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16-112.01 ICON Corporation: CenterPlace Roof Repair CONTRACT AMENDMENT TO THE AGREEMENT BETWEEN THE CITY OF SPOKANE VALLEY AND ICON CORPORATION Contract #16-112.01 For good and valuable consideration,the legal sufficiency of which is hereby acknowledged, City and the Contractor mutually agree as follows: 1. Purpose: This Amendment is for the Contract for the CenterPlace Roof Repair 2016 Project by and between the Parties, executed by the Parties on July 12, 2016, and which terminates on August 31, 2016. Said contract shall be referred to as the "Original Contract" and its terms are hereby incorporated by reference. Total compensation under the Original Contract is not to exceed$45,469.21. 2.Original Contract Provisions: The Parties agree to continue to abide by those terms and conditions of the Original Contract and any amendments thereto which are not specifically modified by this Amendment. 3.Amendment Provisions: This Amendment is subject to the following amended provisions,which are r as follows. All such amended provisions are hereby incorporated by reference herein and shall control over any conflicting provisions of the Original Contract, including any previous amendments thereto. Extend time of performance until December 31, 2016. 4. Compensation Amendment History: This is Amendment #1 of the Original Contract. The history of amendments to the compensation on the Original Contract and all amendments is as follows: Date Compensation Original Contract Amount - 7/12/16 $45,469.21 Amendment#1 8/19/16 $ 0.00 Total Amended Compensation ��g�" $ 45,469.21 The parties have executed this Amendment to the Original Contract this d61 ' day of August,2016. CIT OF SPO N ALLEY: CONTRACTOR: 1/7/za Mark Calhoun, Acting City Manager By: Its: eitefr4Ay AT APPROVED AS TO FORM: 1/44,e ristine Bainbridge, City Cler _. Office tde' orney 1 ____..--....1, ICONCOR-02 WCHRISTESON ACORO" DATE(MM/DD/YYYY) 4,...---- CERTIFICATE OF LIABILITY INSURANCE 6/30/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Spokane Office PHONEFAX PayneWest Insurance,Inc. (NC.No,Ext): 509)838-3501 (NC,No): (509)838-3511 501 N.Riverpoint Blvd.,Ste 403 ADDRESS: Spokane,WA 99202 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:The Continental Insurance Company INSURED INSURER B:American Casualty Co of Reading PA 20427 Icon Corporation INSURER c:Transportation Insurance Co. 20494 PO BOX 10 INSURER D: Greenacres,WA 99016 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRLJCY EXP TYPE OF INSURANCE AINSD DDL SWVD POLICY NUMBER (UBR MM/DD ) (MEFF M/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _$ 1,000,000 CLAIMS-MADE X OCCUR X X C2074781294 10/07/2015 10/07/2016 DAMAGES(EaRENTED ) $ occurrence100,000 PREMISES( X Riggers$1,000,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: WA STOP GAP $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) B X ANY AUTO X X C2074781313 10/07/2015 10/07/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS _AUTOS X HIRED AUTOS X AUT SEED Per accidentDAMAGE $ . $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 C EXCESS LIAB CLAIMS-MADE C2074781327 10/07/2015 10/07/2016 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ ' If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project: Center Place Roof Repair 2016 Icon Corp Job#4089 The City of Spokane Valley is included as Additional insured provided under the contract as per the attached forms. Coverage is primary/non-contributory and includes completed operations and waiver of subrogation in favor of the additional insureds.A per project aggregate applies per the attached forms. CERTIFICATE HOLDER CANCELLATION 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. Attn: Christine Bainbridge 11707 East Sprague Ave.,Suite 106 Spokane,WA 99206 AUTHORIZED REPRESENTATIVE .0.1* 0.1 riva ., I ©1988-2014 ACORD CORPORATION. All rights reserved. G-140331-D CNA (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 10101 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 G-140331-D CNA (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; (3) 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. 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 Coovriaht.CNA All Riahts Reserved. G-18652-J CNA (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 (.nnvrinht f.NA All Rinhtc Racarvarl G-18652-J CNA (Ed. 07-12) 1. ADDITIONAL INSURED 2. With respect to the insurance afforded to SECTION II-WHO IS AN INSURED is amended to these additional insureds, this insurance include as an insured any person or organization does not apply to any occurrence which takes place after the equipment lease (called additional insured)described in paragraphs A.through G.below whom you are required to add expires. as an additional insured on this policy under a D. Lessor-Land written contract or written agreement, provided the An owner or other interest from whom land has written contract or written agreement: been leased by you but only with respect to I. Is currently in effect or becomes effective liability arising out of the ownership, 1 during the term of this policy; and maintenance or use of that specific part of the ii. Was executed prior to the "bodily injury," land leased to you and subject to the following additional exclusions: "property damage" or "personal injury and advertising injury" for which the additional This insurance does not apply to: insured seeks coverage. 