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24-055.01SenskeLawnTreeCareSullivanParkWaterTesting CONTRACT AMENDMENT TO THE AGREEMENT BETWEEN THE CITY OF SPOKANE VALLEY AND SENSKE LAWN AND TREE CARE INC. Spokane Valley Contract# 24-055.01 For good and valuable consideration,the legal sufficiency of which is hereby acknowledged,City and the Contractor mutually agree as follows: 1. Purpose: This Amendment is for the Contract for Sullivan Water Testing by and between the Parties, executed by the Parties on March 14,2024,and which terminates on December 31,2024. Said contract is referred to as the"Original Contract"and its terms are hereby incorporated by reference. 2.Original Contract Provisions:The Parties agree to continue to abide by those terms and conditions of the Original Contract and any amendments thereto which are not specifically modified by this Amendment. 3, Amendment Provisions: The Original Contract is subject to the following amended provisions, which are as follows. All such amended provisions arc hereby incorporated by reference herein and shall control over any conflicting provisions of the Original Contract,including any previous amendments thereto. The term of the contract per section 2 shall be extended to December 31,2025. The total compensation described in section 310 shall be$6,534.00 for the calendar year January 1,2025 through December 31, 2025. The cost for maintenance described in section 3tb)shall be up to a maximum of$3,000.00 inclusive of sales tax for the calendar year January 1,2025 through December 31,2025. 4. Compensation Amendment History: This is Amendment #1 of the Original Contract. The history of amendments to the compensation on the Original Contract and all amendments is as follows: Date Compensation Original Contract Amount 03/14/2024 $6,534.00 Up to$3,000.00 repairs Amendment#1 to be executed $6,534.00 Up to$3,000.00 repairs Total Amended Compensation Up to$19,068.00 The parties have executed this Amendment to the Original Contract this Fyi day of k-C,,2024. CITY OF SPOKANE VALLEY: CONTRACTOR: %ohman By: ew S car P City Manager / Its: S c Branch Manager APPROVED AS TO FORM: Office of the City Attorney 1 Client#: 186359 SENSLAWNI fOQNYVY) ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE Irz(MM{MMu24 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER !Farr Trisha Hankey Propel Insurance L° NE 800 499-0933 !FAX- LA"rc4,fro a sty (AfC,No}: 866 677.1326 601 Union Street;Suite 3400 (nDDRESB trisha.hankey©propelinsurance corn _ _ COM Construction INSURER(S)AFFORDING COVERAGE NAICN Seattle,WA 98101-1371 National l._Insurance .. INSURER A:Alaskaa N Natationas Company 38733 INSURED INSURER B:Homeland Insurance Company of New York 34452 Senske Lawn and Tree Care,LLC — — — 400 North quay Street INSURER C Kennewick,WA 99336 INSURER D: 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_ (r y EppPOLICY .._...._._ _..... .. _....-- --- V1SR ADDL1SUBR ....P4LiCtYYYY}E fVYYY) TYPE OF INSURANCE INSR IWVD ... POLICY NUMBER IMMlDD LIMITS A X COMMERCIAL GENERAL LIABILITY 24APS12454 01/31/2024 01/31/2025 EACH OCCURRENCE S1 000,000 ._._ jCLAIMS-MApE I, J OCCUR PRM EOnce) v 500,000 X PD Ded:$5,000 LINED EXP(Any one person) $5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'LAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE $2,000,000 — ;�PRO- POLICY 1 Xl JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: s AUTOMOBILE LIABILITY IcEomlyED SINGLE LIMIT A � 24AAS12454 01/31/2024 01/31J202 Ea accident) s1,000,000 X ANY AUTO I BODILY INJURY(Per person) S OWNED SCHEDULED I BODILY INJURY(Per accident) $ — ___ _ AUTOS ONLY AUTOS� HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY _Per accident) _- — $ J..._. A x UMBRELLA LIAB iX 1 OCCUR 24ALU12454 01/31/2024 01/31/2025 EACH OCCURRENCE $4,000,000 EXCESS LIAR 1 I CLAIMS-MADE AGGREGATE $4 000 000 DED I 1 RETENTIONS _--� $ _-...._ WORKERS PER 17OTH A 24AWS12454 01/3112024 01/31/2024 _sTArUTE i X IOC- - EMPLOYERS'LIABILITY --- - ANY PROPRIETORlPARTNERIEXECUTIVE Y f N Work Comp E.L.EACH ACCIDENT S 000 000 OFFICERlMEMBER EXCLUDED? - - - --- N 1 N 1 A !24APS12454 01/31/2024 01I3112025�.L.DISEASE-EAEMPLOYEE $1(Mandatory In NH) �"' , ,000,000 If yes,describe order --'- -- _ DESCRIPTION OF OPERATIONS below WA Stop Gap F.L.DISEASE-POLICY OMIT $1,000 000 A Lease/Rent Equip 124AIA12454 01/31/2024 01/31/2024 $220,000/$1,000 died. . B