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HomeMy WebLinkAboutLetter of Transmittal LETTER OF TRANSMITTAL PAPE & SONS CONSTRUCTION, INC. 9401 BUJACICH ROAD,STE 1A GIG HARBOR,WA 98332 253-851-6040 fax 253-851-3290 TO: City of Bremerton ATTN: Noreen Bolo 345 6th Street, Suite 100 DATE: 7/9/2021 Bremerton, WA 98337 JOB NO. #826 RE: Marine Drive Water Main Replacement WE ARE SENDING TO YOU THE FOLLOWING: COPIES DATE NO. DESCRIPTION 1 Certificate of Insurance 1 Payment &Performance Bond COMMENTS: Please date & sign the Payment &Performance Bonds. Once complete please mail or email a copy to Melissa Mishko @ Pape &Sons Construction. ( Melissam@papeinc.com). This documentation is needed for our bonding company. Thank you!! COPY TO. File SIGNED: MCLI,SSGI MI,S120 ACo® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `...•/ 07/08/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Danielle Bryant HENTSCHELL&ASSOC INC PHONE (253)272-1151 FAx 1436 S.Union Ave. (A/C, MA No,Ext): (A/C,No): (253)272-1225 ADDRESS: danielleb@hentscheII.COm INSURER(S)AFFORDING COVERAGE NAIC# Tacoma WA 98405-1925 INSURERA: Phoenix Insurance Company 25623 INSURED INSURER B: The Travelers Indemnity Co. 25658 Pape&Sons Construction,Inc. INSURER C: Travelers Prop Cas Co of Amer 25674 9401 Bujacich Road INSURER D: Suite 1A INSURER E: Gig Harbor WA 98332 INSURER F: COVERAGES CERTIFICATE NUMBER: 20/21 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 AUUL SUI3H LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/POLICYD/ POLICY EXP ( ) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ 300,000 MED EXP(Any one person) $ 10,000 A Y Y DTCOOJ154095PHX20 12/31/2020 12/31/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X PROT LOC 00 PRODUCTS-COMP/OPAGG $ 2 00 JEC , 00, OTHER: WAStopgap/Empl Liab $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED Y Y BA1L6589552026G 12/31/2020 12/31/2021 BODILYINJURY(Per $ AUTOS ONLY X AUTOS ( ) HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY X AUTOS ONLY (Per accident) $ Incl.Hired&Non-Owned $ 1,000,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 C EXCESS LIAB CLAIMS-MADE Y Y CUP0J4039462026 12/31/2020 12/31/2021 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA WASHINGTON STATE FUND (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Installation Floater A DTCOOJ154095PHX20 12/31/2020 12/31/2021 90,000 Limit 1,000,Deductible DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project:Bremerton Marine Dr.Water Main Replacement Blanket Primary Non-Contributory Additional Insured,including completed operations and Blanket Waiver of Subrogation applies in favor of any person or organization if called for by written contract or agreement,per policy forms and conditions;#CGD246 08/05,CGD316 11/11,CGD211 01/04,CAT353 02/15- City of Bremerton,its officials,employees,agents and volunteers are all included as additional insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Bremerton ACCORDANCE WITH THE POLICY PROVISIONS. 345-6th Street AUTHORIZED REPRESENTATIVE Suite 100 Bremerton WA 98337 ., "------ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART I. WHO IS AN INSURED—(Section II)is amended c) The insurance provided to the additional in- to Include any person or organization that you sured does not apply to 'bodily Injury" or agree in a "written contract requiring Insurance" "property damage" caused by "your work" to include as an additional Insured on this Cover- and included in the 'products-completed op- age Part, but: erations hazard" unless the "written contract a) Only with respect to liability for"bodily injury", requiring insurance" specifically requires you "property damage"or"personal injury";and to provide such coverage for that additional insured, and then the insurance provided to b) If, and only to the extent that, the Injury or the additional insured applies only to such damage is caused by acts or omissions of "bodily injury" or "property damage" that oc- you or your subcontractor in the performance curs before the end of the period of time for of "your work" to which the "written contract which the "written contract requiring insur- requiring insurance" applies. The person or ance" requires you to provide such coverage organization does not qualify as an additional or the end of the policy period, whichever is insured with respect to the Independent acts earlier. or omissions of such person or organization. 3. The insurance provided to the additional insured 2. The insurance provided to the additional insured by this endorsement is excess over any valid and by this endorsement is limited as follows: collectible "other insurance", whether primary, a) In the event that the Limits of Insurance of excess, contingent or on any other basis, that is this Coverage Part shown in the Declarations available to the additional insured for a loss we exceed the limits of liability required by the cover under this endorsement. However, if the "written contract requiring insurance", the in- "written contract requiring insurance" specifically surance provided to the additional insured requires that this insurance apply on a primary shall be limited to the limits of liability re- basis or a primary and non-contributory basis, quired by that "written contract requiring in- this insurance is primary to "other Insurance' surance". This endorsement shall not in- available to the additional insured which covers crease the limits of insurance described in that person or organization as a named insured Section III—Limits Of Insurance. for such loss, and we will not share with that b) The insurance provided to the additional in- "other Insurance". But the insurance provided to sured not apply "bodily injury",dithe additional insured by this endorsement still Is "prop- excess over any valid and collectible "other m- erly damage" or "personal injury" arising out surance", whether primary, excess, contingent or of the rendering of, or failure to render, any on any other basis, that is available to the addi- professional architectural, engineering or sur- tional insured when that person or organization is veying services, Including: an additional insured under such "other insure I. The preparing, approving, or failing to ance". prepare or approve, maps, shop draw- 4. As a condition of coverage provided to the ings, opinions, reports, surveys, field or- additional insured by this endorsement: ders or change orders, or the preparing, approving, or failing to prepare or ap- a) The additional insured must give us written prove,drawings and specifications;and notice as soon as practicable of an "occur- rence"ii. Supervisory, inspection, architectural or or an offense which may result in a engineering activities. claim. To the extent possible, such notice 9 g should include: CG D2 46 08 05 0 2005 The St. Paul Travelers Companies,Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY f. How, when and where the "occurrence" any provider of"other insurance"which would or offense took place; cover the additional Insured for a loss we ii. The names and addresses of any injured cover under this endorsement. However, this persons and witnesses;and condition does not affect whether the insur= ance provided to the additional insured by Ili. The nature and location of any injury or this endorsement is primary to "other insur- damage arising out of the"occurrence"or ance" available to the additional insured offense. which covers that person or organization as a b) If a claim is made or"suit"is brought against named insured as described In paragraph 3. the additional insured, the additional insured above. must: 5. The following definition is added to SECTION V. i. immediately