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22-097.00 NA Degerstrom: Mission Ave Bridge Deck Repair Contract This agreement is entered into thisli day of F ,2023.,between the City of Spokane Valley ("City") and NA Degerstrom ("Contractor"), pur uant 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: Mission Ave Bridge Deck Repair Project#0335 Contract 22-097 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$349,760.00. IN WITNESS WHEREOF,the Contractor has executed this instrument,on the date below, and the City has caused this instrument to be executed on the date stated above. 1 Mission Ave Bridge Deck Repair Contract#22-097— NA Degerstrom Page 2 Executed by Contractor February, 8th , 2023. Date Michele Munson Printed Name Chief Financial Officer Title Signature City of Spokane Valley '' a� K�s„►N Printed Name City Manager Title Si ure Pevi ea 1 a City of Spokane Valley Mission Ave Bridge Deck Repair Project • Spokane . Valley. BOND NO: 023221863 CONTRACTOR'S PERFORMANCE BOND to City of Spokane Valley,Washington The City of Spokane Valley, Washington, in Spokane County, has awarded to N.A.Degerstrom,Inc. (Contractor),as Principal,a contract for the construction of the project designated as Mission Ave Bride Deck Repair Project No. 0335 in Spokane Valley,Washington,and said Principal is required under the terms of the Contract to furnish a performance bond in accordance with chapter 39.08 Revised Code of Washington(RCW). The Principal, and Liberty Mutual Insurance Company (Surety), a corporation, organized under the laws of Massachusetts and licensed to do business in the State of Washington as surety and named in the current list of"Surety Companies Acceptable in Federal Bonds"as published in the Federal Register by the Audit Staff Bureau of Accounts,U.S.Treasury Dept.,are jointly and severally held and firmly bound to the City of Spokane Valley,as Obligee,in the sum of$ 349,760.00 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. PRINCIPAL(CONTRACTOR) N.A.Degerstrom,Inc. SURETY Liberty Mutual Insurance Company 2/6/2023 ' 2/6/2023 Principal Signature Date Surety Signatur Date M iC Ct6 M+{fSo(1 Travis Long _ Printed Name Printed Name C.F,;e4 .t r o r+bat O FF i c.er Attorney-in-Fact Title Title Name,address,and telephone of local office/agent of Surety Company is: HUB International Northwest LLC 835 N.Post Street,Suite 203,Spokane,WA 99201 (509)747-3121 Revised I.14.13 mot�1— BOND NO: 023221863 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 N.A.Degerstrom,Inc. (Contractor),as Principal,a contract for the construction of the project designated as Mission Ave Bridge Deck Repair, Project No. 0335 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 Liberty Mutual Insurance Company (Surety), a corporation organized under the laws of Massachusetts 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$ 349,760.00 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. PRINCIPAL(CONTRACTOR) N.A. Degerstrom,Inc. SURETY Liberty Mutual Insurance Company ' 2/6/2023 2/6/2023 Principal Signature Date Surety Signature Date ON;c in eL - elku.NS011 Travis Long Printed Name Printed Name C. oF. .Gtr Attorney-in-Fact Title Title Name,address,and telephone of local office/agent of Surety Company is: HUB International Northwest LLC 835 N.Post Street,Suite 203, Spokane,WA 99201 (509)747-3121 Rey i'Cd 1 14 1 City of Spokane Valley Mission Ave Bridge Deck Repair Project . _ This Power of Attorney limits the acts of those named herein,and they have no authority to • bind the Company except in the manner and to the extent herein stated. 1.‘4: Liberty Liberty Mutual Insurance Company Fj ` Mutual. The Ohio Casualty Insurance Company Certificate No:8207589-985770 West American Insurance Company SURETY POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire,that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts,and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana(herein collectively called the"Companies"),pursuant to and by authority herein set forth,does hereby name,constitute and appoint, Chris Larson;Daniel J.Stowe;Diana R.Williams;Erin L.Repp;H.Keith McNally;Ryan J.Pugh;Shelby L.Foo;Travis Long;Wm Dinneen all of the city of Spokane state of WA each individually if there be more than one named,its true and lawful attorney-in-fact to make, execute,seal,acknowledge and deliver,for and on its behalf as surety and as its act and deed,any and all undertakings,bonds,recognizances and other surety obligations,in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 1st day of April , 2022 . Liberty Mutual Insurance Company PN'tNSIkI�, atY INSO , tNSUgq The Ohio Casualty Insurance Company AJ ooa•o�r "O a co P0k,'V* West American Insurance Company • 3 "btu c3 "% c+ it3 `Pocrt ui 7- •• 1912 0 0 1919Wo a 1991 o uiE ej7 * ti �y1 * 1,N 4M * 1,1X By: -m t 471'7 .c o. oo David M.Carey,Assistant Secretary c w m State of PENNSYLVANIA ss c 2 73 rn County of MONTGOMERY .o , w = On this 