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12-050.00 AM Landshaper: Discovery Park Playground ReinstallationCONSTRUCTION AGREEMENT AM Landshaper, Inc. Discovery Playground Re- installation Project THIS CONSTRUCTION AGREEMENT (the "Agreement ") is made by and between the City of Spokane Valley, a code City of the State of Washington (the "City ") and AM Landshaper, Inc. (the "Contractor ") jointly referred to as (the "Parties "). IN CONSIDERATION of the terms and conditions contained herein the Parties agree as follows: 1. Work to Be Performed. The Contractor shall do all work and furnish all labor, supervision, tools, materials, supplies and equipment and other items necessary for the construction and completion of the reinstallation of play elements at Discovery Playground Project (the "Work ") in accordance with documents described on Exhibit 1 and in accordance with this Agreement (which are by this reference incorporated herein and made part hereof (the "Contract Documents ")), and shall perform any changes in the work in accordance with the Contract Documents. The terms and provisions in this Agreement shall control over any inconsistent or incompatible terms in any other Contract Document. The Contractor shall, for the amount set forth in the Contractor's bid proposal attached hereto, assume and be responsible for the cost and expense of all work required for constructing and completing the Work and related activities provided for in the Contract Documents to the City's satisfaction, within the time limits prescribed in the Contract Documents. The City Manager, or designee, shall administer and be the primary contact for the Contractor. Upon notice from the City, Contractor shall promptly commence work, complete the same in a timely manner, and cure any failure in performance under this Agreement. Unless otherwise directed by the City, all work shall be performed in conformance with the Contract Documents, and all City, State and federal standards, codes, ordinances, regulations and laws as now existing or as may be adopted or amended. 2. Time for Performance. Contractor shall commence the Work within 10 days of receipt of a notice to proceed [or execution of this Agreement] and shall complete the Work within the times specified in the Contract Documents, as may be extended in accordance with this Agreement and the Contract Documents. 3. Liquidated Damages. TIME IS OF THE ESSENCE FOR THIS CONTRACT. Delays cause inconvenience to the residents of the City and cost taxpayer's undue sums of money, adding time needed for administration, engineering, inspection and supervision. It is impractical for the City to calculate the actual cost of delays. Accordingly, the Contractor agrees to pay liquidated damages for failure to achieve Substantial Completion (as defined in the Contract Documents) and shall be in the amount of $0.00 per day. These liquidated damages are not a penalty, but are fixed and agreed upon by and between the Contractor and the City because of the impracticability and difficulty of fixing and ascertaining the actual damages that the City would sustain in the event that the Work is not completed in accordance with the Contract Documents. Liquidated damages may be retained by the City and deducted from payments otherwise due to the Contractor. 4. Compensation. In consideration of the Contractor performing the Work the City agrees to pay the Contractor in accordance with the Contract Documents the sum of three thousand seven hundred seventy Construction Agreement Page 1 of 6 Nib oho five Dollars ($3,775.00), plus Washington State Sales Tax, based on the bid submitted by the Contractor, and as may be adjusted in accordance with the Contract Documents. 5. Payment. The Contractor may elect to be paid in monthly installments, upon presentation of an application for payment in a form satisfactory to the City. Applications for payment shall be sent to the City Clerk at the below stated address. Pursuant to Chapter 60.28 RCW, five percent (5 %) ofthe compensation due Contractor shall be retained by the City. The City reserves the right to withhold payment under this Agreement which is determined in the reasonable judgment of the City Manager or designee to be noncompliant with the Contract Documents, City standards, City Code, and federal or state standards. 6. Notice. Notice shall be given in writing as follows: TO THE CITY: TO THE CONTRACTOR: Name: Christine Bainbridge, City Clerk Name: AM Landshaper, Inc. Phone Number: (509) 921 -1000 Phone Number: 509- 468 -4335 Address: 11707 East Sprague Ave, Suite 106 Address: 8004 North Market Street Spokane Valley, WA 99206 Spokane, Washington 99217 7. Applicable Laws and Standards. The Parties, in the performance of this Agreement, agree to comply with all applicable federal, state, and local laws, codes and regulations. 8. Prevailing Wazes on Public Works. The Contractor, any subcontractor, or other person doing work under this Agreement, shall comply with the requirements of RCW 39.12, and shall pay each employee an amount not less than the Prevailing Rate of Wage, as specified by the Industrial Statistician of the Washington State Department of Labor and Industries ( "L &I "). If employing labor in a class not shown, the Contractor shall request a determination of the correct wage rate for the class and locality from the Industrial Statistician. The Contractor shall provide a copy of any such determinations to the City. Before commencing, during, and upon completion of the work, the Contractor shall file all forms and pay all fees required by L &I and shall indemnify and hold the City harmless from any claims related to its failure to comply with RCW 39.12. The following information is provided pursuant to RCW 39.12.030: A. State of Washington prevailing wage rates applicable to this public works project, published by L &I are located the L &I website address: https• / /fortress.wa.gov /lni/wa el�� ookup /prvWa el�� ookup.aspx B. This Project is located in Spokane County. C. The effective prevailing wage date is the same date as the bid due date as referenced in the original request for bids as may be revised by addenda. Construction Agreement Page 2 of 6 A copy of the applicable prevailing wage rates are also available for viewing at the offices ofthe City located at 11707 East Sprague, Suite 106, Spokane Valley, WA 99206. Upon request, the City will mail a hard copy of the applicable prevailing wages for this project. 9. Relationship of the Parties. It is understood, agreed and declared that the Contractor shall be an independent contractor, and not the agent or employee of the City, that the City is interested in only the results to be achieved, and that the right to control the particular manner, method and means in which the services are performed is solely within the discretion of the Contractor. Any and all employees who provide services to the City under this Agreement shall be deemed employees solely of the Contractor. The Contractor shall be solely responsible for the conduct and actions of all its employees under this Agreement and any liability that may attach thereto. 10. Ownership of Documents. All drawings, plans, specifications, and other related documents prepared by the Contractor under this Agreement are and shall be the property of the City, and may be subject to disclosure pursuant to RCW 42.56 or other applicable public record laws. 11. Records. The City or State Auditor or any of their representatives shall have full access to and the right to examine during normal business hours all of the Contractor's records with respect to all matters covered in this Agreement. Such representatives shall be permitted to audit, examine and make excerpts or transcripts from such records and to make audits of all contracts, invoices, materials, payrolls and record of matters covered by this contract for a period of three years from the date final payment is made hereunder. 12. Warrantv. Unless provided otherwise in the Contract Documents, Contractor warrants that all Work and materials performed or installed under this Agreement are free from defect or failure for a period of one year following final acceptance by the City, unless a supplier or manufacturer has a warranty for a greater period, which warranty shall be assigned or transferred to the City. In the event a defect or failure occurs in work or materials, the Contractor shall, within the warranty period, remedy the same at no cost or expense to the City. This warranty provision shall not be construed to establish a period of limitation with respect to the Contractor's other obligations under this Agreement. 