Such Liability and/or Physical Damage Coverage as is afforded by this provision will be: (1) Equal to the greatest of those coverages afforded any covered "auto"; and (2) Excess over any other collectible insurance. 2. For purposes of this provision, "executive officer" means a person holding any of the officer positions created by your charter, constitution, by-laws or any other similar SCA 23 500D (Ed. 10/11) SCA 23 500D (Ed. 10/11) governing document, and, while a resident of the same household, includes that person's spouse. Such "executive officers" are "insureds" while using a covered "auto" described in this provision. CONDITIONS V. BUSINESS AUTO CONDI I IONS A. Duties In The Event Of Accident, Claim, Suit Or Loss The following is added to Section IV, Paragraph A,2.a. (4) Your "employees" may know of an "accident" or "loss." This will not mean that you have such knowledge, unless such "accident" or "loss" is known to you or if you are not an individual, to any of your executive officers or partners or your insurance manager. The following is added to Section IV, Paragraph A.2.b. (6) Your "employees" may know of documents received concerning a claim or "suit." This will not mean that you have such knowledge, unless receipt of such documents is known to you or if you are not an individual, to any of your executive officers or partners or your insurance manager. B. Concealment, Misrepresentation or Fraud The following is added to Section IV, Paragraph B.2. Your failure to disclose all hazards existing on the date of inception of this Coverage Form shall not prejudice you with respect to the coverage afforded provided such failure or omission is not intentional. C. Policy Period, Coverage Territory Section IV, Paragraphs 7.(5).(a). is revised to provide: a. 45 days of coverage in lieu of 30 days V. DEFINITIONS Section V. Paragraph C. is deleted and replaced by the following: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including mental anguish, mental injury or death resulting from any of these Copyright, CNA Corporation, 2000. Includes copyrighted material of the Insurance Services Office used with its permission, Page 3 of 3 7/28/2014 Business Licensing Service:License QuerySearch • Contact us • Forms • About us • Home • Start your business • Change or update your business information • How to renew your license Search Business Licenses License Information: Entity Name: Business Name: License Type: Entity Type: UBI: Status: Location Address: 120 N RALPH ST SPOKANE, WA, 99202-4744 Q302 cmc7 MAX 3. KUNEY COMPANY MAX 3 KUNEY CO Washington State Business Profit Corporation 328031744 Business ID:001 Location ID:0001 To check the status of this company, go to Secretary of State and Department of Revenue. Licenses Held at this location Spokane General Business Spokane Valley General Business Governing People: DANIEL KUNEY MAX.) KUNEY IV ROBERT A HANEY SHELLY KUNEY Mailing Address: PO BOX 4008 SPOKANE, WA, 99220-0008 Status Active Active Expires 05/31/2015 05/31/2015 Information Current as of 07/28/2014 6:40AM Pacific Time New Search This site is limited to searching for business licenses issued through the Washington State Business Licensing Service. • Contact us • Forms • About us • Privacy ©2011 Washington State Department of Revenue and its licensors. All rights reserved. First Issued 10/15/2012 07/25/2014 http://bls.dor.wa.g ov/LicenseSearchllq sLicenseDetail.aspX?Ret1D=1905193 1/1 4 194133 AR® ATE CERTIFICATE OF LIABILITY INSURANCE D 12/31/2014 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(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 Kristy Bremer Commercial Lines-(509)358-3800 PHONE 509-358-3983 FAX 866-510-9588 (NC.No.Ext): (A1C,No): Wells Fargo Insurance Services USA,Inc.-CA Lic#:OD08408 AEDDREMAIL SS: ty @we9 kris Bremerllsfar o.com 601 West Main Street,Suite 1400 INSURER(S)AFFORDING COVERAGE NAIC# Spokane,WA 99201-0635 INSURER A: Zurich American Insurance Co 16535 INSURED INSURER B: Navigators Insurance Company 42307 Max J.Kuney Company INSURER C: Columbia Casualty Company 31127 PO Box 4008 INSURER D: Westchester Fire Insurance Company 10030 Spokane,WA 99220 INSURER E: Travelers Property Casualty Co of America 25674 INSURER F: COVERAGES CERTIFICATE NUMBER: 8594265 REVISION NUMBER: See below 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. IEFF POLICY EXP TR TYPE OF INSURANCE IVSD SUBRwPOLICY NUMBER (MM/DDY/YYYY) (MM/DDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X GLA378503600 12/31/2014 12/31/2015 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PDREM SES Ea occurrAGE TO ence) 5 300,000 X WA STOP GAP 51,000,000 MED EXP(Any one person) S 15.000 X 55,000 PD Deductible PERSONAL&ADV INJURY 5 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X '- LOC PRODUCTS-COMP/OP AGG 5 2,000,000 OTHER: Ded Per Occurrence 5 5,000 � 4 AUTOMOBILE UABILI Y X X GLA378503600 12/31/2014 12/31/2015 (Ea accident SINGLE LIMIT 5 1,000,000 - x ANY AUTO BODILY INJURY(Per person) 5 ALL OWNED -SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE 5 X HIRED AUTOS x AUTOS (Per accident) x $0 Liab.Dedu $ B UMBRELLA UAB x OCCUR SE14EXC555329IV 12/31/2014 12/31/2015 EACH OCCURRENCE $ 10,000,000 X EXCESS UAB CLAIMS-MADE AGGREGATE 5 10,000,000 DED x RETENTION 5 10.000 5 WORKERS COMPENSATION12/31/2014 12/31/2015 STAH A AND EMPLOYERS'LIABILITY GLA378503600 TUTE ET ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? n N/A WA STOP GAP ONLY (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $ 1,000.000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT 5 C CONTRACTORS ERRORS 4033056237 07/01/2014 07/01/2015 52,000,000 CONTRACTORS ERRORS&OMMISSIONS AND OMMISSION EACH CLAIM AND AGGREGATE $25,000 RETENTON DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) U-CA-424-E-CW 04-11,UGL1175ECW 04/12,CG 25 04 05 09 AS RESPECTS PHASE 2-SULLIVAN RAOD WEST BRIDGE REPLACEMENT PROJECT #0155,FEDERAL AID#BRM4103(007) ADDITIONAL INSURED STATUS AND WAIVER OF SUBROGATION IF REQUIRED BY WRITTEN CONTRACT TO THE CITY OF SPOKANE VALLEY ITS OFFICERS,ELECTED OFFICIALS,EMPLOYEES,AND AGENTS;CH2M HILL INC ITS OFFICERS,ELECTED OFFICIALS,EMPLOYEES AND AGENTS;MARKET POINTE II,LLC;HANSON INDUSTRIES INC;THE STATE OF WASHINGTON DEPT OF NATURAL RESOURCES AND DEPT OF PARKS AND RECREATION THEIR ELECTED AND APPOINTED OFFICALS,AGENTS AND EMPLOYEES AS GRANTED BY THE ACTUAL POLICY FORMS ATTACHED TO THIS CERTIFICATE. CERTIFICATE HOLDER CANCELLATION CITY OF SPOKANE VALLEY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PUBLIC WORKS DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. / 11707 E SPRAGUE AVE,SUITE 106 `C SPOKANE VALLEY WA 99206 AUTHORIZED REPRESENTATIVE rI 9(.449,.._ The ACORD name and logo are registered marks of ACORD ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) iL 37 CID:194133 SID:8594265 Certificate of Insurance (Con't) OTHER Coverage INSR TYPE OF INSURANCE ADDL WVD POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE LIMIT LTR INSR SUBR (MM/DD/YY) (MM/DD/YY) D EXCESS LIABILITY OVER G27491029002 12/31/2014 12/31/2015 $10.000,000 EACH OCCURRENCE PRIMARY NAVIGATORS POLICY S10,000.000 AGGREGATE LIMIT excess of Navigators Policy E SULLIVAN ROAD BRIDGE TO FOLLOW 08/11/2014 07/01/2016 ALL RISK$12,310,000 LIMIT PROJECT SUBJECT TO $5,000 DED.INCLS QUAKE AND FLOOD WITH 2%DED. ($50,000 MINIMUM DED) Certificate of Insurance-Con't (Th POLICY NUMBER: GLA378503600 COMMERCIAL GENERAL LIABILITY CG 25 04 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED LOCATION(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Location(s): Information required to complete this Schedule,if not shown above,will be shown in the Declarations. A. For all sums which the insured becomes legally b. Claims made or"suits" brought; or obligated to pay as damages caused by "occur- c. Persons or organizations making claims or rences"under Section I—Coverage A,and for all bringing"suits". medical expenses caused by accidents under Section I—Coverage C, which can be attributed 3. Any payments made under Coverage A for only to operations at a single designated "lora- damages or under Coverage C for medical tion"shown in the Schedule above: expenses shall reduce the Designated Loca- tionl. A separate Designated Location General General Aggregate Limit for that desig- p g nated "location". Such payments shall not re- Aggregate Limit applies to each designated duce the General Aggregate Limit shown in "location", and that limit is equal to the the Declarations nor shall they reduce any amount of the General Aggregate Limit other Designated Location General Aggre- shown in the Declarations. gate Limit for any other designated "location" 2. The Designated Location General Aggregate shown in the Schedule above. Limit is the most we will pay for the sum of all 4. The limits shown in the Declarations for Each damages under Coverage A, except dam- Occurrence,Damage To Premises Rented To ages because of "bodily injury" or "property You and Medical Expense continue to apply. damage" included in the "products-completed However, instead of being subject to the operations hazard", and for medical expenses General Aggregate Limit shown in the Decla- under Coverage C regardless of the number rations,such limits will be subject to the appli- of: cable Designated Location General Aggre- a. Insureds; gate Limit. CG 25 04 05 09 ©Insurance Services Office,Inc.,2008 Page 1 of 2 0 B. For all sums which the insured becomes legally C. When coverage for liability arising out of the obligated to pay as damages caused by "occur- "products-completed operations hazard" is pro- rences"under Section I—Coverage A,and for all vided, any payments for damages because of medical expenses caused by accidents under "bodily injury" or "property damage" included in Section I— Coverage C, which cannot be attrib- the "products-completed operations hazard" will uted only to operations at a single designated reduce the Products-completed Operations Ag- "location"shown in the Schedule above: gregate Limit, and not reduce the General Ag- 1. Any payments made under Coverage A for gregate Limit nor the Designated Location Gen- damages or under Coverage C for medical eral Aggregate Limit. expenses shall reduce the amount