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19-070.01 NA Degerstrom: University Rd Preservation Dishman to 16th pnw 401111"11\It% CHANGE ORDER NO: 1 ENGINEERING DIVISION CONSTRUCTION CONTRACT NO: 19-070.01 PROJECT UNIVERSITY ROAD PAVEMENT PRESERVATION CONTRACT DATE 4/4/2019 PRIME CONTRACTOR.N.A.DEGERSTROM,INC CIP NO 287 DESCRIPTION OF CHANGES This change order creates items to reduce the pavement repair excavation depth of 8 inches(per plan)to only 2 inches below existing asphalt and to adjust the depth of CSTC backfill for it, accordingly. Once the existing asphalt is removed for each HMA pavement repair location,the City will determine whether the pavement repair depth will still be according to plan depth or whether a reduced depth can be utilized Additional street sweeping will be performed per the direction of the City to help assist the City on identifying pavement repair locations. Item No. Description Unit Quantity Unit Price Total 106(Sch A) Pavement Repair Excavation Incl.Haul S.Y. -3,600 $11 50 $41,40000 108(Sch A) Crushed Surfacing Top Course,8 In.Depth S.Y. -3,600 $14 00 -$50,400.00 149(Sch A) Pavement Repair Excavation Ind.Haul(Reduced Depth) S Y. 3,600 $6.75 $24,300.00 150(Sch A) Crushed Surfacing Top Course,2 In,Depth S.Y. 3,600 $7.00 $25,200.00 161 (Sch A) Street Cleaning HR, 50 $9720 $4,860.00 8 9%Sales Tax(applicable only to Bid Schedule C) N/A Total Amount of this Change Order(Incl.Tax): -$37,440 00 VERBAL APPROVAL AND JUSTIFICATION Independent Justification on File j j j j Yes Verbal Approval N/A j j j j 1 Verbal Approval by N/A PHYSICAL COMPLETION Original Contract Working Days j 55 Revision By This Change Order 0 .. ........ ... .. ... Revisions by Prior Change Orders 0 Total Revised Contract Wonting Days 55 CONTRACT AMOUNT THESE CHANGES RESULT IN THE FOLLOWING ADJUSTMENTS OF TOTAL CONTRACT AMOUNT: ORIGINAL TOTAL CONTRACT AMOUNT $ 3.121,354.50 TOTAL PRIOR CONTRACT CHANGE ORDER AMOUNT(None) $ 0 00 TOTAL CONTRACT AMOUNT PRIOR TO THIS CHANGE ORDER $ 3.121,354.50 NET THIS CHANGE ORDER $ 37440 00 . .... . I ... .. .. .. .... ... .. .. .... ... .. ... .. ... .. TOTAL CONTRACT AMOUNT INCLUDING THIS CHANGE ORDER $ 3,083,914 50 CONTRACTOR ACCEPTANCE /_/ I DATE //.3///9 Thecareragpherobyaccopts this .;yrr/'!., i— • len -84.4 -. 1 e original contract. // RECOMMENDED BY A�/ �L� DATE gl L/c opr'rojed APPROVED BY r Mendip,- Aor DATEt--dc) •c. y / @. n En i S APPROVED BY 4_ trim_ DATE pQ V// City Manager � ATTACHMENTS Distnbubon ORIGINAL TO City of Spokane Valley Clerks Office COPIES TO Contractor,PW Project File.Project Inspector,Finance Department jChange Order No: 1 Construction Contract No: 19-070.01 THE CONTRACT IS MODIFIED AS FOLLOWS: WORK TO INCLUDE Background: In various HMA pavement repair locations there has been adequate depth of existing rock material under the existing asphalt to perform as a suitable subgrade for the HMA patch. The grinding operations eliminated the City's capacity to view destressed pavement locations in order to identify and possibly modify the pavement repair locations. The City requested the Contractor to perform additional street sweeping operations, in order for the City to determine whether the grinding operations eliminated the poor pavement conditions or whether a full/partial HMA pavement repair is still needed. The Contractor planned and bid the project to perform the street sweeping and cleaning after the water main installation and just prior to paving. Description of Change: This change order creates items to reduce the pavement repair excavation depth of 8 inches(per plan)to only 2 inches below existing asphalt and to adjust the depth of CSTC backfill for it, accordingly. Once the existing asphalt is removed for each HMA pavement repair location,the City will determine whether the pavement repair depth will still be according to plan depth or whether a reduced depth can be utilized. Additional street sweeping will be performed per the direction of the City to help assist the City on identifying pavement repair locations. Specification: There are no changes to the specifications because of this change. Plans: Them are no changes to the plans because of this change Time: There are no changes to the working days because of this change Measurement: "Crushed Surfacing Top Course,2 In. Depth"shall be measured by the square yard "Pavement Repair Excavation Incl. Haul(Reduced Depth)"shall be measured by the square yard. "Street Cleaning"will be measured by the hour for the actual time spent cleaning pavement,as authorized by the City. Change Order No: 1 Construction Contract No: 19-070.01 Payment: This change order deletes approximately 25%of the excavation and CSTC bid items involved for the full depth pavement repair areas and adds new items for shallower removals and CSTC items for the same pavement repair areas. Actual quantities will be determined in the field. Payment for new item#149"Crushed Surfacing Top Course,2 In. Depth", square yard. The unit Contract price per square yard"Crushed Surfacing Top Course, 2 In.Depth",shall be full payment for furnishing tools, labor, equipment,and materials required to furnish, load,haul, place and compact crushed surfacing top course to a two inch depth Payment for new item#150"Pavement Repair Excavation Incl. Haul(Reduced Depth)", square yard. The unit Contract price per square yard of"Pavement Repair Excavation Incl.Haul(Reduced Depth)"shall be full pay for all costs incurred to perform the Work described in Section 5-04.3(4)C of the Standard Specifications with the exception , however,that all costs involved in the placement of HMA shall be included in the unit Contract price per square yard for""HMA for Pavement Repairs Cl._PG_ _In. Depth". Payment for new item#151 "Street Cleaning",per hour. Summary of Quantities: t5z a s w a t w, .; , ... 