1. .Any "occurrence" which takes place after However, we will not provide the additional you cease to lease that land; or insured any broader coverage or any higher 2. Structural alterations, new construction or limit of insurance than the least that is: demolition operations performed by or on a. The maximum permitted by law; behalf of such additional insured. b. Required in the written contract or written E. Lessor-Premises agreement; • A manager or lessor of premises but only with c. Afforded to you under this policy; or respect to liability arising out of the ownership, d. Described in the applicable paragraphs A. maintenance or use of that specific part of the through G. below. premises leased to you and subject to the following additional exclusions: A. Controlling Interest This insurance does not apply to: Any persons or organizations with a controlling 1. Any "occurrence" which takes place after interest in you but only with respect to their you cease to be a tenant in that premises; liability arising out of: or 1. Their financial control of you; or 2. Structural alterations, new construction or 2. Premises they own, maintain or control demolition operations performed by or on while you lease or occupy these premises. behalf of such additional insured. This insurance does not apply to structural F. Mortgagee,Assignee or Receiver alterations, new construction and demolition A mortgagee, assignee or receiver but only with operations performed by or for such additional respect to their liability as mortgagee, assignee, insured. or receiver and arising out of the ownership, B. Co-owner of Insured Premises maintenance, or use of a premises by you. A co-owner of a premises co-owned by you and This insurance does not apply to structural covered under this insurance but only with alterations, new construction or demolition respect to the co-owner's liability as co-owner of operations performed by or for such additional such premises. insured. C. Lessor- Equipment G. State or Governmental Agency or Subdivision or Political Subdivisions 1. Any person or organization from whom you lease equipment, but only with respect to A state or governmental agency or subdivision liability for "bodily injury," "property or political subdivision subject to the following damage" or "personal and advertising provisions: injury" caused, in whole or in part, by your 1. This insurance applies only with respect to maintenance, operation or--use of- - the following hazards fog which the state or — equipment leased to you by such person or . governmental. agency . or subdivision or. organization. G-18652-J (Ed. 07-12) Page 2 of 12 n......_:..64 ('MMA nn o;..M4,.o..,...,,,,.4 G-18652-J CNA (Ed. 07-12) political subdivision has issued a permit or A. BROAD KNOWLEDGE OF OCCURRENCE authorization in connection with premises You must give us or our authorized you own, rent, or control and to which this representative notice of an "occurrence," insurance applies: offense, claim, or "suit" only when the a. The existence, maintenance, repair, "occurrence," offense, claim or "suit" is known construction, erection, or removal of to: advertising signs, awnings, canopies, (1) You, if you are an individual; cellar entrances, coal holes, driveways, manholes, marquees, hoistaway (2) A partner, if you are a partnership; openings, sidewalk vaults, street banners, or decorations and similar (3) An executive officer or the employee exposures; or designated by you to give such notice, if you are a corporation; or b. The construction, erection, or removal of elevators; or (4) A manager, if you are a limited liability company. c. The ownership, maintenance or use of B. NOTICE OF OCCURRENCE any elevators covered by this insurance. Your rights under this Coverage Part will not be 2. This insurance applies only with respect to prejudiced if you fail to give us notice of an operations performed by you or on your "occurrence,"offense, claim or"suit" and that behalf for which the state or governmental failure is solely due to your reasonable belief agency or subdivision or political that the"bodily injury"or"property damage" is subdivision has issued a permit or not covered under this Coverage Part. authorization. However, you shall give written notice of this "occurrence,"offense, claim or"suit"to us as 3. This insurance does not apply to: soon as you are aware that this insurance may a. "Bodily injury," "property damage" or apply to such "occurrence," offense claim or "personal and advertising injury" arising suet. out of operations performed for the 4. BROAD NAMED INSURED federal government, state or municipality; or A. Any subsidiary or affiliate organization, other p ty' than a partnership, joint venture or limited b. "Bodily injury" or "property damage" liability company, in which a Named Insured included within the "products-completed specifically shown in the Declarations has operations hazard." management control, directly or through one or A governmental permit which requires you to more subsidiary organizations, at the time of add the governmental entity as an additional loss will qualify as a Named Insured but only if insured will trigger this Provision 1.as if the there is no other similar insurance available to such organization, nor similar insurance which permit were a written contract. would be available but for exhaustion of its 2. BODILY INJURY—EXPANDED DEFINITION limits. For the purpose of this provision, similar SECTION V—DEFINITIONS, the definition of insurance means general liability or equivalent "bodily injury" is changed to read: insurance, no matter whether its coverage is broader or narrower than that provided by this "Bodily injury"means bodily injury, sickness or insurance. But if the only other similar insurance disease sustained by a person, including death, is for a "consolidated (wrap-up) program," then humiliation, shock, mental anguish or mental injury a subsidiary that qualifies as a Named Insured by that person at any time which results as a on such project-specific insurance can still consequence of the bodily injury, sickness or qualify as a Named Insured on this insurance, disease. but not for projects covered by the 3. BROAD KNOWLEDGE OF OCCURRENCE/ "consolidated (wrap-up) program." NOTICE OF OCCURRENCE [Please see Item 26.C.of this endorsement for Condition 2.Duties in The Event of Occurrence, the definition of"consolidated (wrap-up) Offense,Claim or Suit of SECTION IV— program. ] -- - --COMMERCIAL-GENERAL LIABILITY B. This endorsement does not apply_ to _ any CONDITIONS is amended to add the following organization for which coverage is excluded by provisions: another endorsement attached to this policy. G-18652-J (Ed. 07-12) Page 3 of 12 Copyright,CNA All Rights Reserved. G-18652-J CNA (Ed. 07-12) C. Only for the purpose of this endorsement: (4) Explosion. 1. Management control means: I. Damage to Your Work a. Ownership interest representing more "Property damage"to"your work"arising out of than 50% of the voting, appointment, or it, or any part of it and included in the"products- designation power for the subsidiary completed operations hazard." organization's governing body; or This exclusion does not apply: b. Having the right, pursuant to a written (1) If the damaged work or the work out of contract, or pursuant to the by-laws, which the damage arises was charter, operating agreement, or similar performed on your behalf by a document of a specifically shown subcontractor; or Named Insured or controlled subsidiary organization to select, appoint, or (2) If the cause of loss to the damaged designate a majority of the subsidiary work arises as a result of: organization's governing body. Such contract or document must have been (a) Fire; created prior to the time of loss; or (b) Smoke; c. Having the right, pursuant to a written (c) Collapse; or trust agreement, to protect, control the use of, encumber or transfer and sell (d) Explosion. property held by a trust. B. The following paragraph is added to SECTION 2. Governing body means the Board of III–LIMITS OF INSURANCE: Directors of a corporation. Subject to 5.above, $100,000 is the most we 3. Loss means: will pay under Coverage A for the sum of damages arising out of any one"occurrence" a. The occurring of the "bodily injury" or because of"property damage"to"your product" "property damage"; or and"your work"that is caused by fire, smoke, b. The committing of the offense that collapse or explosion and is included within the caused the "personal and advertising "product-completed operations hazard." This sublimit does not apply to "property damage"to injury." "your work"if the damaged work or the work out D. The insurance provided by this policy applies to of which the damage arises was performed on Named Insureds when trading under their own your behalf by a subcontractor. names, or under such trading names or doing- C. This Provision 5. Broadened Liability business-as (DBA) names as any should Coverage For Damage To "Your Product" choose to employ. And "Your Work" does not apply if an 5. BROADENED LIABILITY COVERAGE FOR endorsement of the same name is attached to DAMAGE TO "YOUR PRODUCT" AND "YOUR this policy. WORK" 6. CONTRACTUAL LIABILITY–RAILROADS A. Under SECTION I – COVERAGE A – BODILY With respect to operations performed within 50 feet INJURY AND PROPERTY DAMAGE of railroad property, the definition of"insured LIABILITY, Paragraph 2. Exclusions is contract" in SECTION V–DEFINITIONS is amended to delete exclusions k. and I. and replaced by the following: replace them with the following: [This insurance does not apply to:] "Insured Contract" means: k. Damage to Your Product a. A contract for a lease of premises. However, that portion of the contract for a lease of "Property damage"to"your product"arising premises that indemnifies any person or out of it, or any part of it except when organization for damage by fire to premises caused by or resulting from: while rented to you or temporarily occupied by you with permission of the owner is not an (1) Fire; "insured contract"; (2) Smoke; —b A sidetrack-agreement; . (3) Collapse; or.. • c. Any easement or license agreement; • G-18652-J (Ed. 07-12) Page 4 of 12 (`nnvrinht (:AIA All Rinhtc Racaniari - G-18652-J C'I'IA (Ed. 07-12) d. An obligation, as required by ordinance, to Damages arising out of the loss of, loss of use indemnify a municipality, except in connection of, damage to, corruption of, inability to access, with work for a municipality; or inability to manipulate "electronic data" that does not result from physical injury to tangible e. An elevator maintenance agreement; property. f. That part of any other contract or agreement However, this exclusion does not apply to pertaining to your business (including an liability for damages because of"bodily injury." indemnification of a municipality in connection with work performed for a municipality) under B. The following paragraph is added to SECTION which you assume the tort liability of another III—LIMITS OF INSURANCE: party to pay for "bodily injury" or "property Subject to 5.above, $100,000 is the most we damage" to a third person or organization. Tort will pay under Coverage A for all damages liability means a liability that would be imposed arising out of any one"occurrence"because of by law in the absence of any contract or "property damage"that results from physical agreement. injury to tangible property and arises out of Paragraph f. does not include that part of any "electronic data." contract or agreement: C. The following definition is added to the (1) That indemnifies an architect, engineer or SECTION V—DEFINITIONS: surveyor for injury or damage arising out of: "Electronic data" means information, facts or (a) Preparing, approving or failing to programs stored as or on, created or used on, prepare or approve maps, shop or transmitted to or from computer software drawings, opinions, reports, surveys, (including systems and applications software), field orders, change orders or drawings hard or floppy disks, CD-ROMS, tapes, drives, and specifications; or cells, data processing devices or any other (b) Giving directions or instructions, or media which are used with electronically controlled equipment. failing to give them, if that is the primary cause of the injury or damage; D. For the purposes of the coverage provided by this endorsement, the definition of "property (2) Under which the insured, if an architect, damage" in SECTION V — DEFINITIONS is engineer or surveyor, assumes liability for replaced by the following: an injury or damage arising out of the insured's rendering or failure to render 17. "Property damage" means: professional services, including those listed a. Physical injury to tangible property, in (1) above and supervisory, inspection, including all resulting loss of use of that architectural or engineering activities. property. All such loss of use shall be 7. CONTRACTUAL LIABILITY FOR PERSONAL deemed to occur at the time of the AND ADVERTISING INJURY physical injury that caused it; Under SECTION I—COVERAGE B—PERSONAL b. Loss of use of tangible property that is AND ADVERTISING INJURY LIABILITY, not physically injured. All such loss of Paragraph 2. Exclusions is amended to delete use shall be deemed to occur at the exclusion e.Contractual Liability. time of the "occurrence" that caused it; This provision 7.does not apply to any person or or organization who otherwise qualifies as an c. Loss of, loss of use of, damage to, additional insured on this Coverage Part. corruption of, inability to access, or 8. ELECTRONIC DATA LIABILITY inability to properly manipulate "electronic data," resulting from A. Under SECTION I — COVERAGE A — BODILY physical injury to tangible property. All INJURY AND PROPERTY DAMAGE, such loss of "electronic data" shall be Paragraph 2. Exclusions is amended to delete deemed to occur at the time of the exclusion p. Electronic Data and replace it with "occurrence"that caused it. the following: For the purposes of this insurance, [This insurance does not apply to:] "electronic data"is not tangible property. p. Electronic Data 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. G-18652-J CNA (Ed. 07-12) this policy, then the $100,000 limit provided by amended to delete exclusion a. Expected or this Provision 8. Electronic Data Liability is Intended Injury and replace it with the part of, and not in addition to, that higher limit. following: 9. EXPANDED PERSONAL AND ADVERTISING [This insurance does not apply to:] INJURY-DISCRIMINATION OR HUMILIATION a. Expected or Intended Injury A. SECTION V — DEFINITIONS is amended to "Bodily injury"or"property damage" add the following to the definition of "Personal from the stanpoint and advertising injury": the insureds This exclus on does not apply of h. Discrimination or humiliation that results in to"bodily injury"or"property damage" injury to the feelings or reputation of a resulting from the use of reasonable force natural person, but only if such to protect persons orproperty. discrimination or humiliation is: 11. GENERAL AGGREGATE LIMITS OF (1) Not done intentionally by or at the INSURANCE-PER PROJECT direction of: A. For each construction project away from (a) The insured; or premises you own or rent, a separate (b) Any "executive officer," director, Construction Project General Aggregate stockholder, partner, member or Limit, equal to the amount of the General manager (if you are a limited Aggregate Limit, is the most we will pay for liability company) of the insured; the sum of: and 1. All damages under Coverage A, except (2) Not directly or indirectly related to the damages because of "bodily injury" or employment, prospective employment, produdamage" included in the past employment or termination of "products-completedy operations hazard"; and employment of any person or persons by any insured. 2. All medical expenses under Coverage B. Under SECTION I — COVERAGE B— C, PERSONAL AND ADVERTISING INJURY that arise from "occurrences" or LIABILITY, Paragraph 2. Exclusions is accidents which can be attributed solely amended to add the following additional to ongoing operations at that exclusions: construction project. Such payments [This insurance does not apply to:] shall not reduce the General Aggregate Limit shown in the Declarations, nor the Discrimination Relating To Room, Construction Project Aggregate Limit of Dwelling or Premises any other construction project. "Personal or advertising injury" caused by B. All: discrimination directly or indirectly related to 1. Damages under Coverage B, regardless of the sale, rental, lease or sub-lease or the number of locations or construction prospective sale, rental, lease or sub-lease projects involved; of any room, dwelling or premises by or at the direction of any insured. 2. Damages under Coverage A, caused by Fines Or Penalties "occurrences" which cannot be attributed solely to ongoing operations at a single Fines or penalties levied or imposed by a construction project, except damages governmental entity because of because of "bodily injury" or "property discrimination. damage" included in the "products- This provision 9. does not apply to any person completed operations hazard"; and or organization who otherwise qualifies as an 3. Medical expenses under Coverage C additional insured on this Coverage Part. caused by accidents which cannot be 10. EXPECTED OR INTENDED INJURY attributed solely to ongoing operations at a single construction project, Under SECTION I—COVERAGE A—BODILY _______ INJURY AND PROPERTY DAMAGE will reduce the-General Aggregate-Limit-shown — LIABILITY, Paragraph 2. Exclusions is in the Declarations. G-18652-J (Ed. 07-12) Page 6 of 12 Copyright,CNA All Rights Reserved. G-18652-J CNA (Ed. 07-12) C. The limits shown in the Declarations for Each (a) "Bodily injury" caused by a "health Occurrence, for Damage To Premises Rented care incident" will be considered To You and for Medical Expense continue to caused by an"occurrence"; and apply, but will be subject to either the Construction Project Aggregate Limit or the (b) All acts, errors or omissions that General Aggregate Limit, depending on whether are logically connected by any the "occurrence" can be attributed solely to common fact, circumstance, ongoing operations at a particular construction situation, transaction, event, advice project. or decision will be considered to constitute a single"occurrence"; D. When coverage for liability arising out of the (2) The "bodily injury" occurs during the "products-completed operations hazard" is policy period. All "bodily injury" arising provided, any payments for damages because from an "occurrence"will be deemed to of"bodily injury" or"property damage" included have occurred at the time of the first in the "products-completed operations hazard," act, error, or omission that is part of the regardless of the number of locations involved "occurrence"; and will reduce the Products-Completed Operations Aggregate Limit shown in the Declarations. B. With respect only to the insurance provided by E. If a single construction project away from this Provision 13., Exclusion 2.e. Employer's or rented to the insured has Liability of SECTION I — COVERAGE A— premises owned by BODILY INJURY AND PROPERTY DAMAGE, been abandoned and then restarted, or if the is amended to append the following: authorized contracting parties deviate from plans, blueprints, designs, specifications or Only for "bodily injury" not covered by other timetables, the project will still be deemed to be liability insurance (including state-sanctioned the same construction project. self insurance) available to the insured (or F. The provisions of SECTION III — LIMITS OF which would be available but for exhaustion of its limits), this exclusion does not apply to INSURANCE not otherwise modified by this "bodily injury" that arises out of a "health care endorsement shall continue to apply as incident." stipulated. 12. IN REM ACTIONS C. SECTION V — DEFINITIONS is amended to add the following new definition: Any action in rem against any vessel owned or "Health care incident" means a negligent act, operated by or for you, or chartered by or for you error or omission by your "employees" or will be treated in the same manner as though the "volunteer workers" working on your behalf in action were in personam against you. the rendering of or failure to render professional In rem is a term used to designate actions instituted health care services in any of the following against the thing, as distinct from actions against capacities, or the related furnishing of food, the person, which are said to be in personam. beverages, medical supplies or appliances: 13. INCIDENTAL HEALTH CARE MALPRACTICE a. Physician; COVERAGE b. Nurse; A. With respect only to "bodily injury" that arises out of a"health care incident," COVERAGE A— c. Emergency medical technician; BODILY INJURY AND PROPERTY DAMAGE d. Paramedic; LIABILITY OF SECTION I — COVERAGES is e. Chiropractor; amended to replace Insuring Agreement Paragraphs 1.b.(1) and 1.b.(2) with the f. Dentist; following: g. Athletic trainer; b. This insurance applies to"bodily injury"only h. Audiologist; if you are not in the business of providing g professional health care services, and only i. Physical therapist; if: j. Psychologist; (1) The "bodily injury" is caused by an "occurrence" that takes place in the k. Speech therapist; "coverage territory." For the purpose of I. Other allied health professional; or . this insurance:. G-18652-J (Ed. 07-12) Page 7 of 12 Convriaht.CNA All Riahts Reserved. G-18652-J CNA (Ed. 07-12) m. Provider of first aid or Good Samaritan a. "bodily injury" to a co-"volunteer services rendered in an emergency and for worker" while performing duties related which no payment is demanded or to the conduct of your business; and received. b. "bodily injury" to an "employee"while in D. SECTION I — COVERAGE A — BODILY the course of the "employee's" INJURY AND PROPERTY DAMAGE, employment by you or while performing Paragraph 2. Exclusions is amended to add the duties related to the conduct of your following additional exclusions. These new business; exclusions apply only to this Incidental Health when such "bodilyinjury"arises out of a Care Malpractice Coverage: "health care incident." n" [This insurance does not apply to:] 3. Paragraphs 2.a. (1)(a), (b) and (c) of Dishonesty or Crime SECTION II — WHO IS AN INSURED do Any dishonest, criminal or malicious act, error not apply to "bodily injury" for which insurance is provided this Provision 13. or omission. Clinical Trials/Product Testing 4. Paragraph 2.a.(1)(d) of SECTION II—WHO IS AN INSURED is deleted. Acts, errors or omissions that occur in the G. With respect to the insurance provided by this course of human clinical trials or product Provision 13., the following is added to testing. Paragraph 4.b.(1) of SECTION IV— Medicare/Medicaid Fraud COMMERCIAL GENERAL LIABILITY CONDITIONS: Medicare or Medicaid fraud or abuse. Services Excluded byEndorsement To the extent this insurance applies, it is excess over any of the other insurance (including Any "health care incident"for which coverage is qualified self insurance), whether primary, excluded by endorsement. excess, contingent or on any other basis, E. SECTION V — DEFINITIONS is amended to except for insurance purchased specifically by you to be excess of this policy. add the following subparagraph to Paragraph f. of the definition of"insured contract": 14. JOINT VENTURES / PARTNERSHIP / LIMITED LIABILITY COMPANIES Paragraph f. does not include that part of any contract or agreement: A. The following is added to SECTION II — WHO IS AN INSURED: (4) Under which you assume another's tort liability for "bodily injury" arising out of the 4. You are an insured when you had an rendering of or failure to render professional interest in a joint venture, partnership or health care services. limited liability company which terminated or ended prior to or during this policy F. SECTION II — WHO IS AN INSURED is period, but only to the extent of your amended to add the following provisions: interest in such joint venture, partnership or 1. Your"employees" are insureds with respect limited liability company. This coverage to: does not apply: a. "bodily injury" to a co-"employee" while a. Prior to the termination date of any joint in the course of the co-"employee's" venture, partnership or limited liability employment by you or while performing company; duties related to the conduct of your b. If there is other valid and collectible business; and insurance purchased specifically to b. "bodily injury" to a "volunteer worker" insure the partnership, joint venture or while performing duties related to the limited liability company; or conduct of your business; c. To a joint venture, partnership or limited when such"bodily injury"arises out of a liability company which is or was "health care incident." insured under a "consolidated (wrap- _ __ _..________up)insurance program.." _ __ _ _ 2. Your "volunteer workers" are insureds with .. respect to: . [Please see Item 26.C. of this endorsement G-18652-J (Ed. 07-12) Page 8 of 12 r ...;.hrole All oi..hhc nec.ntewl . G-18652-J CNA (Ed. 07-12) for the definition of"consolidated (wrap-up) Paragraphs (1), (3) and (4) of this exclusion program."] do not apply to "property damage" (other B. The last paragraph of SECTION II — WHO IS than damage by fire) to premises rented to you or temporarily occupied by you with the AN INSURED is deleted and replaced by the permission of the owner, or to the contents following: of premises rented to you for a period of 7 Except as provided under the Contractors' or fewer consecutive days. A separate limit General Liability Extension Endorsement or by of insurance applies to Damage To the attachment of another endorsement(if any), Premises Rented To You as described in no person or organization is an insured with SECTION III—LIMITS OF INSURANCE. respect to the conduct of any current or past Paragraphs (3), (4), (5) and (6) of this partnership, joint venture or limited liability exclusion do not apply to liability assumed company that is not shown as a Named Insured under a sidetrack agreement. in the Declarations. 15. Paragraph (6) of this exclusion does not LEGAL LIABILITY/ALIENATED PREMISES/ BORROWED EQUIPMENT apply to "property damage" included in the "products-completed operations hazard." A. Under SECTION I — COVERAGE A — BODILY B. Under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE, INJURY AND PROPERTY DAMAGE the last Paragraph 2. Exclusions is amended to delete paragraph of Paragraph 2. Exclusions is exclusion j. Damage to Property in its entirety deleted and replaced by the following. and replace it with the following: [This insurance does not apply to:] Exclusions c. through n. do not apply to damage by fire to premises while rented to you j. Damage to Property or temporarily occupied by you with permission "Property damage"to: • of the owner nor to the contents of premises p g rented to you for a period of 7 or fewer (1) Property you own, rent, or occupy; consecutive days. (2) Premises you sell, give away or A separate limit of insurance applies to this abandon, if the "property damage" coverage as described in SECTION III—LIMITS arises out of any part of those OF INSURANCE. premises; C. The following paragraph is added to SECTION (3) Property loaned to you; III—LIMITS OF INSURANCE: (4) Personal property in the care, custody Subject to 5. above, $25,000 is the most we will or control of the insured; pay under Coverage A for damages arising out of any one "occurrence" because of "property (5) That particular part of real property on damage"to tools or equipment loaned to you by which you or any contractors or others that occurs while the equipment is being subcontractors working directly or used to perform operations. indirectly on your behalf are performing operations, if the "property damage" D. Paragraph 6. Damage To Premises Rented To arises out of those operations; or You Limit of SECTION III — LIMITS OF INSURANCE is replaced by the following: (6) That particular part of any property that must be restored, repaired or replaced 6. Subject to Paragraph 5. above, (the Each because "your work" was incorrectly Occurrence Limit), the Damage To performed on it. Premises Rented To You Limit is the most we will pay under SECTION — I— Paragraph (2) of this exclusion does not COVERAGE A for damages because of apply if the premises are"your work." "property damage" to any one premises Paragraphs (3) and (4) of this exclusion do while rented to you or temporarily occupied not apply to "property damage" to tools or by you with the permission of the owner, equipment loaned to you. A separate limit including contents of such premises rented of insurance applies to such tools or to you for a period of 7 or fewer consecutive equipment that are damaged while being days. The Damage To Premises Rented To used-in-your operations._ _ ____ _______-- _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. G-18652-J CNA (Ed. 07-12) b. The Damage To Premises Rented To This paragraph B. does not apply to medical You Limit shown in the Declarations. expenses incurred in the state of Missouri. E. Paragraph 4.b.(1)(a)(ii) of SECTION IV– 19. NON-OWNED AIRCRAFT COMMERCIAL GENERAL LIABILITY Under SECTION I–COVERAGE A–BODILY CONDITIONS is deleted and replaced by the INJURY AND PROPERTY DAMAGE LIABILITY. following: Paragraph 2. Exclusions is amended such that (ii) That is property insurance for premises exclusion g.Aircraft,Auto or Watercraft does not rented to you, for premises temporarily apply to an aircraft you do not own, provided that: occupied by you with the permission of the 1. The pilot in command holds a currently effective owner; or for personal property of others in certificate issued by the duly constituted your care, custody or control; authority of the United States of America or F. This Provision 15. does not apply if Damage To Canada, designating that person as a Premises Rented To You Liability under commercial or airline transport pilot; SECTION – I –.COVERAGE A is excluded by 2. The aircraft is rented to you with a trained, paid endorsement. crew; and 16. LIBERALIZATION CLAUSE 3. The aircraft does not transport persons or cargo If we adopt a change in our forms or rules which for a charge. would broaden coverage for contractors under this 20. NON-OWNED WATERCRAFT endorsement without an additional premium charge, your policy will automatically provide the additional Under SECTION I–COVERAGE A–BODILY coverage as of the date the revision is effective in INJURY AND PROPERTY DAMAGE LIABILITY, your state. Paragraph 2. Exclusions is amended to delete 17. LIQUOR LIABILITY subparagraph (2)of exclusion g.Aircraft,Auto or Watercraft and replace it with the following. Under SECTION I–COVERAGE A–BODILY [This exclusion does not apply to:] INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions is amended to delete exclusion c. (2) A watercraft you do not own that is: Liquor Liability. (a) Less than 75 feet long; and This provision 17.does not apply to any person or (b) Not being used to carry persons or property organization who otherwise qualifies as an for a charge. additional insured on this Coverage Part. 18. MEDICAL PAYMENTS 21. PRIMARY AND NON-CONTRIBUTORY TO OTHER INSURANCE A. Paragraph 7. Medical Expense Limit, of With respect to any person or organization that is SECTION III – LIMITS OF INSURANCE is an additional insured under this Coverage Part, the deleted and replaced by the following: following is added to Paragraph 4.of SECTION IV– 7. Subject to Paragraph 5. above (the Each COMMERCIAL GENERAL LIABILITY Occurrence Limit), the Medical Expense CONDITIONS: Limit is the most we will pay under SECTION – I – COVERAGE C for all If you have agreed in writing in a contract or medical expenses because of"bodily injury" agreement that this insurance is primary and non- sustained by any one person. The Medical contributory relative to an additional insured's own Expense Limit is the greater of: insurance, then this insurance is primary and we will not seek contribution from that other insurance. For (1) $15,000; or the purpose of this Provision 21.,the additional (2) The amount shown in the Declarations insured's own insurance means insurance on which for Medical Expense Limit. the additional insured is a Named Insured. This Provision 21. does not apply in situations B. Paragraph 1.a.(3)(b) of SECTION I– COVERAGE C MEDICAL PAYMENTS, is where the endorsement on this policy affording replaced by the following: coverage to the additional insured specifies that this insurance is excess over any other insurance (b) The expenses are incurred and reported to available to that additional insured. us within three years of the date of the 22 PROPERTY DAMAGE-ELEVATORS accident; and G-18652-J (Ed. 07-12) Page 10 of 12 Copyright,CNA All Rights Reserved. • G-18652-J CNA (Ed. 07-12) A. Under SECTION I — COVERAGE A — BODILY However, this waiver applies only when you have INJURY AND PROPERTY DAMAGE, agreed in writing to waive such rights of recovery in Paragraph 2. Exclusions is amended such that a contract or agreement, and only if the contract or exclusion k. Damage to Your Product, and agreement: subparagraph (3), (4) and (6) of exclusion j. 1. Is in effect or becomes effective during the term Damage to Property do not apply "property of this policy; and damage"that results from the use of elevators. B. With respect only to the coverage provided by 2. Was executed prior to loss. this endorsement, Condition 4. Other 26. WRAP-UP EXTENSION: OWNER CONTROLLED Insurance in SECTION IV — COMMERCIAL INSURANCE PROGRAM, CONTRACTOR GENERAL LIABILITY CONDITIONS is CONTROLLED INSURANCE PROGRAM OR amended to add the following subparagraph CONSOLIDATED (WRAP-UP) INSURANCE b.(1)(a)(v): PROGRAMS 4. Other Insurance Note:The following provision does not apply to any b. Excess Insurance public construction project in the state of Oklahoma, nor to any construction project in the state of (1) This insurance is excess over: Alaska, that is not permitted to be insured under a (a) Any of the other insurance, "consolidated (wrap-up) insurance program" by whether primary, excess, applicable state statute or regulation: contingent or on any other If the endorsement EXCLUSION— basis: CONSTRUCTION WRAP-UP or another (v) That is exclusionary endorsement pertaining to Owner covering Propertyproperty insuranceoothers Controlled Insurance Programs (O.C.I.P.)or damaged from the use of Contractor Controlled Insurance Programs elevators. (C.C.I.P.) is attached to this policy, then the following changes apply: 23. SUPPLEMENTARY PAYMENTS A. The following wording is added to the A. Under Section I — Supplementary Payments endorsement: —Coverages A and B, Paragraph 1.b., the limit With respect to a"consolidated (wrap-up) of $250 shown for the cost of bail bonds is insurance program" project in which you are or replaced by$5,000: were involved, this exclusion does not apply to B. In Paragraph 1.d., the limit of $250 shown for those sums you become legally obligated to pay daily loss of earnings is replaced by$1,000. as damages because of: 24. UNINTENTIONAL FAILURE TO DISCLOSE 1. "Bodily injury," "property damage," or HAZARDS "personal or advertising injury" that occurs should fail to disclose all during your ongoing operations at the If unintentionally youproject, or during such operations of existing hazards at the inception date of your policy, anyone acting on your behalf; nor we will not deny coverage under this Coverage Part because of such failure. 2. "Bodily injury" or "property damage" 25. WAIVER OF SUBGROGATION-BLANKET included within the "products-completed operations hazard" that arises out of those Under SECTION IV—COMMERCIAL GENERAL portions of the project that are not LIABILITY CONDITIONS, The Transfer Of Rights "residential structures." Of Recovery Against Others To Us Condition is B. SECTION IV — COMMERCIAL GENERAL amended by the addition of the following: LIABILITY CONDITIONS is amended to add the We waive any right of recovery we may have following subparagraph 4.b.(1)(c) to Condition against any person or organization because of 4. Other Insurance: payments we make for injury or damage arising out [This insurance is excess over:] of: 1. Your ongoing operations; or (c) Any of the other insurance whether primary, excess, contingent or any other basis that is -- --2.- "Your-work"included-in the"products-completed- insurance available to you as a result of operations hazard." your being a participant in a "consolidated (wrap-up) insurance program," but only as G-18652-J (Ed. 07-12) Page 11 of 12 (:nnvrinhf (:NA All Rinhte Paean/ad G-18652-J CNA (Ed. 07-12) respects your involvement in that used or is intended to be used for human "consolidated (wrap-up) insurance residency including but not limited to single or program." multifamily housing, apartments, C. SECTION V — DEFINITIONS is amended to condominiums, townhouses, co-operatives or add the following definition: planned unit developments and also includes their common areas and/or appurtenant "Consolidated (wrap-up) insurance program" structures (including pools, hot tubs, detached means a construction, erection or demolition garages, guest houses or any similar project for which the prime contractor/project structures). When there is no individual manager or owner of the construction project ownership of units, residential structure does has secured general liability insurance covering not include military housing, college/university some or all of the contractors or subcontractors housing or dormitories, long term care facilities, involved in the project, such as an Owner hotels, or motels. Residential structure also Controlled Insurance Program (O.C.I.P.)or does not include hospitals or prisons. Contractor Controlled Insurance Program This provision 26.does not apply to any person (C.C.I.P.). or organization who otherwise qualifies as an "Residential structure" means any structure additional insured on this Coverage Part. where 30%or more of the square foot area is All other terms and conditions of the Policy remain unchanged. 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. POLICY NUMBER: COMMERCIAL AUTO CA 044/10310 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ.IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (VVAIVER 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 modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Nerned Insured: Endorsement Effective Date: SCHEDULE CD § Name(s)Of Person(s)Or Organization(s): ANY PERSON OR ORGANIZATION POR. WHOM OR WHICH YOU ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT TO OBTAIN THIS : WAIVER FROM US. YOU MUST AGREE TO THAT g REQUIREMENT PRIOR TO LOSS. Information required to complete this Schedule,if not shown above,will be shown in the DeclaratiOns. The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply to the person(s) or organization(s) shown in the pchedule, but only to the Went that subrogation is waived prior to the 'accident' or the loss' under a contract with that person or = organization. Et 1 Et CA 04 44 03 10 Copyright,Insurance Stuvices Office,Inc.,2009 Page 1 on POLICY NUMBER: COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the fallowing: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds"under the Who Is An Insured Provision of the Coverage Form.This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another dale is indicated below. Endorsement Effective: Countersigned By: Named Insured: _�_...._ _._.._....__.... _. ...__.. ...__...._.._.._....�... _...... ..._ (Authorized Representative) SCHEDULE Name of Person(s)or Organizatton(s): ANY PERSON OR ORGA'NTZATTON AS RRQ ITP.ED BY WRITTEN CONTRACT OR AGREEMENT (It no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) AEach person or organization shown in the Schedule is an"insured"for Liability Coverage,but only to the extent that person or organization qualifies as an "insured' under the Who Is An Insured Provision contained In Section A of the Coverage Farm. 11 wito -474 U P 11=0; _ -�__ - -__.__-_ -- .__ -- __-._---____ _ .._ GGAii .. "IMM" CA 20 AS 0200 r:nnvrinht. tnguranra SarviCAR Office. Ing:.. 1 .NB Paw I of 1 B/20/2016 ICON CORPORATION "Wine t ti l C:_... ci iSearch L&I Magi lade: Help lly l:s-.t Safety&H _,ith Claims&Insurance Workplace Rights Trades&Licensing Washington State Department of kj-Labor & Industries • ICON CORPORATION PO BOX 10 Owner or tradesperson GREENACRES,WA 99016 Principals 509-532-1761 JOHNSON,MAX G SPOKANE County Doing business as ICON CORPORATION WA UBI No. Business type 601 838 594 Corporation License Verify the contractor's active registration/license/certification(depending on trade)and any past violations. Construction ContractorActive. Meets current requirements. License specialties GENERAL License no. ICONC**022M3 Effective—expiration 07/23/1998—07/16/2017 Bond Travelers Cas and Surety Co of America $12,000.00 Bond account no. 105623806 Received by L&I Effective date 07/18/2011 07/16/2011 Expiration date Until Canceled Bond history Insurance Continental Insurance Co $1,000,000.00 Policy no. C2074781294 Received by L&l Effective date 09/29/2015 10/07/2014 Expiration date 10/07/2016 Insurance history Savings No savings accounts during the previous 6 year period. Lawsuits against the bond orsavings No lawsuits against the bond or savings accounts during the previous 6 year period. L&l Tax debts No L8l tax debts are recorded for this contractor license during the previous 6 year period,but some debts may be recorded by other agencies. – . 1/: .6/20/2016 ICON CORPORATION License Violations No license violations during the previous 6 year period. Workers' comp Do you know if the business has employees?If so,verify the business is up-to-date on workers'comp premiums. This company has multiple workers' comp accounts. Active accounts L&I Account ID Account is current. 965,948-00 Doing business as ICON CORPORATION Estimated workers reported Quarter 1 of Year 2016"31 to 50 Workers" L&I account representative T4/TERRI MADISON(360)9024654-Email:KIRT235@Ini.wa.gov Track this contractor J j Workplace safety and health Check for any past safety and health violations found on jobsites this business was responsible for. Inspection results date 04/14/2016 No violations Inspection no. 317939880 Location 4141 N.Regal St Spokane,WA 99207 Inspection results date 11/06/2013 No violations Inspection no. 316881200 Location 900 E.Yonezawa Blvd Moses Lake,WA 98837 Inspection results date 08/21/2013 - No violations Inspection no. 316859776 Location 501 Port Industrial Park Way Quincy,WA 98848 Inspection results date 06/13/2013 No violations Inspection no. 316788066 Location 200 Nat Washington Way Ephrata,WA 98823 Inspection results date 04/02/2013 No violations Inspection no. 316625078 n .. .. .� . .. ....... .... An.. _.'.awl!'.*lnnnwln0(+l1\11/.C..1.... 2/3 ' . 6/20/2016 �nmCORPORATION Location 940 Yonesawa Moses LakeWA 98837 Inspection results date Violations09/12/2012 Inspection no. 316338938 Location 1620 NE Colorado WSU Pullman,WA 99163 ---------'----------------------------------'-----------'— Inspection results date No violations omome n Inspection no. 314896390 1 Location French Admin Building WSIJ Pullman,WA 99164 ------' - . Inspection results date Violations onnm:o o Inspection no. 314486853 Location Johnson Toweand Todd Bldg. Pullman,WA 99163 -_-_'---_----______---_--_--_- _-__----_---'_----____ -_-'---- ©Washington State Dept.of Labor uIndustries.Use of this site is subject to the laws of the state of Washington. — —