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21-149.00 Barcott Construction: Barker/UPRR Crossing PH 1 Contract This agreement is entered into this 2 nd day of NOY ' 2021, between the City of Spokane Valley ("City")and Barcott Construction,LLC("Contractor"),pursuant to Title 35 RCW,as adopted or amended. In consideration of the terms and conditions contained herein and attached and made a part of this agreement,the parties agree as follows: I. The Contractor shall do all work and furnish all tools,materials,and equipment for: Barker Rd at Union Pacific Crossing Project,Phase 1 #0313 Contract 21-149 in accordance with and as described in the project plans and specification,and the standard specification of the Washington State of Department of Transportation which are by this reference incorporated herein and made part hereof and, shall perform any changes in the work in accord with the Contract Documents. The Contractor shall provide and bear the expense of all equipment, work, and labor, of any sort whatsoever that may be required for the transfer of materials and for constructing and completing the work provided for in these Contract Documents except those items mentioned therein to be furnished by the City. II. The City hereby promises and agrees with the Contractor to employ, and does employ the Contractor to provide the materials and to do and cause to be done the above described work and to complete and finish the same in accord with the project plans and specification and the terms and conditions herein contained and hereby contracts to pay for the same according to the referenced specifications and the schedule of unit or itemized prices at the time and in the manner and upon.the conditions provided for in this contract. III. The Contractor for himself/herself, and for his/hers heirs, executors, administrators, successors,and assigns,does hereby agree to full performance of all covenants required of the Contractor in the contract. IV. It is further provided that no liability shall attach to the City by reason of entering onto this contract,except as provided herein. V. The project was awarded for the bid amount of$301.966.00. IN WITNESS WHEREOF,the Contractor has executed this instrument,on the date below, and the City has caused this instrument to be executed on the date stated above. City of Spokane Valley C-1 Contract Forms Barker-Union Pacific Crossing,Phase 1 Executed by Contractor O(J 5 , 2021. Date iecf 6cARADit- PrintedV� Name WNW Title gna City of Spokane Valley Mark Calhoun Printed Name City Manager Title .I oak_Col 61...._ Signature) Revised 1-8-16 City of Spokane Valley C-2 Contract Forms Barker-Union Pacific Crossing,Phase 1 1 of 2 Originals ci ri I�lokane vdileY BOND NO: 107 502 831 CONTRACTOR'S PAYMENT BOND(FEDERALLY FUNDED PROJECT) to City of Spokane Valley,Washington The City of Spokane Valley, Washington, in Spokane County, has awarded to Barcott Construction, LLC (Contractor), as Principal, a contract for the construction of the project designated as Barker Rd at Union Pacific Crossing Project, Phase 1, Project No.0313 in Spokane Valley,Washington,and said Principal is required under the terms of the Contract to furnish a payment bond in accordance with chapter 39.08 Revised Code of Washington(RCW)and chapter 60.28 RCW. The Principal, and Travelers Casualty and Surety Company of America (Surety), a corporation organized under the laws of*Connecticut and licensed to do business in the State of Washington as surety and named in the current list of"Surety Companies Acceptable in Federal Bonds"as published in the Federal Register by the Audit Staff Bureau of Accounts,U.S.Treasury Dept.,are jointly and severally held and firmly bound to the City of Spokane Valley,as Obligee,in the sum of$$301,966.00 total Contract amount,subject to the provisions herein. This payment bond shall cover any and all taxes incurred pursuant to Titles 50 and 51 RCW,taxes imposed on the Principal pursuant to Title 82 RCW,and any additional sales taxes. This payment bond shall become null and void,if and when the Principal,its heirs,executors,administrators,successors,or assigns shall pay all persons in accordance with chapters 39.08, 39.12, and 60.28 RCW, including all workers, laborers, mechanics, subcontractors,and materialmen,and all persons who shall supply such contractor or subcontractor with provisions and supplies for the carrying on of such work;shall pay all taxes due pursuant to Titles 50,51,and 82 RCW;and shall indemnify and hold harmless the Obligee from all loss,cost or damage which Obligee may suffer by reason of the failure of Principal to make such required payments;and if such payment obligations have not been fulfilled,this bond shall remain in full force and effect. The Surety for value received agrees that no change, extension of time, alteration or addition to the terms of the Contract, the specifications accompanying the Contract,or to the work to be performed under the Contract shall in any way affect its obligation on this bond,except as provided herein,and waives notice of any change,extension of time,alteration or addition to the terms of the Contract or the work performed.The Surety agrees that modifications and changes to the terms and conditions of the Contract that increase the total amount to be paid the Principal shall automatically increase the obligation of the Surety on this bond and notice to Surety is not required for such increased obligation. This bond may be executed in two original counterparts,and shall be signed by the parties'duly authorized officers.This bond will only be accepted if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf of the surety. Travelers Casualty and Surety Barcott Construction, LLC Company of America PRINCIP L( NTRACTOR) SURETY By: 10-01-2021 By: c A e /' c-7e10-01-2021 ci Si ature Date SuretySignature D g ^���,Piunn,„�. 6acc4 Chris A. Fix a��,�y�1DSUry''% Printed Name Printed Name :�J��,. �'.��. r - a;HARTFORD 0- Attorney in Fact = N CONN. o .Title Title � ' � ` . Name,address,and telephone of local office/agent of Surety Company is: '•. (6.4; `* ' CB&MS of WA.,INC. � 'd ,,,,,,,,,�,,,,,,,`"`,` P.O. Box 681, Bothell, WA 98041 206-361-9693 City of Spokane Valley C-4 Contract Forms Barker-Union Pacific Crossing,Phase I 1 of 2 Originals r-Nrin or" BOND NO: 107 502 831 CONTRACTOR'S PERFORMANCE BOND to City of Spokane Valley,Washington The City of Spokane Valley, Washington, in Spokane County, has awarded to Barcott Construction, LLC (Contractor), as Principal, a contract for the construction of the project designated as Barker Rd at Union Pacific Crossin¢Project, Phase 1 Project No. 0313 in Spokane Valley, Washington, and said Principal is required under the terms of the Contract to furnish a performance bond in accordance with chapter 39.08 Revised Code of Washington(RCW). The Principal, and Travelers Casualty and Surety Company of America (Surety), a corporation, organized under the laws of Connecticut and licensed to do business in the State of Washington as surety and named in the current list of"Surety Companies Acceptable in Federal Bonds"as published in the Federal Register by the Audit Staff Bureau of Accounts,U.S.Treasury Dept.,are jointly and severally held and firmly bound to the City of Spokane Valley,as Obligee,in the sum of$301,966.00 total Contract amount(including Washington State sales tax),subject to the provisions herein. This performance bond shall become null and void, if and when the Principal,its heirs,executors,administrators,successors,or assigns shall well and faithfully perform all of the Principal's obligations under the Contract and fulfill all the terms and conditions of all duly authorized modifications, additions,and changes to said Contract that may hereafter be made, at the time and in the manner therein specified;shall warranty the work as provided in the Contract and shall indemnify and hold harmless the Obligee from any defects in the workmanship and materials incorporated into the work for the period identified in the Contract;and if such performance obligations have not been fulfilled,this bond shall remain in full force and effect. The Surety for value received agrees that no change, extension of time, alteration or addition to the terms of the Contract, the specifications accompanying the Contract,or to the work to be performed under