Loading...
23-092.00 Blackline Inc. Contract This agreement is entered into this 2 of 31„, ee, 2023, between the City of Spokane Valley ("City")and Blackline,Inc.("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: Local Access Preservation Services 2023 Cape Seal Pilot Project—Slurry Contract 23-092 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. Ill. 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$153,950.00. IN WITNESS WHEREOF,the Contractor has executed this instrument,on the date below, and the City has caused this instrument to be executed on the date stated above. Executed by Contractor 3--Uh 13 , 2023. Date CODY LORENZEN Printed Name PRES ENT Title na City of Spokane Valley John Hohman Printed Name City Manager Title Sig atfi ure CITY oFkLi lid. BOND NO: RCB0023065 CONTRACTOR'S PERFORMANCE BOND to City of Spokane Valley,Washington The City of Spokane Valley, Spokane County, Washington, has awarded to Blackline Inc._, as Principal, a contract for the construction of the project designated as Local Access Preservation Services 2023 Cape Seal Pilot Project- Slurry, in Spokane Valley,Washington,and said Principal is required under the terms of the Contract to furnish a performance bond in accordance with chapter 39.08 Revised Code of Washington(RCW). The Principal, and Contractors Bonding and Insurance Company (Surety), a corporation, organized under the laws of Illinois and licensed to do business in the State of Washington as surety and named in the current list of"Surety Companies Acceptable in Federal Bonds"as published in the Federal Register by the Audit Staff Bureau of Accounts,U.S.Treasury Dept.,are jointly and severally held and firmly bound to the City of Spokane Valley,as Obligee,in the sum of$ 153.950.00 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. P' ► " 'AL(CO II : : - line, Inc. SURETY Contractors Bonding and Insurance Company / 9&a1 6 6 2023 P ' e I e Date Surety Sign a Date Cody Lorenzen Shelly Donovan Printed Name Printed Name President Attorney-in-Fact Title Title Name,address,and telephone of local office/agent of Surety Company is: Alliant Insurance Services, Inc. 818 West Riverside Avenue, Suite 800, Spokane, WA 99201509-325-3024 Updated February 9,2023 POWER OF ATTORNEY RLI Insurance Company Contractors Bonding and Insurance Company 9025 N.Lindbergh Dr. Peoria,IL 61615 Phone: 800-645-2402 Know All Men by These Presents: That this Power of Attorney is not valid or in effect unless attached to the bond which it authorizes executed, but may be detached by the approving officer if desired. That RLI Insurance Company and/or Contractors Bonding and Insurance Company, each an Illinois corporation, (separately and together,the"Company")do hereby make,constitute and appoint: Shawn M.Wilson,Nicholas W.Paget,Lauren E Richardson,George C.Schroeder,Shelly Donovan,Teri Bachman,Peggy A.Firth, jointly or severally in the City of Spokane , State of Washington its true and lawful Agent(s) and Attorney(s) in Fact,with full power and authority hereby conferred, to sign, execute, acknowledge and deliver for and on its behalf as Surety, in general, any and all bonds and undertakings in an amount not to exceed Twenty Five Million Dollars ( $25,000,000.00 )for any single obligation. The acknowledgment and execution of such bond by the said Attorney in Fact shall be as binding upon the Company as if such bond had been executed and acknowledged by the regularly elected officers of the Company. RLI Insurance Company and/or Contractors Bonding and Insurance Company, as applicable, have each further certified that the following is a true and exact copy of a Resolution adopted by the Board of Directors of each such corporation,and is now in force,to-wit: "All bonds,policies,undertakings,Powers of Attorney or other obligations of the corporation shall be executed in the corporate name of the Company by the President,Secretary,any Assistant Secretary,Treasurer,or any Vice President,or by such other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or Agents who shall have authority to issue bonds,policies or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds,policies,undertakings,Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile." IN WITNESS WHEREOF, the RLI Insurance Company and/or Contractors Bonding and Insurance Company, as applicable, have caused these presents to be executed by its respective Vice President with its corporate seal affixed this 19th day of April , 2023 . ��,,,,,,,,,,,,,, RLI Insurance Company ¢0oaoo P AND , ' ```` yvM!NCE c Contractors Bonding and Insurance Company ,C2 O P 4�, vy�,_ ��;.• OOAPOAp TF•= i. / L� Al- .)