Pollution/ 17930117170002 01/28/2024101/31/2025 $1 M/$I M Limits Professional . , I ! $10,000 deductible DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES(AGGRO 101,Additional Remarks Schedule,may be attached if more space Is required) RE:Operations performed by the Named Insured. City of Spokane Valley shall be included as Additional Insured per the attached endorsements. CERTIFICATE HOLDER CANCELLATION City of Spokane Valley SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10210 E Sprague Ave ACCORDANCE WITH THE POLICY PROVISIONS. Spokane Valley,WA 99206-0000 AUTHORIZED REPRESENTATIVE i � ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S6389236/M6381895 TTOO Labor&Industries pttps,llni.wa.g v/) Contractors SENSKE LAWN &TREE CARE INC Owner or tradesperson 400 N Quay St Principals KENNEWICK,WA 99336 003 SENSKE,CHRISTOPHER,PRESIDENT BENTENT County WAREHIME,DANIEL P,VICE PRESIDENT HURST,NATHAN RICHARD,CHIEF EXECUTIVE OFFICER TAYLOR,CASEY,CHIEF EXECUTIVE OFFICER SENSKE,CATHERINE A,AGENT Doing business as SENSKE LAWN&TREE CARE INC WA UBI No. Business type 600 124 706 Corporation Governing persons CHRISTOPHER SENSKE CATHERINE A SENSKE; DANIEL WAREHIME; License Verify the contractor's active registration/license I certification(depending on trade)and any pest violations. Construction Contractor Active Meets current requirements. License specialties GENERAL License no. SENSKLT117PT Effective—expiration 10/30/1989—02113/2025 Bond American States Insurance Co $12,000 00 Bond account no. 678000589 Received by L&I Effective date 05/07/2012 04/20/2012 Expiration date Until Canceled Insurance Alaska National Insurance Co $1,000,000.00 Policy no. 23APS12454 Received by L&I Effective date 01/27/2023 01/28/2023 Expiration date 01/28/2024 Insurance history Savings No savings accounts during the previous 8 year period. Lawsuits against the bond or savings No lawsuits against the bond or savings accounts during the previous 6 year period. L&I Tax debts No L&i fax debts are recorded for this contractor license during the previous 6 year period,but some debts may be recorded by other agencies. License Violations No license violations during the previous 6 year period. Certifications& Endorsements OMWBE Certifications No active certiirications exist for this business. Apprentice Training Agent No active Washington registered apprentices exist for this business.Washington allows the use of apprentices registered with Oregon or Montana.Contact the Oregon Bureau of Labor&Industries or Montana Department of Labor &industry to verify if this business has apprentices. Workers'Comp Do you know if the business has employees?If so,verify the business is up-to-date on workers'comp premiums. L&i Account ID Account is current. 156,937-00 Doing business as SENSKE LAWN&TREE CARE LLC Estimated workers reported Quarter 3 of Year 2023"Greater than 100 Workers" L&I account contact TO i RAJ LUKE(360)902-5535-Email:LUKE235@lni.wa.gov Public Works Requirements Verify the contractor is eligible to perform work on public works projects. Required Training-Effective July 1,2019 Exempt from this requirement. Contractor Strikes No strikes have bean issued against this contractor. Contractors not allowed to bid No debarments have been issued against this contractor. Workplace Safety& Health Check for any past safety and health violations found on jobsites this business was responsible for. Inspection results date 1 210 612 02 3 Violations inspection no. 317976775 Location 1924 South Post Street Spokane,WA 99223 inspection results data 09/0712022 No violations Inspection no. 317969988 Location 410 N Quay St Kennewick,WA 99336 Inspection results date 1 1/0 512 020 Violations Inspection no. 317960797 Location A� " CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDmYY) 1 /29/2025 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: CertRequests@ajg.com Arthur J. Gallagher Risk Management Services, LLC PHONE 12750 Merit Drive, Suite 1000 fAIC.E-MAINo.LEtiag72-991-3700 a/AXc No: 972-991 4061 ADDRESS: Dallas TX 75251 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Alaska National Insurance Company 38733 INSURED SENLAWN-01 INSURER B : Homeland Insurance Company of New York 34452 Senske Lawn and Tree Care, LLC 400 North Quay Street INSURERC: Kennewick„ WA 99336 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:679581329 