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Home My WebLink About5682AGENDA BILL CITY OF BREMERTON CITY COUNCIL 3� SUBJECT: Public Works Agreement with Study Session Date: April 26, 2017 Sabelhaus West, Inc. for Rehabilitation and COUNCIL MEETING Date: May 3, 2017 Painting of Interior Block Walls of two (2) Department: PW&U Chlorine Contact Chambers at the Westside Presenter: Pat Coxon Wastewater Treatment Plant Phone: (360) 473-5448 SUMMARY: The existing paint on the chlorine contact chambers walls has been in place since 1985, is cracked and peeling, and needs to be replaced. Staff requested proposals from six painting companies listed on the MRSC small works roster to strip, clean, paint and reseal the walls in both of the chlorine contact chambers. We received four proposals and selected the proposal from Sabelhaus West, Inc. in the amount of $84,629.01, including Washington State sales tax. ATTACHMENTS: 1) Staff Memo; 2) Vendor Quotes: 3) Pictures of Contact Chamber Walls; and 4) Public; Works Agreement FISCAL IMPACTS (Include Budgeted Amount): Included in the 2017 WW CIP with a budget of $200,000. STUDY SESSION AGENDA: 0 No Presentation ❑ Full Presentation STUDY SESSION ACTION: 0 Consent Agenda ❑ General Business ❑ Public Hearing RECOMMENDED MOTION: Move to approve the Public Works Agreement with Sabelhaus West, Inc. in the amount of $84,629.01, including Washington State sales tax; and authorize the Mayor to finalize and execute the agreement with substantially the same terms and conditions as presented. COUNCIL ACTION: [j/Approve Form Updated 01/07/15 ❑ Deny ❑ Table ❑ Continue ❑ No Action PUBLIC WORKS AGREEMENT THIS AGREEMENT, is entered into between the City of Bremerton, a Washington Municipal Corporation ("City"), and Sabelhaus West, Inc. ("Contractor"), whose mailing address is 10880 Old Frontier Road NW, Silverdale, WA 98383 The parties agree as follows: 1. CONTRACTOR SERVICES. The Contractor shall perform the following services for the City: all services described in the Contractor's Proposal dated March 2, 2017. 2. TIME OF COMPLETION. Contractor shall complete the work within one hundred & eighty (180) calendar days from the date of issuance of the City's Notice to Proceed, or as otherwise agreed in writing by the parties. 3. COMPENSATION. The City shall pay the Contractor the total amount of $84,396.08, plus any applicable Washington State Sales Tax, for the work and services contemplated in this agreement. The Contractor shall invoice the City monthly. The City will pay for the portion of the work described in the invoice that has been completed by the Contractor and approved by the City. The City payment shall not constitute a waiver of the City's right to final inspection and acceptance of the project. A. Performance Bond. Pursuant to Chapter 39.08 RCW, the Contractor shall provide the City a performance bond for the full contract amount to be in effect until sixty (60) days after the date of final acceptance, or until receipt of all necessary releases from the State Department of Revenue and the State Department of Labor and Industries and until settlement of any liens filed under Chapter 60.28 RCW, whichever is later. B. Retainage. The City shall hold back a retainage in the amount of five percent (5%) of any and all payments made to contractor for a period of sixty (60) days after the date of final acceptance, or until receipt of all necessary releases from the State Department of Revenue and the State Department of Labor & Industries and until settlement of any liens filed under Chapter 60.28 RCW, whichever is later. Pursuant to RCW 60.28.011, the Contractor may submit a bond for all or any portion of the contract retainage in a form acceptable to the City and from a surety insurer with a minimum A.M. Best financial strength rating of A-. C. Defective or Unauthorized Work. The City reserves its right to withhold payment from Contractor for any defective or unauthorized work. Defective or unauthorized work includes, without limitation: work and materials that do not conform to the requirements of this agreement; and extra work and materials furnished without the City's written approval. If Contractor is unable, for any reason, to satisfactorily complete any portion of the work, the City may complete the work by contract or otherwise, and Contractor shall be liable to the City for any additional costs incurred by the City. "Additional costs" shall mean all reasonable costs, including legal costs and attorney fees, incurred by the City beyond the maximum Contract price specified above. The City further reserves PUBLIC WORKS AGREEMENT — Page 1 of 10 between City of Bremerton and Sabelhaus West, Inc. its right to deduct the cost to complete the Contract work, including any Additional Costs, from any and all, amounts due or to become due the Contractor. D. Final Payment: Waiver of Claims. THE MAKING OF FINAL PAYMENT (EXCLUDING WITHHELD RETAINAGE) SHALL CONSTITUTE A WAIVER OF CLAIMS, EXCEPT THOSE PREVIOUSLY AND PROPERLY MADE AND IDENTIFIED BY CONTRACTOR AS UNSETTLED AT THE TIME REQUEST FOR FINAL PAYMENT IS MADE. 4. INDEPENDENT CONTRACTOR. Contractor is and shall be at all times acting as an independent contractor and not as an employee of the City. The Contractor shall secure at its expense, and shall be responsible for all payments of income tax, social security, state disability insurance compensation, unemployment compensation, and all other payroll deductions for the Contractor, officer, agents, employees and sub -contractors. The Contractor shall also secure all applicable business licenses, if required, in connection with the contract services, including all required licenses for Contractor's officers, agents, employees and sub- contractors. 5. TERMINATION. The City may terminate this agreement for good cause. "Good cause" shall include, without limitation, any one or more of the following events: A. The Contractor's refusal or failure to supply a sufficient number of properly skilled workers or proper materials for completion of the Contract work. B. The Contractor's failure to complete the work within the time specified in this agreement. C. The Contractor's failure to make full and prompt payment to subcontractors or for material or labor. D. The Contractor's persistent disregard of federal, state or local laws, rules or regulations. E. The Contractor's filing for bankruptcy or becoming adjudged bankrupt. If the City terminates this agreement for good cause, the Contractor shall not receive any further monies due under this agreement until the Contract work is completed. 6. PREVAILING WAGES. Contractor shall file a "Statement of Intent to Pay Prevailing Wages," with the State of Washington Department of Labor & Industries prior to commencing the Contract work. Contractor shall pay prevailing wages and comply with. Chapter 39.12 of the Revised Code of Washington, as well as any other applicable prevailing wage rate provisions. The latest prevailing wage rate revision issued by the Department of Labor and Industries is attached. PUBLIC WORKS AGREEMENT — Page 2 of 10 between City of Bremerton and Sabelhaus West, Inc. 7. CHANGES. The City may issue a written work change directive for any change in the; Contract work during the performance of this agreement. If the Contractor determines, for any reason, that'a change order is necessary, Contractor must submit a written change order request to the City's project manager within two (2) business days of the date the Contractor knew or should have known of the facts and events giving rise to the requested change. If the City determines that the change increases or decreases the Contractor's costs or time for performance, the City will make an equitable adjustment. The City will attempt, in good faith, to reach agreement with the Contractor on all equitable adjustments. However, if the parties are unable to agree, the City will determine the equitable adjustment as it deems appropriate. The Contractor shall proceed with the change order work upon receiving a written work change directive or change order from the City. If the Contractor fails to require a change order within the time allowed, the Contractor waives its right to make any claim or submit subsequent change order requests for that portion of the contract work. If the Contractor disagrees with the equitable adjustment the Contractor must complete the change order work; however, the Contractor may elect to protest the adjustment as provided below: A. Procedure and Protest by the Contractor. If the Contractor disagrees with anything required by a work change directive or change order, including any direction, instruction, interpretation, or determination by the City, the Contractor shall: 1. Immediately give a signed written notice of protest to the City; 2. Supplement the written protest within fourteen (14) calendar days with a written statement that provides the following information: a.. The date of the Contract's protest. b. The nature and circumstances that caused the protest. C. The provisions in this agreement that support the protest. d. The estimated dollar cost, if any, of the protested work and how that estimate was determined. e. An analysis of the progress schedule showing the schedule change or disruption if the Contractor is asserting a schedule change or disruption. The Contractor shall keep complete records of extra costs and time incurred as a result of the protested work. The City shall have access to any of the Contractor's records needed for evaluating the protest. 3. The City will evaluate all protests, provided the procedures in this section are followed. If the City determines that a protest is valid, the City will adjust payment for work or time by an equitable adjustment. No adjustment will be made for an invalid protest. PUBLIC WORKS AGREEMENT — Page 3 of 10 between City of Bremerton and Sabelhaus West, Inc. B. Contractor's Duty to Complete Protested Work. In spite of any protest, the Contractor shall proceed promptly with the work as the City has ordered. C. Contractor's Acceptance of Changes. The Contractor accepts all requirements of a change order by: (1) endorsing it, (2) writing a separate acceptance, or (3) not protesting in the way this section provides. A change order that is accepted by Contractor as provided in this section shall constitute full payment and final settlement of all claims for contract time and for direct, indirect and consequential costs, including costs of delays related to any work, either covered or affected by the change. D. Failure to Protest Constitutes Waiver. By not protesting as this section provides, the Contractor also waives any additional entitlement and accepts from the City any written order (including directions, instructions, interpretations, and determination). E. Failure to Follow Procedures Constitutes Waiver. By failing to follow the procedures of this section, the Contractor completely waives any claims for protested work and accepts form the City any written order (including directions, instructions, interpretations, and determination). 8. CLAIMS. The Contractor shall give written notice to the City of all claims other than change orders within fourteen (14) calendar days of the occurrence of the events giving rise to the claims. Any claim for damages, additional payment for any reason, or extension of time, whether under this agreement or otherwise, shall be conclusively deemed to have been waived by the Contractor unless a timely written claim is made in strict accordance with the applicable provisions of this agreement; or, if (and only if) no such provision is applicable, unless that claim is set: forth in detail in writing and received by the City within seven (7) calendar days from the date Contractor knew, or should have known, of the facts giving rise to the claim. At a minimum, a Contractor's written claim must include the information set forth regarding protests in Section 7.A.2.a.-e. FAILURE TO PROVIDE A COMPLETE, WRITTEN NOTIFICATION OF CLAIM WITHIN THE TIME ALLOWED SHALL BE AN ABSOLUTE WAIVER OF ANY CLAIMS ARISING IN ANY WAY FROM THE FACTS OR EVENTS SURROUNDING THAT CLAIM OR CAUSED BY THAT DELAY. Contractor must, in any event, file any claim or bring any suit arising from or connected with this agreement within 120 calendar days from the date the contract work is complete. 9. WARRANTY. The Contractor shall correct all defects in workmanship and materials within two years from the date of the City's acceptance of the Contract work. When defects are corrected, the warranty for that portion of the work shall extend for one year form the date such correction is completed and accepted by the City. The Contractor shall begin to correct any defects within seven (7) calendar days of its receipt of notice from the City of the PUBLIC WORKS AGREEMENT — Page 4 of 10 between City of Bremerton and Sabelhaus West, Inc. defect. If the Contractor does not accomplish the corrections within a reasonable time, the City may complete the corrections and the Contractor shall pay all costs incurred by the City in order to accomplish the correction. 10. INDEMNIFICATION. Contractor shall defend, indemnify and hold the City, its officer, officials, employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or suits including all legal costs and attorney fees, arising out of or in connection with the performance of this agreement, except for injuries and damages caused by the City's sole negligence. The City's inspection or acceptance of any of Contractor's work when completed shall not be grounds to avoid any of these covenants of indemnification. Should a court of competent jurisdiction determine that this agreement is subject to RCW 4.24.115, then, in the event of liability for damages arising out of bodily injury to persons or damages to property caused by or resulting from the concurrent negligence of the Contractor and the City, its officials, employees, agents and volunteers, the Contractor's liability hereunder shall be only to the extent of the Contractor's negligence. IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THIS INDEMNIFICATION CONSTITUTES THE CONTRACTOR'S WAIVER OF IMMUNITY UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSE OF THIS INDEMNIFICATION. THE PARTIES ACKNOWLEDGE THAT THEY HAVE MUTUALLY NEGOTIATED THIS WAIVER. The provisions of this section shall survive the expiration or termination of this agreement. 11. INSURANCE. The Contractor shall procure and maintain for the duration of this agreement insurance of the types and in the amounts described below against claims for injuries to persons or damage to property which may arise from or in connection with the performance of the work by the Contractor, its agents, representative, employees, subconsultants or subcontractors. Before beginning work on the project described in this agreement, the Contractor shall provide a Certificate of Insurance evidencing: 1. Automobile Liability insurance with limits no less than $1,000,000 combined single limit per accident for bodily injury and property damage; and 2. Commercial General Liability insurance written on an occurrence basis with limits no less than $1,000,000 combined single limit per occurrence and $2,000,000 general aggregate for personal injury, bodily injury and property damage. Coverage shall include but not be limited to: blanket PUBLIC WORKS AGREEMENT — Page 5 of 10 between City of Bremerton and Sabelhaus West, Inc. contractual; products/completed operationsibroad form property damage; explosion, collapse and underground (XCU); and employer's liability. 3. Excess Liability insurance with limits not less than $1,000,000 per occurrence and aggregate. Any payment of deductible or self-insured retention shall be the sole responsibility of the Contractor. The City, its officials, employees, agents and volunteers shall be named as an additional insured on the insurance policy, as respects work performed by or on behalf of the Contractor and a copy of the endorsement naming the City as additional insured shall be attached to the Certificate of Insurance. The Contractor's insurance shall contain a clause stating that coverage shall apply separately to each insured against whom claim is made or suit is brought, except with respects to the limits of the insurer's liability. The Consultant's insurance shall be primary and non-contributory insurance as respects the City and shall contain a waiver of subrogation against the City for claims arising out of any operations, liabilities and obligations to which coverage applies. It shall be an affirmative obligation upon Consultant to advise the City's Risk Manager by fax at (360) 473-5161, or by certified mail, return receipt requested to City of Bremerton, attn: Risk Management, 345 6th Street, Suite 600, Bremerton, WA 98337 within two days of the cancellation, suspension or substantive change of any insurance policy set out herein, and failure to do so shall be construed to be a breach of this Agreement. The City reserves the right to receive a certified copy of all the required insurance policies. 12. MISCELLANEOUS. A. Nondiscrimination. In the hiring of employees for the performance of work under this Agreement or any sub -contract hereunder, the Contractor, its sub -contractors, or any person acting on behalf of such Contractor or sub -contractor shall not, by reason of race, religion, color, sex, national origin, or the presence of any sensory, mental, physical disability, or sexual orientation discriminate against any person who is qualified and available to perform the work to which the employment relates. B. Compliance with Laws. Contractor shall comply with all federal, state and local laws, rules and regulations throughout every aspect in the performance of this agreement. C. Work Performed at Contractor's Risk. Contractor shall take all precautions necessary and shall be responsible for the_ safety of its employees, agents, and subcontractors in the performance of this agreement. All work shall be done at Contractor's own PUBLIC WORKS AGREEMENT — Page 6 of 10 between City of Bremerton and Sabelhaus West, Inc. risk, and Contractor shall be responsible for any loss of or damage to materials, tools, or other articles used or held for use in connection with the work. D. Nonwaiver of Breach. The failure of the City to insist upon strict performance of any of the terms and rights contained herein, or to exercise any option herein conferred in one or more instances, shall not be constructed to be a waiver or relinquishment of those terms and rights and they shall remain in full force and effect E. Governing Law. This agreement shall be governed and construed in accordance with the laws of the State of Washington. If any dispute arises between the City and Contractor under any of the provisions of this agreement, resolution of that dispute shall be available only through the jurisdiction, venue and rules of the Kitsap County Superior Court, Kitsap County, Washington. F. Attorney's Fees. To the extent not inconsistent with RCW 39.04.240, in any claim or lawsuit for damages arising from the parties' performance of this agreement, each party shall be responsible for payment of its own legal costs and attorney's fees incurred in defending or bringing such claim or lawsuit; however, nothing in this subsection shall limit the City's right to indemnification under Section 10 of this agreement. G. Written Notice. All communications regarding this agreement shall be sent to the parties at the addresses listed on the signature page of this agreement, unless otherwise notified. Any written notice shall become effective upon delivery, but in any event three (3) calendar days after the date of mailing by registered or certified mail, and shall be deemed sufficiently given if sent to the addressee at the address stated on this agreement. H. Assignment. Any assignment of this agreement by the Contractor without the written consent of the City shall be void. I. Modification. No waiver, alteration, or modification of any of the provisions of this agreement shall be binding unless in writing and- signed by a duly authorized representative of the City and Contractor. J. Severability. If any one or more sections, sub -sections, or sentences of this agreement are held to be unconstitutional or invalid, that decision shall not affect the validity of the remaining portion of this agreement and the remainder shall remain in full force and effect. K. Entire Agreement. The written provisions and terms of this agreement, together with any attached Exhibits, shall supersede all prior verbal statements by any representative of the City and shall supersede all provisions of Contractor's Proposal dated January 26, 2017 that conflict with this agreement. This agreement and any attached Exhibits contain the entire agreement between the parties. Should any language in any Exhibit to this agreement conflict with any language contained in this agreement, the terms of this agreement shall prevail. PUBLIC WORKS AGREEMENT — Page 7 of 10 between City of Bremerton and Sabelhaus West, Inc. IN WITNESS WHEREOF, the parties below have executed this agreement. CONTRACTOR l � ILIWMMff..Q.1. 