13. Contractor to Be Licensed And Bonded. The Contractor shall be duly licensed, registered and bonded by the State of Washington at all times this Agreement is in effect. 14. Insurance. The Contractor shall procure and maintain for the duration of the Agreement, insurance against claims for injuries to persons or damage to property which may arise from or in connection with the performance of the work hereunder by the Contractor, its agents, representatives, or employees. A. Minimum Scope of Insurance. The Contractor shall obtain insurance of the types described below: 1. Automobile liability insurance covering all owned, non - owned, hired and leased vehicles. Coverage shall be written on Insurance Services Office (ISO) form CA 00 01 or a substitute form providing equivalent liability coverage. If necessary, the policy shall be endorsed to provide contractual liability coverage. 2. Commercial general liability insurance shall be written on ISO occurrence form CG 00 01 and shall cover liability arising from premises, operations, independent contractors, products - completed operations, stop gap liability, personal injury and advertising injury, and liability assumed under an insured contract. The commercial general liability insurance shall be Construction Agreement Page 3 of 6 endorsed to provide the Aggregate Per Project Endorsement ISO form CG 25 03 11 85. There shall be no endorsement or modification of the commercial general liability insurance for liability arising from explosion, collapse or underground property damage. The City shall be named as an insured under the Contractor's commercial general liability insurance policy with respect to the work performed for the City using ISO Additional Insured endorsement CG 20 10 10 01 and Additional Insured- Completed Operations endorsement CG 20 3710 01 or substitute endorsements providing equivalent coverage. 3. Workers' compensation coverage as required by the industrial insurance laws of the State of Washington. B. Minimum Amounts of Insurance. The Contractor shall maintain the following insurance limits: 1. Automobile liability insurance with a minimum combined single limit for bodily injury and property damage of $1,000,000 per accident. 2. Commercial general liability insurance shall be written with limits no less than $1,000,000 each occurrence, $2,000,000 general aggregate, and a $2,000,000 products - completed operations aggregate limit. C. Other Insurance Provisions. The insurance policies are to contain, or be endorsed to contain, the following provisions for automobile liability, professional liability and commercial general liability insurance: 1. The Contractor's insurance coverage shall be primary insurance with respect to the City. Any insurance, self - insurance, or insurance pool coverage maintained by the City shall be excess of the Contractor's insurance and shall not contribute with it. 2. The Contractor shall fax or send electronically in .pdf format a copy of insurer's cancellation notice within two business days of receipt by Contractor. D. Acceptability of Insurers. Insurance is to be placed with insurers with a current A.M. Best rating of not less than A:VII. E. Evidence of Coverage. As evidence of the insurance coverages required by this Agreement, the Contractor shall furnish acceptable insurance certificates to the City at the time the Contractor returns the signed Agreement. The certificate shall specify all of the parties who are additional insureds, and will include applicable policy endorsements, and the deduction or retention level. Insuring companies or entities are subject to City acceptance. If requested, complete copies of insurance policies shall be provided to the City. The Contractor shall be financially responsible for all pertinent deductibles, self - insured retentions, and /or self-insurance. 15. Indemnification and Hold Harmless. The Contractor shall, at its sole expense, defend, indemnify and hold harmless City and its officers, agents, and employees, from any and all claims, actions, suits, liability, loss, costs, attorney's fees and costs of litigation, expenses, injuries, and damages of any nature whatsoever relating to or arising out of the services provided by Contractor, Contractor's agents, subcontractors, subconsultants and employees to the fullest extent permitted by law, subject only to the limitations provided below. Construction Agreement Page 4 of 6 Contractor's duty to defend, indemnify and hold harmless City shall not apply to liability for damages arising out of such services caused by or resulting from the sole negligence of City or City's agents or employees. Contractor's duty to defend, indemnify and hold harmless City against liability for damages arising out of such services caused by the concurrent negligence of (a) City or City's agents or employees, and (b) Contractor, Contractor's agents, subcontractors, subconsultants and employees, shall apply only to the extent of the negligence of Contractor, Contractor's agents, subcontractors, subconsultants and employees. Contractor's duty to defend, indemnify and hold City harmless shall include, as to all claims, demands, losses and liability to which it applies, City's personnel- related costs, reasonable attorneys' fees, and the reasonable value of any services rendered by the office of the City Attorney, outside consultant costs, court costs, fees for collection, and all other claim - related expenses. Contractor specifically and expressly waives any immunity that may be granted it under the Washington State Industrial Insurance Act, Title 51 RCW. These indemnification obligations shall not be limited in any way by any limitation on the amount or type of damages, compensation or benefits payable to or for any third party under workers' compensation acts, disability benefit acts, or other employee benefits acts. Provided, that Contractor's waiver of immunity by the provisions of this Addendum extends only to claims against Contractor by City, and does not include, or extend to, any claims by Contractor's employees directly against Contractor. Contractor hereby certifies that this indemnification provision was mutually negotiated. 16. Waiver. No officer, employee, agent or other individual acting on behalf of either party has the power, right or authority to waive any of the conditions or provisions of this Agreement. No waiver in one instance shall be held to be waiver of any other subsequent breach or nonperformance. All remedies afforded in this Agreement or by law, shall be taken and construed as cumulative, and in addition to every other remedy provided herein or by law. Failure of either party to enforce at any time any of the provisions of this Agreement or to require at any time performance by the other party of any provision hereof shall in no way be construed to be a waiver of such provisions nor shall it affect the validity ofthis Agreement or any part thereof. 17. Assignment and Delegation. Neither party shall assign, transfer, or delegate any or all of the responsibilities of this Agreement or the benefits received hereunder without first obtaining the written consent of the other party. 18. Confidentiality. Contractor may, from time to time, receive information which is deemed by the City to be confidential. Contractor shall not disclose such information without the prior express written consent of the City or upon order of a Court of competent jurisdiction. 19. Disputes. All disputes arising under or related to this Agreement that cannot be resolved through informal discussion and negotiations shall be resolved by litigation filed in the Superior Court for Spokane County, unless otherwise required by applicable federal or state law. 20. Subcontractor Responsibility. As required by RCW 39.06.020, the Contractor shall verify responsibility criteria for each first tier subcontractor and its subcontractors of any tier that hires other subcontractors shall verify responsibility criteria for each of its subcontractors. Verification shall include that each subcontractor, at the time of subcontract execution, meets the responsibility criteria listed in RCW 39.04.350(1) and possesses an electrical contractor license, if required by chapter 19.28 RCW, or an elevator contractor license if required by chapter 70.87 RCW. This verification requirement must be included in every subcontract of every tier. Construction Agreement Page 5 of 6 21. Jurisdiction and Venue. This Agreement is entered into in Spokane County, Washington. Venue shall be in Spokane County, State of Washington. 