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20-140.00 Ibex Commercial Flooring: CenterPlace Carpet Replacement Contract No. 20-140.00 CONSTRUCTION AGREEMENT Ibex Flooring,LLC THIS CONSTRUCTION AGREEMENT(the"Agreement") is made by and between the City of Spokane Valley, a code City of the State of Washington ("City") and Ibex Flooring, LLC, ("Contractor") jointly referred to as the"Parties". IN CONSIDERATION of the terms and conditions contained herein the Patties agree as follows: 1.Work to Be Performed. Contractor shall do all work and furnish all labor,supervision,tools,materials, supplies, and equipment and other items necessary for the construction and completion of the CenterPlace Regional Event Center Flooring Replacement Project(the"Work")in accordance with documents described in Exhibit B and in accordance with this Agreement(which are by this reference incorporated herein and made part hereof and referred to as the "Contract Documents"), and shall perform any changes in the work in accordance with the Contract Documents. The terms and provisions in this Agreement shall control over any inconsistent or incompatible terms in any other Contract Document. • Contractor shall, for the amount set forth in.paragraph 4,below,assume and be responsible for the cost and expense of all work required for constructing and completing the Work and related activities to the City's satisfaction, provided for in the Contract Documents, within the time limits prescribed in the Contract Documents. The City Manager or designee shall administer and be the primary contact for Contractor. Upon notice from • City,Contractor shall promptly commence work,complete the same in a timely manner,and cure any failure in performance under this Agreement. Unless otherwise directed by City,all work shall be performed in conformance with the Contract Documents, and all City,state,and federal standards,codes,ordinances,regulations,and laws as now existing or as may be adopted or amended.. 2. Time for Performance. Contractor shall commence the Work within 10 days of receipt of a notice to proceed and shall complete the Work by September 30,2020 or as may be extended in accordance with this Agreement and the Contract Documents. 3. Compensation. In consideration of Contractor performing the Work, City agrees to pay Contractor in accordance with the Contract Documents the sum of$15,690.00, plus Washington State Sales Tax of $1,396.41(if applicable),for a total of$17,086.41,based on the bid submitted by Contractor(Exhibit C),and as may be adjusted in accordance with the Contract Documents. This total is for both the Base Bid and Alternate#1. 4.,Payment. Contractor may elect to be paid in monthly installments,upon presentation of an application for payment in a form satisfactory to City. Applications for payment shall be sent to the City Finance Department at the address stated in paragraph 6. Pursuant to chapter 60.28 RCW,five percent of the compensation due Contractor shall be retained by City. City reserves the right to withhold payment under this Agreement for that portion of the work(if any)which is determined in the reasonable judgment of the City Manager or designee to be noncompliant with the Contract Construction Agreement Page I of 9 • f • • Documents,City standards,City Code,state standards,or federal standards. 5.Notice. Notice other than applications for payment shall be given in writing as follows: TO THE CITY: TO THE CONTRACTOR: Name:Christine Bainbridge,City Clerk Name: Ibex Flooring,LLC Phone:(509)720-5000 Phone: (509)327-3331 Address: 10210 East Sprague Avenue Address: P.O.Box 7538 Spokane Valley, WA 99206 Spokane, WA 99206 6.Applicable Laws and Standards. The Parties,in the performance of this Agreement,agree to comply with all applicable federal,state,and local laws,codes,and regulations. 7. Certification Regarding Debarment, Suspension, and Other Responsibility Matters — Primary Covered Transactions. A.By executing this Agreement,the Consultant certifies to the best of its knowledge and•belief,that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment,declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; 2. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public(federal, state, or local)transaction or contract under a public transaction;violation of federal or state antitrust statutes or commission of embezzlement,theft,forgery,bribery,falsification or destruction of records,making false statements,or receiving stolen property; 3. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph(A)(2)of this certification;and 4. Have not within a three-year period preceding this application/proposal had one or more " public transactions(federal,state,or local)terminated for cause or default. B. Where the prospective primary participant is unable to certify to any of the statements in this certification,such prospective participant shall attach an explanation to this Agreement. 8.Prevailing Wages on Public Works. Contractor,any subcontractor,or other person doing work under this Agreement, shall comply with the requirements of chapter 39.12 RCW, and shall pay each employee an amount not less than the Prevailing Rate of Wage,as specified by the Industrial Statistician of the Washington State Department of Labor and Industries("L&I"). If employing labor in a class not shown,Contractor shall request a determination of the correct wage rate for the class and locality from the Industrial Statistician. Contractor shall provide a copy of any such determinations to City. Before commencing,during,and upon completion of the work,Contractor shall file all forms and pay all fees required by L&I and shall indemnify and hold City harmless from any claims related to its failure to comply with chapter 39.12 RCW. The following information is provided pursuant to RCW 39.12.030: Construction Agreement Page 2 of 9 A. State of Washington prevailing wage rates applicable to this public works project,published by L&I,are located at the L&I website address: https://fortress.wa.gov/lni/wagelookup/prvWagelookup.aspx • B.This Project is Iocated in Spokane County. : C.The effective prevailing wage date is the same date as the bid due date as referenced in the original request for bids and as may be revised by addenda. A copy of the applicable prevailing wage rates is also available for viewing at the City Community&Public Works Department located at 10210 East Sprague Avenue,Spokane Valley,WA 99206. Upon request,City will mail a hard copy of the applicable prevailing wages for this project. 9.Relationship of the Parties. It is understood and agreed that Contractor shall be an independent contractor and not the agent or employee of City, that City is interested only in the results to be achieved,and that the right to control the particular manner,method,and means in which the services are performed is solely within the discretion of Contractor. Any and all employees who provide services to City under this Agreement shall be deemed employees solely of Contractor. Contractor shall be solely responsible for the conduct and actions of all its employees under this Agreement and any liability that may attach thereto. 10.Ownership of Documents. All drawings,plans,specifications,and other related documents prepared by Contractor under this Agreement are and shall be the property of City, and may be subject to disclosure pursuant to chapter 42.56 RCW,or other applicable public record laws. 11.Records. The City or State Auditor or any of their representatives shall have full access to and the right to • examine during normal business hours all of Contractor's records with respect to all matters covered in this Agreement. Such representatives shall be permitted to audit,examine,make excerpts or transcripts from such records,and to make audits of all contracts,invoices,materials,payrolls,and record of matters covered by this Agreement for a period of three years from the date final payment is made hereunder. 12.Warranty. Unless provided otherwise in the Contract Documents,Contractor warrants that all Work and materials performed or installed under this Agreement are free from defect or failure for a period of one year following final acceptance by City,unless a supplier or manufacturer has a warranty fOr a greater period;which warranty shall be assigned or transferred to City. In the event a defect or failure occurs in work or materials, Contractor shall,within the warranty period, remedy the same at no cost or expense to City. This warranty provision shall not be construed to establish a period of limitation with respect to Contractor's other obligations under this Agreement. • 13.Contractor to Be Licensed and Bonded. Contractor shall be duly licensed,registered,and bonded by the State of Washington at all times this Agreement is in effect. 14.Contractor to Provide Performance and Payment Bonds. Contractor shall provide a payment bond and a performance bond in the full amount of the Agreement on the City's bond forms. Alternatively,Contractor may elect to have the City retain 10%of the Agreement amount in lieu of providing the City with a payment bond and a performance bond,pursuant to RCW 39.08.010(3). • 15. Insurance. Contractor shall procure and maintain for the duration of the Agreement insurance against claims for injuries to persons or damage to property which may arise from or in connection with the • • Construction Agreement • Page 3 of 9 performance of the work hereunder by Contractor, its agents,representatives,or employees. A.Minimum Scope of Insurance. Contractor shall obtain insurance of the types described below: 1.Automobile liability insurance covering all owned,non-owned,hired,and leased vehicles. Coverage shall be written on Insurance Services Office(ISO)form CA 00 01 or a substitute form providing equivalent liability coverage. If necessary, the policy shall be endorsed to provide contractual liability coverage. 2.Commercial general liability insurance shall be written on ISO occurrence form CG 00 01 and shall cover liability arising from premises,operations,independent contractors,products- completed operations, stop gap liability, personal injury, advertising injury, and liability assumed under an insured contract. The commercial general liability insurance shall be endorsed to provide a per project aggregate limit using ISO form CG 25 03 05 09 or an equivalent endorsement. There shall be no endorsement or modification of the commercial • general liability insurance for liability arising from explosion, collapse, or underground • property damage.•City shall be named as an additional insured under Contractor's commercial general liability insurance policy with respect to the work performed for City using ISO Additional Insured endorsement CG 20 10 10 01 and Additional Insured-Completed Operations endorsement CG 20 37 10 01 or substitute endorsements providing equivalent coverage. 3.Workers'compensation coverage as required by the industrial insurance laws of the State of Washington. B.Minimum Amounts of Insurance. Contractor shall maintain the following insurance limits: • 1.Automobile liability insurance with a minimum combined single limit for bodily injury and property damage of no less than$1,000,000 per accident. 2.Commercial general liability insurance shall be written with limits no less than$1,000,000 each occurrence, $2,000,000 general aggregate, and no Iess than a $2,000,000 products- completed operations aggregate limit. C.Other Insurance Provisions. The insurance policies are to contain,or be endorsed to contain,the following provisions for automobile liability and commercial general liability insurance: 1. Contractor's insurance coverage shall be primary insurance with respect to City. Any insurance,self-insurance,or insurance pool coverage maintained by City shall be excess of Contractor's insurance and shall not contribute with it. • 2.Contractor shall fax or send electronically in .pdf format a copy of insurer's cancellation notice within two business days of receipt by Contractor. 3.If Contractor maintains higher insurance limits than the minimums shown above,City shall be insured for the full available limits of commercial general and excess or umbrella liability maintained by Contractor,irrespective of whether such limits maintained by Contractor are greater than those required by this Agreement or whether any certificate of insurance furnished to the City evidences limits of liability lower than those maintained by Contractor. Construction Agreement Page 4 of 9 4. Failure on the part of Contractor to maintain the insurance as required shall constitute a material breach of this Agreement, upon which the City may, after giving at least five business days' notice to Contractor to correct the breach, immediately terminate the Agreement, or at its sole discretion, procure or renew such insurance and.pay any and all premiums in connection therewith, with any sums so expended to be repaid to City on • demand, or at the sole discretion of the City, offset against funds due Contractor from the City. • D.Acceptability of Insurers. Insurance is to be placed with insurers with a current A.M.Best rating of • not less than A:VII. E. Evidence of Coverage. As evidence of the insurance coverages required by this Agreement, Contractor shall furnish acceptable insurance certificates to City at the time Contractor returns the signed Agreement,which shall be Exhibit D. The certificate shall specify all of the parties who are additional insureds,and shall include applicable policy endorsements,and the deduction or retention • level. Insuring companies or entities are subject to City acceptance. If requested,complete copies of insurance policies shall be provided to City. Contractor shall be financially responsible for all pertinent deductibles,self-insured retentions,and/or self-insurance. F.Subcontractor Insurance. Contractor shall cause each and every subcontractor to provide insurance coverage that complies with all applicable requirements of the Contractor-provided insurance as set forth herein,except Contractor shall have sole responsibility for determining the limits of coverage to be required to be obtained by subcontractors. Contractor shall ensure that the City is an additional insured on each and every subcontractor's commercial general liability insurance policy using an endorsement at least as broad as ISO additional insured endorsement CG 20 38 04 13. • 16.Indemnification and Hold Harmless. Contractor shall,at its sole expense,defend,indemnify,and hold harmless City and its officers,agents,and employees, from any and all claims,actions, suits, liability, loss, costs,attorney's fees and costs of litigation,expenses,injuries,and damages of any nature whatsoever relating to or arising out of the wrongful or negligent acts,errors,or omissions in the services provided by Contractor, Contractor's agents, subcontractors, subconsultants, and employees to the fullest extent permitted by law, • subject only to the limitations provided below. Contractor's duty to defend,indemnify,and hold City harmless shall not apply to liability for damages arising out of such services caused by or resulting from the sole negligence of City or City's agents or employees. Contractor's duty to defend,indemnify,and hold City harmless against liability for damages arising out of such '• services caused by the concurrent negligence of(a) City or City's agents or employees, and(b)Contractor, Contractor's agents, subcontractors, subconsultants, and employees shall apply only to the extent of the negligence of Contractor,Contractor's agents,subcontractors,subconsultants,and employees. Contractor's duty to defend,indemnify,and hold City harmless shall include,as to all claims,demands,losses, and liability to which it applies,City's personnel-related costs,reasonable attorneys'fees,and the reasonable value of any services rendered by the office of the City Attorney,outside consultant costs,court costs,fees for • collection, and all other claim-related expenses. Contractor specifically and expressly waives any immunity that may be granted it under the Washington State Industrial Insurance Act,Title 51 RCW. These indemnification obligations shall not be limited in any way by any limitation on the amount or type of damages,compensation,or benefits payable to or for any third party under workers' compensation acts, disability benefit acts, or other employee benefits acts. Provided, that Construction Agreement Page 5 of 9 I. Contractor's waiver of immunity by the provisions of this paragraph extends only to claims against Contractor by City,and does not include,or extend to,any claims by Contractor's employees directly against Contractor. Contractor hereby certifies that this indemnification provision was mutually negotiated. 17.Waiver. No officer,employee,agent,or other individual acting on behalf of either party has the power, right,or authority to waive any of the conditions or provisions of this Agreement. No waiver in one instance shall be held to be waiver of any other subsequent breach or nonperformance. All remedies afforded in this Agreement or by law shall be taken and construed as cumulative and in addition to every other remedy provided herein or by law. Failure of either party to enforce at any time any of the provisions of this Agreement or to require at any time performance by the other party of any provision hereof shall in no way be construed to be a waiver of such provisions nor shall it affect the validity of this Agreement or any part thereof. 18. Assignment and Delegation.. Neither party shall assign, transfer, or delegate any or all of the responsibilities of this Agreement or the benefits received hereunder without first obtaining the written consent of the other party. 19. Confidentiality. Contractor may,from time-to-time,receive information which is deemed by City to be confidential. Contractor shall not disclose such information without the prior express written consent of City or upon order of a Court of competent jurisdiction. 20.Disputes. All disputes arising under or related to this Agreement that cannot be resolved through informal • discussion and negotiations shall be resolved by litigation filed in the Superior Court of the State of Washington for Spokane County,unless otherwise required by applicable federal or state law. 21. Subcontractor Responsibility. As required by RCW 39.06.020, Contractor shall verify responsibility criteria for each first tier subcontractor and its subcontractors of any tier that hires other subcontractors shall verify responsibility criteria for each of its subcontractors. Verification shall include that each subcontractor,at the time of subcontract execution,meets the responsibility criteria listed in RCW 39.04.350(1)and possesses an electrical contractor license,if required by chapter 19.28 RCW,or an elevator contractor license if required by chapter 70.87 RCW. This verification requirement shall be included in every subcontract of every tier. 22.Jurisdiction and Venue. This Agreement is entered into in Spokane County,Washington. Venue shall be in Spokane County,State of Washington. 23.Entire Agreement. This Agreement constitutes the entire and complete agreement between the parties and supercedes any prior oral or written agreements. This Agreement may not be changed,modified,or altered except in writing signed by the Parties. 24. Anti-kickback. No officer or employee of City, having the power or duty to perform an official act or action related to this Agreement, shall have or acquire any interest in this Agreement, or have solicited, accepted,or granted a present or future gift,favor,service, or other thing of value from any person with an interest in this Agreement. 25.Business Registration. Prior to commencement of Work under this Agreement,Contractor shall register • with the City as a business if it has not already done so. • 26.Severability. If any section,sentence,clause,or phrase of this Agreement should be held to be invalid for any reason by a court of competent jurisdiction,such invalidity shall not affect the validity of any other section, sentence,clause,or phrase of this Agreement. Construction Agreement • Page 6 of 9 27.Exhibits. Exhibits attached and incorporated into this Agreement are: A. Assurance of compliance with applicable federal laws B. Scope of Work C. Cost Statement D. Insurance Endorsements E. Performance and Payment Bond M The Parties have executed this Agreement this th day ofittty, 2020. CITY OF SPOKANE VALLEY: Contractor: lbGtoftovie.tj (ytQi 1A13A,L b i C(4.5i Mark Calhoun,City Manager By: 'VWvut,*✓ elisIn�✓ gittiGvi Its: Authorized Representative ATTEST: uistine Bainbridge,City Cleric APPROVED AS TO FORM: Office f the Ci A ey Construction Agreement Page 7 of 9 Exhibit A—Assurance of Compliance with Applicable Federal Law During the performance of this Agreement,the Contractor,for itself,its assignees,and successors in interest(hereinafter referred to as the"Contractor")agrees as follows: 1.Compliance with Regulations:The Contractor shall comply with the federal laws set forth in Section 7 of this Exhibit("Acts and the Regulations")relative to non-discrimination in federally-assisted programs of the U.S.Department of Transportation,Washington State Department of Transportation(WSDOT),as they may be amended from time-to-time,which are herein incorporated by reference and made a part of this Agreement. 2.Non-discrimination:The Contractor,with regard to the work performed by it during this Agreement,shall not discriminate on the grounds of race, color, or national origin in the selection and retention of subcontractors, including procurements of materials and leases of equipment. The Contractor shall not participate directly or indirectly in the discrimination prohibited by the Acts and the Regulations, including employment practices when the contract covers any activity,project,or program set forth in Appendix B of 49 CFR Part 21. 