1st day of April , 2022 before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance ct0i o Company,The Ohio Casualty Company,and West American Insurance Company,and that he,as such,being authorized so to do,execute the foregoing instrument for the purposes 0> therein contained by signing on behalf of the corporations by himself as a duly authorized officer. > IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at King of Prussia,Pennsylvania,on the day and year first above written. c•N (2_0 O , Q<r�H2ON W.3 TF! Commonwealth of Pennsylvania-Notary Sul t..0 e , 7 Teresa Pastel's,Notary Public Montgomery County p 0) OF My°ommission expires March 28,2025 By: Ltt () o a)c P Commission number 1128044 ai... tvogd� Member Pennsylvania Association Notaries eresa Pastella,Notary Public Q o t(6 N cn ARV •t This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual 3 co 0•S Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: li 61 ai ARTICLE IV—OFFICERS:Section 12.Power of Attorney. o 0 Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and subject to such limitation as the Chairman or the a :2 President may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal,acknowledge and deliver as surety m co co> c ai any and all undertakings,bonds,recognizances and other surety obligations.Such attorneys-in-fact,subject to the limitations set forth in their respective powers of attorney,shall o 3 o have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation.When so executed, suchID 2 a)Z o instruments shall be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attorney-in-fact under the ` ai provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority. ti a ARTICLE XIII—Execution of Contracts:Section 5.Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president,and subject to such limitations as the chairman or the president may prescribe, shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings, bonds,recognizances and other surety obligations.Such attorneys-in-fact subject to the limitations set forth in their respective powers of attorney,shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company.When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation—The President of the Company,acting pursuant to the Bylaws of the Company,authorizes David M.Carey,Assistant Secretary to appoint such attorneys-in- fact as may be necessary to act on behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Authorization—By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company,wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds,shall be valid and binding upon the Company with the same force and effect as though manually affixed. I,Renee C.Llewellyn,the undersigned,Assistant Secretary,The Ohio Casualty Insurance Company,Liberty Mutual Insurance Company,and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full,true and correct copy of the Power of Attorney executed by said Companies,is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this 6th day of February , 2023 . 1NSU ,tY INso \NSUg P ,,J oto4ri, GP °t ,t4 . cY ot,"& +O 3` bto Q3o bc �. : Ft . . / �(p : W o Q o d.l..CNU3"aa 0�,AMP3�`P S `� �NDIAMfa 2/ By• eh * * H1 * *�a s�,M * *aa Renee C.Llewellyn,Assistant Secretary LMS-12873 LMIC OCIC WAIC Multi Co 02/21 NADEGER-03 KBREMER .4CORO~ DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 2/6/2023 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 Kristy Bremer Hub International Northwest LLC PO Box 3144 lac No,Ext):(509)319-2909 FAX No): E-MAIL Krist Bremer hubinternational.com Spokane,WA 99220 ADDREss: Y• @ INSURER(S)AFFORDING COVERAGE _ NAIC# INSURER A:Alaska National Insurance Company 38733 INSURED INSURER B: N.A.Degerstrom,Inc. INSURER C: 3303 N.Sullivan Road INSURERD: Spokane Valley,WA 99216 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 IMM/DD/YYYYI IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 J CLAIMS-MADE X OCCUR 22FPS09101 6/30/2022 6/30/2023 DAMAGES( RENTED 100,000 X X PREMISES(Ea occurrent@) $ X Aggregate Limits Per MED EXP(Any one person) $ 5,000 X Emp Liab/Stop Gap PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000./ POLICY X JH:T LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: WA WY STOP GAP $ 1,000,000 COMBINED SINGLE LIMIT 1,000,000 A AUTOMOBILE LUU3ILITY (Ea accident) $ X ANY AUTO X X 22FAS09101 6/30/2022 6/30/2023 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOSRE� ONLY AUTOS y�� p BODILY INJURY(Per accident) $ X AUTOS ONLY X AUTO O Y (Perr accident)AMAGE A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 ✓ EXCESS LIAB CLAIMS-MADE X X 22FLU09101 6/30/2022 6/30/2023 AGGREGATE $ 10,000,000 s/ DED X RETENTION$ 10,000 $ A WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY 22JWS09101 10/1/2022 10/1/2023 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ FFICER/MEMBER EXCLUDED? Y N/A (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 $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if morespace is required) RE:MISSION AVE BRIDGE DECK REPAIR-CHIP#0335-CONTRACT NUMBER 22-097 -FEDERAL AID NO.BHM-4060(002) PRIMARY NON-CONTRIBUTORY ADDITIONAL INSURED AND WAIVER OF SUBROGATION TO THE CITY OF SPOKANE VALLEY IF REQUIRED BY WRITTEN CONTRACT AND AS GRANTED BY THE ACTUAL INSURANCE POLICY FORMS THAT ARE ATTACHED TO THE CERTIFICATE IN ACCORDANCE WITH THE TERMS AND CONDITIONS OF THE POLICIES. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Spokane ValleyTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P ACCORDANCE WITH THE POLICY PROVISIONS. 10210 E.Sprague Avenue Spokane Valley,WA 99206 AUTHORIZEDIZ REPRESENTATIVE WRI 4abt-0`" ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CONTRACTORS' GENERAL LIABILITY ENHANCEMENT ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Coverage afforded under this extension of coverage endorsement does not apply to any person or organization covered as an additional insured on any other endorsement now or hereafter attached to this Coverage Part. SCHEDULE OF COVERAGES ARE SUMMARIZED BELOW 1. Miscellaneous Additional Insureds 13. Blanket Waiver of Subrogation 8 additional insured extensions. Waiver of subrogation where required by written contract or written agreement. Primary and Noncontributory Insurance 14. In Rem Actions 2. Damage To Premises Rented to You Limit increased to$500,000. 15. Voluntary Property Damage Limits added: $5,000 occurrence, $10,000 3. Medical Payments aggregate. Limits increased to$15,000. Reporting period increased to three years from 1. MISCELLANEOUS ADDITIONAL INSUREDS the date of accident. Section II Who Is An Insured is amended to 4. Non-owned Watercraft include as an additional Insured any person or Increased to 50 feet. organization described in Paragraphs 2.a. through 2.h. below whom you are required to add 5. Supplementary Payments as an additional insured on this policy under a Cost of bail bonds increased to$10,000. written contract or written agreement. However, Daily loss of earnings increased to$500. the written contract or written agreement must be: 6. Newly Formed Or Acquired Organizations 1. Currently in effect or becoming effective Coverage extended to the end of the policy period during the term of this policy; and or the next anniversary of this policy's effective date. 2. Executed prior to the "bodily injury", "property damage" or"personal injury and 7. Liberalization Clause advertising injury", but 8. Unintentional Failure To Disclose Hazards Only the following persons or organizations are additional insureds under this 9. Notice of Occurrence endorsement and coverage provided to such additional insureds is limited as provided 10. Broad Knowledge of Occurrence herein: 11. Bodily Injury-Extension of Coverage a. State or Governmental Agency or Subdivision or Political Subdivi- 12. Expected Or Intended Injury sions Reasonable force - bodily injury or property damage. ANIC GL 1187 08 21 Page 1 of 7 Any state or governmental agency or (2) Structural alterations, new con- subdivision or political subdivision struction or demolition operations that has issued a permit in performed by or on behalf of connection with operations performed such additional insured. by you or on your behalf and that you are required by any ordinance, law or d. Mortgagee, Assignee or Receiver building code to include as an additional insured on this coverage A mortgagee, assignee or receiver part is an additional insured, but only but only with respect to their liability with respect to liability for "bodily as mortgagee, assignee, or receiver injury", "property damage", "personal and arising out of the ownership, and advertising injury" arising out of maintenance, or use of a premises by such operations. you. The insurance provided to such state This insurance does not apply to or political subdivision does not apply structural alterations, new construc- to any "bodily injury", "property tion or demolition operations damage" or"personal and advertising performed by or for such additional injury" arising out of operations insured. performed for that state or political subdivision. e. Owners or Other Interests From Whom Land Has Been Leased b. Controlling Interest An owner or other interest from whom Any persons or organizations with a land has been leased by you but only controlling interest in you but only with respect to liability arising out of with respect to their liability arising the ownership, maintenance or use of out of: that specific part of the land leased to you and subject to the following (1) Their financial control of you, or additional exclusions: (2) Premises they own, maintain or This insurance does not apply to: control while you lease or occupy these premises. (1) Any `occurrence" which takes place after you cease to lease This insurance does not apply to that land; or structural alterations, new construc- tion and demolition operations (2) Structural alterations, new con- performed by or for such additional