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 LTR OF INSURANCE ADDLSUBRTYPE INSD WVD POLICY NUMBER MMIDDPOLICY EFF POLICY EXP (MM/DD/YYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY 24APS12454 1/31/2024 4/30/2025 EACH OCCURRENCE $1,000,000 CLAIMS -MADE %� OCCUR DAMAGE TO RENTE PREMISES Ea occurDrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO ❑ JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY 24AAS12454 1/31/2024 4/30/2025 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS IX BODILY INJURY (Per accident) $ PROPERTYDAMAGE Per accident $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY A X UMBRELLALIAB X OCCUR 24ALU12454 1/31/2024 4/30/2025 EACH OCCURRENCE $4,000,000 AGGREGATE $ 4,000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION $ jnnnn $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE 25A WS 12454 1/31/2025 4/30/2025 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 B Poll utionand Professional 793-01-17-17-0002 1/28/2024 4/30/2025 Limit/Deductible $1,000,000/$25,000 A Leased/Rented Equipment 24A IA 12454 1/31/2024 4/30/2025 Limit $220,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) 10 day notice of cancellation for non-payment; 30 day notice of cancellation for any other reason Excess liability follows form See Attached... CFRTIFICATF MAI nFR CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Spokane Valley 10210 E Sprague Ave Spokane Valley WA 99206-0000 AUTHORIZED REPRESENTATIVE 1U1 � V4 a - / ✓ V ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE AGENCY CUSTOMER ID: SENLAWN-01 LOC #: ACORO ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Arthur J. Gallagher Risk Management Services, LLC NAMED INSURED Senske Lawn and Tree Care, LLC 400 North Quay Street Kennewick„ WA 99336 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Certificate Holder is an Additional Insured as respects to the General and Excess Liability policies, pursuant to and subject to the policy's terms, definitions, conditions and exclusions. RE: Operations performed by the Named Insured. City of Spokane Valley shall be included as Additional Insured per the attached endorsements. ACORD 101 (2008/01) © 2008 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 8 additional insured extensions. Primary and Noncontributory Insurance 2. Damage To Premises Rented to You Limit increased to $500,000. 3. Medical Payments Limits increased to $15,000. Reporting period increased to three years from the date of accident. 4. Non -owned Watercraft Increased to 50 feet. 5. Supplementary Payments Cost of bail bonds increased to $10,000. Daily loss of earnings increased to $500. 6. Newly Formed Or Acquired Organizations Coverage extended to the end of the policy period or the next anniversary of this policy's effective date. 7. Liberalization Clause 8. Unintentional Failure To Disclose Hazards 9. Notice of Occurrence 10. Broad Knowledge of Occurrence 11. Bodily Injury - Extension of Coverage 12. Expected Or Intended Injury Reasonable force - bodily injury or property damage. 13. Blanket Waiver of Subrogation Waiver of subrogation where required by written contract or written agreement. 14. In Rem Actions 15. Voluntary Property Damage Limits added: $5,000 occurrence, $10,000 aggregate. 1. MISCELLANEOUS ADDITIONAL INSUREDS Section II Who Is An Insured is amended to include as an additional Insured any person or organization described in Paragraphs 2.a. through 2.h. below whom you are required to add as an additional insured on this policy under a written contract or written agreement. However, the written contract or written agreement must be: 1. Currently in effect or becoming effective during the term of this policy; and 2. Executed prior to the "bodily injury", "property damage" or "personal injury and advertising injury", but Only the following persons or organizations are additional insureds under this endorsement and coverage provided to such additional insureds is limited as provided herein: a. State or Governmental Agency or Subdivision or Political Subdivi- sions 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, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifica- tions; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employ- ment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury' or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of, or the failure to render, any professional