091, DAW20; Notices to be sent to: CONTRACTOR: THE CITY OF BREMERTON Print Name: Title: Y DATE �" 03 h -7 Notices to be sent to: CITY OF BREMERTON: Pat Coxon 1600 Oyster Bay Ave. S Bremerton, WA 98312 (360) 473-5448 (360) 473-5455 (facsimile) APPROVED AS TO FORM: Bremerton City Attorney L ok Bremerton City Clerk R; ;LEGAL'fiontracts\FORMS1ShortFonn. PW.Agr.doc PUBLIC WORKS AGREEMENT —Page 8 of 10 between City of Bremerton and Sabelhaus West, Inc. J Page 1 of 1 State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Washington State Prevailing Wage The PREVAILING WAGES listed here include both the hourly wage rate and the hourly rate of fringe benefits. On public works projects, worker's wage and benefit rates must add to not less than this total. A brief description of overtime calculation requirements are provided on the Benefit Code Key. Journey Level Prevailing Wage Rates for the Effective Date: 4/17/2017 Count Trade Job Classification Wa a Holida Overtime Note 'Kitsap Painters Journey Level $40.60 62 26 httns://fortress.wa.eovAni/wagelookiin/nrvWanPinnkiin acnx nii?nni'7 M Page 1 of 1 State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Washington State Prevailing Wage The PREVAILING WAGES listed here include both the hourly wage rate and the hourly rate of fringe benefits. On public works projects, worker's wage and benefit rates must add to not less than this total. A brief description of overtime calculation requirements are provided on the Benefit Code Key, Apprentice Level Prevailing Wage Rates for Kitsap County and Painters Trade for the Effective Date: 4/17/2017 StepOccupation' gnEndArenice Hours Hours Holiday Over Note Wa a 'Step 1 Painter and Decorator 1 1166$26.34 6Z ZB `Step 2 Painter and Decorator 1167 2333 $17,51 6Z 26 (Step 3 Painter and Decorator 2334 3499 $28.67 6Z 2B ;Step 4 Painter and Decorator 3500 4666 $30.88 6Z 28 Step 5 Painter and Decorator 4667 5833 $32.10 6Z 18 AStep 6 Painter and Decorator 5834 7000 $33.33 6Z ,. 2B https:Hfortress.wa.gov/lni/wagelookup /Apprentice WaeeLookuo.asnx 4/171?()17 sebelheusOwest License SAB ELW1975R2 Established 1987 Date: March 2, 2017 To: Bremerton Waste Water treatment plant Attn: Larry Willman Project: Chlorine contact chamber walls Scope of Work: Blasting and coating of interior block walls approximately 8960 sq ft Specification: Wasser coatings' We purpose to furnish labor and materials for the following scope of work: 1. Write up and submit products, AHA, and JHA for specific project 2. Mobilize and set up containment on job site 3. Set up compressors, dust collectors and blast pots 4. Pressure wash walls with 3000 psi rotary tip blasters to SSPC SP12 5. Sweep blast to remove any loose or flaking coatings and remove sand 6. Patch cracks, bare CMU area or tuck pointing using recommended patching compound 7. Apply full coat of MC -tar 100 red at 5to 7 mils DFT 8. Apply full coat of MC-aroshield in Sky blue 2 2to 4 mils DFT 9. Apply full coat of MC Anti -Graffiti 100 @ 1.5 to 2 mils DFT 10. Remove containment and cleanup site Price for the sum of $ 77,641.29 Assumptions: Water and power are available on site Wash waiver can be drained or pumped by owner Proposal assumes no more than 250 sq ft of patching per 68 ft wall No performance bond is included in the pricing Price does not include Washington State Sales tax Work will need to be done during dry weather and temperatures above 50 degrees Prevailing wages as of 2/20/2017 Terms: Payments to be made on a 30 -day cycle, billing on the ist payment due by the 10th. Signature of acceptance: Date: Pricing will be guaranteed for orders received at Sabelhaus West within 30 days of the date on this quotation. MAR 4 3 2017 CITY OF: BREMERTON W&STEWAMR IMTMENT PLANT Sabelhaus West, Inc. 10880 Old Frontier Road NW, Silverdale, WA 98383 Phone: (360) 662-9860 / Fax: (360) 662-9866 office@sabelhauswest.com www.sabelhauswest.com � DECEIVED MAY 15 2017 PERFORMANCE BOND Bond No. 023038778 SECTION 006113 Cay OF BREMERTON \&PASTEWAIER 1REATMENT PLANT KNOW ALL MEN BY THESE PRESENTS, That Sabelhaus West, Inc. as CONTRACTOR, and The Ohio Casualty Insurance Company as Surety, are held and firmly bound unto City of Bremerton hereinafter called "OWNER," in the sum of Ninety-one Thousand Nine Hundred Ninety-one And 73/100THS ($91,991.73) dollars, for the payment of which sum, well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITIONS OF THIS OBLIGATION ARE SUCH, that said CONTRACTOR has been awarded and is about to enter into the annexed Agreement with said OWNER to perform the WORK as specified or indicated in the Public Works Agreement entitled "City of Bremerton, Department of Public Works and Utilities, Bremerton, Washington, Chlorine Contact Chambers, Painting Project; now, therefore, In the event CONTRACTOR fails to timely or properly perform any of the requirements of the Contract Documents at the times and in the manner contained therein, the Surety shall be liable under this bond up to the amount of the bond for the full amount of the OWNERS's expenses to construct or repair all work as well as all loss, cost, expense or damage suffered by the OWNER in excess of the Contract amount due to the CONTRACTOR'S failure to comply with any contract or permit conditions or other applicable laws and regulations. The: Surety agrees that within 30 calendar days of receiving notice that the OWNER has declared a CONTRACTOR default and formally terminated the CONTRACTOR'S right to complete the Contract pursuant to its terms and conditions and that the CONTRACTOR has defaulted on all or part of the terms guaranteed by this bond, the Surety shall either. 1. Notify the OWNER in writing of its intent to cure the default itself within a reasonable period of time acceptable to the OWNER. The OWNER agrees to pay the balance of the Contract price to the Surety in accordance with the terms of the Contract, or 2. Tender to the OWNER the demanded sum, up to the amount of the bond. However, if the amount necessary for the OWNER to cure the default is less than the amount tendered, the OWNER will return, without interest, any overpayment to the Surety. PROVIDED, that any alterations in the WORK to be done or the materials to be furnished, or changes in the time of completion, which may be made pursuant to the terms of said Contract Documents, shall not in any way release said CONTRACTOR or said Surety hereunder, nor shall any, extensions of time granted under the provisions of said Contract Documents, release either said CONTRACTOR or said Surety, and notice of such alterations or extensions of the Agreement is hereby waived by said Surety. The obligation of the Surety shall include reimbursing the City for all costs and expenses, Chlorine Contact Chambers Painting Project PERFORMANCE BOND 00 61 13-1 (including, but not limited to fees and charges of engineers, architects, attorneys, and other professionals, and court costs if litigation is commenced) incurred by the OWNER in enforcing the provisions of this Bond. The CONTRACTOR hereby agrees that the CONTRACTOR'S obligation to perform the required work is not limited to the amount of funds held by the Surety. This bond is irrevocable and cannot be canceled by the Surety or the CONTRACTOR. This bond shall remain in full force and effect for a period of one (1) year following final acceptance of the project by the City, and until the bond is released in writing by the OWNER at the written request of the Surety or CONTRACTOR. IN WITNESS WHEREOF, we have hereunder set our hands and seals this 8th day of May, 2017 , 2M. (SEAL) (SEAL) Sabelhaus West, Inc. The Ohio Casualty Insurance Company (CONTRACTOR) (Surety) By, �' By: (Signature and SEAL) (Signature and SEAL) Aliceon A. Keltner, Attorney -in -Fact (SEAL AND NOTARIAL ACKNOWLEDGEMENT OF SURETY) Address of Surety to which all notices shall be sent: she Ohio Casualty Insurance Company 1001 4th Ave Suite 3700 Address of Surety for service of process: (must be a physical address) Chlorine Contact Chambers Painting Project Seattle, WA 98154 The Ohio Casualty insurance Company 1001 4th Ave Suite 3700 Seattle, WA 98154 PERFORMANCE BOND 00 6113-2 PAYMENT BOND Bond No. 023038778 SECTION 006116 KNOW ALL MEN BY THESE PRESENTS, That Sabelhaus West, Inc. as CONTRACTOR, and The Ohio Casualty Insurance Company as Surety, are held and firmly bound unto City of Bremerton hereinafter called "OWNER," in the sum of Ninety-one Thousand Nine Hundred Ninety-one And 73/100THS ($91,991.73) dollars, for the payment of which sum, well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITIONS OF THIS OBLIGATION ARE SUCH, that said CONTRACTOR has been awarded and is about to enter into the annexed Agreement with said OWNER to perform the WORK as specked or indicated in the Contract Documents entitled "City of Bremerton, Department of Public Works and Utilities, Bremerton, Washington, Chlorine Contact Chambers, Painting Project; now, therefore, If said CONTRACTOR, , or subcontractor, fails to pay for any materials, equipment, or other supplies, or for rental of same, used in connection with the performance of work contracted to be done, or for amounts due under applicable State law for any work or labor thereon, said Surety will pay, for the same in an amount not exceeding the sum specified above, and, in the event suit is brought upon this bond, reasonable attorneys fees to be fixed by the court. This bond shall inure to the benefit of any persons, companies, or corporations entitled to file claims under applicable State law so as to give a right of action to them or their assigns in any suit brought upon this bond. PROVIDED, that any alterations in the WORK to be done or the materials to be furnished, or changes in the time of completion, which may be made pursuant to the terms of said Contract Documents, shall not in any way release said CONTRACTOR or said Surety thereunder, nor shall any, extensions of time granted under the provisions of said Contract Documents release either said CONTRACTOR or said Surety, and notice of such alterations or extensions of the Agreement is hereby waived by said Surety. The obligation of the Surety shall include reimbursing the City of all costs and expenses, (including, but not limited to fee and charges of engineers, architects, attorneys, and other professionals, and court costs if litigation Is commenced) incurred by the OWNER in enforcing the provisions of this Bond. Chlorine Contact Chamber Painting Project PAYMENT BOND 00 61 16-1 IN WITNESS WHEREOF, we have hereunder set our hands and seals this stn day of May, 2017 1 Ifts. Sabelhaus West, Inc. The Ohio Casualty Insurance Company (CONTRACTOR) (Surety) By:. �.i//�liia.- By: (Signature and SEAL) (Signature and SEAL) Aliceon A. Keltner, Attorney -in -Fact (SEAL AND NOTARIAL ACKNOWLEDGEMENT OF SURETY) Address of Surety to which all notices shall be sent: The Ohio Casualty Insurance Company 1001 4th Ave Suite 3700 Seattle, WA 98154 Address of Surety for service of process: (must be a physical address) Chlorine Contact Chamber Painting Project The Ohio Casualty Insurance Company 1001 4th Ave Suite 3700 Seattle, WA 98154 PAYMENT BOND 00 61 16-2 .Ttil POWER OF ATTORNEY IS NOT VALID UNLESS -JT IS�PRINTED QN RED BACKGRO°UND- � r� �1. �T\h�ts_P, --; r" i Attorney hm\ts the t:, f, hose named:here�n---n -,:y, ave no aut%ty btnd�he Camp f-_ :e�pt m,-:-, manners' rid to:the�xte�er�n s�ted�� y \ ✓ `.✓' - �.f _ S, ��. \1, f T.he•Ohlo;Casualty,Insurance,E,ompany WestAine`rlcan.Insurance>Companyr ✓-- ':Z-� _-' -a�� ' ''./�.,v�—�.f"`�s^• `.../`��.--..--`"`::.i"' ------"�f � �l\_r-� --,I°--.f' ✓�`r'�`—.--\..--"\--^✓'`:,i `\`./`�✓�-ti. v:-�:. �.�"\✓'\_. .�' ,' 11 l i/ \% Ute/^ ��\�\; �•,�_ `� -% �' -- = ��_-,✓- �. - POWER7�7�OFrATTORNEY \j=- � KNOWN ALL -PERSONS BX THESE PRESENTS:That�Ttie Otho;Casualty-ensu`ance-Company`'__ corporation-duly;organiie_d,under the laws of the"State=of-New Hampstiire%tfiat ✓� �Libertrty,Mu-ffiI%Iiisuiance%C`ompany i&�a orporation d'uly:or nized unde�.ahe'laws ofahe:State `OMs ss chusetts and West>Am ire can I suranc Com a = ca u� r ii n I'� rorga"nrzed uncle"r"=ttie laws of`the State of Indiana (hereirrcollecti1.velydcalled the -Companies,) pursuant to and by authority herein set'fortfi does-hereby-narne;-constit`ute:and appoint;'-- y : .�-Aliceon AA ,Keltnf r Annelies M IRtchte;-.Brandon K Bush;>Brent E' .Heilesen;: , arley-Esprritu - - rristopher Kinyon-,Cynthia l':Jay Diane'M�Hardinq�Er c r__ '`A�Zirh erman Heather-L�EAIIen;: Jahi6!s-B�Binder Jamre`Dtemer _ion J .Qja Julie 6 Troitt,`:;Karen C Swanspn Kyle J`Howat;;Mary S�Norrell P_eter,` ' _ _ J Comfort! \ ✓"�vC J f :_ '+.�_°�u-5:^ - �` ._,,�^,"`/ \/_\•_r-_'. �.!'" mall of ttie:city of Tacoma f �state,of WA��`✓ I each mtltvidually ifahere b`evmore Phar :one named; its true and.lawful'attomey in -fact: to make ezecut sea ack wledge 1^r;-� and deliver forand sin ita:behalf as,surety and as:its act and"deed ariy and.all undertakings; bonds tecogrnzances and other: surety:obligations, in pursuance:of:these:presents•and shala I -.�'�.-,r .\.1.--,`�.r'; .' �./\�`-�"� . �.' _ / '-^'`�`r,M f"� /' ! f- •,,+..i^�:.. "\ .;.\._zrz!"`.-„��r--,moi:'`"'^,�l be�� as g upo> 4Gom s asyif�they have:been dulyssigned by the ptesldent`antl'attested by the secretafy of the Companies their owri,p... persons ; _', 1� SIN WITNESS NJHEREOF this Power of;Attorney ffas been ubscnbed by an authorized offcer or official of the Companies the corporafeaeals ofithe:Comparnes.have been,affixed -_ �% thereto this 9t da -of arctic ` 2ot7_�`�� \ - � �^a— �` % �� Y fes✓ -_` r % I � — �\� \sir, .-r �✓ ^,. -_\ . --r r �✓ \ ✓ •� t+s '-- n „4_v` !'USS `a� t � c��r✓ ”` y;i SUq r \`.% \ ✓`arm'," 1�:\ `^•�-�--.✓l'\=e\.-f� l; \i __' � -, - a Y F ti �t4 � F --,r\=��.-_'- -' ��'__ _—__-,Jhe Ohto Jasualt �Insurance;Com an - r -,y . N. 11 C� r �� ti '' lu - - � `�' �` "^fir`\/ i \ / �s� sLlb"Prty MUtUa� IllSllr ria cf Illpany�— -� ,�. �.19'�� t.s`. >-: �1;}12�,a, `):' a ..fil•991� �✓ ,../~'�•✓',=\ ^" \//"`�`.r �"g �`'._,r'"�""`.`-' �'-, •'` �'-<-.,'`'-"--,,. �4 �\ _ ""�-..`�i :/' ' _<_."`•,-s'-/' `} �../` `' ^a, n , �`` �,motif".,\,:.1.-,��."--✓"�:tij-�:1-.,,._,__ .�'�,.-✓-�� '\..- - \� -.__ _ c � , ,' �- � a r ✓ %✓ \ r� ✓ L,=�..--_r ✓ ^ - \ ✓ merlca�n assurance" Ol7lpany ✓ . -� N �..55�, 3 `',;� x a`�` f- +~.-,,'�h4�.... ,__ r rte',.,qll ✓' .�-..ZZI .!��✓"\:�� .,� `..l'�.✓'"�r-` ' ,, ..^�~, � --.r -��\� �d.' ✓ _*' :ter \\ '\* v �! J i m ^v' �.-_`\ ./'\f `\/ ; N \� f"✓\ � ✓F f. Q_ �: '\.; � `..... 'w,./'-\r'`,..i.%-.�L �.1�'^ V:. •�, ,'_-, .s. U".�-'°'..-�. -Z-""�V-r,� .BY iRv' '.,.� /'\ /'�,. i 1"�.`i - \ -' ..� "'�' �- ' STATE`;OF RENIVSYLVANIA ; = `s"s' s^ Y `✓f ��" --�/ I , - avid M Car'Ass, stan`t S_'r-`' y � �-�M ++ GOUNTYO MONTGOMERY��\r� `i 'r �✓�z�\� \-'^ �``\ �'i� ��e ',za) Op,this 9th; !da`y of. March' 201:7 before m p rs Ilaon y, appear de ua dvi M%Carey wn ao cknowledgeci h mselt,to-,berth. Assistant-6ecretary:of-Liberty Mutual -Insurance` =v v d Company The Qh o:Casualty Company and.West Am`e(icanhnsyrance,Gompany; and-tha�he as such tieing authorized oto do a ecu the fgre'goirig instrumentej the pu`posesr� "' -therein contained:byaigning;on.behalf-of;the corporations by-hiinselfas a duly�authorizzed:officer�� ^ Z_- S 'i `-\ _Z� .�';-_--Z5' -- �i�`✓ Ed W O" M' '___ . __- �✓_,� ,�✓^\,y�-'` ,_-"-,^\`,,�% \f^� ✓"'moi_-' i' ^ /\- '_- — - _r^ _'`\ i✓`r `. /� `\"lam _ ^_ ^ \ � �C C ..-�, `\l"w.l"`,.✓;."`,-/`^.ter°' C-,`�.E �"_ r'�,� e- —.-- .-�-.1�a. ✓i-- 11 ..-,_--✓"\✓"-r,ej-.,,✓'\.-� _s.:E et:. -IN-AlfNESS WHERI Or-Y6ave fiereunto:subscribed my-name,and--affixed my --notarial seal,at--King-of-'Prussia„Pennsylvania; on-,the-dayzana-year=first above written - fit �I — -O _Ml"\�l"�: '"'�.,-"✓"✓``.J"`..-/ 1!^•:.-� _Ps1" "�-~`��.,.J'� COMMONYVE4j„\--�; f',-.ti"'.��',"i' ^�: ter '-\i+."' \s �''. O; 'O' i �✓��\moi ��4",./"1'•qr "', 1 " i � `, vNotanaFSea�...''\/\ / O u r\ -, I .✓ � �\ Zl� "d; f; iii-:;? , �� ' Teresa.Pastetfa Notary Publec•.� / .By moi- �✓� 1'y" = •' a —, /\%_'' ,— �. r-- trF �i U er MerionT -' Jr - \i \✓ r - `'a: pp >--�p . Montgome yG:unty.\ \Teresa=P�astella NotaryrPublic��/�v dy=, C i ��,.%^��.°'--"_ �.i�`,,. ��r�4 I l Zig',yCommissionExpres-March232021 ✓fir.`/'.`'`.i%-'':'-_'��ZL -'�`�`-,^�"`-°`'�-%� y d t/ ��✓ ' 4j �-y M1A mbei„Fenn`sy'i aniaAssoa tioncf;No'fane 1 �f i rte✓✓ � l ' O -P `Q- d ;'"°`�/- �� I I_ ' _” /! �✓ 9 P �r't - _-✓-_-ZE ., '� � tiff s/ ��:' ✓� dT M, �, Thrs�P_ower;of;Attorney is -made and executed.pur,suant to=and by-authority-'o✓the-ffollowing by.=laws-.and;Author¢ations~of The-Ohio:Casualt Insurance;Company;FLiberty Mutual, to p, �L Ins rr ce Company and West Ameri ac n Insurance G pant' which re olutions`°are now full for and effect readih as follows. ✓�=��-'�`- I - i,. O, M-zL- ART,ICLEIV OF,EICERS;�Sectionv12rPower of.Attorney.-Any:officeror•otherofficialV,theVCorporation.authorized forthat•purpose:in-writ ng•by.theeGhairman.orthe:President andsublect= -'O ;; to such limitat on as the Ctiai�Pman orrthe Pres`dent may<prescr�be;; shall' ppomt such atto`r fneys nfaet„as maybe:necessary-to ac'tiin behalf oftfeiC`orporation to mage; a ute�sealy :y�+ .n. f-, ,--•,. r-`. 1".^, ,-\° -•,��- �•°. .•-•.`•fes '”. ,-� �^ r_ -�: .i.: /'^r -•�✓. ..--, i-..'-.--:.- �'-^^ i"`� f:..�.-�. O :_ =a`cknowledg`e and:deliveras surety any and.all'undertakings,;t onds recggnizances and;otherfsurety_obligations. Such:ettorneys in fact; subject tb the imitationsset•tortli•in.ttfeir respectve% = _7-7 -"".vim _! *w:°. �\./-.-+"�... ..J� ✓ -.•..'sem. .s \.. �.--`..� \✓� .fes ✓ \.l ✓ \ r;�✓,-..'r✓,-:\:/ \ir-� /--\ fr.✓.��.�r--.,..- .may � ;d,-powers:of attorney�sfiall:have full;rpower to bind=the Corporation:by�their signature,antl=execution-of.aany'such-'instruments-and'to.attach-therefo-tthe seal -of the,Corporation. When -so'' -7_Gt, p tC- T, f_\, � ,, l4 hg.:g V y,`� .��v d,attested�to bya SecretaryAny power ocauthonty grantedao any�epresentative oattorney m fact:under > 1- execute_ suc-rnstnaments:shall be;as:bmdm as if si nedathe President an !! �' `the- rovisionsofthjs artic ems be:revoked'at any:tirre-by the Board tlfe Cha'`• �y y -'-`, g g r '' '�"�'- -~_ kD �: r r ci ^� : % .��✓ ' � �;`-� `rr ✓�✓Presitle � is rr� r �re��'Y✓-` '�`✓-�r-�..r-� ="N _•�a�+ ARTICLE-XIII'Exe ufion o;C no tracts', SECTION 5 Suret"y;Bondsiand UndertakingAny offic\e�r ofahe:Companyrauthanzed;forthat,purposin`wrlt�ngbyahe chairman:or-the.president C` v,�, ,,.r.�..!-,...,ti;.--.yf``� u-\ter'.•.-.��-.0 r.-.-•�:°--�. r^�. .^ r-: `--r"'��.. ,,` - n _ �--� 'o: -\ -1 r� s -C. an_dsubtect to such limitations as the chairhtan or -the president may;presentie; shalhappointsuchvattomeys in -fact; as:may be•necessary to actin behalf ofahe Company,tormake=execute ;_;N .++-,y,� ,�; �-: ^: s--'�✓�-e ..1 ;,�1,-.ti'�.1.-� •.�✓ „✓r�.✓r.�.r `v --.4:-.a - :-- •..r -: '�,.-`rte ..'rte✓ ,�-: --\ r-.� ,�-...\i•-.;�.-r-,,:ar i-'_ -�' M :OM1; searacknlowledgeVand deliversas�u�rety any�and all dertakings bondsvrecognizances.and othertisurety obligations'Such-attorneys m fact�subjwto-ttie=l m tationsaet•forth m'their =�� r_. r-, `rte.,: w _� --x\11• r ..."--,� -� - .:.�✓ � . �\ r .__ ✓-, �esspective powers of attorneyshall•have'full pawer,to bind the,Gbmpany by their signature,and:executioniiof;any`�chJnstru merits andctu;attac,-thereto,theaeal of t, he,Company �Whe sn o 0 a ✓-1 executed such instruments shall be as binding as ifsrgned by -the president and attested by the secretary � ✓�� ,. - �� - co. y ✓"' ✓V „.\� ..;: - ilii _.:::I.\`�1 ' . :_ ^ L � \/,moi✓ /� i�.1�; : - , �G ttficatecof-Des §nak on�The President orthe;' oZ any; acting,putsuant t the Bylaws of the Company authorizes payed M Carey Asststant:Secretaryao appoinbsuch;attorneys=ink act%asima be; en ce SS ar ;fo act=on.behalf of the Com�an -to make execute=seal'ackriowled e and deliver as fu et an :and all unde`rtakin s bo-nntls ec nuances and other suref= "=` r '✓Y' ., Y- Z .,r :: . P Y r -',;' '*.� `: 9 .; i Y . 4„ \ .g .� ✓ v ✓ - Y \ r �obhgationsI — { r� r `i � i' __ ✓^✓ r`i -. �r - hor tion By unanimous consent,of the Companys Board of Directors=ttie,Companyconsent:11s that facsimile ro mechanically';reproducedsignature�ofany,assistant secretary ofthe�\� � Gom an whereJer a sarin u ori a=certified.co of an o ew of attorne ss ued b the:Com an _in connection with sure yzbon s shall be::4id and bindin u on.the Com an w thl ^�P- ' ;- PP ' - P . - PY Y P.,�✓ yv_-'• ..Y ' , P Y:r :� ty-' ✓" ✓ -• . - -.9,, P ,,✓ \;,P Y- � ✓- -thesame force•and-effect as though -manually affixed : ` ." t.' :' ^ - ✓_ _ -� V r��hB - ' Llewellyn the undersigned,, Assistant; Secretary The Ohla Casualty�lnsu ance Company Liberty Mutual Insurance Company and West Americanlnsurance-G mpany-do ,hereby cedify that the original power of attorney of:,whicn. he=foregoing%is a full tine and correct copy of the Power of Attorney executei by said. Companies; is rn full force,and'effect and�'�L I i has not been revoked \� ice` ✓ �~1. �' . r� ' •\ �" ✓IN TESFIMpNYpWHEREOF I have�hereuntoset:my-hand:antl:affixetl.the es als:ofsai9.Companies:fhrsi day.of=.�_ ` :^ -L^�r ;-20 `i�� y �,,.-%' ✓,rte ..�'\./�.-`m .*-'i--,`../ --%-,r”` ' •.l�..f`~'�'. ,�^`-`--`\\! ':..✓/"\':i 1�✓'` \:.-^ _-":' ✓ ✓" __ ✓'ti_`....:�ti-��.�\-'✓` ✓'\..r', �,?,'JrL `�-� e. r ..i` �yiP t/,+', !`�✓ `'-_'"^•._- -.+^v—.-"'�.�"\".r .� '\-j'`.J"' ,-^,.,•._i `"`,..-f'\.i\,/-,,-rte — �. 4�" o c, F -� ,' p , t ✓ a c . t �' `~.-✓ ,✓ l^"'\.� Vim" ✓--,,.✓� r-: ,-` '�—✓`�.-�P-.e✓�� 11 - 11 r .�.�� X1.912-'.- `r *.i'~? -�•.. - - \✓"`�./"°./ .✓"`�../-`::✓"'`.!'^..'i;..! %`�..1�=,�6 �vr.. \✓'\-.\_-..r'°./..:/r.,.-'.:e\✓^ ...- 991✓.,--'\..i"�✓",../`"�../'��\/`\✓~•✓"._ Y : -"� �'\✓- �� r ` �� 5-'-'-- - , i� `\ r \V^.i..,, �� r ° �^Renee G.-Llewe ssistanFSec�etar�`� r\✓`✓ r. ��`-' -.�,� ..,r;J, �.� �� . ;:v »?�n�r \t' ,-r. '..:�•"' "\''^-'\1 1.l"'/-�.�"`�.i\"tel^,✓ -`,.%"tel'\/' \/� I' r •f 1 r"-�'�✓--\ - l' `,u-�S- I _�--„�Rr-- -, �,;.J'” o�"*�- ,Z` :./--.-,,..t`�--,-` -. ,-"\�--- —'� --_/tea ,:-- =: ,.- �-.1-�,... ''`,—l'"�./.�`• °; r ti ` �'r�^,`..rP�.. ;,,✓^�.�.✓. r'* ^ ✓"`-i �`✓`�.�- �f�\� :: �`—✓ 4^' %1..1-'\1---,, ��.%- \J�✓^`"'^ i yu" r`"�✓� ✓ r, i ter/ \�✓ir104:of - -800- �\l� r U:_ i�__ ALM$ 12873 0220187 ✓✓ , �!