struction or demolition operations insured. performed by or on behalf of such additional insured. c. Managers or Lessors of Premises f. Co-owner of Insured Premises A manager or lessor of premises but only with respect to liability arising out A co-owner of a premises co-owned of the ownership, maintenance or use by you and covered under this of that specific part of the premises insurance but only with respect to the leased to you and subject to the co-owners liability as co-owner of following additional exclusions: such premises. This insurance does not apply to: (1) Any `occurrence" which takes place after you cease to be a tenant in that premises; or ANIC GL 1187 08 21 Page 2 of 7 g. Lessor of Equipment Such person(s) or organization(s) is an additional insured only with Any person or organization from respect to liability for "bodily injury", whom you lease equipment. Such "property damage" or "personal and person or organization is an advertising injury" caused, in whole or additional insured only with respect to in part, by: their liability for "bodily injury", "property damage" or "personal and a. Your acts or omissions; or Advertising injury" caused, in whole or in part, by your maintenance, oper- b. The acts or omissions of ation or use of equipment leased to those acting on your behalf; you by such person or organization. or A person's or organization's status as an additional insured under this c. "Your Work" performed for endorsement ends when their written the additional insured contract or written agreement with described in Paragraph 1. or you for such leased equipment ends. 2. above and included in the "products-completed With respect to the insurance operations hazard." afforded these additional insureds, the following additional exclusions In the performance of your ongoing apply: operations or completed operations for the additional insured described in This insurance does not apply: Paragraph 1. or 2.above. (1) To any "occurrence" which takes However, the insurance afforded to place after the equipment lease such additional insured described expires; or above: (2) To "bodily injury", "property a. Only applies to the extent damage", or "personal and permitted by law; and advertising injury" arising out of the sole negligence of such b. Will not be broader than that additional insured. which you are required by the contract or agreement to h. Owners, Lessees or Contractors — provide for such additional Ongoing Operations and insured. Completed Operations 3. With respect to the insurance 1. Any person or organization for afforded to these additional whom you are performing insureds, the following additional operations or have performed exclusions apply: operations when you and such person or organization have This insurance does not apply to: agreed in writing in a contract or agreement that such person or 1. "Bodily injury", "property organization be added as an damage" or "personal and additional insured on your policy; advertising injury" arising out and of the rendering of, or the failure to render, any 2. Any other person or organization professional architectural, you are required to add as an engineering or surveying additional insured under the services, including: contract or agreement described in Paragraph 1. above. ANIC GL 1187 08 21 Page 3 of 7 a. The preparing, Section III - Limits of Insurance, the following is approving, or failing to added: prepare or approve, maps, shop drawings, With respect to the insurance afforded to the opinions, reports, additional insureds described in Paragraphs a. surveys, field orders, through h. above, the most we will pay on behalf change orders or of such additional insured is the amount of drawings and specifica- insurance: tions; or (1) Required by the contract or b. Supervisory, inspection, agreement; or architectural or engineering activities. (2) Available under the applicable Limits of Insurance shown in the This exclusion applies even if Declarations; the claims against any insured allege negligence or whichever is less. other wrongdoing in the supervision, hiring, employ- This provision shall not increase the applicable ment, training or monitoring Limits of Insurance shown in the Declaration. of others by that insured, if the "occurrence" which 2. Damage To Premises Rented to You caused the "bodily injury" or "property damage", or the SECTION III — LIMITS OF INSURANCE, offense which caused the Paragraph 6. is replaced by the following: "personal and advertising injury", involved the rendering 6. Subject to Paragraph 5. above, the of, or the failure to render, Damage to Premises Rented to You Limit any professional is the most we will pay under Coverage A architectural, engineering or for damages because of "property surveying services. damage" to any one premises, while rented to you, or in the case of damage Primary And Noncontributory Insurance by fire, while rented to you or temporarily occupied by you with