22. Entire Agreement. This Agreement constitutes the entire and complete agreement between the parties and supercedes any prior oral or written agreements. This Agreement may not be changed, modified or altered except in writing signed by the Parties. 23. Anti - kickback. No officer or employee of the City, having the power or duty to perform an official act or action related to this Agreement shall have or acquire any interest in this Agreement, or have solicited, accepted or granted a present or future gift, favor, service or other thing of value from any person with an interest in this Agreement. 24. Business Registration. Prior to commencement of Work under this Agreement, Contractor shall register with the City as a business. 25. Severability. If any section, sentence, clause or phrase of this Agreement should be held to be invalid for any reason by a court of competent jurisdiction, such invalidity shall not affect the validity of any other section, sentence, clause or phrase of this Agreement. 26. Exhibits. Exhibits attached and incorporated into this Agreement are: 1. Scope of Work 2. Insurance Certificates The Parties have executed this Agreement this day of '2012. ATTEST- Christine Bainbridge, City Clerk Contractor: Owner REDACTED Tax ID No._ APPROVED AS TO FORM: l Office oft e City Atto ey [has his document contains confidential tax information and been redacted pursuant to RCW 82.32.330. You may petition for a review of our findings pertaining to any redacted or withheld documents pursuant to Spokane Valley Municipal Code (SVMC) 2.75.080; and obtain judicial review pursuant to RCW 42.56.550. Construction Agreement Page 6 of 6 Exhibit 1 — Scope of Services Discovery Playground Play Elements Re- installation Project In general, the project consists of custom mounting bracket fabrication on play elements and reinstallation of those elements. 1. Discovery Playground is located at 2426 N. Discovery Place, Spokane Valley, WA 99216. 2. Contractor to: a. Pick up eagle eggs and fish and deliver to their shop. b. Construct templates as per plans and specifications. c. Remove clamp pieces and replace with owner provided clamps. d. Custom cut 1/8" aluminum plate — 2 each piece. e. Fabricate connection rod detail. f. Fasten plates to equipment as designed and thread existing pipe embeds. g. Install additional anchor bolts along with `Industrial Velcro" to base plates. h. Re- install playground pieces. 3. Contract cost to include all labor, materials and supplies necessary to perform the job along with any necessary permit fees. 4. Work to be completed by April 30, 2012. 5. CenterPlace representative for this project is: -Mike Stone - Office: 720 -5400 -Fax: 688 -0188 - mstone0spokanevalley.org PRODUCER AMLAN -1 04/04/12 THIS CERTIFICATE 19 I UED AS A MAI IER OF INFOR T10 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Western States Ins. - Spokane HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 501 N Riverpoint Blvd, Ste 403 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOV Spokane WA 99202 -1649 Phone: 509 - 838 -3501 Fax:509- 838 -3511 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A The Cincinnati Insurance Co. A.M. Landshaper, Inc. INSURER B: Mark Albin INSURER C: 8004 North Market Spokane WA 99217 INSURER D: l INSURER E: 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLEY EFFECTIVE DATE MM/D POLICY EXPIRATION DATE MM/D LIMITS A $ GENERAL LIABILITY COMMERCIAL GENERALLIABILfTY CLAIMS MADE ® OCCUR EPP0128051 02/24/12 02/24/13 EACH OCCURRENCE $1,000,000 $ i_T PREMISES (Ea,,. U ce) $ 100,000 MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY $ JECOT- LOC PRODUCTS - COMP/OP AGG $ 2,000,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS EPP0128051 02/24/12 02/24/13 COMBINED SINGLE LIMIT (Ea accident) 41 $ 1,000,000 BODILY INJURY (Par (Per person) $ BODILY INJURY (Per accident) $ $ PROPERTY DAMAGE (Per accident) $ BILITY TO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ BRELLA LIABILITY CLAIMSMADE IBLE ION $10, 000 NCArnu E('nUD--- EPP0128051 02/24/12 02/24/13 _ EACH OCCURRENCE $1,000,000 AGGREGATE $ $ AND EMPLOYERS LIABILITY wt sIATU- O - A ANY PROP RIETOR/PARTNER/EXECUrn�- Y�/W EEP0128051 TORYLIMffS ER OFFICERIMEMBEREXCLUDED? U 02/24/12 02/24/13 E.LEACHACCIDENr $ j,000,OOO (Mandatory in NH) WA STOP GAP ONLY If yes, describe under E.L DISEASE - EA EMPLOYE $1,000,000 SPECIAL PROVISIONS below OTHER E.L. DISEASE - POLICY LIMIT $1,000,000 A Equipment Floater EPP0128051 02/24/12 02/24/13 Leased $250,000 l>iSCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Rented $1000 DED B<: Discovery Park Playground Project Certificate Holder is named as Blanket Additional Insured per endorsment #GA233 02/07 including primary and non - contributory and waiver of subrogation, attached. 1H 11ricATE HOLDER City of Spokane Valley Attn: Mike Stone 11707 East Sprague Ave. Suite 106 i5pokane Valley WA 99206 25 (2009/01) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATR DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SMALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE AA 1 - n The ACORD name and loco are reoistered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. 25 4/9/12 8:51 AM State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360- 902 -5335 PO Box 44540, Olympia, WA 98504 -4540 Statement of Intent to Pay Prevailing Wage Document Received Intent Id: Affidavit Id: Status: Approved On Date: 4/5/2012 506639 4/6/2012 Company Details A M LANDSHAPER INC 8004 N. MARKET SPOKANE, WA 99217 509 - 468 -4335 Industrial Insurance Account Id: Filed By Prime Contractor Company Name Contractor Registration No. WA UBI Number Phone Number Project Information Awarding Agency UBI #: 601701273 Reg #: AMLANI *971 DO E -mail: amlandshaper @msn.com 816,368 -01 Albin, Mark A M LANDSHAPER INC AMLANI *971 DO 601701273 509 - 468 -4335 SPOKANE VALLEY, CITY OF 1170 7 EAST SPRAGUE AVE STE 106 SPOKANE VALLEY, WA - 99206 out: blank Page 1 of 3 Awarding Agency Contact Awarding Agency Contact Phone Number Contract Number Project Name Bid due date Award Date Project Site Address or Directions Intent Details 4/9/12 8:51 AM Mike Stone 509- 720 -5400 Discovery Playground Play Elements Re- installation Project 3/26/2012 3/30/2012 2426 N. Discovery Place Spokane Valley, WA 99216 Does your company intend to hire subcontractors to No perform all work? Does your company intend to hire any subcontractors? me Will your company have employees perform work on Yes this project? Do you intend to use any apprentices? (apprentices No are considered employees.) Will this project utilize American Recovery and No Reinvestment Act (ARRA) funds? Specifically, will this project utilize any No weatherization or energy efficiency upgrade funds (ARRA or otherwise)? How many owner /operators performing work on the 1 project own 30% or more of the company? What is the estimated contract amount? Or is this a $4,103.43 time and materials estimate? bout:blank Page 2 of 3 4/9/12 8:51 AM Expected project start date: (MM- DD -YYYY) 4/2/2012 In what county (or counties) will the project be Spokane done? In what city (or nearest city) will the project be Spokane Valley done? Journey Level Wages County Trade Occupation Wage Fringe Workers Spokane Playground & Park ,Journey Level $9.04 3 Equipment Installers =: Show /Hide Existing Notes -- On 4/5/2012:- - Work to be performed: The contractor shall do all work and furnish all labor for the construction and completion of reinstallation of play elements at Discovery Playground Park. The play equipment will be picked up by hand and reinstalled and anchored on a metal base to avoid being stolen. bout:blank Page 3 of 3 Verify Workers' Comp Premium Status - Employer Liability Certificate Washington State Department of Labor and Industries Department of Labor and Industries Employer Liability Certificate Date: 03/29/2012 UBI #: 601 701 273 Business Name: A M LANDSHAPER INC Legal Business Name: A M LANDSHAPER INC Account #: 816,368 -01 'Doing Business As' Name: A M LANDSHAPER INC Page 1 of 1 Employer Liability Certificate Estimated Workers Reported: Quarter 4 of Year 20117 to 10 Workers" (See Description Below) Workers' Comp Premium Status: Account is current. Firm has voluntarily reported and Licensed Contractor? License: Expire Date: paid their premiums. Yes AMLANI* 971 DO 2/24/2014 Account Representative: T2 / KATHY WITHERS (360)902 -4829 - Email: WITE235 @lni.wa.gov What does "Estimated Workers Reported" mean? Estimated workers reported represents the number of full time position requiring at least 480 hours of work per calendar quarter. A single 480 hour position may be filled by one person, or several part time workers. Industrial Insurance Information Employers report and pay premiums each quarter based on hours of employee work already performed, and are liable for premiums found later to be due. Industrial insurance accounts have no policy periods, cancellation dates, limitations of coverage or waiver of subrogation (See RCW 51.12.050 and 51.16.190). https: // fortress. wa. gov/ lni/ erpsi /AcctInfoPrint.aspx ?Accountld= 81636801 &AccountManag... 