architectural, engineering or surveying services. Primary And Noncontributory Insurance The following is added to the Other Insurance Condition and supersedes any provision to the contrary: This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. Section III - Limits of Insurance, the following is added: With respect to the insurance afforded to the additional insureds described in Paragraphs a. through h. above, the most we will pay on behalf of such additional insured is the amount of insurance: (1) Required by the contract or agreement; or (2) Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This provision shall not increase the applicable Limits of Insurance shown in the Declaration. 2. Damage To Premises Rented to You SECTION III — LIMITS OF INSURANCE, Paragraph 6. is replaced by the following: Subject to Paragraph 5. above, the Damage to Premises Rented to You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, while rented to you or temporarily occupied by you with permission of the owner. If a limit is shown for Damage to Premises Rented to You the most we will pay under Coverage A for damages because or "property damage" to any one premises is the Limit shown in the Declarations or $500,000, whichever is greater. 3. MEDICAL PAYMENTS A. Section III — Limits of Insurance, Paragraph 7. is replaced by the following: 7. Subject to Paragraph 5. above the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury' sustained by any one person. ANIC GL 1187 08 21 Page 4 of 7 If a limit is shown for Medical Expense in the Declarations the most we will pay under Coverage C for all medical expenses because of "bodily injury" sustained by any one person is the Limit shown in the Declarations or $15,000, whichever is greater. B. This provision 5. (Medical Payments) does not apply if Section I - Coverage C Medical Payments is excluded either by the provisions of the Coverage Part or by endorsement. C. Paragraph 1.a.(3)(b) of Section I - Coverage C - Medical Payments, is replaced by the following: (b) The expenses are incurred and reported to us within three years of the date of the accident; and 4. NON -OWNED WATERCRAFT A. If endorsement CG 21 09, CG 21 10, CG 24 50, or CG 24 51 is attached to the policy, Paragraph A. 2. g. (2) (b) is replaced by the following: (b) A watercraft that you do not own that is: (i) Less than 50 feet long: and (ii) Not being used to carry persons or property for a charge. B. If Paragraph A. does not apply, Paragraph g. (2) of 2. EXCLUSION under SECTION I — COVERAGES, COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY is replaced by the following: (2) A watercraft that you do not own that is: (a) Less than 50 feet long; and (b) Not being used to carry persons or property for a charge. 5. SUPPLEMENTARY PAYMENTS A. Under Section I - Supplementary Payments - Coverage A and B, Paragraph 1.b., the limit of $250 shown for the cost of bail bonds is replaced by $10,000; B. In Paragraph 1.d., the limit of $250 shown for daily loss of earnings is replaced by $500. 6. NEWLY FORMED OR ACQUIRED ORGANIZATIONS Paragraph 3.a. of Section II - Who Is An Insured is deleted and replaced by the following: Coverage under this provision is afforded only until the end of the policy period or the next anniversary of this policy's effective date after you acquire or form the organization, whichever is earlier. 7. LIBERALIZATION CLAUSE If we adopt a change in our forms or rules which would broaden coverage for contractors under this endorsement without an additional premium charge, your policy will automatically provide the additional coverages as of the date the revision is effective in your state. 8. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS — Paragraph 6. — Representations is replaced by the following: 6. Representations By accepting this policy, you agree a. The statements in the Declarations are accurate and complete; b. Those statements are based upon representations you made to us; and c. We have issued this policy in reliance upon your representations. ANIC GL 1187 08 21 Page 5 of 7 The unintentional omission of, or unintentional error in, any information you provided to us which we relied upon in issuing this policy will not prejudice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable laws and regulations. 