3. Solicitations for Subcontracts, Including Procurements of Materials and Equipment: In all solicitations,either by competitive bidding,or negotiation made by the Contractor for work to be performed under a subcontract,including procurements of materials,or leases of equipment,each potential subcontractor or supplier shall be notified by the Contractor of the Contractor's obligations under this Agreement and the Acts and the Regulations relative to non-discrimination on the grounds of race,color,or national origin. 4.Information and Reports:The Contractor shall provide all information and reports required by the Acts, the Regulations,and directives issued pursuant thereto,and shall permit access to its books,records,accounts, other sources of infonnation,and its facilities as maybe determined by the City or the WSDOT to be pertinent to ascertain compliance with such Acts,Regulations, and instructions. Where any information required of Contractor is in the exclusive possession of another who fails or refuses to furnish the information, the Contractor shall so certify to the City or the WSDOT, as appropriate, and shall set forth what efforts it has made to obtain the information. 5.Sanctions for Noncompliance:In the event of a Contractor's noncompliance with the non-discrimination provisions of this Agreement,the City will impose such contract sanctions as it or the WSDOT may determine to be appropriate,including,but not limited to: a.withholding payments to the Contractor under the Agreement until the Contractor complies;and/or b. cancelling,terminating,or suspending the Agreement,in whole or in part. 6.Incorporation of Provisions:The Contractor shall include the provisions of paragraphs one through six of this Exhibit in every subcontract,including procurements of materials and leases of equipment,unless exempt by the Acts, the Regulations and directives issued pursuant thereto. The Contractor shall take action with respect to any subcontract or procurement as the City or the WSDOT may direct as a means of enforcing such provisions,including sanctions for noncompliance. Provided,that if the Contractor becomes involved in,or is threatened with litigation by a subcontractor or supplier because of such direction,the Contractor may request that the City enter into any litigation to protect the interests of the City. In addition,the Contractor may request the United States to enter into the litigation to protect the interests of the United States. 7. Pertinent Non-Discrimination Authorities: During the performance of this Agreement, the Contractor agrees to comply with the following non-discrimination statutes and authorities;including but not limited to: Construction Agreement Page 8 of 9 • Title VI of the Civil Rights Act of 1964(42 U.S.C.§2000d et seq.,78 stat.252),(prohibits discrimination on the basis of race,color,national origin); and 49 CFR Part 21; The Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, (42 U.S.C. §4601),(prohibits unfair treatment of persons displaced or whose property has been acquired because of Federal or Federal-aid programs and projects); Federal-Aid Highway Act of 1973,(23 U.S.C.§324 et seq.),(prohibits discrimination on the basis of sex); • Section 504 of the Rehabilitation Act of 1973, (29 U.S.C. §794 et seq.), as amended, (prohibits discrimination on the basis of disability); and 49 CFR Part 27; The Age Discrimination Act of 1975,as amended,(42 U.S.C.§6101 et seq.),(prohibits discrimination on the basis of age); Airport and Airway Improvement Act of 1982,(49 USC §471,Section 47123),as amended,(prohibits discrimination based on race, creed,color,national origin,or sex); The Civil Rights Restoration Act of 1987,(PL 100-209),(Broadened the scope,coverage and applicability of Title VI of the Civil Rights Act of 1964,The Age Discrimination Act of 1975 and Section 504 of the Rehabilitation Act of 1973,by expanding the definition of the terms"programs or activities"to include all of the programs or activities of the Federal-aid recipients,sub-recipients and contractors,whether such programs or activities are Federally funded or not); Titles II and III of the Americans with Disabilities Act, which prohibit discrimination on the basis of disability in the operation of public entities,public and private transportation systems,places of public accommodation,and certain testing entities(42 U.S.C.§§12131-12189)as implemented by Department of Transportation regulations at 49 C.F.R. parts 37 and 38; The Federal Aviation Administration's Non-discrimination statute (49 U.S.C. §47123) (prohibits discrimination on the basis of race, color,national origin, and sex); Executive Order 12898,Federal Actions to Address Environmental Justice in Minority Populations and Low-Income Populations,which ensures Non-discrimination against minority populations by discouraging programs,policies,and activities with disproportionately high and adverse human health or environmental ( effects on minority and low-income populations; Executive Order 13166,Improving Access to Services for Persons with Limited English Proficiency,and resulting agency guidance, national origin discrimination includes discrimination because of Limited English proficiency(LEP).To ensure compliance with Title VI,you must take reasonable steps to ensure that LEP persons have meaningful access to your programs(70 Fed.Reg.at 74087 to 74100); Title IX of the Education Amendments of 1972, as amended,which prohibits you from discriminating because of sex in education programs or activities(20 U.S.C. §1681 et seg.). Construction Agreement Page 9 of 9 CITY OF pol�a�e Parks and Recreation Department 000Valley® 2426 N. Discovery Place • Spokane Valley, WA 99216 509.688.0300 ♦ Fax: 509.688.0188 ♦ parksandrec®spokanevalley.org July 6, 2020 Bid Invitation For City of Spokane Valley Parks & Recreation Department • Project Title: CenterPlace Regional Event Center Flooring Replacement Project • Project Scope: 1. Removal of existing carpet and wall base in Rooms 112, 112B, 111, and 108 (Base Bid) and Rooms 160 and 161 (Alternate #1). 2. Install new specified carpet and wall base, including using appropriate adhesive materials, as specified within this document or as per manufacturer's recommendations. 3. Project to be completed by September 4, 2020. 4. Once the Contractor begins the carpet removal, each room will need to be completed within three working days. Hours of work will need to be agreed upon with the City, but there is the potential of working when the building is vacant. 5. Once the project begins, the specific room will be closed to all activities and programs. 6. Contractor is responsible to verify all dimensions of flooring areas of this project. 7. Contractor is responsible to follow all existing COVID-19 guidelines currently in place for Spokane County and the State of Washington. • Project Location: CenterPlace Regional Event Center is located at 2426 N. Discovery Place, Spokane Valley, Washington 99216. • Room Inspection: Contractors interested in an on-site inspection of the rooms can inspect them on Monday, July 13, 2020, between 10 a.m.-12:00 p.m. local time. Please call ahead to schedule a specific inspection time since CenterPlace is closed to the public. Staff will be on hand to explain the project and answer questions. 1 • Bidder Requirements: • This is a prevailing wage public works project. • Successful contractor will need to have a current City of Spokane Valley business license as well as being licensed and bonded. • Contractor shall be duly licensed, registered, and bonded by the State of Washington at all times this Agreement is in effect. • Contractor shall provide a payment bond and a performance bond in the full amount of the Agreement on the City's bond forms. Alternatively, Contractor may elect to have the City retain 50% of the Agreement amount in lieu of providing the City with a payment bond and a performance bond, pursuant to RCW 39.08.010(3). • The insurance requirements will include naming the City of Spokane Valley as additionally insured and having the following minimum amounts of insurance: a. Automobile Liability - $1,000,000 per accident. b. Commercial General Liability - $1,000,000 per occurrence and $2,000,000 general aggregate and $2,000,000 products-completed operation aggregate limit. • Flooring Specifications for Rooms 111 and 108 1. Wall Base —Johnsonite — 283 2. Carpet — Shaw Contract Group ■ Style — block print tile • Product Type — carpet tile • Collection — Homage • Style # - 59572 • Color Name — carved 71750 • Construction — multi-level pattern loop • Fiber: Eco Solution Q Nylon • Dye Method: 88% solution Dyed, 12% Yarn Dyed • Primary Backing — synthetic • Secondary Backing — ecoworx tile • Tufted Weight: 24.0 oz./yd2 • Product Size — 24 x 24 inches ■ Gauge — 1/12 inch • Stitches — 9 per inch ■ Warranty— lifetime commercial limited • Flooring Specifications for Rooms 112, 112B, 160 and 161 1. Wall Base — Johnsonite — 283 2. Carpet— Shaw-Philly • Style — Feedback • Product Type — carpet tile • Collection — Interference Collection • Style # - 54565 2 • Color Name — Radar 603 • Philly 54462 Color Accents Tile in color 62740 Suede (3 boxes) • Construction — multi-level pattern loop • Fiber: Eco Solution Q Nylon • Dye Method: 88% solution Dyed, 12% Yarn Dyed • Primary Backing — synthetic • Secondary Backing — ecoworx tile • Tufted Weight: 24.0 oz./yd2 • Product Size — 24 x 24 inches • Gauge — 1/12 inch • Stitches — 9 per inch • Warranty — lifetime commercial limited • Room Sizes • 108 — Approximately 1508 sq. ft.- 58'x 26' 155 feet of cove base • 111 — Approximately 754 sq. ft. — 29'x 26' 106 feet of cove base • 112 — Approximately 273 sq. ft. — 13'x 21' 68 feet of cove base • 112B —Approximately 241' sq. ft. — 13'x 19' 64 feet of cove base • 160 — Approximately 240' sq. ft. — 15.5'x 15.5' 62 feet of cove • 161 — Approximately 176' sq. ft. — 11'x 16' 54 feet of cove base • Project Guidelines: 1. Contractor will notify the Director of Parks and Recreation Department of their planned work schedule in writing prior to beginning the project. 2. Contractor will notify the Director of Parks and Recreation Department of any work that will involve excessive noise, dust or any work that will disrupt CenterPlace operations. 3. City of Spokane Valley reserves the right to stop work by contractors for any reason deemed to be necessary. 4. Contractor will keep the jobsite clean and free of safety hazards during the entire project. 5. If for any reason work must be stopped by contractor, the Director of Parks and Recreation must be notified. 6. Open flames and combustibles are prohibited unless prior authorization by the Director of Parks and Recreation. 7. Contractor is responsible for any permits that are required for this project. 8. All work will adhere to manufacturer's specifications and acceptable installation practices. 3 . i . 9. All applicable permits will be posted on jobsite. 10.AIl work must be approved by the City of Spokane Valley Parks and Recreation Department prior to completion of project. 11. Contractor will be responsible for any damage done to the facility or its contents. 12. Work access to the rooms will be determined. 13. Project is to be completed while CenterPlace is open and active with events and meetings. Currently CenterPlace is closed to the public until Spokane County reaches Phase 3. • Project Contact: Mike Stone, Director of Parks and Recreation, (509) 720-5400. • Bid Due Date: Written bids need to be delivered to the Spokane Valley Parks & Recreation Department no later than 12:00 p.m. local time on Monday, July 20, 2020. The Parks and Recreation Department is located within CenterPlace at 2426 N. Discovery Place, Spokane Valley, Washington 99216. • Additional Information For additional information, please contact Mike Stone, Director of Parks and Recreation at (509) 720-5400 or mstoneC@spokanevalley.org. 4 • ibex Commercial Flooring 2925 N.Martin St/PO Box 7538,Spokane, WA 99207 . Phone: (509)327-3331/Fax: (509)327-4033 Email:nathannaibexfloorina com WA License#IBEXFFL944Q9 /ID License#RCE-24321 July 14,2020 To: City of Spokane Valley Attn: Mike Stone Re: CenterPlace Flooring Replacement Scope or Work is per Bid Invitation dated 7/6/20 for carpet replace in#112, 112B, 111 and 108 with an alternate add for rooms#160 and 161. *Carpet could take up to 7 weeks(6 weeks production and 1 week transit) to procure, depending on mill stock. Base Bid Carpet demo &install with rubber base at 112, 112B, 111 and 108 $13,090.00 Sales Tax(a,8.9% • $1,165.01 Base Bid Total $14,255.01 Alternate#1 (Add to Base Bid) Carpet demo &install with rubber base at 160 and 161 $2,600.00 Sales Tax @ 8.9% $231.40 Alternate #1 (Add) Total $2,831.40 *Excludes any furniture handling. Thank you, • Nathan Myers Project Manager Ibex Flooring LtC IBEXFLO-01 MMILLER3 ACORO" DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 7/27/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: Hub International Northwest LLC PO Box 3144 PHOO,Nr o,E>a):(509)747-3121 FAX No):(509)623-1073 Spokane,WA 99220 E-MAIL I SS:nowspkinfo@hubinternational.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Cincinnati Insurance Company 10677 INSURED INSURER B: IBEX Flooring LLC INSURER C: PO Box 7538 INSURER D: Spokane,WA 99207 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD,WVD (MM/DD/YYYY) IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X EPP0547117 8/2/2019 8/2/2020 pREM SEsrcg occu ante) $ 1,000,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JET LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) X ANY AUTO EBA0547117 8/2/2019 8/2/2020 BODILY INJURY(Per person) $ OWNED -SCHEDULED _ AUTOSO ONLY AUTOS E pBRORDILY INJURY(Per accident) $ X AUTOS ONLY X AUUTOS ONLY (Parr acEciidentDAMAGE A X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE EPP0547117 8/2/2019 8/2/2020 AGGREGATE $ 2,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION STATUTEPER ERH AND EMPLOYERS'LIABILITY Y/N 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 $ A WA Stop Gap EPP0547117 8/2/2019 8/2/2020 $1 M/$1 M/$1 M DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) RE:Project:CenterPlace Regional Event Center Carpet Replacement The City of Spokane Valley is included as primary and non-contributory additional insured.Per Project Aggregate Limit Applies.Coverage applies per attached forms. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Spokane Valle THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY P y ACCORDANCE WITH THE POLICY PROVISIONS. 2426 N Disovery Place Spokane Valley,WA 99216 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS ADDITIONAL INSURED - AUTOMATIC STATUS WHEN REQUIRED IN WRITTEN CONTRACT, AGREEMENT, PERMIT OR AUTHORIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Additional Insured - Owners, Lessees Or (1) The Coverage Part to which this Contractors - Automatic Status For Other endorsement is attached pro- Parties When Required In Written Contract vides coverage for "bodily injury" Or Agreement With You or "property damage" included 1. Section II - Who Is An Insured is within the "products-completed operations hazard"; and amended to include as an additional in- sured any person or organization you (2) The written contract or written have agreed in writing in a contract or agreement requires you to pro- agreement to add as an additional in- vide additional insured coverage sured on this Coverage Part. Such per- included within the "products- son(s) or organization(s) is an additional completed operations hazard" insured only with respect to liability for: for that person or organization. a. "Bodily injury", "property damage" or If the written contract or written "personal and advertising injury" agreement requires you to provide caused, in whole or in part, by the additional insured coverage included performance of your ongoing opera- within the "products-completed oper- tions by you or on your behalf, under ations hazard" for a specified length that written contract or written of time for that person or organiza- agreement. Ongoing operations does tion, the "bodily injury" or "property not apply to "bodily injury" or"proper- damage" must occur prior to the ex- ty damage"occurring after: piration of that period of time in order (1) All work, including materials, for this insurance to apply. parts or equipment furnished in If the written contract or written connection with such work, on agreement requires you to provide the project (other than service, additional insured coverage for a maintenance or repairs) to be person or organization per ISO addi- performed by or on behalf of the tional insured endorsement form additional insured(s) at the loca- number CG 20 10, without specifying tion of the covered operations an edition date, this Paragraph b. has been completed; or does not apply to that person or or- (2) That portion of"your work"out of ganization. which the injury or damage aris- 2. If the written contract or written agree- es has been put to its intended ment described in Paragraph 1. above use by any person or organiza- specifically requires you to provide addi- tion other than another contrac- tional insured coverage to that person or for or subcontractor engaged in organization: performing operations for a prin- cipal as a part of the same pro- a. Arising out of your ongoing opera- ject; and tions or arising out of"your work"; or b. "Bodily injury" or "property damage" b. By way of an edition of an ISO addi- caused, in whole or in part, by "your tional insured endorsement that in- work" performed under that written cludes arising out of your ongoing contract or written agreement and in- operations or arising out of "your cluded in the "products-completed work"; operations hazard", but only if: Includes copyrighted material of Insurance GA 472 09 17 Services Office, Inc.,with its permission. Page 1 of 3 then the phrase caused, in whole or in This insurance does not apply to: part, by in Paragraph A.1.a. and/or Para- graph A.1.b. above, whichever applies, is a. "Bodily injury", "property damage" or replaced by the phrase arising out of. "personal and advertising injury" aris- ing out of operations performed for 3. With respect to the insurance afforded to the federal government, state or mu- the additional insureds described in Para- nicipality; or graph A.1., the following additional exclu- sion applies: b. "Bodily injury" or "property damage" included within the "products- This insurance does not apply to "bodily completed operations hazard." injury", "property damage" or "personal and advertising injury" arising out of the C. The insurance afforded to additional insureds rendering of, or the failure to render, any described in Paragraphs A. and B.: professional architectural, engineering or 1. Only applies to the extent permitted by surveying services, including: law; and a. The preparing, approving or failing to 2. Will not be broader than that which you prepare or approve, maps, shop are required by the written contract, writ- drawings, opinions, reports, surveys, ten agreement, written permit or written field orders, change orders or draw- authorization to provide for such addition- ings and specifications; or al insured; and b. Supervisory, inspection, architectural 3. Does not apply to any person, organiza- or engineering activities. tion, state, governmental agency or sub- This exclusion applies even if the claims division or political subdivision specifically against any insured allege negligence or named as an additional insured for the other wrongdoing in the supervision, hir- same project in the schedule of an en- ing, employment,training or monitoring of dorsement added to this Coverage Part. others by that insured, if the "occurrence" D. With respect to the insurance afforded to the which caused the "bodily injury" or "prop- additional insureds described in Paragraphs erty damage", or the offense which A, and B.,the following is added to Section III caused the "personal and advertising inju- -Limits Of Insurance: ry", involved the rendering of, or the fail- ure to render, any professional architec- The most we will pay on behalf of the addi- tural, engineering or surveying services. tional insured is the amount of insurance: 4. This Paragraph A. does not apply to addi- 1. Required by the written contract, written tional insureds described in Paragraph B. agreement, written permit or written au- thorization described in Paragraphs A. B. Additional Insured -State Or Governmental and B.; or Agency Or Subdivision Or Political Subdi- vision - Automatic Status When Required 2. Available under the applicable Limits of In Written Permits Or Authorizations ' Insurance shown in the Declarations; 1. Section II - Who Is An Insured is whichever is less. amended to include as an additional in- sured any state or governmental agency This endorsement shall not increase the appli- or subdivision or political subdivision you cable Limits of Insurance shown in the Decla- have agreed in writing in a contract, rations. agreement, permit or authorization to add E. Section IV - Commercial General Liability as an additional insured on this Coverage Conditions is amended to add the following: Part. Such state or governmental agency or subdivision or political subdivision is an Automatic Additional Insured Provision additional insured only with respect to op- erations performed by you or on your be- This insurance applies only if the "bodily inju- half for which the state or governmental ry" or "property damage" occurs, or the "per- agency or subdivision or political subdivi- sonal and advertising injury" offense is com- sion issued, in writing, a contract, agree- milled: ment, permit or authorization. 