available D. For the purposes of this endorsement, the Defi- under the General Aggregate Limit or the nitions Section is amended by the addition of Products-completed Operations Aggregate the following definition: Limit,whichever is applicable;and "Location"means premises involving the same or 2. Such payments shall not reduce any Desig- connecting lots,or premises whose connection is nated Location General Aggregate Limit. interrupted only by a street, roadway, waterway or right-of-way of a railroad. E. The provisions of Section III — Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 ©Insurance Services Office,Inc.,2008 CG 25 04 05 09 0 Coverage Extension Endorsement ZURICH Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff.Date of End. Producer No. Add'I.Prem Return Prem. GLA37850360 12/31/2014 12/31/2015 • THiS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Business Auto Coverage Form Motor Carrier Coverage Form A. Amended Who Is An Insured 1. The following is added to the Who Is An Insured Provision in Section II—Liability Coverage The following are also'insureds": a. Any"employee"of yours is an insured"while using a covered "auto"you don't own, hire or borrow for acts performed within the scope of employment by you. b. Anyone volunteering services to you is an "insured" while using a covered "auto" you don't own, hire or borrow to transport your clients or other persons in activities necessary to your business. c. Anyone else who furnishes an'auto"referenced in Paragraphs a.and b.above. El) d. Any person(s) or organization(s) where required by written contract or written agreement executed prior to any"accident"provided the"accident"arises out of operations contemplated by such contract or agreement. 2. The following is added to the Other Insurance Provision in the Conditions Section: Coverage for any person(s) or organization(s) where required by written contract or written agreement executed prior to any"accident"will apply on a primary basis and any insurance maintained by the additional 'insured"will apply on an excess basis. However, in no event will this coverage extend beyond the terms and conditions of the coverage form. B. Amendment—Supplementary Payments• Paragraphs a.(2)and a.(4)of the Coverage Extensions Provision in Section II—Liability Coverage are replaced by the following: (2) Up to$5,000 for the cost of ball bonds(including bonds for related traffic law violations)required because of an "accident"we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the Insured"at our request,including actual loss of earnings up to$500 a day because of time off from work. C. Fellow Employee Coverage The Fellow Employee Exclusion contained in Section II—liability Coveraga does not apply. D. Driver Safety Program Liability and Physical Damage Coverage 1. The following is added to the Racing Exclusion in Section II—Liability Coverage This exclusion does not apply to covered "autos"participating in a driver safety program event, such as,but not limited to,auto or truck rodeos and other auto or truck agility demonstrations. • U-CA424-E CW(04-11) Page 1015 Includes copyrighted material of Insurance Services Office,Inc..with its permission. / Agenl Copy - 2. The following is added to Paragraph 2. in the Exclusions of Section III —Physical Damage Coverage of the Business Auto Coverage Form and Paragraph 2.b. in the Exclusions of Section iV—Physical Damage Coverage of the Motor Carrier Coverage Form: This exclusion does not apply to covered "autos"participating in a driver safety program event, such as,but not limited to,auto or truck rodeos and other auto or truck agility demonstrations. E. Lease or Loan Gap Coverage The following is added to the Coverage Provision of the Physical Damage Coverage Section: Lease Or Loan Gap Coverage In the event of a total loss"to a covered"auto",we will pay any unpaid amount due on the lease or loan for a covered "auto",less: a. Any amount paid under the Physical Damage Coverage Section of the coverage form;and b. Any: (1) Overdue lease or loan payments at the time of the loss"; (2) Financial penalties imposed under a lease for excessive use,abnormal wear and tear or high mileage; (3) Security deposits not returned by the lessor; (4) Costs for extended warranties,credit life insurance,health,accident or disability insurance purchased with the loan or lease;and (5) Carry-over balances from previous leases or loans. F. Towing and Labor The following is added to Paragraph A.2.of the Physical Damage Coverage Section: We will pay up to$75 for towing and labor costs incurred each time a covered"auto"of the private passenger type is disabled. However,the labor must be performed at the place of disablement. G. Extended Glass Coverage The following is added to Paragraph A.3.a.of the Physical Damage Coverage Section: If glass must be replaced,the deductible will be$100 or the deductible shown in the Declarations,whichever is less. If glass can be repaired and is actually repaired rather than replaced,the deductible will be waived. You have the option of having the glass repaired rather than replaced. • H. Hired Auto Physical Damage—Increased Loss of Use Expenses The Loss Of Use Expenses Provision of the Physical Damage Coverage Section Is replaced by the following: Loss Of Use Expenses For Hired Auto Physical Damage,we will pay expenses for which an Insured"becomes legally responsible to pay for loss of use of a vehicle rented or hired without a driver under a written rental contract or written rental agreement. We will pay for loss of use expenses if caused by: (1) Other than collision only if the Declarations indicate that Comprehensive Coverage Is provided for any covered "auto"; (2) Specified Causes Of Loss only if the Declarations indicate that Specified Causes Of Loss Coverage is provided for any covered"auto';or (3) Collision only if the Declarations indicate that Collision Coverage is provided for any covered"auto". However,the most we will pay for any expenses for loss of use is$100 per day,to a maximum of$3000. I. Personal Effects Coverage • The following is added to the Coverage Provision of the Physical Damage Coverage Section: Personal Effects Coverage a We will pay up to$750 for"loss"to personal effects which are: (1) Personal property owned by an Insured";and U-CA-424-E CW(04-11) Page 2 of 5 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Agent Copy (2) In or on a covered'auto". b. Subject to Paragraph a.above,the amount to be paid for"loss"to personal effects will be based on the lesser of: (1) The reasonable cost to replace;or (2) The actual cash value. c. The coverage provided in Paragraphs a.and b.above, only applies in the event of a total theft of a covered"auto". No deductible applies to this coverage. However, we will not pay for"loss"to personal effects of any of the following: (1) Accounts, bills, currency, deeds,evidence of debt, money, notes, securities, or commercial paper or other documents of value. (2) Bullion, gold, silver, platinum, or other precious alloys or metals; furs or fur garments; Jewelry, watches, precious or semi-precious stones. (3) Paintings,statuary and other works of art. (4) Contraband or property in the course of Illegal transportation or trade. - (5) Tapes,records,discs or other similar devices used with audio,visual or data electronic equipment. Any coverage provided by this Provision is excess over any other insurance coverage available for the same'loss". J. Tapes,Records and Discs Coverage 1. The Exclusion In Paragraph B.4.a. of Section III —Physical Damage Coverage in the Business Auto Coverage Form and the Exclusion in Paragraph B.2.c. of Section IV—Physical Damage Coverage in the Motor Carrier Coverage Form do not apply. 2. The following Is added to Paragraph 1.a.Comprehensive Coverage under the Coverage Provision of the Physical Damage Coyerage Section: We will pay for'loss"to tapes, records, discs or other similar devices used with audio,visual or data electronic equipment. We will pay only if the tapes,records,discs or other similar audio,visual or data electronic devices: (a) Are the property of an'insured";and (b) Are in a covered"auto"at the time of'loss". The most we will pay for such 'loss" to tapes, records, discs or other similar devices is $500. The Physical Damage Coverage Deductible Provision does not apply to such'loss". K. Airbag Coverage The Exclusion in Paragraph B.3.a. of Section III—Physical Damage Coverage in the Business Auto Coverage Form and the Exclusion in Paragraph B.4.a of Section IV—Physical Damage Coverage in the Motor Carrier Coverage Form do not apply to the accidental discharge of an airbag. L. Two or More Deductibles The following is added to the Deductible Provision of the Physical Damage Coverage Section: If an accident is covered both by this policy or coverage form and by another policy or coverage form issued to you by us,the following applies for each covered"auto"on a per vehicle basis: 1. If the deductible on this policy or coverage form is the smaller(or smallest)deductible,it will be waived;or 2. If the deductible on this policy or coverage form is not the smaller(or smallest)deductible, it will be reduced by the amount of the.smaller(or smallest)deductible. M. Physical Damage—Comprehensive Coverage—Deductible The following is added to the Deductible Provision of the Physical Damage Coverage Section: Regardless of the number of covered"autos"damaged or stolen,the maximum deductible that will be applied to Comprehensive Coverage for all"loss"from any one cause is$5,000. ll-CA-424-E CW(04-11) Page 3 of 5 Includes copyrighted material of Insurance Services Office.Inc.,with its permission. Agent Copy • N. Temporary Substitute Autos—Physical Damage 1. The following is added to Section I—Covered Autos: Temporary Substitute Autos—Physical Damage If Physical Damage Coverage is provided by this coverage form on your owned covered "autos", the following types of vehicles are also covered"autos"for Physical Damage Coverage: Any "auto"you do not own when used with the permission of its owner as a temporary substitute for a covered "auto"you do own but is out of service because of its: 1. Breakdown; 2. Repair; 3. Servicing; 4. "Loss";or • • 5. Destruction. 