permission of the The following is added to the Other Insurance owner. Condition and supersedes any provision to the contrary: If a limit is shown for Damage to Premises Rented to You the most we will pay under This insurance is primary to and will not seek Coverage A for damages because or "property contribution from any other insurance available to damage" to any one premises is the Limit shown an additional insured under your policy provided in the Declarations or $500,000, whichever is that: greater. (1) The additional insured is a 3. MEDICAL PAYMENTS Named Insured under such other insurance; and A. Section III— Limits of Insurance, Paragraph 7. is replaced by the following: (2) You have agreed in writing in a contract or agreement that this 7. Subject to Paragraph 5. above the insurance would be primary and Medical Expense Limit is the most we will would not seek contribution from pay under Coverage C for all medical any other insurance available to expenses because of "bodily injury" the additional insured. sustained by any one person. ANIC GL 1187 08 21 Page 4 of 7 If a limit is shown for Medical Expense in 5. SUPPLEMENTARY PAYMENTS the Declarations the most we will pay under Coverage C for all medical A. Under Section I - Supplementary Payments expenses because of "bodily injury" - Coverage A and B, Paragraph 1.b., the sustained by any one person is the Limit limit of$250 shown for the cost of bail bonds shown in the Declarations or $15,000, is replaced by$10,000; whichever is greater. B. In Paragraph 1.d., the limit of$250 shown for B. This provision 5. (Medical Payments) does daily loss of earnings is replaced by$500. not apply if Section I - Coverage C Medical Payments is excluded either by the 6. NEWLY FORMED OR ACQUIRED provisions of the Coverage Part or by ORGANIZATIONS endorsement. Paragraph 3.a. of Section ll -Who Is An Insured C. Paragraph 1.a.(3)(b) of Section I -Coverage is deleted and replaced by the following: C - Medical Payments, is replaced by the following: Coverage under this provision is afforded only until the end of the policy period or the next (b) The expenses are incurred anniversary of this policy's effective date after you and reported to us within acquire or form the organization, whichever is three years of the date of the earlier. accident; and 7. LIBERALIZATION CLAUSE 4. NON-OWNED WATERCRAFT If we adopt a change in our forms or rules which A. If endorsement CG 21 09, CG 21 10, CG 24 would broaden coverage for contractors under 50, or CG 24 51 is attached to the policy, this endorsement without an additional premium Paragraph A. 2. g. (2) (b) is replaced by the charge, your policy will automatically provide the following: additional coverages as of the date the revision is effective in your state. (b) A watercraft that you do not own that is: 8. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS (i) Less than 50 feet long: and SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS — Paragraph 6. — (ii) Not being used to carry Representations is replaced by the following: persons or property for a charge. 6. Representations B. If Paragraph A. does not apply, Paragraph g. By accepting this policy, you agree: (2) of 2. EXCLUSION under SECTION I — COVERAGES, COVERAGE A — BODILY a. The statements in the Declarations are INJURY AND PROPERTY DAMAGE accurate and complete; LIABILITY is replaced by the following: b. Those statements are based upon (2) A watercraft that you do not own representations you made to us; and that is: c. We have issued this policy in reliance (a) Less than 50 feet long; and upon your representations. (b) Not being used to carry persons or property for a charge. ANIC GL 1187 08 21 Page 5 of 7 The unintentional omission of, or (4) A manager, if you are a limited unintentional error in, any information you liability company. provided to us which we relied upon in issuing this policy will not prejudice your 11. EXPANDED BODILY INJURY rights under this insurance. However, this provision does not affect our right to collect Section V - Definitions, the definition of "bodily additional premium or to exercise our rights of injury" is changed to read: cancellation or nonrenewal in accordance with applicable laws and regulations. "Bodily injury" means bodily injury, sickness or disease sustained by a person, including death, 9. NOTICE OF OCCURRENCE humiliation, shock, mental anguish or mental injury by that person at any time which results as The following is added to Paragraph 2. of Section a consequence of the bodily injury, sickness or IV - Commercial General Liability Conditions - disease. Duties In The Event of Occurrence, Offense, Claim or Suit: 12. EXPECTED OR INTENDED INJURY Your rights under this Coverage Part will not be Exclusion a. of Section I - Coverage A - Bodily prejudiced if you fail to give us notice of an Injury and Property Damage Liability is "occurrence", offense, claim or "suit" and that replaced by the following: failure is solely due to your reasonable belief that the "bodily injury" or "property damage" is not a. "Bodily injury" or "property damage" covered under this Coverage Part. However, you expected or intended from the shall give written notice of this "occurrence", standpoint of the insured. This offense, claim or "suit" to us as soon as you are exclusion does not apply to "bodily aware that this insurance may apply to such injury" or"property damage" resulting "occurrence", offense, claim or"suit." from the use of reasonable force to protect persons or property. 