1. During the policy period; and 2. With respect to the insurance afforded to 2. Subsequent to your execution of the writ- the additional insureds described in Para- ten contract or written agreement, or the graph B.1., the following additional exclu- issuance of a written permit or written au- sions apply: thorization, described in Paragraphs A. and B. Includes copyrighted material of Insurance GA 472 09 17 Services Office, Inc.,with its permission. Page 2 of 3 F. Except when G. below applies, the following is 1. The additional insured is a Named In- added to Section IV - Commercial General sured under such other insurance; and Liability Conditions, 5. Other Insurance, 2. You have agreed in writing in a contract, and supersedes any provision to the contrary: agreement, permit or authorization de- When Other Additional Insured Coverage scribed in Paragraph A. or B. that this in- Applies On An Excess Basis surance would be primary to any other in- surance available to the additional in- This insurance is primary to other insurance sured. available to the additional insured described in Paragraphs A.and B.except: As used in this endorsement, wrap-up insur- ance means any insurance provided by a con- 1. As otherwise provided in Section IV - solidated (wrap-up) insurance program. Commercial General Liability Condi- tions, 5. Other Insurance, b. Excess In- Primary And Noncontributory Insurance surance; or When Required By Written Contract, 2. For any other valid and collectible insur- Agreement, Permit Or Authorization ance available to the additional insured as Except when wrap-up insurance applies to the an additional insured by attachment of an claim or "suit" on behalf of the additional in- endorsement to another insurance policy sured, this insurance is primary to and will not that is written on an excess basis. In such seek contribution from any other insurance case,this insurance is also excess. available to the additional insured described in Paragraphs A.and B. provided that: G. The following is added to Section IV - Com- mercial General Liability Conditions, 5. 1. The additional insured is a Named In- Other Insurance, and supersedes any provi- sured under such other insurance; and sion to the contrary: 2. You have agreed in writing in a contract, Primary Insurance When Required By Writ- agreement, permit or authorization de- ten Contract, Agreement, Permit Or Au- scribed in Paragraph A. or B. that this in- thorization surance would be primary and would not Except when wrap-up insurance applies to the seek contribution from any other insur- anceclaim or "suit" on behalf of the additional in- sured, available to the additional insured. this insurance is primary to any other As used in this endorsement, wrap-up insur- insurance available to the additional insured ance means any insurance provided by a con- described in Paragraphs A. and B. provided solidated (wrap-up) insurance program. that: Includes copyrighted material of Insurance GA 472 09 17 Services Office, Inc.,with its permission. Page 3 of 3 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS' COMMERCIAL GENERAL LIABILITY BROADENED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Endorsement-Table of Contents: Coverage: Begins on Page: 1. Employee Benefit Liability Coverage 3 2. Unintentional Failure To Disclose Hazards 9 3. Damage To Premises Rented To You 9 4. Supplementary Payments 10 5. Medical Payments 10 6. 180 Day Coverage For Newly Formed Or Acquired Organizations 10 7. Waiver Of Subrogation 11 8. Automatic Additional Insured-Specified Relationships: 11 • Managers Or Lessors Of Premises; • Lessor Of Leased Equipment; • Vendors; • State Or Governmental Agency Or Subdivision Or Political Subdivision - Permits Or Authorizations Relating To Premises; and • Mortgagee,Assignee Or Receiver 9. Property Damage To Borrowed Equipment 14 10. Employees As Insureds - Specified Health Care Services And Good Samaritan Services 15 11. Broadened Notice Of Occurrence 15 12. Nonowned Aircraft 15 13. Bodily Injury Redefined 15 14. Expected Or Intended Injury Redefined 15 15. Former Employees As Insureds 15 16. Voluntary Property Damage Coverage And Care, Custody Or Control Liability Coverage 16 17. Broadened Contractual Liability-Work Within 50' Of Railroad Property 17 18. Alienated Premises 17 B. Limits Of Insurance: The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorse- ment, except as provided below: 1. Employee Benefit Liability Coverage Each Employee Limit: $1,000,000 Aggregate Limit: $3,000,000 Deductible Amount: $ 1,000 3. Damage To Premises Rented To You The lesser of: a. The Each Occurrence Limit shown in the Declarations; or b. $500,000 unless otherwise stated $ 4. Supplementary Payments a. Bail Bonds: $2,500 Includes copyrighted material of Insurance GA 233 09 17 Services Office, Inc.,with its permission. Page 1 of 17 b. Loss Of Earnings: $ 500 5. Medical Payments Medical Expense Limit: $ 10,000 9. Property Damage To Borrowed Equipment Each Occurrence Limit: $10,000 Deductible Amount: $ 250 16. Voluntary Property Damage Coverage (Coverage a.) And Care, Custody Or Control Liability Coverage (Coverage b.) Limits Of Insurance Coverage a. $1,000 Each Occurrence $5,000 Aggregate Coverage b.$5,000 Each Occurrence unless otherwise stated $ Deductible Amount(Each Occurrence) Coverage a.$250 Coverage b.$250 unless otherwise stated $ COVERAGE PREMIUM BASIS RATE ADVANCE PREMIUM (a) Area (For Limits in Excess of (For Limits in Excess of (b) Payroll $5,000) $5,000) (c) Gross Sales (d) Units (e) Other b. Care, Custody Or $ Control TOTAL ANNUAL PREMIUM $ Includes copyrighted material of Insurance GA 233 09 17 Services Office, Inc.,with its permission. Page 2 of 17 C. Coverages this endorsement pro- vided: 1. Employee Benefit Liability Coverage a. The followingis added to Section I - a) You did not have knowledge of a Coverages: claim or"suit"on or ef- Employee Benefit Liability Cover- before the first festive date" of this age endorsement. (1) Insuring Agreement You will be (a) We will pay those sums that deemed to have the insured becomes legally knowledge of a obligated to pay as damag- claim or "suit" es caused by any act, error when any "author- or omission of the insured, ized representa- or of any other person for tive"; whose acts the insured is legally liable, to which this i) Reports all, or insurance applies. We will any part, of the have the right and duty to act, error or defend the insured against omission to us any "suit" seeking those or any other damages. However, we will insurer; have no duty to defend ii) Receives a against any "suit" seeking written or ver- damages to which this in- bal demand or surance does not apply. We claim for dam- may, at our discretion, in- ages because vestigate any report of an of the act, er- act, error or omission and ror or omis- settle any claim or"suit" that sion; and may result. But: 1) The amount we will pay b) There is no other applicable insur- for damages is limited ance. as described in Section III - Limits Of Insur- (2) Exclusions ance; and This insurance does not apply to: 2) Our right and duty to defend ends when we (a) Bodily Injury, Property have used up the appli- Damage Or Personal And cable limit of insurance Advertising Injury in the payment of judg- "Bodily injury", "property ments or settlements. damage" or "personal and No other obligation or liabil- advertising injury". ity to pay sums or perform (b) Dishonest, Fraudulent, acts or services is covered Criminal Or Malicious Act unless explicitly provided for under Supplementary Damages arising out of any Payments. intentional, dishonest, fraudulent, criminal or mali- (b) This insurance applies to cious act, error or omission, damages only if the act, er- committed by any insured, ror or omission, is negligent- including the willful or reck- ly committed in the "admin- less violation of anystatute. istration" of your "employee benefit program"; and (c) Failure To Perform A Con- 1) Occurs during the policy tract period; or Damages arising out of fail- 2) Occurred prior to the ure of performance of con- "first effective date" of tract by any insurer. Includes copyrighted material of Insurance GA 233 09 17 Services Office, Inc.,with its permission. Page 3 of 17 (d) Insufficiency Of Funds (i) Taxes, Fines Or Penalties Damages arising out of an Taxes, fines or penalties, in- insufficiency of funds to cluding those imposed un- meet any obligations under der the Internal Revenue any plan included in the Code or any similar state or "employee benefit program". local law. (e) Inadequacy Of Perfor- (j) Employment-Related Prac- mance Of Invest- tices ment/Advice Given With Respect To Participation Any liability arising out of any: Any claim based upon: (1) Refusal to employ; 1) Failure of any invest- ment to perform; (2) Termination of employ- ment; 2) Errors in providing in- formation on past per- (3) Coercion, demotion, formance of investment evaluation, reassign- vehicles; or ment, discipline, defa- mation, harassment, 3) Advice given to any humiliation, discrimina- person with respect to tion or other employ- that person's decision to ment- related practices, participate or not to par- acts or omissions; or ticipate in any plan in- cluded in the "employee (4) Consequential a reu f (1)lia liability li benefit program". (3)above. (f) Workers' Compensation This exclusion applies And Similar Laws whether the insured may be Any claim arising out of your held liable as an employer failure to comply with the or in any other capacity and mandatory provisions of any to any obligation to share workers' compensation, un- damages with or repay employment compensation someone else who must pay insurance, social security or damages because of the in- disability benefits law or any jury. similar law. (3) Supplementary Payments (g) ERISA Section I - Coverages, Sup- Damages for which any in- plementary Payments - Cover- sured is liable because of li- ages A And B also apply to this ability imposed on a fiduci- Coverage. ary by the Employee Re- tirement Income Security b. Who Is An Insured Act of 1974, as now or As respects Employee Benefit Lia- hereafter amended, or by bility Coverage, Section II - Who Is any similar federal, state or An Insured is replaced by the follow- local laws. ing: (h) Available Benefits (1) If you are designated in the Dec- Any claim for benefits to the larations as: extent that such benefits are (a) An individual, you and your available, with reasonable spouse are insureds, but on- effort and cooperation of the ly with respect to the con- insured, from the applicable duct of a business of which funds accrued or other col- you are the sole owner. lectible insurance. (b) A partnership or joint ven- ture, you are an insured. Your members, your part- Includes copyrighted material of Insurance GA 233 09 17 Services Office, Inc.,with its permission. Page 4 of 17 ners, and their spouses are zation. However, coverage under also insureds but only with this provision: respect to the conduct of your business. (a) Is afforded only until the 180th day after you acquire (c) A limited liability company, or form the organization or you are an insured. Your the end of the policy period, members are also insureds, whichever is earlier; and but only with respect to the conduct of your business. (b) Does not apply to any act, Your managers are in- error or omission that was sureds, but only with respect committed before you ac to their duties as your man- quired or formed the organi- agers. zation. (d) An organization other than a c. Limits Of Insurance partnership, joint venture or As respects Employee Benefit Lia- limited liability company, you bility Coverage, Section III - Limits are an insured.Your"execu- Of Insurance is replaced by the fol- tive officers" and directors lowing: are insureds, but only with respect to their duties as (1) The Limits of Insurance shown in your officers or directors. Section B. Limits Of Insurance, Your stockholders are also 1. Employee Benefit Liability insureds, but only with re- Coverage and the rules below fix spect to their liability as the most we will pay regardless stockholders. of the number of: (e) A trust, you are an insured. (a) Insureds; Your trustees are also in- sureds, but only with respect (b) Claims made or "suits" to their duties as trustees. brought; (2) Each of the following is also an (c) Persons or organizations insured: making claims or bringing "suits"; (a) Each of your "employees" who is or was authorized to (d) Acts, errors or omissions; or administer your "employee (e) Benefits included in your benefit program"; "employee benefit program". (b) Any persons, organizations (2) The Aggregate Limit shown in or "employees" having prop- Section B. Limits Of Insurance, er temporary authorization 1. Employee Benefit Liability to administer your "employ- Coverage of this endorsement is ee benefit program" if you the most we will pay for all dam- die, but only until your legal ages because of acts, errors or representative is appointed; omissions negligently committed or in the "administration" of your (c) Your legal representative if "employee benefit program". you die, but only with re- (3) Subject to the limit described in spect to duties as such.That (2) above, the Each Employee representative will have all Limit shown in Section B. Limits your rights and duties under Of Insurance, 1. Employee this Coverage Part. Benefit Liability Coverage of (3) Any organization you newly ac- this endorsement is the most we quire or form, other than a part- will pay for all damages sus- nership, joint venture or limited tained by any one "employee", liability company, and over which including damages sustained by you maintain ownership or major- such "employee's" dependents ity interest, will qualify as a and beneficiaries, as a result of: Named Insured if no other similar (a) An act, error or omission; or insurance applies to that organi- Includes copyrighted material of Insurance GA 233 09 17 Services Office, Inc.,with its permission. Page 5 of 17 (b) A series of related acts, er- tification of the action taken, rors or omissions, regard- you shall promptly reim- less of the amount of time burse us for such part of the that lapses between such Deductible Amount as we acts, errors or omissions; have paid. negligently committed in the d. Additional Conditions "administration" of your "employ- ee benefit program". As respects Employee Benefit Lia- bility Coverage, Section IV - Corn- However, the amount paid under mercial General Liability Condi- this endorsement shall not ex- tions is amended as follows: ceed, and will be subject to the limits and restrictions that apply (1) Item 2. Duties In The Event Of to the payment of benefits in any Occurrence, Offense, Claim Or plan included in the "employee Suit is replaced by the following: benefit program." 2. Duties In The Event Of An (4) Deductible Amount Act, Error Or Omission, Or Claim Or Suit (a) Our obligation to pay dam- ages on behalf of the in- a. You must see to it that sured applies only to the we are notified as soon amount of damages in ex- as practicable of an act, cess of the Deductible error or omission which Amount stated in the Decla- may result in a claim. rations as applicable to To the extent possible, Each Employee. The limits notice should include: of insurance shall not be re- (1) What the act, error duced by the amount of this or omission was deductible. and when it oc- (b) The Deductible Amount curred; and stated in the Declarations (2) The names and applies to all damages sus- addresses of any- tained by any one "employ- one who may suf- ee", including such "employ- fer damages as a ee's" dependents and bene- result of the act, ficiaries, because of all acts, error or omission. errors or omissions to which this insurance applies. b. If a claim is made or "suit" is brought against (c) The terms of this insurance, any insured, you must: including those with respect to: (1) Immediately record the specifics of the 1) Our right and duty to claim or "suit" and defend the insured the date received; against any "suits" and seeking those damag- es; and (2) Notify us as soon 2) Your duties, and the du as practicable. ties of any other in- You must see to it that volved insured, in the we receive written no- event of an act, error or tice of the claim or"suit" omission, or claim; as soon as practicable. apply irrespective of the ap- c. You and any other in- plication of the Deductible volved insured must: Amount. (1) Immediately send (d) We may pay any part or all us copies of any of the Deductible Amount to demands, notices, effect settlement of any summonses or le- claim or "suit" and, upon no- gal papers re- Includes copyrighted material of Insurance GA 233 09 17 Services Office, Inc.,with its permission. Page 6 of 17 ceived in connec- tion by equal shares, tion with the claim we will follow this meth- or"suit"; od also. Under this ap- proach each insurer (2) Authorize us to ob- contributes equal tain records and amounts until it has other information; paid its applicable limit (3) Cooperate with us of insurance or none of in the investigation the loss remains, or settlement of the whichever comes first. claim or defense If any of the other in- against the "suit"; surance does not permit and contribution by equal (4) Assist us, upon our shares, we will contrib- (4) in the en- ute by limits. Under this forcement of any method, each insurer's right against any share is based on the person or organi- ratio of its applicable zation which may limit of insurance to the be liable to the in- total applicable limits of sured because of insurance of all insur- an act, error or ers. omission to which c. No Coverage this insurance may also apply. This insurance shall not t cover any loss for which d. No insured will, except the insured is entitled to at that insured's own recovery under any cost, voluntarily make a other insurance in force payment, assume any previous to the effective obligation, or incur any date of this Coverage expense without our Part. consent. (2) Item 5. Other Insurance is e. Additional Definitions re- placed by the following: As respects Employee Benefit 5. Other Insurance Lia- bility Coverage, Section V - Defini- tions is amended as follows: If other valid and collectible (1) The following definitions are insurance is available to the added: insured for a loss we cover • under this Coverage Part, 1. "Administration" means: our obligations are limited as follows: a. Providing information to "employees", including a. Primary Insurance their dependents and This insurance is prima- beneficiaries, with re- spect to eligibility for or ry except when c. below scope of "employee applies. If this insurance benefit programs"; is primary, our obliga- tions are not affected b. Interpreting the "em- unless any of the other ployee benefit pro- insurance is also prima- grams"; ry. Then, we will share with all that other insur- c. Handling records in ance by the method de- connection with the scribed in b. below. "employee benefit pro- grams"; or b. Method Of Sharing d. Effecting, continuing or If all of the other insur- terminating any "em- ance permits contribu- ployee's" participation in Includes copyrighted material of Insurance GA 233 09 17 Services Office, Inc.,with its permission. Page 7 of 17 any benefit included in c. Unemployment insur- the "employee benefit ance, social security program". benefits, workers' com- pensation and disability However, "administration" benefits; and does not include: deduc- d. Vacation plans, includ- a. Handling payroll ing buy and sell pro- tions; or grams; leave of ab- b. The failure to effect or sence programs, includ- maintain any insurance ing military, maternity, or adequate limits of family, and civil leave; coverage of insurance, tuition assistance plans; including but not limited transportation and to unemployment insur- health club subsidies. ance, social security 4. "First effective date" means benefits, workers' corn- the date upon which cover- pensation and disability age was first effected in a benefits. series of uninterrupted re- 2. "Cafeteria plans" means newals of insurance cover- plans authorized by applica- age. ble law to allow"employees" (2) The following definitions are de- to elect to pay for certain leted in their entirety and re- benefits with pre-tax dollars. placed by the following: 3. "Employee benefit pro- 8. "Employee" means a person grams" means a program actively employed, formerly providing some of all of the employed, on leave of ab- following benefits to "em- sence or disabled, or retired. ployees", whether provided "Employee" includes a through a "cafeteria plan" or "leased worker". "Employee" otherwise: does not include a "tempo- a. Group life insurance; nary worker". group accident or health 21. "Suit" means a civil proceed- insurance; dental, vision ing in which money damag- and hearing plans; and es because of an act, error flexible spending ac- or omission to which this in- counts; provided that no surance applies are alleged. one other than an "em- "Suit" includes: ployee" may subscribe to such benefits and a. An arbitration proceed- such benefits are made ing in which such dam- generally available to ages are claimed and to those "employees" who which the insured must satisfy the plan's eligibil- submit or does submit ity requirements; with our consent; b. Profit sharing plans, b. Any other alternative employee savings dispute resolution pro- plans, employee stock ceeding in which such ownership plans, pen- damages are claimed sion plans and stock and to which the in- subscription plans, pro- sured submits with our vided that no one other consent; or than an "employee" may subscribe to such c. An appeal of a civil pro- benefits and such bene- ceeding. fits are made generally available to all "employ- ees" who are eligible under the plan for such benefits; Includes copyrighted material of Insurance GA 233 09 17 Services Office, Inc., with its permission. Page 8 of 17 2. Unintentional Failure To Disclose Haz- 2) Rust or other cor- ards rosion, decay, de- terioration, hidden Section IV- Commercial General Liabil- or latent defect or ity Conditions, 7. Representations is any quality in amended by the addition of the following: property that caus- Based on our dependence upon your rep- es it to damage or resentations as to existing hazards, if un- destroy itself; intentionally you should fail to disclose all 3) Smog; such hazards at the inception date of your policy, we will not reject coverage under 4) Mechanical break- this Coverage Part based solely on such down, including failure. rupture or bursting caused by centrif- 3. Damage To Premises Rented To You ugal force; a. The last Paragraph of 2. Exclusions 5) Settling, cracking, under Section I - Coverage A- Bod- shrinking or ex- ily Injury And Property Damage