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GOODS AND SERVICES AGREEMENT THIS AGRLC'EMENT, is entered into between the City of Bremerton, a Washington Municipal Corporation ("City"), and Pro -Vac ("Vendor"), whose mailing address is: 6622 112`x' St E, Puyallup, WA 98373. The parties agree as follows: I. VENDOR SERVICES. The Vendor shall provide the following goods and materials and/or perform the following services for the City: See attached Proposal, Scope of Work, and Deliverables: • CCTV truck and crew to inspect existing storm pipe, • CCTV inspect approximately 10,500' of pipe ranging from 36" to 84", • Provide traffic control as needed, and • Provide videos and inspection reports for all work completed. II. TIME OF COMPLETION. Vendor shall complete the work and provide all goods, materials, and services within 60 calendar days from the date all parties have signed this Agreement. III. COMPENSATION. The City shall pay the Vendor the total amount of $20,150, including applicable Washington State Sales Tax, for the goods, materials and services contemplated in this Agreement. The City shall pay the Vendor the following amounts according to the following schedule: An amount of $1.92 per linear foot of inspected stormwater pipe with associated video, and inspection reports for all work completed. Work will be completed using physical access and walking of large diameter pipes and CCTV truck and crew to inspect existing stormwater system. Provide traffic control as needed. A. Defective or Unauthorized Work. The City reserves its right to withhold payment from Vendor for any defective or unauthorized goods, materials or services. If Vendor is unable, for any reason, to complete any part of this Agreement, the City may obtain the goods, materials or services on its own or from a third party, and Vendor 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 Agreement price specified above. The City further reserves its right to deduct the cost to complete this Agreement, including any Additional Costs, from any and all amounts due or to become due the Vendor. IV. INDEPENDENT CONTRACTOR. Vendor is and sliall be at all times acting as an independent contractor and not as an employee of the City. The Vendor 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 Vendor, officer, agents, employees and subcontractors. The Vendor shall also secure all applicable business licenses, if required, in connection with the contract services, including all required Page 1 of 7 Goods and Services Agreement Rev. 07/2018 licenses for Vendor's officers, agents, employees and subcontractors. V. 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 Vendor's refusal or failure to supply a sufficient number of properly skilled workers or proper materials for completion of this Agreement. B. The Vendor's failure to complete this Agreement within the time specified in this Agreement. C. The Vendor's failure to make full and prompt payment to subcontractors or for material or labor. D. The Vendor's failure to comply with federal, state or local laws, rules or regulations. E. The Vendor's filing for bankruptcy or becoming adjudged bankrupt. If the City terminates this Agreement for good cause, the Vendor shall not receive any further monies due under this Agreement until the goods, materials, and services required by this Agreement are completed and fully performed by the City or a third party of the City's choosing. VI. CHANGES. The City may issue a written change order for any change in the goods, materials or services to be provided during the performance of this Agreement. If the Vendor determines, for any reason, that a change order is necessary, Vendor must submit a written change order request to an authorized agent of the City within fourteen (14) calendar days of the date Vendor 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 Vendor'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 Vendor on all equitable adjustments. However, if the parties are unable to agree, the City will determine the equitable adjustment as it deems appropriate. The Vendor shall proceed with the change order work upon receiving either a written change order from the City or an oral order from the City before actually receiving the written change order. If the Vendor fails to require a change order within the time allowed, the Vendor waives its right to make any claim or submit subsequent change order requests for that portion of the contract work. If the Vendor disagrees with the equitable adjustment the Vendor must complete the change order work; however, the Vendor may elect to protest the adjustment as provided below: A. Procedure and Protest by the Vendor. If the Vendor disagrees with anything required by a change order, another written order, or an oral order from the City, including any direction, instruction, interpretation, or determination by the City, the Vendor shall: 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: Page 2 of 7 Goods and Services Agreement Rev. 07/2018 a. The date of the Vendor'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 Vendor is asserting a schedule change or disruption. 2. The Vendor 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 Vendor's records needed for evaluating the protest. 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. B. Vendor's Duty to Complete Protested Work. In spite of any protest, the Vendor shall proceed promptly to provide the goods, materials and services required by the City under this Agreement. C. Vendor's Acceptance of Chanties. The Vendor 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 Vendor 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 Vendor also waives any additional entitlement and accepts from the City any written or oral order (including directions, instructions, interpretations, and determination), E. Failure to Follow Procedures Constitutes Waiver. By failing to follow the procedures of this section, the Vendor completely waives any claims for protested work and accepts from the City any written or oral order (including directions, instructions, interpretations, and determination). VII. CLAIMS. The Vendor 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 Vendor 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 Vendor knew, or should have known, of the facts giving rise to the claim. At a minimum, a Vendor's written claim must include the information set forth regarding protests in Section 6(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 Page 3 of 7 Goods and Services Agreement Rev. 07/2018 ARISING IN ANY WAY FROM THE FACTS OR EVENTS SURROUNDING THAT CLAIM OR CAUSED BY THAT DELAY. Vendor must, in any event, file any claim or bring any suit arising from or connected with this Agreement within 120 calendar days from the elate the contract work is complete. VIII. WARRANTY. The Vendor shall correct all defects in workmanship and materials within one year 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 from the date such correction is completed and accepted by the City. The Vendor shall begin to correct any defects within seven (7) calendar days of its receipt of notice from the City of the defect. If the Vendor does not accomplish the corrections within a reasonable time, the City may complete the corrections and the Vendor shall pay all costs incurred by the City in order to accomplish the correction. IX. INDEMNIFICATION. Vendor shall defend, indemnify and hold the City, its officers, 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. Vendor's obligation to indemnify shall not extend to that portion of damages caused by the City's sole negligence. The City's inspection or acceptance of any of Vendor'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 Vendor and the City, its officers, officials, employees, agents and volunteers, the Vendor's liability hereunder shall be only to the extent of the Vendor's negligence. IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THIS INDEMNIFICATION CONSTITUTES THE VENDOR'S WAIVER OF IMMUNITY UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES 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. X. INSURANCE. The Vendor shall procure and maintain for the duration of this Agreement, insurance against claims for injuries to persons or damage to property that may arise from or in connection with the performance of the Contract work by the Vendor, its agents, representatives, employees or subcontractors. Before beginning work on the project described in this Agreement, the Vendor shall provide a Certificate of Insurance evidencing: A. Automobile Liability insurance with limits no less than $1,000,000 combined single limit per accident for bodily injury and property damage; and B. 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 aggregate for Page 4 of 7 Goods and Services Agreement Rev. 07/2018 personal injury, bodily injury and property damage. Coverage shall include but not be limited to: blanket contractual; products/completed operations/broad form property damage; and employer's liability. C. Excess Liability insurance with limits not less than $1,000,000. Jilnit,, per occurrence and aggregate.!' D. -Professional-Liability insurtance-witl"imits-no--less than -$1,04070 0- snit --per asCrrence/olnim. E. Workers Compensation insurance as statutorily required by the Industrial Insurance Act of the State of Washington, Title 51, Revised Code of Washington and employer's liability with limits not less than $1,000,000. Any payment of deductible or self-insured retention shall be the sole responsibility of the Vendor. All required policies shall be provided on an "occurrence" basis except professional liability insurance (if required), which shall be provided on a "claims -made" basis. The City shall be named as an additional insured on the Commercial General Liability insurance policy, as respects work performed by or on behalf of the Vendor and a copy of the endorsement naming the City as additional insured shall be attached to the Certificate of Insurance. The City reserves the right to receive a certified copy of all the required insurance policies. The Vendor's Commercial General Liability 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 Vendor's insurance shall be primary 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 affinnative obligation upon Vendor 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 6"' Street, Suite 100, 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 also reserves its unqualified right to require at any time and for any reason, proof of coverage in the form of a duplicate of the insurance policy with all endorsements as evidence of coverage. XI. MISCELLANEOUS. A. Licenses and Taxes. Vendor shall possess a current Bremerton Business License and any regulatory license required to :fulfill Vendor's obligations under this contract. B&0 taxes shall be paid when due, and Vendor, by this agreement, assigns any payments due under this contract to the City Clerk for payment of such taxes which have been declared delinquent. B. Conflict and Precedence. In the event of a conflict between the contract documents, the document which rates higher on the following list shall take precedence: Page 5 of 7 Goods and Services Agreement Rev. 07/2018 Addenda, if any, Contract, Specifications, Terms and Conditions, Contractor's proposal. C. Documents Incorporated by Reference. The following documents are incorporated by reference, to include, but not be limited to: 1. Terms and Conditions, 2. Specifications, 3. Proposal, and 4. Non -Collusion Affidavit. E. Use of Photographs and Images. Vendor shall not use or distribute photographs or images depicting City officials, personnel, property, or equipment whether prepared by Vendor or provided by City without prior written consent of the City. The City will not unreasonably withhold its consent. F. Nondiscrimination. In the hiring of employees for the performance of work under this Agreement the Vendor, its subcontractors, or any person acting on behalf of Vendor shall not, by reason of race, religion, color, sex, sexual orientation, national origin, or the presence of any sensory, mental, or physical disability, discriminate against any person who is qualified and available to perform the work to which the employment relates. G. Compliance with haws. Vendor shall comply with all federal, state and local laws, rules and regulations throughout every aspect in the performance of this Agreement. H. Work Performed at Vendor's Risk. Vendor 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 Vendor's own risk, and Vendor 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. I. 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 Vendor under any of the provisions of this Agreement, resolution of that dispute shall be available exclusively under the jurisdiction, venue and rules of the Kitsap County Superior Court, Kitsap County, Washington, J. Attorney's Fees. 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 9 of this Agreement. J. Written Notice. All communications regarding this Agreement shall be sent to the parties at the addresses listed below, 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 Page 6 of 7 Goods and Services Agreement Rev. 07/2018 address stated in this Agreement. Notices to be sent to: CITY: Attn: Chance Berthiaume City of Bremerton PW&U 100 Oyster Bay Ave N Bremerton, WA 98312 Notices to be sent to; VENDOR: Attn: Melanie Ross Olson Brothers Pro -Vac 6622 112°i St E. Puyallup, WA 98373 K. Assignment. Any assignment of this Agreement by the Vendor without the written consent of the City shall be void. L. 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 Vendor. M. Severability. If any one or more sections, subsections, 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. N. Entire Agreement. The written provisions and terms of this Agreement, together with any attached Exhibits, supersede all prior verbal statements by any representative of the City, and those statements shall not be construed as forming a part of or altering in any manner 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. IN WITNESS WHEREOF, the parties below have executed this Agreement. CITY: City of Bremerton By: Print Name: Chat Martin Its: Director of Public Works & Utilities Date: (P I t z/ r - APPROVED AS TO FORM: VENDOR: Pro -Vac By: Print Name: Wesley Brood Its: V.P. Date: "! a 6 l ATTEST: By: / By: ROGER A. LUBOVICH, Bremerton City Attorney ANGELA WbODS, City Clerk RALega1\Lega1Tonns\FORMS ON COBWEMoods and Services Agreement Rev. 07 2018.docx Page 7 of 7 Goods and Services Agreement Rev. 07/2018 6622 112th St E I Puyallup, WA 98373 (888) 565-5665 1 Fax: (253) 435-5788 1 www.pro-vac.com 9/12/18 City of Bremerton Stormwater 100 Oyster Bay Ave N Bremerton WA Pine Road Basin Trunk Line Proposal to CCN inspect SCOPE OF WORK: • CCN truck and crew to Inspect existing storm pipe. • CCTV Inspect approximately 10,500' of pipe ranging from 36" to 84". • Provide traffic control as needed. • Provide videos and inspection reports for all work completed. Estimated total: $20,150.00 Cost per foot for 10,500': $1.92 per linear foot Please note that the above estimate does not include sales tax, tax on materials, or permits. We propose to furnish all materials and labor to perform work upon designated areas. Pro -Vac Clean Service will notify the customer of any problems or change of conditions. Disposal of waste will be in accordance with all state regulations, and any additional work found during the course of cleaning and inspection, will be forwarded upon another proposal. Other services we provide: • Parking lot/street sweeping • Storm drain main line cleaning/jetting • Catch basin cleaning & repair Pipe inspection camera / grouting & repairs Emergency spill response Tank cleaning / confined space entry If you have any questions or need additional information, please don't hesitate to call me at (253) 435-4328 Sincerely, Graham Gill Pro -Vac Clean Service (253) 606-1072 1 graham@pro-vac.com Customer agrees to pay all the costs and fees charged For the services rendered as slated on this proposal. The terms are Net 30 days, 1.5% on unpaid balance monthly. If collection services are required, solely In the opinion of Pro -Vac, to collect the debt, I agree to pay reasonable costs for collection including attorney fees and costs and any collection agency fees. If legal action Is requlred the parties agree that the venue of the action will be Pierce CountySuperior Court, State of Washington. It is further agreed that any accounts past due will be assessed at late fees of 1.5% per month, cumulative. Customer Signature Print Name Date Pro -Vac Signature Print Name Date OLSON BROTHERS PRO -VAC LLC RM Department of Labor & Industries Page 1 of 2 Certificate of Workers' Compensation Coverage WA UBI No. L&I Account ID Legal Business Name Doing Business As Workers' Comp Premium Status Estimated Workers Reported (See Description Below) Account Representative Licensed Contractor? License No. License Expiration October 9, 2018 602 170 975 565,502-01 OLSON BROTHERS PRO -VAC LLC OLSON BROTHERS PRO -VAC LLC Account is current. Quarter 2 of Year 2018 "Greater than 100 Workers" Employer Services Help Line, (360) 902-4817 Yes OLSONBP985J2 06/27/2020 What does "Estimated Workers Reported" mean? Estimated workers reported represents the number of full time position requiring at least 480 hours of work per calendar quarter. A single 480 hour position may be filled by one person, or several part time workers. Industrial Insurance Information Employers report and pay premiums each quarter based on hours of employee work already performed, and are liable for premiums found later to be due. Industrial insurance accounts have no policy periods, cancellation dates, limitations of coverage or waiver of https://secure.lni.wa.gov/verify/Details/liabilityCertificate.aspx?UBI=602170975&LIC=O... 10/9/2018 OLSON BROTHERS PRO -VAC LLC subrogation (See RCW 51 .12.050 and 51 .16.1 90). Page 2 of 2 https://secure.Ini.wa. gov/verify/Details/liabilityCertificate. aspx?UBI=602170975 &LIC=O... 10/9/2018 nl gnRRn_n9 _ICTINIWI IFV ` h ®i2L7i CERTIFICATE OF LIABILITY INSURANCE �►�---''" DATE 09191DD� 09/19/2018 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER Mesirow Insurance Services, Inc. 353 N. Clark St 11th fl Chicago, IL 60654 _ CONTACT Chicago P&C Cert Team PHONE FAX A1C, No Ext): (312) 595-6200 J .CHC4NSCERTS@alliant.com INSURER ($) AFFORDING COVERAGE NAIL# AGE TO RENTED INSURER A; Continental Casualty insurance Company 20443 MED EXP (Anyone Arson INSURED INSURER a: Continental Insurance Company 35289 INSURER C:Navigators Insurance Com an 42307 Olson Brothers ProVac, LLC dba Pro -vac INSURER D: Allied World Assurance Company U.S. Inc 119489 6622 112th Street East Puyallup, WA 98373 INSURER E : _INSURER F: COVFRACsES CFRTIFICATF NIIMRFR• /2FVICInIU Pill IMint_a- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, IJSR TYPE OF INSURANCE ADDL SUB R -- POLICY EFF POLICY EXP AIN n POLICY NUMBER LIMITS A X COMMERCIAL GENERAL CLAIMS -MADE I X III���GENERALLIABILITRRRY X PD Ded: $2,000l1kc�-^ 1 X X 6043651609 11/16/2017 /16/2018 EACH OCCURRENCE $ 1'000 0 AGE TO RENTED $ 1,000, OO MED EXP (Anyone Arson 15,000 $ PERSONAL&ADVINJURY _ $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT u LOC GENERALA.GGREGATF 2,000, O PRODUCTS-COMPIOPAGG $ 2,000, OO oTrIER. Stop Gap WA $ 1,000, B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ee strident/ 1,000, O JX ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS 6023021447 11/16/2017 11/16/2018 BODILY INJURY (Peryerson _ $ BODILY INJURY Per agUilen0 $ X AiJ3 ONLY X AUOTOS yyONLY N eOP_ E_�2J'Y DAMAGE scan $ $ C UMBRELLA LIABX OCCUR EACH OCCURRENCE $ 5'000,000 X EXCESS LIAB CLAIMS -MADE PT17EXC9218411V 11/16/2017 11/16/2018 AGGREGATE DED RETENTION $ I PER OTH- .ER—_ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE QFaFnI:E R/rMYJMBER EXCLUDED? It�M //ir t YJNNFHi�) If yes, describe under NIA E.L. EACH ACCIDENT ---- $ E.L. DISEASE -EA EMPLOYEE$ E L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS below D Pollution Liability 03098830 11/1612017 11/16/2018 See Description DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Pollution Liability Limits: $2,000,000 Occ / $2,000,000 Aggr.: $10,000 Ded. 999-1896-999 - Ostrich Bay Creek LID Retrofit Plan Design; Client Project #1489. RE: Pine Road stormwater drainage basin City of Bremerton is additional insured regarding general liability as required by written contract with respect to the referenced project. SEE ATTACHED ACORD 101 City of Bremerton Public Works & Utilities 100 Oyster Bay Ave N_ Bremerton, WA 98312 ACORD 25 (2016/03) 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 c ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: OLSOBRO-02 JSTINIKLIEV LOC #: 1 "R" ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY !NAMED INSURED escrow Insurance Services, Inc. 'Olson Brothers ProVac, LLC dba Pro -vac _ 6622 112th Street East POLICY NUMBER Puyallup, WA 98373 EE PAGE 1 CARRIER NAIL CODE EE PAGE 1 ISEE P 1 EFFECT>VE DATE: SEE PAGE 1 %DDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Description of Operations/Locations[Vehicles: The General Liability policy will apply on a primary, non-contributory basis where required by written contract. A waiver of subrogation applies with respect to the General Liability policy where required by written contract signed prior to a loss. Coverage is included for products and completed operations where required by written contract. Contractual Liability coverage applies with respect to the General Liability policy, per CNA form CG0001-0413. Collapse and subsidence are included in Earth Movement coverage. The Excess Liability policy is a follow -form policy, subject to policy exclusions. %-UKU 1U1 (ZUUurUT) © 2008 ACORD CORPORATION. All rights reserved_ The ACORD name and logo are registered marks of ACORD CNA...... CNA PARAMOUNT Commercial General Liability Coverage Part e. Damages because of bodily injury include damages claimed by any person or organization for care, loss of services or death resulting at any time from the bodily injury 2. Exclusions This Insurance does not apply to a. Expected Or Intended Injury Bodily injury or property damage expected or intended from the standpoint of the Insured This exclusion does not apply to bodily injury resulting from the use of reasonable force to protect persons or property b. Contractual Liability Bodily injury or property damage for which the Insured is obligated to pay damages by reason of the assumption of liability in a contract or agreement This exclusion does not apply to liability for damages (1) That the Insured would have in the absence of the contract or agreement, or (2) Assumed in a contract or agreement that is an Insured contract, provided the bodily injury or property damage occurs subsequent to the execution of the contract or agreement Solely for the purposes of liability assumed in an Insured contract, reasonable attorneys' fees and necessary litigation expenses incurred by or for a parry other than an Insured are deemed to be damages because of bodily injury or property damage, provided (a) Liability to such party for, or for the cost of, that parry's defense has also been assumed in the same Insured contract, and (b) Such attorneys' foes and litigation expenses are for defense of that party against a civil or alternative dispute resolution proceeding in which damages to which this insurance applies are alleged c_ Liquor Liability Bodily injury or property damage for which any Insured may be held liable by reason of. (1) Causing or contributing to the intoxication of any person, (2) The furnishing of alcoholic beverages to a person under the legal drinking age or under the influence of alcohol, or (3) Any statute, ordinance or regulation relating to the sale, gift, distribution or use of alcoholic beverages This exclusion applies even if the claims against any Insured allege negligence or other wrongdoing in (a) The supervision, hiring, employment, training or monitoring of others by that Insured; or (b) Providing or failing to provide transportation with respect to any person that may be under the influence of alcohol, if the occurrence which caused the bodily injury or property damage, involved that which is described in Paragraph (1), (2) or (3) above However, this exclusion applies only if you are in the business of manufacturing, distributing, selling, serving or furnishing alcoholic beverages. For the purposes of this exclusion, permitting a person to bring alcoholic beverages on your premises, for consumption on your premises, whether or not a fee is charged or a license is required for such activity, is not by itself considered the business of selling, serving or furnishing alcoholic beverages d. Workers' Compensation And Similar Laws Any obligation of the Insured under a workers' compensation, disability benefits or unemployment compensation law or any similar law. CG0001 04-13 Copyright Insurance Services Mice, Inc , 2012 Page 2 of 20 CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: I. The WHO IS AN INSURED section is amended to add as an Insured any person or organization whom the Named Insured is required by written contract to add as an additional insured on this coverage part, including any such person or organization, if any, specifically set forth on the Schedule attachment to this endorsement. However, such person or organization is an Insured only with respect to such person or organization's liability for: A. unless paragraph B. below applies, 1. bodily injury, property damage, or personal and advertising injury caused in whole or in part by the acts or omissions by or on behalf of the Named Insured and in the performance of such Named Insured's ongoing operations as specified in such written contract; or 2. bodily injury or property damage caused in whole or in part by your work and included in the products - completed operations hazard, and only if a. the written contract requires the Named Insured to provide the additional insured such coverage; and b. this coverage part provides such coverage. B. bodily injury, property damage, or personal and advertising injury arising out of your work described in such written contract, but only if: 1. this coverage part provides coverage for bodily injury or property damage included within the products completed operations hazard; and 2. the written contract specifically requires the Named Insured to provide additional insured coverage under the 11-85 or 10-01 edition of CG2010 or the 10-01 edition of CG2037. II. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: A. coverage broader than required by the written contract; or 4 B. a higher limit of insurance than required by the written contract. Ill. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of: A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: 1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. supervisory, inspection, architectural or engineering activities; or B. any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this coverage part. IV. Notwithstanding anything to the contrary in the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance, this insurance is excess of all other insurance available to the additional insured whether on a primary, excess, contingent or any other basis. However, if this insurance is required by written CNA75079XX (1-15) Policy No: 6043651609 Page 1 of 2 Endorsement No: 4 CONTINENTAL CASUALTY COMPANY Effective Date: 11/16/2017 Insured Name: OLSON BROTHERS PRO -VAC, LLC Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement contract to be primaryand non-contributory, this insurance will be primary and non-contributory relative solely to insurance on which the additional insured is a named insured. V. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2. except as provided in Paragraph IV, of this endorsement, agree to make available any other insurance the additional insured has for any loss covered under this coverage part; 3. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlement of the claim; and 4. tender the defense and indemnity of any claim to any other insurer or self insurer whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph (4) does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VI. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires the Named Insured to make a person or organization an additional insured on this coverage part, provided the contract or agreement: A. is currently in effect or becomes effective during the term of this policy; and B. was executed prior to: 1. the bodily injury or property damage; or 2. the offense that caused the personal and advertising injury for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA75079XX (1-15) Policy No: 6043651609 Page 2 of 2 Endorsement No: 4 CONTINENTAL CASUALTY COMPANY Effective Date: 11/1G/2017 Insured Name: OLSON BROTHERS PRO -VAC, LLC Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Certification of Compliance with Wage Payment Statutes The bidder hereby certifies that, within the three-year period immediately preceding the bid solicitation date (September 26, 2028), the bidder is not a "willful" violator, as defined in RCW 49.48.082, of any provision of chapters 49.46, 49.48, or 49.52 RCW, as determined by a final and binding citation and notice of assessment issued by the Department of Labor and industries or through a civil judgment entered by a court of limited or general jurisdiction. I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. �0 -kkvZc $ 'J CU V ti L Bidder's Business Name Signature of Authorized Officiaff _ u') 0 slew. � �,, o� Printed Name Title q -,.,2 Date City `r! Wm State Check One: Sole Proprietorship ❑ Partnership ❑ Joint Venture ❑ Corporation El State of Incorporation, or if not a corporation, State where business entity was formed: L.� P If a co -partnership, give firm name under which business is transacted: * If a corporation, proposal must be executed in the corporate name by the president or vice-president (or any other corporate officer accompanied by evidence of authority to sign). If a co -partnership, proposal must be executed by a partner. Chance Berthiaume From: Melanie Ross <melanie.ross@pro-vac.com> Sent: Tuesday, October 2, 2018 10:31 AM To: Chance Berthiaume Subject: Re: compliance wage Attachments: CCE10022018_0001.pdf Sorry, I thought that was attached. Yes, we pay prevailing wages. Please let me know if you need an Intent filed for this project and I will send you the information. If you need anything further, please let me know. Thank you. vtd4 u.'e Re" Please Note and Update My New Email Address C) Melanie.RoSSf&pro-vac.cum October 2, 2018 For file: Sole Source justification for Pro -Vac contract concerning Pine Rd. Stormwater System Pro -Vac has provided video inspection and condition assessment services for the Stormwater and Wastewater Utilities for many years. They have the ability and reputation for providing in depth and detailed assessments that include video inspections using the same format Bremerton does which allows us to review video inspections using the same equipment we have for our system. Engineering and consultants use these videos for specific projects. The native format used by the video equipment allows us to catalog the inspection videos on the webserver for future review. They were chosen for this sna" or-ks contract as the sole source provider for these reasons. Chance W Berthiaume City of Bremerton Stormwater Permit Coordinator O� ON�BROTHERS PRO -VAC LLC Home Espanol Contact Page 1 of 2 Search L&I ^�Em A -Z Index Help My L&I Safety & Health Claims & Insurance Workplace Rights Trades & Licensing Washington State Departrnent of Labor & Industries OLSON BROTHERS PRO -VAC LLC Owner or tradesperson 6622 112TH ST E Principals PUYALLUP, WA 98373 OLSON, MICHAEL 253-435-4328 PIERCE County VERNON,PARTNER/MEMBER MICHAEL OLSON,STEVEN V DUANE, PARTNER/MEMBER OLSON Doing business as OLSON BROTHERS PRO -VAC LLC WA UBI No. Business type 602 170 975 Limited Liability Company Governing persons MICHAEL V OLSON STEVE D OLSON; License Verify the contractor's active registration / license / certification (depending on trade) and any past violations. Construction Contractor ...................I........ . Active. Meets current requirements. License specialties Sanitation System / Side sewers License no. OLSONBP985J2 Effective — expiration 06/27/2002— 06/27/2020 Bond ............ TRAVELERS CAS & SURETY CO $6,000.00 Bond account no. 103770245 Received by L&I Effective date 04/22/2002 04/10/2002 Expiration date Until Canceled Insurance ....................... Continental Cas Co $1,000,000.00 Policy no. 6043651609 Received by L&I Effective date 11/16/2017 11/16/2016 Expiration date 11/16/2018 Insurance history Savings ................... https:Hsecure.Ini.wa.gov/verify/Detail.aspx?UBI=602170975 &LIC=OL SONBP9 8 5 J2& SAW= Help us improve 10/9/2018 01 SON BROTHERS PRO -VAC LLC No savings accounts during the previous 6 year period. Lawsuits against the bond or savings No lawsuits against the bond or savings accounts during the previous 6 year period. L&I Tax debts ................................ No L&I tax debts are recorded for this contractor license during the previous 6 year period, but some debts may be recorded by other agencies. License Violations No license violations during the previous 6 year period. I Workers' comp Do you know if the business has employees? If so, verify the business is up-to-date on workers' comp premiums L&I Account ID 565,502-01 ........................... Account is current. Doing business as OLSON BROTHERS PRO -VAC LLC Estimated workers reported Quarter 2 of Year 2018 "Greater than 100 Workers" L&I account contact T3 / KENT ANDERSON (360)902-6963 - Email: ANDN235@ini.wa.gov Public Works Strikes and Debarments Verify the contractor is eligible to perform work on public works projects. Contractor Strikes No strikes have been issued against this contractor. Contractors not allowed to bid No debarments have been issued against this contractor. Workplace safety and health Check for any past safety and health violations found on jobsites this business was responsible for. Inspection results date 10/31/2017 Violations Inspection no. 317946912 Location 2600 Yakima Valley Highway Sunnyside, WA 98944 O Washington State Dept. of Labor 8 Industries Use of this site is subject to the laws of the state of Washington. Page 2 of 2 Help us improve https:Hsecure.Ini.wa.gov/verify/Detail.aspx?UBI=602170975&LIC=OLSONBP985J2&SAW= 10/9/2018 OT SON BROTHERS PRO -VAC LLC Violations .011IR %I Home Espanol Contact Safety & Health Claims & Insurance Washington State Department of Labor & Industries < Return to search results Workplace Safety and Health Violations OLSON BROTHERS PRO -VAC LLC, Inspection no. 317946912 violations ......................_...................._......................................111111.1.............1........... Fall protection recfuired at four feet or more Type of violation Corrected Serious Violation description Could cause serious injury or illness. Fall protection.required at ten feet or more Type of violation Corrected Serious Violation description Could cause serious injury or illness. Working from the platform Type of violation Corrected Serious Violation description Could cause serious injury or illness. Elevating and lowering the platform Type of violation Corrected Serious Violation description Could cause serious injury or illness. © Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington. Page 1 of 1 (Search L&I EM A -Z Index Help My L&I Workplace Rights Trades & Licensing Help us improve https:Hsecure.Ini.wa.gov/verify/Details/safetyViolations.aspx?UBI=602170975&LIC=OL SONBP985... 10/9/2018 #5i-c1 AWWRD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YWY) 4lesim... i 11/16/2019 8/23/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Lockton Companies NAMEALT 1185 Avenue of the Americas,Suite 2010 PHONE I FAX New York NY 10036E-MAIL°'EMI: (A/C,No): 646-572-7300 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Continental Casualty Company 20443 INSURED Olson Brothers Pro-Vac,LLC O g. b•3. ) INSURER B:The Continental Insurance Company 35289 1458107 6622 112th Street East INSURER C:Navigators Insurance Company 42307 Puyallup WA 98373 Sk) 0 INSURER D:Allied World Assurance Company(U.S.)Inc. 19489 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 16266391 REVISION NUMBER: XXXXXXX THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF 1 POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDIYYYY)I IMM/DD/YYYY) LIMITS _ COMMERCIAL GENERAL LIABILITY A X y y 6043651609 11/16!_018 11/16/2019 EACH OCCURRENCE $ 1,000 0I.0 DAMAGE TO RENTED CLAIMS-MADE X OCCU$ PREMISES(Ea occurrence) $ 1,000,100 V/ v/° MED EXP(Any one person) $ 15,000 f PERSONAL&ADV INJURY $ 1,000,000 Ir EN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000e E— POLICY JEa LOC PRODUCTS-COMP/OP AGG $ 2,000, O0 ( OTHER: $ B I AUTOMOBILE LIABILITY N N 6023021447 11/16/2018 11/16/2019 (Ea accident91NGLE LIMIT $ 1,000, 1 X ANY AUTO BODILY INJURY(Per person) $ X i OWNED AUTOS ONLY AUTOSSCHED BODILY INJURY(Per accident) $ XXXXXXX HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY (Per accident) $ XXXXXXX $ XXXXXXX C X UMBRELLA UAB X OCCUR N N PT17EXC21841IV 11/16/2018 11/16/2019 EACH OCCURRENCE $ 5,000,QOQ ' EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,0 0 DED RETENTION$ $ XXXXXXX WORKERS COMPENSATION NOT APPLICABLE PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y l N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ XXXXXXX OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ XXXXXXX If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-P•LICY LIMIT $ XXXXXXX D Pollution N N 0309-8830 11/16/2018 11/16/2019 $2,000,111. $10,000 deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) •OH is a mo polistic state for Workers Compensation and is outside the scope of this certificate.RE:Pine Road Basin Truck Line;Client Project#5874.City of Bre erton is additio sured regarding general liability as required by written contract with respect to the referenced project.The General Liability policy will apply on a pricy, n - ntnbutory basis where required by written contract. A waiver of d ogation applies with respect to the General Liability policy where required by written contract signed I prior to a loss.Coverage is included for products and completed opera ns where required by written contract.The Excess Liability policy is a follow-form policy,subject to policy exclusions. CERTIFICATE HOLDER CANCELLATION 16266391 City of Bremerton 'J c L �+ t T SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE SNS Lill` S-f �3f� 'dV THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Bremerton WA 98 • at t33-1-- �/J AUTHORIZED REPRE&CN AT E /� /(f� 4r XJ I _ ©1 88-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART as follows. If any other endorsement attached to this policy amends any provision also amended by this endorsement, then that other endorsement controls with respect to such provision, and the changes made by this endorsement with respect to such provision do not apply. TABLE OF CONTENTS 1. Additional Insureds 2. Additional Insured - Primary And Non-Contributory To Additional Insured's Insurance 3. Bodily Injury - Expanded Definition 4. Broad Knowledge of Occurrence/ Notice of Occurrence 5. Broad Named Insured 6. Broadened Liability Coverage For Damage To Your Product And Your Work 7. Contractual Liability- Railroads 8. Electronic Data Liability 9. Estates, Legal Representatives and Spouses 10.Expected Or Intended Injury- Exception for Reasonable Force 11.General Aggregate Limits of Insurance - Per Project 12.In Rem Actions 13.Incidental Health Care Malpractice Coverage 14.Joint Ventures/Partnership/Limited Liability Companies 15.Legal Liability - Damage To Premises / Alienated Premises / Property In The Named Insured's Care, Custody or Control 16. Liquor Liability 17. Medical Payments 18. Non-owned Aircraft Coverage 19. Non-owned Watercraft 20.Personal And Advertising Injury - Discrimination or Humiliation 21.Personal And Advertising Injury- Contractual Liability 22. Property Damage - Elevators 23.Supplementary Payments 24.Unintentional Failure To Disclose Hazards 25.Waiver of Subrogation - Blanket 26.Wrap-Up Extension: OCIP CCIP, or Consolidated (Wrap-Up) Insurance Programs C NA74705XX (1-15) Policy No: 6043651609 Page 1 of 17 Endorsement No: 2 CONTINENTAL CASUALTY COMPANY Effective Date: 11 /16 /2018 Insured Name: OLSON BROTHERS PRO—VAC , LLC Copyright CNA All Rights Reserved.Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement 1. ADDITIONAL INSUREDS a. WHO IS AN INSURED is amended to include as an Insured any person or organization described in paragraphs A. through H. below whom a Named Insured is required to add as an additional insured on this Coverage Part under a written contract or written agreement, provided such contract or agreement: (1) is currently in effect or becomes effective during the term of this Coverage Part; and (2) was executed prior to: (a) the bodily injury or property damage;or (b) the offense that caused the personal and advertising injury, for which such additional insured seeks coverage. b. However, subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: (1) a higher limit of insurance than required by such contract or agreement;or (2) coverage broader than required by such contract or agreement, and in no event broader than that described by the applicable paragraph A.through H. below. Any coverage granted by this endorsement shall apply only to the extent permissible by law. A. Controlling Interest Any person or organization with a controlling interest in a Named Insured, but only with respect to such person or organization's liability for bodily injury, property damage or personal and advertising injury arising out of: 1. such person or organization's financial control of a Named Insured; or 2. premises such person or organization owns, maintains or controls while a Named Insured leases or occupies such premises; provided that the coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by, on behalf of, or for such additional insured. B.Co-owner of Insured Premises A co-owner of a premises co-owned by a Named Insured and covered under this insurance but only with respect to such co-owner's liability for bodily injury, property damage or personal and advertising injury as co- owner of such premises. C. Lessor of Equipment Any person or organization from whom a Named Insured leases equipment, but only with respect to liability for bodily injury, property damage or personal and advertising injury caused, in whole or in part, by the Named Insured's maintenance,operation or use of such equipment, provided that the occurrence giving rise to such bodily injury, property damage or the offense giving rise to such personal and advertising injury takes place prior to the termination of such lease. D. Lessor of Land Any person or organization from whom a Named Insured leases land but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of the ownership, maintenance or use of such land, provided that the occurrence giving rise to such bodily injury, property damage or the offense giving rise to such personal and advertising injury takes place prior to the termination of such lease. The CNA74705XX(1-15) Policy No:6043651609 Page 2 of 17 Endorsement No: 2 CONTINENTAL CASUALTY COMPANY Effective Date: 11 /16/2018 Insured Name:OLSON BROTHERS PRO-VAC,LLC Copyright CNA All Rights Reserved.Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by, on behalf of, or for such additional insured. E. Lessor of Premises An owner or lessor of premises leased to the Named Insured, or such owner or lessor's real estate manager, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of the ownership, maintenance or use of such part of the premises leased to the Named Insured, and provided that the occurrence giving rise to such bodily injury or property damage, or the offense giving rise to such personal and advertising injury, takes place prior to the termination of such lease. The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by, on behalf of,or for such additional insured. F. Mortgagee,Assignee or Receiver A mortgagee, assignee or receiver of premises but only with respect to such mortgagee, assignee or receiver's liability for bodily injury, property damage or personal and advertising injury arising out of the Named Insured's ownership, maintenance, or use of a premises by a Named Insured. The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by,on behalf of, or for such additional insured. G.State or Governmental Agency or Subdivision or Political Subdivisions—Permits A state or governmental agency or subdivision or political subdivision that has issued a permit or authorization but only with respect to such state or governmental agency or subdivision or political subdivision's liability for bodily injury, property damage or personal and advertising injury arising out of: 1 . the following hazards in connection with premises a Named Insured owns,rents,or controls and to which this insurance applies: a. the existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk vaults, street banners,or decorations and similar exposures;or b. the construction,erection,or removal of elevators;or c. the ownership, maintenance or use of any elevators covered by this insurance; or 2.the permitted or authorized operations performed by a Named Insured or on a Named Insured's behalf. The coverage granted by this paragraph does not apply to: a. Bodily injury, property damage or personal and advertising injury arising out of operations performed for the state or governmental agency or subdivision or political subdivision;or b. Bodily injury or property damage included within the products-completed operations hazard. With respect to this provision's requirement that additional insured status must be requested under a written contract or agreement, the Insurer will treat as a written contract any governmental permit that requires the Named Insured to add the governmental entity as an additional insured. H.Trade Show Event Lessor 1. With respect to a Named Insured's participation in a trade show event as an exhibitor, presenter or displayer, any person or organization whom the Named Insured is required to include as an additional insured, but only with respect to such person or organization's liability for bodily injury, property damage or personal and advertising injury caused by: CNA74705XX(1-15) Policy No:6043651609 Page 3 of 17 Endorsement No: 2 CONTINENTAL CASUALTY COMPANY Effective Date: 11/16/2018 Insured Name: OLSON BROTHERS PRO—VAC . LLC Copyright CNA All Rights Reserved.Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement a. the Named Insured's acts or omissions;or b. the acts or omissions of those acting on the Named Insured's behalf, in the performance of the Named Insured's ongoing operations at the trade show event premises during the trade show event. 2. The coverage granted by this paragraph does not apply to bodily injury or property damage included within the products-completed operations hazard. 2.ADDITIONAL INSURED-PRIMARY AND NON-CONTRIBUTORY TO ADDITIONAL INSURED'S INSURANCE 4 The Other Insurance Condition in the COMMERCIAL GENERAL LIABILITY CONDITIONS Section is amended to add the following paragraph: If the Named Insured has agreed in writing in a contract or agreement that this insurance is primary and non- contributory relative to an additional insured's own insurance, then this insurance is primary, and the Insurer will not seek contribution from that other insurance. For the purpose of this Provision 2.,the additional insured's own insurance means insurance on which the additional insured is a named insured. Otherwise, and notwithstanding anything to the contrary elsewhere in this Condition, the insurance provided to such person or organization is excess of any other insurance available to such person or organization. 3. BODILY INJURY—EXPANDED DEFINITION Under DEFINITIONS,the definition of bodily injury is deleted and replaced by the following: Bodily injury means physical injury, sickness or disease sustained by a person, including death, humiliation, shock, mental anguish or mental injury sustained by that person at any time which results as a consequence of the physical injury, sickness or disease. 4. BROAD KNOWLEDGE OF OCCURRENCE/NOTICE OF OCCURRENCE Under CONDITIONS, the condition entitled Duties in The Event of Occurrence, Offense, Claim or Suit is amended to add the following provisions: A. BROAD KNOWLEDGE OF OCCURRENCE The Named Insured must give the Insurer or the Insurer's authorized representative notice of an occurrence, offense or claim only when the occurrence, offense or claim is known to a natural person Named Insured, to a partner, executive officer, manager or member of a Named Insured, or an employee designated by any of the above to give such notice. B. NOTICE OF OCCURRENCE The Named Insured's rights under this Coverage Part will not be prejudiced if the Named Insured fails to give the Insurer notice of an occurrence, offense or claim and that failure is solely due to the Named Insured's reasonable belief that the bodily injury or property damage is not covered under this Coverage Part. However, the Named Insured shall give written notice of such occurrence, offense or claim to the Insurer as soon as the Named Insured is aware that this insurance may apply to such occurrence,offense or claim. 5. BROAD NAMED INSURED WHO IS AN INSURED is amended to delete its Paragraph 3. in its entirety and replace it with the following: 3. Pursuant to the limitations described in Paragraph 4. below, any organization in which a Named Insured has management control: a. on the effective date of this Coverage Part; or CNA74705XX(1-15) Policy No:6043651609 Page 4 of 17 Endorsement No: 2 CONTINENTAL CASUALTY COMPANY Effective Date: 11 /16/2018 Insured Name: OLSON BROTHERS PRO-VAC , LLC Copyright CNA All Rights Reserved.Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement b. by reason of a Named Insured creating or acquiring the organization during the policy period, qualifies as a Named Insured, provided that there is no other similar liability insurance, whether primary, contributory, excess, contingent or otherwise,which provides coverage to such organization, or which would have provided coverage but for the exhaustion of its limit, and without regard to whether its coverage is broader or narrower than that provided by this insurance. But this BROAD NAMED INSURED provision does not apply to: (a) any partnership, limited liability company or joint venture; or (b) any organization for which coverage is excluded by another endorsement attached to this Coverage Part. For the purpose of this provision, management control means: A. owning interests representing more than 50% of the voting, appointment or designation power for the selection of a majority of the Board of Directors of a corporation; or B. having the right, pursuant to a written trust agreement, to protect, control the use of, encumber or transfer or sell property held by a trust. 4. With respect to organizations which qualify as Named Insureds by virtue of Paragraph 3. above, this insurance does not apply to: a. bodily injury or property damage that first occurred prior to the date of management control, or that first occurs after management control ceases; nor b. personal or advertising injury caused by an offense that first occurred prior to the date of management control or that first occurs after management control ceases. 5. The insurance provided by this Coverage Part applies to Named Insureds when trading under their own names or under such other trading names or doing-business-as names (dba) as any Named Insured should choose to employ. 6. BROADENED LIABILITY COVERAGE FOR DAMAGE TO YOUR PRODUCT AND YOUR WORK A. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete exclusions k.and I.and replace them with the following: K' it This insurance does not apply to: k. Damage to Your Product Property damage to your product arising out of it, or any part of it except when caused by or resulting from: (1) fire; (2) smoke; (3) collapse;or (4) explosion. I. Damage to Your Work Property damage to your work arising out of it, or any part of it and included in the products-completed operations hazard. This exclusion does not apply: (1) If the damaged work, or the work out of which the damage arises, was performed on the Named Insured's behalf by a subcontractor;or CNA74705XX(1-15) Policy No:6043651609 Page 5 of 17 Endorsement No: 2 CONTINENTAL CASUALTY COMPANY Effective Date: 11 /16/2018 Insured Name: OLSON BROTHERS PRO—VAC , LLC Copyright CNA All Rights Reserved.Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement (2) If the cause of loss to the damaged work arises as a result of: (a) fire; (b) smoke; (c) collapse;or (d) explosion. B. The following paragraph is added to LIMITS OF INSURANCE: Subject to 5. above, $100,000 is the most the Insurer will pay under Coverage A for the sum of damages arising out of any one occurrence because of property damage to your product and your work that is caused by fire, smoke, collapse or explosion and is included within the product-completed operations hazard. This sublimit does not apply to property damage to your work if the damaged work,or the work out of which the damage arises,was performed on the Named Insured's behalf by a subcontractor. C. This Broadened Liability Coverage For Damage To Your Product And Your Work Provision does not apply if an endorsement of the same name is attached to this policy. 7. CONTRACTUAL LIABILITY—RAILROADS With respect to operations performed within 50 feet of railroad property,the definition of insured contract is replaced by the following: Insured Contract means: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to a Named Insured or temporarily occupied by a Named Insured with permission of the owner is not an insured contract; b. A sidetrack agreement; c. Any easement or license agreement; d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to the Named Insured's business (including an indemnification of a municipality in connection with work performed for a municipality) under which the Named Insured assumes the tort liability of another party to pay for bodily injury or property damage to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1)That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving or failing to prepare or approve maps, shop drawings,opinions, reports, surveys, field orders, change orders or drawings and specifications;or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; (2) Under which the Insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in (1) above and supervisory, inspection,architectural or engineering activities. 8. ELECTRONIC DATA LIABILITY CNA74705XX(1-15) Policy No: 6043651609 Page 6 of 17 Endorsement No: 2 CONTINENTAL CASUALTY COMPANY Effective Date: 11 /16/2018 Insured Name:OLSON BROTHERS PRO-VAC,LLC Copyright CNA All Rights Reserved.Includes copyrighted material of Insurance Services Office,Inc.,with Its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement A. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete exclusion p. Electronic Data and replace it with the following: This insurance does not apply to: P.Access Or Disclosure Of Confidential Or Personal Information And Data-related Liability Damages arising out of: (1) any access to or disclosure of any person's or organization's confidential or personal information, including patents, trade secrets, processing methods, customer lists, financial information, credit card information, health information or any other type of nonpublic information;or (2) the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate electronic data that does not result from physical injury to tangible property. However, unless Paragraph (1) above applies,this exclusion does not apply to damages because of bodily injury. This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses, forensic expenses, public relation expenses or any other loss, cost or expense incurred by the Named Insured or others arising out of that which is described in Paragraph(1)or(2) above. B. The following paragraph is added to LIMITS OF INSURANCE: Subject to 5. above, $100,000 is the most the Insurer will pay under Coverage A for all damages arising out of any one occurrence because of property damage that results from physical injury to tangible property and arises out of electronic data. C. The following definition is added to DEFINITIONS: Electronic data means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software (including systems and applications software), hard or floppy disks, CD-ROMS, tapes, drives,cells,data processing devices or any other media which are used with electronically controlled equipment. D. For the purpose of the coverage provided by this ELECTRONIC DATA LIABILITY Provision, the definition of property damage in DEFINITIONS is replaced by the following: Property damage means: a. Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; b. Loss of use of tangible property that is not physically injured.All such loss of use shall be deemed to occur at the time of the occurrence that caused it;or c. Loss of, loss of use of, damage to, corruption of, inability to access, or inability to properly manipulate electronic data, resulting from physical injury to tangible property. All such loss of electronic data shall be deemed to occur at the time of the occurrence that caused it. For the purposes of this insurance,electronic data is not tangible property. E. If Electronic Data Liability is provided at a higher limit by another endorsement attached to this policy, then the $100,000 limit provided by this ELECTRONIC DATA LIABILITY Provision is part of, and not in addition to, that higher limit. 9. ESTATES, LEGAL REPRESENTATIVES,AND SPOUSES The estates, heirs, legal representatives and spouses of any natural person Insured shall also be insured under this policy; provided, however, coverage is afforded to such estates,heirs, legal representatives,and spouses only for CNA74705XX(1-15) Policy No:6043651609 Page 7 of 17 Endorsement No: 2 CONTINENTAL CASUALTY COMPANY Effective Date: 11 /16/2018 Insured Name:OLSON BROTHERS PRO—VAC , LLC Copyright CNA All Rights Reserved.Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement claims arising solely out of their capacity or status as such and, in the case of a spouse, where such claim seeks damages from marital community property, jointly held property or property transferred from such natural person Insured to such spouse. No coverage is provided for any act, error or omission of an estate, heir, legal representative, or spouse outside the scope of such person's capacity or status as such, provided however that the spouse of a natural person Named Insured and the spouses of members or partners of joint venture or partnership Named Insureds are Insureds with respect to such spouses' acts, errors or omissions in the conduct of the Named Insured's business. 10. EXPECTED OR INTENDED INJURY-EXCEPTION FOR REASONABLE FORCE tinder COVERAGES, Coverage A - Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete the exclusion entitled Expected or Intended Injury and replace it with the following: This insurance does not apply to: Expected or Intended Injury Bodily injury or property damage expected or intended from the standpoint of the Insured. This exclusion does not apply to bodily injury or property damage resulting from the use of reasonable force to protect persons or property. 11. GENERAL AGGREGATE LIMITS OF INSURANCE-PER PROJECT A. For each construction project away from premises the Named Insured owns or rents, a separate Construction Project General Aggregate Limit, equal to the amount of the General Aggregate Limit shown in the Declarations, is the most the Insurer will pay for the sum of: 1. All damages under Coverage A, except damages because of bodily injury or property damage included in the products-completed operations hazard; and 2. All medical expenses under Coverage C, that arise from occurrences or accidents which can be attributed solely to ongoing operations at that construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations, nor the Construction Project General Aggregate Limit of any other construction project. B. All: 1. Damages under Coverage B, regardless of the number of locations or construction projects involved; 2. Damages under Coverage A, caused by occurrences which cannot be attributed solely to ongoing operations at a single construction project, except damages because of bodily injury or property damage included in the products-completed operations hazard; and 3. Medical expenses under Coverage C caused by accidents which cannot be attributed solely to ongoing operations at a single construction project, will reduce the General Aggregate Limit shown in the Declarations. C. The limits shown in the Declarations for Each Occurrence, for Damage To Premises Rented To You and for Medical Expense continue to apply, but will be subject to either the Construction Project General Aggregate Limit or the General Aggregate Limit shown in the Declarations, depending on whether the occurrence can be attributed solely to ongoing operations at a particular construction project. D. When coverage for liability arising out of the products-completed operations hazard is provided,any payments for damages because of bodily injury or property damage included in the products-completed operations hazard will reduce the Products-Completed Operations Aggregate Limit shown in the Declarations, regardless of the number of projects involved. CNA74705XX(1-15) Policy No:6043651609 Page 8 of 17 Endorsement No: 2 CONTINENTAL CASUALTY COMPANY Effective Date: 11 /16/2018 Insured Name:OLSON BROTHERS PRO-VAC,LLC Copyright CNA All Rights Reserved.Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement E. If a single construction project away from premises owned by or rented to the Insured has been abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables,the project will still be deemed to be the same construction project. F. The provisions of LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue to apply as stipulated. 12. IN REM ACTIONS A quasi in rem action against any vessel owned or operated by or for the Named Insured, or chartered by or for the Named Insured, will be treated in the same manner as though the action were in personam against the Named Insured. 13. INCIDENTAL HEALTH CARE MALPRACTICE COVERAGE Solely with respect to bodily injury that arises out of a health care incident: A. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Insuring Agreement is amended to replace Paragraphs 1.b.(1)and 1.b.(2)with the following: b. This insurance applies to bodily injury provided that the professional health care services are incidental to the Named Insured's primary business purpose, and only if: (1) such bodily injury is caused by an occurrence that takes place in the coverage territory. (2) the bodily injury first occurs during the policy period.All bodily injury arising from an occurrence will be deemed to have occurred at the time of the first act, error, or omission that is part of the occurrence; and B. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to: i. add the following to the Employers Liability exclusion: This exclusion applies only if the bodily injury arising from a health care incident is covered by other liability insurance available to the Insured (or which would have been available but for exhaustion of its limits). ii. delete the exclusion entitled Contractual Liability and replace it with the following:This insurance does not apply to: Contractual Liability the Insured's actual or alleged liability under any oral or written contract or agreement, including but not limited to express warranties or guarantees. iii. add the following additional exclusions: This insurance does not apply to: Discrimination any actual or alleged discrimination, humiliation or harassment, including but not limited to claims based on an individual's race, creed, color, age, gender, national origin, religion, disability, marital status or sexual orientation. Dishonesty or Crime Any actual or alleged dishonest,criminal or malicious act,error or omission. Medicare/Medicaid Fraud CNA74705XX(1-15) Policy No: 6043651609 Page 9 of 17 Endorsement No: 2 CONTINENTAL CASUALTY COMPANY Effective Date: 11 /16/2018 Insured Name: OLSON BROTHERS PRO—VAC , LLC Copyright CNA All Rights Reserved.Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement any actual or alleged violation of law with respect to Medicare, Medicaid, Tricare or any similar federal, state or local governmental program. Services Excluded by Endorsement Any health care incident for which coverage is excluded by endorsement. C. DEFINITIONS is amended to: 1. add the following definitions: Health care incident means an act, error or omission by the Named Insured's employees or volunteer workers in the rendering of: a. professional health care services on behalf of the Named Insured or g. Good Samaritan services rendered in an emergency and for which no payment is demanded or received. Professional health care services means any health care services or the related furnishing of food, beverages, medical supplies or appliances by the following providers in their capacity as such but solely to the extent they are duly licensed as required: a. Physician; b. Nurse; c. Nurse practitioner; d. Emergency medical technician; e. Paramedic; f. Dentist; g. Physical therapist; h. Psychologist; i. Speech therapist; j. Other allied health professional; or Professional health care services does not include any services rendered in connection with human clinical trials or product testing. ii. delete the definition of occurrence and replace it with the following: Occurrence means a health care incident.All acts,errors or omissions that are logically connected by any common fact,circumstance,situation,transaction, event,advice or decision will be considered to constitute a single occurrence; iii. amend the definition of Insured to: a. add the following: the Named Insured's employees are Insureds with respect to: (1) bodily injury to a co-employee while in the course of the co-employee's employment by the Named Insured or while performing duties related to the conduct of the Named Insured's business;and CNA74705XX(1-15) Policy No: 6043651609 Page 10 of 17 Endorsement No: 2 CONTINENTAL CASUALTY COMPANY Effective Date: 11 /16/2018 Insured Name:OLSON BROTHERS PRO-VAC,LLC Copyright CNA All Rights Reserved.Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement (2) bodily injury to a volunteer worker while performing duties related to the conduct of the Named Insured's business; when such bodily injury arises out of a health care incident. the Named Insured's volunteer workers are Insureds with respect to: (1) bodily injury to a co-volunteer worker while performing duties related to the conduct of the Named Insured's business;and (2) bodily injury to an employee while in the course of the employee's employment by the Named Insured or while performing duties related to the conduct of the Named Insured's business; when such bodily injury arises out of a health care incident. b.delete Subparagraphs(a),(b),(c) and (d)of Paragraph 2.a.(1)of WHO IS AN INSURED. D. The Other Insurance condition is amended to delete Paragraph b.(1) in its entirety and replace it with the following: Other Insurance b. Excess Insurance (1)To the extent this insurance applies, it is excess over any other insurance, self insurance or risk transfer instrument, whether primary, excess, contingent or on any other basis, except for insurance purchased specifically by the Named Insured to be excess of this coverage. 14.JOINT VENTURES I PARTNERSHIP/LIMITED LIABILITY COMPANIES WHO IS AN INSURED is amended to delete its last paragraph and replace it with the following: No person or organization is an Insured with respect to the conduct of any current or past partnership,joint venture or limited liability company that is not shown as a Named Insured in the Declarations, except that if the Named Insured was a joint venturer, partner, or member of a limited liability company and such joint venture, partnership or limited liability company terminated prior to or during the policy period, such Named Insured is an Insured with respect to its interest in such joint venture, partnership or limited liability company but only to the extent that: a. any offense giving rise to personal and advertising injury occurred prior to such termination date, and the personal and advertising injury arising out of such offense first occurred after such termination date; b. the bodily injury or property damage first occurred after such termination date; and c. there is no other valid and collectible insurance purchased specifically to insure the partnership, joint venture or limited liability company;and If the joint venture, partnership or limited liability company is or was insured under a consolidated (wrap-up) insurance program, then such insurance will always be considered valid and collectible for the purpose of paragraph c. above. But this provision will not serve to exclude bodily injury, property damage or personal and advertising injury that would otherwise be covered under the Contractors General Liability Extension Endorsement provision entitled WRAP-UP EXTENSION: OCIP, CCIP, OR CONSOLIDATED (WRAP-UP) INSURANCE PROGRAMS.Please see that provision for the definition of consolidated (wrap-up) insurance program. 15. LEGAL LIABILITY — DAMAGE TO PREMISES / ALIENATED PREMISES I PROPERTY IN THE NAMED INSURED'S CARE, CUSTODY OR CONTROL A. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete exclusion j. Damage to Property in its entirety and replace it with the following: This insurance does not apply to: CNA74705XX(1-15) Policy No:6043651609 Page 11 of 17 Endorsement No: 2 CONTINENTAL CASUALTY COMPANY Effective Date: 11 /16/2018 Insured Name: OLSON BROTHERS PRO—VAC , LLC Copyright CNA All Rights Reserved.Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement Damage to Property Property damage to: (1) Property the Named Insured owns, rents,or occupies, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property; (2) Premises the Named Insured sells,gives away or abandons, if the property damage arises out of any part of those premises; (3) Property loaned to the Named Insured; (4) Personal property in the care,custody or control of the Insured; (5) That particular part of real property on which the Named Insured or any contractors or subcontractors working directly or indirectly on the Named Insured's behalf are performing operations, if the property damage arises out of those operations;or (6) That particular part of any property that must be restored, repaired or replaced because your work was incorrectly performed on it. Paragraphs (1), (3) and (4) of this exclusion do not apply to property damage (other than damage by fire) to premises rented to the Named Insured or temporarily occupied by the Named Insured with the permission of the owner, nor to the contents of premises rented to the Named Insured for a period of 7 or fewer consecutive days. A separate limit of insurance applies to Damage To Premises Rented To You as described in LIMITS OF INSURANCE. Paragraph (2)of this exclusion does not apply if the premises are your work. Paragraphs (3), (4), (5) and (6) of this exclusion do not apply to liability assumed under a sidetrack agreement. Paragraph (6) of this exclusion does not apply to property damage included in the products-completed operations hazard. Paragraphs(3) and(4)of this exclusion do not apply to property damage to: I. tools,or equipment the Named Insured borrows from others, nor ii. other personal property of others in the Named Insured's care, custody or control while being used in the Named Insured's operations away from any Named Insured's premises. However,the coverage granted by this exception to Paragraphs(3) and (4)does not apply to: a. property at a job site awaiting or during such property's installation,fabrication,or erection; b. property that is mobile equipment leased by an Insured; c. property that is an auto, aircraft or watercraft; d. property in transit; or e. any portion of property damage for which the Insured has available other valid and collectible insurance,or would have such insurance but for exhaustion of its limits, or but for application of one of its exclusions. A separate limit of insurance and deductible apply to such property of others. See LIMITS OF INSURANCE as amended below. CNA74705XX(1-15) Policy No:6043651609 Page 12 of 17 Endorsement No: 2 CONTINENTAL CASUALTY COMPANY Effective Date: 11 /16/2018 Insured Name: OLSON BROTHERS PRO—VAC,LLC Copyright CNA All Rights Reserved.Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement B. Under COVERAGES, Coverage A - Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete its last paragraph and replace it with the following: Exclusions c. through n. do not apply to damage by fire to premises while rented to a Named Insured or temporarily occupied by a Named Insured with permission of the owner, nor to damage to the contents of premises rented to a Named Insured for a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described in LIMITS OF INSURANCE. C. The following paragraph is added to LIMITS OF INSURANCE: Subject to 5. above, $25,000 is the most the Insurer will pay under Coverage A for damages arising out of any one occurrence because of the sum of all property damage to borrowed tools or equipment, and to other personal property of others in the Named Insured's care, custody or control, while being used in the Named Insured's operations away from any Named Insured's premises. The Insurer's obligation to pay such property damage does not apply until the amount of such property damage exceeds $1,000. The Insurer has the right but not the duty to pay any portion of this$1,000 in order to effect settlement. If the Insurer exercises that right,the Named Insured will promptly reimburse the Insurer for any such amount. D. Paragraph 6., Damage To Premises Rented To You Limit, of LIMITS OF INSURANCE is deleted and replaced by the following: 6. Subject to Paragraph 5. above, (the Each Occurrence Limit), the Damage To Premises Rented To You Limit is the most the Insurer will pay under Coverage A for damages because of property damage to any one premises while rented to the Named Insured or temporarily occupied by the Named Insured with the permission of the owner, including contents of such premises rented to the Named Insured for a period of 7 or fewer consecutive days.The Damage To Premises Rented To You Limit is the greater of: a. $500,000; or b. The Damage To Premises Rented To You Limit shown in the Declarations. E. Paragraph 4.b.(1)(aXii)of the Other Insurance Condition is deleted and replaced by the following: (ii) That is property insurance for premises rented to the Named Insured, for premises temporarily occupied by the Named Insured with the permission of the owner; or for personal property of others in the Named Insured's care, custody or control; 16. LIQUOR LIABILITY Under COVERAGES, Coverage A- Bodily Injury and Property Damage Liability,the paragraph entitled Exclusions is amended to delete the exclusion entitled Liquor Liability. This LIQUOR LIABILITY provision does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part. 17. MEDICAL PAYMENTS A. LIMITS OF INSURANCE is amended to delete Paragraph 7. (the Medical Expense Limit)and replace it with the following: 7. Subject to Paragraph 5. above (the Each Occurrence Limit), the Medical Expense Limit is the most the Insurer will pay under Coverage C — Medical Payments for all medical expenses because of bodily injury sustained by any one person.The Medical Expense Limit is the greater of: (1) $15,000 unless a different amount is shown here: $N,NNN,NNN,NNN; or (2) the amount shown in the Declarations for Medical Expense Limit. CNA74705XX(1-15) Policy No: 6043651609 Page 13 of 17 Endorsement No: 2 CONTINENTAL CASUALTY COMPANY Effective Date: 11 /16/2018 Insured Name: OLSON BROTHERS PRO—VAC , LLC Copyright CNA All Rights Reserved.Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement B. Under COVERAGES, the Insuring Agreement of Coverage C - Medical Payments is amended to replace Paragraph 1.a.(3)(b)with the following: (b)The expenses are incurred and reported to the Insurer within three years of the date of the accident; and 18. NON-OWNED AIRCRAFT Under COVERAGES, Coverage A - Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended as follows: The exclusion entitled Aircraft,Auto or Watercraft is amended to add the following: This exclusion does not apply to an aircraft not owned by any Named Insured, provided that: 1. the pilot in command holds a currently effective certificate issued by the duly constituted authority of the United States of America or Canada, designating that person as a commercial or airline transport pilot; 2. the aircraft is rented with a trained, paid crew to the Named Insured; and 3. the aircraft is not being used to carry persons or property for a charge. 19.NON-OWNED WATERCRAFT Under COVERAGES, Coverage A - Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete subparagraph (2) of the exclusion entitled Aircraft, Auto or Watercraft, and replace it with the following. This exclusion does not apply to: (2)a watercraft that is not owned by any Named Insured, provided the watercraft is: (a) less than 75 feet long; and (b) not being used to carry persons or property for a charge. 20.PERSONAL AND ADVERTISING INJURY—DISCRIMINATION OR HUMILIATION A. Under DEFINITIONS, the definition of personal and advertising injury is amended to add the following tort: Discrimination or humiliation that results in injury to the feelings or reputation of a natural person. B. Under COVERAGES, Coverage B — Personal and Advertising Injury Liability, the paragraph entitled Exclusions is amended to: 1. delete the Exclusion entitled Knowing Violation Of Rights Of Another and replace it with the following: This insurance does not apply to: Knowing Violation of Rights of Another Personal and advertising injury caused by or at the direction of the Insured with the knowledge that the act would violate the rights of another and would inflict personal and advertising injury. This exclusion shall not apply to discrimination or humiliation that results in injury to the feelings or reputation of a natural person, but only if such discrimination or humiliation is not done intentionally by or at the direction of: (a) the Named Insured;or (b) any executive officer, director, stockholder, partner, member or manager(if the Named Insured is a limited liability company)of the Named Insured. 2. add the following exclusions: CNA74705XX(1-15) Policy No:6043651609 Page 14 of 17 Endorsement No: 2 CONTINENTAL CASUALTY COMPANY Effective Date: 11 /16/2018 Insured Name:OLSON BROTHERS PRO-VAC,LLC Copyright CNA All Rights Reserved.Includes copyrighted material of Insurance Services Office,Inc..with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement This insurance does not apply to: Employment Related Discrimination Discrimination or humiliation directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person by any Insured. Premises Related Discrimination discrimination or humiliation arising out of the sale, rental, lease or sub-lease or prospective sale, rental, lease or sub-lease of any room,dwelling or premises by or at the direction of any Insured. Notwithstanding the above, there is no coverage for fines or penalties levied or imposed by a governmental entity because of discrimination. The coverage provided by this PERSONAL AND ADVERTISING INJURY—DISCRIMINATION OR HUMILIATION Provision does not apply to any person or organization whose status as an Insured derives solely from Provision 1. ADDITIONAL INSURED of this endorsement;or attachment of an additional insured endorsement to this Coverage Part. This PERSONAL AND ADVERTISING INJURY—DISCRIMINATION OR HUMILIATION Provision does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part. 21.PERSONAL AND ADVERTISING INJURY-CONTRACTUAL LIABILITY A. Under COVERAGES, Coverage B —Personal and Advertising Injury Liability, the paragraph entitled Exclusions is amended to delete the exclusion entitled Contractual Liability. B. Solely for the purpose of the coverage provided by this PERSONAL AND ADVERTISING INJURY - CONTRACTUAL LIABILITY provision, the following changes are made to the section entitled SUPPLEMENTARY PAYMENTS—COVERAGES A AND B: 1. Paragraph 2.d. is replaced by the following: d. The allegations in the suit and the information the Insurer knows about the offense alleged in such suit are such that no conflict appears to exist between the interests of the Insured and the interests of the indemnitee; 2. The first unnumbered paragraph beneath Paragraph 2.1.(2)(b) is deleted and replaced by the following: So long as the above conditions are met, attorneys fees incurred by the Insurer in the defense of that indemnitee, necessary litigation expenses incurred by the Insurer, and necessary litigation expenses incurred by the indemnitee at the Insurer's request will be paid as defense costs. Such payments will not be deemed to be damages for personal and advertising injury and will not reduce the limits of insurance. C. This PERSONAL AND ADVERTISING INJURY - CONTRACTUAL LIABILITY Provision does not apply if Coverage B —Personal and Advertising Injury Liability is excluded by another endorsement attached to this Coverage Part. This PERSONAL AND ADVERTISING INJURY - CONTRACTUAL LIABILITY Provision does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part. 22.PROPERTY DAMAGE—ELEVATORS A. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended such that the Damage to Your Product Exclusion and subparagraphs(3),(4)and(6)of the Damage to Property Exclusion do not apply to property damage that results from the use of elevators. CNA74705XX(1-15) Policy No:6043651609 Page 15 of 17 Endorsement No: 2 CONTINENTAL CASUALTY COMPANY Effective Date: 11 /16/ 2018 Insured Name: OLSON BROTHERS PRO—VAC , LLC Copyright CNA All Rights Reserved.Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement B.Solely for the purpose of the coverage provided by this PROPERTY DAMAGE—ELEVATORS Provision,the Other Insurance conditions is amended to add the following paragraph: This insurance is excess over any of the other insurance,whether primary,excess,contingent or on any other basis that is Property insurance covering property of others damaged from the use of elevators. 23.SUPPLEMENTARY PAYMENTS The section entitled SUPPLEMENTARY PAYMENTS—COVERAGES A AND B is amended as follows: A. Paragraph 1.b.is amended to delete the$250 limit shown for the cost of bail bonds and replace it with a$5,000. limit; and B. Paragraph 1.d. is amended to delete the limit of$250 shown for daily loss of earnings and replace it with a $1,000. limit. 24. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS If the Named Insured unintentionally fails to disclose all existing hazards at the inception date of the Named Insured's Coverage Part, the Insurer will not deny coverage under this Coverage Part because of such failure. 25.WAIVER OF SUBROGATION-BLANKET Under CONDITIONS,the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended to add the following: The Insurer waives any right of recovery the Insurer may have against any person or organization because of payments the Insurer makes for injury or damage arising out of: 1. the Named Insured's ongoing operations;or 14. your work included in the products-completed operations hazard. However,this waiver applies only when the Named Insured has agreed in writing to waive such rights of recovery in a written contract or written agreement, and only if such contract or agreement: 1. is in effect or becomes effective during the term of this Coverage Part; and 2. was executed prior to the bodily injury, property damage or personal and advertising injury giving rise to the claim. 26.WRAP-UP EXTENSION:OCIP,CCIP,OR CONSOLIDATED(WRAP-UP)INSURANCE PROGRAMS Note: The following provision does not apply to any public construction project in the state of Oklahoma, nor to any construction project in the state of Alaska,that is not permitted to be insured under a consolidated (wrap-up) insurance program by applicable state statute or regulation. If the endorsement EXCLUSION—CONSTRUCTION WRAP-UP is attached to this policy, or another exclusionary endorsement pertaining to Owner Controlled Insurance Programs(0.C.I.P.)or Contractor Controlled Insurance Programs(C.C.I.P.)is attached,then the following changes apply: A. The following wording is added to the above-referenced endorsement: With respect to a consolidated (wrap-up) insurance program project in which the Named Insured is or was involved, this exclusion does not apply to those sums the Named Insured become legally obligated to pay as damages because of: 1. Bodily injury,property damage,or personal or advertising injury that occurs during the Named Insured's ongoing operations at the project, or during such operations of anyone acting on the Named Insured's behalf; nor CNA74705XX(1-15) Policy No: 6043651609 Page 16 of 17 Endorsement No: 2 CONTINENTAL CASUALTY COMPANY Effective Date: 11 / 16/2018 Insured Name: OLSON BROTHERS PRO—VAC,LLC Copyright CNA All Rights Reserved.Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement 2. Bodily injury or property damage included within the products-completed operations hazard that arises out of those portions of the project that are not residential structures. B. Condition 4.Other Insurance is amended to add the following subparagraph 4.b.(1Xc): This insurance is excess over: (c)Any of the other insurance whether primary, excess,contingent or any other basis that is insurance available to the Named Insured as a result of the Named Insured being a participant in a consolidated (wrap-up) insurance program, but only as respects the Named Insured's involvement in that consolidated (wrap-up) insurance program. C. DEFINITIONS is amended to add the following definitions: Consolidated (wrap-up) insurance program means a construction, erection or demolition project for which the prime contractor/project manager or owner of the construction project has secured general liability insurance covering some or all of the contractors or subcontractors involved in the project, such as an Owner Controlled Insurance Program (0.C.I.P.)or Contractor Controlled Insurance Program(C.C.I.P.). Residential structure means any structure where 30% or more of the square foot area is used or is intended to be used for human residency, including but not limited to: 1. single or multifamily housing, apartments, condominiums, townhouses, co-operatives or planned unit developments;and 2. the common areas and structures appurtenant to the structures in paragraph 1. (including pools, hot tubs, detached garages, guest houses or any similar structures). However, when there is no individual ownership of units, residential structure does not include military housing, college/university housing or dormitories, long term care facilities, hotels or motels. Residential structure also does not include hospitals or prisons. This WRAP-UP EXTENSION: OCIP, CCIP,OR CONSOLIDATED(WRAP-UP)INSURANCE PROGRAMS Provision does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part. All other terms and conditions of the Policy remain unchanged. This endorsement,which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA74705XX1-15 ( ) Policy No:6043651609 Page 17 of 17 Endorsement No: 2 CONTINENTAL CASUALTY COMPANY Effective Date: 11 /16/2018 Insured Name: OLSON BROTHERS PRO—VAC , LLC Copyright CNA All Rights Reserved.Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products-Completed Operations Coverage Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: I. WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury caused in whole or in part by your acts or omissions, or the acts or omissions of those acting on your behalf: A. in the performance of your ongoing operations subject to such written contract; or B. in the performance of your work subject to such written contract, but only with respect to bodily injury or property damage included in the products-completed operations hazard, and only if: 1. the written contract requires you to provide the additional insured such coverage; and 2. this coverage part provides such coverage. II. But if the written contract requires: A. additional insured coverage under the 11-85 edition, 10-93 edition,or 10-01 edition of CG2010,or under the 10- 01 edition of CG2037;or B. additional insured coverage with "arising out of language;or C. additional insured coverage to the greatest extent permissible by law; then paragraph I. above is deleted in its entirety and replaced by the following: WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of your work that is subject to such written contract. III. Subject always to the terms and conditions of this policy, including the limits of insurance,the Insurer will not provide such additional insured with: A. coverage broader than required by the written contract; or B. a higher limit of insurance than required by the written contract. IV.The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of: A. the rendering of,or the failure to render,any professional architectural, engineering, or surveying services, including: 1. the preparing,approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders,change orders or drawings and specifications; and 2. supervisory, inspection,architectural or engineering activities;or B.any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this coverage part. V. Under COMMERCIAL GENERAL LIABILITY CONDITIONS,the Condition entitled Other Insurance is amended to add the following,which supersedes any provision to the contrary in this Condition or elsewhere in this coverage part: CNA75079XX(10-16) Policy No:6043651609 Page 1 of 2 Endorsement No: 7 CONTINENTAL CASUALTY COMPANY Effective Date: 11 /16/2018 Insured Name: OLSON BROTHERS PRO—VAC , LLC Copyright CNA Al Rights Reserved.Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products-Completed Operations Coverage Endorsement Primary and Noncontributory Insurance With respect to other insurance available to the additional insured under which the additional insured is a named insured,this insurance is primary to and will not seek contribution from such other insurance, provided that a written contract requires the insurance provided by this policy to be: 1. primary and non-contributing with other insurance available to the additional insured; or 2. primary and to not seek contribution from any other insurance available to the additional insured. But except as specified above,this insurance will be excess of all other insurance available to the additional insured. VI. Solely with respect to the insurance granted by this endorsement,the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer written notice of any claim,or any occurrence or offense which may result in a claim; 2. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlement of the claim; and 3. make available any other insurance,and tender the defense and indemnity of any claim to any other insurer or self-insurer,whose policy or program applies to a loss that the Insurer covers under this coverage part. However,if the written contract requires this insurance to be primary and non-contributory,this paragraph 3. does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VII.Solely with respect to the insurance granted by this endorsement,the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires you to make a person or organization an additional insured on this coverage part, provided the contract or agreement: A. is currently in effect or becomes effective during the term of this policy; and B. was executed prior to: 1. the bodily injury or property damage;or 2. the offense that caused the personal and advertising injury; for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. All other terms and conditions of the Policy remain unchanged. This endorsement,which forms a part of and is for attachment to the Policy issued by the designated Insurers,takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below,and expires concurrently with said Policy. CNA75079XX(10-16) Policy No:6043651609 Page 2 of 2 Endorsement No: 7 CONTINENTAL CASUALTY COMPANY Effective Date: 11/16/2018 Insured Name:OLSON BROTHERS PRO—VAC ,LLC Copyright CNA All Rights Reserved.Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA Business Auto Policy Policy Endorsement ' LESSOR - ADDITIONAL INSURED AND LOSS PAYEE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: OLSON BROTHERS PRO-VAC, LLC Endorsement Effective Date: 11/16/2018 SCHEDULE Insurance Company: The Continental Insurance Company Policy Number: 6023021447 Effective Date: 11/16/2018 Expiration Date: 11/16/2019 Named Insured: OLSON BROTHERS PRO-VAC, LLC Address: 6622 112TH ST E PUYALLUP, WA 98373-4630 Additional Insured (Lessor): Address: Designation Or Description Of "Leased Autos": Coverages Limit Of Insurance Liability $1,000,000 Each "Accident" Comprehensive Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus Refer to Declarations Deductible For Each Covered "Leased Auto" Collision Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus Refer to Declarations Deductible For Each Covered "Leased Auto" Specified Causes Of Loss Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus Deductible For Each Covered "Leased Auto" Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Form No: CA 20 01 10 13 Policy No:BUA 6023021447 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 11/16/2018 Endorsement No: 3; Page: 1 of 2 Policy Page: 16 of 43 Underwriting Company: The Continental Insurance Company, 151 N Franklin St, Chicago, IL 60606 �,� _� Copyright Insurance Services Office, Inc., 2011 CNA Business Auto Policy Policy Endorsement A. Coverage 1. Any "leased auto" designated or described in the Schedule will be considered a covered "auto" you own and not a covered "auto" you hire or borrow. 2. For a "leased auto" designated or described in the Schedule, the Who Is An Insured provision under Covered Autos Liability Coverage is changed to include as an "insured" the lessor named in the Schedule. However, the lessor is an "insured" only for "bodily injury" or "property damage" resulting from the acts or omissions by: a. You; b. Any of your "employees" or agents; or c. Any person, except the lessor or any "employee" or agent of the lessor, operating a "leased auto" with the permission of any of the above. 3. The coverages provided under this endorsement apply to any "leased auto" described in the Schedule until the expiration date shown in the Schedule, or when the lessor or his or her agent takes possession of the "leased auto", whichever occurs first. B. Loss Payable Clause 1. We will pay, as interest may appear, you and the lessor named in this endorsement for "loss" to a " leased auto". 2. The insurance covers the interest of the lessor unless the "loss" results from fraudulent acts or omissions on your part. 3. If we make any payment to the lessor, we will obtain his or her rights against any other party. C. Cancellation 1. If we cancel the policy, we will mail notice to the lessor in accordance with the Cancellation Common Policy Condition. 2. If you cancel the policy, we will mail notice to the lessor. 3. Cancellation ends this agreement. D. The lessor is not liable for payment of your premiums. E. Additional Definition As used in this endorsement: "Leased auto" means an "auto" leased or rented to you, including any substitute, replacement or extra auto" needed to meet seasonal or other needs, under a leasing or rental agreement that requires you to provide direct primary insurance for the lessor. Form No: CA 20 01 10 13 Policy No:BUA 6023021447 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 11/16/2018 Endorsement No: 3; Page: 2 of 2 Policy Page: 17 of 43 Underwriting Company: The Continental Insurance Company, 151 N Franklin St, Chicago, IL 60606 ®Copyright Insurance Services Office, Inc.,2011 CNA Business Auto Policy Policy Endorsement IWAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: OLSON BROTHERS PRO-VAC, LLC Endorsement Effective Date: 11/16/2018 SCHEDULE Name(s) Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION FOR WHOM OR WHICH YOU ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT TO OBTAIN THIS WAIVER FROM US. YOU MUST AGREE TO THAT REQUIREMENT PRIOR TO LOSS. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. Form No: CA 04 44 10 13 Policy No:BUA 6023021447 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 11/16/2018 Endorsement No: 2; Page: 1 of 1 Policy Page: 15 of 43 Underwriting Company: The Continental Insurance Company, 151 N Franklin St, Chicago, IL 60606 °Copyright Insurance Services Office, Inc., 2011 CNA Business Auto Policy Policy Schedule ' BROADENED POLLUTION LIABILITY COVERAGE SCHEDULE As per the policy declarations, this policy provides coverage subject to the limits of insurance indicated below: Aggregate Limit $1,000,000 Endorsement Premium Included "Property damage" and "covered pollution costs or expense" per "accident" deductible $500 Refer to the policy declarations page for other forms and endorsements attached to and forming a part of this policy. Form No: G-22454-A (10-1994) Policy No:BUA 6023021447 Policy Schedule; Page: 1 of 1 Policy Effective Date: 11/16/2018 Underwriting Company: The Continental Insurance Company, 151 N Franklin St,Chicago, IL 60606 Policy Page: 14 of 43 e Copyright CNA All Rights Reserved. 10/3/2019 OLSON BROTHERS PRO-VAC LLC Home Esi dol Contact Search L&I SEARCH A-I,Index Help Mc L.&l Safety&Health Claims&Insurance Workplace Rights Trades&Licensing Washington State Department of `,,Labor & Industries OLSON BROTHERS PRO-VAC LLC Owner or tradesperson 6622 112TH ST E Principals PUYALLUP,WA 98373 OLSON,MICHAEL 253-435-4328 VERNON,PARTNER/MEMBER PIERCE County OLSON,STEVEN DUANE,PARTNER/MEMBER Doing business as OLSON BROTHERS PRO-VAC LLC WA UBI No. Business type 602 170 975 Limited Liability Company Governing persons MICHAEL V OLSON STEVE D OLSON; License Certifications & Endorsements Workers' comp Do you know if the business has employees?If so,verify the business is up-to-date on workers'comp premiums. L&I Account ID Account is current. 565,502-01 ................................ Doing business as OLSON BROTHERS PRO VAC LLC Estimated workers reported Quarter 2 of Year 2019"Greater than 100 Workers" L&I account contact T3/KENT ANDERSON(360)902-6963-Email:ANDN235@Ini.wa.gov Public Works Requirements Workplace safety and health ©Washington State Dept.of Labor&Industries.Use of this site is subject to the laws of the state of Washington. Help us improve https://secure.lni.wa.gov/verify/Detail.aspx?UBI=602170975&LIC=OLSONBP985J2&SAW= 1/1 'Y z/ CONTRACT MODIFICATION AGREEMENT NO. 5874 BETWEEN THE CITY OF BREMERTON AND OLSON BROTHERS Pro- Vac, LLC PROJECT CTV Truck Inspection of Pine RD Stormwater Pipe DATE October 17, 2019 THIS CONTRACT MODIFICATION AGREEMENT SPECIFICALLY AMENDS THE AGREEMENT (the "Contract") entered into between the City of Bremerton and Olson Brother Pro-Vac, LLC on October 10,2018 agrees to complete work by December 31, 2019, contract number 5874. All provisions in the Contract shall remain in full force and effect except as expressly modified by this document. For valuable consideration and by mutual consent of the parties, the modifications to the Contract are as follows: I. Section I. Scope , is modified as follows: No chane Section II. Term , is modified as follows: The Consultant shall complete the work described in this Contract Modification Agreement by Contract end date is extended to December 31. 2019. Section III. Compensation , is modified as follows: No change II. Consultant accepts all requirements of this Contract Modification by endorsing below. Consultant further agrees that this Contract Modification constitutes full and final settlement of all of the Consultant's claims for contract time and for all costs of any kind, including without limitation, costs of delays related to any work either covered or affected by this Contract Modification, claims related to on-site or home office overhead, or lost profits. This Contract Modification does not limit the City's right to bring a claim for past performance. The undersigned consultant approves the foregoing Contract Modification as to the changes, if any, in the contract price specified for each item, including any and all supervision costs and other miscellaneous costs relating to the change in work, and as to the extension of time allowed, if any, for completion of the entire work due to said Contract Modification. Page 1 of 2 Contract Modification Rev.07/18 This document will become a supplement of the contract and all provisions will apply hereto. It is understood that this Contract Modification shall be effective when approved by the City of Bremerton. The parties whose names appear below warrant that they are authorized to enter into a contract modification that is binding on the parties of this contract. In addition, Consultant warrants that it has or will inform the surety of this change,and shall take appropriate action to modify any bonds required under the contract to address this change. IN WITNESS WHEREOF, the parties have executed this Contract Modification on the day and year first written above. City Engineer/Public Works Director approved to process o�� le7L2r. nitials and Date) CONSULTANT THE CITY OF BREMERTON By: G-.<�1--- By: Print Name: pl LAct.,\: e. aS ,rint Name: Thomas Knuckey Its: C`-'A\ . L 5 aL" , 1 Its: Public Works Director Date: /o -,2 At i o, Date: 10/17/2019 APPROVED AS TO FORM: ATTEST: By: V 1 , By: 1 01J# i4-015VTA ROGER A. LUBOVICH, Bremerton City Attorney ANGELA 4 e 0 : , City Clerk +OOv'c r NOTICES TO BE SENT TO: NOTICES TO BE SENT TO: Olsen Brothers Pro-Vac. LLC Mr. Chance Berthiaume Attention: Melanie Ross Title Stormwater Permit Coordinator 6622 112th St E City of Bremerton Water Resources Puyallup. WA 98373 Address 100 Oyster Bay Ave N. Address Bremerton, WA 98312 Phone/Fax R:\Legal\Legal\Forms\FORMS ON COBWEB\Contract Modification Rev.07 2018.doc\ Page 2 of 2 Contract Modification Rev.07'18 V- 5 � vJ ACOREY CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �..------ 11/16/2020 11/14/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Lockton Companies CONTACT 1185 Avenue of the Americas,Suite 2010 PHONN,Ext): FAX No): New York NY 10036 E-MAIL 646-572-7300 RECEIVED ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Continental Casualty Company 20443 INSURED Olson Brothers Pro-Vac,LLC N U V 26 2 U i J INSURER B: The Continental Insurance Company 35289 1458107 6622 112th Street East INSURER C: Navigators Insurance Company 42307 Puyallup WA 98373 City of Bremerton INSURER D: Allied World Assurance Company(U.S)Inc 19489 D\1�. 11 .aca, 1 1� ,SND Risk Management INSURER E: INSURER-r: COVERAGES CERTIFICATE NUMBER: 16266391 REVISION NUMBER: XXXXXXX THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MWDD/YYYY)(MM/DD/YYYY) A x COMMERCIAL GENERAL LIABILITY A y y 6079756997 11/16/2019 11/16/2020 EACH OCCURRENCE $ 1,000, 0 CLAIMS-MADE X OCCUR r' DAMAGE REM SES((ETO a occurrence) $ 1,00000 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,001,0 9 POLICY.PE C n LOC PRODUCTS-COMP/OP AGG $ 2,00 1,000 — OTHER: $ -- (, B AUTOMOBILE LIABILITY N N 6079761990 11/16/2019 11/16/2020 COBINED SINGLE LIMIT (Ea Maccident) _$ 1,000, X ANY AUTO BODILY INJURY(Per person) $ XXXXXXX _ WNED AUTOS ONLY _AUTOSULED BODILY INJURY(Per accident;$ XXXXXXX X AUTOS ONLY X AUTOS ONLYY PROPERTY (Per sin $ XXXXXXX- - $ XXXXXXX1 / C X UMBRELLA LIAB X OCCUR N N CH19EXC921841IV 11/16/2019 11/16/2020 EACH OCCURRENCE $ 5,000,Q 0-49 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,d 0/ DED RETENTION$ $ XXXXXXX WORKERS COMPENSATION PER 0TH- AND EMPLOYERS'LIABILITY Y/NSTATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A NOT APPLICABLE E.L.EACH ACCIDENT $ XXXXXXX OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ XXXXXXX If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE POLICY LIMIT $ XXXXXXX D Pollution N N 0309-8830 11/16/2019 11/16/2020 $2,04000 $l 0,W Deductible DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) *WA is a monopolistic state for Workers Compensation and is outside the scope of this certificate*RE:Pine Road Basin Truck Line;Client Project#5874.City of Brewton is additionaJyfsured regarding general liability as required by written contr ct with respect to the referenced project.The General Liability policy will apply on a prim no ntribftfrtory basis where required by written contract. A waiver• :..rogation applies with respect to the General Liability policy where required by written contract signed prior to a loss.Coverage is included for products and complete. operations where required by written contract.The Excess Liability policy is a follow-form policy, subject to policy exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 16266391 AUTHORIZED REPRESENTATIVE City of Bremerton Public Works&Utilities 100 Oyster Bay Ave N. Bremerton WA 98312L�24.1 l ACORD 25(2016/03) ©1 8-2015 ACORD CORPORATION.All rights reserved The ACORD name and logo are registered marks of ACORD 4t SS tq5 AC CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 11/16/2020 11/14/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCERp CONTACT Lockton Com anies NAME: 1185 Avenue of the Americas,Suite 2010 ( /CC,PHONE, Ext): FAX No): New York NY 10036 E-MAIL 646-572-7300 RECEIVED ADDRESS: INSURERIS)AFFORDING COVERAGE NAIC# INSURER A: Continental Casualty Company 20443 INSURED Olson Brothers Pro-Vac,LLC N U V 2 6 2019 INSURER B: The Continental Insurance Company 35289 1458107 6622112th Street East INSURER C: Navigators Insurance Company 42307 Puyallup WA 98373 City of Bremerton INSURER D Allied World Assurance Company(U.S)Inc. 19489 Risk Management INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 15843817 REVISION NUMBER: XXXXXXX THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVF RFFN RFn11CFn RY PAIn et AIMR LTR L ADDL SUER LIMITS TYPE OF INSURANCE INSD WVD � �y"� A x COMMERCIAL GENERAL LIABILITY N N 6079 I "(/, k- p(0 - V a 1RRENCE $ 1,000,000 CLAIMS-MADE n OCCUR I,, /�, Ea RENTED $ 1,000,000 1 ) S u s u�/ _ (�iJ 04(Q c4-0( 'ny one person) $ 15,000 &ADV INJURY $ 1,000,000 IffGENII_AGGREGATE LIMIT APPLIES PER: GGREGATE $ 2,000,000 J POLICY X TE LOC \( Pa r a r -ti,4 f k 6 Y1 -COMP/OP AGG $ 2,000,000 B 'tom y BILE LIABILITY N N 6079 ///7 ,,- si Q ,�/1� SINGLE LIMIT ) $ 1.000,000 X ANY AUTO (.S �` 1 JRY(Per person) $ XXXXXXX OWNED SCHEDULED AUTOS ONLY AUTOS JRY(Per accident,$ XXXXXXX _ HIRED NON-OWNED DAMAGE $ XXXXXXX X AUTOS ONLY X AUTOS ONLY S-602—k- $ XXXXXXX C X UMBRELLA LIAB X OCCUR N N CHI' 1RRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE E $ 5,000,000 DED RETENTION$ $ XXXXXXX WORKERS COMPENSATIONTE 0T H- AND EMPLOYERS'LIABILITY Y/N NOT ER ANY PROPRIETOR/PARTNER/EXECUTIVEN/A :IDENT $ XXXXXXX OFFICER/MEMBER EXCLUDED? (Mandatory in NH) -EA EMPLOYEE $ER EXCLIf es,describe under D Pollution N N 0309-8830 11/16/2019 11/16/2020 $2,000,000 $10,000 Deductible DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) *WA is a monopolistic state for Workers Compensation and is outside the scope of this certificate* CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 15843817 AUTHORIZED REPRESENTATIVE City of Bremerton Public Works&Utilities 100Oyster Bay Ave N. Bre alidne"-- Bremerton WA 98312 Q ACORD 25(2016/03) ©1 8-2015 ACORD CORPORATION.All rights reserved The ACORD name and logo are registered marks of ACORD CONTINUATION DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS(Use only if more space is required) 999-1896-999 -Ostrich Bay Creek LID Retrofit Plan Design; Client Project#1489. RE: Pine Road stormwater drainage basin City of Bremerton is additional insured regarding general liability as required by written contract with respect to the referenced project. The General Liability policy will apply on a primary, non-contributory basis where required by written contract. A waiver of subrogation applies with respect to the General Liability policy where required by written contract signed prior to a loss. Coverage is included for products and completed operations where required by written contract. Contractual Liability coverage applies with respect to the General Liability policy,per CNA form CG0001-0413. Collapse and subsidence are included in Earth Movement coverage. The Excess Liability policy is a follow-form policy, subject to policy exclusions. ACORD 25(2016/03) Certificate Holder ID: 15843817