9. NOTICE OF OCCURRENCE The following is added to Paragraph 2. of Section IV - Commercial General Liability Conditions - Duties In The Event of Occurrence, Offense, Claim or Suit: Your rights under this Coverage Part will not be prejudiced if you fail to give us notice of an "occurrence", offense, claim or "suit" and that failure is solely due to your reasonable belief that the "bodily injury" or "property damage" is not covered under this Coverage Part. However, you shall give written notice of this "occurrence", offense, claim or "suit" to us as soon as you are aware that this insurance may apply to such "occurrence", offense, claim or "suit." 10. BROAD KNOWLEDGE OF OCCURRENCE The following is added to Paragraph 2. of Section IV - Commercial General Liability Conditions - Duties in The Event of Occurrence, Offense, Claim or Suit: You must give us or our authorized representative notice of an "occurrence", offense, claim, or "suit" only when the "occurrence", offense, claim or "suit' is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) An executive officer or the employee designated by you to give such notice, if you are a corporation; or (4) A manager, if you are a limited liability company. 11. EXPANDED BODILY INJURY Section V - Definitions, the definition of "bodily injury" is changed to read: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including death, humiliation, shock, mental anguish or mental injury by that person at any time which results as a consequence of the bodily injury, sickness or disease. 12. EXPECTED OR INTENDED INJURY Exclusion a. of Section I - Coverage A - Bodily Injury and Property Damage Liability is replaced by the following: a. "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. 13. BLANKET WAIVER OF SUBROGATION The Transfer Of Rights Of Recovery Against Others To Us Condition (Section IV - Commercial General Liability Conditions) is amended by the addition of the following: We waive any right of recovery against any person or organization, because of any payment we make under this Coverage Part, to whom the insured has waived its right of recovery in a written contract or agreement. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person or organization prior to loss. ANIC GL 1187 08 21 Page 6 of 7 14. IN REM ACTIONS Any action in rem against any vessel owned, operated by or for, or chartered by or for you will be treated in the same manner as though the action were in personam against you. 15. VOLUNTARY PROPERTY DAMAGE The following is added, Section I — Coverage A — Bodily Injury and Property Damage Liability 1., Insuring Agreement: We will pay, at your request, for "property damage" to property of others while in the care, custody or control of an insured, arising out of your business operations away from your insured premises for which this policy is written and occurring during the policy period. However, the "property damage" must be the result of unintentional damage or destruction but does not include disappearance, theft, or loss of use. 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. For the purpose of this coverage only, Section I — Coverage A — Bodily Injury and Property Damage Liability 2. Exclusions J. (4.) is deleted. As respects coverage afforded under Voluntary Property Damage, the following is added to Section III — Limits of Insurance: Regardless of the number of insureds, claims or "suits" brought, or persons or organizations making claims or bringing "suits": 1. Subject to 2. Below, the most we will pay for "property damage" arising from any one "occurrence" arising out of "property damage to property of others caused by you and while in your care, custody or control is $5,000. 2. The most we will pay for the sum of all "property damage" in an annual policy period is $10,000. This amount is part of and not in addition to the General Aggregate Limit described in Paragraph 2. of Section III — Limits of Insurance. Includes copyrighted material of Insurance Services Office, Inc., with its permission ANIC GL 1187 08 21 Page 7 of 7 This page has been left blank intentionally. COMMERCIAL GENERAL LIABILITY CG20331219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN A WRITTEN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II -- Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. CG 20 33 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement you have entered into with the additional insured; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 