Li- pansion; ability is replaced by the following: festa- Exclusions c. through do not apply 6) Nesting or icharge g q• pp y tion, or discharge to "property damage" by fire, explo- or release of waste sion, lightning, smoke or soot to products or secre- premises while rented to you or tern- tions, by insects, porarily occupied by you with permis- birds, rodents or sion of the owner, for which the other animals; or amount we will pay is limited to the Damage To Premises Rented To 7) Presence, growth, You Limit as described in Section III proliferation, - Limits Of Insurance. spread or any ac- tivityb. The insuranceprovided under Sec- cluding o fungus, for mold or tion I - Coverage A - Bodily Injury mildew, and any And Property Damage Liability ap- mycotoxins, plies to "property damage"arising out spores, scents or of water damage to premises that are byproducts pro- both rented to and occupied by you. duced or released (1) As respects Water Damage Le- by fungi. gal Liability, as provided in Para- (b) "Property damage" caused graph 3.b.above: directly or indirectly by any The exclusions under Section I - of the following: Coverage A- Bodily Injury And (i) Earthquake, volcanic Property Damage Liability, 2. eruption, landslide or Exclusions, other than i. War any other earth move- and the Nuclear Energy Liabil- ment; ity Exclusion (Broad Form),are deleted and the following are (ii) Water that backs up or added: overflows or is other- wise discharged from a This insurance does not apply to: sewer, drain, sump, (a) "Property damage": sump pump or related equipment; (i) Assumed in any con- tract or agreement; or (iii) Water under the ground surface pressing on, or (ii) Caused by or resulting flowing or seeping from any of the follow- through: ing: 1) Foundations, walls, 1) Wear and tear; floors or paved surfaces; Includes copyrighted material of Insurance GA 233 09 17 Services Office, Inc.,with its permission. Page 9 of 17 2) Basements, you with permission of whether paved or the owner; not; or b. In the case of damage 3) Doors, windows or by fire, explosion, light- other openings. ning, smoke or soot, (c) "Property damage" caused while rented to you; or by or resulting from water c. In the case of damage that leaks or flows from by water, while rented plumbing, heating, air condi- to and occupied by you. tioning, fire protection sys- tems, or other equipment, (2) The most we will pay is limited as caused by or resulting from described in Section B. Limits freezing, unless: Of Insurance, 3. Damage To Premises Rented To You of this (i) You did your best to endorsement. maintain heat in the building or structure; or 4. Supplementary Payments (ii) You drained the equip- Under Section I - Supplementary Pay- ment and shut off the ments- Coverages A And B: water supply if the heat a. Paragraph 2. is replaced by the fol- was not maintained. lowing: (d) "Property damage"to: Up to the limit shown in Section B. (i) Plumbing, heating, air Limits Of Insurance, 4.a. Bail Bonds conditioning, fire protec- of this endorsement for cost of bail tion systems, or other bonds required because of accidents equipment or applianc- or traffic law violations arising out of es; or the use of any vehicle to which the Bodily Injury Liability Coverage ap- (ii) The interior of any plies.We do not have to furnish these building or structure, or bonds. to personal property in the building or structure, b. Paragraph 4. is replaced by the fol- caused by or resulting lowing: from rain, snow, sleet or All reasonable expenses incurred by ice, whether driven by the insured at our request to assist us wind or not. in the investigation or defense of the c. Limit Of Insurance claim or"suit", including actual loss of earnings up to the limit shown in Sec- With respect to the insurance afford- tion B. Limits Of Insurance, 4.b. ed in Paragraphs 3.a. and 3.b.above, Loss Of Earnings of this endorsement the Damage To Premises Rented per day because of time off from To You Limit as shown in the Decla- work. rations is amended as follows: 5. Medical Payments (1) Paragraph 6. of Section III - Limits Of Insurance is replaced The Medical Expense Limit of Any One by the following: Person as stated in the Declarations is amended to the limit shown in Section B. 6. Subject to Paragraph 5. Limits Of Insurance, 5. Medical Pay- above, the Damage To ments of this endorsement. Premises Rented To You Limit is the most we will pay 6. 180 Day Coverage For Newly Formed under Coverage A - Bodily Or Acquired Organizations Injury And Property Dam- Section II - Who Is An Insured is age Liability for damages amended as follows: because of "property dam- age"to any one premises: Subparagraph a. of Paragraph 3. is re- a. While rented to you, or placed by the following: temporarily occupied by a. Insurance under this provision is af- forded only until the 180th day after Includes copyrighted material of Insurance GA 233 09 17 Services Office, Inc.,with its permission. Page 10 of 17 you acquire or form the organization use of that part of the prem- or the end of the policy period, ises leased to you, subject whichever is earlier; to the following additional exclusions: 7. Waiver Of Subrogation This insurance does not ap- Section IV- Commercial General Liabil- ply to: ity Conditions, 9. Transfer Of Rights Of Recovery Against Others To Us is (i) Any "occurrence" which amended by the addition of the following: takes place after you cease to be a tenant in We waive any right of recovery we may that premises; have against any person or organization against whom you have agreed to waive (ii) Structural alterations, such right of recovery in a written contract new construction or or agreement because of payments we demolition operations make for injury or damage arising out of performed by or on be- your ongoing operations or "your work" half of such additional done under a written contract or agree- insured. ment with that person or organization and included in the "products-completed oper- (b) Lessor Of Leased Equip- ations hazard". However, our rights may ment only be waived prior to the "occurrence" Any person or organization giving rise to the injury or damage for from whom you lease which we make payment under this Cov- equipment when you and erage Part. The insured must do nothing such person(s) or organiza- after a loss to impair our rights. At our re- tion(s) have agreed per Par- quest,the insured will bring "suit" or trans- agraph 8.a.(1) of this en- fer those rights to us and help us enforce dorsement to provide insur- those rights. ance. Such person(s) or or- 8. Automatic Additional Insured - Speci- ganization(s) are insureds fied Relationships only with respect to liability for "bodily injury", "property a. The following is added to Section II - damage" or "personal and Who Is An Insured: advertising injury" caused, in (1) Any person(s) or organization(s) m or inpart, your maaintint enancee, operation or described in Paragraph 8.a.(2) of use of equipment leased to this endorsement (hereinafter re- you by such person(s) or or- ferred to as additional insured) ganization(s). A person's or whom you are required to add as organization's status as an an additional insured under this additional insured under this • Coverage Part by reason of a endorsement ends when written contract, written agree- their contract or agreement ment, written permit or written with you for such leased authorization. equipment ends. However, (2) Only the following persons or or- this insurance does not ap- ganizations are additional in- ply to any "occurrence" sureds under this endorsement, which takes place after the and insurance coverage provided equipment lease expires. to such additional insureds is lim- (c) Vendors ited as provided herein: Any person or organization (a) Managers Or Lessors Of Premises (referred to below as ven- dor) with whom you have The manager or lessor of a agreed per Paragraph premises leased to you with 8.a.(1) of this endorsement whom you have agreed per to provide insurance, but on- Paragraph 8.a.(1) of this en- ly with respect to "bodily in- dorsement to provide insur- jury" or "property damage" ance, but only with respect arising out of"your products" to liability arising out of the which are distributed or sold ownership, maintenance or in the regular course of the Includes copyrighted material of Insurance GA 233 09 17 Services Office, Inc.,with its permission. Page 11 of 17 vendor's business, subject or repair opera- to the following additional tions, except such exclusions: operations per- formed at the ven- (i) The insurance afforded dor's premises in the vendor does not connection with the apply to: sale of the product; 1) "Bodily injury" or 7) Products which, af- "property damage" ter distribution or for which the ven- sale by you, have dor is obligated to been labeled or re- pay damages by labeled or used as reason of the as- a container, part or sumption of liability ingredient of any in a contract or other thing or sub- agreement. This stance by or for the exclusion does not vendor; or apply to liability for damages that the 8) "Bodily injury" or vendor would have "property damage" in the absence of arising out of the the contract or sole negligence of agreement; the vendor for its own acts or omis- 2) Any express war- sions or those of ranty unauthorized its employees or by you; anyone else acting 3) Any physical or on its behalf. How- chemical change in ever, this exclusion the product made does not apply to: intentionally by the a) The excep- vendor; tions contained 4) Repackaging, ex- in Paragraphs cept when un- (c) (i) 4) or 6) packed solely for of this en- the purpose of in- dorsement; or spection, demon- b) Such inspec- stration, testing, or tions, adjust- the substitution of ments, tests or parts under in- servicing as structions from the the vendor has manufacturer, and agreed to then repackaged in make or nor- the original con- mally under- tainer; takes to make 5) Any failure to make in the usual such inspections, course of adjustments, tests business, in or servicing as the connection vendor has agreed with the distri- to make or normal- bution or sale ly undertakes to of the prod- make in the usual ucts. course of busi- (ii) This insurance does not ness, in connection apply to any insured with the distribution person or organization: or sale of the products; 1) From whom you 6) Demonstration, in- have acquired such products, or stallation, servicing any ingredient, part Includes copyrighted material of Insurance GA 233 09 17 Services Office, Inc.,with its permission. Page 12 of 17 or container, enter- (e) Mortgagee, Assignee Or ing into, accompa- Receiver nying or containing such products; or Any person or organization with whom you have agreed 2) When liability in- per Paragraph 8.a.(1) of this cluded within the endorsement to provide in- "products- surance, but only with re- completed opera- spect to their liability as tions hazard" has mortgagee, assignee, or re- been excluded un- ceiver and arising out of the der this Coverage ownership, maintenance, or Part with respect to use of the premises by you. such products. However, this insurance does not apply to structural (d) State Or Governmental alterations, new construction Agency Or Subdivision Or and demolition operations Political Subdivision - performed by or for that per- Permits Or Authorizations son or organization. Relating To Premises state orgovernmental (3) The insurance afforded to addi- Any tional insureds described in Par- agency or subdivision or po- agraph 8.a.(1) of this endorse- litical subdivision with which ment: you have agreed per Para- graph 8.a.(1) of this en- (a) Only applies to the extent dorsement to provide insur- permitted by law; and ance, subject to the follow- ing additional provision: (b) Will not be broader than that which you are required by This insurance applies only the written contract, written with respect to the following agreement, written permit or hazards for which the state written authorization to pro- or governmental agency or vide for such additional in- subdivision or political sub- sured; and division has issued a permit or authorization in connec- (c) Does not apply to any per- tion with premises you own, son, organization, vendor, rent or control and to which state, governmental agency this insurance applies: or subdivision or political subdivision, specifically (i) The existence, mainte- named as an additional in- nance, repair, construc- sured under any other provi- tion, erection or removal sion of, or endorsement of advertising signs, added to, this Coverage awnings, canopies, cel- Part, provided such other lar entrances, coal provision or endorsement holes, driveways, man- covers the injury or damage holes, marquees, hoist for which this insurance ap- away openings, side- plies. walk vaults, street ban- ners or decorations and b. With respect to the insurance afford- similar exposures; or ed to the additional insureds de- scribed in Paragraph 8.a.(1) of this (ii) The construction, erec- endorsement, the following is added tion or removal of eleva- to Section III- Limits Of Insurance: tors; or The most we will pay on behalf of the (iii) The ownership, mainte- additional insured is the amount of in- nance or use of any el- surance: evators covered by this insurance. (1) Required by the written contract, written agreement, written permit or written authorization described Includes copyrighted material of Insurance GA 233 09 17 Services Office, Inc.,with its permission. Page 13 of 17 in Paragraph 8.a.(1) of this en- tion I - Coverage A - Bodily Injury dorsement; or And Property Damage Liability: (2) Available under the applicable Paragraphs (3) and (4) of this exclu- Limits of Insurance shown in the sion do not apply to tools or equip- Declarations; ment loaned to you, provided they are whichever is less. not being used to perform operations at the time of loss. This endorsement shall not increase b. With respect to the insurance provid- the applicable Limits of Insurance ed by this section of the endorse- shown in the Declarations. ment, the following additional provi- c. Section IV - Commercial General sions apply: Liability Conditions is amended to (1) The Limits of Insurance shown in include the following: the Declarations are replaced by Automatic Additional Insured Pro- the limits designated in Section vision B. Limits Of Insurance, 9. Property Damage To Borrowed This insurance applies only if the Equipment of this endorsement "bodily injury" or "property damage" with respect to coverage provid- occurs, or the "personal and advertis- ed by this endorsement. These ing injury" offense is committed: limits are inclusive of and not in (1) During the policy period; and addition to the limits being re- placed. The Limits of Insurance (2) Subsequent to your execution of shown in Section B. Limits Of the written contract or written Insurance, 9. Property Damage agreement, or the issuance of a To Borrowed Equipment of this written permit or written authori- endorsement fix the most we will zation, described in Paragraph pay in any one "occurrence" re- 8.a.(1). gardless of the number of: d. Section IV - Commercial General (a) Insureds; Liability Conditions is amended as (b) Claims made or "suits" follows: brought; or Condition 5. Other Insurance is (c) Persons or organizations amended to include: making claims or bringing Primary And Noncontributory In- "suits". surance (2) Deductible Clause This insurance is primary to and will dam- not seek contribution from any other (a) Our obligation pay insurance available to an additional ages on your behalf applies only dam- insured per Paragraph 8.a.(1) of this to the amount agees forteach "occurrence" endorsement provided that: which are in excess of the (1) The additional insured is a Deductible Amount stated in Named Insured under such other Section B. Limits Of Insur- insurance; and ance, 9. Property Damage To Borrowed Equipment of (2) You have agreed in writing in a this endorsement. The limits contract, agreement, permit or of insurance will not be re- authorization described in 8.a.(2) duced by the application of of this endorsement that this in- such deductible amount. surance would be primary and would not seek contribution from (b) Section IV - Commercial any other insurance available to General Liability Condi- the additional insured. tions, 2. Duties In The Event Of Occurrence, Of- 9. Property Damage To Borrowed Equip- fense, Claim Or Suit, ap- ment plies to each claim or "suit" irrespective of the amount. a. The following is added to Exclusion 2.j. Damage To Property under Sec- Includes copyrighted material of Insurance GA 233 09 17 Services Office, Inc.,with its permission. Page 14 of 17 (c) We may pay any part or all 12. Nonowned Aircraft of the deductible amount to effect settlement of any The following is added to Exclusion 2.g. claim or "suit" and, upon no- Aircraft, Auto Or Watercraft under Sec- tification of the action taken, tion I - Coverage A - Bodily Injury And you shall promptly reim- Property Damage Liability: burse us for such part of the This exclusion does not apply to an air- deductible amount as has craft you do not own, provided that: been paid by us. 10. Employees As Insureds - Specified a. The pilot in command holds a current p effective certificate, issued by a duly Health Care Services And Good Samar- constituted authority of the United itan Services States of America or Canada, desig- Paragraph 2.a.(1)(d) under Section II - Hating that person as a commercial or Who Is An Insured does not apply to: airline transport pilot; a. Your "employees" who provide pro- b. The aircraft is rented with a trained, fessional health care services on your paid crew; and behalf as a duly licensed nurse, c. The aircraft does not transport per- emergency medical technician or sons or cargo for a charge. paramedic in the jurisdiction where an "occurrence" or offense to which this 13. Bodily Injury Redefined insurance applies takes place; or Section V - Definitions, 4. "Bodily injury" b. Your "employees" or "volunteer work- is replaced by the following: ers", other than an employed or vol- unteer doctor, providing first aid or 4. "Bodily injury" means bodily harm or good samaritan services during their injury, sickness, disease, disability, work hours for you will be deemed to humiliation, shock, fright, mental an- be acting within the scope of their guish or mental injury, including care, employment by you or performing du loss of services or death resulting ties related to the conduct of your from any of these at any time. business. 14. Expected Or Intended Injury Redefined 11. Broadened Notice Of Occurrence The last sentence of Exclusion 2.a. Ex- Paragraph a. of Condition 2. Duties In pected Or Intended Injury under Sec- The Event Of Occurrence, Offense, tion I - Coverage A - Bodily Injury And Claim Or Suit under Section IV - Corn- Property Damage Liability is replaced by mercial General Liability Conditions is the following: replaced by the following: This exclusion does not apply to "bodily a. You must see to it that we are notified injury" or"property damage" resulting from as soon as practicable of an "occur- the use of reasonable force to protect per- rence" or an offense which may result sons or property. in a claim. To the extent possible, no- 15. Former Employees As Insureds tice should include: (1) How, when and where the "oc- The following is added to Paragraph 2. under Section II -Who Is An Insured: currence"or offense took place; (2) The names and addresses of 2. Each of the following is also an in- any injured persons and wit- sured: nesses; and Any of your former "employees", di- rectors, managers, members, part- (3) The nature and location of any ners or "executive officers", including injury or damage arising out of but not limited to retired, disabled or the"occurrence" or offense. those on leave of absence, but only This requirement applies only when for acts within the scope of their em- the "occurrence" or offense is known ployment by you or for duties related to an "authorized representative". to the conduct of your business. Includes copyrighted material of Insurance GA 233 09 17 Services Office, Inc.,with its permission. Page 15 of 17 16. Voluntary Property Damage Coverage (2) Exclusions a. Coverage D - Voluntary Property This insurance does not apply to Damage Coverage "property damage" that would be es is amended to excluded by Coverage A- Bodi- Section I - Coverages ly Injury And Property Damage include the following: Liability, 2. Exclusions, except (1) Insuring Agreement for j. Damage To Property, par- agraphs (3), (4), (5) and (6), k. (a) We will pay the cost to re- Damage To Your Product, and pair or replace "property I. Damage To Your Work. damage" to property of oth- ers arising out of operations (3) Definitions incidental to your business For purposes of Voluntary when: Property Damage Coverage 1) Damage is caused by only, the following definitions un- you; or der Section V - Definitions are replaced by the following: 2) Damage occurs while in your possession. 16. "Occurrence" means an in- cident, including continuous At your written request, we or repeated exposure to will make this payment re- substantially the same gen- gardless of whether you are eral harmful conditions that at fault for the "property result in "property damage". damage". 20. "Property damage" means If you, at our request, re- physical injury to tangible place, or make any repairs property. "Electronic data" is to, damaged property of not tangible property, and others, the amount we will "property damage" does not pay under Voluntary Prop- include disappearance, ab- erty Damage Coverage will straction or theft. be determined by your actu- al cost to replace or repair b. Care, Custody Or Control Liability the damaged property, ex- Coverage cluding any profit or over- For purposes of the coverage provid- head. ed by Care, Custody Or Control Li- Any payment we make un- ability Coverage in this endorsement der Voluntary Property only: Damage Coverage shall not be interpreted as an admis- (1) Section I - Coverage A - Bodily Injury And Property Damage sion of liability by you or by Liability, 2. Exclusions, j. us. Damage To Property, Subpara- It shall be your duty, not our graphs (3), (4) and (5) do not ap- duty, to defend any claim or ply to "property damage" to the "suit"to which this insurance property of others described applies. therein. No other obligation or liabil- (2) It shall be your duty, not our duty, ity to pay sums or perform to defend any claim or "suit" to acts or services is covered. which this insurance applies. (b) This insurance applies to No other obligation or liability to "property damage"only if: pay sums or perform acts or ser- vices is covered. 