the Contract shall in any way affect its obligation on this bond,and waives notice of any change,extension of time,alteration or addition to the terms of the Contract or the work performed. The Surety agrees that modifications and changes to the terms and conditions of the Contract that increase the total amount to be paid the Principal shall automatically increase the obligation of the Surety on this bond and notice to Surety is not required for such increased obligation. This bond may be executed in two original counterparts,and shall be signed by the parties'duly authorized officers.This bond will only be accepted if it is accompanied by a fully executed and original power of attorney for the officer executing on behalf of the surety. Barcott Construction, LLC Travelers Casualty and Surety PRINC L CTOR) SURETY Compan of America By: 10 01 2021 By: CA. /l/* 10-01-2021 cip ignature Date Surety Signature Date Jeff gates gatesti Chris A. Fix ,,`yP�D SUi ry, Printed Name Printed Name = �,-' ‘��'-, Oifl.L,/ Attorney in Fact -` ;HARTFORD i Title Title .; CONN. o Name,address,and telephone of local office/agent of Surety Company is: 'o, d�----": ��'' :' CB&MS of WA.,INC. "F,,.yh•it,,,,,,,„N���`` P.O. Box 681, Bothell, WA 98041 206-361-9693 City of Spokane Valley C-3 Contract Forms Barker-Union Pacific Crossing,Phase I Travelers Casualty and Surety Company of America • 41106. Travelers Casualty and Surety Company TRAVELERS J St. Paul Fire and Marine Insurance Company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the "Companies"),and that the Companies do hereby make,constitute and appoint CHRIS A FIX of SEATTLE Washington , their true and lawful Attorney-in-Fact to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF,the Companies have caused this instrument to be signed,and their corporate seals to be hereto affixed,this 17th day of January, 2019. eo,TY Aq Me Mt ""jr " ao�\ 441: : State of Connecticut By: City of Hartford ss. Robert L.Rane , enior Vice President On this the 17th day of January, 2019, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of Travelers Casualty and Surety Company of America,Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of said Companies by himself as a duly authorized officer. IN WITNESS WHEREOF,I hereunto set my hand and official seal. atis (/ /�G�1Y #� My Commission expires the 30th day of June,2021 (76:14\ 1O Anna P.Nowik,Notary Public This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Travelers Casualty and Surety Company of America,Travelers Casualty and Surety Company, and St.Paul Fire and Marine Insurance Company,which resolutions are now in full force and effect,reading as follows: RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President,the Treasurer, any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds,recognizances,contracts of indemnity,and other writings obligatory in the nature of a bond,recognizance,or conditional undertaking,and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her;and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary;and it is FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or(b) duly executed (under seal, if required)by one or more Attomeys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority;and it is FURTHER RESOLVED,that the signature of each of the following officers: President,any Executive Vice President,any Senior Vice President,any Vice President,any Assistant Vice President,any Secretary,any Assistant Secretary,and the seal of the Company may be affixed by facsimile to any Power of Attomey or to any certificate relating thereto appointing Resident Vice Presidents,Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof,and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kevin E. Hughes, the undersigned, Assistant Secretary of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, do hereby, Yt1 1'tflttt ttje above and foregoing is a true and correct copy of the Power of Attomey executed by said Companies,which remains in full force andsitsof,10 U '''•,,� Dated this/ day ofadt)ter ,07602(. ,r- M+ r *.TI AAA s ;HARTFORD, rs �' _ CONN.• ;o s %WV �.,� ' • ��`•• '"+ 4 '���''?al `* ��,.�'�,,, Kev Hughes,Assi tant Secretary ,•ai+wn uuINN,O To verify the authenticity of this Power of Attorney,please call us at 1-800-421-3880. Please refer to the above-named Attorney-in-Fact and the details of the bond to which this Power of Attorney is attached. / ' ® DATE(MWDD/YYYY) ACCOR o CERTIFICATE OF LIABILITY INSURANCE 09/30/2021 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). PRODUCER CONTACT Mallory Visser NAME: Rice Insurance LLC PHONE o,Ext): A (360)734-1161 FX No): (360)734-1173 1400 Broadway ADDRESS: malloryv@riceinsurance.com P.O.Box 639 INSURER(S)AFFORDING COVERAGE NAIC e Bellingham WA 98227 INSURER A: Western National Mutual Insurance Company 15377 INSURED INSURER B: Barcott Construction,LLC INSURER C: • 212-34 Middle Fork Rd. INSURER D: INSURER E: Chehalis WA 98532 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2112679921 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 LTR TYPE OF INSURANCE _ INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A Y Y CPP 1256369 01/22/2021 01/22/2022 PERSONAL BADV INJURY $ 1,000,000 GENAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE $ 2,000,000 L POLICY X E 4 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED Y Y CPP 1255689 01/22/2021 01/22/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ "2000000 A EXCESS LIAB CLAIMS-MADE Y Y UMB 1043398 01/22/2021 01/22/2022 AGGREGATE $ 2,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER �/ oTH- WA Stop Gap AND EMPLOYERS'LIABILITY STATUTE X ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N EL.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? N/A CPP 1256369 01/22/2021 01/22/2022 . (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Limit 50,000 Leased/Rented Equipment A CPP 1256378 01/22/2021 01/22/2022 Deductible 500 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) RE:Barker-Union Pacific Crossing City of Spokane-Public works is Additional Insured for General Liability for Ongoing Operations per form WNGL49 0715 and Completed Operations per form WNGL84 0715.Coverage is Primary and Non-Contributory.Waiver of Subrogation applies per form WNGL39 0818.Per Project Aggregate applies per form CG2503 0509.Auto Additional Insured and Waiver of Subrogation apply per form WNCA27 0616.Umbrella is follow form. 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-Public works ACCORDANCE WITH THE POLICY PROVISIONS. 10210 Sprague Ave AUTHORIZED REPRESENTATIVE Spokane Valley WA 99206 I 1,� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): PER WRITTEN CONTRACT OR AGREE MENT WHERE YOU AGREED TO PRO VIDE A SEPARATE GENERAL AGGRE GATE LIMIT FOR EACH PROJECT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes le- gate Limit for that designated construction gaily obligated to pay as damages caused by project. Such payments shall not reduce "occurrences" under Section I — Coverage A, the General Aggregate Limit shown in the and for all medical expenses caused by acci- Declarations nor shall they reduce any dents under Section I — Coverage C, which other Designated Construction Project can be attributed only to ongoing operations General Aggregate Limit for any other at a single designated construction project designated construction project shown in shown in the Schedule above: the Schedule above. 1. A separate Designated Construction Proj- 4. The limits shown in the Declarations for ect General Aggregate Limit applies to Each Occurrence, Damage To Premises each designated construction project, and Rented To You and Medical Expense that limit is equal to the amount of the continue to apply. However, instead of General Aggregate Limit shown in the being subject to the General Aggregate Declarations. Limit shown in the Declarations, such 2. The Designated Construction Project Gen- limits will be subject to the applicable eral Aggregate Limit is the most we will Designated Construction Project General pay for the sum of all damages under Aggregate Limit. Coverage A, except damages because of B. For all sums which the insured becomes "bodily injury" or "property damage" legally obligated to pay as damages caused by included in the "products-completed oper- "occurrences" under Section I — Coverage A, ations hazard", and for medical expenses and for all medical expenses caused by under Coverage C regardless of the accidents under Section I — Coverage C, number of: which cannot be attributed only to ongoing a. Insureds; operations at a single designated construction project shown in the Schedule above: b. Claims made or "suits" brought; or 1. Any payments made under Coverage A c. Persons or organizations making for damages or under Coverage C for claims or bringing "suits". medical expenses shall reduce the amount 3. Any payments made under Coverage A available under the General Aggregate for damages or under Coverage C for Limit or the Products-completed Opera- medical expenses shall reduce the Desig- tions Aggregate Limit, whichever is ap- nated Construction Project General Aggre- plicable; and CG 25 03 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 2 2. Such payments shall not reduce any Des- D. If the applicable designated construction proj- ignated Construction Project General ect has been abandoned, delayed, or aban- Aggregate Limit. doned and then restarted, or if the authorized C. When coverage for liability arising out of the contracting parties deviate from plans, blue "products-completed operations hazard" is prints, designs, specifications or timetables, provided, any payments for damages because the project will still be deemed to be the same of "bodily injury" or "property damage" in- construction project. cluded in the "products-completed operations E. The provisions of Section III — Limits Of In- hazard" will reduce the Products-completed surance not otherwise modified by this Operations Aggregate Limit, and not reduce endorsement shall continue to apply as the General Aggregate Limit nor the Desig- stipulated. nated Construction Project General Aggregate Limit. Page 2 of 2 0 Insurance Services Office, Inc., 2008 CG 25 03 05 09 COMMERCIAL GENERAL LIABILITY WNGL840715 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to a. The preparing, approving, or failing to pre- include the following: pare or approve, maps, shop drawings, Any person(s) or organizations(s) for whom you opinions, reports, surveys, field orders, have performed operations is also an additional change orders or drawings and specifica- insured, if you and such person(s) or organiza- tons; or tion(s) have agreed in writing in a contract or b. Supervisory, inspection, architectural or agreement that such person(s) or organization(s) engineering activities. be added as an additional insured on your policy This exclusion applies even if the claims for completed operations. Such person(s) or or- against an additional insured allege negli- ganization(s) is an additional insured only with re- genre or other wrongdoing in the supervision, spect to liability for "bodily injury" or "property hiring, employment, training or monitoring of damage" caused, in whole or part, by "your work" others by that insured, if the "occurrence" at the location specified in the written contract or which caused the "bodily injury" or "property agreement and included in the "products- damage", or the offense which caused the completed operations hazard". "personal and advertising injury", involved the However, the insurance afforded to such additional rendering of or failure to render any profes- insured: sional services by you with respect to your 1. Only applies to the extent permitted by law; providing engineering, architectural or survey- and ing services in your capacity as an engineer, architect or surveyor. 2. Will not be broader than that which you are re- 2. "Bodily injury" or "property damage" that oc- quired by the contract or agreement to provide curs prior to the execution of, or subsequent to for such additional insured. the expiration of, the contract or agreement in B. With respect to the insurance afforded to these which you agreed that such person(s) or or- additional insureds, the following additional exclu- ganization(s) be added as an additional in- sions apply: sured. This insurance does not apply to: 1. "Bodily injury", "property damage"or"personal and advertising injury" arising out of the ren- dering of, or the failure to render, any profes- sional architectural, engineering or surveying services, including: WN GL 84 07 15 Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. C. With respect to the insurance afforded to these 1. The minimum amount required by the contract additional insureds, the following is added to Sec- or agreement; or tion III—Limits Of Insurance: 2. The Limits of Insurance shown in the Declara- If coverage provided to the additional insured is tions; required by a contract or agreement, the most we whichever is less. will pay on behalf of the additional insured is: This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. WN GL 84 07 15 Page 2 of 2 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. COMMERICAL GENERAL LIABILITY WN GL 39 08 18 COMMERCIAL GENERAL LIABILITY ENHANCEMENT ENDORSEMENT The Commercial General Liability Enhancement Endorsement is an optional endorsement that provides coverage en- hancements. The following is a summary of broadened coverages provided by this endorsement. No coverage is pro- vided by this summary, refer to following endorsement for changes in your policy. SUMMARY OF COVERAGES PAGE Bodily Injury And Property Damage Liability 0o Non Owned Watercraft Up To 50 Feet 2 Property Damage Liability 0o Elevators 3 00 Fire, Lightning, Explosion Or Sprinkler Leakage Exception 3 00 Borrowed Equipment ($25,000 Per Occurrence, $50,000 Aggregate, $2,500 Deductible Per Occurrence 3 Supplementary Payments — Amended 00 Bail Bonds Up To$5,000 4 00 Loss of Earnings Up To $500/Day 4 Who Is An Insured Amendments 00 Employee Bodily Injury To A Co-Employee 4 00 Newly Formed Or Acquired Organizations For Up To 180 Days 4 00 Blanket Additional Insured—Vendors —As Required By Contract 4 00 Blanket Additional Insured—Lessor Of Leased Equipment 6 0o Blanket Additional Insured—Managers Or Lessors Of Premises 6 00 Blanket Additional Insured —State Or Governmental Agency Or Subdivision Or Political Subdivision—Permits Or Authorizations 7 w Blanket Additional Insured —State Or Governmental Agency Or Subdivision Or Political Subdivision—Permits Or Authorizations Relating To Premises 8 Damage To Premises Rented To You — $300,000 9 Medical Payments Increased Limit — $10,000 Or Amount Shown on Declarations 9 Conditions 0o Knowledge of Occurrence, Offense, Claim Or Suit Amended 9 00 Unintentional Failure To Disclose Hazards 9 0o Waiver of Subrogation 10 Insured Contract Amended 10 Personal And Advertising Injury Redefined 0o Televised, Videotaped Or Electronic Publication 10 WN GL 39 08 18 Includes copyrighted material of the Insurance Service Office, Inc.,with its permission. Page 1 of 10 COMMERCIAL GENERAL LIABILITY WN GL 39 08 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY COMMERCIAL GENERAL LIABILITY ENHANCEMENT ENDORSEMENT This endorsement modifies the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. The SECTIONS of the Commercial General Liability Coverage Form identified in this endorsement will be amended as shown below. SECTION I— COVERAGES AMENDMENTS (3) Parking an "auto" on, or on the ways next to, COVERAGE A — BODILY INJURY AND PROPERTY premises you own or rent, provided the"auto" DAMAGE LIABILITY is not owned by or rented or loaned to you or the insured; A. Non Owned Aircraft Or Watercraft (4) Liability assumed under any "insured con- Item 2. Exclusions, Paragraph g. is replaced by the tract" for the ownership, maintenance or use following: of aircraft or watercraft; or g. Aircraft, Auto Or Watercraft (5) "Bodily injury" or "property damage" arising "Bodily injury" or"property damage" arising out of out of: the ownership, maintenance, use or entrustment (a) The operation of machinery or equipment to others of any aircraft, "auto" or watercraft that is attached to, or part of, a land owned or operated by or rented or loaned to any vehicle that would qualify under the insured. Use includes operation and "loading or definition of"mobile equipment" if it were unloading". not subject to a compulsory or financial This exclusion applies even if the claims against responsibility law or other motor vehicle any insured allege negligence or other wrong insurance law where it is licensed or doing in the supervision, hiring, employment, principally