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HomeMy WebLinkAbout6756 Docusign Envelope ID: F37033C6-DE99-44CB-8788-1A992F53D1AA GOODS AND SERVICES AGREEMENT THIS AGREEMENT, is entered into between the City of Bremerton, a Washington Municipal Corporation ("City"), and PumpTech Integration L2 Systems, LLC ("Vendor"), whose mailing address is:3326 Bickford Ave, Ste C, Snohomish, WA 98290 The parties agree as follows: L VENDOR SERVICES. The Vendor shall provide the following goods and materials and/or perform the following services for the City: VFD & PLC Cabinet Removal and Replacement at Lift Station WB-6 IL TIME OF COMPLETION. Vendor shall complete the work and provide all goods, materials and services within 60 calendar days from the date all parties have signed this Agreement. III. COMPENSATION. The City shall pay the Vendor the total amount of $97,703.20, including applicable Washington State Sales Tax, for the goods, materials and services contemplated in this Agreement. The City shall pay the Vendor the following amounts according to the following schedule: Net 30 Days from Date of Delivery A. Defective or Unauthorized Work. The City reserves its right to withhold payment from Vendor for any defective or unauthorized goods, materials or services. If Vendor is unable, for any reason, to complete any part of this Agreement, the City may obtain the goods, materials or services on its own or from a third party, and Vendor shall be liable to the City for any additional costs incurred by the City. "Additional costs" shall mean all reasonable costs, including legal costs and attorney fees, incurred by the City beyond the maximum Agreement price specified above. The City further reserves its right to deduct the cost to complete this Agreement, including any Additional Costs, from any and all amounts due or to become due the Vendor. IV. INDEPENDENT CONTRACTOR. Vendor is and shall be at all times acting as an independent contractor and not as an employee of the City. The Vendor shall secure at its expense, and shall be responsible for all payments of income tax, social security, state disability insurance compensation, unemployment compensation, and all other payroll deductions for the Vendor, officer, agents, employees and subcontractors. The Vendor shall also secure all applicable business licenses, if required, in connection with the contract services, including all required licenses for Vendor's officers, agents, employees and subcontractors. V. TERMINATION. The City may terminate this Agreement for good cause. "Good cause" shall include, without limitation, any one or more of the following events: A. The Vendor's refusal or failure to supply a sufficient number of properly skilled workers or proper materials for completion of this Agreement. Page 1 of 8 Goods and Services Agreement Rev. 04/2023 Docusign Envelope ID: F37033C6-DE99-44CB-8788-1A992F53D1AA B. The Vendor's failure to complete this Agreement within the time specified in this Agreement. C. The Vendor's failure to make full and prompt payment to subcontractors or for material or labor. D. The Vendor's failure to comply with federal, state or local laws,rules or regulations. E. The Vendor's filing for bankruptcy or becoming adjudged bankrupt. If the City terminates this Agreement for good cause, the Vendor shall not receive any further monies due under this Agreement until the goods, materials, and services required by this Agreement are completed and fully performed by the City or a third party of the City's choosing. VI. CHANGES. The City may issue a written change order for any change in the goods, materials or services to be provided during the performance of this Agreement. If the Vendor determines,for any reason,that a change order is necessary, Vendor must submit a written change order request to an authorized agent of the City within fourteen (14) calendar days of the date Vendor knew or should have known of the facts and events giving rise to the requested change. If the City determines that the change increases or decreases the Vendor's costs or time for performance, the City will make an equitable adjustment. The City will attempt, in good faith,to reach agreement with the Vendor on all equitable adjustments. However, if the parties are unable to agree, the City will determine the equitable adjustment as it deems appropriate. The Vendor shall proceed with the change order work upon receiving either a written change order from the City or an oral order from the City before actually receiving the written change order. If the Vendor fails to require a change order within the time allowed, the Vendor waives its right to make any claim or submit subsequent change order requests for that portion of the contract work. If the Vendor disagrees with the equitable adjustment the Vendor must complete the change order work; however, the Vendor may elect to protest the adjustment as provided below: A. Procedure and Protest by the Vendor. If the Vendor disagrees with anything required by a change order, another written order, or an oral order from the City, including any direction, instruction, interpretation, or determination by the City,the Vendor shall: 1. Immediately give a signed written notice of protest to the City; 2. Supplement the written protest within fourteen (14) calendar days with a written statement that provides the following information: a. The date of the Vendor's protest. b. The nature and circumstances that caused the protest. c. The provisions in this Agreement that support the protest. d. The estimated dollar cost, if any, of the protested work and how that estimate was determined. e. An analysis of the progress schedule showing the schedule change or disruption if the Vendor is asserting a schedule change or disruption. Page 2 of 8 Goods and Services Agreement Rev. 04/2023 Docusign Envelope ID: F37033C6-DE99-44CB-8788-1A992F53D1AA 3. The Vendor shall keep complete records of extra costs and time incurred as a result of the protested work. The City shall have access to any of the Vendor's records needed for evaluating the protest. The City will evaluate all protests, provided the procedures in this section are followed. If the City determines that a protest is valid, the City will adjust payment for work or time by an equitable adjustment. No adjustment will be made for an invalid protest. B. Vendor's Duty to Complete Protested Work. In spite of any protest, the Vendor shall proceed promptly to provide the goods, materials and services required by the City under this Agreement. C. Vendor's Acceptance of Changes. The Vendor accepts all requirements of a change order by: (1) endorsing it, (2) writing a separate acceptance, or (3) not protesting in the way this section provides. A change order that is accepted by Vendor as provided in this section shall constitute full payment and final settlement of all claims for contract time and for direct, indirect and consequential costs, including costs of delays related to any work, either covered or affected by the change. D. Failure to Protest Constitutes Waiver. By not protesting as this section provides, the Vendor also waives any additional entitlement and accepts from the City any written or oral order(including directions, instructions, interpretations, and determination). E. Failure to Follow Procedures Constitutes Waiver. By failing to follow the procedures of this section, the Vendor completely waives any claims for protested work and accepts from the City any written or oral order(including directions, instructions, interpretations, and determination). VII. CLAIMS. The Vendor shall give written notice to the City of all claims other than change orders within fourteen (14) calendar days of the occurrence of the events giving rise to the claims. Any claim for damages, additional payment for any reason, or extension of time, whether under this Agreement or otherwise, shall be conclusively deemed to have been waived by the Vendor unless a timely written claim is made in strict accordance with the applicable provisions of this Agreement; or, if(and only if) no such provision is applicable, unless that claim is set forth in detail in writing and received by the City within seven (7) calendar days from the date Vendor knew, or should have known, of the facts giving rise to the claim. At a minimum, a Vendor's written claim must include the information set forth regarding protests in Section VI(A)(2)(a)-(e). FAILURE TO PROVIDE A COMPLETE, WRITTEN NOTIFICATION OF CLAIM WITHIN THE TIME ALLOWED SHALL BE AN ABSOLUTE WAIVER OF ANY CLAIMS ARISING IN ANY WAY FROM THE FACTS OR EVENTS SURROUNDING THAT CLAIM OR CAUSED BY THAT DELAY. Vendor must, in any event, file any claim or bring any suit arising from or connected with this Agreement within 120 calendar days from the date the contract work is complete. VIII. WARRANTY. The Vendor shall correct all defects in workmanship and materials within Page 3 of 8 Goods and Services Agreement Rev. 04/2023 Docusign Envelope ID: F37033C6-DE99-44CB-8788-1A992F53D1AA one year from the date of the City's acceptance of the contract work. When defects are corrected, the warranty for that portion of the work shall extend for one year from the date such correction is completed and accepted by the City. The Vendor shall begin to correct any defects within seven (7) calendar days of its receipt of notice from the City of the defect. If the Vendor does not accomplish the corrections within a reasonable time, the City may complete the corrections and the Vendor shall pay all costs incurred by the City in order to accomplish the correction. IX. INDEMNIFICATION. Vendor shall defend, indemnify and hold the City, its officers, officials, employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or suits, including all legal costs and attorney fees, arising out of or in connection with the performance of this Agreement. Vendor's obligation to indemnify shall not extend to that portion of damages caused by the City's sole negligence. The City's inspection or acceptance of any of Vendor's work when completed shall not be grounds to avoid any of these covenants of indemnification. Should a court of competent jurisdiction determine that this Agreement is subject to RCW 4.24.115, then, in the event of liability for damages arising out of bodily injury to persons or damages to property caused by or resulting from the concurrent negligence of the Vendor and the City, its officers, officials, employees, agents and volunteers,the Vendor's liability hereunder shall be only to the extent of the Vendor's negligence. IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THIS INDEMNIFICATION CONSTITUTES THE VENDOR'S WAIVER OF IMMUNITY UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF THIS INDEMNIFICATION. THE PARTIES ACKNOWLEDGE THAT THEY HAVE MUTUALLY NEGOTIATED THIS WAIVER. The provisions of this section shall survive the expiration or termination of this Agreement. X. INSURANCE. The Vendor shall procure and maintain for the duration of this Agreement, insurance against claims for injuries to persons or damage to property that may arise from or in connection with the performance of the contract work by the Vendor, its agents, representatives, employees or subcontractors. Before beginning work on the project described in this Agreement, the Vendor shall provide a Certificate of Insurance evidencing: A. Automobile Liability insurance with limits no less than $1,000,000 combined single limit per accident for bodily injury and property damage; and B. Commercial General Liability insurance written on an occurrence basis with limits no less than $1,000,000 combined single limit per occurrence and $2,000,000 aggregate for personal injury, bodily injury and property damage. Coverage shall include but not be limited to: blanket contractual; products/completed operations/broad form property damage; and employer's liability. Page 4 of 8 Goods and Services Agreement Rev. 04/2023 Docusign Envelope ID: F37033C6-DE99-44CB-8788-1A992F53D1AA C. Excess Liability insurance with limits not less than $1,000,000 limit per occurrence and aggregate. D. Professional Liability insurance with limits no less than $1,000,000 limit per occurrence/claim. E. Workers Compensation insurance as statutorily required by the Industrial Insurance Act of the State of Washington, Title 51, Revised Code of Washington and employer's liability with limits not less than $1,000,000. Any payment of deductible or self-insured retention shall be the sole responsibility of the Vendor. All required policies shall be provided on an "occurrence" basis except professional liability insurance (if required), which shall be provided on a"claims-made"basis. The City shall be named as an additional insured on the Commercial General Liability insurance policy, as respects work performed by or on behalf of the Vendor and a copy of the endorsement naming the City as additional insured shall be attached to the Certificate of Insurance. The City reserves the right to receive a certified copy of all the required insurance policies. The Vendor's Commercial General Liability insurance shall contain a clause stating that coverage shall apply separately to each insured against whom claim is made or suit is brought, except with respects to the limits of the insurer's liability. The Vendor's insurance shall be primary and non-contributory insurance as respects the City and shall contain a waiver of subrogation against the City for claims arising out of any operations, liabilities and obligations to which coverage applies. It shall be an affirmative obligation upon Vendor to advise the City's Risk Manager by fax at(360)473-5161, or by certified mail, return receipt requested to City of Bremerton, Attn: Risk Management, 345 6th Street, Suite 100, Bremerton, WA 98337 within two days of the cancellation, suspension or substantive change of any insurance policy required herein, and failure to do so shall be construed to be a breach of this Agreement. The City also reserves its unqualified right to require at any time and for any reason, proof of coverage in the form of a duplicate of the insurance policy with all endorsements as evidence of coverage. XI. MISCELLANEOUS. A. Licenses and Taxes. Vendor shall possess a current Bremerton Business License and any regulatory license required to fulfill Vendor's obligations under this Agreement. B&O taxes shall be paid when due, and Vendor, by this Agreement, assigns any payments due under this Agreement to the City Clerk for payment of such taxes which have been declared delinquent. B. Conflict and Precedence. In the event of a conflict between the contract documents, the document which rates higher on the following list shall take precedence: Page 5 of 8 Goods and Services Agreement Rev. 04/2023 Docusign Envelope ID: F37033C6-DE99-44CB-8788-1A992F53D1AA 1. Amendments/ Change Orders to Goods and Services Agreement 2. Goods and Services Agreement 3. Specifications 4. Terms and Conditions 5. Vendor's Proposal C. Documents Incorporated by Reference. The following documents are incorporated by reference, including but not limited to: 1. Terms and Conditions, 2. Specifications, 3. Proposal, and 4. Non-Collusion Affidavit. D. Use of Photographs and Images. Vendor shall not use or distribute photographs or images depicting City officials, personnel, property, or equipment whether prepared by Vendor or provided by City without prior written consent of the City. The City will not unreasonably withhold its consent. E. Equal Employment Opportunity Statement. In the hiring of employees for the performance of work under this Agreement, the Vendor, its subcontractors, or any person acting on behalf of Vendor shall not discriminate in any employment practice on the basis of age (40+), sex, race, creed, color, national origin, sexual orientation/gender identity, marital status, military status, or the presence of any physical, mental or sensory