record the specifics of the DEFINITIONS; claim or"suit"and the date received;and "Written contract requiring insurance" means II. Notify us as soon as practicable. that part of any written contract or agreement The additional insured must see to it that we under which you are required to include a receive written notice of the claim or"suit"as Person or organization as an additional in- soon as practicable. sured on this Coverage Part, provided that the"bodily injury"and "property damage" cc- c) The additional Insured must immediately curs and the"personal injury"is caused by an send us copies of all legal papers received in offense committed: connection with the claim or"suit", cooperate a. After the signing and execution of the with us in the investigation or settlement of the claim or defense against the "suit", and contract or agreement by you; otherwise comply with all policy conditions. b. While that part of the contract or d) The additional insured must tender the de- agreement is in effect;and fense and indemnity of any claim or"suit"to c. Before the end of the policy period. Page 2 of 2 ©2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (includes Products-Completed Operations If Required By Contract) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS (1) Any "bodily injury', "property damage" or The following is added to SECTION I! —WHO IS AN "personal injury" arising out of the providing, INSURED: or failure to provide, any professional Any person or organization that you agree in a architectural, engineering or surveying written contract or agreement. to include as an services, including: additional insured on this Coverage Part is an (a) The preparing, approving, or failing to insured, but only. prepare or approve, maps, shop a. With respect to liability for "bodily injury" or drawings, opinions, reports, surveys, "property damage" that occurs, or for "personal field orders or change orders, or the injury' caused by an offense that is committed, preparing, approving, or failing to subsequent to the signing of that contract or prepare or approve, drawings and agreement and while that part of the contract or specifications; and agreement is in effect; and b. If, and onlyto the extent that, such injury or (b) Supervisory, inspection, architectural or engineering activities. damage is caused by acts or omissions of you or your subcontractor in the performance of "your (2) Any "bodily injury" or "property damage" work" to which the written contract or agreement caused by "your work" and included in the applies. Such person or organization does not "products-completed operations hazard" qualify as an additional insured with respect to unless the written contract or agreement the independent acts or, omissions of such specifically requires you to provide such person or organization. coverage for that additional insured during The insurance provided to such additional insured is the policy period. subject to the following provisions: c. The additional insured must comply with the a. If the Limits of Insurance of this Coverage Part following duties: shown in the Declarations exceed the minimum limits required by the written contract or (1) Give us written notice as soon as practicable agreement, the insurance provided' to the of an "occurrence" or an offense which may additional insured will be limited to such result in a claim. To the extent possible,such minimum required limits. For the purposes of notice should include: determining whether this limitation applies, the (a) How, when and where the "occurrence" minimum limits required by the written contract or or offense took place; agreement will be considered to include the minimum limits of any Umbrella or Excess (b) The names and addresses of any injured liability coverage required for the additional persons and witnesses;and insured by that written contract or agreement. (c) The nature and location of any injury or This provision will not increase the limits of insurance described in Section ill — Limits Of damage arising out of the "occurrence" Insurance, or offense. b. The insurance provided to such additional (2) If a claim is made or"suit" is brought against insured does not apply to: the additional insured: CG D2 46 0419 et 2018 The Travelers Indemnity Company.All rights reserved. Page 1 of 2 COMMERCIAL GENERAL LIABILITY (a) Immediately record the specifics of the (4) Tender the defense and indemnity of any claim or"suit"and the date received; and claim or "suit" to any provider of other (b) Notify us as soon as practicable and see insurance which would cover such additional to it that we receive written notice of the insured for a loss we cover, However, this claim or"suit"as soon as practicable, condition does not affect whether the (3) Immediately send us copies of all legal insurance provided to such additional insured is primary to other insurance papers received in connection with the claim or "suit", cooperate with us in the available to such additional insured which investigation or settlement of the claim or covers that person or organization as a defense against the "suiC', and otherwise named insured as described in Paragraph 4., Other Insurance, of Section IV—Commercial comply with all policy conditions. General Liability Conditions. ii immtamiNhu MEM Minmemo inommanliml MOM N= r-- m rr� G� -^— Page 2 of 2 ©2018 The Travelers Indemnity Company.All rights reserved. CG D2 46 04 19 010728 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS XTEND ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE—This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses dpsr-.ribed in any of the provisions of this endorsement may be excluded or • limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to vI the extent that coverage is excluded or limited by such an endorsement.The following listing Is a general cover- age description only. Limitations and exclusions may apply to these coverages.Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and Is not covered. M. 'L A. Aircraft Chartered With Pilot H. Blanket Additional insured — Lessors Of Leased Equipment B. Damage To Premises Rented To You C. Increased Supplementary Payments I. Blanket Additional Insured — States Or Political D. Incidental Medical Malpractice Subdivisions—Permits �, E. Who Is An Insured —Newly Acquired Or Formed J. Knowledge And Notice Of Occurrence Or Offense .t Organizations K. Unintentional Omission ftop F. Who Is An Insured— Broadened Named Insured L Blanket Waiver Of Subrogation —Unnamed Subsidiaries M. Amended Bodily Injury Definition ,r,, G. Blanket Additional Insured — Owners, Managers N. Contractual Liability—Railroads ``4 Or Lessors Of Premises • ZPROVISIONS INJURY AND PROPERTY DAMAGE LI- A. AIRCRAFT CHARTERED WITH PILOT ABILITY: MThe following Is added to Exclusion g., Aircraft, Exclusions c. and g. through n. do not apply ,c Auto Or Watercraft,In Paragraph 2.of SECTION to "premises damage". Exclusion f.(1)(a) I — COVERAGES — COVERAGE A BODILY IN- does not apply to "premises damage"caused Z JURY AND PROPERTY DAMAGE LIABILITY: by: `ct ` This exclusion does not apply to an aircraft that a. Fire; .4 is: b. Explosion; "S, (a) Chartered with a pilot to any insured; c. Lightning; �`�„ (b) Not owned by any insured;and d. Smoke resulting from such fire,explosion, a (c) Not being used to carry any person or prop- or lightning;or q arty for a charge. e. Water; T` B. DAMAGE TO PREMISES RENTED TO YOU unless Exclusion f.of Section I—Coverage A O —Bodily Injury And Property Damage Liability C..) 1. The first paragraph of the exceptions In Ex- elusion j., Damage To Property, in Para is replaced by another endorsement to this Para- graph 2. of SECTION I — COVERAGES — Coverage Part that has Exclusion—All Pollu- COVERAGE A BODILY INJURY AND ton Injury Or Damage or Total Pollution Ex- PROPERTY DAMAGE LIABILITY is deleted. elusion in its title. 