10. BROAD KNOWLEDGE OF OCCURRENCE 13. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph 2. of Section IV - Commercial General Liability Conditions - The Transfer Of Rights Of Recovery Against Duties in The Event of Occurrence, Offense, Others To Us Condition (Section IV - Claim or Suit: Commercial General Liability Conditions) is amended by the addition of the following: You must give us or our authorized representative notice of an "occurrence", offense, claim, or "suit" We waive any right of recovery against any only when the "occurrence", offense, claim or person or organization, because of any payment "suit' is known to: we make under this Coverage Part, to whom the insured has waived its right of recovery in a (1) You, if you are an individual; written contract or agreement. Such waiver by us applies only to the extent that the insured has (2) A partner, if you are a waived its right of recovery against such person partnership; or organization prior to loss. (3) An executive officer or the employee designated by you to give such notice, if you are a corporation; or ANIC GL 1187 08 21 Page 6 of 7 14. IN REM ACTIONS For the purpose of this coverage only, Section I— Coverage A — Bodily Injury and Property Any action in rem against any vessel owned, Damage Liability 2. Exclusions J. (4.) is operated by or for, or chartered by or for you will deleted. be treated in the same manner as though the action were in personam against you. As respects coverage afforded under Voluntary Property Damage, the following is added to 15. VOLUNTARY PROPERTY DAMAGE Section III—Limits of Insurance: The following is added, Section I—Coverage A— Regardless of the number of insureds, claims or Bodily Injury and Property Damage Liability 1., "suits" brought, or persons or organizations Insuring Agreement: making claims or bringing "suits": We will pay, at your request, for "property 1. Subject to 2. Below, the most we will pay for damage" to property of others while in the care, "property damage" arising from any one custody or control of an insured, arising out of "occurrence" arising out of "property damage your business operations away from your to property of others caused by you and while insured premises for which this policy is written in your care, custody or control is$5,000. and occurring during the policy period. 2. The most we will pay for the sum of all However, the "property damage" must be the "property damage" in an annual policy period result of unintentional damage or destruction but is $10,000. This amount is part of and not in does not include disappearance, theft, or loss of addition to the General Aggregate Limit use. described in Paragraph 2. of Section III — Limits of Insurance. You agree with us that we shall have no duty to defend any claims and/or "suits" for which the only coverage provided is under this coverage extension. Includes copyrighted material of Insurance Services Office, Inc., with its permission ANIC GL 1187 08 21 Page 7 of 7 • ey Alaska NationalM L. . AV INSURANCE PANY DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): All Projects Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally 3. Any payments made under Coverage A for obligated to pay as damages caused by damages or under Coverage C for medical "occurrences" under Section I — Coverage A, and expenses shall reduce the Designated for all medical expenses caused by accidents Construction Project General Aggregate Limit under Section I — Coverage C, which can be for that designated construction project. Such attributed only to ongoing operations at a single payments shall not reduce the General designated construction project shown in the Aggregate Limit shown in the Declarations nor Schedule above: shall they reduce any other Designated 1. A separate Designated Construction Project Construction Project General Aggregate Limit General Aggregate Limit applies to each for any other designated construction project designated construction project, and that limit shown in the Schedule above. is equal to the amount of the General 4. The limits shown in the Declarations for Each Aggregate Limit shown in the Declarations. Occurrence, Damage To Premises Rented To 2. The Designated Construction Project General You and Medical Expense continue to apply. Aggregate Limit is the most we will pay for the However, instead of being subject to the sum of all damages under Coverage A, except General Aggregate Limit shown in the damages because of "bodily injury" or Declarations, such limits will be subject to the "property damage" included in the "products- applicable Designated Construction Project completed operations hazard", and for medical General Aggregate Limit. expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or"suits" brought; or c. Persons or organizations making claims or bringing"suits". CG 25 03 05 09 Page 1 of 2 XV Alaska National INSURANCE COMPANY B. For all sums which the insured becomes legally C. When coverage for liability arising out of the obligated to pay as damages caused by "products-completed operations hazard" is "occurrences" under Section I — Coverage A, and provided, any payments for damages because of for all medical expenses caused by accidents "bodily injury" or"property damage" included in the under Section I — Coverage C, which cannot be "products-completed operations hazard" will attributed only to ongoing operations at a single reduce the Products-completed Operations designated construction project shown in the Aggregate Limit, and not reduce the General Schedule above: Aggregate Limit nor the Designated Construction 1. Any payments made under Coverage A for Project General Aggregate Limit. damages or under Coverage C for medical D. If the applicable designated construction project expenses shall reduce the amount available has been abandoned, delayed, or abandoned and under the General Aggregate Limit or the then restarted, or if the authorized contracting Products-completed Operations Aggregate parties deviate from plans, blueprints, designs, Limit, whichever is applicable; and specifications or timetables, the project will still be 2. Such payments shall not reduce any deemed to be the same construction project. Designated Construction Project General E. The provisions of Section III — Limits Of Insurance Aggregate Limit. not otherwise modified by this endorsement shall continue to apply as stipulated. This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective on the date issued at 12:01 A.M. standard time at your mailing address shown in the policy. The information below is required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective Policy No. Insured Endorsement No. 22 Countersigned By © Insurance Services Office, Inc., 2008 CG25030509 Page2of2 • alirAlaska National INSURANCE COMPANY BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Various provisions in this endorsement restrict SECTION IV — Business Auto Conditions, coverage. Read the entire policy carefully to Paragraph A. 5. — Transfer of Rights of Recovery I determine rights, duties, and what is and is not Against Others To Us is amended to include: covered. 5. Transfer of Rights of Recovery Against Throughout this policy, the words "you" and "your" Others to Us refer to the Named Insured shown in the Declarations. The words "we", "us", and "our" refer to This condition does not apply to any the company providing this insurance. person(s) or organization(s) to the extent that subrogation against that person or Other words and phrases that appear in quotation organization is waived prior to the "accident" marks have special meaning. Refer to SECTION V— or the"loss" under a contract with that person DEFINITIONS in the Business Auto Coverage Form. or organization. The coverages provided by this endorsement apply SECTION II — COVERED AUTO LIABILITY per "accident" and, unless otherwise specified, are COVERAGE, Paragraph A.2.a. (2)— Supplementary subject to all of the terms, conditions, exclusions and Payments is replaced by the following: deductible provisions of the policy, to which it is attached. (2) Up to $10,000 for cost of bail bonds (including bonds for related traffic law SECTION II — COVERED AUTO LIABILITY violations) required because of an COVERAGE, Paragraph A.1. Who Is An Insured is "accident" we cover. We do not have amended to include: to furnish these bonds. d. Any "employee" of yours while operating SECTION II — COVERED AUTO LIABILITY an "auto" hired or rented under a COVERAGE, Paragraph A.2.a. (4)— Supplementary contract or agreement in an "employee's" Payments is replaced by the following: name, with your permission, while performing duties related to the conduct (4) All reasonable expenses incurred by of your business. the "insured" at our request, including actual loss of earnings up to $500 a e. Any person or organization for whom you day because of time off from work. have agreed in writing to provide insurance such as is afforded by this Coverage Form, but only with respect to liability arising out of the ownership, maintenance or use of"autos" covered by this policy. If such person or organization has other insurance then this insurance is primary to and we will not seek contribution from the other insurance. ANIC CA 1150 10 13 Page 1 of 4 Alaska National v INSURANCE COMPANY c. "Loss" caused by falling objects or SECTION II — COVERED AUTO LIABILITY missiles. COVERAGE, Paragraph A.2.c.