garaged; or training or monitoring of others by that insured, if (b) The operation of any of the machinery or the"occurrence" which caused the "bodily injury" equipment listed in Paragraph f. (2) or f. or "property damage" involved in the ownership, (3) of the definition of "mobile equip- maintenance, use or entrustment to others of any ment". aircraft, "auto" or watercraft that is owned or B. Damage To Property Coverage Extensions operated by or rented or loaned to any insured. Item 2. Exclusions, Paragraph j. is replaced by the This exclusion does not apply to: following: (1) A watercraft while ashore on premises you j. Damage To Property own or rent; (2) A watercraft you do not own that is: "Property damage" to: (a) Less than 50 feet long; and (1) Property you own, rent, or occupy, including any costs or expenses incurred by you, or (b) Not being used to carry persons or prop- any other person, organization or entity, for erty for a charge; repair, replacement, enhancement, restora- This Subparagraph (2) applies to any person, tion or maintenance of such property for any who with your expressed or implied consent, reason, including prevention of injury to a either uses or is responsible for the use of the person or damage to another's property; watercraft; (2) Premises you sell, give away or abandon, if the "property damage" arises out of any part of those premises; WN GL 39 08 18 Includes copyrighted material of the Insurance Service Office, Inc.,w ith its permission. Page 2 of 10 (3) Property loaned to you; The insurance provided for "property damage" from (4) Personal property in the care, custody or con- the use of elevators and for "property damage" to trol of the insured; borrowed equipment is excess over any other valid That particular part of real property on which and collectible property insurance (including any de- (5) ductible portion thereof) available to the insured you or any contractors or subcontractors whether primary, excess, contingent or on any other working directly or indirectly on your behalf are performing operations, if the "property basis. damage" arises out of those operations; or C. Damage To Premises Rented To You (6) That particular part of any property that must Item 2. Exclusions, the last paragraph is replaced by be restored, repaired or replaced because the following: "your work" was incorrectly performed on it. Exclusions c. through n. do not apply to damage by Paragraphs (1), (3) and (4) of this exclusion do not fire, lightning, explosion or sprinkler leakage to apply to "property damage" (other than damage by premises while rented to you or temporarily occupied fire, lightning, explosion or sprinkler leakage) to by you with permission of the owner. A separate limit premises, including the contents of such premises, of insurance applies to this coverage as described in rented to you for a period of seven or fewer Paragraph 6. of SECTION III — LIMITS OF consecutive days. A separate limit of insurance INSURANCE. applies to Damage To Premises Rented To You as described in SECTION III—LIMITS OF INSURANCE. COVERAGE B — PERSONAL AND ADVERTISING However, the provisions of this paragraph do not INJURY LIABILITY apply if coverage for Damage To Premises Rented To You is excluded by endorsement. D. Personal And Advertising Injury Item 2. Exclusions is amended by replacing Sub- Paragraph (2) of this exclusion does not apply if the paragraphs b. and c. with the following: premises are "your work" and were never occupied, rented or held for rental by you. b. Material Published With Knowledge Of Falsity Paragraphs (3) and (4) of this exclusion do not apply "Personal and advertising injury" arising out of to the use of elevators. oral, written, televised, videotaped or electronic publication, in any manner, of material, if done by Paragraphs (3), (4), (5) and (6) of this exclusion do or at the direction of the insured with knowledge not apply to liability assumed under a sidetrack of its falsity. agreement. c. Material Published Prior To Policy Period Paragraph (4) of this exclusion does not apply to "Personal and advertising injury" arising out of "property damage" to borrowed equipment while not oral, written, televised, videotaped or electronic being used to perform operations at the jobsite. publication, in any manner, of material whose first Subject to Paragraph 2. of SECTION III—LIMITS OF publication took place before the beginning of the INSURANCE, the rules below fix the most we will pay policy period. for "property damage" under this provision: (1) $25,000 any one "occurrence", regardless of the SUPPLEMENTARY PAYMENTS —COVERAGES A number of persons or organizations who sustain AND B damages because of that "occurrence"; E. Supplementary Payments —Coverages A and B (2) $50,000 annual aggregate; and Item 1. is amended by replacing Subparagraphs b. (3) We will pay only for damages in excess of$2,500 and d. with the following: as a result of any one "occurrence", regardless of b. Up to $5,000 for cost of bail bonds required be- the number of persons or organizations who cause of accidents or traffic law violations arising sustain damages because of that "occurrence". out of the use of any vehicle to which the Bodily We may, or if required by law, pay all or any part Injury Liability Coverage applies. We do not have of any deductible amount, if applicable, to effect to furnish these bonds. settlement of any claim or "suit". Upon notice of our payment of a deductible amount, you shall d. All reasonable expenses incurred by the insured promptly reimburse us for the part of the at our request to assist us in the investigation or deductible amount we paid. defense of the claim or"suit", including actual loss of earnings up to $500 a day because of time off Paragraph (6) of this exclusion does not apply to from work. "property damage" included in the "products-com- pleted operations hazard". WN GL 39 08 18 Includes copyrighted material of the Insurance Service Office, Inc.,with its permission. Page 3 of 10 SECTION II—WHO IS AN INSURED AMENDMENTS The following are added: A. Employee Bodily Injury To A Co-Employee C. Blanket Additional Insured — Vendors — As Re- Paragraph 2. a.(1) is replaced by the following: quired By Contract However, none of these "employees" or "volunteer 1. Section II — Who Is An Insured is amended to workers" are insureds for "bodily injury" or "personal include as an additional insured any person(s) or and advertising injury": organization(s) (referred to throughout this endorsement as vendor) with whom you have (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if agreed in a written contract, executed prior to loss, to name as an additional insured, but only you are a limited liability company), to a co with respect to "bodily injury" or "property "employee" while in the course of his or her damage" arising out of"your products" which are employment or performing duties related to the distributed or sold in the regular course of the conduct of your business, or to your other "volunteer workers" while performing duties vendor's business. related to the conduct of your business; However, (b) To the spouse, child, parent, brother or sister of a. The insurance afforded to such vendor only the co-employee" or "volunteer worker" as a applies to the extent permitted by law; and consequence of Paragraph (1)(a) above; b. If coverage provided to the vendor is required (c) For which there is any obligation to share by a contract or agreement, the insurance damages with or repay someone else who must afforded to such vendor will not be broader pay damages because of the injury described in than that which you are required by the Paragraph (1)(a) or (b) above; or contract or agreement to provide for such (d) Arising out of his or her providing or failing to vendor. 2. With respect to the insurance afforded to these provide professional health care services. vendors, the following additional exclusions However, if a suit seeking damages for "bodily injury" or "personal and advertising injury" to any co- apply: "employee" or other "volunteer worker" arising out of a. The insurance afforded the vendor does not and in the course of the co-employee's" or"volunteer apply to: worker's" employment or while performing duties (1) "Bodily injury" or "property damage" for related to the conduct of your business, or a suit which the vendor is obligated to pay dam- seeking damages brought by the spouse, child, ages by reason of the assumption of parent, brother or sister of the co-employee" or other liability in a contract or agreement. This "volunteer worker", is brought against you or a co- exclusion does not apply to liability for "employee" or a "volunteer worker", we will reimburse damages that the vendor would have in the reasonable costs that you incur in providing a the absence of the contract or defense to the co-employee" or "volunteer worker" agreement; against such matters. Any reimbursement made (2) Any express warranty unauthorized by pursuant to this sub-section will be in addition to the you; limits of liability set forth in the Declarations. (3) Any physical or chemical change in the B. Newly Acquired Organizations product made intentionally by the vendor; Paragraph 3. a. is replaced by the following: (4) Repackaging, except when unpacked a. Coverage under this provision is afforded only solely for the purpose of inspection, until the 180th day after you acquire or form the demonstration, testing, or the organization or the end of the policy period, substitution of parts under instructions whichever is earlier; from the manufacturer, and then repackaged in the original container; WN GL 39 08 18 Includes copyrighted material of the Insurance Service Office, Inc.,with its permission. Page 4 of 10 (5) Any failure to make such inspections, 4. With respect to the insurance afforded to these adjustments, tests or servicing as the vendors, the following is added to Section III — vendor has agreed to make or normally Limits Of Insurance: undertakes to make in the usual course If coverage provided to the vendor is required by of business, in connection with the a contract or agreement, the most we will pay on distribution or sale of the products; behalf of the vendor is: (6) Demonstration, installation, servicing or a. The minimum amount required by the repair operations, except such contract or agreement; or operations performed at the vendor's premises in connection with the sale of b. The Limits of Insurance shown in the the product; Declarations; (7) Products which, after distribution or sale whichever is less. by you, have been labeled or relabeled or used as a container, part or ingredient of This endorsement shall not increase the any other thing or substance by or for the applicable Limits of Insurance shown in the vendor; or Declarations. (8) "Bodily injury or "property damage" 5. With respect to the insurance afforded to these arising out of the sole negligence of the additional insureds, the following additional vendor for its own acts or omissions or exclusion applies: those of its employees or anyone else This insurance does not apply to: acting on its behalf. However, this a. "Bodily injury", "property damage" or exclusion does not apply to: "personal and advertising injury" arising out (i) The exceptions contained in of the rendering of, or the failure to render, Subparagraphs (4) or (6); or any professional architectural, engineering or (ii) Such inspections, adjustments, tests surveying services, including: or servicing as the vendor has (1) The preparing, approving, or failing to agreed to make or normally prepare or approve, maps, shop undertakes to make in the usual drawings, opinions, reports, surveys, course of business, in connection field orders, change orders or drawings with the distribution or sale of the and specifications; or products. (2) Supervisory, inspection, architectural or 3. This Provision C. does not apply: engineering activities. a. To any insured person or organization from This exclusion applies even if the claims whom you have acquired such products, or against an additional insured allege any ingredient, part or container, entering negligence or other wrongdoing in the into, accompanying or containing such supervision, hiring, employment, training products; or monitoring of others by that insured, if b. To any vendor for which coverage as an addi- the "occurrence" which caused the tional insured specifically is scheduled by "bodily injury" or "property damage", or endorsement; or the offense which caused the "personal c. When liability included within the "products- and advertising injury", involved the completed operations hazard" has been ex- rendering of or failure to render any eluded for such product either by the provi- professional services by you with respect sions of the coverage part or by endorse- to your providing engineering, ment. architectural or surveying services in your capacity as an engineer, architect or surveyor. WN GL 39 08 18 Includes copyrighted material of the Insurance Service Office, Inc.,w ith its permission. Page 5 of 10 4. With respect to the insurance afforded to these D. Blanket Additional Insured — Lessor Of Leased additional insureds, the following additional Equipment exclusion applies: 1. Section II — Who Is An Insured is amended to This insurance does not apply to: include as an additional insured any person(s) or a. "Bodily injury", "property damage" or organization(s) from whom you lease equipment "personal and advertising injury" arising out when you and such person(s) or organization(s) of the rendering of, or the failure to render, have agreed in writing in a contract or agreement, executed prior to loss, that such person(s) or any professional architectural, engineering or organization(s) be added as an additional insured surveying services, including: on your policy. Such person(s) or organization(s) (1) The preparing, approving, or failing to is an insured only with respect to liability for prepare or approve, maps, shop "bodily injury", "property damage" or "personal drawings, opinions, reports, surveys, and advertising injury"caused, in whole or in part, field orders, change orders or drawings by your maintenance, operation or use of and specifications; or equipment leased to you by such person(s) or (2) Supervisory, inspection, architectural or organization(s). engineering activities. However, the insurance afforded to such This exclusion applies even if the claims additional insured: against an additional insured allege a. Only applies to the extent permitted by law; negligence or other wrongdoing in the and supervision, hiring, employment, training or b. Will not be broader than that which you are monitoring of others by that insured, if the required by the contract or agreement to "occurrence" which caused the "bodily injury" provide for such additional insured. or "property damage", or the offense which A person's or organization's status as an addi caused the "personal and advertising injury", tional insured under this endorsement ends when involved the rendering of or failure to render their contract or agreement with you for such any professional services by you with respect leased equipment ends. to your providing engineering, architectural or surveying services in your capacity as an 2. With respect to the insurance afforded to these engineer, architect or surveyor. additional insureds, this insurance does not apply to any "occurrence" which takes place after the E. Blanket Additional Insured — Managers Or Les- equipment lease expires. sors Of Premises 3. With respect to the insurance afforded to these 1. Section II — Who Is An Insured is amended to additional insureds, the following is added to include as an additional insured any person(s) or Section III— Limits Of Insurance: organization(s) with whom you have agreed in a If coverage provided to the additional insured is written contract, executed prior to loss, to name required by a contract or agreement, the most we as an additional insured, but only with respect to will pay on behalf of the additional insured is: liability arising out of the ownership, maintenance a. The minimum amount required by the or use of that part of the premises leased to you, contract or agreement; or subject to the following additional exclusions: b. The Limits of Insurance shown in the This insurance does not apply to: Declarations; a. Any"occurrence" which takes place after you whichever is less. cease to be a tenant in that premises. This endorsement shall not increase the b. Structural alterations, new construction or applicable Limits of Insurance shown in the demolition operations performed by or on Declarations. behalf of such additional insured. WN GL 39 08 18 Includes copyrighted material of the Insurance Service Office, Inc.,with its permission. Page 6 of 10 However: F. Blanket Additional Insured — State Or a. The insurance afforded to such additional Governmental Agency Or Subdivision Or Political insured only applies to the extent permitted Subdivision — Permits Or Authorizations by law; and Section II — Who Is An Insured is amended to in- b. If coverage provided to the additional insured elude as an additional insured any state or is required by a contract or agreement, the governmental agency or subdivision or political insurance afforded to such additional insured subdivision with whom you have agreed in a written will not be broader than that which you are contract, executed prior to loss, to name as an required by the contract or agreement to additional insured, subject to the following provisions: provide for such additional insured. 1. This insurance applies only with respect to op- 2. With respect to the insurance afforded to these erations performed by you or on your behalf for additional insureds, the following is added to which the state or governmental agency or sub- Section III— Limits Of Insurance: division or political subdivision has issued a If coverage provided to the additional insured is permit or authorization. required by a contract or agreement, the most we However: will pay on behalf of the additional insured is: a. The insurance afforded to such additional a. The minimum amount required by the insured only applies to the extent permitted contract or agreement; or by law; and b. The Limits of Insurance shown in the b. If coverage provided to the additional insured Declarations; is required by a contract or agreement, the insurance afforded to such additional insured whichever is less. will not be broader than that which you are This endorsement shall not increase the required by the contract or agreement to applicable Limits of Insurance shown in the provide for such additional insured. Declarations. 2. This insurance does not apply to: 3. With respect to the insurance afforded to these a. "Bodilyinjury", "property damage" "per- additional insureds, the following additional p p y g or sonal and advertising injury" arising out of op- exclusion applies: erations performed for the federal govern- This insurance does not apply to: ment, state or municipality; or a. "Bodily injury", "property damage" or b. "Bodily injury" or "property damage" included "personal and advertising injury" arising out within the "products-completed operations of the rendering of, or the failure to render, hazard". any professional architectural, engineering or 3. With respect to the insurance afforded to these surveying services, including: additional insureds, the following is added to (1) The preparing, approving, or failing to Section III— Limits Of Insurance: prepare or approve, maps, shop If coverage provided to the additional insured is drawings, opinions, reports, surveys, required by a contract or agreement, the most we field orders, change orders or drawings will pay on behalf of the additional insured is: and specifications; or erviso a. The minimum amount required by the (2) Su p ry, inspection, architectural or contract or agreement; or engineering activities. This exclusion applies even if the claims b. The Limits of Insurance shown in the against an additional insured allege Declarations; negligence or other wrongdoing in the whichever is less. supervision, hiring, employment, training or This endorsement shall not increase the monitoring of others by that insured, if the applicable Limits of Insurance shown in the "occurrence" which caused the"bodily injury" Declarations. or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or failure to render any professional services by you with respect to your providing engineering, architectural or surveying services in your capacity as an engineer, architect or surveyor. WN GL 39 08 18 Includes copyrighted material of the Insurance Service Office, Inc.,w ith its permission. Page 7 of 10 4. With respect to the insurance afforded to these b. The construction, erection or removal of additional insureds, the following additional elevators; or exclusion applies: c. The ownership, maintenance or use of any This insurance does not apply to: elevators covered by this insurance. a. "Bodily injury", "property damage" or However, "personal and advertising injury" arising out a. The insurance afforded to such additional of the rendering of, or the failure to render, insured only applies to the extent permitted any professional architectural, engineering or by law; and surveying services, including: b. If coverage provided to the additional insured (1) The preparing, approving, or failing to is required by a contract or agreement, the prepare or approve, maps, shop insurance afforded to such additional insured drawings, opinions, reports, surveys, will not be broader than that which you are field orders, change orders or drawings required by the contract or agreement to and specifications; or provide for such additional insured. (2) Supervisory, inspection, architectural or 2. With respect to the insurance afforded to these engineering activities. additional insureds, the following is added to This exclusion applies even if the claims Section III—Limits Of Insurance: against an additional insured allege If coverage provided to the additional insured is negligence or other wrongdoing in the required by a contract or agreement, the most we supervision, hiring, employment, training or will pay on behalf of the additional insured is: monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" a. The minimum amount required by the or "property damage", or the offense which contract or agreement; or caused the "personal and advertising injury", b. The Limits of Insurance shown in the involved the rendering of or failure to render Declarations; any professional services by you with respect to your providing engineering, architectural or whichever is less. surveying services in your capacity as an This endorsement shall not increase the engineer, architect or surveyor. applicable Limits of Insurance shown in the G. Blanket Additional Insured — State Or Declarations. Governmental Agency Or Subdivision Or Political 3. With respect to the insurance afforded to these Subdivision — Permits Or Authorizations Relating additional insureds, the following additional To Premises exclusion applies: Section II — Who Is An Insured is amended to in- This insurance does not apply to: clude as an additional insured any state or a. "Bodily injury", "property damage" or governmental agency or subdivision or political "personal and advertising injury" arising out subdivision with whom you have agreed in a written of the rendering of, or the failure to render, contract, executed prior to loss, to name as an any professional architectural, engineering or additional insured, subject to the following provision: surveying services, including: 1. This insurance applies only with respect to the fol- (1) The preparing, approving, or failing to lowing hazards for which the state or prepare or approve, maps, shop governmental agency or subdivision or political drawings, opinions, reports, surveys, subdivision has issued a permit or authorization field orders, change orders or drawings in connection with premises you own, rent or and specifications; or control and to which this insurance applies: (2) Supervisory, inspection, architectural or a. The existence, maintenance, repair, engineering activities. construction, erection or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decorations and similar exposures; or WN GL 39 08 18 Includes copyrighted material of the Insurance Service Office, Inc.,w ith its permission. Page 8 of 10 This exclusion applies even if the claims SECTION IV — COMMERCIAL GENERAL LIABILITY against an additional insured allege CONDITIONS AMENDMENTS negligence or other wrongdoing in the supervision, hiring, employment, training or A. Knowledge Of Occurrence monitoring of others by that insured, if the Item 2. Duties In The Event Of Occurrence, Of- "occurrence" which caused the"bodily injury" fense, Claim or Suit is amended by adding the fol- or "property damage", or the offense which lowing: caused the "personal and advertising injury", e. You must give us or our authorized representa- involved the rendering of or failure to render tive prompt notice of an "occurrence", claim or any professional services by you with respect loss only when the "occurrence", claim or loss is to your providing engineering, architectural or known to: surveying services in your capacity as an engineer, architect or surveyor. (1) You, if you are an individual; (2) A partner, if you are a partnership; SECTION III—LIMITS OF INSURANCE AMENDMENTS (3) An executive officer or insurance manager, if you are a corporation; or A. Damage To Premises Rented To You (4) A member or manager, if you are a limited Paragraph 6. is replaced by the following: liability company. 6. Subject to Paragraph 5. above, the most we will B. Other Insurance pay under Coverage A for damages because of Item 4. Other Insurance, b. Excess Insurance (1) "property damage" to any one premises, while rented to you, or in the case of damage by fire, (a) (ii) is replaced by the following. lightning, explosion or sprinkler leakage, while (ii) That is fire, lightning, explosion or sprinkler leak- rented to you or temporarily occupied by you with age insurance for premises rented to you or permission of the owner is the greater of: temporarily occupied by you with permission of the owner; a. $300,000; or C. Unintentional Failure To Disclose Hazards b. The amount shown next to the Damage To Item 6. Representations is replaced by the following: Premises Rented To You Limit in the Decla- rations. 6. Representations And Unintentional Failure To However, the provisions of this paragraph do not Disclose Hazards apply if Damage To Premises Rented To You a. By accepting this policy, you agree: Coverage is excluded by endorsement. (1) The statements in the Declarations are B. Medical Expense Limit accurate and complete; (2) Those statements are based upon repre- Paragraph 7. is replaced with the following: sentations you made to us; and 7. Subject to Paragraph 5. above, the most we will (3) We have issued this policy in reliance pay under Coverage C for all medical expenses because of "bodily injury" sustained by any one upon your representations. person is the greater of: b. If you unintentionally fail to disclose any haz- ardsa. $10,000; or existing at the inception date of your policy, we will not deny coverage under this b. The amount shown next to the Medical Ex- Coverage Part because of such failure. pense Limit in the Declarations. However, this provision does not affect our This insurance does not apply if coverage for right to collect additional premium or exercise Medical Expenses is excluded either by the pro- our right of cancellation or non-renewal. visions of the coverage part or by endorsement. WN GL 39 08 18 Includes copyrighted material of the Insurance Service Office, Inc.,w ith its permission. Page 9 of 10 WNCA270616 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BUSINESS AUTO ENHANCEMENT ENDORSEMENT This endorsement modifies the insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. The SECTIONS of the Business Auto Coverage Form identified in this endorsement will be amended as shown below. SECTION II — COVERED AUTOS LIABILITY g. Any "employee" of yours is an "insured" while COVERAGE AMENDMENTS operating a covered "auto" hired or rented under A. Who Is An Insured a contract or agreement in the "employee's" name, with your permission, while performing SECTION II — COVERED AUTOS LIABILITY duties related to the conduct of your business. COVERAGE, A. Coverage, 1. Who Is An Insured B. Blanket Additional Insured is amended to add: d. Any legally incorporated subsidiary of yours in SECTION II — COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured, which you own more than 50% of the voting stock on the effective date of this coverage form. paragraph c. is amended to add the following: However, "insured" does not include any Any person or organization who is required under a written contract or agreement between you and that subsidiary of yours that is an `Insured" under person or organization, that is signed and executed any other automobile liability policy, or would be by you before the "bodily injury" or "property an "insured" under such policy but for damage" occurs and that is in effect during the policy termination of such policy or the exhaustion on period, to be named as an additional insured is an such policy's limits of insurance. "insured" for Liability Coverage, but only for e. Any organization which is newly acquired or damages to which this insurance applies and only to formed by you and over which you maintain - the extent that persons or organization qualifies as majority ownership. However, coverage under an "insured" under the Who Is An Insured provision this provision: contained in Section II. (1) is afforded only for the first 180 days after C. Liability Coverage Extensions — Supplementary you acquire or form the organization or until Payments the end of the policy period, whichever comes first; SECTION II — COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 2. Coverage (2) does not apply to "bodily injury" or"property Extensions, a. Supplementary Payments is damage" that results from an "accident" that amended by replacing subparagraphs (2) and (4) occurred before you formed or acquired the with the following: organization; (2) Up to $5,000 for cost of bail bonds (including (3) does not apply to any newly acquired or bonds for related traffic law violations) required formed organization that is a joint venture or because of an "accident" we cover. We do not partnership; and have to furnish these bonds. (4) does not apply to an "insured" under any (4) All reasonable expenses incurred by the other automobile liability policy, or would be "insured" at our request, including actual loss of an "insured" under such a policy but for ter- earnings up to $500 a day because of time off mination of such policy or the exhaustion of from work. such policy's limits of insurance. f. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs. WN CA 27 06 16 Includes copyrighted material of Insurance Services Office,with its permission Page 2 of 5 D. Fellow Employee Coverage D. Glass Repair— Deductible Waiver SECTION II — COVERED AUTOS LIABILITY SECTION III — PHYSICAL DAMAGE COVERAGE, COVERAGE, B. Exclusions, 5. Fellow Employee, A. Coverage, 3. Glass Breakage — Hitting A Bird the following is added: Or Animal — Falling Objects Or Missiles, is Co-Employee Lawsuit Defense Cost amended by adding the following: Reimbursement No deductible will apply to glass breakage if such If a suit seeking damages for "bodily injury" to any glass is repaired, in a manner acceptable to us, fellow "employee" of the "insured" arising out of and rather than replaced. in the course of the fellow "employee's" employment E. Hired Auto Physical Damage or while performing duties related to the conduct of SECTION III — PHYSICAL DAMAGE COVERAGE, your business, or a suit seeking damages brought A. Coverage is amended by adding the following: by the spouse, child, parent, brother or sister of that fellow "employee", is brought against you, we will 5. Hired Auto Physical Damage reimburse reasonable costs that you incur in the If hired "autos" are covered "autos" for Liability defense of such matters. Any reimbursement made Coverage and if Comprehensive, Specified pursuant to this sub-section will be in addition to the Causes of Loss, or Collision coverages are pro- limits of liability set forth in the Declarations. vided under this coverage form for any "auto" you own, then the Physical Damage Coverages SECTION III — PHYSICAL DAMAGE COVERAGE provided are extended to "autos" you hire of like AMENDMENTS kind and use, subject to the following: A. Transportation Expense— Limits Amended a. The most we will pay for any one "loss" is $50,000 or the actual cash value or cost to SECTION III — PHYSICAL DAMAGE COVERAGE, repair or replace, whichever is less, minus a A. Coverage, 4. Coverage Extensions, a. Trans- deductible; portation Expenses is amended by replacing $20 b. The deductible will be equal to the largest per day/$600 maximum limit with $50 per day/$1000 deductible applicable to any owned "auto" maximum. for that coverage. Any Comprehensive B. Hired Auto Physical Damage — Loss Of Use deductible does not apply to "loss" caused Expenses—Limits Amended by fire or lightening; SECTION III — PHYSICAL DAMAGE COVERAGE, c. Hired Auto Physical Damage coverage is A. Coverage, 4. Coverage Extensions, b. Loss of excess over any other collectible insurance; Use Expenses is amended by replacing the$20 per and day/$600 maximum limit with $50 per day/$750 d. Subject to the above limit, deductible and maximum limit. excess provisions we will provide coverage C. Personal Effects Coverage equal to the broadest coverage applicable to SECTION III — PHYSICAL DAMAGE COVERAGE, any covered "auto" you own. A. Coverage, 4. Coverage Extensions is amended If a limit for Hired Auto Physical Damage is by adding the following: indicated in the Declarations, then that limit c. Personal Effects replaces, and is not added to, the $50,000 limit indicated above. We will pay up to $500 for "loss" to personal effects, which are: (1) Owned by an"insured"; and (2) In or on your covered"auto." This coverage applies only in the event of the total theft of your covered "auto." No deductible applies to this coverage WN CA 27 06 16 Includes copyrighted material of Insurance Services Office,with its permission Page 3 of 5 F. Rental Reimbursement G. Accidental Airbag Deployment Coverage SECTION III — PHYSICAL DAMAGE COVERAGE SECTION III — PHYSICAL DAMAGE COVERAGE, A. Coverage, is amended by adding the following: A. Coverage is amended by adding the following: 6. Rental Reimbursement 7. Accidental Airbag Deployment Coverage This coverage applies only to a covered "auto" of We will pay to reset or replace factory installed the private passenger or light truck type as airbag(s) in any covered "auto" for accidental follows: discharge, other than discharge due to a a. We will pay for rental reimbursement collision loss. expenses incurred by you for the rental of a This coverage is applicable only if comprehen- private passenger or light truck type "auto" sive coverage applies to the covered"auto". because of "loss" to a covered private pas- This coverage is excess over any other collecti- senger or light truck type "auto". Payment ble insurance or reimbursement by manufac- applies in addition to the otherwise applica- turer's warranty. ble amount of each coverage you have on a covered private passenger or light truck type H. Auto Loan/Lease Gap Coverage "auto." No deductibles apply to this SECTION III PHYSICAL DAMAGE COVERAGE, coverage. Item A., Coverage, is amended by adding the b. We will pay only for those expenses incurred following: during the policy period beginning 24 hours 8. Auto Loan/Lease Gap Coverage after the"loss"and ending, regardless of the This coverage applies only to a covered "auto" policy's expiration, with the lesser of the fol- described or designated in the Schedule or in lowing number of days: the Declarations as including physical damage (1) The number of days reasonably re- coverage. quired to repair or replace the covered In the event of a covered total "loss" to a private passenger or light truck type "auto". If "loss" is caused by theft, this covered "auto" described or designated in the number of days is added to the number Schedule or in the Declarations, we will pay any of days it takes to locate the covered unpaid amount due on the lease or loan for a private passenger or light truck type covered "auto" less: "auto"and return it to you; or a. The amount paid under the Physical (2) 30 days. Damage Coverage Section on the policy; c. Our payment is limited to the lesser of the and following amounts: b. Any: (1) Necessary and actual expenses (1) Overdue lease/loan payments at the incurred, or time of the"loss"; (2) $50 per day, up to a maximum of (2) Financial penalties imposed under a $1,000. lease for excessive use, abnormal wear d. This coverage does not apply while there and tear or high mileage; are spare or reserve private passenger or (3) Security deposits not returned by the light truck type "autos" available to you for lessor; your operations. (4) Costs for extended warranties, Credit e. If "loss" results from the total theft of a Life Insurance, Health, Accident or covered "auto" of the private passenger or Disability Insurance purchased with the light truck type, we will pay under this cover- loan or lease; and age only that amount of your rental reim- (5) Carry-over balances from previous bursement expenses which is not already provided for under SECTION III — loans or leases. PHYSICAL DAMAGE COVERAGE, A. Coverage,4. Coverage Extensions. For the purposes of this Rental Reimbursement coverage, light truck is defined as a truck with a gross vehicle weight of 10,000 lbs. or less as defined by the manufacturer as the maximum loaded weight the auto is designed to carry. WN CA 27 06 16 Includes copyrighted material of Insurance Services Office,with its permission Page 4 of 5 C. Unintentional Failure to Disclose Hazards SECTION IV - BUSINESS AUTO CONDITIONS AMENDMENTS SECTION IV- BUSINESS AUTO CONDITIONS, B. General Conditions, 2. Concealment, Misrepre- A. Duties In The Event Of Accident, Claim, Suit Or sentation Or Fraud, is amended by adding the Loss Amended following paragraph: SECTION IV— BUSINESS AUTO CONDITIONS, A. If you unintentionally fail to disclose any hazards Loss Conditions, 2. Duties In The Event Of existing at the inception date of the policy, or during Accident, Claim, Suit Or Loss, a. is amended by the policy period in connection with any additional adding the following: hazards, we will not deny coverage under this Cov- This condition applies only when the "accident" or erage Part because of such failure. "loss" is known to: D. Employee Hired Auto (1) You, if you are an individual; SECTION IV- BUSINESS AUTO CONDITIONS, B. (2) A partner, if you are a partnership; General Conditions, 5. Other Insurance, (3) An executive officer or insurance manager, if paragraph b. is deleted and replace by the following: you are a corporation; or b. For Hired Auto Physical Damage Coverage, the (4) A member or manager, if you are a limited following are deemed to be a covered "autos" liability company. you own: But, this section does not amend the provisions (1) Any covered "auto" you lease, hire, rent or relating to notification of police, protection or exami- borrow. nation of the property which was subject to the (2) Any covered "auto" hired or rented by your "loss". "employee" under a contract in that B. Blanket Waiver of Subrogation individual "employee's" name, with your permission, while performing duties related Section IV - BUSINESS AUTO CONDITIONS, A. to the conduct of your business. Loss Conditions, 5. Transfer of Rights of Recovery Against Others to Us, is amended by However, any"auto"that is leased, hired, rented adding the following exception: or borrowed with a driver is not a covered "auto". However, we waive any right of recovery we may have against any person or organization to the extent required of you by a written contract signed and executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. WN CA 27 06 16 Includes copyrighted material of Insurance Services Office,with its permission Page 5 of 5 10/5/21, 12:59 PM BARCOTT CONSTRUCTION LLC ,,.ew STATE OF WASHINGTON Department of Labor & Industries Certificate of Workers' Compensation Coverage October 5, 2021 WA UBI No. 603 578 876 L&I Account ID 626,316-00 Legal Business Name BARCOTT CONSTRUCTION LLC Doing Business As BARCOTT CONSTRUCTION LLC Workers' Comp Premium Status: Account is current. Estimated Workers Reported Quarter 2 of Year 2021 "7 to 10 Workers" (See Description Below) Account Representative Employer Services Help Line, (360)902-4817 Licensed Contractor? Yes License No. BARCOCL846JQ License Expiration 04/18/2022 What does "Estimated Workers Reported" mean? Estimated workers reported represents the number of full time position requiring at least 480 hours of work per calendar quarter. A single 480 hour position may be filled by one person, or several part time workers. Industrial Insurance Information Employers report and pay premiums each quarter based on hours of employee work already performed, and are liable for premiums found later to be due. Industrial insurance accounts have no policy periods, cancellation dates, limitations of coverage or waiver of subrogation (See RCW 51.1 2.050 and 51.16.1 90). https://secure.lni.wa.gov/verify/Details/IiabilityCertificate.aspx?UBI=603578876&SAW=&ACCT=62631600&LIC=BARCOCL846JQ 1/1