2. The following replaces the last paragraph of A separate limit of insurance applies to Paragraph 2., Exclusions, of SECTION I — "premises damage" es described in Para- COVERAGES — COVERAGE A. BODILY graph 6. of SECTION III — LIMITS OF IN- SURANCE. CG D316 11 11 c 2011 The Travelers Indemnity Company.All rights reserved. Page 1 of 6 COMMERCIAL GENERAL LIABILITY 3. The following replaces Paragraph 6. of SEC- C. INCREASED SUPPLEMENTARY PAYMENTS TION IIi—LIMITS OF INSURANCE: 1. The following replaces Paragraph 1.b. of Subject to 5. above, the Damage To Pram- SUPPLEMENTARY PAYMENTS — COVER- ises Rented To You Limit is the most we will AGES A AND 8 of SECTION I — COVER- pay under Coverage A for damages because AGE: of"premises damage" to any one premises. b. Up to $2,500 for the cost of bail bonds The Damage To Premises Rented To You required because of accidents or traffic Limit will apply to all "property damage" law violations arising out of the use of any proximately caused by the same "occur- vehicle to which the Bodily Injury Liability rence", whether such damage results from: Coverage applies. We do not have to fur- fire; explosion;lightning;smoke resulting from nish these bonds. g. such fire, explosion, or lightning; or water; or C 2. The following any combination of any of these causes. g replaces Paragraph 1.d. of SUPPLEMENTARY PAYMENTS — COVER- iw The Damage To Premises Rented To You AGES A AND B of SECTION I — COVER- Limit will be: AGES: ''''.4 a. The amount shown for the Damage To d. All reasonable expenses incurred by the L; Premises Rented To You Limit on the insured at our request to assist us In the Declarations of this Coverage Part;or investigation or defense of the claim or 1 b. $300,000 if no amount is shown for the "suit", including actual loss of earnings up E Damage To Premises Rented To You to $500 a day because of time off from Limit on the Declarations of this Coverage work. Part D. INCIDENTAL MEDICAL MALPRACTICE r„ 4. The following replaces Paragraph a. of the 1. The following is added to the definition of"cc- definition of"insured contract"In the DEFINI- currence"in the DEFINITIONS Section: TIONS Section: a. A contract for a lease of premises_ How- "Occurrence"also means an act or omission ~`�' ever, that portion of the contract foracommitted in providing or failing to provide "incidental medical services", first aid or . lease of premises that indemnifies any "Good Samaritan services"to a person or organization for "premises person. damage"is not an Insured contract"; t 2. The following is added to Paragraph 2.a.(1)of a 5. The following is added to the DEFINITIONS SECTION II—WHO IS AN INSURED: Section: Paragraph (1)(d) above does not apply to ' "Premises damage" means "property dam- "bodily injury" arising out of providing or fail- " ing to provide: age to: Any (I) "incidental medical services" by any of ,r a. 4,- premises while rented to you or tern- your "employees" who is a nurse practi- k*t4. porarily occupied by you with permission boner,registered nurse,licensed practical of the owner;or '' nurse, nurse assistant, emergency medi- a b. The contents of 'ei any premises while such cal technician or paramedic;or :1 premises is rented to you,if you rent such premises for a period of seven or fewer (II) Fast aid or"Good Samaritan serrates"by consecutive days. any of your "employees" or "volunteer 6. The following replaces Paragraph 4.b.(1)(b) unteer workers", other than en employed or vol- of SECTION P/—COMMERCIAL GENERAL "volunteerdoctor. Any such "employees"of failing tor o LIABILITY CONDITIONS: workers' providing or to provide first aid or"Good Samaritan ser- (b) That is insurance for"premises damage"; vices"during their work hours for you will or be deemed to be acting within the scope T. Paragraph 4.b.(1)(c) of SECTION IV — of their employment by you or performing COMMERCIAL GENERAL LIABILITY CON- duties related to the conduct of your busi- DITIONS is deleted. ness. Page 2 of 6 ©2011 The Travelers Indemnity Company.All rights reserved. CG D3 16 11 11 COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 5. of 4. Any organization you newly acquire or form, SECTION IIi—LIMITS OF INSURANCE: other than a partnership,joint venture or Ilm- For the purposes of determining the appiica- ited liability company, of which you are the ble Each Occurrence Limit, all related acts or sole owner or in which you maintain the ma- omissions committed in providing or failing to jority ownership interest, will qualify as a provide "Incidental medical services", first aid Named insured if there is no other insurance or"Good Samaritan services°to any one per- which provides similar coverage to that or- son will be deemed to be one"occurrence". ganizatlon.However. 4. The following exclusion is added to Para- a. Coverage under this provision is afforded graph 2., Exclusions, of SECTION I —COV- only: ERAGES—COVERAGE A BODILY INJURY (1) Until the 180th day after you acquire or AND PROPERTY DAMAGE LIABILITY: form the organization or the end of the cc Sale Of Pharmaceuticals policy period, whichever Is earlier, if you col "Bodily Injury" or 'property damage" arising do not report such organization in writing out of the willful violation of a penal statute or to us within 180 days after you acquire or "V ordinance relating to the sale of pharmaceutl- form It;or cals committed by, or with the knowledge orCc (2) Until the end of the policy period, when IZI consent of, the Insured. that date is later than 180 days after you 5. The following is added to the DEFINITIONS acquire or form such organization, if you Section: report such organization in writing to us "Incidental medical services"means: within 180 days after you acquire or form -g a. Medical,surgical,dental,laboratory,x-ray It, and we agree in writing that it will con- 0 or nursing service or treatment, advice or tinue to be a Named insured until the end `*-) instruction, or the related furnishing of of the policy period; • food or beverages;or b. Coverage A does not apply to "bodily injury" ti b. The furnishing or dispensing of drugs or or "property damage" that occurred before medical, dental, or surgical supplies or you acquired or formed the organization;and ' appliances. c, Coverage B does not apply to "personal in- "Good Samaritan services" means any emer- jury" or "advertising injury" arising out of an gency medical services for which no compen- offense committed before you acquired or d sation is demanded or received. formed the organization. eto 4.1 6. The following is added to Paragraph 4.b., Ex- F. WHO IS AN INSURED—BROADENED NAMED e case Insurance, of SECTION iV — COM- INSURED—UNNAMED SUBSIDIARIES © MERCIAL GENERAL LtAB1UTY CONDI- TIONS: The following is added to SECTION II—WHO IS The insurance is excess over any valid and AN INSURED: collectible other insurance available to the in- Any of your subsidiaries,other than a partnership, sured,whether primary,excess, contingent or joint venture or limited liability company, that is on any other basis,that is available to any of not shown as a Named Insured in the Declare- a your "employees" or "volunteer workers" for bons is a Named Insured If you maintain an own- "bodily injury" that arises out of providing or ership Interest of more than 50% In such subsidi- failing to provide "incidental medical ser- ary on the first day of the policy period. oc g vices", first aid or"Good Samaritan services" No such subsidiary is an insured for"bodily injury' to any person to the extent not subject to or"property damage" that occurred, or "personal Paragraph 2.a.