3/29/2012 AMLANDS-01 MWHITNEY ACOROY DATE(MM/DD/YYYY) 4.......---- CERTIFICATE OF LIABILITY INSURANCE 2/19/2014 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 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: Spokane-Riverpoint PHONE 509 838-3501 FAX 509 838-3511 PayneWest Insurance,Inc. INC,No.Ext):( ) (A/C,No):( ) 501 N.Riverpoint Blvd.,Ste 403 ADDRESS: Spokane,WA 99202 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:The Cincinnati Insurance Co. INSURED INSURER B: A.M.Landshaper,Inc. > INSURER C: Mark Albin INSURER D: 8004 North Market Spokane,WA 99217 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER (MM/DD//YYYY) (MM/DD/YYYY) LIMITS LTR INSR NND GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X EPP0128051 2/24/2014 2/24/2015 PREMISES Ea EoNc ence) $ 500,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 7 POLICY X 'ET LOC WA STOP GAP $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ A X ANY AUTO EPP0128051 2/24/2014 2/24/2015 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS _AUTOS X HIRED AUTOS X NON-OWNED (Peraccident)DAMAGE $ AUTOS $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE EPP0128051 2/24/2014 2/24/2015 AGGREGATE $ 1,000,000 DED X RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Equipment Floater EPP0128051 2/24/2014 2/24/2015 Leased and Rented 250,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Re:;Discovery Park Playground Project Certificate Holder is named as Blanket Additional Insured per endorsment#GA233 02/07 including primary and non-contributory and waiver of subrogation,attached. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Spokane Valley Attn:Mike Stone ACCORDANCE WITH THE POLICY PROVISIONS. 11707 East Sprague Ave. Suite 106 Spokane Valley,WA 99206 AUTHORIZED�RE'PP1RESENTATIVE e I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD 12._0 SO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS' COMMERCIAL GENERAL LIABILITY BROADENED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Endorsement-Table of Contents: Coverage: Begins on Page: 1. Employee Benefit Liability Coverage 2 2. Unintentional Failure to Disclose Hazards 7 3. Damage to Premises Rented to You 8 4. Supplementary Payments 9 5. Medical Payments 9 6. Voluntary Property Damage (Coverage a.)and Care,Custody or Control Liability Coverage(Coverage b.) 9 7. 180 Day Coverage for Newly Formed or Acquired Organizations 10 8. Waiver of Subrogation 10 9. Automatic Additional Insured -Specified Relationships: 10 • Managers or Lessors of Premises; • Lessor of Leased Equipment; • Vendors; • State or Political Subdivisions-Permits Relating to Premises; • State or Political Subdivisions-Permits;and • Contractors'Operations 10. Broadened Contractual Liability-Work Within 50'of Railroad Property 14 11. Property Damage to Borrowed Equipment 14 12. Employees as Insureds-Specified Health Care Services: 14 • Nurses; • Emergency Medical Technicians;and • Paramedics 13. Broadened Notice of Occurrence 14 B. Limits of Insurance: The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorse- ment,except as provided below: 1. Employee Benefit Liability Coverage Each Employee Limit: $ 1,000,000 Aggregate Limit: $ 3,000,000 Deductible: $ 1,000 3. Damage to Premises Rented to You The lesser of: a. The Each Occurrence Limit shown in the Declarations;or b. $500,000 unless otherwise stated$ 4. Supplementary Payments a. Bail bonds: $ 1,000 b. Loss of earnings: $ 350 5. Medical Payments Medical Expense Limit: $ 10,000 Includes copyrighted material of Insurance GA 233 02 07 Services Office,Inc.,with its permission. Page 1 of 15 6. Voluntary Property Damage (Coverage a.)and Care, Custody or Control Liability Coverage (Coverage b.) Limits of Insurance (Each Occurrence) Coverage a.$1,000 Coverage b.$5,000 unless otherwise stated $ Deductibles(Each Occurrence) Coverage a.$250 Coverage b.$250 unless otherwise stated $ COVERAGE PREMIUM BASIS RATE ADVANCE PREMIUM (a) Area (For Limits in Excess of (For Limits in Excess of (b) Payroll $5,000) $5,000) (c) Gross Sales (d) Units (e) Other b. Care, Custody $ or Control TOTAL ANNUAL PREMIUM $ 11. Property Damage to Borrowed Equipment Each Occurrence Limit: $ 10,000 Deductible: $ 250 C. Coverages: have used up the ap- plicable insur- 1. Employee Benefit Liability Coverage ance in the limit of a. The following is added to SECTION I judgments or settle- - COVERAGES: Employee Benefit ments. Liability Coverage. No other obligation or liabil- ity to pay sums or perform acts or services is covered (a) We will pay those sums that unless explicitly provided for the insured becomes legally under Supplementary Pay- obligated to pay as dam- ments. ages caused by any act, er- (b) This insurance applies to ror or omission of the in- damages only if the act, er- sured, or of any other per ror or omission, is negli- son for whose acts the in gently committed in the sured is legally liable, to "administration" of your which which this insurance ap- "employee benefit pro- plies. We will have the right gram"; and and duty to defend the in- sured against any "suit" 1) Occurs during the pol- seeking those damages. icy period; or However, we will have no duty to defend against any 2) Occurred prior to the "suit" seeking damages to effective date of this which this insurance does endorsement provided: not apply. We may, at our discretion, investigate any a) You did not have report of an act, error or knowledge of a omission and settle any claim or "suit" on claim or "suit" that may re- or before the ef- sult. But: fective date of this endorsement. 1) The amount we will pay for damages is limited You will be as described in SEC- deemed to have TION III - LIMITS OF knowledge of a INSURANCE;and claim or "suit" when any 2) Our right and duty to "authorized repre- defend ends when we sentative"; Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 2 of 15 i) Reports all, or formance of investment any part, of the vehicles;or act, error or omission to us 3) Advice given to any or any other person with respect to insurer; that person's decision to participate or not to ii) Receives a participate in any plan written or ver- included in the "em- bal demand or ployee benefit pro- claim for dam- gram". ages because of the act, er- (f) Workers' Compensation ror or orris- and Similar Laws sion;and Any claim arising out of b) There is no other your failure to comply with applicable insur- the mandatory provisions of ance. any workers'compensation, unemployment compensa- (2) Exclusions tion insurance, social secu- rity insurance does not apply rity or disability benefits law PP y or any similar law. to: (a) Bodily Injury, Property (g) ERISA Damage or Personal and Damages for which any in- Advertising Injury sured is liable because of "Bodil injury", "property liability imposed on a fiduci- Y 1 rY P P y ary by the Employee Re- damage" or "personal and tirement Income Security advertising injury". Act of 1974, as now or (b) Dishonest, Fraudulent, hereafter amended, or by Criminal or Malicious Act any similar federal, state or local laws. Damages arising out of any (h) Available Benefits intentional, dishonest, fraudulent, criminal or mali- Any claim for benefits to the cious act, error or omission, extent that such benefits committed by any insured, are available, with reason- including the willful or reck- able effort and cooperation less violation of any statute. of the insured, from the ap- (c) Failure to Perform a Con- plicable funds accrued or tract other collectible insurance. Damages arising out of fail (i) Taxes, Fines or Penalties ure of performance of con- Taxes, fines or penalties, tract by any insurer. including those imposed (d) Insufficiency of Funds under the Internal Revenue Code or any similar state or Damages arising out of an local law. insufficiency of funds to meet any obligations under (j) Employment-Related any plan included in the Practices "employee benefit pro- Any liability arising out of gram". any: (e) Inadequacy of Perform- (1) Refusal to employ; ance of Investment / Ad- vice Given With Respect (2) Termination of em- to Participation ployment; Any claim based upon: (3) Coercion, demotion, 1 Failure of any invest- evaluation, reassign- 