33 12 19 AV Alaska National 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 AV Alaska National INSURANCE COMPANY B. For all sums which the insured becomes legally C. obligated to pay as damages caused by "occurrences" under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical D. expenses shall reduce the amount available under the General Aggregate Limit or the Products -completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Designated Construction Project General Aggregate Limit. When coverage for liability arising out of the "products -completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Designated Construction Project General Aggregate Limit. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of Section III — Limits Of Insurance 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 Insured Countersigned By Policy No. © Insurance Services Office, Inc., 2008 Endorsement No. CG 25 03 05 09 Page 2 of 2 Alaska National INSURANCE COMPANY BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following BUSINESS AUTO COVERAGE FORM Various provisions in this endorsement restrict SECTION IV — Business Auto Conditions, coverage. Read the entire policy carefully to Paragraph A. 5. — Transfer of Rights of Recovery determine rights, duties, and what is and is not Against Others To Us is amended to include: covered. Throughout this policy, the words "you" and "your" refer to the Named Insured shown in the Declarations. The words "we", "us", and "our" refer to the company providing this insurance. Other words and phrases that appear in quotation marks have special meaning. Refer to SECTION V — DEFINITIONS in the Business Auto Coverage Form. The coverages provided by this endorsement apply per "accident" and, unless otherwise specified, are subject to all of the terms, conditions, exclusions and deductible provisions of the policy, to which it is attached. SECTION II — COVERED AUTO LIABILITY COVERAGE, Paragraph A.1. Who Is An Insured is amended to include: d. Any "employee" of yours while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your business. e. Any person or organization for whom you 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. 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 subrogation against that person or organization is waived prior to the "accident" or the "loss" under a contract with that person or organization. SECTION II — COVERED AUTO LIABILITY COVERAGE, Paragraph A.2.a. (2) — Supplementary Payments is replaced by the following: (2) Up to $10,000 for cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. SECTION II — COVERED AUTO LIABILITY COVERAGE, Paragraph A.2.a. (4) — Supplementary Payments is replaced by the following: (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. ANIC CA 1150 10 13 Page 1 of 4 ,&& Alaska National INSURANCE COMPANY SECTION II — COVERED AUTO LIABILITY COVERAGE, Paragraph A.2.c. —Voluntary Property Damage is added as follows: c. Voluntary Property Damage At your written request, we may make a voluntary payment for Property Damage caused by an "insured", but without liability to a third party, up to $25,000. We will not make a Voluntary Property Damage payment to anyone who is an 'insured" under this policy. SECTION III — PHYSICAL DAMAGE COVERAGE, Paragraph A.2. — Towing is replaced by the following: Towing We will pay up to $500 for towing and labor costs incurred each time a covered "auto" that is a: a. Private passenger; b. Truck; c. Pick-up truck; d. Panel ; or e. Van type vehicle under 20,000 lbs. of Gross Vehicle Weight is disabled. However, the labor must be performed at place of disablement. SECTION III — PHYSICAL DAMAGE COVERAGE, Paragraph A.3. — Glass Breakage — Hitting a Bird or Animal — Falling Objects or Missiles is replaced by the following: Glass Breakage — Hitting a Bird or Animal — Falling Objects or Missiles 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 c. "Loss" caused by failing objects or missiles. However, you have the option of having glass breakage caused by a covered "auto's" collision or overturn considered a "loss" under Collision Coverage. Glass Repair —Waiver of Deductible No deductible applies to glass breakage, if the glass is repaired rather than replaced. SECTION III — PHYSICAL DAMAGE COVERAGE, Paragraph AA.a. — Transportation Expenses is replaced by the following: a. Transportation Expenses We will pay up to $200 per day to a maximum of $1,500 for temporary transportation expense incurred by you because of the total theft of a covered "auto" that is a: (1) Private passenger; (2) Truck; (3) Pick-up truck; (4) Panel; or (5) Van type vehicle under 20,000 lbs. of Gross Vehicle Weight. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss". ANIC CA 1150 10 13 Page 2 of 4 ,&& Alaska National INSURANCE COMPANY SECTION III — PHYSICAL DAMAGE COVERAGE, Paragraph AA.b. — Loss of Use Expenses is replaced by the following: b. Loss of Use Expenses — Hired, Rented, or Borrowed Automobiles We will pay expenses for which an "insured" becomes legally responsible to pay for loss of use of a vehicle hired, rented or borrowed without a driver under a written rental contract or agreement. We will pay for loss of use expenses, if caused by: (1) Other than Collision, only if the Declarations indicate that Comprehensive Coverage is provided for the vehicle withdrawn from service. (2) Specified Causes of Loss only if the Declarations indicate that Specified Causes of Loss Coverage is provided for the vehicle withdrawn from service. (3) Collision only if the Declarations indicate that Collision Coverage is provided for the vehicle withdrawn from service. However, the most we will pay for any expenses for loss of use is $200 per day, to a maximum of $1,500. SECTION III — PHYSICAL DAMAGE COVERAGE, Paragraph AA.c. — Non -Transportation Loss of Use Expenses is added as follows: c. Non -Transportation Loss of Use Expenses We will pay up to $2,000 for non - transportation expense incurred by you, because of "loss" to a covered "auto", if caused by: (1) Other than Collision, only if the Declarations indicate that Comprehensive Coverage is provided for the "auto" withdrawn from service; (2) Specified Causes of Loss only if the Declarations indicate that Specified Causes of Loss Coverage is provided for the "auto" withdrawn from service; or (3) Collision only if the Declarations indicate that Collision Coverage is provided for the "auto" withdrawn from service. SECTION III — PHYSICAL DAMAGE COVERAGE, Paragraph AA.d. — Airbag Coverage is added as follows: d. Airbag Coverage We will pay for the cost to repair, replace, or reset an airbag that inflates for any reason other than as a result of a collision, if the Declarations indicate that the covered "auto" has Comprehensive Coverage or Specified Causes of Loss Coverage. SECTION III — PHYSICAL DAMAGE COVERAGE, Paragraph AA.e. — Rental Reimbursement Coverage is added as follows: e. Rental Reimbursement Coverage We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of an "auto" because of "loss" to a covered "auto" that is a: (1) Private Passenger; (2) Truck; (3) Pick-up truck; (4) Panel; or (5) Van type vehicle under 20,000 lbs. of Gross Vehicle Weight. Payment applies in addition to the otherwise applicable amount of each coverage you have on a covered "auto". No deductibles apply to this coverage. ANIC CA 1150 10 13 Page 3 of 4 Alaska National INSURANCE COMPANY (1) We will pay only for those expenses incurred during the policy period beginning 24 hours after the "loss" and ending, regardless of the policy's expiration, with the lesser of the following number of days: (a) The number of days reasonably required to repair or replace the covered "auto". (b) 30 days. (2) This coverage does not apply while there are spare or reserve "autos" available to you for your operations. (3) The Rental Reimbursement Coverage described above does not apply to a covered "auto" that is described or designated as a covered "auto" on Rental Reimbursement Coverage Form CA 99 23. SECTION IV — BUSINESS AUTO CONDITIONS — Paragraph B.2. — Concealment, Misrepresentation Or Fraud is amended by adding Unintentional Failure to Disclose Hazards at the end of Paragraph B.2. as follows: Unintentional Failure to Disclose Hazards If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non -renewal. SECTION IV — BUSINESS AUTO CONDITIONS — Paragraph B.5.b. — Other Insurance is replaced by the following: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: (1) Any covered "auto" you lease, hire, 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". SECTION V — DEFINITIONS — Paragraph C. — "Bodily injury" is replaced by the following: C. "Bodily injury" means bodily injury, sickness or disease sustained by a