disability. F. ADA Statement. The City of Bremerton does not discriminate on the basis of disability in programs and activities, which it operates pursuant to the requirements of the Americans with Disabilities Act of 1990, and ADA Amendments Act. This policy extends to both employment and admission to participation in the programs, services and activities of the City of Bremerton. Reasonable accommodation for employees or applicants for employment will be provided. G. Compliance with Laws. Vendor shall comply with all federal, state and local laws, rules and regulations throughout every aspect in the performance of this Agreement. H. Prevailing Wages. Vendor shall file a "Statement of Intent to Pay Prevailing Wages"with the State of Washington Department of Labor& Industries prior to commencing the contract work. Vendor shall pay prevailing wages and comply with Chapter 39.12 of the Revised Code of Washington, as well as any other applicable prevailing wage rate provisions. The latest prevailing wage rate revision issued by the Department of Labor and Industries is attached. L Work Performed at Vendor's Risk. Vendor shall take all precautions necessary and shall be responsible for the safety of its employees, agents, and subcontractors in the performance of this Agreement. All work shall be done at Vendor's own risk, and Vendor shall be responsible for any loss of or damage to materials, tools, or other articles used or held for use in connection with the work. J. Governing Law. This Agreement shall be governed and construed in accordance Page 6 of 8 Goods and Services Agreement Rev. 04/2023 Docusign Envelope ID: F37033C6-DE99-44CB-8788-1A992F53D1AA with the laws of the State of Washington. If any dispute arises between the City and Vendor under any of the provisions of this Agreement, resolution of that dispute shall be available exclusively under the jurisdiction, venue and rules of the Kitsap County Superior Court, Kitsap County, Washington. K. Attorney's Fees. In any claim or lawsuit for damages arising from the parties' performance of this Agreement, each party shall be responsible for payment of its own legal costs and attorney's fees incurred in defending or bringing such claim or lawsuit; however, nothing in this subsection shall limit the City's right to indemnification under Section IX of this Agreement. L. Written Notice. All communications regarding this Agreement shall be sent to the parties at the addresses listed below, unless otherwise notified. Any written notice shall become effective upon delivery, but in any event three (3) calendar days after the date of mailing by registered or certified mail, and shall be deemed sufficiently given if sent to the addressee at the address stated in this Agreement. Notices to be sent to: Notices to be sent to: CITY: VENDOR: Attn: Eric Burris Attn: Glen Lee City of Bremerton Pumptech Intergration 345 6th Street, Suite 100 3326 Bickford Ave, Ste C Bremerton, WA 98337-1891 Snohomish, WA 98290 M. Assignment. Any assignment of this Agreement by the Vendor without the written consent of the City shall be void. N. Modification. No waiver, alteration, or modification of any of the provisions of this Agreement shall be binding unless in writing and signed by a duly authorized representative of the City and Vendor. O. Severability. If any one or more sections, subsections, or sentences of this Agreement are held to be unconstitutional or invalid, that decision shall not affect the validity of the remaining portion of this Agreement and the remainder shall remain in full force and effect. P. Suspension & Debarment. For contracts involving Washington State or Federal funding, Vendor hereby certifies, by signing this agreement, that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Washington State, Federal department, or agency. Vendor shall provide immediate written notice to the City if at any time it learns that it is or has become ineligible for certification. Should Vendor enter into a covered transaction with another firm, Vendor agrees by signing this agreement that it will verify that the firm with whom it intends to do business is not debarred, suspended, ineligible, excluded or disqualified. Q. Entire Agreement. The written provisions and terms of this Agreement, together with any attached Exhibits, supersede all prior verbal statements by any representative of the City, Page 7 of 8 Goods and Services Agreement Rev. 04/2023 Docusign Envelope ID: F37033C6-DE99-44CB-8788-1A992F53D1 AA and those statements shall not be construed as forming a part of or altering in any manner this Agreement. This Agreement and any attached Exhibits contain the entire Agreement between the parties. Should any language in any Exhibit to this Agreement conflict with any language contained in this Agreement, the terms of this Agreement shall prevail. IN WITNESS WHEREOF, the parties below have executed this Agreement. CITY: VENDOR: CITY OF BREMERTON Pumptech Intergration gSigned by: 'Vet aLehA, By: By: BAr4Wyoi -re/,ti...Wh e e 1 e r Glen I_e e Print Name: y Print Name: Its: Mayor Its: Date: 9/3/`2024 Date: APPROVED AS TO FORM: ATTEST: Signed by: DocuSigned by: A.A A. ht,CitA, ,at, �R.bUt,V'bt, B : ' l ' 1 B . Y 52ACBczs38 I t3114t�L... Y o17€4Do62ro2167... KYLIE J. FINNELL, Bremerton City Attorney ANGELA HOOVER;-City-Clerk R:\Legal\Legal\Forms\FORMS ON COBWEB\Goods and Services Agreement Rev.04 20aiPda Mon roe for City Cl e rk Page 8 of 8 Goods and Services Agreement Rev. 04/2023 Docusign Envelope ID: F37033C6-DE99-44CB-8788-1A992F53D1AA 7;711—C7-/ /-7 /rstci-ativrs City of Bremerton - WW By: Glen Lee Attn: William Wendling Date 6/14/2024 Re: WB6—VFD& PLC Cabinet Removal and Replacement Pumptech Integration is pleased to provide the following quotation to remove 3 each existing AB VFD Units&Sump Pump Controller and replace with 3 each pre-purchased AB 755TL VFD Units and new Sump Pump controller. Remove existing PLC cabinet backpan and replace with new pre- purchased PLC backpan. Includes removal of existing power cabling from switchgear and installation of new power cabling from each drive unit to switchgear. Re-termination of field wiring to each motor controller. Scope of Work: Existing Equipment Removal: 1. De-Energize system for safe working condition—Lockout/Tagout as needed. 2. Verify existing labeling against design prints on field wiring leaving panels, replace as needed. 3. Disconnect field wiring from 3 each AB VFD units, Sump Pump, and PLC backpan. Verify cable labeling and/or replace as needed. 4. Remove existing overhead feeder from switchgear to drives. 5. Providing onsite equipment lifting means to move old VFDs, sump controller, and PLC backpan out of building and load onto customers transport. 6. Clean up area and remove debris. New Equipment Installation 7. Prep installation area for new equipment. 8. Make switchgear modifications to support terminations, install new Power Monitor Unit and Display in switchgear. 9. Take delivery of 3 each new VFDs, Sump Pump, and PLC backpan from City—currently stored at WWTP. 10. Install, level, and secure 3 new VFDs and Sump Pump Controller in building per seismic zone 4 requirements. 11. Install new backpan into PLC cabinet. 12. Install new power supply cabling to VFDs and Sump Pump Controller. 13. Terminate power&control wiring to VFDs, Sump Pump Controller, and PLC backpan. 14. Torque per manufacturers specification and meg feeds. 15. Test power connections to/from devices, document in field test report. 16. Clean area of work Pumptech Integration -L2 Systems, LLC 3326 Bickford Ave STE C Snohomish, WA 98290 Phone: (360) 386-9675 Docusign Envelope ID: F37033C6-DE99-44CB-8788-1A992F53D1AA Startup&Testing 17. Inspect installation and wiring of 3 VFDs, sump pump controller, PLC cabinet, and switchgear. 18. Power up and commission VFDs and sump controller. Verify both utility and standby sources for correct operation. 19. Power up and commission PLC cabinet, test programing, and VFD interface. 20. Complete Startup Report. Customer Acceptance and Training 21. Provide onsite walk thru with customer, inspect work provided, review documentation. 22. Test run each pump and verify operation with customer. Make any final adjustments to system parameters as needed. 23. Test system with either power source, verify transition sequences. Materials included: Equipment mounting hardware Cable tray& accessories New input power cabling for 3 each VFDs and Sump Pump Terminations, lugs, & hardware Estimated Duration: Prep & Removal of existing equipment—1 week Placement and installation of new equipment—2 weeks Inspection—2 Days Startup &commissioning—2 days Customer Acceptance &Training— 1 day Cost of this scope of work: $89,460.00 Labor @ Prevailing Wage Rates Does not include taxes _ Please call, if you have any questions on the above, 7;101/. 97 70 7. ;7_0 Thank You, Glen Lee Pumptech Integration Mobile:425-923-8317 GIen.LeeCcc7L2SvstemsLLC.com Pumptech Integration -L2 Systems, LLC 3326 Bickford Ave STE C Snohomish, WA 98290 Phone: (360 386-9675 Page 1 of 1 ' r DATE(MM/DD/YYY f YW) CERTIFICATE OF LIABILITY INSURANCE 09/03/2024 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 WTW Certificate Center NAME: Willis Towers Watson Northeast, Inc. (AE /O,No,Ext):N 1-877-945-7378 (A/C,No): 1-888-467-2378 c/o 26 Century Blvd E-MAIL P.O. Box 305191 ADDRESS: certificates @ wtwco.com Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: The Charter Oak Fire Insurance Company 25615 INSURED INSURER B: Travelers Indemnity Company of CT 25682 PumpTech, LLC dba PumpTech Integration 12020 SE 32nd St, Suite 2 INSURER C: Travelers Property Casualty Company of Ame 25674 Bellevue, WA 98005 INSURER D: Travelers Property Casualty Insurance Comp 36161 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W34623526 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W LIMITS LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $ 300,000 A MED EXP(Any one person) $ 5,000 Y-630-331D063A-COF-24 08/26/2024 08/26/2025 1,000,000 PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X JECT PO- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED 810-1Y037218-24-14-G 08/26/2024 08/26/2025 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 C X EXCESS LIAB CLAIMS-MADE EX-4Y788505-24-14 08/26/2024 08/26/2025 AGGREGATE $ 10,000,000 DED RETENTION$ $ WORKERS COMPENSATION X PER AND EMPLOYERS'LIABILITY STATUTE ERH Y/N D ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? No N/A UB-4Y056146-24-14-G 08/26/2024 08/26/2025 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Bremerton is included as an Additional Insured as respects to General Liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE City of Bremerton 345 6th Street, Suite 100 p °- Bremerton, WA 98337-1891 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD sR ID: 26386389 BATCH: 3605236 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR MANUFACTURERS AND WHOLESALERS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE —This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Who Is An Insured —Unnamed Subsidiaries H. Blanket Additional Insured — Governmental B. Who Is An Insured — Employees And Volunteer Entities — Permits Or Authorizations Relating To Workers — Bodily Injury To Co-Employees And Operations Co-Volunteer Workers I. Blanket Additional Insured — Grantors Of Franchises C. Who Is An Insured — Newly Acquired Or Formed Limited Liability Companies J. Incidental Medical Malpractice D. Blanket Additional Insured —Broad Form Vendors K. Medical Payments — Increased Limit E. Blanket Additional Insured —Controlling Interest L. Blanket Waiver Of Subrogation F. Blanket Additional Insured —Mortgagees, M. Contractual Liability—Railroads Assignees, Successors Or Receivers G. Blanket Additional Insured — Governmental Entities — Permits Or Authorizations Relating To Premises PROVISIONS A. WHO IS AN INSURED — UNNAMED a. Before you maintained an ownership interest SUBSIDIARIES of more than 50% in such subsidiary; or The following is added to SECTION II — WHO IS b. After the date, if any, during the policy period AN INSURED: that you no longer maintain an ownership Any of your subsidiaries, other than a partnership interest of more than 50% in such subsidiary. or joint venture, that is not shown as a Named For purposes of Paragraph 1. of Section II —Who Insured in the Declarations is a Named Insured if: Is An Insured, each such subsidiary will be a. You are the sole owner of, or maintain an deemed to be designated in the Declarations as: ownership interest of more than 50% in, such subsidiary on the first day of the policy period; a. A limited liability company; and b. An organization other than a partnership, joint b. Such subsidiary is not an insured under venture or limited liability company; or similar other insurance. No such subsidiary is an insured for"bodily injury" C A trust; or "property damage" that occurred, or "personal as indicated in its name or the documents that and advertising injury" caused by an offense govern its structure. corn mitted: CG D4 58 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 1 of 5 Includes copyrighted material of Insurance Services Office,Inc.with its permission COMMERCIAL GENERAL LIABILITY B. WHO IS AN INSURED — EMPLOYEES AND a. A limited liability company; VOLUNTEER WORKERS—BODILY INJURY TO b. An organization, other than a partnership, CO-EMPLOYEES AND CO-VOLUNTEER WORKERS joint venture or limited liability company; or The following is added to Paragraph 2.a.(1) of SECTION II—WHO IS AN INSURED: c. A trust; Paragraphs (1)(a), (b) and (c) above do not apply as indicated in its name or the documents to "bodily injury" to a co-"employee" while in the that govern its structure. course of the co-"employee's" employment by you D. BLANKET ADDITIONAL INSURED — BROAD or performing duties related to the conduct o f your FORM VENDORS business, or to "bodily injury" to your other "volunteer workers" while performing duties The following is added to SECTION II — WHO IS related to the conduct of your business. AN INSURED: C. WHO IS AN INSURED — NEWLY ACQUIRED Any person or organization that is a vendor and OR FORMED LIMITED LIABILITY COMPANIES that you have agreed in a written contract or The following replaces Paragraph 3. of SECTION agreement to include as an additional insured on II—WHO IS AN INSURED: this Coverage Part is an insured, but only with respect to liability for "bodily injury" or "property 3. Any organization you newly acquire or form, damage" that: other than a partnership or joint venture, and a. Occurs subsequent to the signing of that of which you are the sole owner or in which contract or agreement; and you maintain an ownership interest of more than 50%, will qualify as a Named Insured if b. Arises out of "your products" that are there is no other similar insurance available to distributed or sold in the regular course of that organization. However: such vendor's business. a. Coverage under this provision is afforded The insurance provided to such vendor is subject only: to the following provisions: (1) Until the 180th day after you acquire a. The limits of insurance provided to such or form the organization or the end of vendor will be the minimum limits that you the policy period, whichever is earlier, agreed to provide in the written contract or if you do not report such organization agreement, or the limits shown in the in writing to us within 180 days after Declarations,whichever are less. you acquire or form it; or b. The insurance provided to such vendor does (2) Until the end of the policy period, not apply to: when that date is later than 180 days (1) Any express warranty not authorized by after you acquire or form such you or any distribution or sale for a organization, if you report such purpose not authorized by you; organization in writing to us within 180 days after you acquire or form it; (2) Any change in "your products" made by b. Coverage A does not