11 106 Pavement Repair Excavation S.Y. 14,600 11,000 -3,600 $11.50 -$41,400.00 Incl.Haul 108 Crushed Surfacing Top Course, S.Y. 12,700 9,100 -3,600 $14.00 -$50,400.00 8 In.Depth 149 Pavement Repair Excavation S.Y. 0 3,600 +3,600 $6.75 +$24,300.00 (NEW) Incl.Haul(Reduced Depth) 150 Crushed Surfacing Top Course, S.Y. 0 3,600 +3,600 $7.00 +$25,200.00 (NEW) 2In.Depth 151 Street Cleanin (NEW) g HR. 0 50 +50 $97.20 +4,860.00 TOTAL -$37,440.00 hNADEG ER-03 K13FtI IVEh: ALOKO CERTIFICATE OF LIABILITY INSURANCE DATE 1219 ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON, THE CE RTIFICA TE NOI.CIIE,'. 'I311S CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERA ISE AFFORDED BI T-IE "(IL!::Ir', BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSIIRERIE I AI,I YI I('REEL' ' REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER I IM'ORTANT. If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL IFI^lIPEDprowsions ow o:,In oeePl If SUBROGATION 15 WAIVED, subject to the terms and conditions of the policy,certain policies may mold t an endorsement A NI.17n em (HI this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). rexnoucER CONTACT Kristy Bremer Hub'riternational Northwest LLC PHONE raw 999 West Riverside Avenue,Suits 510 (AN.No,Ext) ($09)319-2909 E-Mul Kristy.Bremerghubinternational corn 'Spokane,WA 99201 ADDRESS `l V - 1 INSURER(S)AFFORDING D JLRAGE N<11:# , ,_ - _________ - _ - INSURER Alaska National Insurance Company _ 8137 3:I INELIF ED INSURERS1 I N A Degerstroni,Inc INSURERC 1 3303 N.Sullivan Road INSURER D Spokane Valley WA 99216 - 11 INSURER `___,.______ ___ __ INSURER F COVERAGES CERTIFICATE NUMBER: REVI:,IDN NUMBER. -H,S IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAPII D ABOVE FOP 1HE ND.Ir'Y PEI IO(I II I INDICATED NOIVVITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OROTHEF EOCLillNT WJH FESPECT RI ;V1-11',H IH,, I CERTIFICATE MAY BE ISSUED OR MAY PERT/VN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEE E N IS SU CECT TC ALL I HE EI'MS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS NSR tNSD SUER POLICY EFF POLICY EXP LTp TYPE OF INSURANCE 'NSD WTD POLICY NUMBER IMM/DINTYYYI IMM;DD/YYYYI I,:MTh A X COMMERCIAL GLNERALLI4BILITV L(IN(1, al __-1 _ EACH )_�:URRElICE 9____ ' I CLAIMS MADE X, 'IcI:UR 19FPSD9101 6/30/2019 6/3012020 DAMPL1 to REN FEY h00,illltl X X 3611vJ9WLEaz.EV>rrF: i X Per Project Aggregat '115,1.100 NED E xP,Any_xiy 31 9__— -_ _X Emp Liab/Stop Gap -- 1,000,1 MI PERCY P LAP. IN IVRY 1 CEN L AGGREGATE LIMI F APF LIES PER I LG ENE'r L AOGRI UTF ! /nl[I�I!VE _I POI I XI PRD-CT PIll JI1S-C'i 1 LOC - -__- 2,h0(:n(11; -� )ELIP/IF'PLG I OTHER SrCIV' OAP I,(0(I,ullll. A AUTOMOBILE LIABILITY CONdIN e1) Incl I: RIFT 1,10(1,1100 .2. Ldrn1- ----- 9__--- ---___ X ANY AUTO X X 19FAS09101 6/31)/2019 6/30/2020 B03OOp 'NuyRT_'erPerp 9 OWNEDCHEDJLED _ AUTOS ONO ■ AUTOS BOOR" NJDRV. Ver xnaer,J 9__ -I I. X HIRER © NUTOSON D, PROPtfT DAMAGE ___ AUTOS ONLY AUTOS N'-V yrs ac_ERE_ 9___ __ _c —_ -_— — 9 A X UMBRELLA line X, aCcuR EACH g_UIRPENSEr 10,000,11)(' EXCESS LAD ;LAIMS MADE 19FLU09101 6/30/2019 6/30/2020AGGr, yH,IT _--_-- 'I.OIIt;1E1(1 DED X RETENTIONS 0 A 'NORKERS COMPENSATION X - 'LTTH AND EMPLOYERS'LIABILITY YIN e.d LIE ER yr'RO2RIETORPAR TNEPJE/ECUTIVE I8J WS 09101 1011/2018 10/1/2019 '!,000,'10(1 J-FICER.MEMBER EXCLUDED? Y N/A EL Er LM_CCIUF NT - 1_ Mandatory in NH) EL DI„ '6000,1i1I _LSE EMPLOYEE 1—_— -_ asRe®�dN under ',00°,1 VIII DESCRIPTION OF OPERATIONS belch? _ _ EL DI 4SEP(LItY LIMii 9_ 1111 DESCIIPTION OF OPERAPON£(LOCATIONS,VEHICLES (AGGRO 101.Additional Remarks Schedule may be attached If more space is FeaultedI UNIVERSITY ROAD PRESERVATION PROJECT NO 0287 TRANSPORTATION BOARD PROJECT NO O-3-208(11[')-I AM CONTRACT NSD 19-VU PRIMARY ADDITIONAL INSURED STATUS AND WAIVER OF SUBROGATION TO CITY OF SPOKANE VALLEY,CONTRACTING AGENCY. IT'S on ICE RS, ELECTED OFFICIALS,AGENTS,EMPLOYEES,AND VOLUNTEERS AND MODEL IRRIGATION DISTRICT 16,VARELA&A99OI7I8,1'ES INC ANC -HEIR OFFICERS,ELECTED OFFICIALS,EMPLOYEES,AGENTS AND VOLUNTEERS AS REQUIRED BY WRITTEN CONTRACT:AND AS GRANTED EY THF /,01 II/l( INSURANCE POLICY FORMS THAT ARE ATTACHED TO THIS CERTFICATE. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIIICD POLICIES BE CANCELLED IEEIORE 1 CITY OF SPOKANE VALLEY THE EXPIRATION DATE THEREOF, NOTICE WILL DI[ DEL NEITE] RI 10210 EAST SPRAGUE AVE ACCORDANCE WITH THE POLICY PROVISIONS SPOKANE VALLEY,WA 99206 AUTHOR�IZ/ED LREP\R\ESENTATIVE I ACORD 25(2016/03) li ��©1199888-2015 ACORD CORPORATION. A I ri3HG eservnd. The ACORD name and logo are registered marks of ACORD ►€ Alaska NaCE tional PANY CONTRACTORS'GENERAL LIABILITY ENHANCEMENT ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT C:AREFIJLLY, This endorsement modifies insurance provided under the following' COMMERCIAL GENERAL LIABILITY COVERAGE PART Coverage afforded under this extension of coverage endorsement does not apply to any parson or cicanz covered as an additional insured on any other endorsement now or hereafter attached-to this Coverage 'nit SCHEDULE OF COVERAGES ARE SUMMARIZED BELOW 1. Miscellaneous Additional Insureds 14. In Rem Actions 8 additional insured extensions 1. MISCELLANEOUS ADDITIONAL INSUIRI=DS Primary and Noncontributory Insurance Section II Who Is I:n Insured ie ams v9ac lc 2. Damage To Premises Rented to You include as an addit :nal Insured any perco3 or Limit increased to$500,000 organization described in Paracraphs 2a. through 2.h. below whom you are recuired lo aid 3. Medical Payments as an additional insured on this po icy uncial' a Limits increased to $15,000 written contract or wr tten agreemen H:wevar, Reporting period increasea to three years from the written contract o-written agreement mus I to the date of accident 4. Non-owned Watercraft 1. Currently in effect or becoming Offectve during the telly. of this policy, and Increased to 50 feet. 5. Supplementary Payments 2. Executed poor to the "bcdily m,Jrr+', PP rY y "property damage' or persora ,r ury and Cost of bail bonds increased to$110,000 advertising irjury- but Daily loss of earnings increased to $500 Only the following persons_ or crgan !alions 6. Newly Formed Or Acquired Organizations are additional insureds undo this Coverage extended to the end of the policy period endorsement and coverage prcv del to such or the next anniversary of this policy's effective additional insured„ is limited as erovioed date herein 7. Liberalization Clause a. State or Governmental Agency or Subdivision or Political fiubdiai- 8. Unintentional Failure To Disclose Hazards Mons 9. Notice of Occurrence Any state or governmental acen:,y or sub10. Broad Knowledge of Occurrence that gas issuedopolitical :.crag in 0 that gas a par nil in 11. BodilyInjuryExtension of Coverage connection with operahors perramec - 9 by you o"on your behalf and hat you are required by any ordinance, law or 12. Expected Or Intended Injury budding code to include as an Reasonable force - bodily injury or property additional nsured on this cove-age damage part is an adddior al ensu ed, ut orly ly 13. Blanket Waiver Subrogation with respeci ped to ha Wily 'or t pe , property damage" ' :erronal Waiver of subrogation where required by written and advertising injury' wising ca, of contract or written agreement such ope rations ANIC GL 1187 07 16 Faila 1 Cr 6 Alaska ',.. 44‘? INSURANCE C NationalY The insurance provided to such state e. Owners or Other Interests From or political subdivision does not apply Whom Land Has Been Leased to any "bodily injury", "property damage" or"personal and advertising An owner cr other interest from vroom injury" arising out of operations land has been leased by you cut only performed for that state or political with respect to Lability arising cut of subdivision the ownership, maintenance cr use of that specific part of the land ;rased to b. Controlling Interest you and subject to the lollcwing additional exclusions Ary persons or organizations with a controlling interest in you but only This insurance does not apply to. with respect to their liability arising out of (1) Any 'occurrence' which takes place after you cease to lease (1) Their financial control of you, or that lard, or (2) Premises they own, maintain or (2) Structural alterations, new con- control while you lease or occupy structicn or demolition cpara lions these premises performed by or of oehalf of such additional insured This insurance does not apply to structural alterations new construc- f. Co-owner of Insured Premises bon and demolition operations performed by or for such additional A co-owner of a premises cc-owned insured by you and covered under this insurance hut only with respect to the c. Managers or Lessors of Premises co-owners liability as cc-owner 01 such premises A manager or lessor of premises but only with respect to liability arising out g. Lessor of Equipment of the ownership, maintenance or use of that specific part of the premises Any person or organization rom leased to you and subject to the whom you lease equipment Such following additional exclusions person or organization is an additional insured only with respect tc This insurance does not apply to their liability for bodily injury', "property carnage" or 'personal and (1) Any "occurrence." which takes Advertising injury caused, in whole place after you cease to be a or in part, by your maintenance, aper- tenant in that premises, or ation or use of equipment leased to you by such person or organization (2) Structural alterations, new con- A persons or organization's status as struction or demolition operations an