('t} of Section II — Who Is An Injury" or "advertising injury" caused by an of- Insured. fense committed after the date, If any, during the E. WHO IS AN INSURED — NEWLY ACQUIRED policy period, that you no longer maintain an OR FORMED ORGANIZATIONS ownership interest of more than 50%In such sub- The following replaces Paragraph 4. of SECTION sidlary. II—WHO IS AN INSURED: CG D31611 11 0 2011 The Travelers Indemnity Company.All rights reserved. Page 3 of 6 COMMERCIAL GENERAL LIABILITY G. BLANKET ADDITIONAL INSURED—OWNERS, H. BLANKET ADDITIONAL INSURED—LESSORS MANAGERS OR LESSORS OF PREMISES OF LEASED EQUIPMENT The following is added to SECTION II —WHO IS The following Is added to SECTION II—WHO IS AN INSURED: AN INSURED: Any person or organization that is a premises Any person or organization that is an equipment owner, manager or lessor and that you have lessor and that you have agreed In a written con- agreed in a written contract or agreement to in- tract or agreement to include as an insured on dude as an additional insured on this Coverage this Coverage Part is an insured, but only with re- Part is an insured, but only with respect to liability spect to liabilityfor"bodilyinjury", for "bodily injury', "property damage", "personal "advertising� J rti, "property tdhat: injury"or'advertising in'u °that age", "personal injury"or injury"that: g• J ry ta. Is "bodily injury" or "property damage" that a. Is "bodily injury" or "property damage" that se occurs, or is "personal injury" or "advertising occurs, or is "personal Injury" or"advertising injury" caused by an offense that is commit- injury" caused by an offense that is cornmit- t ted, subsequent to the execution of that con- ted, subsequent to the execution of that con- '. tract or agreement;and tract or agreement;and t b. Arises out of the ownership, maintenance or b. Is caused, in whole or in part, by your acts or e> omissions in the maintenance, operation or youof that part of any premises leased to use of equipment leased to you by such equipment lessor. O The Insurance provided to such premises owner, The insurance provided to such manager or lessor is subject to the following pro- equipment lessor �t visions: is subject to the following provisions: C a. The limits of insurance provided to such a. The limits of insurance provided to such 'as premises owner, manager or lessor will be equipment lessor will be the minimum limits '4 the minimum limits which you agreed to pro- which you agreed to provide in the written vide in the written contract or agreement, or 4 contract or agreement, or the limas shown on the limits shown on the Declarations, which- the Declarations,whichever are less. ever are less. b. The insurance provided to such equipment © b. The Insurance lessor does not apply to any"bodily injury"or tai provided to such premises "property damage" that occurs, or "personal owner,manager or lessor does not apply to: to injury"or"advertising injury"caused by an of- a (1) Any "bodily injury" or "property damage" fense that is committed, after the equipment that occurs, or"personal injury'or"adver- lease expires. tising Injury"caused by an offense that is c. The Insurance provided to such equipment ise committed, after you cease to be a tenant lessor Is excess over any valid and collectible in that premises;or other insurance available to such equipment et (2) Structural alterations, new construction or lessor, whether primary, excess, contingent demolition operations performed by or on or on any other basis, unless you have behalf of such premises owner, lessor or agreed in the written contract or agreement te manager. that this insurance must be primary to, or C' c. The insurance provided to such premises non-contributory with, such other insurance, Cz owner, manager or lessor is excess over any in which case this insurance will be primary C valid and collectible other insurance available to, and non-contributory with, such other in- to such premises owner, manager or lessor, surance. whether primary, excess, contingent or on I. BLANKET ADDITIONAL INSURED — STATES any other basis, unless you have agreed in OR POLITICAL SUBDIVISIONS—PERMITS the written contract or agreement that this in- surance must be primary to, or non- The following Is added to SECTION II —WHO IS contributory with, such other insurance, in AN INSURED: which case this insurance will be primary to, Any state or political subdivision that has issued a and non-contributory with, such other insur- permit in connection with operations performed by ance. you or on your behalf and that you are required Page 4 of 6 0 2011 The Travelers Indemnity company.All rights reserved, CG D3 1611 11 COMMERCIAL GENERAL LIABILITY by any ordinance, law or building code to include (ii) A manager of any limited liability as an additional insured on this Coverage Part is company;or an insured, but only with respect to liability for (lii)An executive officer or director of "bodily injury", "property damage", "personal in- any other organization; jury"or"advertising injury"arising out of such op- erations. that Is your partner, joint venture member or manager;or The insurance provided to such state or political (b} My "employee" authorized by such subdivision does not apply to: partnership,p, joint venture, limited li- e. Any "bodily injury," "property damage," "per- ability company or other organization sonai injury"or"advertising injury"arising out to give notice of an "occurrence" or of operations performed for that state or po- offense. Qlitical subdivision;or (0) Notice to us of such"occurrence"or of an b. Any "bodily injury" or "property damage" in- offense will be deemed to be given as eluded in the"products-completed operations soon as practicable if it is given in good ..4 hazard". faith as soon as practicable to your work Dle J. KNOWLEDGE AND NOTICE OF OCCUR- ers' compensation insurer. This applies RENCE OR OFFENSE only If you subsequently give notice to us The following is added to Paragraph 2., Duties in °f the"occurrence"or offense as soon as practicable after any of the persons de- The Event of Occurrence, Offense, Claim or scribed In Paragraphs e. (1)or(2) above Suit, of SECTION iV — COMMERCIAL GEN- scribed that the"occurrence"or offense �'`'s ERAL LIABILITY CONDITIONS: $. The following provisions apply to Paragraph may result in sums to which the insurance s for a provided under this Coverage Part may rposes of the in- apply. -4 a. above, but onlY the psurance provided under this Coverage Part to However, if this Coverage �,, you or any insured listed in Paragraph 1.or 2. Part includes an en - you of Section II—Who Is An Insured: dorsement that provides limited coverage for (1) Notice to us of such "occurrence" or of- "bodily injury" or "property damage" or pollution fense must be given as soon as practice- costs arising out of a discharge, release or es- 4 cape of"pollutants"which contains a requirement Mr ble only after the"occurrence"ar offense that the discharge, release or escape of "pollut- et is known by you(if you are an individual), ants' must be reported to us within a specific any of your partners or members who Is number of days after its abrupt commencement, an individual (if you are a partnership or this Paragraph e. does not affect that require- joint venture), any of your managers who ment. C., is an individual(if you are a limited liability --s company), any of your "executive offs- K. UNINTENTIONAL OMISSION cars"or directors (if you are an organize- The following is added to Paragraph 6., Repro- -a lion other than a partnership,joint venture sentations, of SECTION iV — COMMERCIAL sti Ittl or limited liability company) or any "em- GENERAL LIABILITY CONDITIONS: * ployee" authorized by you to give notice The unintentional omission of, or unintentional of an "occurrence"or offense. error in, any infonnadjon provided by you which k (2) if you are a partnership, joint venture or we relied upon in issuing this policy will not preju- ct limited liability company,and none of your dice your rights under this insurance. However, partners, joint venture members or man- this provision does not affect our right to collect agers are individuals, notice to us of such additional premium or to exercise our rights of "occurrence"or offense must be given as cancellation or nonrenewai in accordance with soon as practicable only after the "occur- applicable insurance laws or regulations. rence"or offense is known by: L. BLANKET WAIVER OF SUBROGATION (a) Any individual who Is: The following is added to Paragraph 6., Transfer (I) A partner or member of any part- Of Rights Of Recovery Against Others To Us, nership or joint venture; of SECTION IV—COMMERCIAL GENERAL Li- ABILFTY CONDITIONS: CO D3 1611 11 (2011 The Travelers Indemnity Company.All rights reserved, Page 5 of 6 COMMERCIAL GENERAL LIABILITY If the insured has agreed in a contract or agree- 3. "Bodily injury" means bodily injury, mental ment to waive that insured's right of recovery anguish, mental injury,shock,fright,disability, against any person or organization, we waive our humiliation, sickness or disease sustained by right of recovery against such person or organize- a person, including death resulting from any lion,but only for payments we make because of: of these at any time. a. "Bodily injury" or "property damage" that oc- N, CONTRACTUAL LIABILITY—RAILROADS curs;or 1. The following replaces Paragraph c. of the b. Personal Injury" or "advertising injury" definition of"insured contract"in the DEFINI- caused by an offense that Is committed; TIONS Section: subsequent to the execution of that contract or c. Any easement or license agreement; , agreement. 2. Paragraph tell of the definition of "insured r,5 M. AMENDED BODILY INJURY DEFINITION contract" in the DEFINITIONS Section is de- The following replaces the definition of "bodily lam' injury"in the DEFINITIONS Section: .41 I tt 41 Cy Page 6 of 6 @ 2011 The Travelers Indemnity Company.All rights reserved. CG 03 16 11 11 COMMERCIAL GENERAL LIABILITY POLICY NUMBER; ISSUE DATE; - - THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY DESIGNATED PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Project Designated Project(s): General Aggregate(s): A. For all sums which the insured becomes legally 3. Any payments made under COVERAGE A. obligated to pay as damages caused by "occur- for damages or under COVERAGE C. for rences" under COVERAGE A. (SECTION I), and medical expenses shall reduce the Desig- for all medical expenses caused by accidents un- nated Project General Aggregate Limit for der COVERAGE C (SECTION I), which can be that designated "project". Such payments attributed only to operations at a single desig- shall not reduce the General Aggregate Limit nated"project"shown in the Schedule above: shown in the Declarations nor shall they re- 1. A separate Designated Project General Ag- duce any other Designated Project General gregate Limit applies to each designated"pro- Aggregate Limit for any other designated jeer, and that limit is equal to the amount of "project'shown in the Schedule above. the General Aggregate Limit shown in the 4. The limits shown in the Declarations for Each Declarations, unless separate Designated Occurrence, Damage To Premises Rented Project General Aggregate(s) are ached- To You and Medical Expense continue to uled above. apply. However, instead of being subject to 2. The Designated Project General Aggregate the General Aggregate Limit shown in the Limit is the most we will pay for the sum of all Declarations, such limits will be subject to the damages under COVERAGE A., except applicable Designated Project General Ag- damages because of"bodily injury" or "prop- gregate Limit. erty damage" included in the "products- E. For all sums which the Insured becomes legally completed operations hazard", and for medi- obligated to pay as damages caused by "occur- cal expenses under COVERAGE C, regard- rences" under COVERAGE A. (SECTION I), and less of the number of: for all medical expenses caused by accidents un- a. Insureds; der COVERAGE C. (SECTION I), which cannot suits brought;or be attributed only to operations at a single desig- b. Claims made or "suits" nated project' shown in the Schedule above: c. Persons or organizations making claims or bringing"suits" CG D211 01 04 Copyright,The Travelers Indemnity Company, 2004 Page 1 of 2 COMMERCIAL GENERAL LIABILITY I. Any payments made under COVERAGE A. vided, any payments for damages because of for damages or under COVERAGE C. for "bodily injury or "property damage" included in medical expenses shall reduce the amount the "products-completed operations hazard" will available under the General Aggregate Limit reduce the Products-Completed Operations Ag- or the Products-Completed Operations Ag- gregate Limit, and not reduce the General Aggre- gregate Limit,whichever is applicable;and gate Limit nor the Designated Project General 2. Such payments shall not reduce any Desig- Aggregate Limit, nated Project General Aggregate Limit. E. For the purposes of this endorsement the [ finl- C. Part 2,of SECTION III LIMITS OF INSURANCE tiona Section is amended by the addition of the is deleted and replaced by the following: following definition: 2. The General Aggregate Limit is the most we "Project" means an area away from premises will pay for the sum of: owned by or rented to you at which you are per- forming operations pursuant to a contract or a. Damages under Coverage B;and agreement. For the purposes of determining the b. Damages from "occurrences" under applicable aggregate limit of insurance, each COVERAGE A (SECTION I) and for all "project" that includes premises involving the medical expenses caused by accidents same or connecting lots,or premises whose con- under COVERAGE C(SECTION I) which median is interrupted only by a street, roadway, cannot be attributed only to operations at waterway or right-of-way of a railroad shall be a single designated"project"shown in the considered a single"project". SCHEDULE above. F. The provisions of SECTION IN — LIMITS OF D. When coverage for liability arising out of the INSURANCE not otherwise modified by this en- "products-completed operations hazard" is pro- dorsement shall continue to apply as stipulated. Page 2 of 2 Copyright,The Travelers indemnity Company, 2004 CG D2 11 01 04 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ iT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT o This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE—This endorsement broadens coverage.However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or ry limited by another endorsement to the Coverage Part, and these coverage broadening previsions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- t age description only.Limitations and exclusions may apply to these coverages.Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties,and what is and is not covered. rs A. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE—LOSS OF o B. BLANKET ADDITIONAL INSURED USE—INCREASED LIMIT C. EMPLOYEE HIRED AUTO I. PHYSICAL DAMAGE TRANSPORTATION EXPENSES—INCREASED LIMIT D. EMPLOYEES AS INSURED J. PERSONAL PROPERTY E. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS K. AIRBAGS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR F. HIRED AUTO — LIMITED WORLDWIDE COV- LOSS ERAGE—INDEMNITY BASIS M. BLANKET WAIVER OF SUBROGATION G. WAIVER OF DEDUCTIBLE—GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS .° PROVISIONS E. A. BROAD FORM NAMED INSURED this insurance applies and only to the extent that The following Is added to Paragraph AA., Who Is person or organization qualifies as an "insured" An Insured,of SECTION 11—COVERED AUTOS under the Who is An Insured provision contained LIABILITY COVERAGE: in Section II. Any organization you newly acquire or form dur- C. EMPLOYEE HIRED AUTO ing the policy period over which you maintain 1. The following is added to Paragraph A.1., SO% or more ownership interest and that is not Who Is An Insured, of SECTION II — COV- a separately insured for Business Auto Coverage. EKED AUTOS LIABILITY COVERAGE: Coverage under this provision is afforded only un- An "employee" of yours is an Insured" while tit the 180th day after you acquire or form the or- operating an "auto" hired or rented under a ganization or the end of the policy period, which- contract or agreement in an "employee's" ever is earlier, name, with your permission,while performing duties related to the conduct of your bust- B. BLANKET ADDITIONAL INSURED ness. The following is added to Paragraph c. in A.1., 2. The following replaces Paragraph b. in B.5., Who Is An Insured, of SECTION II —COVERED Other Insurance, of SECTION IV — BUSI- AUTOS LIABILITY COVERAGE: NESS AUTO CONDITIONS: Any person or organization who is required under b. For Hired Auto Physical Damage Cover- a written contract or agreement between you and age,the following are deemed to be cov- that person or organization, that is signed and ered"autos"you own: executed by you before the "bodily injury" or (1) Any covered "auto" you lease, hire, "property damage" occurs and that is in effect rent or borrow; and during the policy period,to be named as an addi- (2) Any covered"auto"hired or rented by tional insured is an "insured" for Covered Autos your "employee" under a contract in Liability Coverage, but only for damages to which an "employee's" name, with your CA T3 53 E32 15 ©2015 The Travelers lndemnfty Company.All rights reserved. Page 1 of 4 includes copyrighted material of insurance Services Office,Inc,with Its permission. COMMERCIAL AUTO permission, while performing duties (a) With respect to any claim made or"sult" related to the conduct of your bus!- brought outside the United States of ness. America, the territories and possessions However, any "auto"that is leased, hired, of the United States of America, Puerto rented or borrowed with a driver is not a Rico and Canada: �' covered"auto o (I) You must arrange to defend the "1n- D. EMPLOYEES AS INSURED sured"against, and investigate or set- c The following is adco ded to Paragraph A.1.,Who Is tie any such claim or'suit" and keep c4, An Insured,of SECTION II—COVERED AUTOS us advised of all proceedings and ao- LIABILITY COVERAGE: tiers. Isi Any"employee"of yours is an"Insured"while us- (ii) Neither you nor any other involved r ing a covered"auto"you don't own, hire or borrow insured will make any settlement in your business or your personal affairs.iti without our coo nsent. g E. SUPPLEMENTARY PAYMENTS — INCREASED (11i)We may, at our discretion, participate LIMITS in defending the "insured" against, or © In the settlement of, any claim or `t 1. The following replaces Paragraph A.2.a.(2), "suit". of SECTION lII—COVERED AUTOS LIABIL- ,k. ITY COVERAGE: (1v)We will reimburse the "insured" for ,rq sums that the "insured" legally must (2) Up to $3,000 for cost of bail bonds (in- pay as damages because of "bodily ''-'4 eluding bonds for related traffic law viola- injury"or"property damage"to which tions) required because of an "accident" this insurance applies, that the "in- o we cover. We do not have to furnish sured" pays with our consent, but ly these bonds, only up to the limit described In Para- ❑ 2. The following replaces Paragraph A.2.a.(4), graph C., Limits Of Insurance, of .a of SECTION II—COVERED AUTOS LiABIL- SECTION Ii — COVERED AUTOS E !TY COVERAGE; LIABILITY COVERAGE. ca (4) All reasonable expenses incurred by the (v) We will reimburse the "insured" for .� "Insured" at our request, including actual the reasonable expenses Incurred w loss of earnings up to $500 a day be- with our consent for your Invesdiga- "eacause of time off from work, tion of such claims and your defense ❑ F. HIRED AUTO — LIMITED WORLDWIDE COV- Hof the "insured" against any such w "suit",urt but to and o ERAGE INDEMNITYonly up Included BASIS within h n the limit described In Pa -ra ❑ The following replaces Subparagraph (5)in Para- graph C., Limits Of insurance, of A graph B.7., Policy Period, Coverage Territory, SECTION II — COVERED AUTOS of SECTION IV — BUSINESS AUTO CONDI- LIABILITY COVERAGE, and not in TIONS: addition to such Ilmit. Our duty to (5) Anywhere in the world, except any country or make such payments ends when we jurisdiction while any trade sanction, aim have used up the applicable limit of barge, or similar regulation imposed by the insurance in payments for damages, United States of America applies to and pro- settlements or defense expenses. hibits the transaction of business with or (b) This insurance is excess over any valid within such country or jurisdiction, for Cov- and collectible other insurance available ered Autos Liability Coverage for any covered to the "insured' whether primary, excess, "auto" that you lease, hire, rent or borrow contingent or on any other basis. without a driver for a period of 30 days or less and that Is not an "auto"you lease, hire, rent (c) This insurance Is not a substitute for re- or borrow from any of your "employees", qulred or compulsory insurance in any country outside the United States, Its ter- partners (if you are a partnership), members (if you are a limited liability company) or ritories and possessions, Puerto Rico and Canada. members of their households. Page 2 of 4 c 2015 The Travelers Indemnity Company.All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office,Inc.with Its permission. COMMERCIAL AUTO You agree to maintain all required or (2) In or on your covered'auto". compulsory Insurance in any such coup- This coverage applies only In the event of a total try up to the minimum limits required by theft of your covered"auto". local law. Your failure to comply with No deductibles apply to this Personal Property compulsory insurance requirements will coverage. ,ra, not Invalidate the coverage afforded by © this policy,but we will only be liable to the K. AIRBAGS same extent we would have been liable The following is added to Paragraph B.3., Exclu" h had you complied with the compulsory in- lions, of SECTION III — PHYSICAL DAMAGE ©Q surance requirements. COVERAGE; z (d) It is understood that we are not an admit- Exclusion 3.a. does not apply to "loss" to one or Q ted or authorized insurer outside the more airbags in a covered"auto" you own that In- e United States of America, its territories flate due to a cause other than a cause of"loss" fi and possessions, Puerto Rico and Can- set forth in Paragraphs A.1.b. and A.tc., but o ada.We assume no responsibility for the only: as furnishing of certificates of insurance, or a. If that"auto"is a covered "auto"for Compre- e for compliance in any way with the laws hensive Coverage under this policy; o of other countries relating to insurance. b. The airbags are not covered under any war- •a G. WAIVER OF DEDUCTIBLE—GLASS ranty;and ce The following is added to Paragraph D., Deducti- c. The airbags were not intentionally Inflated. .- ble, of SECTION III — PHYSICAL DAMAGE We will pay up to a maximum of$1,000 for any , COVERAGE: one"loss". No deductible for a covered "auto" will apply to L. NOTICE AND KNOWLEDGE OF ACCIDENT OR aa c:� glass damage if the glass is repaired rather than LOSS o replaced. The following is added to Paragraph A.2.a., of t H. HiRED AUTO PHYSICAL DAMAGE—LOSS OF SECTION IV—BUSINESS AUTO CONDITIONS: .S. USE—INCREASED UMIT Your duty to give us or our authorized representa- E' The following replaces the Iasi sentence of Para- tive prompt notice of the "accident"or "loss" ap- re graph A.4.b., Loss Of Use Expenses, of SEC- plies only when the "accident" or"loss" Is known TION III—PHYSICAL DAMAGE COVERAGE: to: at However, the most we will pay for any expenses (a) You(if you are an individual); -ae for loss of use is $65 per day, to a maximum of (b) A partner(if you are a partnership); 't $750 for any one"accident". t (c) A member (if you are a limited liability corn- "'" I. PHYSICAL DAMAGE — TRANSPORTATION pang); EXPENSES—INCREASED UMIT (d) An executive officer, director or Insurance o The following replaces the first sentence in Pare- manager(if you are a corporation or other or- graph A.4.a., Transportation Expenses, of ganization);or SECTION Ili — PHYSICAL DAMAGE COVER- (e) Any"employee" authorized by you to give no- AGE: tice of the"accident"or"loss". We will pay up to $50 per day to a maximum of M. BLANKET WAIVER OF SUBROGATION $1,500 for temporary transportation expense in- The following replaces Paragraph A.5., Transfer curred by you because of the total theft of a coy- Of Rights Of Recovery Against Others To Us, ered "auto"of the private passenger type. of SECTION IV — BUSINESS AUTO CONDI- J. PERSONAL PROPERTY TIONS: The following is added to Paragraph A.4., Cover- 6. Transfer Of Rights Of Recovery Against age Extensions, of SECTION ill — PHYSICAL Others To Us DAMAGE COVERAGE: We waive any right of recovery we may have Personal Property against any person or organization to the ex- tent required of you by a written contract We will pay up to $400 for"loss" to wearing ap- signed and executed prior to any "accident' parel and other personal property which is: or"loss", provided that the"accident"or"loss" (1) Owned by an Insured";and arises out of operations contemplated by CA T3 63 02 15 ©2015 The Travelers Indemnity company.All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Orrice,Inc.With Its permission. COMMERCIAL AUTO such contract. The waiver applies only to the The unintentional omission of, or unintentional person or organization designated in such error In, any Information given by you shall not contract. prejudice your rights under this insurance. How- N. UNINTENTIONAL ERRORS OR OMISSIONS ever this provision does not affect our right to col- The following is added to Paragraph S.2., Con- lect additional premium or exercise our right of ceaimente Misrepresentation, Or Fraud, of cancellation or non-renewal. SECTION IV—BUSINESS AUTO CONDITIONS: 0 R ;LAC 5 *44 e fi Page 4 of 4 ©2015 The Travelers Indemnify Company.All rights reserved. CA T3 53 0215 Includes copyrighted materiel of Insurance Services Office,Inc.with Its permission. COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM PROVISIONS 2. The following is added to Paragraph B.5., Other 1. The following is added to Paragraph A.1.c., Who Insurance of SECTION IV — BUSINESS AUTO Is An Insured, of SECTION II — COVERED CONDITIONS: AUTOS LIABILITY COVERAGE: Regardless of the provisions of paragraph a. and This includes any person or organization who you paragraph d. of this part 5. Other Insurance,this are required under a written contract or insurance is primary to and non-contributory with agreement between you and that person or applicable other insurance under which an organization, that is signed by you before the additional insured person or organization is the "bodily injury" or "property damage" occurs and first named insured when the written contract or that is in effect during the policy period, to name agreement between you and that person or as an additional insured for Covered Autos organization, that is signed by you before the Liability Coverage, but only for damages to which "bodily injury" or "property damage" occurs and this insurance applies and only to the extent of that is in effect during the policy period, requires that person's or organization's liability for the this insurance to be primary and non-contributory. conduct of another"insured". Ofamma 0= oftrom— 'a- -1— �� of -rwr •-arm+ CA T4 74 02 16 02016 The Travelers Indemnity Company.All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office,Inc.with its permission. 008805 i 4 PERFORMANCE BOND Bond No. 2321652 KNOW ALL MEN BY THESE PRESENTS, That Pape&Sons Construction, Inc. as CONTRACTOR, and North American Specialty Insurance Company as Surety, are held and firmly bound unto City of Bremerton hereinafter called"OWNER,"in the sum of $2,018,002.35 dollars, for the payment of which sum, well and truly to be made, we bind ourselves, our heirs, executors, administrators,successors,and assigns,jointly and severally,firmly by these presents. THE CONDITIONS OF THIS OBLIGATION ARE SUCH,that said CONTRACTOR has been awarded and is about to enter into the annexed Agreement with said OWNER to perform the WORK as specified or indicated in the Contract Documents entitled "CITY OF BREMERTON, MARINE DRIVE WATER MAIN REPLACEMENT";now,therefore, In the event CONTRACTOR fails to timely or properly perform any of the requirements of the Contract Documents at the times and in the manner contained therein,the Surety shall be liable under this bond up to the amount of the bond for the full amount of the OWNERS's expenses to construct or repair all work ! as well as all loss,cost,expense or damage suffered by the OWNER in excess of the Contract amount due to the CONTRACTOR'S failure to comply with any contract or permit conditions or other applicable laws and regulations. The Surety agrees that within thirty(30)calendar days of receiving notice that the OWNER has declared a CONTRACTOR default and formally terminated the CONTRACTOR'S right to complete the Contract pursuant to its terms and conditions and that the CONTRACTOR has defaulted on all or part of the terms guaranteed by this bond,the Surety shall either: 1. Notify the OWNER in writing of its intent to cure the default itself within a reasonable period of time acceptable to the OWNER. The OWNER agrees to pay the balance of the Contract price to the Surety in accordance with the terms of the Contract,or 2. Tender to the OWNER the demanded sum,up to the amount of the bond. However,if the amount necessary for the OWNER to cure the default is less than the amount tendered, the OWNER will return,without interest,any overpayment to the Surety. PROVIDED,that any alterations in the WORK to be done or the materials to be furnished, or changes in the time of completion,which may be made pursuant to the terms of said Contract Documents,shall not in any way release said CONTRACTOR or said Surety hereunder, nor shall any extensions of time granted under the provisions of said Contract Documents,release either said CONTRACTOR or said Surety,and notice of such alterations or extensions of the Agreement is hereby waived by said Surety. CITY OF BREMERTON JUNE 2021 MARINE DRIVE WATER MAIN REPLACEMENT A-9 • The obligation of the Surety shall include reimbursing the City for all costs and expenses,(including,but not limited to fees and charges of engineers, architects,attorneys, and other professionals,and court costs if litigation is commenced)incurred by the OWNER in enforcing the provisions of this Bond. The CONTRACTOR hereby agrees that the CONTRACTOR'S obligation to perform the required work is not limited to the amount of funds held by the Surety.This bond is irrevocable and cannot be canceled by the Surety or the CONTRACTOR. This bond shall remain in full force and effect for a period of one(I)year following final acceptance of the project by the City, and until the bond is released in writing by the OWNER at the written request of the Surety or CONTRACTOR. ^ 4 IN WITNESS WHEREOF,we have hereunder set our hands and seals this .21:3l day of _,..,..A.A.A1,41( ,2021. (SEAL) (SEAL) Pape&Sons Construction, Inc. North American Specialty Insurance Company (CONTRACTOR) (Surety) B :CQ B (Signatjue and SEAL) SCAA l�.ti-c.. �G.P�- (Si ure and SEAL) Joanne Reinkensmeyer, Cb�pa/G�-Fe Set✓.eF& -j Attorney-in-Fact (SEAL AND NOTARIAL ACKNOWLEDGEMENT OF SURETY) AddressSuretyto which notices shall be sent: Swiss Re Corporate of all 450 Alaskan Way South, Suite 200 Seattle, WA 98104 Address of Surety for service of process: Hentschell&Associates, Inc. (Must be a physical address) 1436 S. Union Ave. Tacoma, WA 98405 CITY OF BREMERTON JUNE 2021 MARINE DRIVE WATER MAIN REPLACEMENT A-10 PAYMENT BOND Bond No. 2321652 KNOW ALL MEN BY THESE PRESENTS, That Pape&Sons Construction, Inc. as CONTRACTOR, And North American Specialty Insurance Company as Surety, are held and firmly bound unto City of Bremerton hereinafter called"OWNER," in the sum of $2,018,002.35 dollars, for the payment of which sum, well and truly to be made, we bind ourselves, our heirs, executors, administrators,successors,and assigns,jointly and severally,firmly by these presents. THE CONDITIONS OF THIS OBLIGATION ARE SUCH,that said CONTRACTOR has been awarded and is about to enter into the annexed CONTRACT with said OWNER to perform the WORK as specified or indicated in the Contract Documents entitled"CITY OF BREMERTON,MARINE DRIVE WATER MAIN REPLACEMENT";now,therefore, If said CONTRACTOR, or subcontractor, fails to pay for any materials, equipment, or other supplies, or for rental of same,used in connection with the performance of work contracted to be done,or for amounts due under applicable State law for any work or labor thereon,said Surety will pay for the same in an amount not exceeding the sum specified above, and, in the event suit is brought upon this bond, reasonable attorney's fees to be fixed by the court. This bond shall inure to the benefit of any persons,companies,or corporations entitled to file claims under applicable State law so as to give a right of action to them or their assigns in any suit brought upon this bond. PROVIDED,that any alterations in the WORK to be done or the materials to be furnished, or changes in the time of completion,which may be made pursuant to the terms of said Contract Documents,shall not in any way release said CONTRACTOR or said Surety thereunder, nor shall any extensions of time granted under the provisions of said Contract Documents release either said CONTRACTOR or said Surety, and notice of such alterations or extensions of the CONTRACT is hereby waived by said Surety. The obligation of the Surety shall include reimbursing the City of all costs and expenses, (including, but not limited to fee and charges of engineers,architects,attorneys,and other professionals,and court costs if litigation is commenced)incurred by the OWNER in enforcing the provisions of this Bond. CITY OF BREMERTON JUNE 2021 MARINE DRIVE WATER MAIN REPLACEMENT A-11 4 . IN WITNESS WHEREOF,we have hereunder set our hands and seals this c2-0 ,day of < 0 ,2021. (SEAL) (SEAL) Pape&Sons Construction, Inc. North American Specialty Insurance Company (CONTRACTOR) (Surety) By: �C By. 1t r/yA-e_ �.,�� °�L--- � (Signat re and SEAL) 'Sean t a./3 .. (Si ire and SEAL)Joanne Reinkensmeyer, C.nrpbra. 5 ,ei Attorney-in-Fact (SEAL AND NOTARIAL ACKNOWLEDGEMENT OF SURETY) 1 1 F 6 Address of Surety to which all notices shall be sent: Swiss Re Corporate 450 Alaskan Way South, Suite 200 Seattle, WA 98104 I Address of Surety for service of process: Hentschell&Associates, Inc. (Must be a physical address) 1436 S. Union Ave. Tacoma,WA 98405 END OF SECTION I i 1 CITY OF BREMERTON JUNE 2021 MARINE DRIVE WATER MAIN REPLACEMENT A-12 •E SWISS RE CORPORATE SOLUTIONS NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHINGTON INTERNATIONAL INSURANCE COMPANY GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS,THAT North American Specialty Insurance Company,a corporation duly organized and existing under laws of the State of New Hampshire,and having its principal office in the City of Overland Park,Kansas,and Washington International Insurance Company,a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of Overland Park,Kansas,each does hereby make,constitute and appoint: THOMAS P.HENTSCHELL,BRADLEY A.ROBERTS,JULIE A.CRAKER, KAREN J. SMITH,and JOANNE REINKENSMEYER JOINTLY OR SEVERALLY Its true and lawful Attorney(s)-in-Fact,to make,execute,seal and deliver,for and on its behalf and as its act and deed,bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies,as surety,on contracts of suretyship as are or may be required or permitted by law,regulation,contract or otherwise,provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of: FIFTY MILLION($50,000,000.00)DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of both North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on the 9th of May,2012: "RESOLVED,that any two of the Presidents,any Managing Director,any Senior Vice President,any Vice President,any Assistant Vice President, the Secretary or any Assistant Secretary be,and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Company bonds,undertakings and all contracts of surety,and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is FURTHER RESOLVED,that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile,and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Company when so affixed and in the future with regard to any bond,undertaking or contract of surety to which it is attached." yyQEpp Ok G' i 'I "•�"`---- , PNtmoo/ p = 7F. B 4}`•pP.PO'•ysG SEAL . '_ Y ' •'a EAL'�.Steven P.Anderson,Senior Vice President of Washington International Insurance Company $ S' Pry %aµt:?j 1973 MI.'` &Senior Vice President of North American Specialty Insurance Company C! •n iP4./ � � � � Michael A.IIt o to,Senior Vice President V gton International Insurance Company nowise &Senior Vice President of North American Specialty Insurance Company IN WITNESS WHEREOF,North American Specialty Insurance Company and Washington International Insurance Company have caused their official seals to be hereunto affixed,and these presents to be signed by their authorized officers this 19 day of JANUARY ,2018 North American Specialty Insurance Company Washington International Insurance Company State of Illinois County of Cook ss: On this 19 day of JANUARY ,2018 before me,a Notary Public personally appeared Steven P.Anderson ,Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and Michael A.Ito, Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company,personally known to me,who being by me duly sworn,acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies. t OFFICIAL SEAL I M.KENNY yy I Notary Public:State of Minis I �s ` '••^ Ex My C mnuwon pees I M.Kenny,Notary Public I, Jeffrey Goldberg , the duly elected Assistant Secretary of North American Specialty Insurance Company and Washington International Insurance Company,do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said North American Specialty Insurance Company and Washington International Insurance Company,which is still in full force and effect. IN WITNESS WHEREOF,I have set my hand and affixed the seals of the Companies this.2-6 kday of i.t/ ,20 21 . Jeffrey Goldberg,Vice President&Assistant Secretary of Washington International Insurance Company&North American Specialty Insurance Company