2. The following is added to the Coverage Provision of the Physical Damage Coverage Section: Temporary Substitute Autos—Physical Damage We will pay the owner for loss"to the temporary substitute"auto"unless the loss"results from fraudulent acts or omissions on your part. If we make any payment to the owner,we will obtain the owner's rights against any other party. The deductible for the temporary substitute "auto" will be the same as the deductible for the covered "auto" It replaces. O. Amended Duties in The Event Of Accident,Claim,Suit Or Loss Paragraph a.of the Duties In The Event Of Accident,Claim,Suit Or Loss Condition Is replaced by the following: a. In the event of"accident",claim,"suit"or"loss",you must give us or our authorized representative prompt notice of the"accident",claim,"suit"or loss". However,these duties only apply when the"accident",claim,"suit"or'loss" Is known to you(if you are an individual),a partner(if you are a partnership),a member(if you are a limited liability company)or an executive officer or insurance manager(if you are a corporation). The failure of any agent, servant or employee of the Insured"to notify us of any"accident",claim,"suit"or'loss"shall not invalidate the insurance afforded by this policy. • include,as soon as practicable: (1) How,when and where the"accident"or'loss"occurred and if a claim is made or"suit"is brought,written notice of the claim or"suit"including,but not limited to,the date and details of such claim or"suit"; (2) The'Insured's"name and address;and (3) To the extent possible,the names and addresses of any injured persons and witnesses. If you report an"accident",claim,"suit"or'loss"to another insurer when you should have reported to us,your failure to report to us will not be seen as a violation of these amended duties provided you give us notice as soon as practicable after the fact of the delay becomes known to you. P. Waiver of Transfer Of Rights Of Recovery Against Others To Us The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: This Condition does not apply to the extent required of you by a written contract,executed prior to any"accident"or 'loss",provided that the"accident"or'loss"arises out of operations contemplated by such contract. This waiver only applies to the person or organization designated in the contract. Q. Employee Hired Autos—Physical Damage Paragraph b.of the Other Insurance Condition in the Business Auto Coverage Form and Paragraph 1.of the Other Insurance—Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form are replaced by the following: For Hired Auto Physical Damage Coverage,the following are deemed to be covered"autos"you own: U-CA-424-E CW(04-11) Page 4 of 5 includes copyrighted material of Insurance Services Office,Inc.,with its permission. Agent Copy (1) Any covered"auto"you lease,hire,rent or borrow;and (2) Any covered"auto"hired or rented under a written contract or written agreement entered into by an"employee"or elected or appointed official with your permission while being operated within the course and scope of that "employee's"employment by you or that elected or appointed official's duties as respect their obligations to you. However,any"auto"that is leased,hired,rented or borrowed with a driver is not a covered"auto". R. Unintentional Failure to Disclose Hazards The following is added to the Concealment,Misrepresentation Or Fraud Condition: However,we will not deny coverage under this coverage form if you unintentionally: (1) Fail to disclose any hazards existing at the inception date of this coverage form;or (2) Make an error,omission,improper description of'autos"or other misstatement of Information. You must notify us as soon as possible after the discovery of any hazards or any other information that was not provided to us prior to the acceptance of this policy. S. Hired Auto—World Wide Coverage Paragraph(5)(a)of the Policy Period,Coverage Territory Condition is replaced by the following: (a) A covered"auto"is leased,hired,rented or borrowed for a period of 60 days or less;and T. Bodily Injury Redefined The definition of"bodily injury"in the Definitions Section is replaced by the following: "Bodily injury"means bodily injury, sickness or disease, sustained by a person including death or mental anguish, resulting from any of these at any time. Mental anguish means any type of mental or emotional Illness or disease. Ail other terms and conditions of this policy remain unchanged. ••C • U-CA-424-E CW(04-11) Page5of5 includes copyrighted material of Insurance Services Office,Inc.,with its permission. (bent Copy 0 Additional Insured —Automatic — Owners, Lessees Or ZURICH Contractors • Policy No. Eff. Date of Pol. Exp. Date of Pot. Eff.Date of End. Producer No. Add'I.Prem Return Prem. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured: Address(including ZIP Code): This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. Section II—Who Is An Insured is amended to include as an insured any person or organization who you are required to add as an additional insured on this policy under a written contract or written agreement. However, if you have entered into a construction contract or construction agreement with an additional insured person • or organization, the insurance afforded to such additional insured only applies to the extent permitted by law. B. The insurance provided to the additional insured person or organization applies only to "bodily injury", "property damage"or"personal and advertising injury" covered under Section I—Coverage A—Bodily Injury And Property Damage Liability and Section I—Coverage B—Personal And Advertising Injury Liability, but only with respect to liability for"bodily injury","property damage"or"personal and advertising injury"caused, in whole or in part, by: 1. Your acts or omissions;or 2. The acts or omissions of those acting on your behalf, and resulting directly from your ongoing operations or"your work"as included in the "products-completed operations hazard",which is the subject of the written contract or written agreement. C. However,regardless of the provisions of Paragraphs A.and B.above: 1. We will not extend any insurance coverage to any additional insured person or organization: a. That is not provided to you in this policy; or b. That is any broader coverage than you are required to provide to the additional insured person or organization in the written contract or written agreement; and 2. We will not provide Limits of Insurance to any additional insured person or organization that exceed the lower of: a. The Limits of Insurance provided to you in this policy;or b. The Limits of Insurance you are required to provide in the written contract or written agreement • D. The insurance provided to the additional insured person or organization does not apply to: "Bodily injury", "property damage"or"personal and advertising injury"arising out of the rendering or failure to render any professional architectural,engineering or surveying services including: 1. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders,change orders or drawings and specifications;and 2. Supervisory, inspection,architectural or engineering activities. U-GL-1175-E CW(04/12) Page 1 of 2 Includes copyrighted material of Insurance Services Office,Inc.,wish its permission. • E. The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV— Commercial General Liability Conditions: The additional insured must see to it that: 1. We are notified as soon as practicable of an"occurrence"or offense that may result in a claim; 2. We receive written notice of a claim or"suit"as soon as practicable; and 3. A request for defense and indemnity of the claim or"suit" will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured,if the written contract or written agreement requires that this coverage be primary and non-contributory. F. For the coverage provided by this endorsement: 1. The following paragraph is added to Paragraph 4.a.of the Other Insurance Condition of Section IV—Commercial General Liability Conditions: This insurance is primary insurance as respects our coverage to the additional insured person or organization, where the written contract or written agreement requires that this insurance be primary and non-contributory with respect to any other policy upon which the additional insured is a Named Insured. In that event, we will not seek contribution from any other such insurance policy available to the additional insured on which the additional insured person or organization is a Named Insured. 2. The following paragraph is added to Paragraph 4.b.of the Other Insurance Condition of Section IV—Commercial General Liability Conditions: This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same"occurrence",offense, claim or"suit". This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by written contract or written agreement to provide coverage to the additional insured on a primary and non- contributory basis. G. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured. All other terms and conditions of this policy remain unchanged. U-GL-1175-E CW(04/12) Page 2 of 2 Includes copyrighted material of Insurance Services Office,inc.,with Its permission. C MAXJKUN-03KBREMER DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 01/03/2017 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). Kristy Bremer CONTACT PRODUCER NAME: BK-JET Group, LLC PHONEFAX (509) 319-2909(509) 319-2920 (A/C, No, Ext):(A/C, No): 999 W Riverside Avenue, Suite 510 E-MAIL kbremer@bkjet.com Spokane, WA 99201 ADDRESS: INSURER(S) AFFORDING COVERAGENAIC # Zurich American Insurance Company16535 INSURER A : Navigators Insurance Company42307 INSURED INSURER B : Westchester Fire Insurance Company10030 Max J Kuney Company INSURER C : PO BOX 4008 INSURER D : Spokane, WA 99202 INSURER E : INSURER F : COVERAGESCERTIFICATE 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. POLICY EFFPOLICY EXP INSRADDLSUBR TYPE OF INSURANCEPOLICY NUMBERLIMITS (MM/DD/YYYY)(MM/DD/YYYY) LTRINSDWVD A 1,000,000 X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE$ 300,000 DAMAGE TO RENTED X GLA 3785036-0212/31/201612/31/2017 CLAIMS-MADEOCCUR XX $ PREMISES (Ea occurrence) WA STOP GAP/EMP LIAB10,000 X MED EXP (Any one person)$ 1,000,000 PERSONAL & ADV INJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ 2,000,000 XX PRO- POLICYLOC PRODUCTS - COMP/OP AGG$ JECT WA STOP GAP1,000,000 OTHER:$ A 1,000,000 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ (Ea accident) X GLA 3785036-0212/31/201612/31/2017 XX ANY AUTO BODILY INJURY (Per person)$ OWNEDSCHEDULED AUTOS ONLYAUTOSBODILY INJURY (Per accident)$ PROPERTY DAMAGE XX HIREDNON-OWNED (Per accident)$ AUTOS ONLYAUTOS ONLY $ B 10,000,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE$ SE16EXC555329IV12/31/201612/31/2017 10,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE$ 0 X DEDRETENTION$ $ PEROTH- WORKERS COMPENSATION STATUTEER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ N / A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT$ C Excess LiabilityG27491029 00412/31/201612/31/2017 EXCESS OF NAVIGATORS 10,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AS RESPECTS PHASE 2 - SULLIVAN ROAD WEST BRIDGE REPLACEMENT PROJECT #0155, FEDERAL AID #BRM4103(007) ADDITIONAL INSURED STATUS AND WAIVER OF SUBROGATION IF REQUIRED BY WRITTEN CONTRACT AS IT RELATES TO GENERAL AND AUTO LIABILITY TO THE CITY OF SPOKANE VALLEY ITS OFFICERS, ELECTED OFFICIALS, EMPLOYEES, AND AGENTS; CH2M HILL INC ITS OFFICERS, ELECTED OFFICIALS, EMPLOYEES AND AGENTS; MARKET POINTE II, LLC; HANSON INDUSTRIES INC; THE STATE OF WASHINGTON DEPT OF NATURAL RESOURCES AND DEPT OF PARKS AND RECREATION THEIR ELECTED AND APPOINTED OFFICALS, AGENTS AND EMPLOYEES AS GRANTED BY THE ACTUAL POLICY FORMS ATTACHED TO THIS CERTIFICATE. EXCESS LIABILITY POLICY #2 - COVERAGE WITH - WESTCHESTER FIRE INS. POLICY # 827491029-003. EFF. 12/31/15 TO 12/31/16. $10,000,000 LIMIT CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF SPOKANE VALLEY ACCORDANCE WITH THE POLICY PROVISIONS. PUBLIC WORKS DEPARTMENT 11707 E SPRAGUE AVE SUITE 106 SPOKANE VALLEY, WA 99206 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03)© 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Contractors Liability Supplemental Coverages And Conditions Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. Add’l. Prem Return Prem. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part NON-OWNED WATERCRAFT SCHEDULE Watercraft Length: _______ feet (If no amount is shown above, 51 feet applies.) A.Non-owned Watercraft Liability Extended Coverage (2)2.g. Aircraft, Auto Or WatercraftI – Coverage A – Bodily Injury And Paragraph of Exclusion under Section Property Damage Liability is replaced by the following: (2) A watercraft you do not own that is: (a) Less than the length shown in the Non-Owned Watercraft Schedule of this endorsement; and (b) Not being used to carry persons or property for a charge; B.Damage To Premises Rented Or Occupied By You 1.2. ExclusionsI – CoverageA – Bodily Injury And Property The last paragraph under Paragraph of Section Damage Liability is replaced by the following: c.n. Exclusions through do not apply to damage by "specific perils" to premises while rented to you or temporarily occupied by you with permission of the owner. A separate Damage to Premises Rented To You Limit of III Insurance applies to this coverage as described in Section – Limits Of Insurance. 2.(6)j.I – Coverage A – Bodily Injury And The paragraph directly following Paragraph in Exclusion of Section Property Damage Liability is replaced by the following: (1)(3)(4) Paragraphs , and of this exclusion do not apply to "property damage" to premises (other than damage by "specific perils"), including "property damage" to the contents of such premises, rented to you under a rental agreement for a period of 14 or fewer consecutive days. A separate Limit of Insurance applies to Damage to III Premises Rented to You as described in Section – Limits Of Insurance. 3.6.III – Limits Of Insurance Paragraph of Section is replaced by the following: 6.5. Subject to Paragraph above, the Damage To Premises Rented To You Limit is the most we will pay under A Coverage for damages because of "property damage" to any one premises while rented to you, or in the case of damage by one or more "specific perils" to any one premises, while rented to you or temporarily occupied by you with permission of the owner. 4.a.Definitions Paragraph of the "insured contract" definition under the Section is replaced by the following: U-GL-1060-E CW (04/13) Page 1 of 6 Includes copyrighted material of Insurance Services Office, Inc., with its permission. a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by "specific perils" to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; 5.(ii)4.b.(1)Other InsuranceIV – Commercial Paragraph under Paragraph of the Condition under Section General Liability Conditions is replaced by the following: (ii) That is property insurance providing coverage for "specific perils" for premises rented to you or temporarily occupied by you with permission of the owner; 6.Definitions The following definitions are added to the Section: "Specific perils" means fire, lightning, explosion, windstorm or hail, smoke, aircraft or vehicles, riot or civil commotion, vandalism, leakage from fire extinguishing equipment, weight of snow, ice or sleet or "water damage". "Water damage" means accidental discharge or leakage of water or steam as the direct result of the breaking or cracking of any part of a system or appliance containing water or steam. C. Additional Insured – Lessor Of Leased Equipment – Automatic Status When Required In Lease Agreement With You 1.II – Who Is An Insured Section is amended to include as an additional insured any person(s) or organization(s) from whom you lease equipment when you and such person(s) or organization(s) have agreed in a written contract or written agreement that such person(s) or organization(s) be added as an additional insured on your policy. Such person(s) or organization(s) is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s) or organization(s). However, the insurance afforded to such additional insured: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person’s or organization’s status as an additional insured under this endorsement ends when their contract or agreement with you for such leased equipment ends. 2. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any "occurrence" which takes place after the equipment lease expires. 3.III – Limits With respect to the insurance afforded to these additional insureds, the following is added to Section of Insurance : The most we will pay on behalf of the additional insured is the amount of insurance: a. Required by the written contract or written agreement you have entered into with the additional insured; or b. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. C. The insurance provided by this Paragraph shall not increase the applicable Limits of Insurance shown in the Declarations. D. Additional Insured – Managers Or Lessors Of Premises 1.II – Who Is An Insured Section is amended to include as an additional insured any person(s) or organization(s) that you have agreed in a written contract or written agreement to name as an additional insured, but only with respect to liability arising out of the ownership, maintenance or use of that part of premises leased to you and subject to the following additional exclusions: This insurance does not apply to: a. Any "occurrence" which takes place after you cease to be a tenant in that premises. b. Structural alterations, new construction or demolition operations performed by or on behalf of the additional insured manager or lessor of the premises leased to you. However, the insurance afforded to such additional insured: a. Only applies to the extent permitted by law; and U-GL-1060-E CW (04/13) Page 2 of 6 Includes copyrighted material of Insurance Services Office, Inc., with its permission. b. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 2.III – Limits With respect to the insurance afforded to these additional insureds, the following is added to Section of Insurance : The most we will pay on behalf of the additional insured is the amount of insurance: a. Required by the written contract or written agreement you have entered into with the additional insured; or b. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. D. The insurance provided by this Paragraph shall not increase the applicable Limits of Insurance shown in the Declarations. E. Additional Insured – State Or Governmental Agency Or subdivision Or Political Subdivision – Permits Or Authorizations 1.II – Who Is An Insured Section is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision that you have agreed in a written contract or written agreement or that you are required by statute, ordinance or regulation to name as an additional insured, subject to the following provisions: a. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. b. This insurance does not apply to: (1) "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or (2) "Bodily injury" or "property damage included within the "products-completed operations hazard". However, the insurance afforded to such additional insured: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 2.III – Limits With respect to the insurance afforded to these additional insureds, the following is added to Section of Insurance : The most we will pay on behalf of the additional insured is the amount of insurance: a. Required by the written contract or written agreement you have entered into with the additional insured; or b. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. E. The insurance provided by this Paragraph shall not increase the applicable Limits of Insurance shown in the Declarations. F.Personal And Advertising Injury Coverage – Assumed Under Contract Or Agreement 1.e.I – Coverage B – Personal And Advertising Injury Liability Exclusion of Section is replaced by the following: 2.Exclusions This insurance does not apply to: e.Contractual Liability "Personal and advertising injury" for which the insured has assumed liability in a contract or agreement. This exclusion does not apply to: (1) Liability for damages that the insured would have in the absence of the contract or agreement; or (2) Liability for "personal and advertising injury" if: U-GL-1060-E CW (04/13) Page 3 of 6 Includes copyrighted material of Insurance Services Office, Inc., with its permission. (a) The liability pertains to your business and is assumed in a contract or agreement that is an "insured contract"; and (b) The "personal and advertising injury" occurs subsequent to the execution of the contract or agreement. Solely for the purposes of liability so assumed in such "insured contract", reasonable attorney fees and necessary litigation expenses incurred by or for a party other than an insured are deemed to be damages because of "personal and advertising injury", provided: (i) Liability to such party for, or for the cost of, that party’s defense has also been assumed in the same contract or agreement; and (ii) Such attorney fees and litigation expenses are for defense of that party against a civil or alternative dispute resolution proceeding in which damages to which this insurance applies are alleged. 2. For purposes of this "personal and advertising injury" coverage only: d.2.Supplementary Payments – Coverages Paragraph and the second to last paragraph under Paragraph of AB and are replaced by the following: d. The allegations in the "suit" and the information we know about the "occurrence" or offense are such that no conflict appears to exist between the interests of the insured and the interest of the indemnitee; So long as the above conditions are met, attorneys’ fees incurred by us in the defense of that indemnitee, necessary litigation expenses incurred by us and necessary litigation expenses incurred by the indemnitee at our request will be paid as Supplementary Payments. Such payments will not be deemed to be damages for "bodily injury", "property damage" or "personal and advertising injury" and will not reduce the limits of insurance. G. Insured Contract Amendment f.f.(1)f.(3)Definitions Paragraph and through of the "insured contract" definition under the Section is replaced by the following: f. That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another to pay for "bodily injury", "property damage" or "personal and advertising injury" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. f. Paragraph does not include that part of any contract or agreement: (1) That indemnifies a railroad for "bodily injury", "property damage" or "personal and advertising injury" arising out of construction or demolition operations within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, road-beds, tunnel, underpass or crossing; (2) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; (3) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage (2) arising out of the insured’s rendering or failure to render professional services, including those listed in above and supervisory, inspection, architectural or engineering activities; (4) That indemnifies a person or organization for "personal and advertising injury": (a) Arising out of advertising, publishing, broadcasting or telecasting done for you or on your behalf; or (b) To an "employee" of such person or organization that does advertising, publishing, broadcasting or telecasting for you or on your behalf; or (5) That indemnifies a labor leasing firm for "bodily injury" to "leased workers". U-GL-1060-E CW (04/13) Page 4 of 6 Includes copyrighted material of Insurance Services Office, Inc., with its permission. H.Medical Payments – Increased Reporting Period a.I – Coverage C – Medical Payments Paragraph of Section is replaced by the following: a. We will pay medical expenses as described below for "bodily injury" caused by an accident: (1) On premises you own or rent; (2) On ways next to premises you own or rent; or (3) Because of your operations; provided that: (a) The accident takes place in the "coverage territory" and during the policy period; (b) The expenses are incurred and reported to us within three years of the date of the accident; and (c) The injured person submits to examination, at our expense, by physicians of our choice as often as we reasonably require. I.Broad Bail Bond Coverage 1.b.Supplementary Payments – Coverages A And B Paragraph under is replaced by the following: b. The cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. J.Amendment – Duties In The Event of Occurrence, Offense, Claim or Suit 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit The following paragraphs are added to Paragraph IV Commercial General Liability Conditions of Section –: Notice of an "occurrence" or of an offense which may result in a claim under this insurance or notice of a claim or "suit" shall be given to us as soon as practicable after knowledge of the "occurrence", offense, claim or "suit" has been reported to your officer, manager, partner or an "employee" authorized by you to give or receive such notice. Knowledge by "employees" other than your officer, manager, partner or "employee" authorized by you to give or receive such notice of an "occurrence", offense, claim or "suit" does not imply that you also have such knowledge. In the event that an insured reports an "occurrence" to your workers compensation carrier and this "occurrence" later develops into a General Liability claim, covered by this Coverage Part, the insured’s failure to report such "occurrence" to us at the time of the "occurrence" shall not be deemed to be a violation of this Condition. You must, however, give us notice as soon as practicable after being made aware that the particular claim is a General Liability rather than a Workers Compensation claim. K.Unintentional Failure To Disclose Or Describe Hazards 6. RepresentationsIV – Commercial General Liability Conditions Paragraph of Section is replaced by the following: 6.Representations By accepting this policy, you agree: a. The statements in the Declarations are accurate and complete; b. Those statements are based upon representations you made to us; and c. We have issued this policy in reliance upon your representations. Coverage will continue to apply if you unintentionally: (1) Fail to disclose all hazards existing at the inception of this policy; or (2) Make an error, omission or improper description of premises or other statement of information stated in this policy. You must notify us in writing as soon as possible after the discovery of any hazards or any other information that was not provided to us prior to inception of this Coverage Part. L. Bodily Injury Redefined Definitions The "bodily injury" definition under the Section is replaced by the following: U-GL-1060-E CW (04/13) Page 5 of 6 Includes copyrighted material of Insurance Services Office, Inc., with its permission. "Bodily injury" means bodily injury, sickness or disease sustained by a person, including death resulting from any of these at any time. This includes mental anguish, mental injury, shock, fright or death resulting from bodily injury, sickness or disease. M. Two Or More Of Our Coverage Parts/Policies III – Limits of Insurance The following is added to Section : 1.2.3. Subject to Paragraph or above, whichever applies, if this Coverage Part and any other Commercial General Liability Coverage Part or policy providing Commercial General Liability insurance issued to you by us or any other Zurich underwriting company affiliated with us apply to the same "occurrence", only the highest available Each Occurrence Limit under any such Coverage Part or policy applies to such "occurrence". 2.2. Subject to Paragraph above, if this Coverage Part and any other Coverage Part or policy providing Commercial General Liability insurance issued to you by us or any other Zurich underwriting company affiliated with us apply to the same offense, only the highest available Personal And Advertising Injury Limit under any such Coverage Part or policy applies to such offense. 3. Under this Coverage Part and all other Zurich underwriting company Coverage Parts or policies to which 1.2. Paragraphs and above combined apply, the most we will pay for all injury or damage because of "bodily injury" or "property damage" "occurrences", "personal and advertising injury" offenses and medical expenses is: a. The single highest Coverage Part or policy General Aggregate Limit; or b. The single highest Coverage Part or policy Products-Completed Operations Aggregate Limit, whichever applies, whether such "occurrence", offenses or medical expenses are covered by one or more than one Zurich underwriting company policy. 4.4. Other InsuranceIV – Commercial General Liability Any existing provisions under Paragraph under Section Conditions that may be contrary to the provisions of this endorsement are amended to comply with the changes 1.2.3. in coverage as stipulated in Paragraphs ,, and above. This provision does not apply to any Coverage Part or policy issued by us or any other Zurich underwriting company affiliated with us specifically to apply as excess insurance over this Coverage Part. N. Your Work Redefined a.(1)Definitions Paragraph of the "your work" definition under the Section is replaced by the following: 22. "Your work": a. Means: (1) Work or operations performed by you or on your behalf, but does not include work or operations performed by another entity who joined with you to form a partnership or joint venture not shown as a Named Insured in the Declarations, which terminated or ended prior to the effective date of this policy; and All other terms and conditions of this policy remain unchanged. U-GL-1060-E CW (04/13) Page 6 of 6 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Additional Insured – Automatic – Owners, Lessees Or Contractors Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. Add’l. Prem Return Prem. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured : Address (including ZIP Code) : This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A.II – Who Is An Insured Section is amended to include as an additionalinsured any person or organization whom you . are required to add as an additional insured on this policy under a written contract or written agreementSuch person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf, in the performance of your ongoing operations or "your work" as included in the "products-completed operations in the performance of your ongoing oper the "products-completed operations ations or "your work" as included in in the performance of your ongoing oper ations or "your work" as included in hazard", which is the subject of the written contract or written agreement. hazard", which is the subject of the written contract or written agreement. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to: "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services including: a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. U-GL-1175-F CW (04/13) Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. C.2.IV – The following is added to Paragraph Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section Commercial General Liability Conditions : The additional insured must see to it that: 1. We are notified as soon as practicable of an "occurrence" or offense that may result in a claim; 2. We receive written notice of a claim or "suit" as soon as practicable; and 3. A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured if the written contract or written agreement requires that this coverage be primary and non-contributory. D. For the purposes of the coverage provided by this endorsement: 1.IV – Commercial General Liability The following is added to the Other Insurance Condition of Section Conditions : Primary and Noncontributory insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured provided that: a. The additional insured is a Named Insured under such other insurance; and b. You are required by written contract or written agreement that this insurance be primary and not seek contribution from any other insurance available to the additional insured. 2.4.b.IV – Commercial The following paragraph is added to Paragraph of the Other Insurance Condition of Section General Liability Conditions : This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same "occurrence", offense, claim or "suit". This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by a written contract or written agreement to provide coverage to the additional insured on a primary and non- contributory basis. E. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured. F. With respect to the insurance afforded to the additional insureds under this endorsement, the following is added to III – Limits Of Insurance Section: The most we will pay on behalf of the additional insured is the amount of insurance: 1. A. Required by the written contract or written agreement referenced in Paragraph of this endorsement; or 2. Available under the applicable Limits of Insurance shown in the Declarations, whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. All other terms and conditions of this policy remain unchanged. U-GL-1175-F CW (04/13) Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. MAXJKUN-03KBREMER DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/28/2017 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). Kristy Bremer CONTACT PRODUCER NAME: BK-JET Group, LLC PHONEFAX (509) 319-2909(509) 319-2920 (A/C, No, Ext):(A/C, No): 999 W Riverside Avenue, Suite 510 E-MAIL kbremer@bkjet.com Spokane, WA 99201 ADDRESS: INSURER(S) AFFORDING COVERAGENAIC # Phoenix Insurance Co.25623 INSURER A : The Travelers Indemnity Company25658 INSURED INSURER B : Travelers Property Casualty Company of America 25674 Max J Kuney Company INSURER C : PO BOX 4008 INSURER D : Spokane, WA 99202 INSURER E : INSURER F : COVERAGESCERTIFICATE 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. POLICY EFFPOLICY EXP INSRADDLSUBR TYPE OF INSURANCEPOLICY NUMBERLIMITS (MM/DD/YYYY)(MM/DD/YYYY) LTRINSDWVD A 1,000,000 X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE$ 300,000 DAMAGE TO RENTED X CO-3K69906A12/31/201712/31/2018 CLAIMS-MADEOCCUR XX $ PREMISES (Ea occurrence) WA STOP GAP/EMP LIAB10,000 X MED EXP (Any one person)$ 1,000,000 PERSONAL & ADV INJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ 2,000,000 X PRO- POLICYLOC PRODUCTS - COMP/OP AGG$ JECT WA STOP GAP1,000,000 OTHER:$ B 1,000,000 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ (Ea accident) X 810-3K69906A12/31/201712/31/2018 XX ANY AUTO BODILY INJURY (Per person)$ OWNEDSCHEDULED AUTOS ONLYAUTOSBODILY INJURY (Per accident)$ PROPERTY DAMAGE XX HIREDNON-OWNED (Per accident)$ AUTOS ONLYAUTOS ONLY $ C 10,000,000 XX UMBRELLA LIAB OCCUR EACH OCCURRENCE$ CUP3K80689A12/31/201712/31/2018 10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE$ 10,000 X DEDRETENTION$ $ PEROTH- WORKERS COMPENSATION STATUTEER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ N / A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AS RESPECTS PHASE 2 - SULLIVAN ROAD WEST BRIDGE REPLACEMENT PROJECT #0155, FEDERAL AID #BRM4103(007) ADDITIONAL INSURED STATUS AND WAIVER OF SUBROGATION IF REQUIRED BY WRITTEN CONTRACT AS IT RELATES TO GENERAL AND AUTO LIABILITY TO THE CITY OF SPOKANE VALLEY ITS OFFICERS, ELECTED OFFICIALS, EMPLOYEES, AND AGENTS; CH2M HILL INC ITS OFFICERS, ELECTED OFFICIALS, EMPLOYEES AND AGENTS; MARKET POINTE II, LLC; HANSON INDUSTRIES INC; THE STATE OF WASHINGTON DEPT OF NATURAL RESOURCES AND DEPT OF PARKS AND RECREATION THEIR ELECTED AND APPOINTED OFFICALS, AGENTS AND EMPLOYEES AS GRANTED BY THE ACTUAL POLICY FORMS ATTACHED TO THIS CERTIFICATE. EXCESS LIABILITY POLICY #2 - COVERAGE WITH - WESTCHESTER FIRE INS. POLICY # 827491029-003. EFF. 12/31/15 TO 12/31/16. $10,000,000 LIMIT CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF SPOKANE VALLEY ACCORDANCE WITH THE POLICY PROVISIONS. PUBLIC WORKS DEPARTMENT 11707 E SPRAGUE AVE SUITE 106 SPOKANE VALLEY, WA 99206 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03)© 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD only. purposes informational for is It policy. a to form this add not Do only. purposes informational for is It policy. a to form this add not Do only. purposes informational for is It policy. a to form this add not Do DPNNFSDJBMHFOFSBMMJBCJMJUZ UIJTFOEPSTFNFOUDIBOHFTUIFQPMJDZ/QMFBTFSFBEJUDBSFGVMMZ CMBOLFUBEEJUJPOBMJOTVSFE )DPOUSBDUPST* Uijtfoepstfnfounpejgjftjotvsbodfqspwjefevoefsuifgpmmpxjoh; DPNNFSDJBMHFOFSBMMJBCJMJUZDPWFSBHFQBSU 2/d* XIPJTBOJOTVSFE)TfdujpoJJ*jtbnfoefeUifjotvsbodfqspwjefeupuifbeejujpobmjo. upjodmvefbozqfstpopspshboj{bujpouibuzpvtvsfeepftopubqqmzup#cpejmzjokvsz#ps bhsffjob#xsjuufodpousbdusfrvjsjohjotvsbodf##qspqfsuzebnbhf#dbvtfecz#zpvsxpsl# upjodmvefbtbobeejujpobmjotvsfepouijtDpwfs.boejodmvefejouif#qspevdut.dpnqmfufepq. bhfQbsu-cvu;fsbujpotib{bse#vomfttuif#xsjuufodpousbdu sfrvjsjohjotvsbodf#tqfdjgjdbmmzsfrvjsftzpv b* Pomzxjuisftqfduupmjbcjmjuzgps#cpejmzjokvsz#- upqspwjeftvdidpwfsbhfgpsuibubeejujpobm #qspqfsuzebnbhf#ps#qfstpobmjokvsz#<boe jotvsfe-boeuifouifjotvsbodfqspwjefeup c* Jg-boepomzupuiffyufouuibu-uifjokvszps uifbeejujpobmjotvsfebqqmjftpomzuptvdi ebnbhfjtdbvtfeczbdutpspnjttjpotpg #cpejmzjokvsz#ps#qspqfsuzebnbhf#uibupd. zpvpszpvstvcdpousbdupsjouifqfsgpsnbodf dvstcfgpsfuiffoepguifqfsjpepgujnfgps pg#zpvsxpsl#upxijdiuif#xsjuufodpousbdu xijdiuif#xsjuufodpousbdusfrvjsjohjotvs. sfrvjsjohjotvsbodf#bqqmjft/Uifqfstpops bodf#sfrvjsftzpvupqspwjeftvdidpwfsbhf pshboj{bujpoepftopurvbmjgzbtbobeejujpobm psuiffoepguifqpmjdzqfsjpe-xijdifwfsjt jotvsfexjuisftqfduupuifjoefqfoefoubdut fbsmjfs/ pspnjttjpotpgtvdiqfstpopspshboj{bujpo/ 4/ Uifjotvsbodfqspwjefeupuifbeejujpobmjotvsfe 3/ Uifjotvsbodfqspwjefeupuifbeejujpobmjotvsfe czuijtfoepstfnfoujtfydfttpwfsbozwbmjeboe czuijtfoepstfnfoujtmjnjufebtgpmmpxt; dpmmfdujcmf#puifsjotvsbodf#-xifuifsqsjnbsz- fydftt-dpoujohfoupspobozpuifscbtjt-uibujt b* JouiffwfouuibuuifMjnjutpgJotvsbodfpg bwbjmbcmfupuifbeejujpobmjotvsfegpsbmpttxf uijtDpwfsbhfQbsutipxojouifEfdmbsbujpot dpwfsvoefsuijtfoepstfnfou/Ipxfwfs-jguif fydffeuifmjnjutpgmjbcjmjuzsfrvjsfeczuif #xsjuufodpousbdusfrvjsjohjotvsbodf#tqfdjgjdbmmz #xsjuufodpousbdusfrvjsjohjotvsbodf#-uifjo. sfrvjsftuibuuijtjotvsbodfbqqmzpobqsjnbsz tvsbodfqspwjefeupuifbeejujpobmjotvsfe cbtjtpsbqsjnbszboeopo.dpousjcvupszcbtjt- tibmmcfmjnjufeupuifmjnjutpgmjbcjmjuzsf. uijtjotvsbodfjtqsjnbszup#puifsjotvsbodf# rvjsfeczuibu#xsjuufodpousbdusfrvjsjohjo. bwbjmbcmfupuifbeejujpobmjotvsfexijdidpwfst tvsbodf#/Uijtfoepstfnfoutibmmopujo. uibuqfstpopspshboj{bujpobtbobnfejotvsfe dsfbtfuifmjnjutpgjotvsbodfeftdsjcfejo gpstvdimptt-boexfxjmmoputibsfxjuiuibu JJJ TfdujpoMjnjutPgJotvsbodf/ #puifsjotvsbodf#/Cvuuifjotvsbodfqspwjefeup c* Uifjotvsbodfqspwjefeupuifbeejujpobmjo. uifbeejujpobmjotvsfeczuijtfoepstfnfoutujmmjt tvsfeepftopubqqmzup#cpejmzjokvsz#-#qspq. fydfttpwfsbozwbmjeboedpmmfdujcmf#puifsjo. fsuzebnbhf#ps#qfstpobmjokvsz#bsjtjohpvu tvsbodf#-xifuifsqsjnbsz-fydftt-dpoujohfoups pguifsfoefsjohpg-psgbjmvsfupsfoefs-boz pobozpuifscbtjt-uibujtbwbjmbcmfupuifbeej. qspgfttjpobmbsdijufduvsbm-fohjoffsjohpstvs. ujpobmjotvsfexifouibuqfstpopspshboj{bujpojt wfzjohtfswjdft-jodmvejoh; bobeejujpobmjotvsfevoefstvdi#puifsjotvs. j/ Uifqsfqbsjoh-bqqspwjoh-psgbjmjohupbodf#/ qsfqbsfpsbqqspwf-nbqt-tipqesbx. 