-1V I- F RELEASE OF RETAINAGE BOND OF CONTRACTOR Bond No. 023038779 KNOW ALL MEN BY THESE PRESENTS: That we Sabelhaus West, Inc. (hereinafter called Principal), and The Ohio Casualty Insurance Company a corporation organized and doing business under and by virtue of the laws of the state of New Hampshire ; and duly licensed for the purpose of malting, guaranteeing or becoming sole surety upon bonds or undertaltings required and authorized by the State of Washington, (hereinafter called Surety), as Surety, are held firmly bound unto City of Bremerton , (hereinafter called Obligee) in the just and full sutra of Four Thousand Two Hundred Twenty And No/I OOTHS 4220.00 ) plus 5% of any increases in the contract amount that have occurred or may occur, due to change orders, increases in the quantities or the addition of any new item of work THE CONDITIONS OF THIS OBLIGATION ARE SUCH THAT, Whereas, the said Principal on the 2nd day of May , 2017 entered into a written contract with the said obligee for Waste Water Treatment Plant Chamber Walls which said contract is hereby referred to and made a part hereof by reference. WHEREAS, Pursuant to Chapter 60.28 RCW, the above named Principal has requested release of retained percentage earned or which may be earned under said contract, and, WHEREAS, the obligee is willing to release retained percentage in advance of contract terms relating to payment provided the principal shall file bond to indemnify the obligee for all loss, cosh or damages which the obligee may sustain by reason of payment of retainage to the principal, which bond shall be subject to all claims and liens in the same manner and same priority as apply to the retainage percentage released, or to be released, NOW, THEREFORE, the condition of this obligation is such that if the principal shall indemnify the obligee for all loss, cost or damages which the obligee may sustain by reason of payment of retained percentage to the principal then this obligation shall be null and void unless otherwise to remain in full force and effect. IN WITNESS WHEREOF, said principal and said Surety have caused these presents to be duly signed and sealed this 8th day of May , 2017 . Sabelhaus West, Inc. The Ohio Casualty Insurance Company I'mIt t _.`� i Aliceon A. Keltner Attorney -in -Fact THyS ,?CiVVER�JF ATTORNEYrIS NOT VALID UN_L'-E$S IT I$ PRINTED ON RED BACKGROUND � � �,• This Po�wer•of Attorney Irmtts the"a`cts;of-tFio"se:riamed herein and they have no`autti ty to bind the Companycept-in, he manner.and`to theextent�herem�s ed�� rte` � �^�y r- �� ✓ -� ~ ✓i ✓- ! ter / �i �✓ ^� /� ✓^o ✓� �✓� � ✓ Cert f te:No _.7.659031:-- ��% --- - ��1 l ey Mutualt ---,r nc� Co�mpany� /' , -� r ,�-1 The Ohlo Casualty Insurance Company WestAmerican Insurance Company,. ___ `%`�` ^�^� /ti �/ `�1^ 1` sem^' ��✓ �. �- - Q_ , . _ --, ._POWER "F �4TTORIV€Y � �1-1 . -. � ��^��-�,,_; � KNOWN-ALL.PE-RSONS.:BY, THESE- P -RESENTS: That The=Ohio`zCasualty,Insurance Company ts;avcorporatr_,dulyforgan¢ed=underahe-laws of the.State-of�NewVNampshire„that Li6ert�y Mutual l surance Gornpan�y;is a-corpgrationfdu y a,ga',_,u., erthejlaw` oaf theSate o�f-„Massachusett rid Wes American Ins.. ante Company�is=a corporation duly � organized_under-thelaws of;the State=of,Indiana-(herein colllectively c Iled the�"Companies")=pursuant to and -'by authonty-herem sefforth doeshereby,: iQ; constitute and appo nt Aliceoii A .Keltner AA n -dues M `:Richie; B�andon:K BushsB`rent E::Heiles . ;:Garley.Esptntu .Christopher Kinyon; Cynthia L Jay Dian ..,Harding zEric rte— y ; ti _:_ _ _ _` _ _ Swanspn Kyle J HOWat Mary,$,Norcell;Petery - ��- J _Goin ortieather;L A`Il�en 'James_B Binder; Jamie Dfemer .Jon J O'a Jult R Truitt _Karen C './'�\``.�`_ ____ ' `�,.�; o.��-;. C 9.':rte,.. .'\..I�\''^ _ \!�.,n—��-�°„`ff,^�'•u- I - _ ~` 70'R' - `' each indiyiduall`if the e`b`e more than one named; its true and lawful:atto`rne m -fact to,mak zecute; al=acknowled allhe c�y offTacoma� r state of WA `'✓� yam; y and;deliv_er for;and cn;its behalf as surety and as its act and -deed any=and a I undertakings; bonds;.recognizagces and othee surety obhgations;:in.pursuance_of th- s ,presentsand,shall,�"`� E-;t7�--mitis �.'»„^� ✓..,�✓ �•,.s _ ._,,,.t ...�...., .- .✓�✓r-,___' ,z ..ems -,.. �. �..�,--;�...�r.;,��. ...: ...��✓T�-�'-.�`''i"�.��a"�I; be� bin'ding:uponwthe Compamts as ifahey have;;been duly signed by#he.president and'attested byahe secretary of the Companiesanahelr own.proper persons: —,,�� f_ ✓Z111^tip :,�— r c i f ` - .: _��._- :'moi✓ fir U �` r IN WITNESS WHEREOF this Power of Attorney::has beenssubscribed by an:auttionzed`officer orofficial of the;Gompanies:;and the co[porateseals of;ttie"Coinpanies;have been.affixed , - �,,,-�-,,.7_ . �..i,..�`..i '`. -;_- � `...✓" ”' .-,,,,✓ ....rte\ -:. ✓�":�1/";,. /"�`''I 'Z' . '"'`� _ �� thereto•this-,9th day of, March :, w 2oi•7, � �` �.� ✓s.✓ � `. ; ✓�� r 1 �r �i�� i- ✓ orf i i o _�✓ ✓ tie' /� _ ✓ �r `�!~.� /ice t6: j'SU� L4""`uq� '� "'1 11.1-1. 1 i ti � fir`" �— / tom -- _ _,_,,-� � r�- - `t3: .. o? v F �; ti., . Ny e �� r ,, .. .,��, __ � � �r •... � � J ��r The Ohlo Casualty=lnsurance'Gompan r� ,�"z" ✓ ` ^� Ubert Mutual Insurance Goin an r '� w= � X399 is 19t2 x 1991 Y=, s \t \ y�r: s : i ✓p y f � C: x , � � � % , . �. >___ — . r� ✓= Z� __ stAmerican Insurance Company-- ---- �•-: ili:e.,y� ��..,� �f...,./fir.t.•:-^ti,�`*-..�,./,.�..r'i"`�1�. �.,.�-"�..r �. .``, �...%`�'t�"'t.�/"•✓"�.,� d:; `..� w. *"`+. �..''\ .4,@ "'`..%"� 'r,.�.*..�> ./„".._..^� i -ti../ ter'""•.'/`, i- - �: ��.1\'.-"'�✓"'�" .Q: . �'++; ` r` __ ti �`' __ — : ' �- '��"�`- _ -____.:r `�'- ^:David M ,Care Assista'rit 5ecretary`� :�^ �: STATE OF PENNSYLVAN�A`� ss` ` Ef . r� '� •: `ia.� �� ; 4;.o:--, COUNTY OF MONTwOMERY✓ �'^ r ' . "^ i `' �-� ` r` r -'✓-`' ``� ` � �'- _�' ,�� ^� ^tel— �� / `�� ^�- ��, — — — -- ___ � �. , - On this>9th�dayt>f Maich 2017 ,before me,personallly,'appeared—David MjiCa�ey who�acknow�edged himself to.be the Assistanf,SecrVetary o Liberty MutuaLlnsurance 0. dU� ,-Companny,jhe Ohio Casualty Company,�nd West American�Insuranee-Company=and.that=hews=such l eing::authonied so to do; executethe`fo`regoing instrument for"the%purposes =g; ; - :0-.;--- the contain f by_>igning on .char, f;t__ mac, p, ons 6y.h`mself as adulyau�honzed,oif er..:' ,-� —Z-_- � � -�_,Z- -�� ^fie r 0� IN WITNESS:WHERE OF, I have hereuntosubscribed myname and=affixed my -notarial seal•at Kmgcof:Prussia-, Pennsylvania-on-thevdayand=year-first above:writt6n - O: sm �/ :-1 `f•"�,,.��. ;--. /� 1 O'�Ili S ✓ COMMONWEALTH OF�PENNSYLVANIA✓ ^ " =�\ 1 `. i / u r^ 1 �' C1 �' ✓ \E/ ✓ w \� cs ltd.— itii�y! i; �'" //' a M- i "w.l'`_; -, ^: ✓� 1 ,q ' �1ouVvg . �/ 1 t '1 ✓ 1 -^a/ ✓ ��l , \�\ � v= 'a. ; `,./"`..�” _ tt ✓ a { �✓ ^ / NotanalSea ,�✓ � ✓” "-" &_ =R�, �_i-��./,"`�"'✓,..-,�: �✓",.-�"�r,;�✓"`\✓', o-.��✓f'".,� ,: /t=�..�:=, ',..err°-'`,..�. �""',. .�''. \ i .'y MWI)�.i"�- — '0��'. ~�' \- ti r �� -�� -�• •- , � `Up TUe 'Twp Montgume` eco my Te(esa;Pastella, Nota` -:Public s �W L - �..r,,,, r� r 4 r e I.®Mv C mmissi n Exp �e\s-Marc 25 2021 -� `••- , ✓'�� __rim_ d/� R± N:"W-; ^��-' : '""�-�-; �.✓ — ^z— aYfVP ,1✓' `tel' �rMeinber,`Pe'nns`ylvania'"Assodaten ef-Nota'rie's`+ ,�✓, `�` %� `! -O _L_ T,�,' werZSZ At o� y; is maderand ex "_-,_d`p-_ s_. nt to and 6y authorityo�f the �ollow�ing By aws and;Authonzations of Thef Qh�w�Gasual�y Insurance�C`ompany Liberty mutual:: NI_0, M1L .v-� r^,. r^, �--. r,� : ^,� .-^� --;� r-,. --, r, r^. r-• r1 r^,. T, r/"'v,...•,'"\%'"•../,i-`•`/`��"1'�...y. C,: y„�,,-,Insurance Company and-WesfAmerican,insurance Company-which,resolutions.are.how-m�full=forcezan8 effect=readi6g'as,follows�� tip`. V tewLs ARTICLE IV OFFIt�.ERS -Section 1,2 Power ofAttomey. Any officenorothecofficlal o foie Corporation.authonzed;for t�hat:puyrposefn.wnting by the Chaff man or the Presltlent; and s�6fect: �O�c =�-d: ,tdsuch-li im tation as the Chairman;or khe=,restdent ma rescribe shall a ` oint-such attorne s=in fact%as ma zbe net se``sa =to act=ln behalf ofahe-Cor oration�to'make execute seal =`�-d' ++ '1•-+ f ; �.-;•`='=l ✓-:,`Z � �, .`=_ •, ".: � Yip ; ,=\ ✓,--`,!. '�✓ ;� t: --.-r y `� is^�- 5 ,:✓ Y , ,Z ,i -\%r.:: - %. --, p ✓r , / i= ai :O — acknowledge:and;deliverassurety;anyandall undertakings; bonds recogrnzances-and:othersurety:obligations^Suchrattorneys m factsubject to:the;limltations set:forth I, n•theirrespective, a_ ?; �, -powers of attb�ney hall have full p'owe'r to b d ttie Corporation tiy`their signa\ure, nd�executioncof any ucli instcuments_and to attach;thereto the eal:of.the:6orporatlon f When_So_ - ar. L_.r+.'-`: .--.`.+i-.. ^,. .- -:. � r- rr: ,--^�.., ^�.'--., /^moi-••. i -o`✓• r"� r.- ..� �'� i-�. _ . �°•,e-,..t11-.0. :O_rD: 'executed;;such;inst(uments,shall be asbinding as if signed:by the.President`andrattested to-bby the Secretary Any;power or authority;granted to`any�representative�or attorney -•in- aret_un eeh >� `-'- - —,—the (ovist no s:b this article ma be:revoked at:an :time b he�Board t-tFd Chairman the=P, sid'enf o b`the offc`etoor officers Eantin� uS cfi: ower rQauth n :f!�� ✓�o �-i ` s)cCD :7c -c, ARTICLE Xlll Exec ution'of,Contracts? SECTION 5 :SuretyBondsand Undertakings Anyofficer,of the•Companyauthonzed,for-that purpos_e:in,wnting by_the;chairman_or the•presldent= =fit 9'G> 1� , �.✓ �✓ .-.✓ � - ,-✓ _-1 .. �:�- � , - ,. - _ ✓- ✓ �; , �✓ �--r ,� ,., ✓,- .� ✓,.-.vim ,7 v .... -E- �., and'subjectto suct%lim'itations:asahe:chairman orthe:presvdent may,prescribe; shall appoint`suchvattorneys- n factVas:may-tie:necessary to.actin behalf•of the Gompany4o-make execute; �-, , .,O -mc -seal acknowledge and,dehve�r asAsuretyaany,and_all undectak`gs; bonds recogn¢aces<- _,othe`�:-- ty�obhgationV Such attorneys m;fact;subject.to the-lllmitktions:set�forth,in they :a- Z= Vif `�:. r �; " -'i-••. -_- • -;-;` ,- -, --�, r--� -�,`-� , -�. � ,^ .r•� respective-powers`of attorney,'shall have'full power to bind the,Company_by thei'rf gs nature;and execution o-'any`suchinstruments and:to,attach:thereto'•the•seal'of•the-Company When_so_ -O;o ='executed such:instrumentsstiail be as binding as:ifsigned by the president and attested by ktie secretary ,u �r O`wµ ::ice =�::- M,.✓ ,,'Z: �"� •� i �, � f� w Certlficate•of-Designation•= The,Pieiident of•th6 - p-Tpany: acting pursuant to ttie Bylaws of the:Company authorizes David M:,Carey, Assistant=;Secretary to:appgirit suc6;attorn :ins =ti - _` _— . /,-•,\;` .: ul-,�:1` �: r:�..✓ `+. �..:: ^.,,.., �. .. ..:r. ..✓;..�... -._`,fir .... / \' i- ,e rr-.` ..-...: -.,,'��.-\/�-:,.,f��✓--.r✓-..,`.sr-.. �,,✓/., y �� a. p y owfedge and�dellver as_surety any._and<all-undertakings; bonds_ recognizance's and'other suretymr ✓ '. fact.as•may be-necessar 'ko act o'n behalf of the'CQm an to make execute, seal, ackn ..!"'",...r"�'-~\�,...Y,�-,`r"�,✓� i F,. �..-ill, -- :..r` ^^,.--,�.-:,-�,,./r�^�`�.'r"..✓��✓' Authorizatio_� _ y:unammous:consent of the Company s Board of Directors the Company consentsahat facsimile of mechanically reprod \ted s. ignature of any assistantsecretary ofahe r oC inpany Wherever=a a i(a n u on a Certified co of.an :.' o eW of:attorne�issued-b'tthe C-om an in connection with"sure'. ds shall.6e-validand.bindin-Upon the Com an %vvith� PP 9 P_ P,Y Y P Y v Y P Y t_ 9 p p. Y � i- ,..,i'-•••, -�`„-f'..�`' ..'•. �^. ,,m°.�.`°r ..✓r ✓,...;.f^,`., _w.-_ !` 111 . ,fir`\. :`-,—_�_, :;� +:/"�....r^ti..i,../' the same force a"ndre f%ct as_thoughWmanually affixed fy �� _ \/ -•�a•:r�-.�:,.�=-.,,...i ✓ ',.✓ - - .'"fir - .J',. �*,.i`/ :ter :::'/",e _ "�f'"�.l'. •>✓ ".,l",..%y\i'^•,_�",`_," ;.' �`� h`Ren'ee C \Llewellyn e� u -d rsigned Assistant Secretary The Ohio Casualty:'nsu nc Company ;Liberty Mutual l64rance;Company and West�Americann Ilnsurance=Company; do _. �-, - he'_ y , tify that�th_ ,n nal,powervofratt�arney of which fh foregoingJ§ a full kriae and cdrrect copy,of the Power of Attorney executed by said Compan es`Lstnafuvforce a d eftecLand has not been �evoke`d %'"amu_ ; r ,✓_ -;`. :;: � �-,,,, �f . , � ` '^ i ✓j`✓IN TESTIMONY WHEREOF l�have Hereunto seamy hand_and affixed=the.seals:of said.Companies this .day 0f� M . _i ti p : r 20 1 ✓� ---1.-.,w,..✓ :✓ 1_Ilz�..�rrr-a�.._�_-;: _ I ,-_✓ . � `'z -':'`. -'"�i"`.i�--,�":� "--i" `,-- '��`"`'..---,, ,✓-g`,._r :;i..y u/"ti:i"��,,:.�._.��_. ,../-'''\.i �-�Y iLSL `14 coq t;P yt u `�11r^, '✓' .. .sem :,.�j __, ``,�..o,.J"`,:J' `.`..sr :� ~\``'"` �-,`t'<� - `� �'::�^ J` o?yi t 9i ,...�'• ` ��i ✓ P 'Sri,, �`,✓."`.� "'\_f"`... ��.r"",._, __ �Z__, ✓..-,`�.f`,✓"`•m/\:_-' `.../' ✓'� -',.-"-,��..1'\•��"�...^,./"ti,E-^,,,��' F.+`✓^l`...,i�...'�,`✓✓=\-`ti../'�.`1`"J',,'�•- �,.`�..� `ti. -`_ _ !`!,'*..l m� } ,-.'ti._ `,..- _ 'ti/'"'`.:J'"` e_/_, v-: \, moi, :, --,� _..: - , ',. ! 'a.�=�'`.�""�.h1.. J a \1 `, Jr ✓✓ *.la_r``�✓��`� 75"--,.�--;,^u��` -"�" rLi - Se`C! ry r I �`",�.,✓'"` 7 ^,.%:,.f"a�'".1•'^.../`1.i."�.f`•`..M',.:.�"'^�.y�,✓',_/"\r e�Ci'� S •------e ^`eJ"'`.i'^,..1"',•..r". k a ✓ ;! ., v t t ':,. " - - ✓^ �� --,- ' ✓"`., l4f /� fel ^`l`4 `�4f,....,,...�yl;.'_'a s ..fie?. �„�i"•�'..Jr ;<' �.. P,} .,.i `,. ,.�"� "✓ "�^ "�, f�'"'`✓\�.✓""�."'�../ ..s '�_{^-,�-'"\f'"-",»�./`�'" .,."�.i�"^,..i'`'•'''" w'_,_ ..r"'`wwi 4`,*•";-' �I -1, ^..*�~ " -,*./.`w ✓.`" '\'i.�r"�% �.r✓"ice" '\N\i \J"/�','�✓"til^tir„'\.� ✓",.s^,..✓ �'+ ✓'\%�..e ,r^ , I,-- -- ^,��_- ---' '�./"'r-"'h `,./"�� l""`•.i ,.. 1',._. \,- "/'��"'�. ,�.:i-• \l am'." ' 8 03 220 7 r_ ✓ 1 / ^�^ �f`! i � ✓ / ^ � a r'lian4#- 1AR�Q7 CARFWFST ACORDTM CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDD/YYYY) INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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, 5/08/2017 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 NgAME: Abby Mumford Propel Insurance PHONE g00 499-0933 FAX 866 577-1326 AIC No, Ext : A/C, No Seattle Commercial Insurance ADORIEss: abigail.mumford@propelinsurance.com 925 4th Ave, Suite 3200 11101/2017 Seattle, WA 98104 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Charter Oak Fire Insurance Com 25615 INSURED INSURER B: Travelers Property Casualty'Co 25674 Sabelhaus West, Inc. INSURER C: Travelers Indemnity Compy of 25666 10880 Old Frontier Rd NW Silverdale, WA 98383 INSURER D: � INSURER E INSURER F Iff [A IR�PIa:P_lCl �. M 7711210fe11 117 J 11 h4197: NJ =01 L9lll11■JI I I,r, l cldr� THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NA ABOV 1TR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR X X DTC04G547548COF16 11/01/2016 11101/2017 .00 EACH OCCURRENCE $1,000,000N." OOOOOO PREMISES (ERENTED occur ence)$300,000 MED EXP (Any one person) $10,000 X PD Ded:5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY � ECOT F LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: C AUTOMOBILE LIABILITY X X DT8104G547548TIA16 1/01/2016 11/01/201 COMBINED SINGLE LIMIT Ea accident 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident ( ) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident B X UMBRELLA LIAB X OCCUR X X CUP7112O921116 1/01/2016 11/0 1 /2017 EACH OCCURRENCE s5,000,000 EXCESS LIAR CLAIMS -MADE AGGREGATE s5,000,0001%01-1 DED I X I RETENTION $$101000 $ A WORKERS COMPENSATIONDTC04G547548COF16 AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVEWA OFFICER/MEMBER EXCLUDED? N] N / A Stop Gap 1/01/2016 11/01/2017 PER OTH- T X E.L. EACH ACCIDENT $1 000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under E.L. DISEASE -POLICY LIMIT S1.000,000 DESCRIPTION OF OPERATIONS below A Rented & Leased OT6604G414008COF16 1/01/2016 11/01/2017 $100,000 Equipment $1,000 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) (09/2019) Waste Water Treatment Plant Chlorine Contact Chamber Walls, City of Bremerton, Public Works 8r Utilities, 1600 Oyster Bay Ave S, Bremerton, WA 98312 City of Bremerton, its officials, employees, agents and volunteers shall be named as an additional insured City of Bremerton / Risk Management 345 - 6th Street, Suite 600 Bremerton, WA 98337 ACORD 25 (2014/01) 1 of 1 #S2697950/M2592751 I.FAItl I.CLLN I IUN 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 ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CRS00 This page has been left blank intentionally. POLICY NUMBER: DTC04G547548COF15 ISSUE DATE: 5/8/17 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY - NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice of Cancellation PERSON OR ORGANIZATION: City of Bremerton/ Risk Management ADDRESS: 345 -6th Street, Suite 600 Bremerton, WA 98337 PROVISIONS: If we cancel this policy for any statutorily permitted reason other than nonpayment of premium, and a number of days is shown for cancellation in the schedule above, we will mail notice of cancellation to the person or organization shown in the schedule 30_ above. We will mail such notice to the address shown in the schedule above at least the number of days shown for cancellation in the schedule above before the effective date of cancellation. IL T4 05 03 11 © 2011 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS XTEND ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Aircraft Chartered With Pilot B. Damage To Premises Rented To You C. increased Supplementary Payments D. Incidental Medical Malpractice E. Who Is An Insured — Newly Acquired Or Formed Organizations F. Who Is An Insured -- Broadened Named Insured — Unnamed Subsidiaries G. Blanket Additional Insured — Owners, Managers Or Lessors Of Premises PROVISIONS A. AIRCRAFT CHARTERED WITH PILOT The: following is added to Exclusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION I — COVERAGES — COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABILITY: This exclusion does not apply to an aircraft that is: (a) Chartered with a pilot to any insured; (b) Not owned by any insured; and (c) Not being used to carry any person or prop- erty for a charge. B. DAMAGE TO PREMISES RENTED TO YOU 1. The first paragraph of the exceptions in Ex- clusion j., Damage To Property, in Para- graph 2. of SECTION I — COVERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY is deleted. H. Blanket Additional Insured — Lessors Of Leased Equipment I. Blanket Additional Insured — States Or Political Subdivisions — Permits J. Knowledge And Notice Of Occurrence Or Offense K. Unintentional Omission L. Blanket Waiver Of Subrogation M. Amended Bodily Injury Definition N. Contractual Liability — Railroads INJURY AND PROPERTY DAMAGE LI- ABILITY: Exclusions c. and g. through n. do not apply to "premises damage". Exclusion f.(1)(a) does not apply to "premises damage" caused by: a. Fire; b. Explosion; c. Lightning; d. Smoke resulting from such fire, explosion, or lightning; or e. Water; unless Exclusion f. of Section I — Coverage A — Bodily Injury And Property Damage Liability is replaced by another endorsement to this Coverage Part that has Exclusion — All Pollu- tion Injury Or Damage or Total Pollution Ex- clusion in its title. 2. The following replaces the last paragraph of A separate limit of insurance applies to Paragraph 2., Exclusions, of SECTION I — "premises . damage" as described in Para - COVERAGES — COVERAGE A. BODILY graph 6. of SECTION III — LIMITS OF IN- SURANCE. CG D3 16 11 11 © 2011 The Travelers Indemnity Company. All rights reserved. Page 1 of 6 COMMERCIAL GENERAL LIABILITY 3. The following replaces Paragraph 6. of SEC- TION III — LIMITS OF INSURANCE: Subject to 5. above, the Damage To Prem- ises Rented To You Limit is the most we will pay under Coverage A for damages because of "premises damage" to any one premises. The Damage To Premises Rented To You Limit will apply to all "property damage" proximately caused by the same "occur- rence", whether such damage results from: fire; explosion; lightning; smoke resulting from such fire, explosion, or lightning; or water; or any combination of any of these causes. The Damage To Premises Rented To You Limit will be: a. The amount shown for the Damage To Premises Rented To You Limit on the Declarations of this Coverage Part; or b. $300,000 if no amount is shown for the Damage To Premises Rented To You Limit on the Declarations of this Coverage Part. 4. The following replaces Paragraph a. of the definition of "insured contract' in the DEFINI- TIONS Section: a. A contract for a lease of premises. How- ever, that portion of the contract for a lease of premises that indemnifies any person or organization for "premises damage" is not an "insured contract; 5. The following is added to the DEFINITIONS Section: "Premises damage" means "property dam- age" to: a. Any premises while rented to you or tem- porarily occupied by you with permission of the owner; or b. The contents of any premises while such premises is rented to you, if you rent such premises for a period of seven or fewer consecutive days. 6. The following replaces Paragraph 4.b.(1)(b) of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: (b) That is insurance for "premises damage"; or 7. Paragraph 4.b.(1)(c) of SECTION IV — COMMERCIAL GENERAL LIABILITY CON- DITIONS is deleted. C. INCREASED SUPPLEMENTARY PAYMENTS 1. The following replaces Paragraph 1.b. of SUPPLEMENTARY PAYMENTS — COVER- AGES A AND B of SECTION I — COVER- AGE: b. Up to $2,500 for the cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to fur- nish these bonds. The following replaces Paragraph 1.d. of SUPPLEMENTARY PAYMENTS — COVER- AGES A AND B of SECTION I — COVER- AGES: d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $500 a day because of time off from work. D. INCIDENTAL MEDICAL MALPRACTICE 1. The following is added to the definition of "oc- currence" in the DEFINITIONS Section: "Occurrence" also means an act or omission committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to a person. 2. The following is added to Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED: Paragraph (1)(d) above does not apply to "bodily injury" arising out of providing or fail- ing to provide: (i) "Incidental medical services" by any of your "employees" who is a nurse practi- tioner, registered nurse, licensed practical nurse, nurse assistant, emergency medi- cal technician or paramedic; or (ii) First aid or "Good Samaritan services" by any of your "employees" or "volunteer workers", other than an employed or vol- unteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first aid or "Good Samaritan ser- vices" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your busi- ness. Page 2 of 6 © 2011 The Travelers Indemnity Company. All rights reserved. CG D3 16 11 11 3. The following is added to Paragraph 5. of SECTION III — LIMITS OF INSURANCE: For the purposes of determining the applica- ble Each Occurrence Limit, all related acts or omissions committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to any one per- son will be deemed to be one 'occurrence". 4. The following exclusion is added to Para- graph 2., Exclusions, of SECTION I — COV- ERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury" or "property damage" arising out of the willful violation of a penal statute or ordinance relating to the sale of pharmaceuti- cals committed by, or with the knowledge or consent of, the insured. 5. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; or b. The furnishing or dispensing "of drugs or medical, dental, or surgical supplies or appliances. "Good Samaritan services" means any emer- gency medical services for which no compen- sation is demanded or received. 6. The following is added to Paragraph 4.b., Ex- cess Insurance, of SECTION IV — COM- MERCIAL GENERAL LIABILITY CONDI- TIONS: The insurance is excess over any valid and collectible other insurance available to the in- sured, whether primary, excess, contingent or on any other basis, that is available to any of your "employees" or "volunteer workers" for "bodily injury" that arises out of providing or failing to provide "incidental medical ser- vices", first aid or "Good Samaritan services" to any person to the extent not subject to Paragraph 2.a.(1) of Section II — Who Is An Insured. E. WHO IS AN INSURED — NEWLY ACQUIRED OR FORMED ORGANIZATIONS The following replaces Paragraph 4. of SECTION II — WHO IS AN INSURED: COMMERCIAL GENERAL LIABILITY 4. Any organization you newly acquire or form, other than a partnership, joint venture or lim- ited liability company, of which you are the sole owner or in which you maintain the ma- jority ownership interest, will qualify as a Named Insured if there is no other insurance which provides similar coverage to that or- ganization. However: a. Coverage under this provision is afforded only: (1) Until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier, if you do not report such organization in writing to us within 180 days after you acquire or form it; or (2) Until the end of the policy period, when that date is later than 180 days after you acquire or form such organization, if you report such organization in writing to us within 180 days after you acquire or form it, and we agree in writing that it will con- tinue to be a Named Insured until the end of the policy period; b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and c. Coverage B does not apply to "personal in- jury" or "advertising injury" arising out of an offense committed before you acquired or formed the organization. F. WHO IS AN INSURED — BROADENED NAMED INSURED — UNNAMED SUBSIDIARIES The following is added to SECTION II — WHO IS AN INSURED: Any of your subsidiaries, other than a partnership, joint venture or limited liability company, that is not shown as a Named Insured in the Declara- tions is a Named Insured if you maintain an own- ership interest of more than 50% in such subsidi- ary on the first day of the policy period. No such subsidiary is an insured for "bodily injury" or "property damage" that occurred, or "personal injury" or "advertising injury" caused by an of- fense committed after the date, if any, during the policy period, that you no longer maintain an ownership interest of more than 50% in such sub- sidiary. CG D3 16 11 11 © 2011 The Travelers Indemnity Company. All rights reserved. Page 3 of 6 COMMERCIAL GENERAL LIABILITY G. BLANKET ADDITIONAL INSURED — OWNERS, MANAGERS OR LESSORS OF PREMISES The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that is a premises owner, manager or lessor and that you have agreed in a written contract or agreement to in- clude as an additional insured on this Coverage Pari: is an insured, but only with respect to liability for "bodily injury", "property damage", "personal injury" or "advertising injury" that: a. Is "bodily injury" or "property damage" that occurs, or is "personal injury" or "advertising injury" caused by an offense that is commit- ted, subsequent to the execution of that con- tract or agreement; and b. Arises out of the ownership, maintenance or use of that part of any premises leased to you. The insurance provided to such premises owner, manager or lessor is subject to the following pro- visions: a. The limits of insurance provided to such premises owner, manager or lessor will be the minimum limits which you agreed to pro- vide in the written contract or agreement, or the limits shown on the Declarations, which- ever are less. b. The insurance provided to such premises owner, manager or lessor does not apply to: (1) Any "bodily injury" or "property damage" that occurs, or "personal injury" or "adver- tising injury" caused by an offense that is committed, after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such premises owner, lessor or manager. c. The insurance provided to such premises owner, manager or lessor is excess over any valid and collectible other insurance available to such premises owner, manager or lessor, whether primary, excess, contingent or on any other basis, unless you have agreed in the written contract or agreement that this in- surance must be primary to, or non- contributory with, such other insurance, in which case this insurance will be primary to, and non-contributory with, such other insur- ance. H. BLANKET ADDITIONAL INSURED — LESSORS OF LEASED EQUIPMENT The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that is an equipment lessor and that you have agreed in a written con- tract or agreement to include as an insured on this Coverage Part is an insured, but only with re- spect to liability for "bodily injury", "property dam- age", "personal injury" or "advertising injury" that: a. Is "bodily injury" or "property damage" that occurs, or is "personal injury" or "advertising injury" caused by an offense that is commit- ted, subsequent to the execution of that con- tract or agreement; and b. Is caused, in whole or in part, by your acts or omissions in the maintenance, operation or use of equipment leased to you by such equipment lessor. The insurance provided to such equipment lessor is subject to the following provisions: a. The limits of insurance provided to such equipment lessor will be the minimum limits which you agreed to provide in the written contract or agreement, or the limits shown on the Declarations, whichever are less. b. The insurance provided to such equipment lessor does not apply to any "bodily injury" or "property damage" that occurs, or "personal injury" or "advertising injury" caused by an of- fense that is committed, after the equipment lease expires. c. The insurance provided to such equipment lessor is excess over any valid and collectible other insurance available to such equipment lessor, whether primary, excess, contingent or on any other basis, unless you have agreed in the written contract or agreement that this insurance must be primary to, or non-contributory with, such other insurance, in which case this insurance will be primary to, and non-contributory with, such other in- surance. I. BLANKET ADDITIONAL INSURED — STATES OR POLITICAL SUBDIVISIONS — PERMITS The following is added to SECTION 11 — WHO IS AN INSURED: Any state or political subdivision that has issued a permit in connection with operations performed by you or on your behalf and that you are required Page 4 of 6 © 2011 The Travelers Indemnity Company. All rights reserved. CG D3 16 11 11 by any ordinance, law or building code to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage", "personal in- jury" or "advertising injury" arising out of such op- erations. The insurance provided to such state or political subdivision does not apply to: a. Any "bodily injury," "property damage," "per- sonal injury" or "advertising injury" arising out of operations performed for that state or po- litical subdivision; or b. Any "bodily injury" or "property damage" in- cluded in the "products -completed operations hazard". J. KNOWLEDGE AND NOTICE OF OCCUR- RENCE OR OFFENSE The following is added to Paragraph 2., Duties In The Event of Occurrence, Offense, Claim or Suit:, of SECTION IV — COMMERCIAL GEN- ERAL LIABILITY CONDITIONS: e. The following provisions apply to Paragraph a. above, but only for the purposes of the in- surance provided under this Coverage Part to you or any insured listed in Paragraph 1. or 2. of Section II — Who Is An Insured: (1) Notice to us of such "occurrence" or of- fense must be given as soon as practica- ble only after the "occurrence" or offense is known by you (if you are an individual), any of your partners or members who is an individual (if you are a partnership or joint venture), any of your managers who is an individual (if you are a limited liability company), any of your "executive offi- cers" or directors (if you are an organiza- tion other than a partnership, joint venture or limited liability company) or any "em- ployee" authorized by you to give notice of an "occurrence" or offense. (2) If you are a partnership, joint venture or limited liability company, and none of your partners, joint venture members or man- agers are individuals, notice to us of such "occurrence" or offense must be given as soon as practicable only after the "occur- rence" or offense is known by: COMMERCIAL GENERAL LIABILITY (ii) A manager of any limited liability company; or (iii) An executive officer or director of any other organization; that is your partner, joint venture member or manager; or (b) Any "employee" authorized by such partnership, joint venture, limited li- ability company or other organization to give notice of an "occurrence" or offense. (3) Notice to us of such "occurrence" or of an offense will be deemed to be given as soon as practicable if it is given in good faith as soon as practicable to your work- ers' compensation insurer. This applies only if you subsequently give notice to us of the "occurrence" or offense as soon as practicable after any of the persons de- scribed in Paragraphs e. (1) or (2) above discovers that the "occurrence" or offense may result in sums to which the insurance provided under this Coverage Part may apply. However, if this Coverage Part includes an en- dorsement that provides limited coverage for "bodily injury" or "property damage" or pollution costs arising out of a discharge, release or es- cape of "pollutants" which contains a requirement that the discharge, release or escape of "pollut- ants" must be reported to us within a specific number of days after its abrupt commencement, this Paragraph e. does not affect that require- ment. K. UNINTENTIONAL OMISSION The following is added to Paragraph 6., Repre- sentations, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not preju- dice 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 insurance laws or regulations. / L. BLANKET WAIVER OF SUBROGATION \/ (a) Any individual who is: The following is added to Paragraph 8., Transfer (i) A partner or member of any part- Of Rights Of Recovery Against Others To Us, nership or joint venture; of SECTION IV — COMMERCIAL GENERAL LI- ABILITY CONDITIONS: CG D3 16 11 11 © 2011 The Travelers Indemnity Company. All rights reserved. Page 5 of 6 COMME=RCIAL GENERAL LIABILITY IN If the insured has agreed in a contract or agree- ment to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organiza-' tion, but only for payments we make because of: a. "Bodily injury" or "property damage" that oc- curs; or b. "Personal injury" or "advertising injury" caused by an offense that is committed; subsequent to the execution of that contract or agreement. AMENDED BODILY INJURY DEFINITION The following replaces the definition of "bodily injury" in the DEFINITIONS Section: Page 6 of 6 3. "Bodily injury" means bodily injury, mental anguish, mental injury, shock, fright, disability, humiliation, sickness or disease sustained by a person, including death resulting from any of these at any time. N. CONTRACTUAL LIABILITY — RAILROADS 1. The following replaces Paragraph c. of the definition of "insured contract" in the DEFINI- TIONS Section: c. Any easement or license agreement; 2. Paragraph f.(1) of the definition of "insured contract" in the DEFINITIONS Section is de- leted. © 2011 The Travelers Indemnity Company. All rights reserved. CG D3 16 11 1111 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY ISSUE DATE: - - THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY DESIGNATED PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Project(s): EACH "PROJECT" FOR WHICH YOU HAVE AGREED, IN A WRITTEN CONTRACT WHICH IS IN EFFECT DURING THIS POLICY PERIOD, TO PROVIDE A SEPARATE GENERAL AGGREGATE LIMIT, PROVIDED THAT THE CONTRACT IS SIGNED AND EXECUTED BY YOU BEFORE THE "BODILY INJURY" OR "PROPERTY DAMAGE" OCCURS. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under COVERAGE A. (SECTION 1), and for all medical expenses caused by accidents un- der COVERAGE C (SECTION I), which can be attributed only to operations at a single desig- nated "project" shown in the Schedule above: 1. A separate Designated Project General Ag- gregate Limit applies to each designated "pro- ject", and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations, unless separate Designated Project General Aggregate(s) are sched- uled above. 2. The Designated Project General Aggregate Limit is the most we will pay for the sum of all damages under COVERAGE A., except damages because of "bodily injury" or "prop- erty damage" included in the "products - completed operations hazard", and for medi- cal expenses under COVERAGE C, regard- less of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". Designated Project General Aggregate(s): GENERAL AGGREGATE LIMIT SHOWN ON THE DECLARATIONS 3. Any payments made under COVERAGE A. for damages or under COVERAGE C. for medical expenses shall reduce the Desig- nated Project General Aggregate Limit for that designated "project". Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they re- duce any other Designated Project General Aggregate Limit for any other designated "project" shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Project General Ag- gregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under COVERAGE A. (SECTION 1), and for all medical expenses caused by accidents un- der COVERAGE C. (SECTION 1), which cannot be attributed only to operations at a single desig- nated "project" shown in the Schedule above: CG D211 01 04 Copyright, The Travelers Indemnity Company, 2004 Page 1 of 2 COMMERCIAL GENERAL LIABILITY 1. Any payments made under COVERAGE A. for damages or under COVERAGE C. for .medical expenses shall reduce the amount available under the General Aggregate Limit or the Products -Completed Operations Ag- gregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Project General Aggregate Limit. C. Part 2. of SECTION III — LIMITS OF INSURANCE is deleted and replaced by the following: 2. 'The General Aggregate Limit is the most we will pay for the sum of: a. Damages under Coverage B; and Ib. Damages from 'occurrences" under COVERAGE A (SECTION I) and for all medical expenses caused by accidents under COVERAGE C (SECTION 1) which cannot be attributed only to operations at a single designated "project" shown in the SCHEDULE above. D. When coverage for liability arising out of the "products -completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -Completed Operations Ag- gregate Limit, and not reduce the General Aggre- gate Limit nor the Designated Project General Aggregate Limit. E. For the purposes of this endorsement the Defini- tions Section is amended by the addition of the following definition: "Project" means an area away from premises owned by or rented to you at which you are per- forming operations pursuant to a contract or agreement. For the purposes of determining the applicable aggregate limit of insurance, each "project" that includes premises involving the same or connecting lots, or premises whose con- nection is interrupted only by a street, roadway, waterway or right-of-way of a railroad shall be considered a single "project". F. The provisions of SECTION III — LIMITS OF INSURANCE not otherwise modified by this en- dorsement shall continue to apply as stipulated. Page 2 of 2 Copyright, The Travelers Indemnity Company, 2004 CG D2 11 01 04 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BROAD FORM NAMED INSURED B. BLANKET ADDITIONAL INSURED C. EMPLOYEE HIRED AUTO D. EMPLOYEES AS INSURED E. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS F. HIRED AUTO — LIMITED WORLDWIDE COV- ERAGE — INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE — GLASS PROVISIONS A. BROAD FORM NAMED INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any organization you newly acquire or form dur- ing the policy period over which you maintain 50% or more ownership interest and that is not separately insured for Business Auto Coverage. Coverage under this provision is afforded only un- til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- ever is earlier. B. BLANKET ADDITIONAL INSURED The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT J. PERSONAL PROPERTY K. AIRBAGS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS M. BLANKET WAIVER OF SUBROGATION N. UNINTENTIONAL ERRORS OR OMISSIONS this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. C. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COV- ERED AUTOS LIABILITY COVERAGE: An "employee" of yours is an "insured" 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 busi- ness. 2. The following replaces Paragraph b. in B.5., Other Insurance, of SECTION IV — BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "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 an "employee's" name, with your CA T3 53 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO permission, while performing duties related to the conduct of your busi- ness. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". D. EMPLOYEES AS INSURED The: following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. E. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS 1. The following replaces Paragraph A.2.a.