—Voluntary Property Damage is added as follows: However, you have the option of having glass breakage caused by a covered "auto's" c. Voluntary Property Damage collision or overturn considered a "loss" under Collision Coverage. At your written request, we may make a voluntary payment for Property Damage Glass Repair—Waiver of Deductible caused by an "insured", but without liability to a third party, up to$25,000. We No deductible applies to glass breakage, if will not make a Voluntary Property the glass is repaired rather than replaced. Damage payment to anyone who is an "insured" under this policy. SECTION III — PHYSICAL DAMAGE COVERAGE, Paragraph A.4.a. — Transportation Expenses is SECTION III — PHYSICAL DAMAGE COVERAGE, replaced by the following: Paragraph A.2.—Towing is replaced by the following: a. Transportation Expenses Towing We will pay up to $200 per day to a We will pay up to $500 for towing and labor maximum of $1,500 for temporary costs incurred each time a covered "auto" transportation expense incurred by you that is a: because of the total theft of a covered "auto"that is a: a. Private passenger; (1) Private passenger; b. Truck; (2) Truck; c. Pick-up truck; (3) Pick-up truck; d. Panel ; or (4) Panel; or e. Van (5) Van type vehicle under 20,000 lbs. of Gross Vehicle Weight is disabled. However, the labor must be performed at place of type vehicle under 20,000 lbs. of Gross Vehicle Weight. We will pay only for disablement. those covered "autos"for which you carry SECTION III — PHYSICAL DAMAGE COVERAGE, either Comprehensive or Specified Paragraph A,3_ — Glass Breakage — Hitting a Bird Causes of Loss Coverage. We will pay for temporary transportation expenses or Animal — Falling Objects or Missiles is replaced incurred during the period beginning 48 by the following: hours after the theft and ending, Glass Breakage—Hitting a Bird or Animal regardless of the policy's expiration, —Falling Objects or Missiles when the covered "auto" is returned to use or we pay for its"loss". If you carry Comprehensive Coverage for the damaged covered "auto", we will pay the following under Comprehensive Coverage: a. Glass Breakage; b. "Loss" caused by hitting a bird or animal; and ANIC CA 1150 10 13 Page2of4 LW Alaska National SURANCE COMPANY (2) Specified Causes of Loss only if the SECTION III — PHYSICAL DAMAGE COVERAGE, Declarations indicate that Specified Paragraph A.4.b. — Loss of Use Expenses is Causes of Loss Coverage is provided replaced by the following: for the "auto" withdrawn from service; or b. Loss of Use Expenses— Hired, Rented, (3) Collision only if the Declarations or Borrowed Automobiles indicate that Collision Coverage is provided for the "auto" withdrawn We will pay expenses for which an from service. "insured" becomes legally responsible to pay for loss of use of a vehicle hired, SECTION III — PHYSICAL DAMAGE COVERAGE, rented or borrowed without a driver under Paragraph A.4.d. — Airbag Coverage is added as a written rental contract or agreement. follows: We will pay for loss of use expenses, if caused by: d. Airbag Coverage (1) Other than Collision, only if the We will pay for the cost to repair, replace, Declarations indicate that or reset an airbag that inflates for any Comprehensive Coverage is provided reason other than as a result of a for the vehicle withdrawn from collision, If the Declarations indicate that service. the covered "auto" has Comprehensive Coverage or Specified Causes of Loss (2) Specified Causes of Loss only if the Coverage. Declarations indicate that Specified Causes of Loss Coverage is provided SECTION III — PHYSICAL DAMAGE COVERAGE, for the vehicle withdrawn from Paragraph A.4.e. -- Rental Reimbursement service. Coverage is added as follows: (3) Collision only if the Declarations e. Rental Reimbursement Coverage indicate that Collision Coverage is provided for the vehicle withdrawn We will pay up to $75 per day for rental from service. reimbursement expenses incurred by you for the rental of an "auto" because of However, the most we will pay for any "loss"to a covered"auto"that is a: expenses for loss of use is $200 per day, to a maximum of$1,500. (1) Private Passenger; SECTION III — PHYSICAL DAMAGE COVERAGE, (2) Truck; Paragraph A.4.c.—Non-Transportation Loss of Use Expenses is added as follows: (3) Pick-up truck; c. Non-Transportation Loss of Use (4) Panel; or Expenses (5) Van We will pay up to $2,000 for non- transportation expense incurred by you, type vehicle under 20,000 lbs. of Gross because of "loss" to a covered "auto", if Vehicle Weight. Payment applies in caused by: addition to the otherwise applicable amount of each coverage you have on a (1) Other than Collision, only if the covered "auto". No deductibles apply to Declarations indicate that this coverage. Comprehensive Coverage is provided for the"auto"withdrawn from service; ANIC CA 1150 10 13 Page 3 of 4