5/ Btbdpoejujpopgdpwfsbhfqspwjefeupuif joht-pqjojpot-sfqpsut-tvswfzt-gjfmeps. beejujpobmjotvsfeczuijtfoepstfnfou; efstpsdibohfpsefst-psuifqsfqbsjoh- b* Uifbeejujpobmjotvsfenvtuhjwfvtxsjuufo bqqspwjoh-psgbjmjohupqsfqbsfpsbq. opujdfbttppobtqsbdujdbcmfpgbo#pddvs. qspwf-esbxjohtboetqfdjgjdbujpot<boe sfodf#psbopggfotfxijdinbzsftvmujob jj/ Tvqfswjtpsz-jotqfdujpo-bsdijufduvsbmps dmbjn/Upuiffyufouqpttjcmf-tvdiopujdf fohjoffsjohbdujwjujft/ tipvmejodmvef; DHE3571916 3116UifTu/QbvmUsbwfmfstDpnqbojft-Jod/Qbhf2pg3 DPNNFSDJBMHFOFSBMMJBCJMJUZ j/bozqspwjefspg#puifsjotvsbodf#xijdixpvme Ipx-xifoboexifsfuif#pddvssfodf# dpwfsuifbeejujpobmjotvsfegpsbmpttxf pspggfotfupplqmbdf< dpwfsvoefsuijtfoepstfnfou/Ipxfwfs-uijt jj/ Uifobnftboebeesfttftpgbozjokvsfe dpoejujpoepftopubggfduxifuifsuifjotvs. qfstpotboexjuofttft<boe bodfqspwjefeupuifbeejujpobmjotvsfecz jjj/ Uifobuvsfboempdbujpopgbozjokvszps uijtfoepstfnfoujtqsjnbszup#puifsjotvs. ebnbhfbsjtjohpvupguif#pddvssfodf#ps bodf#bwbjmbcmfupuifbeejujpobmjotvsfe pggfotf/ xijdidpwfstuibuqfstpopspshboj{bujpobtb 4/ obnfejotvsfebteftdsjcfejoqbsbhsbqi c* Jgbdmbjnjtnbefps#tvju#jtcspvhiubhbjotu bcpwf/ uifbeejujpobmjotvsfe-uifbeejujpobmjotvsfe nvtu; 6/ UifgpmmpxjohefgjojujpojtbeefeupTFDUJPOW/ EFGJOJUJPOT; j/ Jnnfejbufmzsfdpseuiftqfdjgjdtpguif dmbjnps#tvju#boeuifebufsfdfjwfe<boe #Xsjuufodpousbdusfrvjsjohjotvsbodf#nfbot uibuqbsupgbozxsjuufodpousbdupsbhsffnfou jj/ Opujgzvtbttppobtqsbdujdbcmf/ voefsxijdizpvbsfsfrvjsfeupjodmvefb Uifbeejujpobmjotvsfenvtutffupjuuibuxf qfstpopspshboj{bujpobtbobeejujpobmjo. sfdfjwfxsjuufoopujdfpguifdmbjnps#tvju#bt tvsfepouijtDpwfsbhfQbsu-qspwjefeuibu tppobtqsbdujdbcmf/ uif#cpejmzjokvsz#boe#qspqfsuzebnbhf#pd. d* Uifbeejujpobmjotvsfenvtujnnfejbufmz dvstboeuif#qfstpobmjokvsz#jtdbvtfeczbo tfoevtdpqjftpgbmmmfhbmqbqfstsfdfjwfejo pggfotfdpnnjuufe; dpoofdujpoxjuiuifdmbjnps#tvju#-dppqfsbuf b/ Bgufsuiftjhojohboefyfdvujpopguif xjuivtjouifjowftujhbujpopstfuumfnfoupg dpousbdupsbhsffnfouczzpv< uifdmbjnpsefgfotfbhbjotuuif#tvju#-boe c/ Xijmfuibuqbsupguifdpousbdups puifsxjtfdpnqmzxjuibmmqpmjdzdpoejujpot/ bhsffnfoujtjofggfdu<boe e* Uifbeejujpobmjotvsfenvtuufoefsuifef. d/ Cfgpsfuiffoepguifqpmjdzqfsjpe/ gfotfboejoefnojuzpgbozdmbjnps#tvju#up DHE3571916 Qbhf3pg33116UifTu/QbvmUsbwfmfstDpnqbojft-Jod/ COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS XTEND ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE – This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions 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.H. Aircraft Chartered With Pilot Blanket Additional Insured – Lessors Of Leased Equipment B. Damage To Premises Rented To You I. Blanket Additional Insured – States Or Political C. Increased Supplementary Payments Subdivisions – Permits D. Incidental Medical Malpractice J. Knowledge And Notice Of Occurrence Or Offense E. Who Is An Insured – Newly Acquired Or Formed K. Unintentional Omission Organizations L. Blanket Waiver Of Subrogation F. Who Is An Insured – Broadened Named Insured M. – Unnamed Subsidiaries Amended Bodily Injury Definition G.N. Blanket Additional Insured – Owners, Managers Contractual Liability – Railroads Or Lessors Of Premises PROVISIONS INJURY AND PROPERTY DAMAGE LI- ABILITY : A. AIRCRAFT CHARTERED WITH PILOT c.g.n. Exclusions and through do not apply g.Aircraft, The following is added to Exclusion , f.(1)(a) to "premises damage". Exclusion Auto Or Watercraft,2.SECTION in Paragraph of does not apply to "premises damage" caused I – COVERAGES – COVERAGE A BODILY IN- by: JURY AND PROPERTY DAMAGE LIABILITY : a. Fire; This exclusion does not apply to an aircraft that b. is: Explosion; (a)c. Chartered with a pilot to any insured; Lightning; (b) d. Not owned by any insured; and Smoke resulting from such fire, explosion, or lightning; or (c) Not being used to carry any person or prop- e. erty for a charge. Water; f.IA B. DAMAGE TO PREMISES RENTED TO YOU unless Exclusion of Section – Coverage – Bodily Injury And Property Damage Liability 1. The first paragraph of the exceptions in Ex- is replaced by another endorsement to this j.Damage To Property clusion , , in Para- Coverage Part that has Exclusion – All Pollu- 2.SECTION I – COVERAGES – graph of tion Injury Or Damage or Total Pollution Ex- COVERAGE A BODILY INJURY AND clusion in its title. PROPERTY DAMAGE LIABILITY is deleted. A separate limit of insurance applies to 2. The following replaces the last paragraph of "premises damage" as described in Para- 2.ExclusionsSECTION I – Paragraph , , of 6.SECTION III – LIMITS OF IN- graph of COVERAGES – COVERAGE A. BODILY SURANCE . CG D3 16 11 11Page 1 of 6 © 2011 The Travelers Indemnity Company. All rights reserved. COMMERCIAL GENERAL LIABILITY C. INCREASED SUPPLEMENTARY PAYMENTS 3.6.SEC- The following replaces Paragraph of TION III – LIMITS OF INSURANCE : 1.1.b. The following replaces Paragraph of SUPPLEMENTARY PAYMENTS – COVER- 5. Subject to above, the Damage To Prem- AGES A AND BSECTION I – COVER- of ises Rented To You Limit is the most we will AGE : A pay under Coverage for damages because of "premises damage" to any one premises. b. Up to $2,500 for the cost of bail bonds The Damage To Premises Rented To You required because of accidents or traffic Limit will apply to all "property damage" law violations arising out of the use of any proximately caused by the same "occur- vehicle to which the Bodily Injury Liability rence", whether such damage results from: Coverage applies. We do not have to fur- fire; explosion; lightning; smoke resulting from nish these bonds. such fire, explosion, or lightning; or water; or 2.1.d. The following replaces Paragraph of any combination of any of these causes. SUPPLEMENTARY PAYMENTS – COVER- The Damage To Premises Rented To You AGES A AND B SECTION I – COVER- of Limit will be: AGES : a. The amount shown for the Damage To d. All reasonable expenses incurred by the Premises Rented To You Limit on the insured at our request to assist us in the Declarations of this Coverage Part; or investigation or defense of the claim or "suit", including actual loss of earnings up b. $300,000 if no amount is shown for the to $500 a day because of time off from Damage To Premises Rented To You work. Limit on the Declarations of this Coverage Part. D. INCIDENTAL MEDICAL MALPRACTICE 4.a. The following replaces Paragraph of the 1. The following is added to the definition of "oc- DEFINI- definition of "insured contract" in the DEFINITIONS currence" in the Section: TIONS Section: "Occurrence" also means an act or omission a. A contract for a lease of premises. How- committed in providing or failing to provide ever, that portion of the contract for a "incidental medical services", first aid or lease of premises that indemnifies any "Good Samaritan services" to a person. person or organization for "premises 2.2.a.(1) The following is added to Paragraph of damage" is not an "insured contract"; SECTION II – WHO IS AN INSURED : 5.DEFINITIONS The following is added to the (1)(d) Paragraph above does not apply to Section: "bodily injury" arising out of providing or fail- "Premises damage" means "property dam- ing to provide: age" to: (i) "Incidental medical services" by any of a. Any premises while rented to you or tem- your "employees" who is a nurse practi- porarily occupied by you with permission tioner, registered nurse, licensed practical of the owner; or nurse, nurse assistant, emergency medi- b. The contents of any premises while such cal technician or paramedic; or premises is rented to you, if you rent such (ii) First aid or "Good Samaritan services" by premises for a period of seven or fewer any of your "employees" or "volunteer consecutive days. workers", other than an employed or vol- 6.4.b.(1)(b) The following replaces Paragraph unteer doctor. Any such "employees" or SECTION IV – COMMERCIAL GENERAL of "volunteer workers" providing or failing to LIABILITY CONDITIONS : provide first aid or "Good Samaritan ser- (b) That is insurance for "premises damage"; vices" during their work hours for you will or be deemed to be acting within the scope of their employment by you or performing 7.4.b.(1)(c)SECTION IV – Paragraph of duties related to the conduct of your busi- COMMERCIAL GENERAL LIABILITY CON- ness. DITIONS is deleted. CG D3 16 11 11 Page 2 of 6 © 2011 The Travelers Indemnity Company. All rights reserved. COMMERCIAL GENERAL LIABILITY 3.5. The following is added to Paragraph of 4. Any organization you newly acquire or form, SECTION III – LIMITS OF INSURANCE : other than a partnership, joint venture or lim- ited liability company, of which you are the For the purposes of determining the applica- sole owner or in which you maintain the ma- ble Each Occurrence Limit, all related acts or jority ownership interest, will qualify as a omissions committed in providing or failing to Named Insured if there is no other insurance provide "incidental medical services", first aid which provides similar coverage to that or- or "Good Samaritan services" to any one per- ganization. However: son will be deemed to be one "occurrence". 4. The following exclusion is added to Para- a. Coverage under this provision is afforded 2.ExclusionsSECTION I – COV- graph ,, of only: ERAGES – COVERAGE A BODILY INJURY (1) Until the 180th day after you acquire or AND PROPERTY DAMAGE LIABILITY : form the organization or the end of the Sale Of Pharmaceuticals policy period, whichever is earlier, if you do not report such organization in writing "Bodily injury" or "property damage" arising to us within 180 days after you acquire or out of the willful violation of a penal statute or ordinance relating to the sale of pharmaceuti-form it; or cals committed by, or with the knowledge or (2) Until the end of the policy period, when consent of, the insured. that date is later than 180 days after you 5.DEFINITIONS The following is added to the acquire or form such organization, if you Section: report such organization in writing to us within 180 days after you acquire or form "Incidental medical services" means: it, and we agree in writing that it will con- a. Medical, surgical, dental, laboratory, x-ray tinue to be a Named Insured until the end or nursing service or treatment, advice or of the policy period; instruction, or the related furnishing of food or beverages; or b.A Coverage does not apply to "bodily injury" perty damage" that occurred before or "pro b. The furnishing or dispensing of drugs or you acquired or formed the organization; and medical, dental, or surgical supplies or appliances. c.B Coverage does not apply to "personal in- jury" or "advertising injury" arising out of an "Good Samaritan services" means any emer- offense committed before you acquired or gency medical services for which no compen- formed the organization. sation is demanded or received. 6.4.b.Ex- The following is added to Paragraph , F. WHO IS AN INSURED – BROADENED NAMED cess InsuranceSECTION IV – COM- , of INSURED – UNNAMED SUBSIDIARIES MERCIAL GENERAL LIABILITY CONDI- SECTION II – WHO IS The following is added to TIONS : AN INSURED : The insurance is excess over any valid and Any of your subsidiaries, other than a partnership, collectible other insurance available to the in- joint venture or limited liability company, that is sured, whether primary, excess, contingent or not shown as a Named Insured in the Declara- on any other basis, that is available to any of tions is a Named Insured if you maintain an own- your "employees" or "volunteer workers" for ership interest of more than 50% in such subsidi- "bodily injury" that arises out of providing or ary on the first day of the policy period. failing to provide "incidental medical ser- vices", first aid or "Good Samaritan services" No such subsidiary is an insured for "bodily injury" to any person to the extent not subject to or "property damage" that occurred, or "personal 2.a.