� T =s'. SEAL 5 = SEAL . • By: a°= Barton W.Davis Vice President ZOu• .F • State of Illinois k s ,,/,<L►N 0‘' LINO i�, run»no�o'\` �..4,"""oq‘��`````` SS County of Peoria CERTIFICATE On this 19th day of April 2023 before me, a Notary Public, I, the undersigned officer of RLI Insurance Company and/or personally appeared Barton W. Davis , who being by me duly sworn, Contractors Bonding and Insurance Company, do hereby certify acknowledged that he signed the above Power of Attorney as the aforesaid that the attached Power of Attorney is in full force and effect and is officer of the RLI Insurance Company and/or Contractors Bonding and irrevocable; and furthermore, that the Resolution of the Company as Insurance Company and acknowledged said instrument to be the voluntary set forth in the Power of Attorney, is now in force. In testimony act and deed of said corporation. whereof, I have hereunto set my hand and the seal of the RLI Insurance Company and/or Contractors Bonding and Insurance Company this 6th day of June , 2023 L By: �. �O.e RLI Insurance Company Catherine D.Geiger 0 Notary Public Contractors Bonding and Insurance Company r , CATHERINE D.GEIGER 0 NOTARY 1 OFFICIAL SEAL 0 jic-K rue1� . Notary Public-State of Illinois iBy:STATE°� My Commission Expires 0 Jeffrey is Corporate Secretary �" December 05,2026 1 4675566020212 A0058D 19 Oirai on'of J BOND NO: RCB0023065 CONTRACTOR'S PAYMENT BOND(NON-FEDERALLY FUNDED PROJECT) to City of Spokane Valley,Washington The City of Spokane Valley, Spokane County, Washington, has awarded to Blackline Inc., as Principal, a contract for the construction of the project designated as Local Access Preservation Services 2023 Cape Seal Pilot Project-Slurry,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). The Principal, and Cnntrartors Ronding and Insurance Company (Surety), a corporation organized under the laws Illinois 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$ 153,950.00 total Contract amount(including Washington State sales tax), subject to the provisions herein. 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 and 39.12 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; 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. P IPAL(CO N - !R) Blackline, Inc. SURETY Contractors Bonding and Insurance Company �� 4e ' I 0 ��2023 ' .- ipal '- . re Date Surety Sign./ e Date Cody Lorenzen Shelly Donovan Printed Name Printed Name President Attorney-in-Fact _ Title Title Name,address,and telephone of local office/agent of Surety Company is: Alliant Insurance Services, Inc. 818 West Riverside Avenue, Suite 800, Spokane, WA 99201509-325-3024 Updated February 9,2023 . " POWER OF ATTORNEY RLI Insurance Company Contractors Bonding and Insurance Company 9025 N.Lindbergh Dr. Peoria,IL 61615 Phone: 800-645-2402 Know All Men by These Presents: That this Power of Attorney is not valid or in effect unless attached to the bond which it authorizes executed, but may be detached by the approving officer if desired. That RLI Insurance Company and/or Contractors Bonding and Insurance Company, each an Illinois corporation, (separately and together,the"Company")do hereby make,constitute and appoint: Shawn M.Wilson,Nicholas W.Paget,Lauren E Richardson,George C.Schroeder,Shelly Donovan,Teri Bachman,Peggy A.Firth, jointly or severally in the City of Spokane , State of Washington its true and lawful Agent(s) and Attorney(s) in Fact,with full power and authority hereby conferred, to sign, execute, acknowledge and deliver for and on its behalf as Surety, in general, any and all bonds and undertakings in an amount not to exceed Twenty Five Million Dollars ( $25,000.000.00 )for any single obligation. The acknowledgment and execution of such bond by the said Attorney in Fact shall be as binding upon the Company as if such bond had been executed and acknowledged by the regularly elected officers of the Company. RLI Insurance Company and/or Contractors Bonding and Insurance Company, as applicable, have each further certified that the following is a true and exact copy of a Resolution adopted by the Board of Directors of each such corporation,and is now in force,to-wit: "All bonds,policies,undertakings,Powers of Attorney or other obligations of the corporation shall be executed in the corporate name of the Company by the President,Secretary,any Assistant Secretary,Treasurer,or any Vice President,or by such other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or Agents who shall have authority to issue bonds,policies or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds,policies,undertakings,Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile." IN WITNESS WHEREOF, the RLI Insurance Company and/or Contractors Bonding and Insurance Company, as applicable, have caused these presents to be executed by its respective Vice President with its corporate seal affixed this 19th day of April , 2023 . �,,,,,,,,,,,,,,, RLI Insurance Company N ,,YS',, .JP, NCE C��,A Contractors Bonding and Insurance Company oQ:•GOP 4rF',m •'•o°NPonAro•,9� // . i . SEAL . b . SEAL . By: :;xo•• : • i Barton W.Davis Vice President u e State of Illinois ) 1Nols '%vl ',N ,, } SS County of Peoria ) CERTIFICATE On this 19th day of April , 2023 ,before me, a Notary Public, I, the undersigned officer of RLI Insurance Company and/or personally appeared Barton W. Davis , who being by me duly sworn, Contractors Bonding and Insurance Company, do hereby certify acknowledged that he signed the above Power of Attorney as the aforesaid that the attached Power of Attorney is in full force and effect and is officer of the RLI Insurance Company and/or Contractors Bonding and irrevocable; and furthermore, that the Resolution of the Company as Insurance Company and acknowledged said instrument to be the voluntary set forth in the Power of Attorney, is now in force. In testimony act and deed of said corporation. whereof, I have hereunto set my hand and the seal of the RLI Insurance Company and/or Contractors Bonding and Insurance Company this 6th day of June , 2023 O By: . �-.D. ,-- RLI Insurance Company Catherine D.Geiger Notary Public Contractors Bonding and Insurance Company i CATHERINE D.GEIGER , 1 , ,,pY OFFICIAL SEAL 031-,4‹,,PUBt4 Notary public-State of Illinois i By: .J � I NOS My Commission Expires 0 Jeffrey iCck�w Corporate Secretary December 05,2026 4675566020212 A0058D 19 A, BLACINC-01 HROSE2 ,44CORv CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDMlYY) 6/5/2023 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 NAME: Alliant Insurance Services,Inc. PHONE FAX 818 W Riverside Ave Ste 800 (A/C,No,Ext):(509)325-3024 I(A/C,No):(509)325-1803 Spokane,WA 99201 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Alaska National Insurance Company 38733 INSURED INSURER B: Blackline,Inc. PMB 196 INSURER C: 13023 NE Hwy 99,Suite 7 INSURER D: Vancouver,WA 98686 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 POUCY NUMBER POUCY EFF POUCY EXP OMITS LTR INSD WVDIMM/DD/YYYYI IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X 221PS31764 9/8/2022 9/8/2023 PREMISESa occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: _GENERAL AGGREGATE $ 2,000,000 POLICY X JELQT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO X 22IAS31764 9/8/2022 9/8/2023 BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTOS ONLY _ AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) $ A X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 5,000,000 ✓ EXCESS UAB CLAIMS-MADE 22ILU31764 9/8/2022 9/8/2023 AGGREGATE $ 5,000,000 ✓ DED X RETENTIONS 10,000 $ A WORKERS COMPENSATION AND EMPLOYERS'UABIUTY STATUTE ERH ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 221PS31764 9/8/2022 9/8/2023 E.L.EACH ACCIDENT $ 1,000,000 sr OFFICER/MEMBER EXCLUDED? 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/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project:Local access preservation services 2023 Cape Seal Pilot Project-Slurry Contract No.:23-092 City of Spokane Valley and its officers,elected officials,employees,agents and volunteers are listed as additional insured per attached form.Coverage is primary and non-contributory per attached form CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of SpokaneTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ty Valley ACCORDANCE WITH THE POLICY PROVISIONS. 10210 E Sprague Ave Spokane Valley,WA 99206 AUTHORIZED REPRESENTATIVE . elk lachica—e" ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Alaska National INSURANCE COMPANY BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Various provisions in this endorsement restrict subrogation against that person or coverage. Read the entire policy carefully to organization is waived prior to the "accident" determine rights, duties, and what is and is not or the"loss" under a contract with that person covered. or organization. Throughout this policy, the words "you" and "your" SECTION II — COVERED AUTO LIABILITY refer to the Named Insured shown in the COVERAGE, Paragraph A.2.a. (2) —Supplementary Declarations. The words "we", "us", and "our" refer to Payments is replaced by the following: the company providing this insurance. (2) Up to $10,000 for cost of bail bonds Other words and phrases that appear in quotation (including bonds for related traffic law marks have special meaning. Refer to SECTION V— violations) required because of an DEFINITIONS in the Business Auto Coverage Form. "accident" we cover. We do not have The coverages provided by this endorsement apply to furnish these bonds. per "accident" and, unless otherwise specified, are SECTION II — COVERED AUTO LIABILITY subject to all of the terms, conditions, exclusions and COVERAGE, Paragraph A.2.a. (4) —Supplementary deductible provisions of the policy, to which it is Payments is replaced by the following: attached. (4) All reasonable expenses incurred by SECTION II — COVERED AUTO LIABILITY the"insured" at our request, including COVERAGE, Paragraph A.1. Who Is An Insured is actual loss of earnings up to $500 a amended to include: day because of time off from work. d. Any "employee" of yours while operating SECTION ll — COVERED AUTO LIABILITY an "auto" hired or rented under a contract COVERAGE, Paragraph A.2.c. —Voluntary Property or agreement in an "employee's" name, Damage is added as follows: with your permission, while performing c. Voluntary Property Damage duties related to the conduct of your business. At your written request, we may make a voluntary payment for Property Damage e. Any person or organization for whom you have agreed in writing to provide caused by an "insured", but without insurance such as is afforded bythis liability to a third party, up to$25,000. We will not make a Voluntary Property Coverage Form, but only with respect to Damage payment to anyone who is an liability arising out of the ownership, "insured" under this policy. maintenance or use of"autos"covered by this policy. If such person or organization SECTION III — PHYSICAL DAMAGE COVERAGE, has other insurance then this insurance is Paragraph A.2. —Towing is replaced by the following: primary to and we will not seek Towing contribution from the other insurance. We will pay up to $500 for towing and labor SECTION IV — Business Auto Conditions, costs incurred each time a covered "auto" Paragraph A. 5. — Transfer of Rights of Recovery that is a: Against Others To Us is amended to include: a. Private passenger; 5. Transfer of Rights of Recovery Against Others to Us This condition does not apply to any person(s) or organization(s) to the extent that Blackline, Inc. 221 AS 31764 09/08/22-09/08/23 ANIC CA 1150 10 13 Page 1 of 4 Alaska National INSURANCE COMPANY b. Truck; (3) Pick-up truck; c. Pick-up truck; (4) Panel; or d. Panel ; or (5) Van e. Van type vehicle under 20,000 lbs. of Gross type vehicle under 20,000 lbs. of Gross Vehicle Weight. We will pay only for Vehicle Weight is disabled. However, the those covered "autos" for which you carry labor must be performed at place of either Comprehensive or Specified disablement. Causes of Loss Coverage. We will pay for temporary transportation expenses SECTION III — PHYSICAL DAMAGE COVERAGE, incurred during the period beginning 48 Paragraph A.3. — Glass Breakage — Hitting a Bird hours after the theft and ending, or Animal — Falling Objects or Missiles is replaced regardless of the policy's expiration, by the following: when the covered "auto" is returned to Glass Breakage—Hitting a Bird or Animal use or we pay for its"loss". —Falling Objects or Missiles SECTION III — PHYSICAL DAMAGE COVERAGE, If you carry Comprehensive Coverage for the Paragraph A.4.b. — Loss of Use Expenses is damaged covered "auto", we will pay the replaced by the following: following under Comprehensive Coverage: b. Loss of Use Expenses—Hired, Rented, a. Glass Breakage; or Borrowed Automobiles b. "Loss" caused by hitting a bird or animal; We will pay expenses for which an and "insured" becomes legally responsible to c. "Loss" caused by falling objects or pay for loss of use of a vehicle hired, missiles. rented or borrowed without a driver under a written rental contract or agreement. However, you have the option of having glass We will pay for loss of use expenses, if breakage caused by a covered "auto's" caused by: collision or overturn considered a"loss" under (1) Other than Collision, only if the Collision Coverage. Declarations indicate that Glass Repair—Waiver of Deductible Comprehensive Coverage is provided No deductible applies to glass breakage, if for the vehicle withdrawn from the glass is repaired rather than replaced. service. SECTION III — PHYSICAL DAMAGE COVERAGE, (2) Specified Causes of Loss only if the Paragraph A.4.a. — Transportation Expenses is Declarations indicate that Specified replaced by the following: Causes of Loss Coverage is provided a. Transportation Expenses for the vehicle withdrawn from service. We will pay up to $200 per day to a maximum of $1,500 for temporary (3) Collision only if the Declarations transportation expense incurred by you indicate that Collision Coverage is because of the total theft of a covered provided for the vehicle withdrawn "auto"that is a: from service. (1) Private passenger; (2) Truck; Blackline, Inc. 221 AS 31764 09/08/22-09/08/23 ANIC CA 1150 10 13 Page 2 of 4 AiAlaska National INSURANCE COMPANY However, the most we will pay for any (2) Truck; expenses for loss of use is $200 per day, to a (3) Pick-up truck; maximum of$1,500. (4) Panel; or SECTION III — PHYSICAL DAMAGE COVERAGE,Paragraph A.4.c. —Non-Transportation Loss of Use (5) Van Expenses is added as follows: type vehicle under 20,000 lbs. of Gross c. Non-Transportation Loss of Use Vehicle Weight. Payment applies in Expenses addition to the otherwise applicable amount of each coverage you have on a We will pay up to $2,000 for non- covered "auto". No deductibles apply to transportation expense incurred by you, this coverage. because of "loss" to a covered "auto", if caused by: (1) We will pay only for those expenses (1) Other than Collision, only if the incurred during the policy period Declarations indicate that beginning 24 hours after the "loss" and ending, regardless of the policy's Comprehensive Coverage is provided expiration, with the lesser of the for the"auto"withdrawn from service; following number of days: (2) Specified Causes of Loss only if the (a) The number of days reasonably Declarations indicate that Specified required to repair or replace the Causes of Loss Coverage is provided covered"auto". for the "auto" withdrawn from service; or (b) 30 days. (3) Collision only if the Declarations (2) This coverage does not apply while indicate that Collision Coverage is there are spare or reserve "autos" provided for the "auto" withdrawn available to you for your operations. from service. (3) The Rental Reimbursement Cov- SECTION III — PHYSICAL DAMAGE COVERAGE, erage described above does not Paragraph A.4.d. — Airbag Coverage is added as apply to a covered "auto" that is follows: described or designated as a covered d. Airbag Coverage "auto" on Rental Reimbursement Coverage Form CA 99 23. We will pay for the cost to repair, replace, SECTION IV — BUSINESS AUTO CONDITIONS — or reset an airbag that inflates for any Paragraph B.2. —Concealment, Misrepresentation Or reason other than as a result of a Fraud is amended by adding Unintentional Failure collision, if the Declarations indicate that to Disclose Hazards at the end of Paragraph B.2. as the covered "auto" has Comprehensive follows: Coverage or Specified Causes of Loss Coverage. Unintentional Failure to Disclose Hazards SECTION III — PHYSICAL DAMAGE COVERAGE, If you unintentionally fail to disclose any Paragraph A.4.e. — Rental Reimbursement hazards existing at the inception date of your Coverage is added as follows: policy, we will not deny coverage under this Coverage Form because of such failure. e. Rental Reimbursement Coverage However, this provision does not affect our We will pay up to $75 per day for rental right to collect additional premium or exercise reimbursement expenses incurred by you our right of cancellation or non-renewal. for the rental of an "auto" because of "loss"to a covered "auto"that is a: (1) Private Passenger; Blackline, Inc. 221 AS 31764 09/08/22-09/08/23 ANIC CA 1150 10 13 Page 3 of 4 MrAlaska National INSURANCE COMPANY SECTION IV — BUSINESS AUTO CONDITIONS — SECTION V — DEFINITIONS — Paragraph C. — Paragraph B.5.b. — Other Insurance is replaced by "Bodily injury" is replaced by the following: the following: C. "Bodily injury" means bodily injury, sickness or b. For Hired Auto Physical Damage disease sustained by a person including death or Coverage, the following are deemed to mental anguish resulting from any of these. be covered"autos"you own: Mental anguish means any type of mental or (1) Any covered "auto" you lease, hire, emotional illness or disease rent, or borrow; and (2) Any covered "auto"" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". Blackline, Inc. 221 AS 31764 09/08/22 -09/08/23 ANIC CA 1150 10 13 ©Insurance Services Office, Inc., 2009 Page 4 of 4 111, Alaska National INSURANCECOMPANY 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 7 111, Alaska National INSURANCE COMPANY 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 alir Alaska National INSURANCE COMPANY 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 7 111, Alaska National INSURANCE COMPANY 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 HI — 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 alir Alaska National INSURANCE COMPANY 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 II -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 Mr Alaska Nationai INSURANCE COMPANY 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 non renewal 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 AVAlaska National INSURANCE COMPANY 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. 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. 13 Countersigned By Includes copyrighted material of Insurance Services Office, Inc., with its permission ANIC GL 1187 08 21 Page 7 of 7 lair Ala AlaSka NatiOnai INSURANCE COMPANY DESIGNATED CONSTRUCTION PROJECT(S)GENERAL AGGREGATE LIMIT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): All Projects. Information required to 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 Mr 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. 17 Countersigned By ©Insurance Services Office, Inc., 2008 CG 25 03 05 09 Page 2 of 2