additional Insures under this performed by or on behalf of endorsernent ends when their written such additional insured contract or written agreement with you for sJch leased equipment e d; d. Mortgagee,Assignee or Receiver With respect to the nsurance A mortgagee, assignee or receiver afforded these additional insureds, but only with respect to their liability the following additional exclusions as mortgagee, assignee, or receiver apply and arising out of the ownership, maintenance, or use of a premises by This insurance does not apply you (1) To any "occurrence" which takes This insurance does not apply to place after the equipment lease structural alterations new construc- expires, or tion or demolition operations performed by or for such additional insured ANIC GL 1187 07 16 Page 2 of 6 e ' Aslas National (2) To "bodily injury", "property additional insured However, damage' or "personal and even if coverage within the advertising injury" arising out of "products-completed operations the sole negligence of such hazard" Is required by the written additional insured contract, such coverac,e Is available to the additional insured It Owners, Lessees or Contractors only if the "bodily inrry" or "property damage" occurs prior to (1) Such person or organization is an the end of the time period during additional insured for "bodily which you are required by the injury". "property damage" and written contract to provide such "personal and advertising injury" coverage or the expiration date o1 if, and only to the extent that, the the policy whichever canes first injury or danage is caused by negligent acts or omissions of Any insurance provided to an additional you or your subcontractor In the insured designated under Paragraphs 2.a. performance of "your work" to through 2.g. above does not apply tc bodily which the written contract injury' or "property damage" included within applies Tnis person or organ'- the products-completed operations hazard ' zation does not qualify as an additional insured with respect to Primary And Noncontributory Insurance injury or damage caused in whole or in part by independent The following is adced to the Other lnsuramce negligent acts or omissions of Condition and supersedes any provision to the such person or organization contrary (2) However, this insurance does not This insurance is primary to and will not seek apply to "bodily Injury', "property contribution from any other insurance available tc damage" or "personal and advertising injury" arising out of an additional insured under your policy pro'nded an architect's, engineer's, or that s,'rveyor's rendeing of or failure to render any professional (1) The additional Insured is a services including Named Insured under such other insurance, and i. the preparing, approving, or failing to prepare or approve (2) You have agreed in writing in a maps, drawings, opinions, contract or agreement Fiat this reports, surveys, change Insurance would be primary anc design or would not seek contribution tom orders,cations: and any other insurance availat le tc spthe additional nsured ii. supervisory, inspection, or Section III - Limits of Insurance tie lollowing Is engineering services added (3) The insurance provided to this With respect to the insurance afcrcled to the additional insured, does not additional insureds described in Paragraphs a. cover "bodily injury" or "property through h. above the most we will pay on behalf damaoe" caused by your of such additional insured is the amount of negligent acts and omissions in the performance of "your work" insurance that occurs within the "products- completed operations hazard", (1) Required by the cony-act or unless the written contract agreement, or contains a specific requirement that you procure completed (2) Available under the applicable operations coverage or coverage Limits of Insurance shown in the within the "products-completed Declarations operations hazard" for the whichever is less ANIC GL 1187 07 16 Page 3 of 6 Alaska National INSURANCE COMPANY Ths provision shall not increase the applicable 4. NON-OWNED WATERCRAFT Limits of Insdrance shown in the Declaration A If endorsement CO 21 09, CG 2t 10. CG 24 2. Damage To Premises Rented to You 50, or CG 24 51 is attached to the policy, Paragraph A. 2. g. (2) (b) is replaced by the SECTION ill — LIMITS OF INSURANCE, following Paragraph 6. is replaced by the following (b) A watercraft that you do not 6. Sublect to Paragraph 5. above, the own that is Damage :o Premises Rented to You Limit is the most we will pay under Coverage A (i) Less than 50 teen long for damages because of "property and damage' to any one premises, while rented to you, or in the case of damage (b) Not being used 'o carry by fire while rented to you or temporarily persons or propel/ for a occupied by you with permission of the charge owner B. If Paragraph A does not apply, Para_Irai:h g. If a limit is shown for Damage to Premises (2) of 2. EXCLUSION under SECTION I - Rented to You the most we will pay under COVERAGES, COVERAGE A -- BODILY Coverage A for damages because or "property INJURY AND PROPERTY DAMAGE damage' to ary one premises is the Limit shown LIABILITY is replaced by the foilowinc in the Declarations or $530,000, whichever is greater (2) A watercraft that you do not own that is 3. MEDICAL PAYMENTS (a) t ess than 50 feet long, and A. Section III— Limits of Insurance, Paragraph 7. is replaced by the following (b) Foo being used t, tarry pe'sons or prooerty for a 7. Subject to Paragraph 5 above the charge Medical Expense Limit is the most we will pay under Coverage C for all medical 5. SUPPLEMENTARY PAYMENTS expenses because of "bodily injury" sustained by any one person A. Under Section I -Supplementary Payments - Coverage A and B, Paragraoh 1.b the If a limit s shown for Medical Expense in limit of $250 shown for the cost of ba I bonds the Declarations the most we will pay is replaced by $10,000, under Coverage C for all medical expenses because of "bodily injury' B. In Paragraph 1.d., the of$250 shown 'or sustained by any one person is the Limit daily loss of earnings is replaced ny $506 shown in the Declarations or $15,000. whichever is greater 6. NEWLY FORMED OR ACQUIRED ORGANIZATIONS B. This provision 5 (Medical Payments) does not apply if Section I - Coverage C Medical Paragraph 3.a.of Section II-Who Is An Insured Payments is excluded either by the is deleted and replaced by the following provisions of the Coverage Part or by endorsement Coverage under this provision is afforded only until the end of the policy period on the next C. Paragraph 1.a.(3)(b)of Section I - Coverage anniversary of this policy s effective date after you C - Medical Payments, is replaced by the acquire or form the organization, whict-ever is following earlier (b) The expenses are incurred and reported to us within three years cf the date of the accident, and ANIC GL 1187 07 16 Pag s 4 of 6 ' ; , Alaska NSURANCE ational 7. LIBERALIZATION CLAUSE 10. BROAD KNOWLEDGE OF OCCURRENCE If we adopt a change in our forms or rules which The following is addec .o Paragraph 2. of 'zecti on would broaden coverage for contractors under IV - Commercial General Liability Condition; - this endorsement without an additional premium Duties in The Event of Occurrence, Offense, charge, your policy will automatically provide the Claim or Suit: additional coverages as of tie date the revision is effective in your state You must give us or our authorized repres ant alive notice of an "occurrence", offense, claim, or suit' 8. UNINTENTIONAL FAILURE TO DISCLOSE only when the "occurrence" offense, claim or HAZARDS "suit' is known to SECTION IV — COMMERCIAL GENERAL (1) You, if you are an individual, LIABILITY CONDITIONS — Paragraph 6. — Representations is replaced by the following (2) A partner if you are a partnership, 6. Representations (3) An executive officer or the By accepting this policy, you agree employee designated by !ICU lc give such notice, if yOL ere a a. The statements in the Declarations are corporation, or accurate and complete, (4) A manager, if you are a .united b. Those statements are based upon Irabrbty company. representations you made to us, and 11. EXPANDED BODILY INJURY c. We have issued this policy in reliance Section V - Definitions, the definition 01 'top rly upon your representations injury" is changed to ead The un,ntentional omission of, or "Bodily injury" means bodily injury, sic.kiess or unintentional error in, any information you disease sustained by a person, including) death, provided to us which we relied upon in humiliabon, shock, mental anguish or mental issuing this policy will not prejudice your injury by that person at any time which results as rights under this insurance However, this a consequence of the bodily injury, sickness or provslon does not affect our right to collect disease additional premium or to exercise our rights of cancellation or nonrenewal in accordance 12. EXPECTED OR INTENDED INJURY with applicable laws and regulations Exclusion a. of Section I - Coverage A - Bodily 9. NOTICE OF OCCURRENCE Injury and Property Damage Liability Is replaced by the following The following is added to Paragraph 2. of Section IV - Commercial General Liability Conditions - a. "Bodily ntury' or "property damage Duties In The Event of Occurrence, Offense, expecte° or 'mended from the Claim or Suit: standpoint of the insured This exclusion does not apply to tocily Your rights under this Coverage Part will not be injury" or "property damage resulting prejudiced if you fail to give us notice of an from the use of reasonable bice to "occurrence", offense, claim or 'suit" and that protect persons or property 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" ANIC GL 1187 07 16 Page_ F. o1 6 Alaska INSURANCE COMPANY ,13. BLANKET WAIVER OF SUBROGATION However. this waiver applies only when you have agreed in writing to wa ve such rights of recovery The Transfer Of Rights Of Recovery Against in a contract or aareement. and Orly tl tee Others To Us Condition (Section IV - contract or agreemer.t Commercial General Liability Conditions) is amended by the addition of the following 1. Is in effect or becomes effective d.iring the term of tt is policy, and We waive any right of recovery we may have against any person or organization because of 2. Was executec prior to loss payments we make for injury or damage arising out of 14. IN REM ACTIONS 1. Your ongoing operations-, or Any action in rem against any vessel owned. operated by or for, or chartered by or for yo.. will 2. Your work" included in the "products- be treated in the same manner as the tgh the completed operations hazard " action were in persoram against you This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective on the date issued at 12 01 A M standard time at your mailing address shown in the policy The information below Vs required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective Policy No Insured Endorsement No Countersigned By Includes copyrighted material of Insurance Services Office, Inc , with its permission ANIC GL 1187 07 16 Page 6 of 6 Alaska National 41 `-4 INSURANCE COMPANY DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): All Projects Information required to com•fete this Schedule, if not shown above, will be shown hi the Declarations. A. For an sums which the insured becomes legally 3. Any payments made under Coverage A fol obligated to pay as damages caused by damages or under Coverage C fa- meiIal "occurrences" under Section I — Coverage A, and expenses shall 'educe the Designated for all medical expenses caused by accidents Construction Projec General Aggregate Lani. under Section I — Coverage C, which can be for that designated construction project. Such attributed only to ongoing operations at a single payments shall not reduce the Genera designated construction project shown in the Aggregate Limit sown in the Declarat ons nor Schedule above: shall they redu_e any other Deseglneted 1. A separate Designated Construction Project Construction Proj.;s General Aggregate Limit General Aggregate Limit applies to each for any other designated construction project designated construction project, and that limit shown in the Schedule abode. is equal to the amount of the General 4. The limits shown in the Declarations br Each Aggregate Limit shown in the Declarations. Occurrence, Damage To Premises Rented To 2. The Designated Construction Project General You and Medical Expense continue to apply, Aggregate Limit is the most we will pay for the However, instead of being subject ro the sum of all damages under Coverage A, except General Aggregate Limit shown in the damages because of "bodily injury" or Declarations, such limits will be sjbj'sct to the "property damage" included in the "products- applicable Desigflated Construction Project completed operations hazard', and for medical General Aggregate Limit. expenses under Coverage C regardless of the number of. a. Insureds; b. Claims made or"suits" brought;or c. Persons cr organizations making claims or bringing "suits" CG 25 03 05 09 'age I of 2 Alaska National A INSURANCE COMPANY B. For all sums which the insured becomes legally C. When coverage for liability arising out o the obligated to pay as damages caused by "products-completed operations hazard' is "occurrences" under Section I — Coverage A, and provided, any payner'ts for damages be':uctg of for all medical expenses caused by accidents "bodily injury" or"property damage" inctutnd in the under Section I — Coverage C, which cannot be "products-completed operations hazar]" rvill attributed only to ongoing operations at a single reduce the Products-completed Ciper'iris designated construction project shown in the Aggregate Limit, and not reduce the General Schedule above: Aggregate Limit nor the Designated Construct on 1. Any payments made under Coverage A for Project General Aggregate Limit. damages or under Coverage C for medical D. If the applicable designated construction p-ortcl expenses shall reduce the amount available has been abandoned, celayed, or abanconad and under the General Aggregate Limit or the then restarted, or rt the authorized cairn et ng Products-completed Operations Aggregate parties deviate from plans blueprints, des igns Limit, whichever is applicable;and specifications or timetables, the project w 4 s til be 2. Such payments shall not reduce any deemed to be the sane construction project. Designated Construction Project General E. The provisions of Section III —Limits Of Insurance Aggregate Limit. not otherwise modified by this endorsement shall continue to apply as stipulated. This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective on the date issued at 12:01 A.M. standard time at your mailing address shown in the policy. The information below is required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective Policy No. Insured Endorsement No. 22 Countersigned By Cr Insurance Services Office, Inc.. 2008 CG 25 03 05 09 Page 2 of 2 ? Alaska National INSURANCE COMPANY BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Various provisions in this endorsement restrict SECTION IV — Business Auto Conditions, coverage. Read the entire policy carefully to Paragraph A. 5. —Transfer of Rights of Recovery determine rights, duties, and what is and is not Against Others To Us it:amended to include: covered. 5. Transfer of Rights of Recovery Against Throughout this policy, the words 'you" and "your" Others to Us refer to the Named Insured shown in the Declarations. The words"we', "us", and "our"refer to This condition does not ap my to any the company providing this insurance. person(s) or organizations) to the extent that subrogation against that parson or Other words and phrases that appear in quotation organization is waived prior to the "accident" marks have special meaning. Refer to SECTION V— or the"loss"under a contract with I ha. person DEFINITIONS In the Business Auto Coverage Form. or organization. The coverages provided by this endorsement apply SECTION II — COVERED AUTO LW3ILI f'Y per "accident° and, unless otherwise specified, are COVERAGE, Paragraph A.2.a. (2)— Supplementary subject to all of the terms, conditions, exclusions and Payments is replaced by the following: deductible provisions of the policy, to which it is attached. (2) Up to 510,000 for cost of ba I bords (including bonds for related traffic law SECTION II — COVERED AUTO LIABILITY violations) required because of an COVERAGE, Paragraph Al. Who Is An Insured is "accident" we cover. We do not have amended to include: to furnish these bonds. d. Any "employee" of yours while operating SECTION II — COVERED AUTO LIABiLITY an "auto" hired or rented under a COVERAGE, Paragraph A.2.a. (4)— Supplementary contract or agreement in an "employee's" Payments is replaced by the following name, with your permission, while performing duties related to the conduct (4) All reasonable expense: incurred by of your business, the"insured" at our request, including actual Icss of earnings up le $500 a e. Any person or organization for whom you day because of time off fiom work. have agreed in writing to provide insurance such as is afforded by this Coverage Form, but only with respect to liability arising out of the ownership, maintenance or use of"autos"covered by this policy. If such person or organization has other insurance then this insurance is primary to and we will not seek cortrioution from the other insurance. ANIC CA 1150 10 13 Par e of 4 Alaska National '- — INSURANCE COMPANY c. "Loss' caus_exi by falling object or SECTION II — COVERED AUTO LIABILITY missiles. COVERAGE, Paragraph A.2.c.—Voluntary Property Damage is added as follows. However, you have the option of laving glass breakage caused by a covered "auto's" c. Voluntary Property Damage collision or overturn considered a "los:" under Collision Coverage. At your written request, we may make a voluntary payment for Property Damage Glass Repair—Waiver of Deductible caused by an "insured", but without liability to a third party, up to$25,000 We No deductible a'plies to glass bi ea<age, i1 will not make a Voluntary Property the glass is repaired rather than replaced. Damage payment to anyone who is an "insured"under this policy. SECTION III — PHYSICAL DAMAGE COVERAGE, Paragraph A.4.a. — Transportation Expenses is SECTION III — PHYSICAL DAMAGE COVERAGE, replaced by the following Paragraph A.2 —Towing is replaced by the following: a. Transportation Expenses Towing We will pay up to $200 per day co a We will pay up to $500 for towing and labor maximum of $1,500 for temporary costs incurred each time a covered "auto" transportatioi expense incu-red by you that is a. because of the total theft of a. 3overed "auto"that is a: a. Private passenger; (1) Private passenger; b. Truck: (2) Truck; c. Pick-up truck; (3) Pick-up truck; d. Panel; or (4) Panel; or e. Van (5) Van type vehicle under 20,000 lbs. of Gross Vehicle Weight is disabled. However, the type vehicle under 20,000 lbs. of Gress labor must be performed at place of Vehicle Weight. We will pay only fol disablement. those covered autos"for which you carry either Comprehensive or Specified SECTION III — PHYSICAL DAMAGE COVERAGE, Paragraph A.3. — Glass Breakage — Hitting a Bird Causes of Loss Coverage. We will ses or Animal —Falling Objects or Missiles Is replaced for temporary the period b innng expenses8 b the following: incurred durng the period beginning 48 Y g hours after the theft and ending, regardless of the policy's expiration. Glass Breakage—Hitting a Bird or Animal —Falling Objects or Missiles when the covered "auto" is retuned to use or we pay for its loss". If you carry Comprehensive Coverage for the damaged covered "auto", we will pay the following under Comprehensive Coverage: a. Glass Breakage; b. "Loss' caused by hitting a bird or animal; and ANIC CA 1150 10 13 Page 2 o.4 „ ' Alaska National INSURANCE COMPANY (2) Specifies Causes of Loss ori y if Lie SECTION III — PHYSICAL DAMAGE COVERAGE, Declarations indicate that Sciecitiad Paragraph A.4.b. — Loss of Use Expenses is Causes of Loss Coverages prmwrlad replaced by the following. for the"e uto”withdrawn from service; or b. Loss of Use Expenses— Hired, Rented, (3) Collision only If the Deciarations or Borrowed Automobiles indicate that Collision Coverage is provided for the "auto" withdrawn We will pay expenses for which an from service. "insured" becomes legally responsible to pay for loss of use of a vehicle hired, SECTION III — PHYSICAL DAMAGE COVERAGE, rented or borrowed without a driver under Paragraph A.4.d. — Airbag Coverage is aided as a written rental contract or agreement. follows: We will pay for loss of use expenses, if caused by: d. Airbag Coverage (1) Other than Collision, only if the We will pay for the cost to repair, i .place, Declarations Indicate that or reset an airbag that inflates for any Comprehensive Coverage is provided reason other than as a reu t ',;r a for the vehicle withdrawn from collision, If the Declarations indicate that service. the covered "auto" has Com othersive Coverage or Specified Causes et Less (2) Specified Causes of Loss only if the Coverage. Declarations indicate that Specified Causes of Loss Coverage is provided SECTION III — PHYSICAL DAMAGE COVERAGE, for the vehicle withdrawn from Paragraph Azle. — Rental Reimbursement sennce. Coverage is added as follows: (3) Collision only If the Declarations e. Rental Reimbursement Coverage indicate that Collision Coverage is provided for the vehicle withdrawn We will pay up to $75 per day for rental from service. reimbursement expenses incurred by you for the rental of an °auto" because of However, the most we will pay for any "loss"to a covered "auto"that is a: expenses for loss of use is$200 per day,to a maximum of$1,500. (1) Private Passenger; SECTION III — PHYSICAL DAMAGE COVERAGE, (2) Truck; Paragraph A.4.c.—Non-Transportation Loss of Use Expenses is added as follows: (3) Pick-Jr, truck; c. Non-Transportation Loss of Use (4) Panel; or Expenses (5) Van We will pay up to $2,000 for non- transportation expense incurred by you, type vehicle under 20,000 lbs. of Gress because of "loss" to a covered "auto". if Vehicle Weight Payment apolies in caused by: addition to the otherwise applicable amount of eazfi coverage you have on a (1) Other than Collision, only if the covered "auto". No deductibles apply to Deciarations Indicate that this coverage Comprehensive Coverage is provided for the"auto"withdrawn from service; ANIC CA 1150 10 13 Page£.n•4 .: Alaska National ( 4 INSURANCE COMPANY (1) We will pay only for those expenses SECTION IV - BUSINESS AUTO CONDITIONS - incurred during the policy period Paragraph 8.5 b. - Other Insurance is replaced by beginning 24 hours after the "loss" the following: and ending, regardless of the policy's expiration, with the lesser of the h. For Niree Auto Physical Damage following number of days: Coverage, the following are deemed to be covered "autos"you own: (a) The number of days reasonably required to repair or replace the (1) Any covered "auto" you lease, bre. covered "auto". rent, or r arrow; and (b) 30 days. (2) Any covered "auto"" Hired or rented by your 'employee" under a contract (2) This coverage does not apply while in that individual "employee's' name, there are spare or reserve "autos" with your permission, while available to you for your operations. performing duties related to the conduct;f your business (3) The Rental Reimbursement Coverage described above does not However, any "auto" that is leased, hired. apply to a covered "auto" that is rented or ba'rowed with a driver is ori. a described or designated as a covered covered"auto' "auto" on Rental Reimbursement Coverage Form CA 9923. SECTION V - DEFINITIONS - Paragraph C - "Bodily injury" is replaced by the following' SECTION IV - BUSINESS AUTO CONDITIONS - Paragraph B.2. -Concealment, Misrepresentation Or C. "Bodily injury" mea» bod ly injury, sickness of Fraud is amended by adding Unintentional Failure disease sustained by a person including death or to Disclose Hazards at the end of Paragraph B.2. as mental anguish resulting from any of these. follows: Mental anguish means any type of mental of emotional illness or disease Unintentional Failure to Disclose Hazards If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal. This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective on the date issued at 12:01 A.M. standard time at your mailing address shown in the policy. The information below is required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective Policy No. Insured Endorsement No. 3 Countersigned By U Insurance Services Office, Inc., 2009 ANIC CA 1150 10 13 Page 4 o 4 • 'i Ili Alaska National INSURANCE COMPANY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the ngit to recover our payments from a written contract that equires you to ob-ain this anyone liable for en injury covered by this policy. We agreement from us ) will not enforce our right against the person or organization named in the Schedule (This agreement This agreement shall no: operate directly or indirectly applies only to the extent tnat you perform work under to benefit any one not named in the Schedule SCHEDULE Any person or organization for whom the Insured has agreed by written contract to furnish this waiver This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective on the date issued at 12 01 A M standard time at your mailing address shown in the policy The information below is required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective Policy No. 18JWS 09101 Insured _'ndcrsemert Vo Countersigned By WC CO 03 13 (04 E4;