(1)II Paragraph of Section – Who Is An injury" or "advertising injury" caused by an of- Insured. fense committed after the date, if any, during the E. WHO IS AN INSURED – NEWLY ACQUIRED policy period, that you no longer maintain an OR FORMED ORGANIZATIONS ownership interest of more than 50% in such sub- sidiary. 4.SECTION The following replaces Paragraph of II – WHO IS AN INSURED : CG D3 16 11 11Page 3 of 6 © 2011 The Travelers Indemnity Company. All rights reserved. COMMERCIAL GENERAL LIABILITY G.BLANKET ADDITIONAL INSURED – OWNERS, H. BLANKET ADDITIONAL INSURED – LESSORS MANAGERS OR LESSORS OF PREMISES OF LEASED EQUIPMENT SECTION II – WHO IS The following is added to SECTION II – WHO IS The following is added to AN INSURED : AN INSURED : Any person or organization that is a premises Any person or organization that is an equipment owner, manager or lessor and that you have lessor and that you have agreed in a written con- agreed in a written contract or agreement to in- tract or agreement to include as an insured on clude as an additional insured on this Coverage this Coverage Part is an insured, but only with re- Part is an insured, but only with respect to liability spect to liability for "bodily injury", "property dam- for "bodily injury", "property damage", "personal age", "personal injury" or "advertising injury" that: injury" or "advertising injury" that: a. Is "bodily injury" or "property damage" that a. Is "bodily injury" or "property damage" that occurs, or is "personal injury" or "advertising occurs, or is "personal injury" or "advertising injury" caused by an offense that is commit- injury" caused by an offense that is commit- ted, subsequent to the execution of that con- ted, subsequent to the execution of that con- tract or agreement; and tract or agreement; and b. Is caused, in whole or in part, by your acts or b. Arises out of the ownership, maintenance or omissions in the maintenance, operation or use of that part of any premises leased to use of equipment leased to you by such you. equipment lessor. The insurance provided to such premises owner, The insurance provided to such equipment lessor manager or lessor is subject to the following pro- is subject to the following provisions: visions: a. The limits of insurance provided to such a. The limits of insurance provided to such equipment lessor will be the minimum limits premises owner, manager or lessor will be which you agreed to provide in the written the minimum limits which you agreed to pro- contract or agreement, or the limits shown on vide in the written contract or agreement, or the Declarations, whichever are less. the limits shown on the Declarations, which- b. The insurance provided to such equipment ever are less. lessor does not apply to any "bodily injury" or b. The insurance provided to such premises "property damage" that occurs, or "personal owner, manager or lessor does not apply to: injury" or "advertising injury" caused by an of- (1) Any "bodily injury" or "property damage" fense that is committed, after the equipment that occurs, or "personal injury" or "adver- lease expires. tising injury" caused by an offense that is c. The insurance provided to such equipment committed, after you cease to be a tenant lessor is excess over any valid and collectible in that premises; or other insurance available to such equipment (2) Structural alterations, new construction or lessor, whether primary, excess, contingent demolition operations performed by or on or on any other basis, unless you have behalf of such premises owner, lessor or agreed in the written contract or agreement manager. that this insurance must be primary to, or non-contributory with, such other insurance, c. The insurance provided to such premises in which case this insurance will be primary owner, manager or lessor is excess over any to, and non-contributory with, such other in- valid and collectible other insurance available surance. to such premises owner, manager or lessor, whether primary, excess, contingent or on I. BLANKET ADDITIONAL INSURED – STATES any other basis, unless you have agreed in OR POLITICAL SUBDIVISIONS – PERMITS the written contract or agreement that this in- SECTION II – WHO IS The following is added to surance must be primary to, or non- AN INSURED : contributory with, such other insurance, in Any state or political subdivision that has issued a which case this insurance will be primary to, permit in connection with operations performed by and non-contributory with, such other insur- you or on your behalf and that you are required ance. CG D3 16 11 11 Page 4 of 6 © 2011 The Travelers Indemnity Company. All rights reserved. COMMERCIAL GENERAL LIABILITY (ii) A manager of any limited liability by any ordinance, law or building code to include company; or as an additional insured on this Coverage Part is an insured, but only with respect to liability for (iii) An executive officer or director of "bodily injury", "property damage", "personal in- any other organization; jury" or "advertising injury" arising out of such op- that is your partner, joint venture erations. member or manager; or The insurance provided to such state or political (b) Any "employee" authorized by such subdivision does not apply to: partnership, joint venture, limited li- ability company or other organization a. Any "bodily injury," "property damage," "per- to give notice of an "occurrence" or sonal injury" or "advertising injury" arising out offense. of operations performed for that state or po- litical subdivision; or (3) Notice to us of such "occurrence" or of an offense will be deemed to be given as b. Any "bodily injury" or "property damage" in- cluded in the "products-completed operations soon as practicable if it is given in good hazard". faith as soon as practicable to your work- ers' compensation insurer. This applies J. KNOWLEDGE AND NOTICE OF OCCUR- only if you subsequently give notice to us RENCE OR OFFENSE of the "occurrence" or offense as soon as 2.Duties In The following is added to Paragraph , practicable after any of the persons de- The Event of Occurrence, Offense, Claim or e. (1)(2) scribed in Paragraphs or above SuitSECTION IV – COMMERCIAL GEN- , of discovers that the "occurrence" or offense ERAL LIABILITY CONDITIONS : may result in sums to which the insurance e. The following provisions apply to Paragraph provided under this Coverage Part may a. above, but only for the purposes of the in- apply. surance provided under this Coverage Part to However, if this Coverage Part includes an en- 1.2. you or any insured listed in Paragraph or dorsement that provides limited coverage for II of Section – Who Is An Insured: "bodily injury" or "property damage" or pollution (1) Notice to us of such "occurrence" or of- costs arising out of a discharge, release or es- fense must be given as soon as practica- cape of "pollutants" which contains a requirement ble only after the "occurrence" or offense that the discharge, release or escape of "pollut- is known by you (if you are an individual), ants" must be reported to us within a specific any of your partners or members who is number of days after its abrupt commencement, an individual (if you are a partnership or e. this Paragraph does not affect that require- joint venture), any of your managers who ment. is an individual (if you are a limited liability K. UNINTENTIONAL OMISSION company), any of your "executive offi- 6.Repre- The following is added to Paragraph , cers" or directors (if you are an organiza- sentationsSECTION IV – COMMERCIAL , of tion other than a partnership, joint venture GENERAL LIABILITY CONDITIONS : or limited liability company) or any "em- ployee" authorized by you to give notice The unintentional omission of, or unintentional of an "occurrence" or offense. error in, any information provided by you which we relied upon in issuing this policy will not preju- (2) If you are a partnership, joint venture or dice your rights under this insurance. However, limited liability company, and none of your this provision does not affect our right to collect partners, joint venture members or man- additional premium or to exercise our rights of agers are individuals, notice to us of such cancellation or nonrenewal in accordance with "occurrence" or offense must be given as applicable insurance laws or regulations. soon as practicable only after the "occur- rence" or offense is known by: L. BLANKET WAIVER OF SUBROGATION (a) Any individual who is: fer 8.Trans The following is added to Paragraph , OfRights Of Recovery Against Others To Us , (i) A partner or member of any part- SECTION IV – COMMERCIAL GENERAL LI- of nership or joint venture; ABILITY CONDITIONS : CG D3 16 11 11Page 5 of 6 © 2011 The Travelers Indemnity Company. All rights reserved. COMMERCIAL GENERAL LIABILITY 3. "Bodily injury" means bodily injury, mental If the insured has agreed in a contract or agree- anguish, mental injury, shock, fright, disability, ment to waive that insured's right of recovery humiliation, sickness or disease sustained by against any person or organization, we waive our a person, including death resulting from any right of recovery against such person or organiza- of these at any time. tion, but only for payments we make because of: N. CONTRACTUAL LIABILITY – RAILROADS a. "Bodily injury" or "property damage" that oc- curs; or 1.c. The following replaces Paragraph of the DEFINI- definition of "insured contract" in the b. "Personal injury" or "advertising injury" TIONS Section: caused by an offense that is committed; c. Any easement or license agreement; subsequent to the execution of that contract or agreement. 2.f.(1) Paragraph of the definition of "insured DEFINITIONS contract" in the Section is de- M. AMENDED BODILY INJURY DEFINITION leted. The following replaces the definition of "bodily DEFINITIONS injury" in the Section: CG D3 16 11 11 Page 6 of 6 © 2011 The Travelers Indemnity Company. All rights reserved.