(2), of SECTION II — COVERED AUTOS LIABIL- ITY COVERAGE: (2) Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4), of SECTION II — COVERED AUTOS LIABIL- ITY COVERAGE: (a) With respect to any claim made or "suit" brought outside the United States of America, the territories and possessions of the United States of America, Puerto Rico and Canada: (i) You must arrange to defend the "in- sured" against, and investigate or set- tle any such claim or "suit" and keep us advised of all proceedings and ac- tions. (ii) Neither you nor any other involved "insured" will make any settlement without our consent. (iii) We may, at our discretion, participate in defending the "insured" against, or in the settlement of, any claim or "suit". (iv) We will reimburse the "insured" for sums that the "insured" legally must pay as damages because of "bodily injury" or "property damage" to which this insurance applies, that the "in- sured" pays with our consent, but only up to the limit described in Para- graph C., Limits Of Insurance, of SECTION II — COVERED AUTOS LIABILITY COVERAGE. (4) All reasonable expenses incurred by the (v) We will reimburse the "insured" for "insured" at our request, including actual the reasonable expenses incurred loss of earnings up to $500 a day be- with our consent for your investiga- cause of time off from work. tion of such claims and your defense of the "insured" against any such F. HIRED AUTO — LIMITED WORLDWIDE COV- "suit", but only up to and included ERAGE — INDEMNITY BASIS within the limit described in Para - The following replaces Subparagraph (5) in Para- graph C., Limits Of Insurance, of graph B.7., Policy Period, Coverage Territory, SECTION II — COVERED AUTOS of SECTION IV — BUSINESS AUTO CONDI- LIABILITY COVERAGE, and not in TIONS: addition to such limit. Our duty to (5) Anywhere in the world, except any country or make such payments ends when we jurisdiction while any trade sanction, em- have used up the applicable limit of bargo, or similar regulation imposed by the insurance in payments for damages, United States of America applies to and pro- settlements or defense expenses. hibits the transaction of business with or (b) This insurance is excess over any valid within such country or jurisdiction, for Cov- and collectible other insurance available ered Autos Liability Coverage for any covered to the "insured" whether primary, excess, "auto" that you lease, hire, rent or borrow contingent or on any other basis. without a driver for a period of 30 days or less (c) This insurance is not a substitute for re - and that is not an "auto" you lease, hire, rent quired or compulsory insurance in any or borrow from any of your "employees", country outside the United States, its ter - partners (if you are a partnership), members ritories and possessions, Puerto Rico and (if you are a limited liability company) or Canada. members of their households. Page 2 of 4 © 2015 The Travelers Indemnity Company. All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc. with its permission. You agree to maintain all required or compulsory insurance in any such coun- try up to the minimum limits required by local law. Your failure to comply with compulsory insurance requirements will not invalidate the coverage afforded by this policy, but we will only be liable to the same extent we would have been liable had you complied with the compulsory in- surance requirements. (d) It is understood that we are not an admit- ted or authorized insurer outside the United States of America, its territories and possessions, Puerto Rico and Can- ada. We assume no responsibility for the furnishing of certificates of insurance, or for compliance in any way with the laws of other countries relating to insurance. G. WAIVER OF DEDUCTIBLE — GLASS The following is added to Paragraph D., Deducti- ble, of SECTION III — PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto' will apply to glass damage if the glass is repaired rather than replaced. H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT The following replaces the last sentence of Para- graph AA.b., Loss Of Use Expenses, of SEC- TION III — PHYSICAL DAMAGE COVERAGE: However, the most we will pay for any expenses for loss of use is $65 per day, to a maximum of $750 for any one "accident". I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT The following replaces the first sentence in Para- graph A.4.a., Transportation Expenses, of SECTION III — PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto' of the private passenger type. J. PERSONAL PROPERTY COMMERCIAL AUTO (2) In or on your covered "auto". This coverage applies only in the event of a total theft of your covered "auto". No deductibles apply to this Personal Property coverage. K. AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does_ not apply to 'loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of 'loss" set forth in Paragraphs A.1.b. and A.1.c., but only: a. If that "auto' is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one "loss". L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS The following is added to Paragraph A.2.a., of SECTION IV — BUSINESS AUTO CONDITIONS: Your duty to give us or our authorized representa- tive prompt notice of the "accident" or 'loss" ap- plies only when the "accident" or 'loss" is known to: (a) You (if you are an individual); (b) A partner (if you are a partnership); (c) A member (if you are a limited liability com- pany); (d) An executive officer, director or insurance manager (if you are a corporation or other or- ganization); or (e) Any "employee" authorized by you to give no- tice of the "accident" or "loss". M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — BUSINESS AUTO CONDI- TIONS: The following is added to Paragraph AA., Cover- 5. Transfer Of Rights Of Recovery Against age Extensions, of SECTION III — PHYSICAL Others To Us DAMAGE COVERAGE: We waive any right of recovery we may have Personal Property against any person or organization to the ex- tent required of you by a written contract We will pay up to $400 for 'loss" to wearing ap- signed and executed prior to any "accident" parel and other personal property which is: or "loss", provided that the "accident" or "loss" (1) Owned by an "insured"; and arises out of operations contemplated by CA T3 53 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO such contract. The waiver applies only to the The unintentional omission of, or unintentional person or organization designated in such error in, any information given by you shall not contract. prejudice your rights under this insurance. How - N. UNINTENTIONAL ERRORS OR OMISSIONS ever this provision does not affect our right to col - The following is added to Paragraph B.2., Con- lect additional premium or exercise our right of cealment, Misrepresentation, Or Fraud, of cancellation or non -renewal. SECTION IV — BUSINESS AUTO CONDITIONS: Page 4 of 4 © 2015 The Travelers Indemnity Company. All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc. with its permission. UMBRELLA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS This endorsement modifies insurance provided under the following: COMMERCIAL EXCESS LIABILITY (UMBRELLA) INSURANCE The following is added to Paragraph 11., OUR RIGHT TO RECOVER FROM OTHERS., of SECTION IV — CONDITIONS.: If the insured has agreed in a contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of: a. "Bodily injury" or "property damage" caused by an "occurrence" that takes place; or b. "Personal injury" or "advertising injury" caused by an "offense" that is committed; subsequent to the execution of the contract or agree- ment. UM 04 88 07 08 ©2008 The Travelers Companies, Inc. Page 1 of 1 Includes the copyrighted material of Insurance Services Office. Inc. with its permission. This page has been left blank intentionally. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED ✓ (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED — (Section II) is amended c) The insurance provided to the additional in- to include any person or organization that you sured does not apply to "bodily injury" or agree in a "written contract requiring insurance" "property damage" caused by "your work" to include as an additional insured on this Cover- and included in the "products -completed op - age Part, but: erations hazard" unless the "written contract a) Only with respect to liability for "bodily injury", requiring insurance" specifically requires you "property damage" or "personal injury'; and to provide such coverage for that additional insured, and then the insurance provided to b) if, and only to the extent that, the injury or the additional insured applies only to such damage is caused by acts or omissions of "bodily injury" or "property damage" that oc- you or your subcontractor in the performance curs before the end of the period of time for of "your work" to which the "written contract which the "written contract requiring insur- requiring insurance" applies. The person or ance" requires you to provide such coverage organization does not qualify as an additional or the end of the policy period, whichever is insured with respect to the independent acts earlier. or omissions of such person or organization. 3. The insurance provided to the additional insured 2. The insurance provided to the additional insured by this endorsement is excess over any valid and by this endorsement is limited as follows: collectible "other insurance", whether primary, a) In the event that the Limits of Insurance of excess, contingent or'on any other basis, that is this Coverage Part shown in the Declarations available to the additional insured for a loss we exceed the limits of liability required by the cover under this endorsement. However, if the "written contract requiring insurance", the in- "written contract requiring insurance" specifically surance provided to the additional insured requires that this insurance apply on a primary / shall be limited to the limits of liability re- basis or a primary and non-contributory basis, quired by that "written contract requiring in- this insurance is primary to "other insurance" surance". This endorsement shall not in- available to the additional insured which covers crease the limits of insurance described in that person or organization as a named insured Section ill — Limits Of Insurance. for such loss, and we will not share with that b) The insurance provided to the additional in- "other insurance". But the insurance provided to sured does not apply to ".bodily injury", "prop- the additional insured by this endorsement still is "other erty damage" or. "personal injury" arising out excess over any valid and collectible in- surance", .whether primary, excess, contingent or of the rendering of, or failure to render, any on any other basis, that is available to the addi- professional architectural, engineering or sur- tional insured when that person or organization is veying services, including: an additional insured under such "other insur- i. The preparing, approving, or failing to ance". prepare or approve, maps, shop :draw- 4. As a condition of coverage provided to 'the ings, opinions, reports, surveys, field or- additional insured by this endorsement: ders or change orders, or the preparing, approving, or failing to prepare or ap- a) The additional insured must give us written prove; drawings and specifications; and notice as soon as practicable of an "occur- iiSupervisory, 'inspection, architectural or rence" or an offense which may result in a': claim. To the extent possible, such notice engineering activities. should include'. CC D2 46 08 05 © 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY L How, when and where the "occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the "occurrence" or offense. b) if a claim is made or "suit" is brought against the additional insured, the additional insured must: I. Immediately record the specifics of the claim or "suit" and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit" as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and otherwise comply with all policy conditions. d) The additional insured, must tender the de- fense and indemnity of any claim or "suit" to any provider of "other insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement its primary to "other insur- ance" available to the additional insured Which covers that person or organization as a named insured as described in paragraph r3. above. 5. The following definition is added to SECTION V. — DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to in a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" Oc- curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 © 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY EXCLUSION - SUITS BY ONE NAMED INSURED AGAINST ANOTHER NAMED INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. This insurance does not apply to any claim for damages by any Named Insured against another Narned Insured because of "bodily injury", "prop- erty damage", "personal injury" or "advertising in- jury B. Condition 7. Separation of insureds is deleted and replaced by the following: Except with respect to the Limits of Insurance, the exclusion in A. of this endorsement and any rights or duties specifically assigned in this Coverage Part to the First Named insured, this insurance applies: a. As if the Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or "suit' is brought, CG 03 22 01 04 Copyright, The Travelers Indemnity Company, 2004 Page 1 of 1 010237 5/12/2017 aboutblank 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 Date: 5/9/2017 Company Details [ SABELHAUS WEST INC 10880 OLD FRONTIER ROAD SILVERDALE, WA 98383 360-662-9860 Intent Id 831899 Industrial Insurance Account Id: Filed By j Prime Contractor {Company Name Contractor Registration No. WA UBI Number r Phone Number Project Information 1 Awarding Agency f� Awarding Agency Contact Awarding Agency Contact Phone Number Contract Number Affidavit Id: Status: Approved On 5/11/2017 UBI#: 602176261 Reg#: SABELW1975112 E-mail: aprindle@sabelhauswest.com 55762602 Prindle, Amy SABELHAUS WEST INC SABELW1975R2 BREMERTON, CITY OF/PUBLIC WORKS 3027 OLYMPUS DRIVE BREMERTON, WA -98310 Pat Coxon 360-473-5448 WWTP CI Chmbr abodtlank 1/3 5!1212017 Project Name li Bid due date { Award Date Project Site Address or Directions abouttlank t i Intent Details Does your company intend to hire subcontractors to perform all work? Does your company intend to hire any subcontractors? Waste Water Treatment Plant Chlorine Contact Chamber Walls 3/2/2017 4/17/2017 1600 Oyster Bay Ave S Bremerton, WA 98312 Will your company have employees perform work Yes on this project? Do you intend to use any apprentices? (apprentices are considered employees.) Will this project utilize American Recovery and Reinvestment Act (ARRA) funds? { Specifically, will this project utilize any ±weatherization or energy efficiency upgrade funds (ARRA or otherwise)? No M No How many owner/operators performing work on 0 the project own 30% or more of the company? What is the estimated contract amount? Or is this $84,396.08 } a time and materials estimate? Y Expected project start date: (MM-DD-YYYY) In what county (or counties) will the project be done? In what city (or nearest city) will the project be done? Journey Level Wages � County1 Trade aboMblank Occupation Wage I f=ringe # 5/12/2017 about:blank Workers Kitsap I Painters lJourney Level ; $40.60 i $11.61 B Show/Hide Existing Notes No note exists about:blank 313 Client#: 148397 SABEWEST ACORD,. CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDD/YYYY) INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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, 10/25/2017 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: Carly Sullivan Propel Insurance Seattle Commercial Insurance RECEIVED' ac°NN EXI : 800 499-0933 A/C 866 577-1326 /C,"° E-MAIL ADDRESS: Carly.Sullivan@propelinsurance.com 1/01/2017 925 4th Ave, Suite 3200 Seattle, WA 98104INSURERS) OCT 30 2057 AFFORDING COVERAGE NAIC # INSURER A: Charter Oak Fire Insurance Comp JA 25615 INSURED Sabelhaus West, Inc. INSURER B: Travelers Property Casualty Coo 11 26674, 10880 Old Frontier Rd NW City of Bremerton INSURER C: The Phoenix Insurance Company 623 Silverdale, WA 98383 Risk Management INSURER D: INSURER E: INSURER F: (Ea occurrence) nce)$ MED EXP (Any one person) $10,000 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 CONTRACTOR 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 TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY X X DTC04G547548COF17 1/01/2017 11/01/2018 EACH OCCURRENCE $1000000 CLAIMS -MADE a OCCUR PREMISES ccurs 300,000 X PD Ded:5,000 (Ea occurrence) nce)$ MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: C AUTOMOBILE LIABILITY X X DT8104G547548TIA171/01/2017 11/01/201 E MECINEDdenSINGLELIMIT $1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X HIREDAUTOSX NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident B X LA X OCCUR X X CUP7H2O921116 1/01/2017 11/01/201 EACH OCCURRENCE $5,00 000 E EXCESS EXCESS LIAR B CLAIMS -MADE AGGREGATE $5,000,000 DED I X RETENTION $10000 $ A WORKERS EMPLOY EMPLOYERS' COMPENSATION AND EMPLOYERS' LIABILITY DTC04G547548COF17 1/01/2017 11/01/201 PER X OTH- TAT ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 0 EXCLUDED? ❑ N / A E.L. EACH ACCIDENT $1,000,000 andaR ry in NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 If If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 A Rented & Leased QT6604G414008COF17 1/01/2017 11/01/201 $100,000 Equipment $1,000 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) (09/2019) Waste Water Treatment Plant Chlorine Contact Chamber Walls, City of Bremerton, Public Works & Utilities, 1600 Oyster Bay Ave S, Bremerton, WA 98312 City of Bremerton, its officials, employees, agents and volunteers shall be named as an additional insured / City of Bremerton / Risk Management 345 - 6th Street, Suite 600 Bremerton, WA 98337 ACORD 25 (2014/01) 1 of 1 #S2933810/M2923377 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 ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CRS00 This page has been left blank intentionally. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED / (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED — (Section II) is amended to include any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Cover- age Part, but: a) Only with respect to liability for "bodily injury", "property damage" or "personal injury'; and b) If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the in- surance provided to the additional insured shall be limited to the limits of liability re- quired by that "written contract requiring in- surance". This endorsement shall not in- crease the limits of insurance described in Section III — Limits Of Insurance. b) The insurance provided to the additional in- sured does not apply to "bodily injury", "prop- erty damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or sur- veying services, including: I. The preparing, approving, or failing to prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders or change orders, or the preparing, approving, or failing to prepare or ap- prove, drawings and specifications; and ii. Supervisory, inspection, architectural or engineering activities. c) The insurance provided to the additional in- sured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products -completed op- erations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that oc- curs before the end of the period of time for which the "written contract requiring insur- ance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible 'other insurance", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non-contributory basis, this insurance is primary to 'other insurance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that "other insurance". But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible "other in- surance", whether primary, excess, contingent or on any other basis, that is available to the addi- tional insured when that person or organization is an additional insured under such 'other insur- ance". 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include: CG D2 46 08 05 © 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY I. How, when and where the 'occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the "occurrence" or offense. b) If a claim is made or "suit" is brought against the additional insured, the additional insured must: I. Immediately record the specifics of the claim or "suit' and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit' as soon as practicable. C) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit', cooperate with us in the investigation or settlement of the claim or defense against the "suit', and otherwise comply with all policy conditions. d) The additional insured must tender the de- fense and indemnity of any claim or "suit' to any provider of "other insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to 'other insur- ance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. — DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the 'bodily injury" and "property damage" oc- curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 © 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS XTEND ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Aircraft Chartered With Pilot B. Damage To Premises Rented To You C. Increased Supplementary Payments D. Incidental Medical Malpractice E. Who Is An Insured — Newly Acquired Or Formed Organizations F. Who Is An Insured — Broadened Named Insured — Unnamed Subsidiaries G. Blanket Additional Insured — Owners, Managers Or Lessors Of Premises PROVISIONS A. AIRCRAFT CHARTERED WITH PILOT The following is added to Exclusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION I — COVERAGES — COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABILITY: This exclusion does not apply to an aircraft that is: (a) Chartered with a pilot to any insured; (b) Not owned by any insured; and (c) Not being used to carry any person or prop- erty for a charge. B. DAMAGE TO PREMISES RENTED TO YOU 1. The first paragraph of the exceptions in Ex- clusion j., Damage To Property, in Para- graph 2. of SECTION I — COVERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY is deleted. H. Blanket Additional Insured — Lessors Of Leased Equipment I. Blanket Additional Insured — States Or Political Subdivisions — Permits J. Knowledge And Notice Of Occurrence Or Offense K. Unintentional Omission L. Blanket Waiver Of Subrogation M. Amended Bodily Injury Definition N. Contractual Liability — Railroads INJURY AND PROPERTY DAMAGE Ll- ABILITY.- Exclusions I- ABILITY:Exclusions c. and g. through n. do not apply to "premises damage". Exclusion f.(1)(a) does not apply to "premises damage" caused by: a. Fire; b. Explosion; c. Lightning; d. Smoke resulting from such fire, explosion, or lightning; or e. Water; unless Exclusion f. of Section I — Coverage A — Bodily Injury And Property Damage Liability is replaced by another endorsement to this Coverage Part that has Exclusion — All Pollu- tion Injury Or Damage or Total Pollution Ex- clusion in its title. 2. The following replaces the last paragraph of A separate limit of insurance applies to Paragraph 2., Exclusions, of SECTION 1 — "premises damage" as described in Para - COVERAGES — COVERAGE A. BODILY graph 6. of SECTION III — LIMITS OF IN- SURANCE. CG D3 16 11 11 © 2011 The Travelers Indemnity Company. All rights reserved. Page 1 of 6 COMMERCIAL GENERAL LIABILITY 3. The following replaces Paragraph 6. of SEC- TION III — LIMITS OF INSURANCE: Subject to 5. above, the Damage To Prem- ises Rented To You Limit is the most we will pay under Coverage A for damages because of "premises damage" to any one premises. The Damage To Premises Rented To You Limit will apply to all "property damage" proximately caused by the same "occur- rence", whether such damage results from: fire; explosion; lightning; smoke resulting from such fire, explosion, or lightning; or water; or any combination of any of these causes. The Damage To Premises Rented To You Limit will be: a. The amount shown for the Damage To Premises Rented To You Limit on the Declarations of this Coverage Part; or b. $300,000 if no amount is shown for the Damage To Premises Rented To You Limit on the Declarations of this Coverage Part. 4. The following replaces Paragraph a. of the definition of "insured contract' in the DEFINI- TIONS Section: a. A contract for a lease of premises. How- ever, that portion of the contract for a lease of premises that indemnifies any person or organization for "premises damage" is not an "insured contract; 5. The following is added to the DEFINITIONS Section: "Premises damage" means "property dam- age" to: a. Any premises while rented to you or tem- porarily occupied by you with permission of the owner; or b. The contents of any premises while such premises is rented to you, if you rent such premises for a period of seven or fewer consecutive days. 6. The following replaces Paragraph 4.b.(1)(b) of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: (b) That is insurance for "premises damage'; or 7. Paragraph 4.b.(1)(c) of SECTION IV — COMMERCIAL GENERAL LIABILITY CON- DITIONS is deleted. C. INCREASED SUPPLEMENTARY PAYMENTS 1. The following replaces Paragraph 1.b. of SUPPLEMENTARY PAYMENTS — COVER- AGES A AND B of SECTION I — COVER- AGE: b. Up to $2,500 for the cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to fur- nish these bonds. 2. The following replaces Paragraph 1.d. of SUPPLEMENTARY PAYMENTS — COVER- AGES A AND B of SECTION I — COVER- AGES: d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit', including actual loss of earnings up to $500 a day because of time off from work. D. INCIDENTAL MEDICAL MALPRACTICE 1. The following is added to the definition of "oc- currence" in the DEFINITIONS Section: "Occurrence" also means an act or omission committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to a person. 2. The following is added to Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED: Paragraph (1)(d) above does not apply to "bodily injury" arising out of providing or fail- ing to provide: (i) "Incidental medical services" by any of your "employees" who is a nurse practi- tioner, registered nurse, licensed practical nurse, nurse assistant, emergency medi- cal technician or paramedic; or (ii) First aid or "Good Samaritan services" by any of your "employees" or "volunteer workers", other than an employed or vol- unteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first aid or "Good Samaritan ser- vices" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your busi- ness. Page 2 of 6 © 2011 The Travelers Indemnity Company. All rights reserved. CG D3 16 11 11 COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 5. of 4. Any organization you newly acquire or form, SECTION III — LIMITS OF INSURANCE: other than a partnership, joint venture or lim- For the purposes of determining the applica- ited liability company, of which you are the ble Each Occurrence Limit, all related acts or sole owner or in which you maintain the ma - omissions committed in providing or failing to jority ownership interest, will qualify as a provide "incidental medical services", first aid Named Insured if there is no other insurance or "Good Samaritan services" to any one per- which provides similar coverage to that Or- son will be deemed to be one 'occurrence". ganization. However: 4. The following exclusion is added to Para- graph 2., Exclusions, of SECTION I — COV- ERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY.- Sale IABILITY: Sale Of Pharmaceuticals "Bodily injury" or "property damage" arising out of the willful violation of a penal statute or ordinance relating to the sale of pharmaceuti- cals committed by, or with the knowledge or consent of, the insured. 5. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; or b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. "Good Samaritan services" means any emer- gency medical services for which no compen- sation is demanded or received. 6. The following is added to Paragraph 4.b., Ex- cess Insurance, of SECTION IV — COM- MERCIAL GENERAL LIABILITY CONDI- TIONS: The insurance is excess over any valid and collectible other insurance available to the in- sured, whether primary, excess, contingent or on any other basis, that is available to any of your "employees" or "volunteer workers" for "bodily injury" that arises out of providing or failing to provide "incidental medical ser- vices", first aid or "Good Samaritan services" to any person to the extent not subject to Paragraph 2.a.(1) of Section II — Who Is An Insured. E. WHO IS AN INSURED — NEWLY ACQUIRED OR FORMED ORGANIZATIONS The following replaces Paragraph 4. of SECTION II — WHO IS AN INSURED: a. Coverage under this provision is afforded only: (1) Until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier, if you do not report such organization in writing to us within 180 days after you acquire or form it; or (2) Until the end of the policy period, when that date is later than 180 days after you acquire or form such organization, if you report such organization in writing to us within 180 days after you acquire or form it, and we agree in writing that it will con- tinue to be a Named Insured until the end of the policy period; b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and c. Coverage B does not apply to "personal in- jury" or "advertising injury" arising out of an offense committed before you acquired or formed the organization. F. WHO IS AN INSURED — BROADENED NAMED INSURED — UNNAMED SUBSIDIARIES The following is added to SECTION II — WHO IS AN INSURED: Any of your subsidiaries, other than a partnership, joint venture or limited liability company, that is not shown as a Named Insured in the Declara- tions is a Named Insured if you maintain an own- ership interest of more than 50% in such subsidi- ary on the first day of the policy period. No such subsidiary is an insured for "bodily injury" or "property damage" that occurred, or "personal injury" or "advertising injury" caused by an of- fense committed after the date, if any, during the policy period, that you no longer maintain an ownership interest of more than 50% in such sub- sidiary. CG D3 16 11 11 © 2011 The Travelers Indemnity Company. All rights reserved. Page 3 of 6 COMMERCIAL GENERAL LIABILITY G. BLANKET ADDITIONAL INSURED — OWNERS, MANAGERS OR LESSORS OF PREMISES The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that is a premises owner, manager or lessor and that you have agreed in a written contract or agreement to in- clude as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage", "personal injury" or "advertising injury" that: a. Is "bodily injury" or "property damage" that occurs, or is "personal injury" or "advertising injury" caused by an offense that is commit- ted, subsequent to the execution of that con- tract or agreement; and b. Arises out of the ownership, maintenance or use of that part of any premises leased to you. The insurance provided to such premises owner, manager or lessor is subject to the following pro- visions: a. The limits of insurance provided to such premises owner, manager or lessor will be the minimum limits which you agreed to pro- vide in the written contract or agreement, or the limits shown on the Declarations, which- ever are less. b. The insurance provided to such premises owner, manager or lessor does not apply to: (1) Any "bodily injury" or "property damage" that occurs, or "personal injury" or "adver- tising injury" caused by an offense that is committed, after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such premises owner, lessor or manager. c. The insurance provided to such premises owner, manager or lessor is excess over any valid and collectible other insurance available to such premises owner, manager or lessor, whether primary, excess, contingent or on any other basis, unless you have agreed in the written contract or agreement that this in- surance must be primary to, or non- contributory with, such other insurance, in which case this insurance will be primary to, and non-contributory with, such other insur- ance. H. BLANKET ADDITIONAL INSURED — LESSORS OF LEASED EQUIPMENT The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that is an equipment lessor and that you have agreed in a written con- tract or agreement to include as an insured on this Coverage Part is an insured, but only with re- spect to liability for "bodily injury", "property dam- age", "personal injury" or "advertising injury" that: a. Is "bodily injury" or "property damage" that occurs, or is "personal injury" or "advertising injury" caused by an offense that is commit- ted, subsequent to the execution of that con- tract or agreement; and b. Is caused, in whole or in part, by your acts or omissions in the maintenance, operation or use of equipment leased to you by such equipment lessor. The insurance provided to such equipment lessor is subject to the following provisions: a. The limits of insurance provided to such equipment lessor will be the minimum limits which you agreed to provide in the written contract or agreement, or the limits shown on the Declarations, whichever are less. b. The insurance provided to such equipment lessor does not apply to any "bodily injury" or "property damage" that occurs, or "personal injury" or "advertising injury" caused by an of- fense that is committed, after the equipment lease expires. c. The insurance provided to such equipment lessor is excess over any valid and collectible other insurance available to such equipment lessor, whether primary, excess, contingent or on any other basis, unless you have agreed in the written contract or agreement that this insurance must be primary to, or non-contributory with, such other insurance, in which case this insurance will be primary to, and non-contributory with, such other in- surance. I. BLANKET ADDITIONAL INSURED — STATES OR POLITICAL SUBDIVISIONS — PERMITS The following is added to SECTION II — WHO IS AN INSURED: Any state or political subdivision that has issued a permit in connection with operations performed by you or on your behalf and that you are required Page 4 of 6 © 2011 The Travelers Indemnity Company. All rights reserved. CG D3 16 11 11 by any ordinance, law or building code to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage", "personal in- jury" or "advertising injury" arising out of such op- erations. The insurance provided to such state or political subdivision does not apply to: a. Any "bodily injury," "property damage," "per- sonal injury" or "advertising injury" arising out of operations performed for that state or po- litical subdivision; or b. Any "bodily injury" or "property damage" in- cluded in the "products -completed operations hazard". J. KNOWLEDGE AND NOTICE OF OCCUR- RENCE OR OFFENSE The following is added to Paragraph 2., Duties In The Event of Occurrence, Offense, Claim or Suit, of SECTION IV — COMMERCIAL GEN- ERAL LIABILITY CONDITIONS: e. The following provisions apply to Paragraph a. above, but only for the purposes of the in- surance provided under this Coverage Part to you or any insured listed in Paragraph 1, or 2. of Section II — Who Is An Insured: (1) Notice to us of such "occurrence" or of- fense must be given as soon as practica- ble only after the "occurrence" or offense is known by you (if you are an individual), any of your partners or members who is an individual (if you are a partnership or joint venture), any of your managers who is an individual (if you are a limited liability company), any of your "executive offi- cers" or directors (if you are an organiza- tion other than a partnership, joint venture or limited liability company) or any "em- ployee" authorized by you to give notice of an "occurrence" or offense. (2) If you are a partnership, joint venture or limited liability company, and none of your partners, joint venture members or man- agers are individuals, notice to us of such "occurrence" or offense must be given as soon as practicable only after the "occur- rence" or offense is known by: COMMERCIAL GENERAL LIABILITY (ii) A manager of any limited liability company; or (iii) An executive officer or director of any other organization; that is your partner, joint venture member or manager; or (b) Any "employee" authorized by such partnership, joint venture, limited li- ability company or other organization to give notice of an "occurrence" or offense. (3) Notice to us of such "occurrence" or of an offense will be deemed to be given as soon as practicable if it is given in good faith as soon as practicable to your work- ers' compensation insurer. This applies only if you subsequently give notice to us of the "occurrence" or offense as soon as practicable after any of the persons de- scribed in Paragraphs e. (1) or (2) above discovers that the "occurrence" or offense may result in sums to which the insurance provided under this Coverage Part may apply. However, if this Coverage Part includes an en- dorsement that provides limited coverage for "bodily injury" or "property damage" or pollution costs arising out of a discharge, release or es- cape of "pollutants" which contains a requirement that the discharge, release or escape of "pollut- ants" must be reported to us within a specific number of days after its abrupt commencement, this Paragraph e. does not affect that require- ment. K. UNINTENTIONAL OMISSION The following is added to Paragraph 6., Repre- sentations, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not preju- dice 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 insurance laws or regulations. L. BLANKET WAIVER OF SUBROGATION (a) Any individual who is: The following is added to Paragraph 8., Transfer (i) A partner or member of any part- Of Rights Of Recovery Against Others To Us, nership or joint venture; of SECTION IV — COMMERCIAL GENERAL LI- ABILITY CONDITIONS: CG D3 16 11 11 C 2011 The Travelers Indemnity Company. All rights reserved. Page 5 of 6 COMMERCIAL GENERAL LIABILITY If the insured has agreed in a contract or agree- ment to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organiza- tion, but only for payments we make because of: a. "Bodily injury" or "property damage" that oc- curs; or b. "Personal injury" or "advertising injury" caused by an offense that is committed; subsequent to the execution of that contract or agreement. M. AMENDED BODILY INJURY DEFINITION The following replaces the definition of "bodily injury" in the DEFINITIONS Section: 3. "Bodily injury" means bodily injury, mental anguish, mental injury, shock, fright, disability, humiliation, sickness or disease sustained by a person, including death resulting from any of these at any time. N. CONTRACTUAL LIABILITY — RAILROADS 1. The following replaces Paragraph c. of the definition of "insured contract" in the DEFINI- TIONS Section: c. Any easement or license agreement; 2. Paragraph f.(1) of the definition of "insured contract" in the DEFINITIONS Section is de- leted. Page 6 of 6 © 2011 The Travelers Indemnity Company. All rights reserved. CG D3 16 11 11 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: ISSUE DATE: - THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY DESIGNATED PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Project(s): EACH "PROJECT" FOR WHICH YOU HAVE AGREED, IN A WRITTEN CONTRACT WHICH IS IN EFFECT DURING THIS POLICY PERIOD, TO PROVIDE A SEPARATE GENERAL AGGREGATE LIMIT, PROVIDED THAT THE CONTRACT IS SIGNED AND EXECUTED BY YOU BEFORE THE "BODILY INJURY" OR "PROPERTY DAMAGE" OCCURS. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under COVERAGE A. (SECTION 1), and for all medical expenses caused by accidents un- der COVERAGE C (SECTION 1), which can be attributed only to operations at a single desig- nated "project" shown in the Schedule above: I. A separate Designated Project General Ag- gregate Limit applies to each designated "pro- ject", and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations, unless separate Designated Project General Aggregate(s) are sched- uled above. 2. The Designated Project General Aggregate Limit is the most we will pay for the sum of all damages under COVERAGE A., except damages because of "bodily injury" or "prop- erty damage" included in the "products - completed operations hazard", and for medi- cal expenses under COVERAGE C, regard- less of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". Designated Project General Aggregate(s): GENERAL AGGREGATE LIMIT SHOWN ON THE DECLARATIONS 3. Any payments made under COVERAGE A. for damages or under COVERAGE C. for medical expenses, shall reduce the Desig- nated Project General Aggregate Limit for that designated "project". Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they re- duce any other Designated Project General Aggregate Limit for any other designated "project" shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Project General Ag- gregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under COVERAGE A. (SECTION 1), and for all medical expenses caused by accidents un- der COVERAGE C. (SECTION 1), which cannot be attributed only to operations at a single desig- nated "project" shown in the Schedule above: CG D211 01 04 Copyright, The Travelers Indemnity Company, 2004 Page 1 of 2 COMMERCIAL GENERAL LIABILITY 1. Any payments made under COVERAGE A. for damages or under COVERAGE C. for .medical expenses shall reduce the amount available under the General Aggregate Limit or the Products -Completed Operations Ag- gregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Project General Aggregate Limit. C. Part 2. of SECTION III — LIMITS OF INSURANCE is deleted and replaced by the following: . 2. The General Aggregate Limit is the most we will pay for the sum of: a. Damages under Coverage B; and b. Damages from 'occurrences" under COVERAGE A (SECTION 1) and for all medical expenses caused by accidents under COVERAGE C (SECTION 1) which cannot be attributed only to operations at a single designated "project" shown in the SCHEDULE above. D. When coverage for liability arising out of the "products -completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -Completed Operations Ag- gregate Limit, and not reduce the General Aggre- gate Limit nor the Designated Project General Aggregate Limit. E. For the purposes of this endorsement the Defini- tions Section is amended by the addition of the following definition: "Project" means an area away from premises owned by or rented to you at which you are per- forming operations pursuant to a contract or agreement. For the purposes of determining the applicable aggregate limit of insurance, each "project" that includes premises involving the same or connecting lots, or premises whose con- nection is interrupted only by a street, roadway, waterway or right-of-way of a railroad shall be considered a single "project". F. The provisions of SECTION III — LIMITS OF INSURANCE not otherwise modified by this en- dorsement shall continue to apply as stipulated. Page 2 of 2 Copyright, The Travelers Indemnity Company, 2004 CG 02 11 01 04 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BROAD FORM NAMED INSURED B. BLANKET ADDITIONAL INSURED C. EMPLOYEE HIRED AUTO D. EMPLOYEES AS INSURED E. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS F. HIRED AUTO — LIMITED WORLDWIDE COV- ERAGE — INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE — GLASS PROVISIONS A. BROAD FORM NAMED INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any organization you newly acquire or form dur- ing the policy period over which you maintain 50% or more ownership interest and that is not separately insured for Business Auto Coverage. Coverage under this provision is afforded only un- til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- ever is earlier. B. BLANKET ADDITIONAL INSURED The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT J. PERSONAL PROPERTY K. AIRBAGS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS M. BLANKET WAIVER OF SUBROGATION N. UNINTENTIONAL ERRORS OR OMISSIONS this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section 11. C. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION 11 — COV- ERED AUTOS LIABILITY COVERAGE: An "employee" of yours is an "insured" 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 busi- ness. 2. The following replaces Paragraph b. in B.5., Other Insurance, of SECTION IV — BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1) Any covered "auto" you lease, hire, rent or barrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your CA T3 53 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO permission, while performing duties related to the conduct of your busi- ness. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". D. EMPLOYEES AS INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. E. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS 1. The following replaces Paragraph A.2.a.(2), of SECTION II — COVERED AUTOS LIABIL- ITY COVERAGE: (2) Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4), of SECTION II — COVERED AUTOS LIABIL- ITY COVERAGE: (a) With respect to any claim made or "suit" brought outside the United States of America, the territories and possessions of the United States of America, Puerto Rico and Canada: (i) You must arrange to defend the "in- sured" against, and investigate or set- tle any such claim or "suit" and keep us advised of all proceedings and ac- tions. (ii) Neither you nor any other involved "insured" will make any settlement without our consent. (iii) We may, at our discretion, participate in defending the "insured" against, or in the settlement of, any claim or "suit". (iv) We will reimburse the "insured" for sums that the "insured" legally must pay as damages because of "bodily injury" or "property damage" to which this insurance applies, that the "in- sured" pays with our consent, but only up to the limit described in Para- graph C., Limits Of Insurance, of SECTION II — COVERED AUTOS LIABILITY COVERAGE. (4) All reasonable expenses incurred by the (v) We will reimburse the "insured" for "insured" at our request, including actual the reasonable expenses incurred loss of earnings up to $500 a day be- with our consent for your investiga- cause of time off from work. tion of such claims and your defense F. HIRED AUTO — LIMITED WORLDWIDE COV- of the "insured" against any such "suit", ERAGE — INDEMNITY BASIS but only up to and included within the limit described in Para - The following replaces Subparagraph (5) in Para- graph C., Limits Of Insurance, of graph B.7., Policy Period, Coverage Territory, SECTION II — COVERED AUTOS of SECTION IV — BUSINESS AUTO CONDI- LIABILITY COVERAGE, and not in TIONS: addition to' such limit. Our duty to (5) Anywhere in the world, except any country or make such payments ends when we jurisdiction while any trade sanction, em- have used up the applicable limit of bargo, or similar regulation imposed by the insurance in payments for damages, United States of America applies to and pro- settlements or defense expenses. hibits the transaction of business with or (b) This insurance is excess over any valid within such country or jurisdiction, for Cov- and collectible other insurance available ered Autos Liability Coverage for any covered to the "insured" whether primary, excess, "auto" that you lease, hire, rent or borrow contingent or on any other basis. without a driver fora period of 30 days or less (c) This insurance is not a substitute for re - and that is not an auto you lease, hire, rent quired or compulsory insurance in any or borrow from any of your "employees", country outside the United States, its ter - partners (if you are a partnership), members ritories and possessions, Puerto Rico and (if you are a limited liability company) or Canada. members of their households. Page 2 of 4 © 2015 The Travelers Indemnity Company. All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc. with its permission. You agree to maintain all required or compulsory insurance in any such coun- try up to the minimum limits required by local law. Your failure to comply with compulsory insurance requirements will not invalidate the coverage afforded by this policy, but we will only be liable to the same extent we would have been liable had you complied with the compulsory in- surance requirements. (d) It is understood that we are not an admit- ted or authorized insurer outside the United States of America, its territories and possessions, Puerto Rico and Can- ada. We assume no responsibility for the furnishing of certificates of insurance, or for compliance in any way with the laws of other countries relating to insurance. G. WAIVER OF DEDUCTIBLE — GLASS The following is added to Paragraph D., Deducti- ble, of SECTION III — PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT The following replaces the last sentence of Para- graph A.4.b., Loss Of Use Expenses, of SEC- TION III — PHYSICAL DAMAGE COVERAGE: However, the most we will pay for any expenses for loss of use is $65 per day, to a maximum of $750 for any one "accident'. I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT The following replaces the first sentence in Para- graph A.4.a., Transportation Expenses, of SECTION III — PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. J. PERSONAL PROPERTY COMMERCIAL AUTO (2) In or on your covered "auto". This coverage applies only in the event of a total theft of your covered "auto". No deductibles apply to this Personal Property coverage. K. AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A.1.c., but only: a. If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one "loss". L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS The following is added to Paragraph A.2.a., of SECTION IV — BUSINESS AUTO CONDITIONS: Your duty to give us or our authorized representa- tive prompt notice of the "accident" or 'loss" ap- plies only when the "accident' or 'loss" is known to: (a) You (if you are an individual); (b) A partner (if you are a partnership); (c) A member (if you are a limited liability com- pany); (d) An executive officer, director or insurance manager (if you are a corporation or other or- ganization); or (e) Any "employee" authorized by you to give no- tice of the "accident' or "loss". M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.S., Transfer / Of Rights Of Recovery Against Others To Us, of SECTION IV — BUSINESS AUTO CONDI- TIONS: The following is added to Paragraph A.4., Cover- S. Transfer Of Rights Of Recovery Against age Extensions, of SECTION III — PHYSICAL Others To Us DAMAGE COVERAGE: We waive any right of recovery we may have Personal Property against any person or organization to the ex- tent required of you by a written contract We will pay up to $400 for 'loss" to wearing ap- signed and executed prior to any "accident' parel and other personal property which is: or "loss", provided that the "accident' or "loss" (1) Owned by an "insured"; and arises out of operations contemplated by CA T3 53 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO such contract. The waiver applies only to the The unintentional omission of, or unintentional person or organization designated in such error in, any information given by you shall not contract. prejudice your rights under this insurance. How - N. UNINTENTIONAL ERRORS OR OMISSIONS ever this provision does not affect our right to col - The following is added to Paragraph B.2., Con- lect additional premium or exercise our right of cealment, Misrepresentation, Or Fraud, of cancellation or non -renewal. SECTION IV — BUSINESS AUTO CONDITIONS: Page 4 of 4 © 2015 The Travelers Indemnity Company. All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc. with its permission. UMBRELLA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS This endorsement modifies insurance provided under the following: COMMERCIAL EXCESS LIABILITY (UMBRELLA) INSURANCE The following is added to Paragraph 11., OUR RIGHT TO RECOVER FROM OTHERS., of SECTION IV — CONDITIONS.: If the insured has agreed in a contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of: a. "Bodily injury" or "property damage" caused by an "occurrence" that takes place; or b. "Personal injury' or "advertising injury' caused by an "offense" that is committed; subsequent to the execution of the contract or agree- ment. UM 04 88 07 08 O 2008 The Travelers Companies, Inc. Includes the copyrighted material of Insurance Services Office. Inc. with its permission. Page 1 of 1 This page has been left blank intentionally Client#: 148397 SABEWEST ACORDTM CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DDNYYY) LTRR TYPE OF INSURANCE 10/25/2018 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 CONTACT NAME: Laurie ROSS Propel Insurance PHONE g00 499-0933 FAx A/C No, Ext : p/C, No 866 577-1326 Seattle Commercial Insurance E- RESS: Laurie. Ross@propelinsurance.com 601 Union Street, Suite 3400 MED EXP (Any one person) $10,000 Seattle, WA 98101-1371 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Charter Oak Fire Insurance Company 25615 GEN'L INSURED B: Travelers Property Casualty CoofAmeric -" .,. SabelINSURER West, Inc. The Phoenix Insurance Company 256 INSURER C : p y 10880 Old 10880 Old Frontier Rd NW INSURER D : i 1 V Silverdale, WA 98383 INSURER E: INSURER F: 11/01/2018 UUVERAGES CERTIFICATE NUMBER: REVISION NUMBM:L!t- "" THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POI IOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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. LTRR TYPE OF INSURANCE AD D NSR SUM- WVD POLICY NUMBER POLICYEFF EXP MM/DDY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [4 OCCUR X' PD Ded:$5,000 DTC04G547548COF18 11/01/2018 11/01/2019 EACH OCCURRENCE $1,000,000 PREMISESOEaoccurrDence $300,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY �X� JECOT F7 LOC OTHER GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 $ C AUTOMOBILE X X LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY 810OL8485561826G 11/01/2018 11/01/201 EO ac ideDtSINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CUPOK6107571826 11/01/2018 11/01/201 EACH OCCURRENCE s5,000,000 AGGREGATE $5,000,000 DED I X RETENTION $$10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N OFFICER/MEMBER EXCLUDED? ANY ECUTIVE� (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N /A DTC04G547548COF18 WA Stop Gap _ 11/01/2018 11/01/201 STAT TE X ORH- E L EACH ACCIDENT $1,000,000 E L DISEASE - EA EMPLOYEE $1,000,000 E L DISEASE - POLICY LIMIT $1,000,000 A Rented & Leased Equipment QT6604G414008COF18 11/01/2018 11/01/2019 $100,000 $1,000 Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) �_(VI--yz c16�.0►r?`_t (09/2019) Waste Water Treatment Plant Chlorine Contact Chamber Walls, City of Bremerton, Public Works & Utilities, 1600 Oyster Bay Ave S, Bremerton, WA 98312 City of Bremerton, its officials, employees, agents and volunteers shall be named as an additional insured V LIQ I lr lV/ I C nvL_LJcrt _ L;ANC:tLLA I IUN City of Bremerton / Risk Management 345 - 6th Street, Suite 600 Bremerton, WA 98337-0000 ACORD 25 (2016/03) 1 of 1 #S3421288/M3420853 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. The ACORD name and logo are registered marks of ACORD JMB00 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS XTEND ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Aircraft Chartered With Pilot B. Damage To Premises Rented To You C. Increased Supplementary Payments D. Incidental Medical Malpractice E. Who Is An Insured — Newly Acquired Or Formed Organizations F. Who Is An Insured — Broadened Named Insured — Unnamed Subsidiaries G. Blanket Additional Insured — Owners, Managers Or Lessors Of Premises PROVISIONS A. AIRCRAFT CHARTERED WITH PILOT The following is added to Exclusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION I — COVERAGES — COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABILITY: This exclusion does not apply to an aircraft that is: (a) Chartered with a pilot to any insured; (b) Not owned by any insured; and (c) Not being used to carry any person or prop- erty for a charge. B. DAMAGE TO PREMISES RENTED TO YOU 1. The first paragraph of the exceptions in Ex- clusion j., Damage To Property, in Para- graph 2. of SECTION I — COVERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY is deleted. H. Blanket Additional Insured — Lessors Of Leased Equipment I. Blanket Additional Insured — States Or Political Subdivisions — Permits J. Knowledge And Notice Of Occurrence Or Offense K. Unintentional Omission L. Blanket Waiver Of Subrogation M. Amended Bodily Injury Definition N. Contractual Liability — Railroads INJURY AND PROPERTY DAMAGE LI- ABILITY: Exclusions c. and g. through n. do not apply to "premises damage". Exclusion f.(1)(a) does not apply to "premises damage" caused by: a. Fire; b. Explosion; c. Lightning; d. Smoke resulting from such fire, explosion, or lightning; or e. Water; unless Exclusion f. of Section I — Coverage A — Bodily Injury And Property Damage Liability is replaced by another endorsement to this Coverage Part that has Exclusion — All Pollu- tion Injury Or Damage or Total Pollution Ex- clusion in its title. 2. The following replaces the last paragraph of A separate limit of insurance applies to Paragraph 2., Exclusions, of SECTION I — premises damage" as described in Para - COVERAGES — COVERAGE A. BODILY graph 6. of SECTION III — LIMITS OF IN- SURANCE. CG D3 16 11 11 © 2011 The Travelers Indemnity Company. All rights reserved. Page 1 of 6 COMMERCIAL GENERAL LIABILITY 3. The following replaces Paragraph 6. of SEC- TION III — LIMITS OF INSURANCE: Subject to 5. above, the Damage To Prem- ises Rented To You Limit is the most we will pay under Coverage A for damages because of "premises damage" to any one premises. The Damage To Premises Rented To You Limit will apply to all "property damage" proximately caused by the same "occur- rence", whether such damage results from: fire; explosion; lightning; smoke resulting from such fire, explosion, or lightning; or water; or any combination of any of these causes. The Damage To Premises Rented To You Limit will be: a. The amount shown for the Damage To Premises Rented To You Limit on the Declarations of this Coverage Part; or b. $300,000 if no amount is shown for the Damage To Premises Rented To You Limit on the Declarations of this Coverage Part. 4. The following replaces Paragraph a. of the definition of "insured contract" in the DEFINI- TIONS Section: a. A contract for a lease of premises. How- ever, that portion of the contract for a lease of premises that indemnifies any person or organization for "premises damage" is not an "insured contract'; 5. The following is added to the DEFINITIONS Section: "Premises damage" means "property dam- age" to: a. Any premises while rented to you or tem- porarily occupied by you with permission of the owner; or b. The contents of any premises while such premises is rented to you, if you rent such premises for a period of seven or fewer consecutive days. 6. The following replaces Paragraph 4.b.(1)(b) of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: (b) That is insurance for "premises damage"; or 7. Paragraph 4.b.(1)(c) of SECTION IV — COMMERCIAL GENERAL LIABILITY CON- DITIONS is deleted. C. INCREASED SUPPLEMENTARY PAYMENTS 1. The following replaces Paragraph 1.b. of SUPPLEMENTARY PAYMENTS — COVER- AGES A AND B of SECTION 1 — COVER- AGE: b. Up to $2,500 for the cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to fur- nish these bonds. 2. The following replaces Paragraph 1.d. of SUPPLEMENTARY PAYMENTS — COVER- AGES A AND B of SECTION I — COVER- AGES: d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $500 a day because of time off from work. D. INCIDENTAL MEDICAL MALPRACTICE 1. The following is added to the definition of "oc- currence" in the DEFINITIONS Section: "Occurrence" also means an act or omission committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to a person. 2. The following is added to Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED: Paragraph (1)(d) above does not apply to "bodily injury" arising out of providing or fail- ing to provide: (i) "Incidental medical services" by any of your "employees" who is a nurse practi- tioner, registered nurse, licensed practical nurse, nurse assistant, emergency medi- cal technician or paramedic; or (ii) First aid or "Good Samaritan services" by any of your "employees" or "volunteer workers", other than an employed or vol- unteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first aid or "Good Samaritan ser- vices" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your busi- ness. Page 2 of 6 0 2011 The Travelers Indemnity Company. All rights reserved. CG D3 16 11 11 3. The following is added to Paragraph 5. of SECTION III — LIMITS OF INSURANCE: For the purposes of determining the applica- ble Each Occurrence Limit, all related acts or omissions committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to any one per- son will be deemed to be one "occurrence". 4. The following exclusion is added to Para- graph 2., Exclusions, of SECTION I — COV- ERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury" or "property damage" arising out of the willful violation of a penal statute or ordinance relating to the sale of pharmaceuti- cals committed by, or with the knowledge or consent of, the insured. 5. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; or b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. "Good Samaritan services" means any emer- gency medical services for which no compen- sation is demanded or received. 6. The following is added to Paragraph 4.b., Ex- cess Insurance, of SECTION IV — COM- MERCIAL GENERAL LIABILITY CONDI- TIONS: The insurance is excess over any valid and collectible other insurance available to the in- sured, whether primary, excess, contingent or on any other basis, that is available to any of your "employees" or "volunteer workers" for "bodily injury" that arises out of providing or failing to provide "incidental medical ser- vices", first aid or "Good Samaritan services" to any person to the extent not subject to Paragraph 2.a.(1) of Section II — Who Is An Insured. E. WHO IS AN INSURED — NEWLY ACQUIRED OR FORMED ORGANIZATIONS The following replaces Paragraph 4. of SECTION II — WHO IS AN INSURED: COMMERCIAL GENERAL LIABILITY 4. Any organization you newly acquire or form, other than a partnership, joint venture or lim- ited liability company, of which you are the sole owner or in which you maintain the ma- jority ownership interest, will qualify as a Named Insured if there is no other insurance which provides similar coverage to that or- ganization. However: a. Coverage under this provision is afforded only: (1) Until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier, if you do not report such organization in writing to us within 180 days after you acquire or form it; or (2) Until the end of the policy period, when that date is later than 180 days after you acquire or form such organization, if you report such organization in writing to us within 180 days after you acquire or form it, and we agree in writing that it will con- tinue to be a Named Insured until the end of the policy period; b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and c. Coverage B does not apply to "personal in- jury" or "advertising injury" arising out of an offense committed before you acquired or formed the organization. F. WHO IS AN INSURED — BROADENED NAMED INSURED — UNNAMED SUBSIDIARIES The following is added to SECTION II — WHO IS AN INSURED: Any of your subsidiaries, other than a partnership, joint venture or limited liability company, that is not shown as a Named Insured in the Declara- tions is a Named Insured if you maintain an own- ership interest of more than 50% in such subsidi- ary on the first day of the policy period. No such subsidiary is an insured for "bodily injury" or "property damage" that occurred, or "personal injury" or "advertising injury" caused by an of- fense committed after the date, if any, during the policy period, that you no longer maintain an ownership interest of more than 50% in such sub- sidiary. CG D3 16 11 11 © 2011 The Travelers Indemnity Company. All rights reserved. Page 3 of 6 COMMERCIAL GENERAL LIABILITY G. BLANKET ADDITIONAL INSURED — OWNERS, MANAGERS OR LESSORS OF PREMISES The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that is a premises owner, manager or lessor and that you have agreed in a written contract or agreement to in- clude as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage", "personal injury" or "advertising injury" that: a. Is "bodily injury" or "property damage" that occurs, or is "personal injury" or "advertising injury" caused by an offense that is commit- ted, subsequent to the execution of that con- tract or agreement; and b. Arises out of the ownership, maintenance or use of that part of any premises leased to you. The insurance provided to such premises owner, manager or lessor is subject to the following pro- visions: a. The limits of insurance provided to such premises owner, manager or lessor will be the minimum limits which you agreed to pro- vide in the written contract or agreement, or the limits shown on the Declarations, which- ever are less. b. The insurance provided to such premises owner, manager or lessor does not apply to: (1) Any "bodily injury" or "property damage" that occurs, or "personal injury" or "adver- tising injury" caused by an offense that is committed, after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such premises owner, lessor or manager. The insurance provided to such premises owner, manager or lessor is excess over any valid and collectible other insurance available to such premises owner, manager or lessor, whether primary, excess, contingent or on any other basis, unless you have agreed in the written contract or agreement that this in- surance must be primary to, or non- contributory with, such other insurance, in which case this insurance will be primary to, and non-contributory with, such other insur- ance. H. BLANKET ADDITIONAL INSURED — LESSORS OF LEASED EQUIPMENT The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that is an equipment lessor and that you have agreed in a written con- tract or agreement to include as an insured on this Coverage Part is an insured, but only with re- spect to liability for "bodily injury", "property dam- age", "personal injury" or "advertising injury" that: a. Is "bodily injury" or "property damage" that occurs, or is "personal injury" or "advertising injury" caused by an offense that is commit- ted, subsequent to the execution of that con- tract or agreement; and b. Is caused, in whole or in part, by your acts or omissions in the maintenance, operation or use of equipment leased to you by such equipment lessor. The insurance provided to such equipment lessor is subject to the following provisions: a. The limits of insurance provided to such equipment lessor will be the minimum limits which you agreed to provide in the written contract or agreement, or the limits shown on the Declarations, whichever are less. b. The insurance provided to such equipment lessor does not apply to any "bodily injury" or "property damage" that occurs, or "personal injury" or "advertising injury" caused by an of- fense that is committed, after the equipment lease expires. c. The insurance provided to such equipment lessor is excess over any valid and collectible other insurance available to such equipment lessor, whether primary, excess, contingent or on any other basis, unless you have agreed in the written contract or agreement that this insurance must be primary to, or non-contributory with, such other insurance, in which case this insurance will be primary to, and non-contributory with, such other in- surance. I. BLANKET ADDITIONAL INSURED — STATES OR POLITICAL SUBDIVISIONS — PERMITS The following is added to SECTION II — WHO IS AN INSURED: Any state or political subdivision that has issued a permit in connection with operations performed by you or on your behalf and that you are required Page 4 of 6 0 2011 The Travelers Indemnity Company. All rights reserved. CG D3 16 11 11 by any ordinance, law or building code to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage", "personal in- jury" or "advertising injury" arising out of such op- erations. The insurance provided to such state or political subdivision does not apply to: a. Any "bodily injury," "property damage," "per- sonal injury" or "advertising injury" arising out of operations performed for that state or po- litical subdivision; or b. Any "bodily injury" or "property damage" in- cluded in the "products -completed operations hazard". J. KNOWLEDGE AND NOTICE OF OCCUR- RENCE OR OFFENSE The following is added to Paragraph 2., Duties In The Event of Occurrence, Offense, Claim or Suit, of SECTION IV — COMMERCIAL GEN- ERAL LIABILITY CONDITIONS: e. The following provisions apply to Paragraph a. above, but only for the purposes of the in- surance provided under this Coverage Part to you or any insured listed in Paragraph 1. or 2. of Section II — Who Is An Insured: (1) Notice to us of such "occurrence" or of- fense must be given as soon as practica- ble only after the "occurrence" or offense is known by you (if you are an individual), any of your partners or members who is an individual (if you are a partnership or joint venture), any of your managers who is an individual (if you are a limited liability company), any of your "executive offi- cers" or directors (if you are an organiza- tion other than a partnership, joint venture or limited liability company) or any "em- ployee" authorized by you to give notice of an "occurrence" or offense. (2) If you are a partnership, joint venture or limited liability company, and none of your partners, joint venture members or man- agers are individuals, notice to us of such "occurrence" or offense must be given as soon as practicable only after the "occur- rence" or offense is known by: COMMERCIAL GENERAL LIABILITY (ii) A manager of any limited liability company; or (iii) An executive officer or director of any other organization; that is your partner, joint venture member or manager; or (b) Any "employee" authorized by such partnership, joint venture, limited li- ability company or other organization to give notice of an "occurrence" or offense. (3) Notice to us of such "occurrence" or of an offense will be deemed to be given as soon as practicable if it is given in good faith as soon as practicable to your work- ers' compensation insurer. This applies only if you subsequently give notice to us of the "occurrence" or offense as soon as practicable after any of the persons de- scribed in Paragraphs e. (1) or (2) above discovers that the "occurrence" or offense may result in sums to which the insurance provided under this Coverage Part may apply. However, if this Coverage Part includes an en- dorsement that provides limited coverage for "bodily injury" or "property damage" or pollution costs arising out of a discharge, release or es- cape of "pollutants" which contains a requirement that the discharge, release or escape of "pollut- ants" must be reported to us within a specific number of days after its abrupt commencement, this Paragraph e. does not affect that require- ment. K. UNINTENTIONAL OMISSION The following is added to Paragraph 6., Repre- sentations, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not preju- dice 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 insurance laws or regulations. L. BLANKET WAIVER OF SUBROGATION (a) Any individual who is: The following is added to Paragraph 8., Transfer (i) A partner or member of any part- Of Rights Of Recovery Against Others To Us, nership or joint venture; of SECTION IV — COMMERCIAL GENERAL LI- ABILITY CONDITIONS: CG D3 16 11 11 0 2011 The Travelers Indemnity Company. All rights reserved. Page 5 of 6 COMMERCIAL GENERAL LIABILITY If the insured has agreed in a contract or agree- ment to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organiza- tion, but only for payments we make because of: a. "Bodily injury" or "property damage" that oc- curs; or b. "Personal injury" or "advertising injury" caused by an offense that is committed; subsequent to the execution of that contract or agreement. M. AMENDED BODILY INJURY DEFINITION The following replaces the definition of "bodily injury" in the DEFINITIONS Section: 3. "Bodily injury" means bodily injury, mental anguish, mental injury, shock, fright, disability, humiliation, sickness or disease sustained by a person, including death resulting from any of these at any time. N. CONTRACTUAL LIABILITY — RAILROADS 1. The following replaces Paragraph c. of the definition of "insured contract" in the DEFINI- TIONS Section: c. Any easement or license agreement; 2. Paragraph f.(1) of the definition of "insured contract" in the DEFINITIONS Section is de- leted. Page 6 of 6 0 2011 The Travelers Indemnity Company. All rights reserved. CG D3 16 11 11 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY ISSUE DATE: - - THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY DESIGNATED PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Project(s): EACH "PROJECT" FOR WHICH YOU HAVE AGREED, IN A WRITTEN CONTRACT WHICH IS IN EFFECT DURING THIS POLICY PERIOD, TO PROVIDE A SEPARATE GENERAL AGGREGATE LIMIT, PROVIDED THAT THE CONTRACT IS SIGNED AND EXECUTED BY YOU BEFORE THE "BODILY INJURY" OR "PROPERTY DAMAGE" OCCURS. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under COVERAGE A. (SECTION 1), and for all medical expenses caused by accidents un- der COVERAGE C (SECTION 1), which can be attributed only to operations at a single desig- nated "project" shown in the Schedule above: 1. A separate Designated Project General Ag- gregate Limit applies to each designated "pro- ject", and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations, unless separate Designated Project General Aggregate(s) are sched- uled above. 2. The Designated Project General Aggregate Limit is the most we will pay for the sum of all damages under COVERAGE A., except damages because of "bodily injury" or "prop- erty damage" included in the "products - completed operations hazard", and for medi- cal expenses under COVERAGE C, regard- less of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". Designated Project General Aggregate(s): GENERAL AGGREGATE LIMIT SHOWN ON THE DECLARATIONS 3. Any payments made under COVERAGE A. for damages or under COVERAGE C. for medical expenses shall reduce the Desig- nated Project General Aggregate Limit for that designated "project". Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they re- duce any other Designated Project General Aggregate Limit for any other designated "project" shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Project General Ag- gregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under COVERAGE A. (SECTION 1), and for all medical expenses caused by accidents un- der COVERAGE C. (SECTION 1), which cannot be attributed only to operations at a single desig- nated "project" shown in the Schedule above: CG D2 11 01 04 Copyright, The Travelers Indemnity Company, 2004 Page 1 of 2 COMMERCIAL GENERAL LIABILITY 1. Any payments made under COVERAGE A. for damages or under COVERAGE C. for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products -Completed Operations Ag- gregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Project General Aggregate Limit. C. Part 2. of SECTION III — LIMITS OF INSURANCE is deleted and replaced by the following: 2. The General Aggregate Limit is the most we will pay for the sum of: a. Damages under Coverage B; and b. Damages from 'occurrences" under COVERAGE A (SECTION 1) and for all medical expenses caused by accidents under COVERAGE C (SECTION 1) which cannot be attributed only to operations at a single designated "project' shown in the SCHEDULE above. D. When coverage for liability arising out of the "products -completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -Completed Operations Ag- gregate Limit, and not reduce the General Aggre- gate Limit nor the Designated Project General Aggregate Limit. E. For the purposes of this endorsement the Defini- tions Section is amended by the addition of the following definition: "Project" means an area away from premises owned by or rented to you at which you are per- forming operations pursuant to a contract or agreement. For the purposes of determining the applicable aggregate limit of insurance, each "project" that includes premises involving the same or connecting lots, or premises whose con- nection is interrupted only by a street, roadway, waterway or right-of-way of a railroad shall be considered a single "project'. F. The provisions of SECTION III — LIMITS OF INSURANCE not otherwise modified by this en- dorsement shall continue to apply as stipulated. Page 2 of 2 Copyright, The Travelers Indemnity Company, 2004 CG D2 11 01 04 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BROAD FORM NAMED INSURED B. BLANKET ADDITIONAL INSURED C. EMPLOYEE HIRED AUTO D. EMPLOYEES AS INSURED E. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS F. HIRED AUTO — LIMITED WORLDWIDE COV- ERAGE — INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE — GLASS PROVISIONS A. BROAD FORM NAMED INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any organization you newly acquire or form dur- ing the policy period over which you maintain 50% or more ownership interest and that is not separately insured for Business Auto Coverage. Coverage under this provision is afforded only un- til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- ever is earlier. B. BLANKET ADDITIONAL INSURED The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT J. PERSONAL PROPERTY K. AIRBAGS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS M. BLANKET WAIVER OF SUBROGATION N. UNINTENTIONAL ERRORS OR OMISSIONS this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. C. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COV- ERED AUTOS LIABILITY COVERAGE: An "employee" of yours is an "insured" 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 busi- ness. 2. The following replaces Paragraph b. in B.5., Other Insurance, of SECTION IV — BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "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 an "employee's" name, with your CA T3 53 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO permission, while performing duties related to the conduct of your busi- ness. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". D. EMPLOYEES AS INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. E. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS 1. The following replaces Paragraph A.2.a.(2), of SECTION II — COVERED AUTOS LIABIL- ITY COVERAGE: (2) Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4), of SECTION II — COVERED AUTOS LIABIL- ITY COVERAGE: (a) With respect to any claim made or "suit" brought outside the United States of America, the territories and possessions of the United States of America, Puerto Rico and Canada: (i) You must arrange to defend the "in- sured" against, and investigate or set- tle any such claim or "suit" and keep us advised of all proceedings and ac- tions. (ii) Neither you nor any other involved "insured" will make any settlement without our consent. (iii) We may, at our discretion, participate in defending the "insured" against, or in the settlement of, any claim or "suit". (iv) We will reimburse the "insured" for sums that the "insured" legally must pay as damages because of "bodily injury" or "property damage" to which this insurance applies, that the "in- sured" pays with our consent, but only up to the limit described in Para- graph C., Limits Of Insurance, of SECTION II — COVERED AUTOS LIABILITY COVERAGE. (4) All reasonable expenses incurred by the (v) We will reimburse the "insured" for "insured" at our request, including actual the reasonable expenses incurred loss of earnings up to $500 a day be- with our consent for your investiga- cause of time off from work. tion of such claims and your defense of the "insured" against any such F. HIRED AUTO — LIMITED WORLDWIDE COV- "suit", but only up to and included ERAGE — INDEMNITY BASIS within the limit described in Para - The following replaces Subparagraph (5) in Para- graph C., Limits Of Insurance, of graph B.7., Policy Period, Coverage Territory, SECTION II — COVERED AUTOS of SECTION IV — BUSINESS AUTO CONDI- LIABILITY COVERAGE, and not in TIONS: addition to such limit. Our duty to (5) Anywhere in the world, except any country or make such payments ends when we jurisdiction while any trade sanction, em- have used up the applicable limit of bargo, or similar regulation imposed by the insurance in payments for damages, United States of America applies to and pro- settlements or defense expenses. hibits the transaction of business with or (b) This insurance is excess over any valid within such country or jurisdiction, for Cov- and collectible other insurance available ered Autos Liability Coverage for any covered to the "insured" whether primary, excess, "auto" that you lease, hire, rent or borrow contingent or on any other basis. without a driver for a period of 30 days or less (c) This insurance is not a substitute for re - and that is not an "auto" you lease, hire, rent quired or compulsory insurance in any or borrow from any of your "employees", country outside the United States, its ter - partners (if you are a partnership), members ritories and possessions, Puerto Rico and (if you are a limited liability company) or Canada. members of their households. Page 2 of 4 © 2015 The Travelers Indemnity Company. All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc. with its permission. You agree to maintain all required or compulsory insurance in any such coun- try up to the minimum limits required by local law. Your failure to comply with compulsory insurance requirements will not invalidate the coverage afforded by this policy, but we will only be liable to the same extent we would have been liable had you complied with the compulsory in- surance requirements. (d) It is understood that we are not an admit- ted or authorized insurer outside the United States of America, its territories and possessions, Puerto Rico and Can- ada. We assume no responsibility for the furnishing of certificates of insurance, or for compliance in any way with the laws of other countries relating to insurance. G. WAIVER OF DEDUCTIBLE — GLASS The following is added to Paragraph D., Deducti- ble, of SECTION III — PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT The following replaces the last sentence of Para- graph AA.b., Loss Of Use Expenses, of SEC- TION III — PHYSICAL DAMAGE COVERAGE: However, the most we will pay for any expenses for loss of use is $65 per day, to a maximum of $750 for any one "accident'. I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT The following replaces the first sentence in Para- graph A.4.a., Transportation Expenses, of SECTION III — PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. J. PERSONAL PROPERTY COMMERCIAL AUTO (2) In or on your covered "auto". This coverage applies only in the event of a total theft of your covered "auto". No deductibles apply to this Personal Property coverage. K. AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A.1.c., but only: a. If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one "loss". L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS The following is added to Paragraph A.2.a., of SECTION IV — BUSINESS AUTO CONDITIONS: Your duty to give us or our authorized representa- tive prompt notice of the "accident" or "loss" ap- plies only when the "accident" or "loss" is known to: (a) You (if you are an individual); (b) A partner (if you are a partnership); (c) A member (if you are a limited liability com- pany); (d) An executive officer, director or insurance manager (if you are a corporation or other or- ganization); or (e) Any "employee" authorized by you to give no- tice of the "accident' or "loss". M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — BUSINESS AUTO CONDI- TIONS: The following is added to Paragraph A.4., Cover- 5. Transfer Of Rights Of Recovery Against age Extensions, of SECTION III — PHYSICAL Others To Us DAMAGE COVERAGE: We waive any right of recovery we may have Personal Property against any person or organization to the ex- tent required of you by a written contract We will pay up to $400 for 'loss" to wearing ap- signed and executed prior to any "accident' parel and other personal property which is: or "loss", provided that the "accident' or "loss" (1) Owned by an "insured"; and arises out of operations contemplated by CA T3 53 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO such contract. The waiver applies only to the The unintentional omission of, or unintentional person or organization designated in such error in, any information given by you shall not contract. prejudice your rights under this insurance. How - N. UNINTENTIONAL ERRORS OR OMISSIONS ever this provision does not affect our right to col - The following is added to Paragraph B.2., Con- lect additional premium or exercise our right of cealment, Misrepresentation, Or Fraud, of cancellation or non -renewal. SECTION IV — BUSINESS AUTO CONDITIONS: Page 4 of 4 © 2015 The Travelers Indemnity Company. All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc. with its permission. UMBRELLA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS This endorsement modifies insurance provided under the following: COMMERCIAL EXCESS LIABILITY (UMBRELLA) INSURANCE The following is added to Paragraph 11., OUR RIGHT TO RECOVER FROM OTHERS., of SECTION IV — CONDITIONS.: If the insured has agreed in a contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of: a. "Bodily injury" or "property damage" caused by an "occurrence" that takes place; or b. "Personal injury" or "advertising injury" caused by an "offense" that is committed; subsequent to the execution of the contract or agree- ment. UM 04 88 07 08 © 2008 The Travelers Companies, Inc. Page 1 Of 1 Includes the copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED — (Section 11) is amended to include any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Cover- age Part, but: a) Only with respect to liability for "bodily injury", "property damage" or "personal injury'; and b) If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the in- surance provided to the additional insured shall be limited to the limits of liability re- quired by that "written contract requiring in- surance". This endorsement shall not in- crease the limits of insurance described in Section III — Limits Of Insurance. b) The insurance provided to the additional in- sured does not apply to "bodily injury", "prop- erty damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or sur- veying services, including: The preparing, approving, or failing to prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders or change orders, or the preparing, approving, or failing to prepare or ap- prove, drawings and specifications; and ii. Supervisory, inspection, architectural or engineering activities. c) The insurance provided to the additional in- sured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products -completed op- erations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that oc- curs before the end of the period of time for which the "written contract requiring insur- ance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible "other insurance", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non-contributory basis, this insurance is primary to 'other insurance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that "other insurance". But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible 'other in- surance", whether primary, excess, contingent or on any other basis, that is available to the addi- tional insured when that person or organization is an additional insured under such 'other insur- ance". 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include: CG D2 46 08 05 © 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY L How, when and where the 'occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the 'occurrence" or offense. b) If a claim is made or "suit' is brought against the additional insured, the additional insured must: I. Immediately record the specifics of the claim or "suit' and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit' as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit', cooperate with us in the investigation or settlement of the claim or defense against the "suit', and otherwise comply with all policy conditions. d) The additional insured must tender the de- fense and indemnity of any claim or "suit" to any provider of 'other insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to 'other insur- ance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. — DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 0 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05