apply to "bodily such vendor; injury"or"property damage" that occurred (3) Repackaging, unless unpacked solely for before you acquired or formed the the purpose of inspection, demonstration, organization; and testing, or the substitution of parts under c. Coverage B does not apply to "personal instructions from the manufacturer, and and advertising injury" arising out of an then repackaged in the original container; offense committed before you acquired or (4) Any failure to make such inspections, formed the organization. adjustments, tests or servicing as For the purposes of Paragraph 1. of Section II vendors agree to perform or normally —Who Is An Insured, each such organization undertake to perform in the regular will be deemed to be designated in the course of business, in connection with the Declarations as: distribution or sale of"your products"; Page 2 of 5 ©2017 The Travelers Indemnity Company.All rights reserved. CG D4 58 02 19 Includes copyrighted material of Insurance Services Office,Inc.with its permission COMMERCIAL GENERAL LIABILITY (5) Demonstration, installation, servicing or liability as mortgagee, assignee, successor or repair operations, except such operations receiver for "bodily injury", "property damage" or performed at such vendor's premises in "personal and advertising injury"that: connection with the sale of "your a. Is "bodily injury" or "property damage" that products"; or occurs, or is "personal and advertising injury" (6) "Your products" that, after distribution or caused by an offense that is committed, sale by you, have been labeled or subsequent to the signing of that contract or relabeled or used as a container, part or agreement; and ingredient of any other thing or substance b. Arises out of the ownership, maintenance or by or on behalf of such vendor. use of the premises for which that mortgagee, Coverage under this provision does not apply to: assignee, successor or receiver is required a. Any person or organization from whom you under that contract or agreement to be have acquired "your products", or any included as an additional insured on this ingredient, part or container entering into, Coverage Part. accompanying or containing such products; The insurance provided to such mortgagee, or assignee, successor or receiver is subject to the b. Any vendor for which coverage as an following provisions: additional insured specifically is scheduled by a. The limits of insurance provided to such endorsement. mortgagee, assignee, successor or receiver E. BLANKET ADDITIONAL INSURED — will be the minimum limits that you agreed to CONTROLLING INTEREST provide in the written contract or agreement, or the limits shown in the Declarations, 1. The following is added to SECTION II —WHO whichever are less. IS AN INSURED: b. The insurance provided to such person or Any person or organization that has financial organization does not apply to: control of you is an insured with respect to liability for "bodily injury", "property damage" (1) Any "bodily injury" or "property damage" or"personal and advertising injury"that arises that occurs, or any "personal and out of: advertising injury" caused by an offense that is committed, after such contract or a. Such financial control; or agreement is no longer in effect; or b. Such person's or organization's (2) Any "bodily injury", "property damage" or ownership, maintenance or use of "personal and advertising injury" arising premises leased to or occupied by you. out of any structural alterations, new The insurance provided to such person or construction or demolition operations organization does not apply to structural performed by or on behalf of such alterations, new construction or demolition mortgagee, assignee, successor or operations performed by or on behalf of such receiver. person or organization. G. BLANKET ADDITIONAL INSURED — 2. The following is added to Paragraph 4. of GOVERNMENTAL ENTITIES — PERMITS OR SECTION II—WHO IS AN INSURED: AUTHORIZATIONS RELATING TO PREMISES This paragraph does not apply to any The following is added to SECTION II — WHO IS premises owner, manager or lessor that has AN INSURED: financial control of you. Any governmental entity that has issued a permit F. BLANKET ADDITIONAL INSURED — or authorization with respect to premises owned MORTGAGEES, ASSIGNEES, SUCCESSORS or occupied by, or rented or loaned to, you and OR RECEIVERS that you are required by any ordinance, law, The following is added to SECTION II — WHO IS building code or written contract or agreement to AN INSURED: include as an additional insured on this Coverage Part is an insured, but only with respect to liability Any person or organization that is a mortgagee, for "bodily injury", "property damage" or "personal assignee, successor or receiver and that you and advertising injury" arising out of the have agreed in a written contract or agreement to existence, ownership, use, maintenance, repair, include as an additional insured on this Coverage construction, erection or removal of any of the Part is an insured, but only with respect to its following for which that governmental entity has CG D4 58 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 3 of 5 Includes copyrighted material of Insurance Services Office,Inc.with its permission COMMERCIAL GENERAL LIABILITY issued such permit or authorization: advertising services", first aid or "Good Samaritan signs, awnings, canopies, cellar entrances, coal services" to a person, unless you are in holes, driveways, manholes, marquees, hoist the business or occupation of providing away openings, sidewalk vaults, elevators, street professional health care services. banners or decorations. 2. The following replaces the last paragraph of H BLANKET ADDITIONAL INSURED — Paragraph 2.a.(1) of SECTION II — WHO IS GOVERNMENTAL ENTITIES — PERMITS OR AN INSURED: AUTHORIZATIONS RELATING TO OPER- Unless you are in the business or occupation ATIONS of providing professional health care services, The following is added to SECTION II — WHO IS Paragraphs (1)(a), (b), (c) and (d) above do AN INSURED: not apply to "bodily injury" arising out of Any governmental entity that has issued a permit providing or failing to provide: or authorization with respect to operations (a) "Incidental medical services" by any of performed by you or on your behalf and that you your "employees" who is a nurse, nurse are required by any ordinance, law, building code assistant, emergency medical technician, or written contract or agreement to include as an additional insured on this Coverage Part is an paramedic, athletic trainer, audiologist, insured, but only with respect to liability for"bodily dietician, nutritionist, occupatio nal injury", "property damage" or "personal and therapist or occupational therapy advertising injury" arising out of such operations. assistant, physical therapist or speech- The insurance provided to such governmental language pathologist; or entity does not apply to: (b) First aid or "Good Samaritan services" by any of your "employees" or "volunteer a. Any "bodily injury", "property damage" or workers", other than an employed or "personal and advertising injury" arising out of operations performed for the governmental volunteer doctor. Any such "employees" entity; or or "volunteer workers" providing or failing to provide first aid or "Good Samaritan b. Any "bodily injury" or "property damage" services" during their work hours for you included in the "products-completed will be deemed to be acting within the operations hazard". scope of their employment by you or I. BLANKET ADDITIONAL INSURED — performing duties related to the conduct GRANTORS OF FRANCHISES of your business. The following is added to SECTION II — WHO IS 3. The following replaces the last sentence of AN INSURED: Paragraph 5. of SECTION III — LIMITS OF Any person or organization that grants a franchise INSURANCE: to you is an insured, but only with respect to For the purposes of determining the liability for "bodily injury", "property damage" or applicable Each Occurrence Limit, all related "personal and advertising injury" arising out of acts or omissions committed in providing or your operations in the franchise granted by that failing to provide "incidental medical person or organization. services", first aid or "Good Samaritan If a written contract or agreement exists between services"to any one person will be deemed to you and such additional insured, the limits of be one "occurrence". insurance provided to such insured will be the 4. The following exclusion is added to minimum limits that you agreed to provide in the Paragraph 2., Exclusions, of SECTION I — written contract or agreement, or the limits shown COVERAGES — COVERAGE A — BODILY in the Declarations, whichever are less. INJURY AND PROPERTY DAMAGE J. INCIDENTAL MEDICAL MALPRACTICE LIABILITY: 1. The following replaces Paragraph b. of the Sale Of Pharmaceuticals definition of "occurrence" in the "Bodily injury" or "property damage" arising DEFINITIONS Section: out of the violation of a penal statute or b. An act or omission committed in providing ordinance relating to the sale of pharmaceuticals committed by, or with the or failing to provide "incidental medical knowledge or consent of,the insured. Page 4 of 5 ©2017 The Travelers Indemnity Company.All rights reserved. CG D4 58 02 19 Includes copyrighted material of Insurance Services Office,Inc.with its permission COMMERCIAL GENERAL LIABILITY 5. The following is added to the DEFINITIONS a. $10,000; or Section: b. The amount shown in the Declarations of "Incidental medical services" means: this Coverage Part for Medical Expense a. Medical, surgical, dental, laboratory, x-ray Limit. or nursing service or treatment, advice or L. BLANKET WAIVER OF SUBROGATION instruction, or the related furnishing of The following is added to Paragraph 8., Transfer food or beverages; or Of Rights Of Recovery Against Others To Us, b. The furnishing or dispensing of drugs or of SECTION IV — COMMERCIAL GENERAL medical, dental, or surgical supplies or LIABILITY CONDITIONS: appliances. If the insured has agreed in a contract or 6. The following is added to Paragraph 4.b., agreement to waive that insured's right of Excess Insurance, of SECTION IV — recovery against any person or organization, we COMMERCIAL GENERAL LIABILITY waive our right of recovery against such person or CONDITIONS: organization, but only for payments we make This insurance is excess over any valid and because of: collectible other insurance, whether primary, a. "Bodily injury" or "property damage" that excess, contingent or on any other basis, that occurs; or is available to any of your "employees" for "bodily injury" that arises out of providing or b. "Personal and advertising injury" caused by failing to provide "incidental medical services" an offense that is committed; to any person to the extent not subject to subsequent to the execution of the contract or Paragraph 2.a.(1) of Section II — Who Is An agreement. Insured. M. CONTRACTUAL LIABILITY—RAILROADS K. MEDICAL PAYMENTS—INCREASED LIMIT 1. The following replaces Paragraph c. of the The following replaces Paragraph 7. of SECTION definition of "insured contract" in the III—LIMITS OF INSURANCE: DEFINITIONS Section: 7. Subject to Paragraph 5. above, the Medical c. Any easement or license agreement; Expense Limit is the most we will pay under 2. Paragraph f.(1) of the definition of "insured Coverage C for all medical expenses contract" in the DEFINITIONS Section is because of "bodily injury" sustained by any deleted. one person, and will be the higher of: CG D4 58 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 5 of 5 Includes copyrighted material of Insurance Services Office,Inc.with its permission Docusign Envelope ID: F37033C6-DE99-44CB-8788-1A992F53D1AA Page 1 of 2 r DATE(MM/DD/YYW)CERTIFICATE OF LIABILITY INSURANCE 08/02/2024 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 WTW Certificate Center NAME: Willis Towers Watson Northeast, Inc. (AE /O,No,Ext):N 1-877-945-7378 (A/C,No): 1-888-467-2378 c/o 26 Century Blvd E-MAIL P.0. Box 305191 ADDRESS: certificates @ wtwco.com Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: The Charter Oak Fire Insurance Company 25615 INSURED INSURER B: Travelers Indemnity Company 25658 PumpTech, LLC 12020 SE 32nd St, Suite 2 INSURER, Travelers Property Casualty Company of Ame 25674 Bellevue, WA 98005 INSURER D: Travelers Casualty Insurance Company of Am 19046 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W34424984 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W LIMITS LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $ 300,000 A MED EXP(Any one person) $ 5,000 Y Y Y-630-35733475-COF-23 08/26/2023 08/26/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X JECT PO- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED Y Y 810-35733310-23-14-G 08/26/2023 08/26/2024 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 C EXCESS LIAB CLAIMS-MADE Y Y CUP-3S753763-23-14 08/26/2023 08/26/2024 AGGREGATE $ 10,000,000 DED RETENTION$ $ WORKERS COMPENSATION X PER AND EMPLOYERS'LIABILITY Y STATUTE ERH D ANYPROPRIETOR/PARTNER/EXECUTIVE N/o N/A Y E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED, UB-2Y517642-24-14-G 04/25/2024 08/26/2024 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A WA Stop Gap Y-630-35733475-COF-23 08/26/2023 08/26/2024 E.L. Each Accident $1,000,000 E.L. Disease - Ea Emp$1,000,000 E.L. Disease- Policy $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Parametrix Project Number/Name: #233-1896-8BL / Decommission Beach Sewer in Manette (OF-4 to EB-2) City of Bremerton is included as Additional Insured as respects to General Liability, Auto Liability and Umbrella/Excess Liability. General Liability shall be Primary and Non-Contributory with any other insurance in force for or which may be CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE City of Bremerton 345 6th St., Suite 100 p Bremerton, WA 98337 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 26262471 BATCH: 3566914 Docusign Envelope ID: F37033C6-DE99-44CB-8788-1A992F53D1AA AGENCY CUSTOMER ID: LOC#: ACCPRO ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Willis Towers Watson Northeast, Inc. PumpTech, LLC 12020 SE 32nd St, Suite 2 POLICY NUMBER Bellevue, WA 98005 See Page 1 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance purchased by the Additional Insured. Waiver of Subrogation applies in favor of the Additional Insured with respect to General Liability, Auto Liability, Umbrella/Excess Liability and Workers Compensation, as permitted by law. Umbrella/Excess Liability policy follows form. General Liability includes Contractual Liability and Severability of interests. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 26262471 BATCH: 3566914 CERT: W34424984 Docusign Envelope ID: F37033C6-DE99-44CB-8788-1A992F53D1AA COMMERCIAL AUTO POLICY NUMBER: 810-3 5 73 3310-23-14-G ISSUE DATE: 08-31-23 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LESSOR - ADDITIONAL INSURED AND LOSS PAYEE 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 modi- fied by the endorsement. SCHEDULE Insurance Company: THE TRAVELERS INDEMNITY COMPANY Policy Number 810-35733310-23-14-G Effective Date: 08-26-23 Expiration Date: 08-26-24 Named Insured: PUMPTECH HOLDINGS LLC AND AS PER IL Fl 18 Address: 12020 SE 32ND ST #2 BELLEVUE WA 98005 Additional Insured (Lessor): SEE SCHEDULE Address: Designation Or Description Of"Leased Autos": ANY AUTO LEASED FOR A PERIOD OF SIX MONTHS OR MORE UNDER A LEASING CONTRACT OR AGREEMENT THAT REQUIRES YOU TO PROVIDE DIRECT PRIMARY INSURANCE FOR THE LESSOR Coverages Limit Of Insurance Covered Autos Liability $ 1,000,000 Each "Accident" Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus Comprehensive $ Deductible For Each Covered "Leased Auto" Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus Collision $ Deductible For Each Covered "Leased Auto" Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus Specified Causes Of Loss $ Deductible For Each Covered "Leased Auto" Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CA 20 01 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 3 Docusign Envelope ID: F37033C6-DE99-44CB-8788-1A992F53D1AA COMMERCIAL AUTO A. Coverage 2. The insurance covers the interest of the les- 1. Any "leased auto" designated or described in sor unless the "loss" results from fraudulent the Schedule will be considered a covered acts or omissions on your part. "auto" you own and not a covered "auto" you 3. If we make any payment to the lessor, we will hire or borrow. obtain his or her rights against any other 2. For a "leased auto" designated or described party. in the Schedule, the Who Is An Insured pro- C. Cancellation vision under Covered Autos Liability Cov- erage is changed to include as an "insured" 1. If we cancel the policy, we will mail notice to the lessor named in the Schedule. However, the lessor in accordance with the Cancellation the lessor is an "insured" only for "bodily in- Common Policy Condition. jury" or "property damage" resulting from the 2. If you cancel the policy, we will mail notice to acts or omissions by: the lessor. a. You; b. Any of your "employees" or agents; or 3. Cancellation ends this agreement. c. Any person, except the lessor or any D. The lessor is not liable for payment of your pre- "employee" or agent of the lessor, operat- miums. ing a "leased auto" with the permission of E. Additional Definition any of the above. As used in this endorsement: 3. The coverages provided under this endorse- "Leased auto" means an "auto" leased or rented thent apply to any "leased auto" described in to you, including any substitute, replacement or the Schedule until the expiration date shown n the Schedule, or when the lessor or his or extra "auto" needed to meet seasonal or other her agent takes possession of the "leased needs, under a leasing or rental agreement that auto", whichever occurs first. requires you to provide direct primary insurance B. Loss Payable Clause for the lessor. 1. We will pay, as interest may appear, you and the lessor named in this endorsement for "loss" to a "leased auto". Page 2 of 3 © Insurance Services Office, Inc., 2011 CA 20 01 10 13 Docusign Envelope ID: F37033C6-DE99-44CB-8788-1A992F53D1AA COMMERCIAL AUTO POLICY NUMBER: 810-3 3 73 3310-23-14-G CA20 01 1013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LESSOR - ADDITIONAL INSURED AND LOSS PAYEE Schedule Extension Additional Insured (Lessor): ANY LESSOR UNDER A LEASING CONTRACT OR AGREEMENT OF SIX MONTHS OR MORE THAT REQUIRES YOU TO PROVIDE DIRECT PRIMARY INSURANCE FOR THE LESSOR CA 20 01 10 13 © Insurance Services Office, Inc., 2011 Page 3 of 3 Docusign Envelope ID: F37033C6-DE99-44CB-8788-1A992F53D1AA COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF 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 K. AIRBAGS LIMITS 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 A. BROAD FORM NAMED INSURED this insurance applies and only to the extent that person or organization qualifies as an "insured" The following is added to Paragraph A.1., Who Is under the Who Is An Insured provision contained An Insured, of SECTION II —COVERED AUTOS in Section II. LIABILITY COVERAGE: 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., 50% or more ownership interest and that is not Who Is An Insured, of SECTION II — COV- separately insured for Business Auto Coverage. ERED AUTOS LIABILITY COVERAGE: Coverage under this provision is afforded only un- An "employee" of yours is an "insured" while til 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 busi- 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 02 15 ©2015 The Travelers Indemnity Company.All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc.with its permission. Docusign Envelope ID: F37033C6-DE99-44CB-8788-1A992F53D1AA COMMERCIAL AUTO permission, while performing duties (a) With respect to any claim made or "suit" related to the conduct of your busi- 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". (i) You must arrange to defend the "in- D. EMPLOYEES AS INSURED sured" against, and investigate or set- tle any such claim or "suit" and keep The following is added to Paragraph A.1., Who Is us advised of all proceedings and ac- An Insured, of SECTION II — COVERED AUTOS tions. LIABILITY COVERAGE: Any "employee" of yours is an "insured" while us- (ii) Neither you nor any other involved ing a covered "auto" you don't own, hire or borrow "insured" will make any settlement in your business or your personal affairs. without our consent. E. SUPPLEMENTARY PAYMENTS — INCREASED (iii)We may, at our discretion, participate LIMITS in defending the "insured" against, or in the settlement of, any claim or 1. The following replaces Paragraph A.2.a.(2), "suit". of SECTION II — COVERED AUTOS LIABIL- ITY COVERAGE: (iv)We will reimburse the "insured" for sums that the "insured" legally must (2) Up to $3,000 for cost of bail bonds (in- pay as damages because of "bodily cluding bonds for related traffic law viola- injury" or "property damage" to which tions) required because of an "accident" this insurance applies, that the "in- we cover. We do not have to furnish sured" pays with our consent, but 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 of SECTION II — COVERED AUTOS LIABIL- SECTION II — COVERED AUTOS ITY COVERAGE: LIABILITY COVERAGE. (4) All reasonable expenses incurred by the (v) We will reimburse the "insured" for "insured" at our request, including actual the reasonable expenses incurred loss of earnings up to $500 a day be- with our consent for your investiga- cause of time off from work. tion of such claims and your defense of the "insured" against any such F. HIRED AUTO — LIMITED WORLDWIDE COV- "suit", but only up to and included ERAGE—INDEMNITY BASIS within the limit described in Para- The following replaces Subparagraph (5) in Para- graph C., Limits Of Insurance, of graph B.7., Policy Period, Coverage Territory, SECTION II — COVERED AUTOS of SECTION IV — BUSINESS AUTO CONDI- LIABILITY COVERAGE, and not in TIONS: addition to such limit. Our duty to make such payments ends when we (5) Anywhere in the world, except any country or have used up the applicable limit of jurisdiction while any trade sanction, em- insurance in payments for damages, bargo, or similar regulation imposed by the settlements or defense expenses. United States of America applies to and pro- hibits the transaction of business with or (b) This insurance is excess over any valid within such country or jurisdiction, for Cov- and collectible other insurance available ered Autos Liability Coverage for any covered to the "insured" whether primary, excess, "auto" that you lease, hire, rent or borrow contingent or on any other basis. without a driver for a period of 30 days or less (c) This insurance is not a substitute for re- and that is not an "auto" you lease, hire, rent quired or compulsory insurance in any or borrow from any of your "employees", country outside the United States, its ter- partners (if you are a partnership), members ritories and possessions, Puerto Rico and (if you are a limited liability company) or Canada. members of their households. Page 2 of 4 ©2015 The Travelers Indemnity Company.All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc.with its permission. Docusign Envelope ID: F37033C6-DE99-44CB-8788-1A992F53D1AA COMMERCIAL AUTO You agree to maintain all required or (2) In or on your covered "auto". compulsory insurance in any such coun- 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 compulsory insurance requirements will No deductibles apply to this Personal Property not invalidate the coverage afforded by coverage. 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- had you complied with the compulsory in- sions, of SECTION III — PHYSICAL DAMAGE surance requirements. COVERAGE: (d) It is understood that we are not an admit- Exclusion 3.a. does not apply to "loss" to one or ted or authorized insurer outside the more airbags in a covered "auto" you own that in- United States of America, its territories flate due to a cause other than a cause of "loss" and possessions, Puerto Rico and Can- set forth in Paragraphs A.1.b. and A.1.c., but ada. We assume no responsibility for the only: furnishing of certificates of insurance, or a. If that "auto" is a covered "auto" for Compre- for compliance in any way with the laws hensive Coverage under this policy; of other countries relating to insurance. b. The airbags are not covered under any war- G. WAIVER OF DEDUCTIBLE —GLASS ranty; and 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 glass damage if the glass is repaired rather than LOSS replaced. The following is added to Paragraph A.2.a., of H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF SECTION IV—BUSINESS AUTO CONDITIONS: USE —INCREASED LIMIT Your duty to give us or our authorized representa- The following replaces the last sentence of Para- tive prompt notice of the "accident" or "loss" ap- 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: However, the most we will pay for any expenses (a) You (if you are an individual); for loss of use is $65 per day, to a maximum of (b) A partner (if you are a partnership); $750 for any one "accident". (c) A member (if you are a limited liability com- l. PHYSICAL DAMAGE — TRANSPORTATION pany); EXPENSES—INCREASED LIMIT (d) An executive officer, director or insurance The following replaces the first sentence in Para- manager (if you are a corporation or other or- graph A.4.a., Transportation Expenses, of ganization); or SECTION III — 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 cov- 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- 5. Transfer Of Rights Of Recovery Against age Extensions, of SECTION III — PHYSICAL Others To Us DAMAGE COVERAGE: We waive any right of recovery we may have Personal Property against any person or organization to the ex- tent required of you by a written contract We will pay up to $400 for "loss" to wearing ap- signed and executed prior to any "accident" parel and other personal property which is: or "loss", provided that the "accident" or "loss" (1) Owned by an "insured"; and arises out of operations contemplated by CA T3 53 02 15 ©2015 The Travelers Indemnity Company.All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc.with its permission. Docusign Envelope ID: F37033C6-DE99-44CB-8788-1A992F53D1AA COMMERCIAL AUTO such contract. The waiver applies only to the The unintentional omission of, or unintentional person or organization designated in such error in, any information given by you shall not contract. prejudice your rights under this insurance. How- N. UNINTENTIONAL ERRORS OR OMISSIONS ever this provision does not affect our right to col- The following is added to Paragraph B.2., Con- lect additional premium or exercise our right of cealment, Misrepresentation, Or Fraud, of cancellation or non-renewal. SECTION IV—BUSINESS AUTO CONDITIONS: Page 4 of 4 ©2015 The Travelers Indemnity Compa ny.All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc.with its permission. Docusign Envelope ID:F37033C6-DE99-44CB-8788-1A992F53D1AA 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 II — 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 1 ry 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 III — 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 ©2018 The Travelers Indemnity Company.All rights reserved. Page 1 of 2 Docusign Envelope ID:F37033C6-DE99-44CB-8788-1A992F53D1AA 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 insurance provided to such additional (3) Immediately send us copies of all legal insured is primary to other insurance papers received in connection with the claim available to such additional insured which or "suit", cooperate with us in the covers that person or organization as a investigation or settlement of the claim or named insured as described in Paragraph 4., defense against the "suit", and otherwise Other Insurance, of Section IV — Commercial comply with all policy conditions. General Liability Conditions. Page 2 of 2 ©2018 The Travelers Indemnity Company.All rights reserved. CG D2 46 04 19 Docusign Envelope ID:F37033C6-DE99-44CB-8788-1A992F53D1AA c. Method Of Sharing a. The statements in the Declarations are If all of the other insurance permits contribution accurate and complete; by equal shares, we will follow this method b. Those statements are based upon also. Under this approach each insurer representations you made to us; and contributes equal amounts until it has paid its c. We have issued this policy in reliance upon applicable limit of insurance or none of the loss your representations. remains, whichever comes first. The unintentional omission of, or unintentional If any of the other insurance does not permit error in, any information provided by you which we contribution by equal shares, we will contribute relied upon in issuing this policy will not prejudice by limits. Under this method, each insurer's your rights under this insurance. However, this share is based on the ratio of its applicable provision does not affect our right to collect limit of insurance to the total applicable limits additional premium or to exercise our rights of of insurance of all insurers. cancellation or nonrenewal in accordance with d. Primary And Non-Contributory Insurance If applicable insurance laws or regulations. Required By Written Contract 7. Separation Of Insureds If you specifically agree in a written contract or Except with respect to the Limits of Insurance, and agreement that the insurance afforded to an any rights or duties specifically assigned in this insured under this Coverage Part must apply Coverage Part to the first Named Insured, this on a primary basis, or a primary and nom insurance applies: contributory basis, this insurance is primary to a. As if each Named Insured were the only other insurance that is available to such Named Insured; and insured which covers such insured as a named insured, and we will not share with that other b. Separately to each insured against whom insurance, provided that: claim is made or"suit"is brought. (1) The "bodily injury or"property damage"for 8. Transfer Of Rights Of Recovery Against Others which coverage is sought occurs; and To Us (2) The "personal and advertising injury" for If the insured has rights to recover all or part of any which coverage is sought is caused by an payment we have made under this Coverage Part, offense that is committed; those rights are transferred to us. The insured subsequent to the signing of that contract or must do nothing after loss to impair them. At our agreement by you. request, the insured will bring "suit" or transfer those rights to us and help us enforce them. 5. Premium Audit 9. When We Do Not Renew a. We will compute all premiums for this If we decide not to renew this Coverage Part, we Coverage Part in accordance with our rules will mail or deliver to the first Named Insured and rates. shown in the Declarations written notice of the b. Premium shown in this Coverage Part as nonrenewal not less than 30 days before the advance premium is a deposit premium only. expiration date. At the close of each audit period we will If notice is mailed, proof of mailing will be sufficient compute the earned premium for that period and send notice to the first Named Insured. proof of notice. The due date for audit and retrospective SECTION V— DEFINITIONS premiums is the date shown as the due date 1. "Advertisement" means a notice that is broadcast or on the bill. If the sum of the advance and audit published to the general public or specific market premiums paid for the policy period is greater segments about your goods, products or services than the earned premium, we will return the for the purpose of attracting customers or excess to the first Named Insured. supporters. For the purposes of this definition: c. The first Named Insured must keep records of a. Notices that are published include material the information we need for premium placed on the Internet or on similar electronic computation, and send us copies at such times means of communication; and as we may request. b. Regarding websites, only that part of a website 6. Representations that is about your goods, products or services By accepting this policy, you agree: for the purposes of attracting customers or ourun/nr+inro io <--nnoiHnmrl om orI,IOIQ*iommnmF Page 16 of 21 C 2017 The Travelers Indemnity Company.All rights reserved. CG T1 00 02 19 Docusign Envelope ID:F37033C6-DE99-44CB-8788-1A992F53D1AA COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR MANUFACTURERS AND WHOLESALERS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE —This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Who Is An Insured —Unnamed Subsidiaries H. Blanket Additional Insured — Governmental B. Who Is An Insured — Employees And Volunteer Entities — Permits Or Authorizations Relating To Workers — Bodily Injury To Co-Employees And Operations Co-Volunteer Workers I. Blanket Additional Insured — Grantors Of Franchises C. Who Is An Insured — Newly Acquired Or Formed Limited Liability Companies J. Incidental Medical Malpractice D. Blanket Additional Insured —Broad Form Vendors K. Medical Payments — Increased Limit E. Blanket Additional Insured —Controlling Interest L. Blanket Waiver Of Subrogation F. Blanket Additional Insured —Mortgagees, M. Contractual Liability—Railroads Assignees, Successors Or Receivers G. Blanket Additional Insured — Governmental Entities — Permits Or Authorizations Relating To Premises PROVISIONS A. WHO IS AN INSURED — UNNAMED a. Before you maintained an ownership interest SUBSIDIARIES of more than 50% in such subsidiary; or The following is added to SECTION II — WHO IS b. After the date, if any, during the policy period AN INSURED: that you no longer maintain an ownership Any of your subsidiaries, other than a partnership interest of more than 50% in such subsidiary. or joint venture, that is not shown as a Named For purposes of Paragraph 1. of Section II —Who Insured in the Declarations is a Named Insured if: Is An Insured, each such subsidiary will be a. You are the sole owner of, or maintain an deemed to be designated in the Declarations as: ownership interest of more than 50% in, such subsidiary on the first day of the policy period; a. A limited liability company; and b. An organization other than a partnership, joint b. Such subsidiary is not an insured under venture or limited liability company; or similar other insurance. No such subsidiary is an insured for"bodily injury" C A trust; or "property damage" that occurred, or "personal as indicated in its name or the documents that and advertising injury" caused by an offense govern its structure. corn mitted: CG D4 58 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 1 of 5 Includes copyrighted material of Insurance Services Office,Inc.with its permission Docusign Envelope ID:F37033C6-DE99-44CB-8788-1A992F53D1AA COMMERCIAL GENERAL LIABILITY B. WHO IS AN INSURED — EMPLOYEES AND a. A limited liability company; VOLUNTEER WORKERS—BODILY INJURY TO b. An organization, other than a partnership, CO-EMPLOYEES AND CO-VOLUNTEER WORKERS joint venture or limited liability company; or The following is added to Paragraph 2.a.(1) of SECTION II—WHO IS AN INSURED: c. A trust; Paragraphs (1)(a), (b) and (c) above do not apply as indicated in its name or the documents to "bodily injury" to a co-"employee" while in the that govern its structure. course of the co-"employee's" employment by you D. BLANKET ADDITIONAL INSURED — BROAD or performing duties related to the conduct o f your FORM VENDORS business, or to "bodily injury" to your other "volunteer workers" while performing duties The following is added to SECTION II — WHO IS related to the conduct of your business. AN INSURED: C. WHO IS AN INSURED — NEWLY ACQUIRED Any person or organization that is a vendor and OR FORMED LIMITED LIABILITY COMPANIES that you have agreed in a written contract or The following replaces Paragraph 3. of SECTION agreement to include as an additional insured on II—WHO IS AN INSURED: this Coverage Part is an insured, but only with respect to liability for "bodily injury" or "property 3. Any organization you newly acquire or form, damage" that: other than a partnership or joint venture, and a. Occurs subsequent to the signing of that of which you are the sole owner or in which contract or agreement; and you maintain an ownership interest of more than 50%, will qualify as a Named Insured if b. Arises out of "your products" that are there is no other similar insurance available to distributed or sold in the regular course of that organization. However: such vendor's business. a. Coverage under this provision is afforded The insurance provided to such vendor is subject only: to the following provisions: (1) Until the 180th day after you acquire a. The limits of insurance provided to such or form the organization or the end of vendor will be the minimum limits that you the policy period, whichever is earlier, agreed to provide in the written contract or if you do not report such organization agreement, or the limits shown in the in writing to us within 180 days after Declarations,whichever are less. you acquire or form it; or b. The insurance provided to such vendor does (2) Until the end of the policy period, not apply to: when that date is later than 180 days (1) Any express warranty not authorized by after you acquire or form such you or any distribution or sale for a organization, if you report such purpose not authorized by you; organization in writing to us within 180 days after you acquire or form it; (2) Any change in "your products" made by b. Coverage A does not apply to "bodily such vendor; injury"or"property damage" that occurred (3) Repackaging, unless unpacked solely for before you acquired or formed the the purpose of inspection, demonstration, organization; and testing, or the substitution of parts under c. Coverage B does not apply to "personal instructions from the manufacturer, and and advertising injury" arising out of an then repackaged in the original container; offense committed before you acquired or (4) Any failure to make such inspections, formed the organization. adjustments, tests or servicing as For the purposes of Paragraph 1. of Section II vendors agree to perform or normally —Who Is An Insured, each such organization undertake to perform in the regular will be deemed to be designated in the course of business, in connection with the Declarations as: distribution or sale of"your products"; Page 2 of 5 ©2017 The Travelers Indemnity Company.All rights reserved. CG D4 58 02 19 Includes copyrighted material of Insurance Services Office,Inc.with its permission Docusign Envelope ID:F37033C6-DE99-44CB-8788-1A992F53D1AA COMMERCIAL GENERAL LIABILITY (5) Demonstration, installation, servicing or liability as mortgagee, assignee, successor or repair operations, except such operations receiver for "bodily injury", "property damage" or performed at such vendor's premises in "personal and advertising injury"that: connection with the sale of "your a. Is "bodily injury" or "property damage" that products"; or occurs, or is "personal and advertising injury" (6) "Your products" that, after distribution or caused by an offense that is committed, sale by you, have been labeled or subsequent to the signing of that contract or relabeled or used as a container, part or agreement; and ingredient of any other thing or substance b. Arises out of the ownership, maintenance or by or on behalf of such vendor. use of the premises for which that mortgagee, Coverage under this provision does not apply to: assignee, successor or receiver is required a. Any person or organization from whom you under that contract or agreement to be have acquired "your products", or any included as an additional insured on this ingredient, part or container entering into, Coverage Part. accompanying or containing such products; The insurance provided to such mortgagee, or assignee, successor or receiver is subject to the b. Any vendor for which coverage as an following provisions: additional insured specifically is scheduled by a. The limits of insurance provided to such endorsement. mortgagee, assignee, successor or receiver E. BLANKET ADDITIONAL INSURED — will be the minimum limits that you agreed to CONTROLLING INTEREST provide in the written contract or agreement, or the limits shown in the Declarations, 1. The following is added to SECTION II —WHO whichever are less. IS AN INSURED: b. The insurance provided to such person or Any person or organization that has financial organization does not apply to: control of you is an insured with respect to liability for "bodily injury", "property damage" (1) Any "bodily injury" or "property damage" or"personal and advertising injury"that arises that occurs, or any "personal and out of: advertising injury" caused by an offense that is committed, after such contract or a. Such financial control; or agreement is no longer in effect; or b. Such person's or organization's (2) Any "bodily injury", "property damage" or ownership, maintenance or use of "personal and advertising injury" arising premises leased to or occupied by you. out of any structural alterations, new The insurance provided to such person or construction or demolition operations organization does not apply to structural performed by or on behalf of such alterations, new construction or demolition mortgagee, assignee, successor or operations performed by or on behalf of such receiver. person or organization. G. BLANKET ADDITIONAL INSURED — 2. The following is added to Paragraph 4. of GOVERNMENTAL ENTITIES — PERMITS OR SECTION II—WHO IS AN INSURED: AUTHORIZATIONS RELATING TO PREMISES This paragraph does not apply to any The following is added to SECTION II — WHO IS premises owner, manager or lessor that has AN INSURED: financial control of you. Any governmental entity that has issued a permit F. BLANKET ADDITIONAL INSURED — or authorization with respect to premises owned MORTGAGEES, ASSIGNEES, SUCCESSORS or occupied by, or rented or loaned to, you and OR RECEIVERS that you are required by any ordinance, law, The following is added to SECTION II — WHO IS building code or written contract or agreement to AN INSURED: include as an additional insured on this Coverage Part is an insured, but only with respect to liability Any person or organization that is a mortgagee, for "bodily injury", "property damage" or "personal assignee, successor or receiver and that you and advertising injury" arising out of the have agreed in a written contract or agreement to existence, ownership, use, maintenance, repair, include as an additional insured on this Coverage construction, erection or removal of any of the Part is an insured, but only with respect to its following for which that governmental entity has CG D4 58 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 3 of 5 Includes copyrighted material of Insurance Services Office,Inc.with its permission Docusign Envelope ID:F37033C6-DE99-44CB-8788-1A992F53D1AA COMMERCIAL GENERAL LIABILITY issued such permit or authorization: advertising services", first aid or "Good Samaritan signs, awnings, canopies, cellar entrances, coal services" to a person, unless you are in holes, driveways, manholes, marquees, hoist the business or occupation of providing away openings, sidewalk vaults, elevators, street professional health care services. banners or decorations. 2. The following replaces the last paragraph of H BLANKET ADDITIONAL INSURED — Paragraph 2.a.(1) of SECTION II — WHO IS GOVERNMENTAL ENTITIES — PERMITS OR AN INSURED: AUTHORIZATIONS RELATING TO OPER- Unless you are in the business or occupation ATIONS of providing professional health care services, The following is added to SECTION II — WHO IS Paragraphs (1)(a), (b), (c) and (d) above do AN INSURED: not apply to "bodily injury" arising out of Any governmental entity that has issued a permit providing or failing to provide: or authorization with respect to operations (a) "Incidental medical services" by any of performed by you or on your behalf and that you your "employees" who is a nurse, nurse are required by any ordinance, law, building code assistant, emergency medical technician, or written contract or agreement to include as an additional insured on this Coverage Part is an paramedic, athletic trainer, audiologist, insured, but only with respect to liability for"bodily dietician, nutritionist, occupatio nal injury", "property damage" or "personal and therapist or occupational therapy advertising injury" arising out of such operations. assistant, physical therapist or speech- The insurance provided to such governmental language pathologist; or entity does not apply to: (b) First aid or "Good Samaritan services" by any of your "employees" or "volunteer a. Any "bodily injury", "property damage" or workers", other than an employed or "personal and advertising injury" arising out of operations performed for the governmental volunteer doctor. Any such "employees" entity; or or "volunteer workers" providing or failing to provide first aid or "Good Samaritan b. Any "bodily injury" or "property damage" services" during their work hours for you included in the "products-completed will be deemed to be acting within the operations hazard". scope of their employment by you or I. BLANKET ADDITIONAL INSURED — performing duties related to the conduct GRANTORS OF FRANCHISES of your business. The following is added to SECTION II — WHO IS 3. The following replaces the last sentence of AN INSURED: Paragraph 5. of SECTION III — LIMITS OF Any person or organization that grants a franchise INSURANCE: to you is an insured, but only with respect to For the purposes of determining the liability for "bodily injury", "property damage" or applicable Each Occurrence Limit, all related "personal and advertising injury" arising out of acts or omissions committed in providing or your operations in the franchise granted by that failing to provide "incidental medical person or organization. services", first aid or "Good Samaritan If a written contract or agreement exists between services"to any one person will be deemed to you and such additional insured, the limits of be one "occurrence". insurance provided to such insured will be the 4. The following exclusion is added to minimum limits that you agreed to provide in the Paragraph 2., Exclusions, of SECTION I — written contract or agreement, or the limits shown COVERAGES — COVERAGE A — BODILY in the Declarations, whichever are less. INJURY AND PROPERTY DAMAGE J. INCIDENTAL MEDICAL MALPRACTICE LIABILITY: 1. The following replaces Paragraph b. of the Sale Of Pharmaceuticals definition of "occurrence" in the "Bodily injury" or "property damage" arising DEFINITIONS Section: out of the violation of a penal statute or b. An act or omission committed in providing ordinance relating to the sale of pharmaceuticals committed by, or with the or failing to provide "incidental medical knowledge or consent of,the insured. Page 4 of 5 ©2017 The Travelers Indemnity Company.All rights reserved. CG D4 58 02 19 Includes copyrighted material of Insurance Services Office,Inc.with its permission Docusign Envelope ID:F37033C6-DE99-44CB-8788-1A992F53D1AA COMMERCIAL GENERAL LIABILITY 5. The following is added to the DEFINITIONS a. $10,000; or Section: b. The amount shown in the Declarations of "Incidental medical services" means: this Coverage Part for Medical Expense a. Medical, surgical, dental, laboratory, x-ray Limit. or nursing service or treatment, advice or L. BLANKET WAIVER OF SUBROGATION instruction, or the related furnishing of The following is added to Paragraph 8., Transfer food or beverages; or Of Rights Of Recovery Against Others To Us, b. The furnishing or dispensing of drugs or of SECTION IV — COMMERCIAL GENERAL medical, dental, or surgical supplies or LIABILITY CONDITIONS: appliances. If the insured has agreed in a contract or 6. The following is added to Paragraph 4.b., agreement to waive that insured's right of Excess Insurance, of SECTION IV — recovery against any person or organization, we COMMERCIAL GENERAL LIABILITY waive our right of recovery against such person or CONDITIONS: organization, but only for payments we make This insurance is excess over any valid and because of: collectible other insurance, whether primary, a. "Bodily injury" or "property damage" that excess, contingent or on any other basis, that occurs; or is available to any of your "employees" for "bodily injury" that arises out of providing or b. "Personal and advertising injury" caused by failing to provide "incidental medical services" an offense that is committed; to any person to the extent not subject to subsequent to the execution of the contract or Paragraph 2.a.(1) of Section II — Who Is An agreement. Insured. M. CONTRACTUAL LIABILITY—RAILROADS K. MEDICAL PAYMENTS—INCREASED LIMIT 1. The following replaces Paragraph c. of the The following replaces Paragraph 7. of SECTION definition of "insured contract" in the III—LIMITS OF INSURANCE: DEFINITIONS Section: 7. Subject to Paragraph 5. above, the Medical c. Any easement or license agreement; Expense Limit is the most we will pay under 2. Paragraph f.(1) of the definition of "insured Coverage C for all medical expenses contract" in the DEFINITIONS Section is because of "bodily injury" sustained by any deleted. one person, and will be the higher of: CG D4 58 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 5 of 5 Includes copyrighted material of Insurance Services Office,Inc.with its permission Docusign Envelope ID:F37033C6-DE99-44CB-8788-1A992F53D1AA TRA VELERl ik WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 00 0313 (00) - 001 POLICY NUMBER: UB-2Y517 642-24-14—G 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 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 any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. DATE OF ISSUE: ST ASSIGN: PAGE 1 OF1 Page 1 of 1 ' r DATE(MM/DD/YYY f YW) CERTIFICATE OF LIABILITY INSURANCE 09/03/2024 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 WTW Certificate Center NAME: Willis Towers Watson Northeast, Inc. (AE /O,No,Ext):N 1-877-945-7378 (A/C,No): 1-888-467-2378 c/o 26 Century Blvd E-MAIL P.O. Box 305191 ADDRESS: certificates @ wtwco.com Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: The Charter Oak Fire Insurance Company 25615 INSURED INSURER B: Travelers Indemnity Company of CT 25682 PumpTech, LLC dba PumpTech Integration 12020 SE 32nd St, Suite 2 INSURER C: Travelers Property Casualty Company of Ame 25674 Bellevue, WA 98005 INSURER D: Travelers Property Casualty Insurance Comp 36161 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W34623526 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W LIMITS LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $ 300,000 A MED EXP(Any one person) $ 5,000 Y-630-331D063A-COF-24 08/26/2024 08/26/2025 1,000,000 PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X JECT PO- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED 810-1Y037218-24-14-G 08/26/2024 08/26/2025 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 C X EXCESS LIAB CLAIMS-MADE EX-4Y788505-24-14 08/26/2024 08/26/2025 AGGREGATE $ 10,000,000 DED RETENTION$ $ WORKERS COMPENSATION X PER AND EMPLOYERS'LIABILITY STATUTE ERH Y/N D ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? No N/A UB-4Y056146-24-14-G 08/26/2024 08/26/2025 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Bremerton is included as an Additional Insured as respects to General Liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE City of Bremerton 345 6th Street, Suite 100 p °- Bremerton, WA 98337-1891 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD sR ID: 26386389 BATCH: 3605236 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR MANUFACTURERS AND WHOLESALERS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE —This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Who Is An Insured —Unnamed Subsidiaries H. Blanket Additional Insured — Governmental B. Who Is An Insured — Employees And Volunteer Entities — Permits Or Authorizations Relating To Workers — Bodily Injury To Co-Employees And Operations Co-Volunteer Workers I. Blanket Additional Insured — Grantors Of Franchises C. Who Is An Insured — Newly Acquired Or Formed Limited Liability Companies J. Incidental Medical Malpractice D. Blanket Additional Insured —Broad Form Vendors K. Medical Payments — Increased Limit E. Blanket Additional Insured —Controlling Interest L. Blanket Waiver Of Subrogation F. Blanket Additional Insured —Mortgagees, M. Contractual Liability—Railroads Assignees, Successors Or Receivers G. Blanket Additional Insured — Governmental Entities — Permits Or Authorizations Relating To Premises PROVISIONS A. WHO IS AN INSURED — UNNAMED a. Before you maintained an ownership interest SUBSIDIARIES of more than 50% in such subsidiary; or The following is added to SECTION II — WHO IS b. After the date, if any, during the policy period AN INSURED: that you no longer maintain an ownership Any of your subsidiaries, other than a partnership interest of more than 50% in such subsidiary. or joint venture, that is not shown as a Named For purposes of Paragraph 1. of Section II —Who Insured in the Declarations is a Named Insured if: Is An Insured, each such subsidiary will be a. You are the sole owner of, or maintain an deemed to be designated in the Declarations as: ownership interest of more than 50% in, such subsidiary on the first day of the policy period; a. A limited liability company; and b. An organization other than a partnership, joint b. Such subsidiary is not an insured under venture or limited liability company; or similar other insurance. No such subsidiary is an insured for"bodily injury" C A trust; or "property damage" that occurred, or "personal as indicated in its name or the documents that and advertising injury" caused by an offense govern its structure. corn mitted: CG D4 58 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 1 of 5 Includes copyrighted material of Insurance Services Office,Inc.with its permission COMMERCIAL GENERAL LIABILITY B. WHO IS AN INSURED — EMPLOYEES AND a. A limited liability company; VOLUNTEER WORKERS—BODILY INJURY TO b. An organization, other than a partnership, CO-EMPLOYEES AND CO-VOLUNTEER WORKERS joint venture or limited liability company; or The following is added to Paragraph 2.a.(1) of SECTION II—WHO IS AN INSURED: c. A trust; Paragraphs (1)(a), (b) and (c) above do not apply as indicated in its name or the documents to "bodily injury" to a co-"employee" while in the that govern its structure. course of the co-"employee's" employment by you D. BLANKET ADDITIONAL INSURED — BROAD or performing duties related to the conduct o f your FORM VENDORS business, or to "bodily injury" to your other "volunteer workers" while performing duties The following is added to SECTION II — WHO IS related to the conduct of your business. AN INSURED: C. WHO IS AN INSURED — NEWLY ACQUIRED Any person or organization that is a vendor and OR FORMED LIMITED LIABILITY COMPANIES that you have agreed in a written contract or The following replaces Paragraph 3. of SECTION agreement to include as an additional insured on II—WHO IS AN INSURED: this Coverage Part is an insured, but only with respect to liability for "bodily injury" or "property 3. Any organization you newly acquire or form, damage" that: other than a partnership or joint venture, and a. Occurs subsequent to the signing of that of which you are the sole owner or in which contract or agreement; and you maintain an ownership interest of more than 50%, will qualify as a Named Insured if b. Arises out of "your products" that are there is no other similar insurance available to distributed or sold in the regular course of that organization. However: such vendor's business. a. Coverage under this provision is afforded The insurance provided to such vendor is subject only: to the following provisions: (1) Until the 180th day after you acquire a. The limits of insurance provided to such or form the organization or the end of vendor will be the minimum limits that you the policy period, whichever is earlier, agreed to provide in the written contract or if you do not report such organization agreement, or the limits shown in the in writing to us within 180 days after Declarations,whichever are less. you acquire or form it; or b. The insurance provided to such vendor does (2) Until the end of the policy period, not apply to: when that date is later than 180 days (1) Any express warranty not authorized by after you acquire or form such you or any distribution or sale for a organization, if you report such purpose not authorized by you; organization in writing to us within 180 days after you acquire or form it; (2) Any change in "your products" made by b. Coverage A does not apply to "bodily such vendor; injury"or"property damage" that occurred (3) Repackaging, unless unpacked solely for before you acquired or formed the the purpose of inspection, demonstration, organization; and testing, or the substitution of parts under c. Coverage B does not apply to "personal instructions from the manufacturer, and and advertising injury" arising out of an then repackaged in the original container; offense committed before you acquired or (4) Any failure to make such inspections, formed the organization. adjustments, tests or servicing as For the purposes of Paragraph 1. of Section II vendors agree to perform or normally —Who Is An Insured, each such organization undertake to perform in the regular will be deemed to be designated in the course of business, in connection with the Declarations as: distribution or sale of"your products"; Page 2 of 5 ©2017 The Travelers Indemnity Company.All rights reserved. CG D4 58 02 19 Includes copyrighted material of Insurance Services Office,Inc.with its permission Page 1 of 2 DATE (MMIDD/YYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE ��. 08/26/2024 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 WTW Certificate Center NAME: Willis Towers Watson Northeast, Inc. FAX PHONE 1-677-945-7378 1-888-467-2378 c/o 26 Century Blvd A/C Ext : ArC No : P.O. Box 305191 ADDRESS: certificates@wtwco.com Nashville, TN 372305191 USA INSURERS AFFORDING COVERAGE NAIC # INSURERA: The Charter Oak Fire Insurance Company 25615 INSURED INSURERB: Travelers Indemnity Company of CT 25682 PumpTech, LLC 12020 SE 32nd St, suite 2 INSURERC: Travelers Property Casualty Company of Ame 25674 Bellevue, WA 98005 INSURERD: Travelers Property Casualty Insurance Compi 36161 nnVrRAr;FS rFRTIFIrATF NIIMRFR: W34538412 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDLJSUBR - - PLI OCY EFF POLICY EXP LIMITS LTp POLICYNUMBEfl MMIDD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300,000 ._ _ __- MED EXP (Any one person) $ 5,000 A Y Y Y-630-331D063A-COF-24 08/26/2024 08/26/2025 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY L I JECT PRO- u LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _LEa accident $ 1,000,000 $ X ANY AUTO BODILY INJURY (Per person) B OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Y Y 810-1Y037218-24-14-G 08/26/2024 08/26/2025 BODILY INJURY (Per accident) $ PROPERTY DAMAGE _(Per acciden -_ C UMBRELLA LIAB X OCCUR EXCESS LIAB CLAIMS -MADE Y Y EX-4Y788505-24-14 08/26/2024 08/26/2025 EACHOCCURRENCE $ 10,000,000 X AGGREGATE $ 10,000,000 DED RETENTION$ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER MEMBEREXCLUDED? No (Mandatory In NH) N/A Y UB-4YO56146-24-14-G 08/26/2024 08/26/2025 X STATUTE I I ER E.L. EACH ACCIDENT --- --_ --- — -- -- E.L. DISEASE - EA EMPLOYEE $ 1,000,000 $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 It yes, describe under DESCRIPTION OF OPERATIONS below A WA Stop Gap Y-630-331D063A-COF-24 08/26/2024 DB/26/2025 E.L. Each Accident $1,000,000 E.L. Disease - Ea E $1,000,000 E.L. Disease- Policy $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Parametrix Project Number/Name: ff233-1896-8BL / Decommission Beach Sewer in Manette (OF-4 to EB-2) City of Bremerton is included as Additional Insured as respects to General Liability, Auto Liability and Umbrella/Excess Liability. General Liability shall be Primary and Non -Contributory with any other insurance in force for or which may be rCo'rlcl!`A'rC LJr1I n1:112 f:ANI`.FI I ATInN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE RECEIVED C 11 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. SEP 1 0 2024 AUTHORIZED REPRESENTATIVE City of Bremerton 345 6th St., Suite 100 Bremerton, WA 98337 City of Bremerton r1lbiN IvIallayVilivi rt U 19HH-2U1b ACUHU GUHPUHA I IUN. All rignts reserves. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD sn ID: 26351518 BArch: 3595472 251: 2 ' of 10 AGENCY CUSTOMER ID: LOC #: AC40R" ADDITIONAL REMARKS SCHEDULE Page 2 Of 2 AGENCY NAMED INSURED Willis Towers Watson Northeast, Inc. PumpTech, LLC 12020 SE 32nd St, Suite 2 Bellevue, WA 98005 POLICY NUMBER See Page I CARRIER NAIC CODE See Page 1 Sea Page 1 . EFFECTIVE DATE: See Page I ACORD 101 (2008/01) @ 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 26351518 13ATCH: 3595472 CERT: W34538412 251: 2 of 10 COMMERCIAL AUTO ,61OLICYNUMBER: 810—lYD37218-24-14—G ISSUE DATE: 08-26-24 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LESSOR - ADDITIONAL INSURED AND LOSS PAYEE 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 modi- fied by the endorsement. SCHEDULE Insurance Company: THE TRAVELERS INDEMNITY COMPANY OF CONNECTICUT Policy dumber: 810-1Y037218-24-14—G Expiration Date: 08-26-25 Named Insured: PUMPTECH HOLDINGS LLC AND AS PER IL F1 18 Address: 12020 SE 32ND ST #2 BELLEVUE WA 98005 Additional Insured (Lessor): SEE SCHEDULE Address: Effective Date: 08-26-24 Designation Or Description Of "Leased Autos": ANY AUTO LEASED FOR A PERIOD OF SIX MONTHS OR MORE UNDER A LEASING CONTRACT OR AGREEMENT THAT REQUIRES YOU TO PROVIDE DIRECT PRIMARY INSURANCE FOR THE LESSOR Coverages Limit Of Insurance Covered Autos Liability $ 1, 000, 000 Each "Accident" Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus Comprehensive $ Deductible For Each Covered "Leased Auto" Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus Collision $ Deductible For Each Covered "Leased Auto" Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus Specified $ Deductible For Each Covered "Leased Auto" Causes Of Loss Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CA 20 01 1013 @Insurance Services Office, Inc., 2011 Page I of 3 251: 3 ' of 10 COMMERCIAL AUTO A. Coverage 1. Any "leased auto" designated ordescribed in the Schedule will be considered u covered "auto" you own and not acovered "auto"you hire orborrow. 2. For e"leased auto" designated nrdescribed inthe Schedule, the Who Is An Insured pro- vision under Covered Autos Liability Cov- erage iechanged io include as an "insured" the lessor named in the Schedule. However, the lessor iean "inoumd,only for "bodily |n- jury"or"property damage" resulting from the acts oromissions by: m. You; . b. Any ofyour "emp|oyees"oragents; or c. Any person, except the lessor or any ^emp|nyen^oragent ofthe lessor, operat- ing a"|easedauho"wdhthopermisskonof any ofthe above. 3. The coverages provided under this endorse- ment apply to any "leased auto" described in the Schedule until the expiration date shown in the Schedule, or when the lessor or his or her agent takes poaaoao|on of the "leased auto''.whichever occurs first. B. Loss Payable Clause 1. We will pay, as interest may appear, and the lessor named in this endorsement for Page 2 of 3 2. The insurance covers the interest ofthe les- sor unless the "loss" results from fraudulent acts oromissions onyour part. 3. /fwemake any payment iothe lessor, mmwill obtain his or he/ rights against any other party, C. Cancellation 1. If we cancel the policy, we will mail notice to the lessor inaccordance with the Cancellation Common Policy Condition. 2. If you cancel the policy, we will mail notice to the lessor. 3. Cancellation ends this agreement. D. The lessor is not liable for payment ofyour pre- miums. E. Additional Definition Aaused inthis endorsement: "Leased auto" means an"au\o" leased nrrented to you, including any substitute, replacement or extra "auto" needed to maa| seasonal or other needs, under uleasing or rental agreement that requires you to provide direct primary insurance for the lessor. @ Insurance Services office, |no,2811 251: 3 of IC COMMERCIAL THIS ENDORSEMENTAPOLICY. PLEASE READ IT CAREFULL LESSOR - ADDITIONAL INSURED AND LOSS PAYEJ Schedule Extension Additional Insured (Lessor): ANY LESSOR UNDER A LEASING CONTRACT OR AGREEMENT OF SIX MONTHS OR MORE THAT REQUIRES YOU TO PROVIDE DIRECT PRIMARY INSURANCE FOR THE LESSOR CA 20 01 1013 © Insurance Services Office, Inc,, 2011 Page 3 of 3 251: 4 ` of 10 COMMERCIAL AUTO This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages, Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BROAD FORM NAMEDR B. BLANKET ADDITIONAL INSURED C. EMPLOYEE HIRED AUTO INSUREDD. EMPLOYEES AS E. SUPPLEMENTARY PAYMENTS — INCREAS LIMITS F. HIRED AUTO — LIMITED WORLDWIDE CO INDEMNITY BASIS G. WAIVER OF DEDUCTIBLEGLASS .3a -y., , The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any organization you newly acquire or form dur- ing the policy period over which you maintain 50% or more ownership interest and that is not separately insured for Business Auto Coverage. Coverage under this provision is afforded only un- til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- ever is earlier. The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be narned as an addi- tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which H. HIRED AUTO PHYSICAL DAMAGE INCREASED., - 1. PHYSICAL DAMAGE — TRANSPORTATI EXPENSES — INCREASED LIMIT J. PERSONAL PROPERTY L. NOTICE AND KNOWLEDGE OF ACCIDENT 0 K. AIRBAGS BLANKETM. UNINTENTIONALA. Rx _'' OMISSIONS this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. C. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION 11 -- COV- ERED AUTOS LIABILITY COVERAGE: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your busi- ness. 2. The following replaces Paragraph b. in B.S., Other Insurance, of SECTION IV -4 BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your CA T3 53 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. 251: 4 of 10 i COMMERCIAL AUTO permission, while performing dudes related to the conduct of your busi- ness. However, any "auto" that is leased. Nred, rented orborrowed with a driver is not a covered "auto". The following isadded hoParagraph A.1..Who |s AnInsured, ofSECTION U—COVERED AUTOS LIABILITY COVERAGE: Any "emp|oyee"ofyours iyan"inauved"while us- ing acoveved "auto" you don't own, hire orborrow inyour business oryour personal affairs. E. SUPPLEMENTARY PAYMENTS —INCREASED LIMITS The following replaces ParagmohA2.a.(2). ofSECTION U—COVERED AUTOS LIABIL- ITY [OVERAGE: CB Up to $3.000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. Z The following replaces Paragraph A^I.m.NQ. ofSECTION U—COVERED AUTOS LIABIL- ITY (a) With respect to any dahn made or "suit" brought outside the United States of America, the territories and possessions of the United S\ahso of America, Puerto Rico and Canada: (|) You must arrange to defend the "in- sured" against, and investigate orset- tle anysuchdaim mr"sub"and keep us advised of all proceedings and ac- tions. (U) Neither you nor any other involved "insured" will make any settlement without our consent. (U|)VVe may, at our discretkon, participate indefending the "insured" against, o/ in the settlement of, any claim o/ (iv) We will reimburse the "insured" for sums that the "insured" legally must pay as damages because of "bodily injury" o/"property damage" to which this insurance appUes, that the "in- sured" pays with our consend, but only up to the limit described in Para- graph C.. Limits Of Insurance, of SECTION U — COVERED AUTOS LIABILITY COVERAGE. All reasonable expenses incurred by the k� We will reimburse the "insured" forNA at our request including actual the reasonable expenses incurred with our consent for your inv�sJiga- |oys of earnings up to $500 a day be- loss don of such claims and your defense causnc�Umom��omwork ' of the "insured" against any such F. HIRED AUTO — LIMITED WORLDWIDE COV- "sui[', but only up to and included EAAGE—INDEMNITY BASIS within the limit described in Para - The following replaces Subparagraph(5)in Para- graph C.. Limits Of Insurance, of graph B.7.. Policy Period,�ESECTION od, Coverage Territory, || — COVERED AUTOS of SECTION |V — BUSINESS AUTO{�OND|' LIABILITY COVERAGE, and not in ' T|ONS addition to such limit. Our duty to ' make such payments ends when we (5) Anywhere in the world, except any country or have used up the applicable limit of jurisdiction while any trade sanctinn, em' insurance in payments for damages, bargo, or similar regulation imposed by the settlements o/defense expenses. United States of America applies to and pro- 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 eoed Autos Liability Coverage for any covered to the "insured" whether primary. excess. "auto" that you |eaae, hire' rent or borrow contingent oronany other basis. without driver for a period o/30 days or less (c) This insurance is not a substitute for re - and that is not an "auto" you |ease, hire, rent quired o/ compulsory insurance in any or borrow from any of your "emp|oyems", country outside the United Sta\es, its ter - partners (if you are u partnership), members /hohosand possessions. Puerto Rico and (if you are a limited liability company) or Canada. members of their households. Page 2of4 mzn10The Travelers Indemnity Company. All rights reserved. CAT3S3O215 Includes copyrighted material mInsurance Services Office, Inc. with its permission. e1.s'mm COMMERCIAL AUTO You agree to maintain all required or compulsory insurance in any such coun- try up to the minimum limits required by local law. Your failure to comply with compulsory insurance requirements will not invalidate the coverage afforded by this policy, but we will only be liable to the same extent we would have been liable had you complied with the compulsory in- sun*ncerequiremenis. (d) It is understood that vveare not an admit- ted o/ authorized insurer outside the United States of America, its territories and possessions, Puerto Rico and Can- ada, We assume no responsibility for the furnishing of certificates of insurance, o/ for compliance in any way with the laws of other countries relating to insurance. G. WAIVER OFQEDUCTBLE—GLASS The following is added to Paragraph D.. Deducti- ble, of SECTION U| — PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage J the glass is repaired rather than replaced. H. H(REDAUTOPHYSI[ALDAMAGE—LOSS OF USE — INCREASED LIMIT The following replaces the last sentence nfPara- graph A.4`b.' Loss Of Use Expenses. of SEC- TION III — PHYSICAL DAMAGE COVERAGE: Huwever, the most we will pay for any expenses for loss of use is $65 per day, to a maximum of $750for any one "accideni" |. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT The following replaces the first sentence in Para- graph A.4.a.. Transportation Expenses, of SECTION U| — PHYSICAL DAMAGE COVER- AGE: We will pay up Lo$50 per day bza maximum of $1.500 for temporary transportation expense in - curved by you because of the total theft of cov- ered "auto" of the private passenger type, J. PERSONAL PROPERTY The following isadded toParagraph &4.'Cover- age Extensions, of SECTION U| — PHYSICAL DAMAGE COVERAGE: Personal Property We will pay up iu$408 for "loss" to wearing ap- parel and other personal property which is: (1) Owned by an "insured"; and (2) |norunyour covered "auho' This coverage applies only in the event of total theft ufyour covered "auto" No deductibles apply to this Personal Property coverage. K. AIRBAGS The following isadded (n Paragraph B.3.. Exclu- sions, of SECTION |U—PHYS|CAL DAMAGE COVERAGE: Exclusion ].a.does not apply to"|oss"ioone or more airbags in a covered "auto" You own thatin- f|ahe due to a cause other than a cause of "loss" yet forth in Paragraphs A.1.1b, and A.1.c., but a If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated. We will pay up\oa maximum of$1.000for any L. NOTICE AND KNOWLEDGE QFACCIDENT OR LOSS The following is added to Paragraph A.2,o.. of SECTION |V—BUSINESS AUTO CONDITIONS: Your duty to give vs orour authorized representa- tive prompt notice of the "accident" or "loss" ap- plies only when the "accident" or "loss" is known to: (a) You (if you are anindivWua0; (6) Apartner (if you are apartncmhip); (c) A member (if you are a limited liability com- pany); (d) An executive officer, director or insurance manage/ (if you are a corporation or other or- ganization); or (e) Any "employee" authorized by you to give no- tice K0. BLANKET WAIVER {)F SUBROGATION The following replaces Paragraph /\.S.' Transfer Of Rights Of Recovery Against Others To Um` of SECTION |V — BUSINESS AUTO CONDI- TIONS: S. Transfer Of Rights Of Recovery Against Others ToUs We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract signed and executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by CAT353O215 wzo10The Travelers Indemnity Company. All rights reserved. Page 3of4 Includes copyrighted material of InSUrance Services Office, Inc. with its permission, COMMERCIAL AUTO such contract. The waiver applies only h/the person o/ organization designated in such N. UNINTENTIONAL ERRORS OR OMISSIORS The following is added to Paragraph B.2., Con- cealment, Misrepresentation, Or Fraud, of SECTION IV — BUSINESS AUTO CONDITIONS: The unintentional omission of, or unintentional error in, any information given by you shall not prejudice your rights under this insurance, How- ever this provision does not affect our right hxcol- lect additional premium or exercise our right of cancellation nrnon-renewai Page 4of4 Ocm1uThe Travelers Indemnity mnpa ny.All rights reserved CA T353 0215 Includes copyrighted material of Insurance Services Office, Inc. with its permission. 2s1.o'mm COMMERCIAL GENERAL LIABILITY BLANKET ADDITIONAL INSURED 'includes Products -Completed Operations If Required By Contract) This endorsement modifies insurance providedunder the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following isadded toSECTION U—WHO |SAN INSURED: Any person or organization that you agree in a written contract or agreement to include as an additional insured on this Coverage Pail is an insured, but only: a. With respect to liability for "bodily injury" or "property damage" that occurs. or for "personal injury" caused by an offense that is commitied, subsequent to the signing of that contract or agreement and while that part of the contract or agreement is in effect: and b. If, and only to the extent that, such injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the written contract or agreement app|iea. Such person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such pet -son ororganization, The insurance provided Vosuch additional insured is subject k»the following provisions: a' If the Limits of Insurance of this Coverage Part shown in the Declarations exceed the minimum limits required by the written contract or agreement the insurance provided to the additional insured will be limited to such minimum required limits. For the purposes of determining whether this limitation app|ies, the minimum limits required by the written contract or agreement will be considered to include the minimum limits of any Umbrella or Excess liability coverage required for the additional insured by that written contract o/ agreement. This provision will not increase the limits of insurance described in Section U|| — Limits Of Insurance. (1) Any "bodily injury", "property damage" or "personal injury" arising out of the prmviding, or failure to prnvde, any pnzhessional a»chitechura|, engineering o, surveying sen/ices.inc|uding: (a) The prepahng, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders or change ordecs, or the preparing, apprmvimg, or failing N prepare or approve, drawings and specifications; and (b) Supervisory, inspedion, architectural or engineering activities, (2) Any "bodily injury" or "property damage" caused by "your work" and included in the "prod ucis-comV|eted operations hazard" unless the written contract or agreement specifically requires you to provide such coverage for that additional insured during the policy period. c. The additional insured must comply with the following duties: (1) Give us written notice as sown as practicable of an "occurrence" or an offense which may result inaclaim. Tuthe extent possible, such notice should include: (a) Hmw, when and where the "occurrence'[ o/offense took place; (b) The names and addresses ofany injured persons and witnesses; and (c) The nature and location of any injury or damage arising out of the "occurrence" or offense. b. The insurance provided to such additional (2) |faclaim ismade ox"suit"isbrought against insured does not apply to: the additional insured: CE;D24GD419 0 2018 The Travelers Indeirinity Company. All rights reserved. Page 1 of 2 COMMERCIAL GENERAL LIABILITY (a) Immediately record the specifics of the claim or"suh"and the date received; and (h) Notify us as soon as practicable and see to it that we receive written notice of the claim ur"suh"assoon aapracticable. (3) Immediately send us copies of all legal papers received in connection with the claim o/ "suit', cooperate with us in the investigation or settlement of the claim or defense against the "yuif', and otherwise comply with all policy conditions. NU Tender the defense and indemnity of any claim or ''suk" to any provider of other insurance which would cover such additional insured fora loss we cover. Hmvever, this condition does not affect whether the insurance provided to such additional insured is primary to other insurance available to such additional insured which covers that person or organization as a named insured asdescribed inParagraph 4,. Other Insurance, of Section |V—Commercia| General Liability Conditions. Page 2of2 DmmThe Travelers momnniwCompany. All rights mseme . Ismox-ral Am m1:/'am COMMERCIAL GENERAL LIABILITY B, WHO IS AN INSURED — EMPLOYEES AND VOLUNTEER WORKERS — BODILY INJURY TO CO -EMPLOYEES AND CO -VOLUNTEER WORKERS The following is added to Paragraph 2.a.(1) of SECTION U—WHO |SA0INSURED: Paragraphs d (c) above do not apply to "bodily injury" to a co -"employee" while in the course of the co -"employee's" employment by you or performing duties related to the conduct 0 f Your business, or to "bodily injury" to your other "volunteer workers" while performing duties related to the conduct of your business. C. WHO IS AN INSURED — NEWLY ACQUIRED OR FORMED LIMITED LIABILITY COMPANIES The following replaces Paragraph 3. of SECTION U—VVHO|SANYNSURED: 3. Any organization you newly acquire or form, other than a partnership orjoint venture, and of which You are the sole owner or in which You maintain an ownership interest of more than 50Y4. will qualify as a Named Insured if there isnoother similar insurance available to that organization. However: a' Coverage under this provision is afforded only: (1) Until the 180th day after you acquire or form the organization or the end of the policy period, whichever isearlier, if you do not report such organization in writing to us within 180 days after You acquire orform it o/ (2) Until the end of the policy period. when that date is |eLe/ than 188 days after you acquire or form such orQanizadon, if you report such organization in writing to us within 18Odays after you acquire orform it; b. Coverage A does not apply to ''bodily injury" or"property damage" that occurred before you acquired o/ formed the organization; and c. Coverage B does not apply to "personal and advertising injury" arising out of on offense committed before you acquired or formed the organization, For the purposes ofParagraph 1.of SecdonU —YVhn |sAnInsured, each such organization will be deemed to be designated in the Declarations as: a Alimited liability company; k An organization, other than apadneohip. joint venture or limited liability company; or m. Ahost; as indicated in its name or the documents that govern its structure. D. BLANKET ADDITIONAL INSURED — BROAD FORM VENDORS The following is added N SECTION U —VVHO IS A0|0SURED: Any person ororganization that io avendor and that you have agreed in a written contract or agreementioinclude as an additional insured on this Coverage Part is an insued, but only with respect to liability for "bodily injury" or "property damage" that: a' Occurs subsequent to the signing of that contract o/agneementand b. Arises out of "your products" that are distributed or sold in the regular course of such vendor's business. The insurance provided Losuch vendor issubject tothe following provisions: a, The limits of insurance provided to such vendor will be the minimum limits that you agreed to provide in the written contract or aQreemenL, or the limits shown in the Declarations, whichever are less, b` The insurance provided to such vendor does not apply to: (1) Any express warranty not authorized by you or any distribution or sale for o purpose not authorized by you; (2)Any change in "your products" made by Such vendor; (B Repackaging, unless unpacked solely for the purpose ofinspection, demonstradon, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged inthe original container; (4) Any failure to make such inspec1ions, achustmenb, tests or servicing as vendors agree to pedhnn or normally undertake to perform in the regular course ofbusiness, inconnecdonwith the distribution or sale of "your products"; Page 2of5 mzu17The Travelers Indemnity Company, All rights reserved. CIS D4580219 Includes copyrighted material uInsurance Services omce.Inc. with its permission 251. 8 ofm C COMMERCIAL GENERAL LIABILITY (5) Domonstrohon, insta|adon, servicing or repair operations, except such operations performed at such vendor's premises in connection with the sale of "your products"; or (6) "Your products" that, after distribution or sale by you, have been labeled or relabeled urused asacontainer, part or ingredient ofany other thing orsubstance bvoronbehalf ufsuch vendor. Coverage under ihiaprovision does not apply to: a. Any person or organization from whom you have acquired "your ornducts", or any ingredient, part or container entering into, accompanying or containing such products; or b. Any vendor for which coverage as an additional insured specifically isscheduled by endorsement. E. BLANKET ADDITIONAL INSURED — CONTROLLING INTEREST 1' The following is added to SECTION U —WHO |SANINSURED: Any person or organization that has financial control of you is an insured with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" thcd arises out of: a. Such financial control; o/ b. Such peson's or orgarioaiimfs ownership, maintenance o/ use of premises leased hxo/occupied bvyou. The insurance provided to such person or organization does not apply to structural a|terahons, new construction or demolition operations performed byormn behalf ofsuch person ororganization. 2. The following in added to Paragraph 4. of SECTION |i—WHO )SANINSURED: This paragraph does not apply to any premises owner, manager or lessor that has financial control of you, F. BLANKET ADDITIONAL INSURED — MORTGAGEES, ASS|GNEES, SUCCESSORS OR RECEIVERS The following is added to SECTION ||—VVHO IS ANINSURED: Any person or organization that is a modgagee, assignee, successor or receiver and that you have agreed in a written contract uragreement to include as an additional insured onthis Coverage Part is an insured, but only with respect to its liability as mortgagee, assignee, successor or receiver for "bodily injury", "property damage" or "personal and advertising injury" that: a' Is "bodily injury' or "property damage" that occurs, oris"personal and advertising myu0/ caused by an offense that is commi8ed, subsequent 0othe signing ofthat contract or agreement; and b. Arises out of the ownership, maintenance or use ofthe premises for which that mortgagee, assignee, successor or receiver is required under that contract or agreement to be included as an additional insured on this Coverage Part. The insurance provided to such mortgagee, assignee, successor or receiver is subject to the following provisions: a. The limits of insurance provided to such murtgagee, essignee, successor or receiver will bethe minimum limits that you agreed to provide in the written contract or agreement, or the Umhu shown in the Dez}anahons, whichever are less. b. The insurance provided to such person or organization does not apply to: (1) Any "bodily injury or "property damage" that occurs. or any "personal and advertising hnjury` caused by on offense that is commitbd, after such contract or agreement iynolonger ineffect; or (2) Any "bodily injury", "property d age" or "personal and advertising injury" arising out of any structural okemhons, new construction or dornnUdon operations performed by or on behalf of such mortga0ee, asyignee, successor or G. BLANKET ADDITIONAL INSURED — GOVERNMENTAL ENTITIES — PERMITS OR AUTHORIZATIONS RELATING TO PREMISES The following is added to SECTION U—VVHO IS AN\0SURED: Any governmental entity that has issued a permit or authorization with respect to premises owned or occupied by, or rented or loaned to, you and that you are required by any ordinance, |mw, building code or written contract or agreement to include as anadditional insured onthis Coverage Part is an inuu/ed, but only with respect to liability for "bodily in/ury". "property damage" or "personal and advertising injury" arising out of the exiotence, ovvnership, use, maintanance, repai/, consUocUon, erection or removal of any of the following for which that governmental entity has CGD4S8U219 CDzonThe Travelers Indemnity Company. All rights reserved. Page 3of5 Includes copyrighted material mInsurance Services Office, Inc, with its permission 251: 9 ' am COMMERCIAL GENERAL LIABILITY issued such permit or authorization: advertising signs, awnings, canopies, cellar enbances, coal ho|es, drivevvays, manholes, manlueas, hoist away openings, sidewalk vau|ts, e|evato/s, street banners ordecorations. H BLANKET ADDITIONAL |kBWREQ — GOVERNMENTAL ENTITIES — PERMITS OR AUTHORIZATIONS RELATING TO OPER- ATIONS The following is added to SECTION H—VVAU|S &0|0SURED: Any governmental entity that has issued a permit or authorization with respect to operations performed by you or on your behalf and that you are required by any ordinance, |mw' building code or written contract oragreement Lo include as on additional insured on this Coverage Pail is an insured, but only with respect ioliability for "bodily injury", "property damage" or "personal and advertising i 'ury' arising out oysuch operations. The insurance provided to such governmental entity does not apply to: a. Any "bodily i ju0/'. "property damage" or "persona| and advertising injury" arising out of operations performed for the governmental entity; or b. Any "bodily ivju0/' o/ "property damage" included in the "products -completed operations hazard". i BLANKET ADDITIONAL INSURED — GRANTORS OF FRANCHISES The following is added to SECTION N —VVHC> IS Any person ororganizatkmdhzdOonhsafranchise to you is an insured, but only with respect to liability for "bodily injury". "property damage" or "personal and advertising injury" arising out of your operations in the franchise granted by that person nrorganization. Kawritten contract or agreement exists between You and such additional insured, the limits of insurance provided to such insured will be the minimum limits that you agreed to provide in the written contract oragreement, orthe limits shown inthe Declarations, whichever are less. scnviccs", find aid or ''Good Samaritan services" to a person, unless you are in the business or occupation of providing professional health care semices. 2. The following replaces the last paragraph of Paragraph 2.a.(1) of SECTION U| — WHO IS ANINSURED: Unless you are inthe business oroccupation ofproviding professional health care services, Paragraphs (1)(a), (b)` (c) and (d) above do not apply to ''bodily injury" arising out of providing or failing to provide: (o) "Incidental medical services" by any of your "employees" who is a nursc, nurse assistant emergency medical technician, paramedic, athletic tnainer, au6io|ogisi, dieiicbn, nutritionist, occupational therapist or occupation al therapy asoisiant, physical therapist o/ speech - language pathologist; or (b) First aid cv"Good Samaritan services" by any of your "employees" or "volunteer wodars", other than an employed or vNunhac/ doctor. Any such "employees" or "volunteer workers" providing or failing N provide first aid ur "Good Samaritan services" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. 3. The following replaces the last sentence of Paragraph S. of SECTION U| — LIMITS OF For the purposes of determining the applicable Each Occurrence Limk, all related acts or omissions committed in providing or failing to provide "incidental medical scnices", first aid or "Good Samaritanservices"t*anyone person will be deemed to beone "occurnence" 4. The following exclusion is added to Paragraph 2.' Exclusions, of SECTION | — COVERAGES — COVERAGE /\ — BODILY INJURY AND PROPERTY DAMAGE 1. The following replaces Paragraph b.of the Sale Of Pharmaceuticals definition of "occurrence" in the "Bodily injury" or "property damage" arising DEFINITIONS Section: out of the violation of a penal statute or An actor omission committed in providing ordinance relating to the sale of ~' ' or failing to provide "incidental committed by, medical knowledge or consent of, the ins' or v�ih the red. Page 4ofS Oczo1rThe Travelers Indemnity Company. All rights reserved. CIS D4580219 /n:|voe, copyrighted material of Insurance Services omce, Inc. with it, permission COMMERCIAL GENERAL LIABILITY 5, The following isadded tothe DEFINITIONS Section: "Incidental medical services" means: m. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or L instrucbun, or the related furnishing of food or beverages; or b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. D. The following is added to Paragraph 4.b. Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY This insurance is excess over any valid and collectible other insu/ance, whether p/hnery, excess, contingent oronany other basis, that is available to any of your "employees" for "bodily injury" that arises out of providing or failing to provide "incidental medical services" to any person to the extent not subject to Paragraph 2.a(1) of Section # —VVho Is An The following replaces Paragraph 7.of SECTION III — LIMITS OF INSURANCE: 7. Subject to Paragraph S. above. the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury" sustained by any one person, and will bethe higher of: a. $10,000;m h The amount shown inthe Declarations o( this Coverage Part for K4ed)co| Expense BLANKET WAIVER OF SUBROGATION The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If the insured has agreed in a contract or agreement to waive that insured's right of recovery against any person ororganization, we waive our right ofrecovery against sLich person or organization, but only for payments we make because of: a, "Bodily injury" or "property damage" that occurs;or b. "Personal and advertising injury" caused by anoffense that iscommitted; subsequent to the execution of the contract o/ agreement. M. CONTRACTUAL LIABILITY —RAILROADS 1. The following replaces Paragraph c, of the definition of "insured cont/act" in the DEFINITIONS Section: c- Any easement orlicense agreement; 2, Paragraph f.(1) of the definition of "insured contract" in the DEFINITIONS Section is deleted. CGB4S8O219 0( znl7The Travelers Indemnity Company, All rights reserved. Page Sm[S Includes copyrighted material uInsurance Services Office, Inc. with its permission m1.m'mx WORKERS COMPENSATION AND H.7JR Ts_)RE, T� 0(3,1 E EMPLOYERS LIABILITY POLICY II/�ZT }�I_JIt I' LET (�161 =� _� POLICY NUMBER: UB-4Y056146-24-14—G 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 any one not named in the Schedule. DESIGNATED ORGANIZATION: A!, lY FERS,-44 (- )R P-)R T/,JHIr'II THE HAS AGREED BY WRITTEN C'CflvITRA-'T Er_E+'L1TED PRIG%R T(, LOSS TCi FIJRVISH TIIIS var,IVER e DATE OF ISSUE: ST ASSIGN: PAGE 1 OF1 251: 10 of 10 Page 1 of 2 DATE (MMIDD/YYYY) AkbCOR" CERTIFICATE OF LIABILITY INSURANCE 10/01/2024 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 NAME: WTW Certificate Canter Willis Towers Watson Northeast, Inc. c/o 26 Century Blvd aD"N 1-877-945-7378 aC No; 1-888-467-2378 E-MAIL certificates@atwoo.com P.O. Box 305191 ADDRESS: Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAICN INSURED PumpTech Holdings LLC 12020 SE 32nd St, suite 2 Bellevue, WA 98005 INSURERA: The Charter Oak Fire Insurance Company I 25615 INSURERB: Travelers Indemnity Company of CT 25682 --- - INSURERC; Travelers Property Casualty Company of Ame 25674 INSURERD: Underwriters at Lloyd's London INSURER E : 15792 COVFRAGES CFRTIFICATF NIIMRFR- W35439053 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'', - - - - - ---'ADDLjSUSHI - - - - POLICY EFF POLICY EXP - - -_-- - - - - ------ - - -- - -- - - - - LTR TYPEOFINSURANCE POLICY NUMBER I MMrDD/YYYY MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR _ TO RENTED PREMISES (Ea cccurrence)_- 300,000_S A MED EXP (Any one, person) $ 5, 000 Y Y Y-630-331D063A-COF-24 08/26/2024 08/26/2025 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 I jE o LOG PRODUCTS • COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY X ANY AUTO COMBINED SINGLE LIMIT BODILY INJURY (Per person) 000 $ 1,000,000 $ B OWNED SCHEDULED AUTOS ONLY AUTOS 810-1Y037218-24-14-G 08/26/2024 08/26/2025 BODILY INJURY (Per accident) $ PROPERTY DAMAGE (I'er_accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY C UMBRELLA LIAB X OCCUR EXCESS LIAB CLAIMS -MADE EX-4Y788505-24-14 08/26/2024 08/26/2025 EACH OCCURRENCE $ 10,000,000 X AGGREGATE $ 10,000,000 DED FI RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE PER OT STATUTE ER E.L. EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? (Mandatory in NH) NIA --------- E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below $ E.L. DISEASE - POLICY LIMIT A iWA Stop Gap Y-630-331D063A-COF-24 08/26/2024 08/26/2025 E.L. Each Accident $110001000 i E.L. Disease - Ea Em $1,000,000 E.L. Disease- Policy $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) SEE ATTACHED DECEIVED OCT 15 202.4 UANk;tLLA I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Bremerton AUTHORIZED REPRESENTATIVE Attn: Risk Management 345 6th Street, Suite 600 PO a 3 Bremerton, WA 98337 m 1988.2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 26511272 BATCH: 3642217 7367: 2 ` of 2 ACORE° AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Willis Towers Watson Northeast, Inc. PumpTach Holdings LLC 12D20 SE 32nd St, Suite 2 Bellevue, WA 98005 POLICY NUMBER See Page 1 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 AUUI I IUIVAL hItMAKK5 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance City of Bremerton is named as additional insured with respects to the operations of the named insured. Coverage is primary and non-contributory and waiver of subrogation applies. INSURER AFFORDING COVERAGE: Underwriters at Lloyd's London NAIC#: 15792 POLICY NUMBER: B0621PDAK0001724 EFF DATE: 09/26/2024 EXP DATE: 08/26/2025 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Professional Liability Each Claim $2,000,000 Aggregate $2,000,000 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID:26511272 BATCH:3642217 CERT: W35439053 7367: 2 of 2