1) Y ment, discipline, defa- ment to perform; mation, harassment, 2) Errors in providing in- humiliation, discrimina- formation on past per tion or other employ- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 3 of 15 ment-related practices, (e) A trust, you are an insured. acts or omissions;or Your trustees are also in- sureds, but only with re- (4) Consequential liability spect to their duties as as a result of(1), (2) or trustees. (3)above. (2) Each of the following is also an This exclusion applies insured: whether the insured may be held liable as an employer (a) Each of your "employees" or in any other capacity and who is or was authorized to to any obligation to share administer your "employee damages with or repay benefit program". someone else who must (b) Any persons, organizations pay damages because of or "employees" having the injury. proper temporary authori- (3) Supplementary Payments zation to administer your "employee benefit program" SECTION I - COVERAGES, if you die, but only until your SUPPLEMENTARY PAY- legal representative is ap- MENTS - COVERAGES A AND pointed. B also apply to this Coverage. (c) Your legal representative if b. Who is an Insured you die, but only with re- As respects Employee Benefit Liabil spect to duties as such. ity Coverage, SECTION II - WHO IS That representative will AN INSURED is deleted in its en- have all your rights and du- tirety and replaced by the following: ties under this Coverage Part. (1) If you are designated in the (3) Any organization you newly ac- Declarations as: quire or form, other than a part- (a) An individual, you and your nership, joint venture or limited spouse are insureds, but liability company, and over only with respect to the which you maintain ownership conduct of a business of or majority interest, will qualify which you are the sole as a Named Insured if no other owner. similar insurance applies to that organization. However, cover- (b) A partnership or joint ven- age under this provision: ture, you are an insured. Your members, your part- (a) Is afforded only until the ners, and their spouses are 180th day after you acquire also insureds but only with or form the organization or respect to the conduct of the end of the policy period, your business. whichever is earlier;and (c) A limited liability company, (b) Does not apply to any act, you are an insured. Your error or omission that was members are also insureds, committed before you ac- but only with respect to the quired or formed the or- conduct of your business. ganization. Your managers are in- c. Limits of Insurance sureds, but only with re- spect to their duties as your As respects Employee Benefit Liabil- managers. ity Coverage, SECTION III - LIMITS (d) An organization other than OF INSURANCE is deleted in its en- a partnership, joint venture tirety and replaced by the following: or limited liability company, (1) The Limits of Insurance shown you are an insured. Your in Section B. Limits of Insur- "executive officers" and di- ance, 1. Employee Benefit Li- rectors are insureds, but ability Coverage and the rules only with respect to their below fix the most we will pay duties as your officers or di- regardless of the number of: rectors. Your stockholders are also insureds, but only (a) Insureds; with respect to their liability as stockholders. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 4 of 15 (b) Claims made or "suits" (b) The deductible amount brought; stated in the Declarations (c) Persons or organizations applies to all damages ( ) 9 sustained by any one "em- making claims or bringing ployee", including such "suits"; "employee's" dependents (d) Acts,errors or omissions;or and beneficiaries, because of all acts, errors or omis- (e) Benefits included in your sions to which this insur- "employee benefit pro- ance applies. gram". (c) The terms of this insurance, (2) The Aggregate Limit shown in including those with respect Section B. Limits of Insurance, to: 1. Employee Benefit Liability 1) Our right and duty to Coverage of this endorsement defend the insured is the most we will pay for all damages because of acts, er- against any "suits" rors or omissions negligently seeking those dam- committed in the "administra- tion" of your "employee benefit 2) Your duties, and the program". duties of any other in- (3) Subject to the limit described in volved insured, in the (2) above, the Each Employee event of an act, error or omission,or claim, Limit shown in Section B. Limits of Insurance, 1. Employee apply irrespective of the Benefit Liability Coverage of application of the deductible this endorsement is the most we amount. will pay for all damages sus- tained by any one "employee", (d) We may pay any part or all including damages sustained by of the deductible amount to such "employee's" dependents effect settlement of any and beneficiaries,as a result of: claim or "suit" and, upon notification of the action (a) An act, error or omission;or taken, you shall promptly (b) A series of related acts, er- reimburse us for such part r of the deductible amount as ors or omissions, regard- less of the amount of time we have paid. that lapses between such d. Additional Conditions acts,errors or omissions, committed in the As respects Employee Benefit Li- negligently ability Coverage, SECTION IV - "administration" of your "em- COMMERCIAL GENERAL LIABIL- ployee benefit program". ITY CONDITIONS is amended as However, the amount paid un- follows: der this endorsement shall not (1) Item 2. Duties in the Event of exceed, and will be subject to Occurrence, Offense, Claim or the limits and restrictions that Suit is deleted in its entirety and apply to the payment of benefits replaced by the following: in any plan included in the "em- ployee benefit program". 2. Duties in the Event of an Act, Error or (4) Deductible Amount Omission,or Claim or Suit a. You must see to it that we are noti- (a) Our obligation to pay dam- fied as soon as practicable of an act, ages on behalf of the in- error or omission which may result in sured applies only to the a claim. To the extent possible, no- amount of damages in ex- tice should include: cess of the deductible amount stated in the Decla- (1) What the act, error or omission rations as applicable to was and when it occurred; and Each Employee. The limits of insurance shall not be (2) The names and addresses of reduced by the amount of anyone who may suffer dam- this deductible. ages as a result of the act, error or omission. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 5 of 15 b. If a claim is made or"suit" is brought b. Method of Sharing against any insured,you must: If all of the other insur- (1) Immediately record the specifics ance permits contribu- of the claim or "suit" and the tion by equal shares, date received; and we will follow this method also. Under (2) Notify us as soon as practicable. this approach each in- You must see to it that we receive surer contributes equal written notice of the claim or"suit" as amounts until it has soon as practicable. paid its applicable limit of insurance or none of c. You and any other involved insured the loss remains, must: whichever comes first. (1) Immediately send us copies of If any of the other in- any demands, notices, sum- surance does not per- monses or legal papers re- mit contribution by ceived in connection with the equal shares, we will claim or"suit"; contribute by limits. Under this method, (2) Authorize us to obtain records each insurer's share is and other information; based on the ratio of its Cooperate with us in the investi- applicable limit of in- (3) Coo p surance to the total ap- gation or settlement of the claim plicable limits of insur- or defense against the "suit"; ance of all insurers. and (4) Assist us, upon our request, in c. No Coverage the enforcement of any right This insurance shall not against any person or organiza- cover any loss for tion which may be liable to the which the insured is insured because of an act, error entitled to recovery un- or omission to which this insur- der any other insur- ance may also apply. ance in force previous d. No insured will, except at that in- to the effective date of sured's own cost, voluntarily make a this Coverage Part. payment, assume any obligation, or e. Additional Definitions incur any expense without our con- sent. As respects Employee Benefit Li- ability Coverage, SECTION V - (2) Item 5. Other Insurance is de- DEFINITIONS is amended as fol- leted in its entirety and replaced lows: by the following: (1) The following definitions are 5. Other Insurance added: If other valid and collectible 1. "Administration"means: insurance is available to the insured for a loss we cover a. Providing information to under this Coverage Part, "employees", including our obligations are limited their dependents and as follows: beneficiaries, with re- spect to eligibility for or a. Primary Insurance scope of "employee This insurance is pri- benefit programs"; mary except when c. b. Interpreting the "em- below applies. If this ployee benefit pro- insurance is primary, grams"; our obligations are not affected unless any of c. Handling records in the other insurance is connection with the also primary. Then, we "employee benefit pro- will share with all that grams";or other insurance by the d. Effecting, continuing or method described in b. terminating any "em- ployee's"ployee's" participation Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 6 of 15 in any benefit included benefits, workers' corn- in the "employee bene- pensation and disability fit program". benefits;and However, "administration" d. Vacation plans, includ- does not include: ing buy and sell pro- grams;a roll de- leave of ab- s. Handling p Y sence programs, in- ductions;or cluding military, mater- b. The failure to effect or nity, family, and civil maintain any insurance leave; tuition assis- or adequate limits of tance plans; transpor- coverage of insurance, tation and health club including but not limited subsidies. to unemployment in- (2) The following definitions are surance, social security deleted in their entirety and re- benefits, workers' com- placed by the following: pensation and disability benefits. 21. "Suit" means a civil pro- ceeding means ceeding in which money 2. "Cafeteria P damages because of an plan authorized by applica- act, error or omission to ble law to allow "employ- which this insurance applies ees" to elect to pay for cer- are alleged. "Suit"includes: tain benefits with pre-tax dollars. a. An arbitration pro- ceeding in which such 3. "Employee benefit pro- damages are claimed grams" means a program and to which the in- providing some or all of the sured must submit or following benefits to "em- does submit with our ployees", whether provided consent; through a "cafeteria plan" or otherwise: b. Any other alternative dispute resolution pro- a. Group life insurance; ceeding in which such group accident or damages are claimed health insurance; den- and to which the in- tal, vision and hearing sured submits with our plans; and flexible consent; or spending accounts; provided that no one c. An appeal of a civil other than an "em- proceeding. ployee" may subscribe to such benefits and 8. "Employee" means a per- such benefits are made son actively employed, for- generally available to merly employed, on leave those "employees"who of absence"Employee"disabled, or satisfy the plan's eligi- retired. Employee in- bility requirements; dudes a "leased worker". "Employee" does not in- b. Profit sharing plans, dude a"temporary worker". employee savings plans, employee stock 2. Unintentional Failure to Disclose Haz- ownership plans, pen- ards sion plans and stock SECTION IV- COMMERCIAL GENERAL subscription plans, LIABILITY CONDITIONS, 7. Represen- provided that no one tations is hereby amended by the addi- other than an "em- tion of the following: ployee" may subscribe to such benefits and Based on our dependence upon your such benefits are made representations as to existing hazards, if generally available to unintentionally you should fail to disclose all "employees" who all such hazards at the inception date of are eligible under the your policy, we will not reject coverage plan for such benefits; under this Coverage Part based solely on c. Unemployment insur such failure. ance, social security Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 7 of 15 3. Damage to Premises Rented to You e) Settling, cracking, shrinking or ex- a. The last Subparagraph of Paragraph pansion; or 2. SECTION I - COVERAGES, COVERAGE A. - BODILY INJURY f) Nesting or infesta- AND PROPERTY DAMAGE, 2. LI- tion, or discharge ABILITY Exclusions is hereby de- or release of leted and replaced by the following: waste products or secretions, by in- Exclusions c.through q.do not apply sects, birds, ro- to damage by fire, explosion, light- dents or other ning, smoke or soot to premises animals. while rented to you or temporarily occupied by you with permission of (b) Loss caused directly or indi- the owner. rectly by any of the follow- b. The insurance provided under SEC- ing: TION I - COVERAGES, COVERAGE 1) Earthquake, volcanic A. BODILY INJURY AND PROP- eruption, landslide or ERTY DAMAGE LIABILITY applies any other earth move- to "property damage" arising out of ment; water damage to premises that are 2) Water that backs up or both rented to and occupied by you. overflows from a (1) As respects Water Damage Le- sewer,drain or sump; gal Liability, as provided in 3) Water under the Paragraph 3.b.above: ground surface press- The exclusions under SECTION ing on, or flowing or I - COVERAGES, COVERAGE seeping through: A. BODILY INJURY AND Foundations, or PROPERTY DAMAGE LIABIL- a) Foun, floors 2. Exclusions, other than i. paved surfaces; oors War and the Nuclear Energy Liability Exclusion, are deleted b) Basements, and the following are added: whether paved or This insurance does not apply not; or to: c) Doors, windows or (a) "Property damage": other openings. 1) Assumed in any con- (c) Loss caused by or resulting tract;or from water that leaks or flows from plumbing, heat- 2) Loss caused by or re- ing, air conditioning, or fire suiting from any of the protection systems caused following: by or resulting from freez- ing, unless: a) Wear and tear; 1) You did your best to b) Rust, corrosion, maintain heat in the fungus, decay, building or structure;or deterioration, hid- den or latent de- 2) You drained the fect or any quality equipment and shut off in property that the water supply if the causes it to dam- heat was not main- age or destroy it- tained. self; (d) Loss to or damage to: c) Smog; 1) Plumbing, heating, air d) Mechanical conditioning, fire pro- breakdown in- tection systems, or cluding rupture or other equipment or ap- bursting caused pliances;or by centrifugal 2) The interior of any force; building or structure, or to personal property in the building or structure Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 8 of 15 caused by or resulting 5. Medical Payments from rain, snow, sleet or ice, whether driven The Medical Expense Limit of Any One by wind or not. Person as stated in the Declarations is amended to the limit shown in Section B. c. Limit of Insurance Limits of Insurance, 5. Medical Pay- ments of this endorsement. The Damage to Premises Rented to You Limit as shown in the Declara- 6. Voluntary Property Damage and Care, tions is amended as follows: Custody or Control Liability Coverage (2) Paragraph 6. of SECTION III - a. Voluntary Property Damage Cov- LIMITS OF INSURANCE is erage hereby deleted and replaced by the following: We will pay for"property damage" to property of others arising out of op- 6. Subject to 5. above, the erations incidental to the insured's Damage to Premises business when: Rented to You Limit is the most we will pay under (1) Damage is caused by the in- COVERAGE A. BODILY sured; or INJURY AND PROPERTY (2) Damage occurs while in the in- DAMAGE LIABILITY, for sured's possession. damages because of "property damage" to With your consent, we will make premises while rented to these payments regardless of fault. you or temporarily occupied by you with permission of b. Care, Custody or Control Liability the owner, arising out of Coverage any one "occurrence" to SECTION I - COVERAGES, COV- which this insurance ap- ERAGE A. BODILY INJURY AND plies. PROPERTY DAMAGE LIABILITY, 2. (3) The amount we will pay is lim- Exclusions,j. Damage to Property, ited as described in Section B. Subparagraphs (3), (4) and (5) do Limits of Insurance, 3. Dam- not apply to "property damage" to age to Premises Rented to the property of others described You of this endorsement. therein. 4. Supplementary Payments With respect to the insurance provided by this section of the endorsement, the fol- Under SECTION I - COVERAGE, SUP- lowing additional provisions apply: PLEMENTARY PAYMENTS - COVER- AGES A AND B: a. The Limits of Insurance shown in the Declarations are replaced by the lim- a. Paragraph 2. is replaced by the fol- its designated in Section B.Limits of lowing: Insurance, 6. Voluntary Property Up to the limit shown in Section B. Damage and Care, Custody or P Control Liability Coverage of this Limits of Insurance,4.a. Bail Bonds endorsement with respect to cover- of this endorsement for cost of bail age provided by this endorsement. bonds required because of accidents These limits are inclusive of and not or traffic law violations arising out of in addition to the limits being re- the use of any vehicle to which the placed. The Limits of Insurance Bodily Injury Liability Coverage ap- shown in Section B. Limits of Insur- plies. We do not have to furnish ance, 6. Voluntary Property Dam- these bonds. age and Care, Custody or Control b. Paragraph 4. is replaced by the fol- Liability Coverage of this endorse- lowing: fix the most we will pay in any lowin g: one "occurrence" regardless of the All reasonable expenses incurred by number of: the insured at our request to assist us in the investigation or defense of (1) Insureds; the claim or "suit", including actual (2) Claims made or "suits" brought; loss of earnings up to the limit shown or in Section B. Limits of Insurance, 4.b. Loss of Earnings of this en- (3) Persons or organizations mak- dorsement per day because of time ing claims or bringing"suits". off from work. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 9 of 15 b. Deductible Clause 9. Automatic Additional Insured - Speci- fied Relationships (1) Our obligation to pay damages on your behalf applies only to a. The following is hereby added to the amount of damages for each SECTION II-WHO IS AN INSURED: "occurrence" which are in ex- cess of the deductible amount (1) Any person or organization de- stated in Section B. Limits of scribed in Paragraph 9.a.(2) Insurance, 6. Voluntary Prop- below (hereinafter referred to as erty Damage and Care, Cus- additional insured) whom you tody or Control Liability Cov- are required to add as an addi- erage of this endorsement. The tional insured under this Cover- limits of insurance will not be re- age Part by reason of: duced by the application of such (a) A written contract or deductible amount. agreement;or (2) Condition 2. Duties in the Event (b) An oral agreement or con- of Occurrence, Offense, Claim tract where a certificate of or Suit, applies to each claim or insurance showing that per- suit'irrespective of the amount. son or organization as an (3) We may pay any part or all of additional insured has been the deductible amount to effect issued, settlement of any claim or "suit" is an insured, provided: and, upon notification of the ac- tion taken, you shall promptly (a) The written or oral contract reimburse us for such part of the or agreement is: deductible amount as has been paid by us. 1) Currently in effect or becomes effective 7. 180 Day Coverage for Newly Formed or during the policy pe- Acquired Organizations Hod;and SECTION II - WHO IS AN INSURED is 2) Executed prior to an amended as follows: "occurrence" or offense Subparagraph a. of Paragraph 4. is to which this insurance would apply;and hereby deleted and replaced by the fol- lowing: (b) They are not specifically provision is af- named as an additional in- a. Insurance under this p sured under any other pro- forded only until the 180th day after vision of, or endorsement you acquire or form the organization added to, this Coverage or the end of the policy period, Part. whichever is earlier; 8. Waiver of Subrogation (2) Only the following persons or 9 organizations are additional in- SECTION IV-COMMERCIAL GENERAL sureds under this endorsement, LIABILITY CONDITIONS, 9. Transfer of and insurance coverage pro- Rights of Recovery Against Others to vided to such additional in- Us is hereby amended by the addition of sureds is limited as provided the following: herein: We waive any right of recovery we may (a) The manager or lessor of a have because of payments we make for premises leased to you with injury or damage arising out of your on- whom you have agreed per going operations or"your work"done un- Paragraph 9.a.(1) above to der a written contract requiring such provide insurance, but only waiver with that person or organization with respect to liability aris- and included in the "products-completed ing out of the ownership, operations hazard". However, our rights maintenance or use of that may only be waived prior to the "occur- part of a premises leased to rence" giving rise to the injury or damage you, subject to the following for which we make payment under this additional exclusions: Coverage Part. The insured must do This insurance does not nothing after a loss to impair our rights. apply to: At our request,the insured will bring "suit" or transfer those rights to us and help us 1) Any "occurrence" enforce those rights. which takes place after Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 10 of 15 you cease to be a ten- c) Any physical or ant in that premises. chemical change in the product 2) Structural alterations, made intentionally new construction or by the vendor; demolition operations performed by or on be- d) Repackaging, un- half of such additional less unpacked insured. solely for the pur- pose of o on, (b) Any p erson or organization dem on stration, from which you lease testing, or the equipment with whom you substitution of have agreed per Paragraph parts under in- 9.a.(1) above to provide in- structions from the surance. Such person(s)or manufacturer, and organization(s)are insureds then repackaged solely with respect to their in the original liability arising out of the container; maintenance, operation or use by you of equipment e) Any failure to leased to you by such per- make such in- son(s) or organizations(s). spections, adjust- However, this insurance ments, tests or does not apply to any "oc- servicing as the currence"which takes place vendor has after the equipment lease agreed to make or expires. normally under- takes to make in (c) Any person or organization the usual course (referred to below as ven- of business, in dor) with whom you have connection with agreed per Paragraph the distribution or 9.a.(1) above to provide in- sale of the prod- surance, but only with re- ucts; spect to "bodily injury" or "property damage" arising f) Demonstration, in- out of"your products"which stallation, servic- are distributed or sold in the ing or repair op- regular course of the ven- erations, except dor's business, subject to such operations the following additional ex- performed at the clusions: vendor's premises in connection with 1) The insurance afforded the sale of the the vendor does not product; apply to: "Bodily injury" or g) Products which, a Y 1 rY' after distribution or "property damage" sale by you, have for which the ven- been labeled or dor is obligated to relabeled or used pay damages by as a container, reason of the as- part or ingredient sumption of liabil- of any other thing ity in a contract or or substance by or agreement. This for the vendor. exclusion does not apply to liability for 2) This insurance does damages that the not apply to any in- vendor would sured person or or- have in the ab- ganization: sence of the con- tract or agree- a) From whom you ment; have acquired such products, or b) Any express war- any ingredient, ranty unauthorized part or container, by you; entering into, ac- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 11 of 15 companying or 2) This insurance does containing such not apply to "bodily in- products;or jury", "property dam- age" When liability in- age" or "personal and Y advertising injury" aris- cluded within the ing out of operations "products- performed for the state completed opera- or political subdivision. tions hazard" has been excluded (f) Any person or organization under this Cover- with which you have agreed age Part with re- per Paragraph 9.a.(1) spect to such above to provide insurance, products. but only with respect to li- ability Any state or political subdi- ability arising out of "your (d) Y p work" performed for that vision with which you have additional insured by you or agreed per Paragraph on your behalf. A person or 9.a.(1) above to provide in- organization's status as an surance, subject to the fol- insured under this provision lowing additional provision: of this endorsement contin- This insurance applies only ues for only the period of time required by the written with respect to the following hazards for which the state contract or agreement, but or political subdivision has in no event beyond the ex- issued a permit in connec- piration date of this Cover- tion with premises you own, age Part. If there is no rent or control and to which written contract or agree this insurance applies: ment, or if no period of time is required by the written 1) The existence, mainte- contract or agreement, a nance, repair, con- person or organization's struction, erection, or status as an insured under removal of advertising this endorsement ends signs, awnings, cano- when your operations for pies, cellar entrances, that insured are completed. coal holes, driveways, (3) Any insurance provided to an manholes, marquees, additional insured designated hoist away openings, under Paragraph 9.a.(2): sidewalk vaults, street banners, or decora- (a) Subparagraphs (e) and (f) tions and similar expo- does not apply to "bodily sures;or injury"or"property damage" 2) The construction, erec- included within the "prod- tion, or removal of ele- ucts-completed operations vators;or hazard"; 3) The ownership, main- (b) Subparagraphs (a), (b), (d), tenance, or use of any (e)and (f) does not apply to elevators covered by "bodily injury", "property this insurance. damage" or "personal and advertising injury arising (e) Any state or political subdi- out of the sole negligence vision with which you have or willful misconduct of the agreed per Paragraph additional insured or their 9.a.(1) above to provide in- agents, "employees" or any surance, subject to the fol- other representative of the lowing provisions: additional insured;or 1) This insurance applies (c) Subparagraph (f) does not only with respect to op- apply to "bodily injury", erations performed by "property damage" or "per- you or on your behalf sonal and advertising injury" for which the state or arising out of: political subdivision has 1) Defects in design fur- issued a permit. nished by or on behalf Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 12 of 15 of the additional in- spects any other insurance sured;or policy issued to the addi- tional The rendering of, tional insured, and such 9 , or other insurance policy shall failure to render, any be excess and /or noncon- professional architec- tributing, whichever applies, tural, engineering or with this insurance. surveying services, in- cluding: (b) Any insurance provided by this endorsement shall be a) The preparing, primary to other insurance approving or fail- available to the additional ing to prepare or insured except: approve maps, shop drawings, 1) As otherwise provided opinions, reports, in SECTION IV surveys, field or- COMMERCIAL GEN- ders, change or- ERAL LIABILITY ders or drawings CONDITIONS,5. Other and specifications; Insurance, b. Excess and Insurance;or b) Supervisory, in- 2) For any other valid and spection, archi- collectible insurance tectural or engi- available to the addi- neering activities. tional insured as an 3) "Your work"for which a additional insured by attachment of an en- consolidated (wrap-up) dorsement to another insurance program has insurance policy that is been provided by the written on an excess primecontractor-project basis. In such case, manager or owner of the coverage provided the construction project under this endorse- in which you are in- ment shall also be ex- volved. cess. b. Only with regard to insurance pro- (2) Condition 11. Conformance to vided to an additional insured desig- Specific Written Contract or nated under Paragraph 9.a.(2) Sub- Agreement is hereby added: paragraph (f) above, SECTION III - LIMITS OF INSURANCE is amended 11. Conformance to Specific to include: Written Contract or Agreement The limits applicable to the additional insured are those specified in the With respect to additional written contract or agreement or in insureds described in Para- the Declarations of this Coverage graph 9.a.(2)(f)above only: Part,whichever are less. If no limits are specified in the written contract If a written contract or or agreement, or if there is no written agreement between you contract or agreement, the limits ap- and the additional insured plicable to the additional insured are specifies that coverage for those specified in the Declarations of the additional insured: this Coverage Part. The limits of in- a. Be provided by the In- surance are inclusive of and not in surance Services Of- addition to the limits of insurance fice additional insured shown in the Declarations. form number CG 20 10 c. SECTION IV - COMMERCIAL GEN- or CG 20 37 (where ERAL LIABILITY CONDITIONS is edition specified);or hereby amended as follows: b. Include coverage for (1) Condition 5. Other Insurance is completed operations; amended to include: or (a) Where required by a written c. Include coverage for contract or agreement, this "your work"; insurance is primary and / and where the limits or cov- or noncontributory as re- erage provided to the addi- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 13 of 15 tional insured is more re- 11. of this endorsement fix the strictive than was specifi- most we will pay in any one "oc- cally required in that written currence" regardless of the contract or agreement, the number of: terms of Paragraphs 9.a.(3)(a), 9.a.(3)(b) or 9.b. (a) Insureds; above, or any combination (b) Claims made or "suits" thereof, shall be interpreted brought;or as providing the limits or coverage required by the (c) Persons or organizations terms of the written contract making claims or bring or agreement, but only to "suits". the extent that such limits or coverage is included within (2) Deductible Clause the terms of the Coverage (a) Our obligation to pay dam- Part to which this endorse- ages on your behalf applies ment is attached. If, how- only to the amount of dam- ever, the written contract or ages for each "occurrence" agreement specifies the In- which are in excess of the surance Services Office Deductible amount stated in additional insured form Section B. Limits of Insur- number CG 20 10 but does ante, 11. of this endorse- not specify which edition, or ment. The limits of insur- specifies an edition that ance will not be reduced by does not exist, Paragraphs the application of such De- 9.a.(3)(a) and 9.a.(3)(b) of ductible amount. this endorsement shall not apply and Paragraph 9.b. of (b) Condition 2. Duties in the this endorsement shall ap- Event of Occurrence, Of- Ply. fense, Claim or Suit, ap- 10. Broadened Contractual Liability-Work plies to each claim or "suit" Within 50'of Railroad Property irrespective of the amount. It is hereby agreed that Paragraph f.(1)of (c) We may pay any part or all Definition 12. "Insured contract" (SEC- of the deductible amount to TION V-DEFINITIONS)is deleted. effect settlement of any claim or "suit" and, upon 11. Property Damage to Borrowed Equip- notification of the action ment taken, you shall promptly reimburse us for such part a. The following is hereby added to Ex- of the deductible amount as clusion j. Damage to Property of has been paid by us. Paragraph 2., Exclusions of SEC- TION I -COVERAGES, COVERAGE 12. Employees as Insureds - Specified A. BODILY INJURY AND PROP- Health Care Services ERTY DAMAGE LIABILITY: It is hereby agreed that Paragraph Paragraphs (3) and (4) of this exclu- 2.a.(1)(d) of SECTION II - WHO IS AN sion do not apply to tools or equip- INSURED, does not apply to your "em- ment loaned to you, provided they ployees"who provide professional health are not being used to perform opera- care services on your behalf as duly li- tions at the time of loss. censed: b. With respect to the insurance pro- a. Nurses; vided by this section of the en- b. Emergency Medical Technicians;or dorsement, the following additional provisions apply: c. Paramedics, (1) The Limits of insurance shown in the jurisdiction where an "occurrence" in the Declarations are replaced or offense to which this insurance applies by the limits designated in Sec- takes place. tion B. Limits of Insurance, 11. of this endorsement with respect 13. Broadened Notice of Occurrence to coverage provided by this endorsement. These limits are Paragraph a. of Condition 2. Duties in inclusive of and not in addition to the Event of Occurrence, Offense, the limits being replaced. The Claim or Suit (SECTION IV- COMMER- Limits of Insurance shown in CIAL GENERAL LIABILITY CONDI- Section B. Limits of Insurance, Includes copyrighted material of Insurance GA 233 02 07 Services Office,Inc.,with its permission. Page 14 of 15 TIONS) is hereby deleted and replaced (2) The names and addresses of by the following: any injured persons and wit- a. You must see to it that we are noti- nesses; and fied as soon as practicable of an (3) The nature and location of any "occurrence" or an offense which injury or damage arising out of may result in a claim. To the extent the"occurrence"or offense. possible, notice should include: This requirement applies only when (1) How, when and where the "oc- the"occurrence" or offense is known currence"or offense took place; to an "authorized representative". Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 15 of 15