1) The "property damage" takes place in the "coy- This Paragraph (2) supersedes erage territory"; and any provision in the Coverage Part to the contrary. 2) The "property damage" occurs during the policy (3) "Property damage" for which period. Care, Custody Or Control Lia- bility Coverage provides cover- Includes copyrighted material of Insurance GA 233 09 17 Services Office, Inc.,with its permission. Page 16 of 17 age shall be deemed to be (3) The Voluntary Property Dam- caused by an "occurrence" but age Coverage, Aggregate Limit shall not serve to limit or restrict Of Insurance is the most we will the applicability of any exclusion pay for the sum of all damages for "property damage" under this under Voluntary Property Coverage Part. Damage Coverage. This limit applies separately to each "cov- c. Limits Of Insurance And Deducti- erage term". bles For purposes of the coverage provid- (4) Deductible Clause ed by Voluntary Property Damage (a) Our obligation to pay dam- Coverage and Care, Custody Or ages on your behalf applies Control Liability Coverage, Section only to the amount of dam- III - Limits Of Insurance is amended ages for each "occurrence" to include the following: which are in excess of the Deductible Amount stated (1) The Limits of Insurance shown in for the applicable coverage the Declarations are replaced by in the Schedule. The limits the limits designated in Section of insurance will not be re- B. Limits Of Insurance, 16. duced by the application of Voluntary Property Damage such Deductible Amount. Coverage And Care, Custody Or Control Liability Coverage, (b) Section IV - Commercial in this endorsement. These limits General Liability Condi- are inclusive of, and not in addi- tions, 2. Duties In The tion to, the limits being replaced. Event Of Occurrence, Of- The Limits of Insurance shown in fense, Claim Or Suit, ap- the Schedule fix the most we will plies to each claim or "suit" pay regardless of the number of: irrespective of the amount. (a) Insureds; (c) We may pay any part or all of the Deductible Amount to (b) Claims made or "suits" effect settlement of any brought; or claim or "suit" and, upon no- (c) Persons or organizations tification of the action taken, making claims or bringing you shall promptly reim- "suits". burse us for such part of the Deductible Amount as has (2) (a) Subject to (3) below, the been paid by us. Voluntary Property Dam- age Coverage, Each Occur- 17. Broadened Contractual Liability- Work rence Limit Of Insurance is Within 50'Of Railroad Property the most we will pay for the Section V- Definitions, 12. "Insured con- sum of damages under Vol- tract" is amended as follows: untary Property Damage Coverage; a. Paragraph c. is replaced by the fol- lowing: (b) The Care, Custody Or Con- trol Liability Coverage, c. Any easement or license agree- Each Occurrence Limit Of ment; Insurance is the most we will pay for the sum of damages b. Paragraph f.(1) is deleted in its entire- under Care, Custody Or ry• Control Liability Coverage; 18. Alienated Premises because of all "property damage" Exclusion 2.j. Damage to Property, arising out of any one "occur- Paragraph (2) under Section I - Cover- rence". age A - Bodily Injury And Property Damage Liability does not apply if the premises are "your work". Includes copyrighted material of Insurance GA 233 09 17 Services Office, Inc.,with its permission. Page 17 of 17 COMMERCIAL GENERAL LIABILITY COVERAGE FORM Various provisions in this Coverage Part restrict SUPPLEMENTARY PAYMENTS - COV- this insurance. Read the entire Coverage Part ERAGES A AND B. carefully to determine rights, duties and what is and is not covered. b. This insurance applies to "bodily injury" and "property damage"only if: Throughout this Coverage Part the words "you" and "your" refer to the Named Insured shown in (1) The "bodily injury" or "property dam- the Declarations, and any other person or organi- age" is caused by an "occurrence" zation qualifying as a Named Insured under this that takes place in the "coverage ter- Coverage Part. The words "we", "us" and "our" ritory"; refer to the Company providing this insurance. (2) The "bodily injury" or "property dam- The word "insured" means any person or organi- age" occurs during the policy period; zation qualifying as such under SECTION II-WHO and IS AN INSURED. (3) Prior to the "coverage term" in which Other words and phrases that appear in quotation "bodily injury" or "property damage" marks have special meaning. Refer to SECTION occurs, you did not know, per Para- V-DEFINITIONS, graph 1.d. below, that the "bodily in- jury" or "property damage" had oc- SECTION I-COVERAGES curred or had begun to occur, in COVERAGE A. BODILY INJURY AND PROP- ERTYwhole or in part. DAMAGE LIABILITY c. "Bodily injury" or "property damage" 1. Insuring Agreement which: a. We will pay those sums that the insured (1) Occurs during the "coverage term'; and becomes legally obligated to pay as damages because of "bodily injury" or (2) Was not, prior to the "coverage "property damage" to which this insur- term", known by you, per Paragraph ance applies. We will have the right and 1.d.below,to have occurred; duty,to defend the insured against any includes anycontinuation, change or re- wesuit seeking those damages. However, sumption o that "bodilytinjury" oe ""prop- sured will have no duty to defend the in- p p p- sured against any "suit" seeking dam- erty damage" after the end of the "cover- ages for"bodily injury" or "property dam- age term" in which it first became known age" to which this insurance does not by you. apply. We may, at our discretion, investi- d. You will be deemed to know that "bodily gate any "occurrence" and settle any injury" or "property damage" has oc- claim or"suit"that may result. But: curred at the earliest time when any (1) The amount we will pay for damages "authorized representative": is limited as described in SECTION (1) Reports all, or any part, of the "bodily III-LIMITS OF INSURANCE; and injury" or"property damage" to us or (2) Our right and duty to defend ends any other insurer; when we have used up the applica- (2) Receives a written or verbal demand ble limit of insurance in the payment or claim for damages because of the of judgments or settlements under "bodily injury"or"property damage"; SECTION I - COVERAGES, COV- ERAGE A. BODILY INJURY AND (3) First observes, or reasonably should PROPERTY DAMAGE LIABILITY; have first observed, the "bodily in- SECTION I - COVERAGES, COV- jury"or"property damage"; ERAGE B. PERSONAL AND AD- VERTISING INJURY LIABILITY; or (4) Becomes aware, or reasonably medical expenses under SECTION I should have become aware, by any - COVERAGES, COVERAGE C. means other than as described in (3) MEDICAL PAYMENTS, above, that "bodily injury" or "prop- erty damage" had occurred or had No other obligation or liability to pay sums begun to occur; or or perform acts or services is covered unless expressly provided for under (5) Becomes aware, or reasonably should have become aware, of a Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc.,with its permission. Page 1 of 22 condition from which "bodily injury" (3) Any statute, ordinance or regulation or "property damage" is substantially relating to the sale, gift, distribution certain to occur, or use of alcoholic beverages. e. Damages because of "bodily injury" in- This exclusion applies only if you are in clude damages claimed by any person or the business of manufacturing, distribut- organization for care, loss of services or ing, selling,serving or furnishing alcoholic death resulting at any time from the "bod- beverages. ily injury". d. Workers' Compensation and Similar 2. Exclusions Laws This insurance does not apply to: Any obligation of the insured under a a. Expected or Intended Injuryworkers'compensation, disability benefits P or unemployment compensation law or "Bodily injury" or "property damage" any similar law. which may reasonably be expected to re- e. Employer's Liability suit from the intentional or criminal acts of the insured or which is in fact expected or "Bodily injury"to: intended by the insured, even if the injury or damage is of a different degree or type (1) An "employee" of the insured sus- than actually expected or intended. This tained in the"workplace"; exclusion does not apply to "bodily injury" (2) An "employee" of the insured arising resulting from the use of reasonable force out of the performance of duties re- to protect persons or property. lated to the conduct of the insured's b. Contractual Liability business; or "Bodily injury" or "property damage" for (3) The spouse, child, parent, brother or which the insured is obligated to pay sister of that"employee" as a conse- damages by reason of the assumption of quence of Paragraphs (1) or (2) liability in a contract or agreement. This above. exclusion does not apply to liability for This exclusion applies: damages: (1) That the insured would have in the (1) Whether the insured may be liable as an employer or in any other ca- absence of the contract or agree- pacity; and ment;or (2) To any obligation to share damages (2) Assumed in a contract or agreement with or repay someone else who that is an "insured contract", pro- p y must pay damages because of the vided the "bodily injury" or "property injury. damage" occurs subsequent to the execution of the contract or agree- This exclusion does not apply to liability ment. When a claim for such "bodily assumed by the insured under an "in- injury" or "property damage" is sured contract". made, we will defend that claim pro- vided the insured has assumed the f. Pollutant obligation to defend such claim in the (1) "Bodily injury" or "property damage" "insured contract". Such defense arising out of the actual, alleged or payments will not reduce the limits of threatened discharge, dispersal, insurance. seepage, migration, release, escape c. Liquor Liability or emission of"pollutants": "Bodily injury" or "property damage" for (a) At or from any premises, site or which any insured may be held liable by location which is or was at any reason of: time owned or occupied by, or rented or loaned to, any insured. (1) Causing or contributing to the intoxi- However, Paragraph (a) does cation of any person; not apply to: (2) The furnishing of alcoholic bever- 1) "Bodily injury"to any person ages to a person under the legal injured while on any prem- drinking age or under the influence ises, site or location owned of alcohol; or or occupied by, or rented or loaned to,you provided: Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc.,with its permission. Page 2 of 22 a) The injury is caused by airborne irritants or con- the inadequate ventila- taminants used in a manu- tion of vapors; facturing process or which b) Theperson injured is is the product or by-product J of any manufacturing proc- first exposed to such ess; vapors during the pol- icy period; and 2) "Bodily injury" or "property Within 30 days of such damage" for which you may c) Y be held liable, if you are a first exposure, the per- contractor, and the owner son injured is clinically or lessee of such premises, diagnosed or treated site or location has been by a physician for the added to this Coverage Part medical condition as an additional insured caused by the expo- with respect to your ongo- sure to such vapors. ing operations or "your However, Paragraph c) work" performed for that does not apply if the additional insured at that "bodily injury"is caused premises, site or location by vapors produced by and such premises, site or or originating from location is not and never equipment that is used was owned or occupied by, to heat, cool or dehu- or rented or loaned to, any midify the building, or insured, other than that ad- equipment that is used ditional insured;or to heat water for per- sonal use, by the 3) "Bodily injury" or "property building's occupants or damage" arising out of heat, their guests. smoke or fumes from a This exception 1) shall ap- "hostile fire"; ply only to Named Insureds; (b) At or from any premises, site or we shall have no duty to location which is or was at any defend or pay damages for time used by or for any insured any person or organization or others for the handling, stor- that is not a Named In- age, disposal, processing or sured. However, this para- treatment of waste; graph does not apply if the "bodily injury" is caused by (c) Which are or were at any time vapors produced by or transported, handled, stored, originating from equipment treated, disposed of, or proc- that is used to heat, cool or essed as waste by or for: dehumidify the building, or 1) Any insured; or equipment that is used to heat water for personal use, 2) Any person or organization by the building's occupants for whom you may be le- or their guests. gaily responsible; For the purpose of the ex- (d) At or from any premises, site or ception granted in Para- location on which any insured or graph 1) only, vapors any contractors or subcontrac- means any gaseous or air- tors working directly or indirectly borne irritant or airborne on any insured's behalf are contaminant, including performing operations if the smoke, fumes, vapor or "pollutants" are brought on or to soot, but excluding asbes- the premises, site or location in tos, which is discharged, connection with such operations dispersed, emitted, re- by such insured, contractor or leased or escapes from subcontractor. However, Para- materials, machinery or graph (d)does not apply to: equipment used in the service or maintenance of 1) "Bodily injury" or "property the premises. Vapors does damage" arising out of the not mean any gaseous or discharge, dispersal, seep- age, migration, release, es- Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc.,with its permission. Page 3 of 22 cape or emission of fuels, erations are to test for, monitor, lubricants or other operating clean up, remove, contain, treat, fluids, or exhaust gases, detoxify or neutralize, or in any which are needed to per- way respond to, or assess the form, or are the result of, effects of, "pollutants". the normal electrical, hy- draulic or mechanical func- (2) Any loss, cost or expense arising out tions necessary for the op- of any: eration of "mobile equip- (a) Request, demand, order or ment" or its parts, if such statutory or regulatory require- fuels, lubricants or other ment that any insured or others operating fluids, or exhaust test for, monitor, clean up, re- gases, escape, seep or mi- move, contain, treat, detoxify or grate, or are discharged, neutralize, or in any way re- dispersed, released or spond to, or assess the effects emitted from a vehicle part of, "pollutants";or designed to hold, store or receive them. This excep- (b) Claim or suit by or on behalf of a tion does not apply if the fu- governmental authority for dam- els, lubricants or other op- ages because of testing for, erating fluids, or exhaust monitoring, cleaning up, remov- gases, escape, seep or mi- ing, containing, treating, detoxi- grate, or are discharged, fying or neutralizing, or in any dispersed, released or way responding to, or assessing emitted with the intent to the effects of, "pollutants". cause "bodily injury" or "property damage" or with However, Paragraphs (2)(a) and (b) the knowledge that "bodily do not apply to liability for damages injury"or"property damage" because of "property damage" that is substantially certain to the insured would have in the ab- occur, or if such fuels, lubri- sence of such request, demand, or- cants or other operating der or statutory or regulatory re- fluids, or exhaust gases, quirement, or such claim or "suit" by are brought on or to the or on behalf of a governmental premises, site or location authority. with such intent to escape, g, Aircraft,Auto or Watercraft seep or migrate, or be dis- charged, dispersed, re- "Bodily injury" or "property damage" aris- leased or emitted as part of ing out of the ownership, maintenance, the operations being per- use or entrustment to others of any air- formed by such insured, craft, "auto" or watercraft owned or oper- contractor or subcontractor; ated by or rented or loaned to any in- g) "Bodily injury" or "property sured. Use includes operation and damage" sustained within a loading or unloading . building and caused by the This exclusion applies even if the claims release of gases, fumes or against any insured allege negligence or vapors from materials other wrongdoing in the supervision, hir- brought into that building in ing, employment,training or monitoring of connection with operations others by that insured, if the "occurrence" being performed by you or which caused the "bodily injury" or"prop- on your behalf by a con- erty damage" involved the ownership, tractor or subcontractor; or maintenance, use or entrustment to oth- ers3) "Bodily injury" or "property of any aircraft, "auto" or watercraft damage" arising out heat, that is owned or operated by or rented or smoke or fumes from a loaned to any insured. "hostile fire";or This exclusion does not apply to: (e) At or from any premises, site or (1) A watercraft while ashore on prem- location on which any insured or ises you own or rent; any contractors or subcontrac- tors working directly or indirectly (2) A watercraft you do not own that is: on any insured's behalf are (a) Less than 51 feet long; and performing operations if the op- Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc.,with its permission. Page 4 of 22 (b) Not being used to carry persons governmental authority in hindering or property for a charge; or defending against any of these. (3) Parking an "auto" on, or on the ways j. Damage to Property next to, premises you own or rent, „ provided the "auto" is not owned by Property damage to: or rented or loaned to you or the in- (1) Property you own, rent or occupy, sured; including any costs or expenses in- (4) Liability assumed under any "insured curved by you, or any other person, contract" for the ownership, mainte- organization or entity, for repair, re- nance or use of aircraft or watercraft; placement, enhancement, restora- or tion or maintenance of such property for any reason, including prevention (5) "Bodily injury" or "property damage" of injury to a person or damage to arising out of: another's property; (a) The operation of machinery or (2) Premises you sell, give away or equipment that is on, attached abandon, if the "property damage" to, or part of, a land vehicle that arises out of any part of those prem- would qualify under the defini- ises; tion of "mobile equipment" if it Property loaned to you; were not subject to a compul- (3) P Y sory or financial responsibility (4) Personal property in the care, cus- law or other motor vehicle insur- tody or control of an insured; ance law in the state where it is licensed or principally garaged; (5) That particular part of real property or on which you or any contractors or (b) The operation of any of the ma- subcontractors working directly or indirectly on your behalf are per- chinery or equipment listed in forming operations, if the "property Paragraph f.(2) or f.(3) of the damage" arises out of those opera- definition of"mobile equipment". tions; or h. Mobile Equipment (6) That particular part of any property "Bodily injury" or "property damage" aris- must be restored, repaired or ing out of: replaced because "your work" was incorrectly performed on it. (1) The transportation of "mobile equip- ment" by an "auto" owned or oper- Paragraphs (1), (3) and (4) of this exclu- ated by or rented or loaned to any sion do not apply to "property damage" insured; or (other than damage by fire or explosion) to premises, including the contents of (2) The use of"mobile equipment" in, or .such premises, rented to you for a period while in practice for, or while being of 7 or fewer consecutive days, for which prepared for, any prearranged rac- the amount we will pay is limited to the ing, speed, demolition, or stunting Damage To Premises Rented To You activity. Limit as described in SECTION III - LIM- ITS OF INSURANCE. i. War "Bodily injury" or "property damage", Paragraph (2) of this exclusion does not apply if the premises are "your work" and however caused, arising, directly or indi- were never occupied, rented or held for rectly,out of: rental by you. (1) War, including undeclared or civil Paragraphs (3), (4), (5) and (6) of this ex- war; clusion do not apply to liability assumed (2) Warlike action by a military force, in- under a sidetrack agreement. cluding action in hindering or de- Paragraph (6) of this exclusion does not fending against an actual or ex- apply to "property damage" included in pected attack, by any government, the "products-completed operations haz- sovereign or other authority using ard". military personnel or other agents; or (3) Insurrection, rebellion, revolution, k. Damage to Your Product usurped power, or action taken by "Property damage" to "your product" arising out of it or any part of it. Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc.,with its permission. Page 5 of 22 I. Damage to Your Work q. Employment-Related Practices "Property damage" to "your work" arising "Bodily injury"to: out of it or any part of it and included in the "products-completed operations haz- A person arising out of any: ard". (a) Refusal to employ that person; This exclusion does not apply if the dam- (b) Termination of that person's aged work or the work out of which the employment; or damage arises was performed on your behalf by a subcontractor. (c) Other employment-related prac- tices, policies, acts or omissions m. Damage to Impaired Property or Prop- including but not limited to coer- erty Not Physically Injured cion, criticism, demotion, "Property damage" to "impaired property" evaluation, failure to promote, or property that has not been physically reassignment, discipline, defa- injured,arising out of: mation, harassment, humiliation or discrimination directed at that (1) A defect, deficiency, inadequacy or person; or dangerous condition in "your prod- uct"or"your work"; or (2) The spouse, child, parent, brother or sister of that person as a conse- (2) A delay or failure by you or anyone quence of "bodily injury" to that per- acting on your behalf to perform a son at whom any of the employment- contract or agreement in accordance related practices described in Para- with its terms, graphs (a), (b) or (c) above is di- This exclusion does not apply to the loss rected. of use of other property arising out of This exclusion applies: sudden and accidental physical injury to "your product" or "your work" after it has (1) Whether the insured may be liable been put to its intended use, as an employer or in any other ca- pacity; and n. Recall of Products, Work or Impaired Property (2) To any obligation to share damages with or repay someone else who Any liability or damages claimed for any must pay damages because of the loss, cost or expense incurred by you or injury. others for the loss of use, withdrawal, re- call, inspection, repair, replacement, ad- r. Additional Insured Prior Knowledge justment, removal or disposal of: An additional insured added by attach- (1) "Your product"; ment of an endorsement to this Coverage Part that is seeking coverage for a claim (2) "Your work";or or "suit", if that additional insured knew, "Impaired property"; per the following paragraph, that "bodily (3) p p p y"; injury" or "property damage" had oc- if such product, work or property is with- curred or had begun to occur, in whole or drawn or recalled from the market or from in part, prior to the "coverage term" in use by any person or organization be- which such "bodily injury" or "property cause of a known or suspected defect, damage"occurs or begins to occur. deficiency, inadequacy or dangerous An additional insured added by attach- condition in it. ment of an endorsement to this Coverage o. Personal and Advertising Injury Part will be deemed to have known that "bodily injury" or "property damage" has "Bodily injury"arising out of"personal and occurred or has begun to occur at the advertising injury". earliest time when that additional insured, or any one of its owners, members, part- p. Asbestos ners, managers, executive officers, "em- "Bodily injury" or "property damage" aris- ployees" assigned to manage that addi- ing out of, attributable to, or any way re- tional insured's insurance program, or lated to asbestos in any form or trans- "employees" assigned to give or receive miffed in any manner. notice of an "occurrence", "personal and advertising injury"offense, claim or"suit": Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc., with its permission. Page 6 of 22 (1) Reports all, or any part, of the "bodily a. We will pay those sums that the insured injury" or"property damage" to us or becomes legally obligated to pay as any other insurer; damages because of "personal and ad- vertising injury" to which this insurance (2) Receives a written or verbal demand applies. We will have the right and duty or claim for damages because of the to defend the insured against any "suit" "bodily injury"or"property damage"; seeking those damages. However, we (3) First observes, or reasonably should will have no duty to defend the insured have first observed, the "bodily in- against any "suit" seeking damages for jury"or"property damage"; "personal and advertising injury"to which this insurance does not apply. We may, (4) Becomes aware, or reasonably at our discretion, investigate any offense should have become aware, by any and settle any claim or"suit"that may re- means other than as described in (3) suit. But: above, that "bodily injury" or "prop- erty damage" had occurred or had (1) The amount we will pay for damages begun to occur; or is limited as described in SECTION III- LIMITS OF INSURANCE; and (5) Becomes aware, or reasonably (2) Our right and duty to defend ends should have become aware, of a when we have used up the applica- condition from which "bodily injury" or"property damage" is substantially ble limit of insurance in the payment certain to occur. of judgments or settlements under SECTION I - COVERAGES, COV- s. Electronic Data ERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY; Damages arising out of the loss of, loss SECTION I - COVERAGES, COV- of use of, damage to, corruption of, in- ERAGE B. PERSONAL AND AD- ability to access, or inability to manipulate VERTISING INJURY LIABILITY; or "electronic data". medical expenses under SECTION t. Distribution of Material in Violation of - COVERAGES, COVERAGE C. Statutes MEDICAL PAYMENTS. "Bodily injury" or "property damage" aris- No other obligation or liability to pay sums ing directly or indirectly out of any action or perform acts or services is covered or omission that violates or is alleged to unless expressly provided for under violate: SUPPLEMENTARY PAYMENTS - COV- ERAGES A AND B. a. The Telephone Consumer Protection Act (TCPA), including any amend- b. This insurance applies to "personal and ment of or addition to such law;or advertising injury"only if: b. The CAN-SPAM Act of 2003, includ- (1) The "personal and advertising injury" ing any amendment of or addition to is caused by an offense arising out such law;or of your business; and c. Any statute, ordinance or regulation, (2) The"personal and advertising injury" other than the TCPA or CAN-SPAM offense was committed in the "cov- Act of 2003, that prohibits or limits the erage territory" during the policy pe- sending, transmitting, communicating riod; and or distribution of material or informa- (3) Prior to the "coverage term" in which tion. the "personal and advertising injury" Exclusions c, through q. do not apply to offense is committed, you did not "property damage" by fire or explosion to know, per Paragraph 1.d. below, that premises while rented to you or temporarily the offense had been committed or occupied by you with permission of the owner, had begun to be committed, in whole for which the amount we will pay is limited to or in part. the Damage to Premises Rented To You Limit c. "Personal and advertising injury" caused as described in SECTION III - LIMITS OF IN- by an offense which: SURANCE. COVERAGE B. PERSONAL AND ADVERTISING (1) Was committed during the "coverage INJURY LIABILITY term";and 1. Insuring Agreement Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc.,with its permission. Page 7 of 22 (2) Was not, prior to the "coverage (1) The inception of this Coverage Part; term", known by you, per Paragraph or 1.d. below,to have been committed; (2) The "coverage term" in which insur- includes any continuation, change or re- ance coverage is sought. sumption of that offense after the end of the "coverage term" in which it first be- d. Criminal Acts came known by you. "Personal and advertising injury" arising d. You will be deemed to know that a "per- out of a criminal act committed by or at sonal and advertising injury" offense has the direction of the insured. been committed at the earliest time when e. Contractual Liability any"authorized representative": (1) Reports all, or any part, of the "per- "Personal and advertising injury" for which the insured is obligated to pay sonal and advertising injury" to us or damages by reason of the assumption of any other insurer; liability in a contract or agreement. This (2) Receives a written or verbal demand exclusion does not apply to liability for or claim for damages because of the damages: "personal and advertising injury"; (1) That the insured would have in the (3) First observes, or reasonably should absence of the contract or agree- have first observed, the offense that ment; or caused the "personal and advertis- (2) Assumed in a contract or agreement ing injury"; that is an "insured contract", pro- (4) Becomes aware, or reasonably vided the "personal and advertising should have become aware, by any injury" is caused by or arises out of means, other than as described in an offense committed subsequent to (3) above, that the offense had been the execution of the contract or committed or had begun to be com- agreement. When a claim for such miffed;or "personal and advertising injury" is made, we will defend that claim, pro- (5) Becomes aware, or reasonably vided the insured has assumed the should have become aware, of a obligation to defend such claim in the condition from which "personal and "insured contract". Such defense advertising injury" is substantially payments will not reduce the limits of certain to occur. insurance. 2. Exclusions f. Breach of Contract This insurance does not apply to: "Personal and advertising injury" arising out of a breach of contract, except an im- a. Knowing Violation of Rights of Another plied contract to use another's advertising "Personal and advertising injury" caused idea in your"advertisement". by or at the direction of the insured with the knowledge that the act would violate g. Quality or Performance of Goods - Failure to Conform to Statements the rights of another and would inflict "personal and advertising injury". "Personal and advertising injury" arising out of the failure of goods, products or b. Material Published With Knowledge of services to conform with any statement of Falsity quality or performance made in your "ad- "Personal and advertising injury" arising vertisement". out of oral or written publication of mate- h. Wrong Description of Prices rial, if done by or at the direction of the in- sured with knowledge of its falsity. "Personal and advertising injury" arising out of the wrong description of the price c. Material Published Prior to Coverage of goods, products or services stated in Term your"advertisement". "Personal and advertising injury" arising I. Infringement of Copyright, Patent, out of oral or written publication of mate- Trademark or Trade Secret rial whose first publication took place be- fore the later of the following: "Personal and advertising injury" arising out of the infringement of copyright, pat- Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc.,with its permission. Page 8 of 22 ent, trademark, trade secret or other in- or discrimination directed at that tellectual property rights. person; or However,this exclusion does not apply to (2) The spouse, child, parent, brother or infringement, in your "advertisement", of sister of that person as a conse- copyright,trade dress or slogan. quence of "personal and advertising Insureds in Media and Internet Type injury"to that person at whom any of j• yp the employment-related practices Businesses described in Paragraphs (a), (b) or "Personal and advertising injury" com- (c)above is directed. mitted by an insured whose business is: This exclusion applies: (1) Advertising, broadcasting, publishing (1) Whether the insured may be liable or telecasting; as an employer or in any other ca- (2) Designing or determining content of parity; and web-sites for others; or (2) To any obligation to share damages (3) An Internet search, access, content with or repay someone else who or service provider, must pay damages because of the injury. However,this exclusion does not apply to n. Pollutant Paragraphs 17. a., b. and c. of"personal and advertising injury" under SECTION V "Personal and advertising injury" arising - DEFINITIONS. out of the actual, alleged or threatened For the purposes of this exclusion, the discharge, dispersal, seepage, migration, placing of frames, borders or links, or ad- release, escape or emission of "pollut- vertising, for you or others anywhere on ants"at any time. the Internet is not, by itself, considered o. Pollutant-Related the business of advertising, broadcasting, publishing or telecasting. Any loss, cost or expense arising out of k. Electronic Chatrooms or Bulletin any: Boards (1) Request, demand, order or statutory or regulatory requirement that any "Personal and advertising injury" arising insured or others test for, monitor, out of an electronic chatroom or bulletin clean up, remove, contain, treat, board any insured hosts, owns, or over detoxify or neutralize, or in any way which any insured exercises control. respond to, or assess the effects of, I. Unauthorized Use of Another's Name "pollutants";or or Product (2) Claim or suit by or on behalf of a "Personal and advertising injury" arising governmental authority for damages out of the unauthorized use of another's because of testing for, monitoring, name or product in your e-mail address, cleaning up, removing, containing, domain name or metatag, or any other treating, detoxifying or neutralizing, similar tactics to mislead another's poten- or in any way responding to, or as- tial customers. sessing the effects of, "pollutants". m. Employment Related Practices p. Asbestos "Personal and advertising injury"to: "Personal and advertising injury" arising out of, attributable to, or any way related (1) A person arising out of any: to asbestos in any form or transmitted in (a) Refusal to employ that person; any manner. (b) Termination of that person's q. Additional Insured Prior Knowledge employment; or An additional insured added by attach- ment of an endorsement to this Coverage (c) Other employment-related prac- Part that is seeking coverage for a claim tices, policies, acts or omissions or "suit", if that additional insured knew, including but not limited to coer- per the following paragraph, that a "per- cion, criticism, demotion, sonal and advertising injury" offense had evaluation, failure to promote, been committed or had begun to be reassignment, discipline, defa- committed, in whole or in part, prior to the mation, harassment, humiliation "coverage term" in which such offense Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc.,with its permission. Page 9 of 22 was committed or began to be commit- "Personal and advertising injury" arising ted. directly or indirectly out of any action or omission that violates or is alleged to An additional insured added by attach- violate: ment of an endorsement to this Coverage Part will be deemed to have known that a a. The Telephone Consumer Protection "personal and advertising injury" offense Act (TCPA), including any amend- has been committed or has begun to be ment of or addition to such law;or committed at the earliest time when that b. The CAN-SPAM Act of 2003, includ- additional insured, or any one of its own- ers, members, partners, managers, ex- ing any amendment of or addition to ecutive officers, "employees" assigned to such law;or manage that additional insured's insur- C. Any statute, ordinance or regulation, ance program, or "employees" assigned other than the TCPA or CAN-SPAM to give or receive notice of an "occur- Act of 2003, that prohibits or limits the rence", "personal and advertising injury" sending, transmitting, communicating offense, claim or"suit": or distribution of material or informa- (1) Reports all, or any part, of the "per- tion. sonal and advertising injury"to us or COVERAGE C. MEDICAL PAYMENTS any other insurer; (2) Receives a written or verbal demand 1. Insuring Agreement or claim for damages because of the a. We will pay medical expenses as de- "personal and advertising injury"; scribed below for "bodily injury" caused (3) First observes, or reasonably should by an accident: have first observed, the offense that (1) On premises you own or rent; caused the "personal and advertis- (2) On ways next to premises you own ing injury"; or rent; or (4) Becomes aware, or reasonably should have become aware, by any (3) Because of your operations; means other than as described in (3) provided that: above, that the "personal and adver- tising injury" offense had been com- (1) The accident takes place in the mitted or had begun to be commit- "coverage territory" and during the ted; or policy period; (5) Becomes aware, or reasonably (2) The expenses are incurred and re- should have become aware, of a ported to us within three years of the condition from which "personal and date of the accident; and advertising injury" is substantially certain to occur. (3) The injured person submits to ex- amination, at our expense, by physi- r. War cians of our choice as often as we "Personal and advertising injury", how- everreasonably require. caused, arising, directly or indirectly, b. We will make these payments regardless out of: of fault. These payments will not exceed the applicable limit of insurance. We will (1) War, including undeclared or civil pay reasonable expenses for: war; (1) First aid administered at the time of (2) Warlike action by a military force, in- an accident; cluding action in hindering or de- fending against an actual or ex- (2) Necessary medical, surgical, x-ray pected attack, by any government, and dental services, including pros- sovereign or other authority using thetic devices; and military personnel or other agents; or (3) Necessary ambulance, hospital, (3) Insurrection, rebellion, revolution, professional nursing and funeral usurped power, or action taken by services. governmental authority in hindering or defending against any of these. 2. Exclusions s. Distribution of Material in Violation of We will not pay expenses for"bodily injury": Statutes Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc.,with its permission. Page 10 of 22 a. Any Insured cluding actual loss of earnings up to $250 a To any insured, except "volunteer work- day because of time off from work. ers". 5. All costs taxed against the insured in the "suit". b. Hired Person To aperson hired to do work for or on 6. Prejudgment interest awarded against the insured on that part of the judgment we be- behalf of any insured or a tenant of any come obligated to pay and which falls within insured. the applicable limit of insurance. If we make c. Injury on Normally Occupied Premises an offer to pay the applicable limit of insur- ance,we will not pay any prejudgment interest To a person injured on that part of prem- based on that period of time after the offer. ises you own or rent that the person nor- mallyoccupies. 7. All interest on the full amount of any judgment that accrues after entry of the judgment and d. Workers' Compensation and Similar before we have paid, offered to pay, or de- Laws posited in court the part of the judgment that To a person, whether or not an "em- is within the applicable limit of insurance. ployee" of any insured, if benefits for the These payments will not reduce the limits of insur- "bodily injury" are payable or must be ance. provided under a workers' compensation SECTION II-WHO IS AN INSURED or disability benefits law or a similar law. e. Athletic Activities 1. If you are designated in the Declarations as: To any person injured while officiating, a. An individual, you and your spouse are coaching, practicing for, instructing or insureds, but only with respect to the participating in any physical exercises or conduct of a business of which you are games, sports, or athletic contests or ex- the sole owner. hibitions of an athletic or sports nature. b. A partnership or joint venture, you are an f. Products-Completed Operations Haz- insured. Your members, your partners, and and their spouses are also insureds, but only with respect to the conduct of your Included within the "products-completed business. operations hazard". c. A limited liability company, you are an in- g. Coverage A Exclusions sured. Your members are also insureds, Excluded under COVERAGE A. BODILY but only with respect to the conduct of AND PROPERTY DAMAGE LI- your business. Your managers are in- INJURY INJURY sureds, but only with respect to their du- . ties as your managers. SUPPLEMENTARY PAYMENTS - COVERAGES d. An organization other than a partnership, A AND B joint venture or limited liability company, We will pay, with respect to any claim we investi- you are an insured. Your "executive offi- gate or settle, or any "suit" against an insured we cers" and directors are insureds, but only defend: with respect to their duties as your offi- cers or directors. Your stockholders are 1. All expenses we incur. also insureds, but only with respect to 2. Up to$250 for cost of bail bonds required their liability as stockholders. be- cause of accidents or traffic law violations e. A trust,you are an insured. Your trustees arising out of the use of any vehicle to which are also insureds, but only with respect to the Bodily Injury Liability Coverage applies, their duties as trustees. We do not have to furnish these bonds. 2. Each of the following is also an insured: 3. The cost of bonds to release attachments, but only for bond amounts within the applicable a. Your "volunteer workers" only while per- limit of insurance. We do not have to furnish forming duties related to the conduct of your business, or your "employees", these bonds, other than either your "executive officers" 4. All reasonable expenses incurred by the in- (if you are an organization other than a sured at our request to assist us in the inves- partnership,joint venture or limited liability tigation or defense of the claim or "suit", in- company) or your managers (if you are a limited liability company), but only for acts within the scope of their employment by Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc.,with its permission. Page 11 of 22 you or while performing duties related to d. Your legal representative if you die, but the conduct of your business. However, only with respect to duties as such. That none of these "employees" or "volunteer representative will have all your rights workers"are insureds for: and duties under this Coverage Part. (1) "Bodily injury" or "personal and ad- 3. Any organization you newly acquire or form, vertising injury": other than a partnership, joint venture or lim- ited liability company, and over which you (a) To you, to your partners or maintain ownership or majority interest, will members (if you are a partner- qualify as a Named Insured if there is no other ship or joint venture), to your similar insurance available to that organiza- members (if you are a limited li- tion. However: ability company), to a co- "employee" while in the course a. Insurance under this provision is afforded of his or her employment or only until the 90th day after you acquire performing duties related to the or form the organization or the end of the conduct of your business, or to policy period,whichever is earlier; your other "volunteer workers" COVERAGE A. BODILY INJURY AND b. while performing duties related PROPERTY DAMAGE LIABILITY does to the conduct of your business; not apply to "bodily injury" or "property (b) To the spouse, child, parent, damage" that occurred before you ac- brother or sister of that co- quired or formed the organization;and "employee" or "volunteer C. COVERAGE B. PERSONAL AND AD- worker as a consequence of VERTISING INJURY LIABILITY does not Paragraph (1)(a) above; apply to "personal and advertising injury" (c) For which there is any obligation arising out of an offense committed be- to share damages with or repay fore you acquired or formed the organi- someone else who must pay zation. damages because of the injury described in Paragraphs (1)(a) No person or organization is an insured with re- or(b)above; or spect to the conduct of any current or past part- nership, joint venture or limited liability company (d) Arising out of his or her provid- that is not shown as a Named Insured in the Dec- ing or failing to provide profes- larations. sional health care services. SECTION III-LIMITS OF INSURANCE (2) "Property damage"to property: 1. The Limits of Insurance shown in the Declara- (a) Owned, occupied or used by; or tions and the rules below fix the most we will (b) Rented to, in the care, custody pay regardless of the number of: or control of, or over which a. Insureds; physical control is being exer- cised for any purpose by, b. Claims made or"suits"brought; or you, any of your "employees", "vol- c. Persons or organizations making claims unteer workers", any partner or or bringing"suits". member (if you are a partnership or 2. a. The General Aggregate Limit is the most joint venture), or any member (if you we will pay for the sum of: are a limited liability company). (1) Medical expenses under COVER- b. Any person (other than your "employee" AGE C.MEDICAL PAYMENTS; or "volunteer worker"), or any organiza- tion while acting as your real estate man- (2) Damages under COVERAGE A. ager. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, except dam- c. Any person or organization having proper ages because of "bodily injury" or temporary custody of your property if you "property damage" included in the die, but only: "products-completed operations (1) With respect to liability arising out of hazard"; and the maintenance or use of that prop- (3) Damages under COVERAGE B. erty; and PERSONAL AND ADVERTISING (2) Until your legal representative has INJURY LIABILITY. been appointed. This General Aggregate Limit will not ap- ply if either the Location General Aggre- Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc.,with its permission. Page 12 of 22 gate Limit of Insurance Paragraph 2.b., your behalf at the same location for or the Construction {}ro 3: General Ag- the same persons or organizations, gregate Limit of Insurance, Paragraph no matter how often or under how 2.c.applies. many different contracts, will be b. A separate Location General Aggregate d prme oject to be a single construction Limit of Insurance, equal to the amount of Po the General Aggregate Limit shown in the 3. The Products-Completed Operations Aggre- Declarations, shall apply to each location gate Limit is the most we will pay under COV- owned by, or rented or leased to you and ERAGE A. BODILY INJURY AND PROP- is the most we will pay for the sum of: ERTY DAMAGE LIABILITY for damages under COVERAGE A. be- cause of "bodily injury" and "property dam- (1) Damages 9 age" included in the "products-completed op- BODILY INJURY AND PROPERTY erations hazard". DAMAGE LIABILITY, except dam- ages because of "bodily injury" or 4. Subject to 2.a. above, the Personal and Ad- "property damage" included in the vertising Injury Limit is the most we will pay "products-completed operations under COVERAGE B. PERSONAL AND AD- hazard"; and VERTISING INJURY LIABILITY for the sum of Medical expenses under COVER- all damages because of all "personal and ad- (2) P vertising injury" sustained by any one person AGE C. MEDICAL PAYMENTS, or organization. which can be attributed to operations at 5. Subject to 2. or 3. above, whichever applies, only a single location owned by, or rented the Each Occurrence Limit is the most we will or leased to you. pay for the sum of: c• 9`"'�° �� S` `�� -i��'` a. Damages under COVERAGE A. BODILY ; ii �rR Ih lii r i [ ,, Li 1 Est INJURY AND PROPERTY DAMAGE LI- ; jj�� ,-i,r' l� f Ili, Ir_if ),i 'h ABILITY; and RA,sta 5-1A r1, �, ,;',1-,...,.,.9ii�3i n _111. 'I.,- u,., 4-2, ,, i, ujN IINI,,1f_ti lc,--,,_,,_.[I and is the b. Medical expenses under COVERAGE C. most we will pay for the sum of: MEDICAL PAYMENTS; (1) Damages under COVERAGE A. because of all "bodily injury" and "property BODILY INJURY AND PROPERTY damage" arising out of any one "occurrence". DAMAGE LIABILITY, except dam- ages because of "bodily injury" or 6. Subject to 5. above, the Damage to Premises "property damage" included in the Rented to You Limit is the most we will pay "products-completed operations under COVERAGE A. BODILY INJURY AND hazard"; and PROPERTY DAMAGE LIABILITY for dam- ages because of "property damage" to any (2) Medical expenses under COVER- one premises, while rented to you, or in the AGE C. MEDICAL PAYMENTS; case of damage by fire or explosion, while rented to you or temporarily occupied by you which can be attributed only to ongoing with permission of the owner. operations and only at a single construc- tion project. 7. Subject to 5. above, the Medical Expense Limit is the most we will pay under COVER- d. Only for the purpose of determining which AGE C. MEDICAL PAYMENTS for all medical General Aggregate Limit of Insurance, expenses because of"bodily injury"sustained 2.a.,2.b., or 2.c.,applies: by any one person. (1) Location means premises involving The Limits of Insurance of this Coverage Part ap- the same or connecting lots, or ply separately to each "coverage term", premises, whose connection is inter- rupted only by a street, roadway, SECTION IV - COMMERCIAL GENERAL LI- waterway or right-of-way of a rail- ABILITY CONDITIONS road. 1. Bankruptcy (2) Construction project means a loca- tion you do not own, rent or lease Bankruptcy or insolvency of the insured or of where ongoing improvements, al- the insured's estate will not relieve us of our terations, installation, demolition or obligations under this Coverage Part. maintenance work is performed by 2. Duties in the Event of Occurrence, Offense, you or on your behalf. All connected Claim or Suit ongoing improvements, alterations, installation, demolition or mainte- a. You must see to it that we are notified as nance work performed by you or on soon as practicable of an "occurrence" or Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc.,with its permission. Page 13 of 22 a "personal and advertising injury" of- under the terms of this Coverage Part or that fense which may result in a claim. To the are in excess of the applicable limit of insur- extent possible, notice should include: ance. An agreed settlement means a settle- ment and release of liability signed by us, the (1) How, when and where the "occur- insured and the claimant or the claimant's le- rence"or offense took place; gal representative. (2) The names and addresses of any 4. Liberalization injured persons and witnesses;and If,within 60 days prior to the beginning of this (3) The nature and location of any injury Coverage Part or during the policy period, we or damage arising out of the "occur- make any changes to any forms or endorse- rence"or offense. ments of this Coverage Part for which there is b. If a claim is made or "suit" is brought currently no separate premium charge, and against any insured, you must: that change provides more coverage than this Coverage Part, the change will automatically (1) Immediately record the specifics of apply to this Coverage Part as of the latter of: the claim or "suit" and the date re- a. The date we implemented the change in ceived; and your state; or (2) Notify us as soon as practicable. b. The date this Coverage Part became ef- You must see to it that we receive written fective;and notice of the claim or "suit" as soon as will be considered as included until the end of practicable. the current policy period. We will make no c. You and any other involved insured must: additional premium charge for this additional coverage during the interim. (1) Immediately send us copies of any demands, notices, summonses or 5. Other Insurance legal papers received in connection with the claim or"suit"; If other valid and collectible insurance is available to the insured for a loss we cover (2) Authorize us to obtain records and under COVERAGE A. BODILY INJURY AND other information; PROPERTY DAMAGE LIABILITY or COV- ERAGE B. PERSONAL AND ADVERTISING (3) Cooperate with us in the investiga- INJURY LIABILITY of this Coverage Part, our tion or settlement of the claim or de- obligations are limited as follows: fense against the"suit";and a. Primary Insurance (4) Assist us, upon our request, in the enforcement of any right against any This insurance is primary except when b. person or organization which may be below applies. If this insurance is pri- liable to the insured because of in- mary, our obligations are not affected jury or damage to which this insur- unless any of the other insurance is also ance may also apply. primary. Then, we will share with all that other insurance by the method described d. No insured will, except at that insured's in c.below. own cost, voluntarily make a payment, assume any obligation, or incur any ex- b. Excess Insurance pense, other than for first aid, without our consent. This insurance is excess over: 3. Legal Action Against Us (1) Any of the other insurance, whether primary, excess, contingent or on No person or organization has a right under any other basis: this Coverage Part: (a) That is Fire, Extended Cover- a. To join us as a party or otherwise bring age, Builder's Risk, Installation us into a "suit" asking for damages from Risk or similar insurance for an insured; or "your work"; b. To sue us on this Coverage Part unless (b) That is Fire or Explosion insur- all of its terms have been fully complied ance for premises rented to you with. or temporarily occupied by you A person or organization may sue us to with permission of the owner; re- cover on an agreed settlement or on a final (c) That is insurance purchased by judgment against an insured; but we will not you to cover your liability as a be liable for damages that are not payable tenant for "property damage" to Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc.,with its permission. Page 14 of 22 premises rented to you or tern- shown in the Declarations of this Cover- porarily occupied by you with age Part. permission of the owner;or c. Method of Sharing (d) If the loss arises out of the maintenance or use of aircraft, If all of the other insurance permits con- "autos" or watercraft to the ex- tribution by equal shares, we will follow tent not subject to SECTION I - this method also. Under this approach COVERAGES, COVERAGE A. each insurer contributes equal amounts BODILY INJURY AND PROP- until it has paid its applicable limit of in- ERTY DAMAGE LIABILITY, 2. surance or none of the loss remains, Exclusions, g.Aircraft,Auto or whichever comes first. Watercraft. If any of the other insurance does not (2) Any other primary insurance avail- permit contribution by equal shares, we able to the insured covering liability will contribute by limits. Under this for damages arising out of the method, each insurer's share is based on premises or operations, or the prod- the ratio of its applicable limit of insurance ucts and completed operations, for to the total applicable limits of insurance which the insured has been added of all insurers. as an additional insured by attach- 6. Premium Audit ment of an endorsement. (3) Any other insurance: a. We will compute all premiums for this Coverage Part in accordance with our (a) Whether primary, excess, con- rules and rates. tingent or on any other basis, b. Premium shown in this Coverage Part as except when such insurance is advance premium is a deposit premium written specifically to be excess only. At the close of each audit period we over this insurance; and will compute the earned premium for that (b) That is a consolidated (wrap-up) period and send notice to the first Named insurance program which has Insured. The due date for audit and ret- been provided by the prime rospective premiums is the date shown contractor/project manager or as the due date on the bill. If: owner of the consolidated proj- (1) The earned premium is less than the ect in which you are involved. deposit premium, we will return the When this insurance is excess, we will excess to the first Named Insured; or have no duty under COVERAGE A. (2) The earned premium is greater than BODILY INJURY AND PROPERTY the deposit premium, the difference DAMAGE LIABILITY or COVERAGE B. will be due and payable to us by the PERSONAL AND ADVERTISING IN- first Named Insured upon notice from JURY LIABILITY to defend the insured against any "suit" if any other insurer has us. a duty to defend the insured against that c. The first Named Insured must keep rec- "suit". If no other insurer defends, we will ords of the information we need for pre- undertake to do so, but we will be entitled mium computation,and send us copies at to the insured's rights against all those such times as we may request. other insurers. 7. Representations When this insurance is excess over other insurance, we will pay only our share of By accepting this Coverage Part,you agree: the amount of the loss, if any, that ex- a. The statements in the Declarations are ceeds the sum of: accurate and complete; (1) The total amount that all such other b. Those statements are based upon repre- insurance would pay for the loss in sentations you made to us; and the absence of this insurance; and (2) The total of all deductible and self- c. We have issued this Coverage Part in re- insured amounts under all that other liance upon your representations. insurance. 8. Separation of Insureds We will share the remaining loss, if any, Except with respect to the Limits of Insurance, with any other insurance that is not de- and any rights or duties specifically assigned scribed in this Excess Insurance provi- in this Coverage Part to the first Named In- sion and was not bought specifically to sured, this insurance applies: apply in excess of the Limits of Insurance Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc.,with its permission. Page 15 of 22 a. As if each Named Insured were the only (1) An individual, you and your spouse Named Insured; and are"authorized representatives". b. Separately to each insured against whom (2) A partnership or joint venture, your claim is made or"suit"is brought. members, your partners, and their spouses are "authorized representa- 9. Transfer of Rights of Recovery Against tives". Others to Us (3) A limited liability company, your If the insured has rights to recover all or part members and your managers are of any payment we have made under this "authorized representatives". Coverage Part, those rights are transferred to us. The insured must do nothing after loss to (4) An organization other than a part- impair them. At our request, the insured will nership, joint venture or limited liabil- bring "suit" or transfer those rights to us and ity company, your "executive offi- help us enforce them. cers" and directors are "authorized a Forms or Policies representatives". Provided you are 10. Two or More Coverage not a publicly traded organization, Issued by Us your stockholders are also "author- If this Coverage Part and any other Coverage ized representatives". Form, Coverage Part or policy issued to you (5) A trust,your trustees are "authorized by us or any company affiliated with us apply representatives". to the same "occurrence" or "personal and advertising injury" offense, the aggregate b. Your"employees": maximum limit of insurance under all the Cov- erage Forms, Coverage Parts or policies shall (1) Assigned to manage your insurance not exceed the highest applicable limit of in- program;or surance under any one Coverage Form, Coy- (2) Responsible for giving or receiving erage Part or policy. This condition does not notice of an "occurrence", "personal apply to any Coverage Form, Coverage Part and advertising injury" offense, claim or policy issued by us or an affiliated company or"suit"; specifically to apply as excess insurance over this Coverage Part. are also"authorized representatives". 11. When We Do Not Renew 3. "Auto"means: If we decide not to renew this Coverage Part, a. A land motor vehicle, trailer or semitrailer we will mail or deliver to the first Named In- designed for travel on public roads, in- sured shown in the Declarations written notice cluding any attached machinery or of the nonrenewal not less than 30 days be- equipment; or fore the expiration date. b. Any other land vehicle that is subject to a If notice is mailed, proof of mailing will be suf- compulsory or financial responsibility law ficient proof of notice. or other motor vehicle insurance law in SECTION V-DEFINITIONS • the state where it is licensed or principally garaged. 1. "Advertisement"means a notice that is broad- However, "auto" does not include "mobile cast, telecast or published to the general pub- equipment". lic or specific market segments about your goods, products or services for the purpose of 4. "Bodily injury"means bodily injury, sickness or attracting customers or supporters. "Adver- disease sustained by a person, including tisement" includes a publicity article. For pur- death resulting from any of these at any time. poses of this definition: 5. "Coverage term" means the following individ- a. Notices that are published include mate- ual increment, or if a multi-year policy period, rial placed on the Internet or on similar increments, of time,which comprise the policy electronic means of communication;and period of this Coverage Part: b. Regarding web-sites, only that part of a a. The year commencing on the Effective web-site that is about your goods, prod- Date of this Coverage Part at 12:01 AM ucts or services for the purposes of at- standard time at your mailing address tracting customers or supporters is con- shown in the Declarations, and if a multi- sidered an "advertisement". year policy period, each consecutive t. "Authorized representative"means: an- nual period thereafter,or portion thereof if any period is for a period of less than 12 a. If you are designated in the Declarations months, constitute individual "coverage as: terms". The last "coverage term" ends at Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc.,with its permission. Page 16 of 22 12:00 AM standard time at your mailing 10. "Hostile fire" means one which becomes un- address shown in the Declarations on the controllable or breaks out from where it was earlier of: intended to be. (1) The day the policy period shown in 11. "Impaired property" means tangible property, the Declarations ends; or other than "your product" or "your work", that (2) The day the policy to which this cannot be used or is less useful because: Cov- erage Part is attached is terminated a. It incorporates "your product" or "your or cancelled, work" that is known or thought to be de- fective, deficient, inadequate or danger- b. However, if after the issuance of this ous; or Coverage Part, any "coverage term" is extended for an additional period of less b. You have failed to fulfill the terms of a than 12 months, that additional period of contract or agreement; time will be deemed to be part of the last if such propertycan be restored to use by: preceding "coverage term". 6. "Coverage territory"means: a. The repair, replacement, adjustment or removal of"your product" or "your work"; a. The United States of America (including or its territories and possessions), Puerto Rico and Canada; b. Your fulfilling the terms of the contract or agreement. b. International waters or airspace, but only if the injury or damage occurs in the 12. "Insured contract"means: course of travel or transportation between a. A contract for a lease of premises. How- any places included in a.above; or ever, that portion of the contract for a c. All other parts of the world if the injury or lease of premises that indemnifies any damage arises out of: person or organization for "property damage" by fire or explosion to premises (1) Goods or products made or sold by while rented to you or temporarily occu- you in the territory described in a. pied by you with permission of the owner above; is not an "insured contract"; (2) The activities of a person whose b. A sidetrack agreement; home is in the territory described in a.above, but is away for a short time c. Any easement or license agreement, ex- on your business; or cept in connection with construction or demolition operations on or within 50 feet (3) "Personal and advertising injury" of- of a railroad; fenses that take place through the Internet or similar electronic means d. An obligation, as required by ordinance, of communication, to indemnify a municipality, except in connection with work for a municipality; provided the insured's responsibility to pay damages is determined in a "suit" on e. An elevator maintenance agreement; the merits, in the territory described in a. f. That part of any other contract or agree- above or in a settlement to which we ment pertaining to your business (includ- agree. ing an indemnification of a municipality in 7. "Electronic data" means information, facts or connection with work performed for a programs stored as or on, created or used on, municipality) under which you assume or transmitted to or from computer software, the tort liability of another party to pay for including systems and applications software, "bodily injury", "property damage" or hard or floppy disks, CD-ROMs,tapes, drives, "personal and advertising injury"to a third cells, data processing devices or any other person or organization. Tort liability media which are used with electronically con- means a liability that would be imposed trolled equipment. by law in the absence of any contract or agreement. 8. "Employee" includes a "leased worker". "Em- ployee" does not include a "temporary Paragraph f. does not include that part of worker". any contract or agreement: 9. "Executive officer" means a person holding (1) That indemnifies a railroad for"bodily any of the officer positions created by your injury", "property damage" or "per- charter, constitution, by-laws or any other sonal and advertising injury" arising similar governing document. out of construction or demolition op- erations, within 50 feet of any rail- Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc.,with its permission. Page 17 of 22 road property and affecting any rail- engines; marketing analysis; and road bridge or trestle, tracks, road- providing access to the Internet or beds, tunnel, underpass or crossing; other similar networks;or (2) That indemnifies an architect, engi- (7) Under which the insured, if a web- neer or surveyor for injury or damage site designer or content provider, or arising out of: Internet search, access, content or (a) Preparing, approving, or failing service provider, assumes liability for injury or damage arising out of the to prepare or approve, maps, insured's rendering or failure to ren- shop drawings, opinions, re- der Internet services, including those ports, surveys, field orders, listed in Paragraph (6), above. change orders or drawings and specifications;or 13. "Leased worker" means a person leased to Giving or instructions, you by a labor leasing firm under an agree- (b) or failing directionst give them, that ment between you and the labor leasing firm, to perform duties related to the conduct of the primary cause of the injury your business. "Leased worker" includes su- or damage; pervisors furnished to you by the labor leasing (3) Under which the insured, if an archi- firm. "Leased worker" does not include a tect, engineer or surveyor, assumes "temporary worker". liability for an injury or damage aris- 14. "Loading or unloading" means the handling of ing out of the insured's rendering or property: failure to render professional serv- ices, including those listed in Para- a. After it is moved from the place where it is graph (2) above and supervisory, in- accepted for movement into or onto an spection, architectural or engineering aircraft,watercraft or"auto"; activities; b. While it is in or on an aircraft, watercraft (4) That indemnifies an advertising, pub- or"auto";or lic relations or media consulting firm for "personal and advertising injury" c. While it is being moved from an aircraft, arising out of the planning, execution watercraft or "auto" to the place where it or failure to execute marketing corn- is finally delivered; munications programs. Marketing but "loading or unloading" does not include communications programs include the movement of property by means of a me- but are not limited to comprehensive chanical device, other than a hand truck, that marketing campaigns; consumer, is not attached to the aircraft, watercraft or trade and corporate advertising for "auto". all media; media planning, buying, monitoring and analysis; direct mail; 15. "Mobile equipment" means any of the follow- promotion; sales materials; design; ing types of land vehicles, including any at- presentations; point-of-sale materi- tached machinery or equipment: als; market research; public relations and new product development; a. Bulldozers, farm machinery, forklifts and other vehicles designed for use princi- (5) Under which the insured, if an adver- pally off public roads; tising, public relations or media con- sulting firm, assumes liability for b. Vehicles maintained for use solely on or "personal and advertising injury" next to premises you own or rent; arising out of the insured's rendering c. Vehicles that travel on crawler treads; or failure to render professional services, including those services d. Vehicles, whether self-propelled or not, listed in Paragraph (4), above; maintained primarily to provide mobility to (6) That indemnifies a web-site designer permanently mounted: or content provider, or Internet (1) Power cranes, shovels, loaders, dig- search, access, content or service gers or drills;or provider for injury or damage arising out of the planning, execution or fail- (2) Road construction or resurfacing ure to execute Internet services, equipment such as graders, scrap- Internet services include but are not ers or rollers; limited to design, production, distri- bution, maintenance and administra- e. Vehicles not described in a., b., c, or d. tion of web-sites and web-banners; above that are not self-propelled and are hosting web-sites; registering do- maintained primarily to provide mobility to main names; registering with search Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc.,with its permission. Page 18 of 22 permanently attached equipment of the d. Oral or written publication, in any manner, following types: of material that slanders or libels a per- sonAir compressors, pumps andgen- or organization or disparages a per- (1) P son's or organization's goods, products or erators, including spraying, welding, services; building cleaning, geophysical explo- ration, lighting and well servicing e. Oral or written publication, in any manner, equipment; or of material that violates a person's right of (2) Cherry pickers and similar devices privacy; used to raise or lower workers; f. The use of another's advertising idea in f. Vehicles not described in a., b., c. or d. your"advertisement";or above maintained primarily for purposes g. Infringing upon another's copyright, trade other than the transportation of persons dress or slogan in your"advertisement". or cargo. 18. "Pollutant"means any solid, liquid,gaseous or However, self-propelled vehicles with the thermal irritant or contaminant, including following types of permanently attached smoke, vapor, soot, fumes, acids, alkalis, equipment are not "mobile equipment" chemicals, petroleum, petroleum products but will be considered "autos": and petroleum by-products, and waste. Waste includes materials to be recycled, re- (1) Equipment designed primarily for: conditioned or reclaimed. "Pollutants" include (a) Snow removal; but are not limited to substances which are generally recognized in industry or govern- (b) Road maintenance, but not con- ment to be harmful or toxic to persons, prop- struction or resurfacing;or erty or the environment regardless of whether the injury or damage is caused directly or indi- (c) Street cleaning; rectly by the"pollutants"and whether: (2) Cherry pickers and similar devices a. The insured is regularly or otherwise en- mounted on automobile or truck gaged in activities which taint or degrade chassis and used to raise or lower the environment; or workers; and b. The insured uses, generates or produces (3) Air compressors, pumps and gen- the"pollutant". erators, including spraying, welding, building cleaning, geophysical explo- 19. "Products-completed operations hazard": ration, lighting and well servicing a. Includes all "bodily injury" and "property equipment. damage" occurring away from premises However, "mobile equipment" does not in- you own or rent and arising out of "your dude any land vehicles that are subject to a product"or"your work"except: compulsory or financial responsibility law or (1) Products that are still in your physical other motor vehicle insurance law in the state where it is licensed or principally garaged. possession; or Land vehicles subject to a compulsory or fi- (2) Work that has not yet been corn- nancial responsibility law or other motor vehi- pleted or abandoned. However, cle insurance law are considered "autos". "your work" will be deemed corn- 16. "Occurrence" means an accident, including pleted at the earliest of the following continuous or repeated exposure to substan- times: tially the same general harmful conditions. (a) When all of the work called for in 17. "Personal and advertising injury" means in- your contract has been corn- jury, including consequential "bodily injury", pleted; or arising out of one or more of the following of- (b) When all of the work to be done fenses: at the job site has been com- a, False arrest,detention or imprisonment; pleted if your contract calls for work at more than one job site; b. Malicious prosecution; or c. The wrongful eviction from,wrongful entry (c) When that part of the work done into, or invasion of the right of private oc- at a job site has been put to its cupancy of a room, dwelling or premises intended use by any person or that a person occupies, committed by or organization other than another on behalf of its owner, landlord or lessor; contractor or subcontractor working on the same project. Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc.,with its permission. Page 19 of 22 Work that may need service, main- her work and acts at the direction of and tenance, correction, repair or re- within the scope of duties determined by you, placement, but which is otherwise and is not paid a fee, salary or other compen- complete, will be treated as corn- sation by you or anyone else for their work pleted. performed for you. b. Does not include "bodily injury" or "prop- 24. "Workplace" means that place and during erty damage"arising out of: such hours to which the "employee" sustain- ing "bodily injury" was assigned by you, or (1) The transportation of property, un- any other person or entity acting on your be- less the injury or damage arises out half,to work on the date of"occurrence". of a condition in or on a vehicle not owned or operated by you, and that 25. "Your product": condition was created by the "load- ing or unloading" of that vehicle by a. Means: any insured; (1) Any goods or products, other than (2) The existence of tools, uninstalled real property, manufactured, sold, equipment or abandoned or unused handled, distributed or disposed of materials;or by: (3) Products or operations for which the (a) You; classification, listed in the Declara- (b) Others trading under your name; tions or in a schedule, states that or products-completed operations are included. (c) A person or organization whose 20. "Property damage" means: business or assets you have acquired; and a. Physical injury to tangible property, in- (2) Containers (other than vehicles), cluding all resulting loss of use of that materials, parts or equipment fur- property. All such loss of use shall be nished in connection with such deemed to occur at the time of the physi- goods or products. cal injury that caused it;or b. Loss of use of tangible property that is b. Includes: not physically injured. All such loss of (1) Warranties or representations made use shall be deemed to occur at the time at any time with respect to the fit- of the"occurrence"that caused it. ness, quality, durability, performance For the purposes of this insurance, "electronic or use of"your product"; and data" is not tangible property. (2) The providing of or failure to provide 21. "Suit" means a civil proceeding in which warnings or instructions. money damages because of "bodily injury", c. Does not include vending machines or "property damage" or "personal and advertis- other property rented to or located for the ing injury" to which this insurance applies are use of others but not sold. alleged. "Suit"includes: 26. "Your work": a. An arbitration proceeding in which such damages are claimed and to which the a. Means: insured must submit or does submit with (1) Work or operations performed by our consent; you or on your behalf; and b. Any other alternative dispute resolution (2) Materials, parts or equipment fur- proceeding in which such damages are nished in connection with such work claimed and to which the insured submits or operations. with our consent; or c. An appeal of a civil proceeding. b. Includes: 22. "Temporary worker" means a person who is (1) Warranties or representations made fit- furnished to you to substitute for a permanent ness,any time with respect to mthe e "employee" on leave or to meet seasonal or r use of y, durability, performance short-term workload conditions. or of"your work"; and 23. "Volunteer worker" means a person who is (2) The providing of or failure to provide not your "employee", and who donates his or warnings or instructions. Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc.,with its permission. Page 20 of 22 NUCLEAR ENERGY LIABILITY EXCLUSION (Broad Form) 1. The insurance does not apply: an insured of services, materials, A. Under anyLiabilityCoverage, to "bodilyparts or equipment in connection 9 with the planning, construction, injury"or"property damage": maintenance, operation or use of (1) With respect to which an insured un- any "nuclear facility", but if such fa- der this Coverage Part is also an in- cility is located within the United sured under a nuclear energy liability States of America, its territories or policy issued by Nuclear Energy Li- possessions or Canada, this Exclu- ability Insurance Association, Mutual sion (3) applies only to "property Atomic Energy Liability Underwriters, damage" to such "nuclear facility" Nuclear Insurance Association of and any property thereat. Canada, or any of their successors, 2. As used in this exclusion: or would be an insured under any such policy but for its termination "Hazardous properties" includes radioactive, upon exhaustion of its limit of liability; toxic or explosive properties. or "Nuclear material" means "source material", (2) Resulting from the "hazardous prop- "special nuclear material" or "by-product ma- erties" of"nuclear material" and with terial". respect to which (a) any person or organization is required to maintain "Source material", "special nuclear material", financial protection pursuant to the and "by-product material" have the meanings Atomic Energy Act of 1954, or any given them in the Atomic Energy Act of 1954 law amendatory thereof, or (b) the or in any law amendatory thereof. insured is, or had this Coverage Part "Spent fuel" means any fuel element or fuel not been issued would be, entitled to component, solid or liquid, which has been indemnity from the United States of used or exposed to radiation in a "nuclear re- America, or any agency thereof, un- actor". der any agreement entered into by the United States of America, or any "Waste" means any waste material (a) con- agency thereof, with any person or taining "by-product material" other than the organization. tailings or wastes produced by the extraction or concentration of uranium or thorium from B. Under any Medical Payments coverage, any ore processed primarily for its "source to expenses incurred with respect to material" content, and (b) resulting from the "bodily injury" resulting from the "hazard- operation by any person or organization of ous properties" of "nuclear material" and any "nuclear facility" included under the first arising out of the operation of a "nuclear two paragraphs of the definition of "nuclear facility"by any person or organization. facility". C. Under any Liability Coverage, to "bodily "Nuclear facility"means: injury" or "property damage" resulting from the "hazardous properties" of "nu- A. Any"nuclear reactor"; clear material",if: B. Any equipment or device designed or (1) The "nuclear material" (a) is at any used for (1) separating the isotopes of "nuclear facility" owned by, or oper- uranium or plutonium, (2) processing or ated by or on behalf of, an insured, utilizing "spent fuel", or (3) handling, or (b) has been discharged or dis- processing or packaging "waste"; persed therefrom; C. Any equipment or device used for the (2) The"nuclear material"is contained in processing, fabricating or alloying of "spent fuel" or "waste" at any time "special nuclear material" if at any time possessed, handled, used, proc- the total amount of such material in the essed, stored, transported or dis- custody of the insured at the premises posed of, by or on behalf of an in- where such equipment or device is lo- sured; or cated consists of or contains more than 25 grams of plutonium or uranium 233 or (3) The "bodily injury" or "property dam- any combination thereof, or more than age" arises out of the furnishing by 250 grams of uranium 235; Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc.,with its permission. Page 21 of 22 D. Any structure, basin, excavation, prem- "Nuclear reactor" means any apparatus de- ises or place prepared or used for the signed or used to sustain nuclear fission in a storage or disposal of"waste"; self-supporting chain reaction or to contain a and includes the site on which any of the critical mass of fissionable material. foregoing is located, all operations conducted "Property damage" includes all forms of ra- on such site and all premises used for such dioactive contamination of property. operations. Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc.,with its permission. Page 22 of 22 Some L&I regional offices are now open on a limited basis by appointment only,for services that cannot be provided over the phone or online. Masks are required for in-person appointments. Call the office near you (hops://Ini.wa.gov/agency/contact/#office-locations),for assistance,or call 360-902-5800 from 8 a.m.to 5 p.m. weekdays (except state holidays). Labor&Industries(https://Ini.wa.gov). IBEX FLOORING LLC Owner or tradesperson PO BOX 7538 SPOKANE,WA 99207 Principals 509-327-3331 MYERS,NATHAN SPOKANE County BENJAMIN,PARTNER/MEMBER MYERS,ASHLI CATHRYN,PARTNER/MEMBER Doing business as IBEX FLOORING LLC WA UBI No. Business type 602 653 391 Limited Liability Company Governing persons ASHLI CATHRYN MYERS NATHAN BENJAMIN MYERS; License Verify the contractor's active registration/license/certification(depending on trade)and any past violations. Construction Contractor Active "'"'" Meets current requirements. License specialties GENERAL License no. IBEXFFL944Q9 Effective—expiration 12/06/2006-12/06/2020 Bond CBIC $12,000.00 Bond account no. FB4044 Received by L&I Effective date 11/19/2010 11/16/2010 Expiration date Until Canceled Insurance Cincinnati Ins Co $1,000,000.00 Policy no. EPP0547117 Received by L&I Effective date 09/06/2019 08/02/2019 Expiration date 08/02/2020 Insurance history Savings No savings accounts during the previous 6 year period. Lawsuits against the bond or savings No lawsuits against the bond or savings accounts during the previous 6 year period. L&I Tax debts No L&l tax debts are recorded for this contractor license during the previous 6 year period,but some debts may be recorded by other agencies. License Violations No license violations during the previous 6 year period. Certifications & Endorsements OMWBE Certifications_ No active certifications exist for this business. Apprentice Training Agent No activeVisiiington redietered apprentices exist for this business.Washington allows the use of apprentices registered with Oregon or Montana.Contact the Oregon Bureau of Labor&Industries or Montana Department of Labor &Industry to verify if this business has apprentices. Workers' Comp Do you know if the business has employees?If so,verify the business is up-to-date on workers'comp premiums. L&I Account ID Account is current. 969,461-02 Doing business as IBEX FLOORING LLC Estimated workers reported Quarter 1 of Year 2020"51 to 75 Workers" L&I account contact T3/SYDNEY RAVES(360)902-4659-Email:RAVS235@lni.wa.gov Public Works Requirements Verify the contractor is eligible to perform work on public works projects. Required Training—Effective July 1,2019 Exempt from this requirement.`"' Contractor Strikes No strikes have been issued against this contractor. Contractors not allowed to bid No debarments have been issued against this contractor. Workplace Safety & Health Check for any past safety and health violations found on jobsites this business was responsible for. No inspections during the previous 6 year period. IBEXFLO-01 MMAYNARD A ORD" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 8/4/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT Amy Cathey PRODUCER NAME: Hub International Northwest LLC PHONE HON o,Ext):(509)863-0323 I( No): 835 N Post Street FAX Suite 203 E-MAIL amy.cathey@hubinternationai.com Spokane,WA 99201 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Cincinnati Insurance Company 10677 INSURED INSURER B:Cincinnati Casualty 28665 IBEX Flooring LLC INSURER C: PO Box 7538 INSURER D: Spokane,WA 99207 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. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X EPP0547117 8/2/2020 8/2/2021 DAMAGE TO RENTED 1,000,000 PREMISES(Ea occurrencel $ MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JEai LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY (Ea accidentSINGLE LIMIT $ 1,000,000 X ANY AUTO EBA0547117 8/2/2020 8/2/2021 BODILY INJURY(Per person) $ AUTOS ONLYS RED SCHEDULED BODILY� INJURYp (Per accident) $ X AUTOS ONLY X AUUTOS ONLY (Perr accdent)AMAGE $ $ B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB —^ CLAIMS-MADE EPP0547117 8/2/2020 8/2/2021 AGGREGATE $ 2,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION STATUTEPER ERH AND EMPLOYERS'LIABIUTY ANY YIPROP IIETOR/PARTNER E ECUTIVE Y/N N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A WA Stop Gap EPP0547117 8/2/2020 8/2/2021 $1M/$1M/$1M DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Project:CenterPlace Regional Event Center Carpet Replacement The City of Spokane Valley is included as primary and non-contributory additional insured.Per Project Aggregate Limit Applies.Coverage applies per 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. 2426 N Disovery Place Spokane Valley,WA 99216 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD