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HomeMy WebLinkAbout6430P52(A)0280O2 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 09/06/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON Inc 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 LIC #OC36861 1-415-403-1491 CONTACT Kimberly Leikam Alliant Insurance Services, Inc. PHONE FAX rAfr ,, e-w, 415-403-1491 11AIr u.a. 415-874-4818 100 Pine street, 11th Floor San Francisco, CA 94111 ADDRESS: kleikam@alliant.com INSURER(S) AFFORDING COVERAGE NAIC q INSURERA: VALLEY FORGE INS CO 20508 INSURED Intermountain Slurry Seal, Inc. 585 West Beach Street Watsonville, CA 95076 INSURERB: CONTINENTAL CAS CO 20443 INSURERC: TRANSPORTATION INS CO 20494 INSURERD: INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 66509224 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER MM IDD/YYYY MM DDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY X X GL2074978689 10/01/20 10/01/23 EACH OCCURRENCE $ 21000,000 CLAIMS -MADE Ix I OCCUR TO ES(RENTED PREMISES (Ea occurrence) PREMI $ 2,0001000 X Contractual Liability MED EXP (Any one person) $ Nil X XCU Hazards PERSONAL B,ADVINJURY $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10, 000, 000 POLICY X JEST LOC PRODUCTS - COMPIOPAGG $ 21000,000 OTHER: $ A AUTOMOBILE LIABILITY X X BUA2074978692 10/01/20 10/01/23 COMBINED SINGLE LIMIT Ea accident $ 21000,000 X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY X Contractua $ B X UMBRELLA LIAB X OCCUR CUE2068209453 10/01/21 10/01/22 EACH OCCURRENCE $ 11000,000 X AGGREGATE $ 11000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A C C WORKERS COMPENSATION AND EMPLOYER8' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICE R/MEMBEREXCLUDED? (Mandatory In NH) If as, describe under C DESRIPTION OF OPERATIONS below NIA X X X X WC274978644 (AOS/Stop Ga WC274978630 (CA) WC274978658 (NY) WC274978661 (MT,WI,HI) j.0/O1/21 10/01/21 10/01/21 10/01/21 10/01/22 10/01/22 10/01/22 10/01/22 X PERA STATUTE ERH E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 E.L. DISEASE - POLICY LIMIT $ 2,0001000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Job #1651 - 2022 - 2024 Chip Seal and Slurry Seal Unit Priced Contract The City, its officials, employees, agents and volunteers are named additional insureds per the attached forme. GL Per ISO Form CG0001 10/01; AL Per ISO Form CA0001 10/13 CERTIFICATE HOLDER CANCELLATION 1651 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Bremerton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, 345 6th Street, Suite 100 AUTHORIZED REPRESENTATIVE Bremerton, WA 98337 USA ACORD 25 (2016103) jnielson 66509224 ©1988-2015 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD 00 w O rV r;z�arzsaiz M CA r n z w G-140331,,D AWAIA (Ed. 01/13) ti. w 00 BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - o WITH PRODUCTS -COMPLETED OPERATIONS COVERAGE M It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE 00 00 PART as follows: w SCHEDULE (OPTIONAL) Name %J Additional Insured Persons Or Organlza#ions (As required by "written contract" per Paragraph A. below.) Locations of Covered Operations (As per the "written contract," provided the location is within the "coverage territory" of this Coverage Part,) A. Section II -Who Is An Insured is amended to include as an additional insured: 1. Any person or organization whom you are required by "written contract" to add as an additional insured on this Coverage Part; and 2. The particular person or organization, if any, scheduled above. B. The insurance provided to the additional insured is limited as follows: 1. The person or organization is an additional insured only with respect to liability for "bodily injury," "property damage," or "personal and advertising injury" caused in whole or in part by: a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your ongoing operations specified in the "written contract"; or b. "Your work" that is specified in the "written contract" but only for "bodily injury" or "property damage" I ncluded 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. 2. If the "written contract" specifically requires you to provide additional insurance coverage via the 10/01 edition of CG2010 (aka CG 20 10 10 01), or via the 10/01 edition of CG2037 (aka CG 20 37 10 01), or via the 11/85 edition of CG2010 (aka CG 20 10 11 85), then in paragraph BA above, the words 'caused in whole or in part by' are replaced by the words 'arising out of', 3. We will not provide the additional insured any broader coverage or any higher limit of insurance than: a. The maximum permitted by law; b. That required by the "written contract"; c. That described in B.1, above; or d. That afforded to you under this policy, whichever is less. 4. Notwithstanding anything to the contrary in Condition 4. Other Insurance (Section IV), this insurance is excess of all other insurance available to the additional insured whether on a primary, excess, contingent or G-140331-D (Ed. 01/13) POLICY #: GL2074978689 Page 1 of 2 EFFECTIVE: 10/01/2020 Copyright, CNA All Rights Reserved. P520f"128(H)2 G 140 CNA(Ed. 01/1/13) m any other basis. But if required by the "written contract" to be primary and non-contributory, this insurance w will be primary and non-contributory relative to insurance on which the additional insured is a Named Insured. o 5. The insurance provided to the additional insured does not apply to "bodily injury," "property damage," or "personal and advertising injury" arising out of: 00 a. The rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: z (1) The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, w 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, 1. The Duties In The Event of Occurrence, Offense, Claim or Suit condition is amended to add the fallowing additional conditions applicable to the additional insured: An additional insured under this endorsement will as soon as practicable: (1) Give us written notice of an "occurrence" or an offense which may result in a claim or "suit" under this I nsurance, and of any claim or "suit" that does result; (2) Except as provided in Paragraph B.4. of this endorsement, agree to make available any other insurance the additional insured has for a loss we cover under this Coverage Pail; (3) Send us copies of all legal papers received, and otherwise cooperate with us in the investigation, defense, or settlement of the claim or "suit"; and (4) Tender the defense and indemnity of any claim or "suit" to any other insurer or self insurer whose policy or program applies to a loss we cover under this Coverage Part. But if the "written contract" requires this insurance to be primary and non-contributory, this provision (4) does not apply to insurance on which the additional insured is a Named Insured. We have no duty to defend or indemnify an additional insured under this endorsement until we receive from the additional insured written notice of a claim or "suit." D. Only for the purpose of the insurance provided by this endorsement, SECTION V - 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: 1. Is currently in effect or becomes effective during the term of this policy; 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 the additional insured seeks coverage under this Coverage Part. All other terms and conditions of the Policy remain unchanged. G-140331-D (Ed.01/13) Page 2 of 2 Material used with permission of ISO Properties, Inc. POLICY #: GL2074978689 EFFECTIVE: 10/01 /2020 Copyright, CNA All Rights Reserved. rszcixasarz POLICY NUMBER: GL2074978689 EFFECTIVE: 10/01 /2020 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Cons#ruction Project(s): Any construction project as required by a written contract or agreement that was executed prior to the date of loss, Information required to complete this Schedule, if not shown above, will be shown in A. For all sums which the insured becomes legally 3. Any payments made under Coverage A for obligated to pay as damages caused by damages or under Coverage C for medical "occurrences" under Section I Coverage A, and expenses shall reduce the Designated for all medical expenses caused by accidents Construction Project General Aggregate Limit under Section I - Coverage C, which can be for that designated construction project. Such attributed only to ongoing operations at a single payments shall not reduce the General designated construction project shown in the Aggregate Limit shown in the Declarations nor Schedule above: shall they reduce any other Designated 1. A separate Designated Construction Project Construction Project General Aggregate Limit General Aggregate Limit applies to each for any other designated construction project designated construction project, and that limit shown in the Schedule above. is equal to the amount of the General 4. The limits shown in the Declarations for Each Aggregate Limit shown in the Declarations. Occurrence, Damage To Premises Rented To 2. The Designated Construction Project General You and Medical Expense continue to apply. Aggregate Limit is the most we will pay for the However, instead of being subject to the sum of all damages under Coverage A, General Aggregate Limit shown in the except damages because of "bodily injury" or Declarations, such limits will be subject to the "property damage" included in the "products- applicable Designated Construction Project completed operations hazard," and for General Aggregate Limit. medical expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits." CG 25 03 05 09 Copyright, Insurance Services Office, Inc., 2008 Page 1 of 2 P326Mzau"z C4 S. For all sums which the insured becomes legally C. When coverage for liability arising out of the 00 obligated to pay as damages caused by "products -completed operations hazard" is o "occurrences" under Section I - Coverage A, and provided, any payments for damages because of for all medical expenses caused by accidents "bodily injury" or "property damage" included in under Section I - Coverage C, which cannot be the "products -completed operations hazard" will00 M attributed only to ongoing operations at a single reduce the Products -completed Operations designated construction project shown in the Aggregate Limit, and not reduce the General z Schedule above; Aggregate Limit nor the Designated Construction w 1. Any payments made under Coverage A for Project General Aggregate Limit. damages or under Coverage C for medical D. If the applicable designated construction project expenses shall reduce the amount available has been abandoned, delayed, or abandoned under the General Aggregate Limit or the and then restarted, or if the authorized Products -completed Operations Aggregate contracting parties deviate from plans, blueprints, Limit, whichever is applicable, and designs, specifications or timetables, the project 2. Such payments shall not reduce any will still be deemed to be the same construction Designated Construction Project General project. Aggregate Limit. E. The provisions of Section III Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 Copyright, Insurance Services Office, tnc., 2008 CG 25 03 05 09 P526(X)2AW2 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. o Waiver of Transfer of Rights of Recovery Against Others to Us M r` n This endorsement modifies insurance provided under the following: z w Commercial General Liability Coverage Form Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, The Transfer Of Rights Of Recovery Against Others To Us Condition is amended by the addition of the following: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of: 1. Your ongoing operations; or 2. "Your work" included in the "products completed operations hazard." However, this waiver applies only when you have agreed in writing to waive such rights of recovery in a contract or agreement, and only if the contract or agreement: 1. Is in effector becomes effective during the term of this policy; and 2. Was executed prior to loss. This endorsement is part of your policy and takes effect on the effective date of your policy, unless another effective date is shown below. Must Be Completed ENDT, NO. POLICY NO. 26 G L 2074978689 Complete Only When This Endorsement Is Not Prepared with the Polic Or Is Not to be Effective with the Polic ISSUED TO: EFFECTIVE DATE OF THIS ENDORSEMENT: Granite Construction Incorporated 10/01/20 P52(d1112M1N12 G-15115-A (Ed. 10/89) POLICY NUMBER; GL2074978689 EFFECTIVE: 10/01 /2020 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART In the event of cancellation or material change that reduces or restricts the insurance afforded by this Coverage Part (other than the reduction of aggregate limits through payment of claims), we agree to mail prior written notice of can- cellation or material change to: 1. Name: Any person or organization you are required by written contract or agreement to mail prior written notice of cancellation or material change. 2. Address; Per Certificates of Insurance on file with the broker. 3. Number of days advance notice: For non-payment of premium, the greater of: ® the number of days required by state statute or • the number of days required by written contract For any other reason, the lesser of: ® 60 days or ® the number of days required in a written contract G-15115-A Page 1 of 1 (Ed. 10/89) w O �� M h P3200028IN12 CNA71527XX (Ed. 10/12) It is understood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as follows: Name of Additional Insured Persons Or Organizations Any person or organization whom the named insured is required by written contract to add as an additional insured on this policy. 1. In conformance with paragraph A.1.c. of Who Is An Insured of Section II - LIABILITY COVERAGE, the person or organization scheduled above is an insured under this policy. 2. The insurance afforded to the additional insured under this policy will apply on a primary and non-contributory basis if you have committed it to be so in a written contract or written agreement executed prior to the date of the "accident" for which the additional insured seeks coverage under this policy. All other terms and conditions of the Policy remain unchanged. CNA71527XX (10/12) Page 1 of 1 Insured Name: Granite Construction Incorporated Copyright CNA All Rights Reserved. Policy No: Endorsement No: Effective Date: BUA2074978692 10/01 /2020 rsza�uizsnuz i �� �� R �, R ..> � I .; .� � i � r � � � � A, � � �' �� f � � " ■ � � 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: Granite Construction Incorporated Endorsement Effective ®ate: 10/01/?020 Names) ®f Person(s) tar Organization(s): Any person or organization for whom or which you are required by written contract or agreement to obtain this waiver from us. Information re wired to com lete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against ®there To Us condition does not apply to the persons) or organizations) 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, w O W ti J F�a Copyright, Insurance Services Office, Inc., 2011 .,• P5261K)281N@ LL GO C. THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ° i Notice of Cancellation or Material Change - Designated Person or Organization This endorsement modifies insurance provided under the following: w Business Auto Coverage Form ;In the event of cancellation or material change that reduces or restricts the insurance afforded by this Coverage Part, we agree to mail prior written notice of cancellation or material change to: SCHEDULE rl. Name: Any person or organization you are required by written contract or agreement io mail prior i written notice of cancellation or material change. 2. Address: Per Certificates of Insurance on file with the broker, 3. Number of days advance notice: For non-payment of premium, the greater of: • the number of days required by state statute or • the number of days required by written contract For any other reason, the lesser of: • 60 days or • the number of days required in a written contract This endorsement Is part of your policy and lakes effect on the effective date of your policy, unless another effective date is shown below. Must Be Completed ENDT. NO. POLICY NO. 19 BUA 2074978692 CHA IEA/M19B618 red With the Policv Or Is Not to be Effective with the Polic ISSUED T0: EFFECTIVE QATE OF THIS Granite Construction Company ENDORSEMENT 10/01/2020 C�-39543A P526W28M2 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313 (Ed. 4-84) m w O WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT " We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our 00 right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) z w This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule This endorsement changes the policy to which it is attached. It is agreed that Part One - Workers' Compensation Insurance G. Recovery From Others and Part Two - Employers' Liability Insurance H. Recovery From Others are amended by adding the following; We will not enforce our right to recover against persons or organizations. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) PREMIUM CHARGE - Refer to the Schedule of Operations The charge will be an amount to which you and we agree that is a percentage of the total standard premium for California exposure. The amount is N/A. All other terms and conditions of the policy remain unchanged. This endorsement, which forms a pars of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. This endorsement changes the policy to which it is attached effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 10/01/2021 Policy No. WC274978644 Valley Forge Insurance Co. Endorsement No. 000 WC274978668 Transportation Insurance Co. Insured Granite Construction Incorporated WC274978661 Transportation Insurance Co. Premium $ WC274978630 Valley Forge Insurance Co. Countersigned by WC 00 0313 ® 7983 Nakionel Council on Compensation Insurance. P52lNN129(N)2 C-ZLIAW &A CNA(Ed, 10193) ` •' M R: :• 'c ♦ ► • is 60 days or the number of days required In a written contract 2, Notice will be mailed t®; Address: Per Certificates of Insurance on file with the broker This endorsement changes the policy to which II Is attached and fs efleclive nn the date Issued unless athenvlse slated. (The information below Vs required only when this endorsement is Issued subsequent to preparation of the poly,) Endorsement Effective 10.1-21 Policy No.WC274978630 Valley Forge Insurance Company AO AN I 'W UU1111111111711MIlliftAllal Im P526iro281e)2 ACORVO DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 09/20/2022 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 00 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. r" 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 LIC #OC36861 1-415-403-1491 CONTACT Y Leikam Kimberly O Alliant Insurance Services, Inc. PHONE 415-403-1491 FAx 415-874-4618 E-MAIL � A1C No kleikam@alliant.com 560 Mission Street, 6th F100T ADDRESS:_ W INSURER(S) AFFORDING COVERAGE NAIC # San Francisco, CA 94105 INSURERA:TRANSPORTATION INS CO 20494 INSURED INSURERB: VALLEY FORGE INS CO 20508 Intermountain Slurry Seal, Inc, INSURERC: CONTINENTAL CAS CO 20443 585 West Beach Street INSURERD: INSURER E : Watsonville, CA 95076 INSURERF: COVERAGES CERTIFICATE NUMBER: 66630731 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER EFF MMIDD/YYYY MMI POLICYPOLICY /YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR X X GL2074978689 10/01/20 10/01/23 EACH OCCURRENCE $ 2,000,000 DAMAGES RENTED PREMISES PREMISES Ea occurrence $ 000, 000 X Contractual Liability MED EXP (Any one person) $ Nil X XCU Hazards PERSONAL $ADVINJURY $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10, 000, 000 POLICY X jECT LOC PRODUCTS - COMP/OPAGG $ 21000,000 $ OTHER: B AUTOMOBILE LIABILITY X X BUA2074978692 10/01/20 10/01/23 COMBINED SINGLE LIMIT Ea accident $ 2 000,000 X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTYDAMAGE Per accident $ X HIRED X NOWOWNED AUTOS ONLY AUTOS ONLY X Contractua $ C X UMBRELLALIAB X OCCUR CUB2068209453 10/01/22 10/01/23 EACH OCCURRENCE $ 11000,000 X AGGREGATE $ 11000, 000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE F OFFICER/MEMBEREXCLUE (Mandatory In NH) NIA X X WC274978630 (CA) WC274970644 (AOS/Stop Ga 10/01/22 J0/01/22 10/01/23 10/01/23 X ER STATUTE ERH E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 If as, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Addillonal Remarks Schedule, may be attached if more apace Is required) Job #1651 - 2022 - 2024 Chip Seal and Slurry Seal Unit Priced Contract The City, its officials, employees, agents and Volunteers are named additional insureds per the attached forme. GL Per ISO Form CG0001 10/011 AL Per ISO Form CA0001 10/13 1651 ty of Bremerton 345 6th Street, Suite 100 Bremerton, WA 98337 ACORD 25 (2016103) kaleikam 66630731 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2075 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD p5161N12HIN12 w O �i 0 rn rn z w P>2(�INI2RIN13 �lorkers Cornpen§ation end Employers Liability Insurance We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual. Schedule Any Person or Organization on whose behalf you are required to obtain this waiver of our right to recover from under a written contract or agreement. The premium charge for the endorsement is reflected in the Schedule of Operations. 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 Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below, Form No: WC 00 03 13 (04-1984) Policy No: WC 2 74978644 Endorsement Effective Date: Endorsement Expiration Date: Policy C-fiective Date: 10101I2022 Endorsement No: 32; Page: 1 of 1 Policy Page: 296 of 442 Underwriting Company: Transportation Insurance Company, 151 N Franklin St, Chicago, IL 60606 Copyright 1983 National Council on Compensation Insurance. CO w O 0 rn z w rsuuusxaiz ;i 4 s � t =G# 6t. This endorsement changes the policy to which it is attached, It is agreed that Part One -Workers' Compensation Insurance G. Recovery Frorn ®thorn and Part Two - Employers' Liability Insurance hl. Recov®ry From ®thers are amended by adding the following: We will not enforce our right to recover against persons or organizations. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us,) PREMI�IIyI ChIARGE -Refer to the Schedule of (7perations The charge will be an amount to whioh you and we agree that is a percentage of the total standard premium for California exposure. The amount is 2%. 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 Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective ®ate) is shown below, and expires concurrently with said policy unless another expiration date is shown below. Form No: G-19160-8 111-19971 Poliry No: WC 2 7497$630 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 10/01/2022 Endorsement No; 6; Page: 1 of 1 Policy Page: 53 of $3 Underwriting Company: Valley Forge Insurance Company, 151 N Franklin St, Chicago, IL 60606 115 w O 0 rn a, � Copyright CNA All Rights Reserved, »,*»<+< <,<-© :«■< c4 <?-.#_:.< .*t«- :-:r-:.,«< » o IFTHM a .:» ._ . »- e }_ :=r c J a a : » w . -iT4MiTwTvM �q « e, e :a.«w, adays . : the number of days required in _ written contract a a=w+ zw=»ce MMIJIMMMA RRICE WC p§�!|�■� »aw», 24r,n7644 Transportation Insurance Company +� _ \ \ w / rsze��uznieiz �� 'THIS ENDORSEMENT CHANGES THE POLIC`r. PLEASE READ IT CAREFULLY. Notice of Cancellation ar Nlateriai Change — Designated Person or �Organizatfon This endorsement modifies insurance provided under the following: Business Auto Coverage Form .In the event of cancellation or material change that reduces or restricts the insurance afforded by this Coverage Part, we agree to mail prior written notfce of canc�ellaiion or material change to: SCHEDULE rf. Name: Any person or organization you are required by written contract or agreement to mail prior i written notice of cancellation or material change. 2. Address: Per Certificates of Insurance on file with the broker, 3. Number of days advance notice; For non-payment of premium, the greater of; • the number of days required by state statute or • the number of days required by written contract For any other reason, the lesser of: • so days or • the number of days required in a written contract This endorsement is part of your policy and takes effect on the effective date of your policy, unless another effective date is shown below. Completed N0. 1 viva IEA/M19BB18 Complete Only When This Endorsement Is Not Prepared With the Polic Or Is Not to be Effective with the Polic ISSUED T0: EFFECTIVE DATE OF THIS Granite Construction Company ENDORSEMENT 10/01 /2020 G-39543A E� P52MM2KW2 OLICY NUMBER: BUA2074978692 COMMERCIAL AUTO l 04 44 ENDORSEMENTTHIS POLICY. • PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF AGAINST OTHERS TO US (WAIVER OF SUBROGATION) 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: Granite Construction Incorporated Endorsement Effective Date: 10/01/2020 SCHEDULE Names) Of Persons) 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. 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. CA04441013 Copyright, Insurance Services Office, Inc., 2011 Page 1 of 1 i P520002XIN12 CNA71527XX (Ed. 10/12) It is understood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as follows: ®' Any person or organization whom the named insured is required by written contract to add as an additional insured on this policy. 1. In conformance with paragraph A.1.c. of Who Is An Insured of Section II -LIABILITY COVERAGE, the person or organization scheduled above is an insured under this policy. 2. The insurance afforded to the additional insured under this policy will apply on a primary and non-contributory basis if you have committed it to be so in a written contract or written agreement executed prior to the date of the "accident" for which the additional insured seeks coverage under this policy. All other terms and conditions of the Policy remain unchanged. CNA71527XX (10/12) Page 1 of 1 Insured Name; Granite Construction Incorporated Copyright CNA All Rights Reserved. Policy No: Endorsement No: Effective Date: BUA2074978692 10/01 /2020 w O w P>zanoz8W2 G 15115-A (Ed. 10/89) POLICY NUMBER: GL2074978689 EFFECTIVE: 10/01 /2020 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART In the event of cancellation or material change that reduces or restricts the insurance afforded by this Coverage Part (other than the reduction of aggregate limits through payment of claims), we agree to mail prior written notice of can- cellation or material change to; SCHEDULI° 1. Name: Any person or organization you are required by written contract or agreement to mail prior written notice of cancellation or material change. 2. Address: Per Certificates of Insurance on file with the broker. 3. Number of days advance notice: For non-payment of premium, the greater of: • the number of days required by state statute or • the number of days required by written contract For any other reason, the lesser of: • 60 days or • the number of days required in a written contract G-15115-A (Ed. 10/89) Page 1 of 1 m w O 0 w P52(�1N12NDU2 i •' • • •- �r� • � This endorsement modifies insurance provided under the following: Under SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS, The Transfer Of Rights Of Recovery Against Others To Us Condition is amended by the addition of the following: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of; 1. Your ongoing operations; or 2, "Your work" included in the "products completed operations hazard." However, this waiver applies only when you have agreed in writing to waive such rights of recovery in a contract or agreement, and only if the contract or agreement: 1, Is in effect or becomes effective during the term of this policy; and 2. Was executed prior to loss. This endorsement is part of your policy and takes effect on the effective date of your policy, unless another effective date is shown below, Must Be Completed ENDT. NO, POLICY NO. 26 GL 2074978689 Complete Only When This Endorsement Is Not Prepared with the Polic Or Is Not to be Effective with the Polic ISSUED TO: EFFECTIVE DATE OF THIS ENDORSEMENT: Granite Construction Incorporated 10/01/20 eiw�x�zxan B. For all sums which the insured becomes legally C. When coverage for liability arising out of the obligated to pay as damages caused by "products -completed operations hazard" is o "occurrences" under Section I -Coverage A, and provided, any payments for damages because of `* for all medical expenses caused by accidents "bodily injury" or "property damage" included in under Section 1 -Coverage C, which cannot be the "products -completed operations hazard" will attributed only to ongoing operations at a single reduce the Products -completed .Operations designated construction project shown in the Aggregate Limit, and not reduce the General Schedule above: Aggregate Limit nor the Designated Construction 1. Any payments made under Coverage A for Project General Aggregate Limit. damages or under Coverage C for medical D. If the applicable designated construction project expenses shall reduce the amount available has been abandoned, delayed, or abandoned under the General Aggregate Limit or the and then restarted, or if the authorized Products -completed Operations Aggregate contracting parties deviate from plans, blueprints, Limit, whichever is applicable; and designs, specifications or timetables, the project 2. Such payments shall not reduce any will still be deemed to be the same construction Designated Construction Project General project. Aggregate Limit. E. The provisions of Section III - Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 Copyright, Insurance Services Office, Inc., 2008 CG 25 03 05 09 r>zr,�rozsunz POLICY NUMBER; GL2074978689 EFFECTIVE; 10/01/2020 � It � � � � � � � � ■ � This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART E.I�3:1�I�I1 r=� �+ � �• C��Y.�'klF'I��7 Any construction project as required by a written contract or agreement that was executed prior to the date of loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally 3. Any payments made under Coverage A for obligated to pay as damages caused by damages or under Coverage C for medical "occurrences" under Section I -Coverage A, and expenses shall reduce the Designated for all medical expenses caused by accidents Construction Project General Aggregate Limit under Section I - Coverage C, which can be for that designated construction project. Such attributed only to ongoing operations at a single payments shall not reduce the General designated construction project shown in the Aggregate Limit shown in the Declarations nor Schedule above: shall they reduce any other Designated 9. A separate Designated Construction Project Construction Project General Aggregate Limit General Aggregate Limit applies to each for any other designated construction project designated construction project, and that limit shown in the Schedule above. is equal to the amount of the General 4. The limits shown in the Declarations for Each Aggregate Limit shown in the Declarations. Occurrence, Damage To Premises Rented To 2. The Designated Construction Project General You and Medical Expense continue to apply. Aggregate Limit is the most we will pay for the However, instead of being subject to the sum of all damages under Coverage A, General Aggregate Limit shown in the except damages because of "bodily Injury" or Declarations, such limits will be subject to the "property damage" included in the "products- applicable Designated Construction Project completed operations hazard," and for General Aggregate Limit. medical expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits." Copyright, Insurance Services Office, Inc., 2008 .�� �•• 0 rn 7 W rsz6"o2802 G 140331-D (Ed, 01/13) any other basis. But if required by the "written contract" to be primary and non-contributory, this insurance will be primary and non-contributory relative to insurance on which the additional insured is a Named Insured. 5. The insurance provided to the additional insured does not apply to "bodily injury," "property damage," or It 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. C. SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: 1. The Duties In The Event of Occurrence, Offense, Claim or Suit condition is amended to add the following additional conditions applicable to the additional insured: An additional insured under this endorsement will as soon as practicable: (1) Give us written notice of an "occurrence" or an offense which may result in a claim or "suit" under this insurance, and of any claim or "suit" that does result; (2) Except as provided in Paragraph B.4. of this endorsement, agree to make available any other insurance the additional insured has for a loss we cover under this Coverage Part; (3) Send us copies of all legal papers received, and otherwise cooperate with us in the investigation, defense, or settlement of the claim or "suit'; and (4) Tender the defense and indemnity of any claim or "suit" to any other insurer or self insurer whose policy or program applies to a loss we cover under this Coverage Part. But if the "written contract" requires this insurance to be primary and non-contributory, this provision (4) does not apply to insurance on which the additional insured is a Named Insured. We have no duty to defend or indemnify an additional insured under this endorsement until we receive from the additional insured written notice of a claim or "suit." D. Only for the purpose of the insurance provided by this endorsement, SECTION V - 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 contractor agreement: 1. Is currently in effect or becomes effective during the term of this policy; 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 the additional insured seeks coverage under this Coverage Part. All other terms and conditions of the Policy remain unchanged. G-140331-D (Ed.01/13) Page 2 of 2 Material used with permission of ISO Properties, Inc. POLICY #: GL2074978689 EFFECTIVE: 10/01 /2020 0 z w Copyright, CNA All Rights Reserved. MM 1111111111111110 G-140331-D CNA(Ed, 01/13) u. 00 BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - o WITH PRODUCTS®COMPLETED OPERATIONS COVERAGE M It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART as follows: SCHEDULE (OPTIONAL) (As required by "written contract" per Paragraph A. below.) (As per the "written contract," provided the location is within the "coverage territory" of this Coverage Part,) A. Section II -Who Is An Insured is amended to include as art additional insured: 1. Any person or organization whom you are required by "written contract" to add as an additional insured on this Coverage Part; and 2. The particular person or organization, if any, scheduled above. B. The insurance provided to the additional insured is limited as follows: 1. The person or organization is an additional insured only with respect to liability for "bodily injury," "property damage," or "personal and advertising injury" caused in whole or in part by: a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your ongoing operations specified in the "written contract"; or b. "Your work" that is specified in the "written contract" but only for "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 additional insured such coverage; and (2) This Coverage Part provides such coverage. 2. If the "written contract" specifically requires you to provide additional insurance coverage via the 10/01 edition of CG2010 (aka CG 20 10 10 01), or via the 10/01 edition of CG2037 (aka CG 20 37 10 01), or via the 11 /85 edition of CG2010 (aka CG 20 10 11 85), then in paragraph 13.1. above, the words 'caused in whole or in part by' are replaced by the words 'arising out of'. 3. We will not provide the additional insured any broader coverage or any higher limit of Insurance than: a. The maximum permitted by law; b. That required by the "written contract"; c. That described in B.1. above; or d. That afforded to you under this policy, whichever is less. 4. Notwithstanding anything to the contrary in Condition 4. Other Insurance (Section IV), this insurance is excess of all other insurance available to the additional insured whether on a primary, excess, contingent or G-140331-D (Ed.01/13) Page 1 of 2 Copyright, CNA All Rights Reserved. POLICY #: GL2074978689 EFFECTIVE: 10/01 /2020 P5260e2X,H)2 r a DATE(MMIDDIYYYY) CORV CERTIFICATE OF LIABILITY INSURANCE 09/12/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES u. BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED CIO REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, 1 O 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 LIC #OC36861 1-415-403-1491 NAMKimberly Kimberly Leikam 00 Alliant Insurance Services, Inc. PHONE FAX 415-403-1491 _ `' 1AlcTls.�x0• �C No); 415-674-4818 560 Mission Street, 6th Floor RECEIVED E� -ADDRESS: kleikamCaalliant.com _ W INSURERISI AFFORDING COVERAGE _ NAIC q San Francisco, CA 94105 INSURERA: TRANSPORTATION INS CO 20494 INSURED P2 2023 INSURERS: VALLEY FORGE INS CO 20508 Intermountain Slurry Seal, Inc. INSURERC:CONTINENTAL CAS CO 20443 585 West Beach Street City of Bremerton INSURERD: Risk Management INSURER -- _ _--- -- Watsonville, CA 95076 1 INSURERF: COVERAGES CERTIFICATE NUMBER: 69625541 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ INSR ADDLTYPE OF INSURANCE lam SUBR POLICY NUMBER MMIDDNYYY POLICY LTR M DDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY X X GL2074978689 10/01/23 10/01/26 EACHOCCURRENCE $ 2,000,000 DAMAGE TO RENTED $ 21000,000 CLAIMS -MADE OCCUR PREMISES_(Eaoccurrence) X Contractual Liability MED EXP (Any one person) $ Nil X _ XCU Hazards PERSONAL & ADV INJURY $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 POLICY L 1 JPROo ECT E LOC PRODUCTS - COMP/OP AGG 21000,000_ _$ OTHER: $ B AUTOMOBILE LIABILITY X X BUA2074978692 10/01/23 10/01/26 COMBINED SINGLE LIMIT Ea amldenl)_ __ $ 2,000,000 X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS PROPERTYDAMAGE ---___ $ _ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY Per accident X Contractua $ C X UMBRELLALIAB X OCCUR CUE2068209453 10/01/23 10/01/24 EACH OCCURRENCE $ 1,0001000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 11000,000 X _ DED RETENTION $ $ B WORKERS COMPENSATION X WC274978630 (CA) 10/01/23 10/01/24 X STATUTE ER__, AND EMPLOYERS' LIABILITY A ANYPROPRIETOR/PARTNER/EXECUTIVE X WC274978644 (AOS/Stop Ga a0/01/23 10/01/24 E.L. EACH ACCIDENT $ 2,000,000 OFFICER/MEMBEREXCLUDED? (Mandatory in NH) NIA — --- E.L. DISEASE - EA EMPLOYEE $ 2, 000, 000 E.L, DISEASE - POLICY LIMIT $ 2,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (ACORD 101, Addltional Remarks Schedule, may be attached if more space Is required) Job #1165250 - 2022 - 2024 Chip Seal and Slurry Seal Unit Priced Contract The City, its officials, employees, agents and volunteers are named additional insureds per the attached forme, GL Per ISO Form CG0001 10/01; AL Per ISO Form CA0001 10/13 CERTIFICATE HOLDER CANCELLATION 1651 1165250 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Bremerton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 345 6th Street, Suite 100 AUTHORIZED REPRESENTATIVE Bremerton, WA 98337 USA (f ACORD 25 (2016103) ttaganap 69625541 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I'S2(11(12NU112 Q� 00 w O �i �i 7 z w P526028M2 G 140331-D (Ed. 01/13) It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART as follows: SCHEDULE (OPTIONAL) Name of Addi#tonal Insured Persons Or Organizations (As required by "written contract" per Paragraph A. below.) Locations of Covered Operations (As per the "written contract," provided the location is within the "coverage territory" of this Coverage Part.) A. Section II -Who Is An Insured is amended to include as an additional insured: 1. Any person or organization whom you are required by "written contract" to add as an additional insured on this Coverage Part; and 2. The particular person or organization, if any, scheduled above. B. The insurance provided to the additional insured is limited as follows: 1. The person or organization is an additional insured only with respect to liability for "bodily injury," "property damage," or "personal and advertising injury" caused in whole or in part by: a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your ongoing operations specified in the "written contract"; or b. "Your work" that is specified in the "written contract" but only for "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. 2. If the "written contract" specifically requires you to provide additional insurance coverage via the 10/01 edition of CG2010 (aka CG 20 10 10 01), or via the 10/01 edition of CG2037 (aka CG 20 37 10 01), or via the 11/85 edition of CG2010 (aka CG 20 10 11 85), then in paragraph B.1. above, the words 'caused in whole or in part by' are replaced by the words 'arising out of'. 3. We will not provide the additional Insured any broader coverage or any higher limit of insurance than: a. The maximum permitted by law; b. That required by the "written contract"; c. That described in Bell. above; or d. That afforded to you under this policy, whichever is less. 4. Notwithstanding anything to the contrary in Condition 4. Other Insurance (Section IV), this insurance is excess of all other insurance available to the additional insured whether on a primary, excess, contingent or G-140331-D (Ed.01/13) POLICY#:GL2074978680 Page 1 of 2 EFFECTIVE: 10/01/2023 Copyright, CNA All Rights Reserved. 1'5261912811112 G-140331-D CN(Ed. 01/13) a� any other basis. But if required by the "written contract" to be primary and non-contributory, this insurance � will be primary and non-contributory relative to insurance on which the additional insured is a Named Insured, o rn 5. The insurance provided to the additional insured does not apply to "bodily injury," "property damage," or "personal and advertising injury" arising out of: rl a. The rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: z (1) The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, w 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, 1. The ®uties In The Event ®f Occurrence, Offense, Claim ®r Suit condition is amended to add the following additional conditions applicable to the additional insured: An additional insured under this endorsement will as soon as practicable: (1) Give us written notice of an "occurrence" or an offense which may result in a claim or "suit" under this insurance, and of any claim or "suit" that does result; (2) Except as provided in Paragraph 13.4. of this endorsement, agree to make available any other insurance the additional insured has for a loss we cover under this Coverage Part; (3) Send us copies of all legal papers received, and otherwise cooperate with us in the investigation, defense, or settlement of the claim or "suit"; and (4) Tender the defense and indemnity of any claim or "suit" to any other insurer or self insurer whose policy or program applies to a loss we cover under this Coverage Part. But if the "written contract" requires this insurance to be primary and non-contributory, this provision (4) does not apply to insurance on which the additional insured is a Named Insured, We have no duty to defend or indemnify an additional insured under this endorsement until we receive from the additional insured written notice of a claim or "suit." B. Only for the purpose of the insurance provided by this endorsement, SECTION V - 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 contractor agreement: 1. Is currently in effect or becomes effective during the term of this policy; 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 the additional insured seeks coverage under this Coverage Part. All other terms and conditions of the Policy remain unchanged. G-140331-D (Ed.01/13) Page 2 of 2 Material used with permission of ISO Properties, Inc. POLICY #: GL2074978689 EFFECTIVE: 10/01 /2023 Copyright, CNA All Rights Reserved. P5260028,R)2 POLICY NUMBER: GL2074978689 COMMERCIAL GENERAL LIABILITY EFFECTIVE: 10/01 /2023 CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): Any construction project as required by a written contract or agreement that was executed prior to the date of loss, red to complete this if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally 3. Any payments made under Coverage A for obligated to pay as damages caused by damages or under Coverage C for medical "occurrences" under Section I - Coverage A, and expenses shall reduce the Designated for all medical expenses caused by accidents Construction Project General Aggregate Limit under Section I - Coverage C, which can be for that designated construction project. Such attributed only to ongoing operations at a single payments shall not reduce the General designated construction project shown in the Aggregate Limit shown in the Declarations nor Schedule above: shall they reduce any other Designated 1. A separate Designated Construction Project Construction Project General Aggregate Limit General Aggregate Limit applies to each for any other designated construction project designated construction project, and that limit shown in the Schedule above. is equal to the amount of the General 4. The limits shown in the Declarations for Each Aggregate Limit shown in the Declarations. Occurrence, Damage To Premises Rented To 2. The Designated Construction Project General You and Medical Expense continue to apply. Aggregate Limit is the most we will pay for the However, instead of being subject to the sum of all damages under Coverage A, General Aggregate Limit shown in the except damages because of "bodily injury" or Declarations, such limits will be subject to the "property damage" included in the "products- applicable Designated Construction Project completed operations hazard," and for General Aggregate Limit. medical expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits." CG 25 03 05 09 Copyright, Insurance Services Office, Inc., 2008 Page 1 of 2 P52619QH002 9. For all sums which the insured becomes legally Co When coverage for liability arising out of the obligated to pay as damages caused by "products -completed operations hazard" is o "occurrences" under Section I - Coverage A, and provided, any payments for damages because of " for all medical expenses caused by accidents "bodily injury" or "property damage" included in under Section 1 Coverage C, which cannot be the "products -completed operations hazard" will attributed only to ongoing operations at a single reduce the Products -completed Operations co designated construction project shown in the Aggregate Limit, and not reduce the General Schedule above: Aggregate Limit nor the Designated Construction w 1. Any payments made under Coverage A for Project General Aggregate Limit. damages or under Coverage C for medical ®. If the applicable designated construction project expenses shall reduce the amount available has been abandoned, delayed, or abandoned under the General Aggregate Limit or the and then restarted, or if the authorized Products -completed Operations Aggregate contracting parties deviate from plans, blueprints, Limit, whichever is applicable, and designs, specifications or timetables, the project 2. Such payments shall not reduce any will still be deemed to be the same construction Designated Construction Project General project. Aggregate Limit. E. The provisions of Section III Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated, Copyright, Insurance Services Office, Inc., 2008 P5260028002 C-2047&A (Ed. 10193) WORKERS'r.AO: AND EMPLOYERS'POLICY• NOTICE00 :,CANCELLATION OR MATERIAL CHANGEENDORSEMENT 00 In the event of cancellation or other material change of the policy, we will mail advance notice to the person or > organization name• in the Schedule, The numberof days advance notice shown • 60 days or the number of days required in a written contract e. •- • i 1 •. as •. `.i:• . R.. i ^... a • i - � i i _ 9. ,.. ,, a: • a •' ibis endorsement changes the policy to whieh It Is attached and is e8'eclive on the date Issued ur�ess ather�nsa stated. (The intorrnatlon below is requlrod only when tfiis endarsemenl is issued subsequent to preparallon at the palicy.) Endarsemeni Effecilue 10.1.23 Policy No, WC274978630 Valley Forge insurance Company WC274978644 Transportation Insurance Company 15260029 W2 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us, This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule, Any person or organization for which the employer has agreed by written contract, executed prior to lass, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual. Schedule Any Person or Organization on whose behalf you are required fie obtain fihis waiver of our right to recover from under a written contract or agreement. The premium charge for the endorsement is reflected in the Schedule of Operations, 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 Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. Form No: WC 00 03 13 104-1984) Policy No: WC 2 74970644 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 10101/2023 Endorsement No: 32; Page: 1 of 1 Policy Page: 296 of 442 Underwriting Company: Transportation Insurance Company, 151 N Franklin St, Chicago, IL 60606 Copyright 1983 National Council on Compensation Insurance, "1 P52GIN1UM2 This endorsement changes the policy to which it is attached, It is agreed that Part One Workers' Compensation Insurance G. Recovery From Others and Part Two - Empioyers' Liability Insurance H. Recovery From Others are amended by adding the following: We will not enforce our right to recover against persons or organizations, (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) PREMIUM CHARGE - Refer to the Schedule of Operations The charge will be an amount to which you and we agree that is a percentage of the total standard premium for California exposure. The amount is 2%. 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 Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below, Porm No: G-19160-B 111-19971 Policy No: WC 2 74978630 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 10/01/2023 Endorsement No: 6; Page: 1 of 1 POlicy Page: 53 of 83 Underwriting Company: Valley Forge Insurance Company, 151 N Franklin St, Chicago, IL 60606 1) Copyright CNA All Rights Reserved.... P526INI28I912 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. i Notice of Cancellation or Material Change — Designated Person or Organization This endorsement modifies insurance provided under the following: Business Auto Coverage Form .In the event of cancellation or material change that reduces or restricts the insurance afforded by this Coverage Part, we agree to mail prior written notice of cancellation or material change to: SCHEDULE rl. Name: Any person or organization you are required by written contract or agreement to mail prior I written notice of cancellation or material change. 2. Address; Per Certificates of Insurance on fi►e with the broker, 3. Number of days advance notice: For non-payment of premium, the greater of: • the number of days required by state statute or • the number of days required by written contract For any other reason, the lesser of; • 60 days or • the number of days required in a written contract This endorsement Is part of your policy and takes effect on the effective date of your policy, unless another effective date Is shown below. Must Be Completed ENDT. N0. POLICY NO, 19 BUA 2074978692 civ�► IEAIM196618 Complete Only When This Endorsement Is Not Prepared With the Polic Or Is Not to be Effective with the Polic ISSUED TO: EFFECTIVE DATE OF THIS Granite Construction Incorporated ENDORSEMENT 10/01 /2023 G-39543A N r t 04 ., 1 ENDORSEMENTTHIS POLICY, TRANSFERWAIVER OF OF RIGHTS OF RECOVERY AGAINST O US (WAIVER SUBROGATION) 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: Granite Construction Incorporated Endorsement Effective Date: 10/01/2023 SCHEDULE Names) Of Persons) 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. Information required to complete this Schedule, if not s The Transfer Of Rights Of Recovery Against Others To Us condition does not app►y 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. will be shown in the Declarations. cv W CA04441013 Copyright, Insurance Services Office, Inc., 2011 Page 1 of 1 rszauuzx�wz CNA71527XX (Ed. 10/12) Any person or organizatian whom the named insured is required by written contract to add as an additional insured on this policy. 1. In conformance with paragraph A.i.c. of Who Is An Insured of Section II -LIABILITY COVERAGE, the person or organization scheduled above is an insured under this policy. 2. The insurance afforded to the additional insured under this policy will apply on a primary and non-contributory basis if you have committed it to be so in a written contract or written agreement executed prior to the date of the "accident" for which the additional insured seeks coverage under this policy, All other terms and conditions of the Policy remain unchanged. CNA71527XX (10/12) Page 1 of 1 Insured Name: Granite Construction Incorporated Copyright CNA All Rights Reserved. Policy No; Endorsement No: Effective Date: BUA2074978692 10/01 /2023 w w 0 h W Nszcawzs(N)z G 15115-A (Ed. 10/89) POLICY NUMBER: GL2074978689 EFFECTIVE: 10/01 /2023 1' ± This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART In the event of cancellation or material change that reduces or restricts the insurance afforded by this Coverage Part (other than the reduction of aggregate limits through payment of claims), we agree to mail prior written notice of can- cellation or material change to: SCHEDULE_ 1. Name: Any person or organization you are required by written contract or agreement to mail prior written notice of cancellation or material change. 2. Address; Per Certificates of Insurance on file with the broker. 3. Number of days advance notice: For non-payment of premium, the greater of: • the number of days required by state statute or • the number of days required by written contract For any other reason, the lesser of: • 60 days or • the number of days required in a written contract G-15115-A (Ed. 10/89) Page 1 of 1 m w 0 )5261M28002 This endorsement modifies insurance provided under the following: Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, The Transfer Of Rights Of Recovery Against Others To Us Condition is amended by the addition of the following: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of: 1. Your ongoing operations; or 2. "Your work" included in the "products completed operations hazard." However, this waiver applies only when you have agreed in writing to waive such rights of recovery in a contract or agreement, and only if the contract or agreement: 1. Is in effector becomes effective during the term of this policy; and 2. Was executed prior to loss. This endorsement is part of your policy and takes effect on the effective date of your policy, unless another effective date is shown below. Must Be Completed ENDT, NO, POLICY NO. 26 G L 2074978689 Complete Only When This Endorsement Is Not Prepared with the Polic Or Is Not to be Effective with the Polic ISSUED TO: EFFECTIVE DATE OF THIS ENDORSEMENT: Granite Construction Incorporated 10/01/23