person including death or mental anguish resulting from any of these. Mental anguish means any type of mental or emotional illness or disease 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 Insured Countersigned By Policy No. © Insurance Services Office, Inc., 2009 Endorsement No. ANIC CA 1150 10 13 Page 4 of 4 Alaska National INSURANCE COMPANY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from a written contract that requires you to obtain this anyone liable for an injury covered by this policy. We agreement from us.) will not enforce our right against the person or organization named in the Schedule. (This agreement This agreement shall not operate directly or indirectly applies only to the extent that you perform work under to benefit any one not named in the Schedule. SCHEDULE Any person or organization for whom the Insured has agreed by written contract to furnish this waiver. This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective on the date issued at 12:01 A.M. standard time at your mailing address shown in the policy. The information below is required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective Policy No. Insured Countersigned By Endorsement No. 6 WC 00 03 13 (04 84) 2q-055= A� o® CERTIFICATE OF LIABILITY INSURANCE DATsnMIDDNYM nozs 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 endorsements . PRODUCER CONTACT NAME: CertRe uests M a' .cam Arthur J. Gallagher Risk Management Services, LLC PHONE FAX 12750 Merit Drive, Suite 1000 u g72-991-3700 a:972-991 d061 E-MAIL DRESS: Dallas TX 75251 INSURERS AFFORDING COVERAGE MAID INSURER A: Homeland Insurance Company of New York 34452 INSURED SENLAWN 01 INSURER B: ACE American Insurance Company 22667 Senske Lawn and Tree Care, LLC 400 North Quay Street INSURER C: OBE Specialty Insurance Com an 11515 INSURER D: XL Specialty Insurance Company 37885 Kennewick„ WA 99336 INsugERE: Steadfast Insurance Company 26387 NSURER F: COVERAGES CERTIFICATE NUMBER:549011015 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 SUER POLICYNUMBER POLICY ffYYYI MMUOYEXP UMRs e X COMMERCIALGENEIRALUABILITY CLAIMS -MADE rx]OCCUR HDOG48927191 4/30/2025 4/30/2026 EACH OCCURRENCE $1.000,000 PREMAGE TO SES EB acwRence $100,000 MEO EXP (Any one rem) $ 5,000 PERSONALAADV INJURY $1,000,000 GENL AGGREGATE LIMIT APPLIES PER: X POLICY JECT LOC OTHER: GENERA -AGGREGATE $5,000D00 PRODUCTS-COMP/OP AGO $2,000,000 $ B AUTOMOBILELMBILTY ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED X NON WNED AUTOS ONLY AUTOSONLV ISAH11349262 4/30/2025 4/30/2026 COMBINED SINGLE LIMIT Me accident $2,000,000 X BODILY INJURY (Per person) S BODILY INJURY (Per accident) S X PROPERTY DAMAGE Per accident S S C X UMBRELLALL4B EXCESS LIAR X OCCUR CLAIMS -MADE 140002601 4/30/2025 4/30/2026 EACHOCCURRENCE $4,000,000 AGGREGATE $4,000,000 DEO I I RETENTION $ a B WORKERS COMPENSATION AND EMPLOYERS' LIABILITYY/N ANYPROPRIETORiPARTNERIEXEWTWE OFFICER/MEMBEREXCLUDED? (Mandatory In NH) If yes, deal under DESCRIPTION OF OPERATIONS below N/A SCFC72604532 WLRC72604490 4/30/2025 4/302025 4/302026 4/30/2026 X O STATUTE ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 EA -DISEASE -POLICY LIMIT $1,000,000 A D E Pollution and Professional Leased/Rented Equipment E.. Auto 7930117170003 UM00217818MA25A SXS255063100 41301202' 4/30/2025 4/302025 4/30/2026 4/30/2026 4/30/2026 UmIWeductlble Unit OcrJk $1,000,000/$25,000 $220,000 $3M/$3M DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace is required) 10 day notice of cancellation for non-payment; 30 day notice of cancellation for any other reason EXCESS liability follows form See Attached... City of Spokane Valley 10210 E Sprague Ave Spokane Valley WA 99206-0000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: SENLAWN-01 LOC #: ACC)Rb ADDITIONAL REMARKS SCHEDULE Page 1 0 1 AGENCY Arthur J. Gallagher Risk Management Services, LLC NAMED INSURED Senske Lawn and Tree Care, LLC 400 North Quay Street Kennewick„ WA 99336 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Certificate Holder is an Additional Insured as respects to the General and Excess Liability policies, pursuant to and subject to the policy's terns, definitions, Conditions and exclusions. RE: Operations performed by the Named Insured. City of Spokane Valley shall be included as Additional Insured per the attached endorsements. ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD