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HomeMy WebLinkAbout6740 Docusign Envelope ID:2A92783B-2687-4A47-A109-9408A29C124A PROFESSIONAL SERVICES AGREEMENT Street Tree List Update The City of Bremerton ("City") and Sound Urban Forestry, LLC ("Consultant"), referred to collectively as the "Parties," enter into the following Agreement for professional services: L Scope: The Consultant agrees to perform the services more specifically described in the Scope of Work, dated May 7, 2024, including any attachments thereto, attached hereto as Exhibit A, which is incorporated by reference herein. The Scope of Work may be modified only pursuant to Section VII.H of this Agreement. If the Scope of Work provides for unspecified additional services such services shall only be performed upon the express written request of the City. Consultant further represents that the services furnished under this Agreement will be performed in accordance with generally accepted professional practices in effect at the time such services are performed. IL Term: The City and the Consultant agree that work will begin on the tasks described in Exhibit A immediately upon execution of this Agreement. The parties agree that the work described in Exhibit A is to be completed as provided for in the work schedule attached hereto as Exhibit A; provided however,that additional time shall be granted by the City for excusable delays or extra work as provided for in Section X.A of this agreement. III. Compensation: In consideration of the services provided pursuant to this Agreement,the City shall pay Consultant in an amount not to exceed $3 150. Consultant's charges and bills shall conform to the fee schedule attached hereto as Exhibit A and incorporated herein by this reference. The Consultant shall submit regular billing statements detailing work performed and amount charged on each task or portion thereof The descriptions shall conform to and fall within the categories set out in the Scope of Work and/or Fee Schedule. Upon receipt of a conforming billing statement, the City shall promptly process payment. PROVIDED, HOWEVER, the City reserves the right to prioritize scoped work and accelerate and/or delay work tasks under the time frame set forth in Section II herein. The Consultant's labor rates and billing fees shall be as delineated in Exhibit A. Consultant shall not perform work beyond the Scope of Work, nor shall be compensated for such work, unless the Scope of Work or amount of compensation is modified pursuant to this Agreement. Consultant shall only be compensated for additional services if requested pursuant to Section I and, if not otherwise provided, such compensation shall be in accordance with Exhibit A. If a billing statement does not conform to this Agreement,the City may withhold payment until the statement is brought into compliance. Such withholding does not relieve Consultant of its obligations under this Agreement. IV. Relationship of Parties: Consultant represents that it is skilled in the matters addressed in the Scope of Work and is performing independent functions and responsibilities within its field Page 1 of 8 Bremerton/Sound Urban Forestry,LLC Street Tree List Update Rev. 04/2023 Docusign Envelope ID:2A92783B-2687-4A47-A109-9408A29C124A of expertise. Consultant and its personnel are independent Consultants and not employees of the City. Consultant and its personnel have no authority to bind the City or to control the City's employees and other Consultants. None of the benefits provided by the City to its employees, including, but not limited to, compensation, insurance, and unemployment insurance are available from the City to the employees, agents, representatives, or sub-consultants of the Consultant. Consultant will be solely and entirely responsible for its acts and for the acts of Consultant's agents, employees, representatives and sub-consultants during the performance of this Agreement. The City may, during the term of this Agreement, engage other independent Consultants to perform the same or similar work. As an independent Consultant, Consultant is responsible for its own management. The City's administration and enforcement of this Agreement shall not be deemed an exercise of managerial control over Consultant or its personnel. As an independent Consultant, Consultant is responsible for payment of all taxes and licensing fees necessary to perform its obligations under this Agreement. These taxes and fees include but are not limited to State industrial insurance, Business & Occupation, State professional licensing, and City business licensing. If any taxes or fees due the City have been declared delinquent,the City may withhold the delinquent amount,plus any additional charges arising from the delinquency,from any payments due Consultant. V. Indemnification: A. Consultant 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 except for that portion of the injuries and damages caused by the City's sole negligence, unless Consultant is conducting work pursuant to Subsection B below. The City's review or acceptance of any of the work when completed shall not be grounds to avoid any of these covenants of indemnification. B. Architects, Engineers and Any Other Professional Listed In and Performing Services Defined in RCW 4.24.115. Should a court of competent jurisdiction determine that Consultant's services provided pursuant to 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 Consultant and the City, its officers, officials, employees, agents and volunteers, the Consultant's liability hereunder shall be only to the extent of the Consultant's negligence. IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE CONSULTANT'S WAIVER OF IMMUNITY UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF THIS INDEMNIFICATION. THE PARTIES FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY NEGOTIATED THIS WAIVER. Page 2 of 8 Bremerton/Sound Urban Forestry,LLC Street Tree List Update Rev. 04/2023 Docusign Envelope ID:2A92783B-2687-4A47-A109-9408A29C124A The provisions of this section shall survive the expiration or termination of this Agreement. VI. Insurance: The Consultant shall procure and maintain for the duration of the Agreement, insurance against claims for injuries to persons or damage to property which may arise from or in connection with the performance of the work hereunder by the Consultant, its agents, representatives, employees, sub-consultants or sub-Consultants. Before beginning work on the project described in this Agreement, the Consultant shall provide a Certificate of Insurance evidencing: 1. Automobile Liability insurance with limits no less than $1,000,000 combined single limit per accident for bodily injury and property damage; and 2. Commercial General Liability insurance written on an occurrence basis with limits no less than $1,000,000 combined single limit per occurrence and general 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; explosion, collapse and underground (XCU) if applicable; and 3. Excess Liability insurance with limits not less than $1,000,000 limit per occurrence and aggregate; and 4. Professional Liability insurance with limits no less than $1,000,000 limit per occurrence/claim; and Any payment of deductible or self-insured retention shall be the sole responsibility of the Consultant. All required policies shall be provided on an "occurrence" basis except professional liability insurance (if required), which may 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 Consultant and a copy of an endorsement that is acceptable to the City, which names the City as an 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 and endorsements. The City further reserves the right to reject any unacceptable policies and/or endorsements. The Consultant'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 Consultant's insurance shall be primary and non-contributory insurance as respects the City and shall contain a waiver of subrogation against the City for claims arising out of any operations, liabilities and obligations to which coverage applies. It shall be an affirmative obligation upon Consultant to advise the City's Risk Manager by fax at (360) 473-5161, or by certified mail, return receipt requested to City of Bremerton, Attn: Risk Management, 345 6th Street, Suite 100, Bremerton, WA 98337 within two days of the cancellation, suspension or Page 3 of 8 Bremerton/Sound Urban Forestry,LLC Street Tree List Update Rev. 04/2023 Docusign Envelope ID:2A92783B-2687-4A47-A109-9408A29C124A substantive change of any insurance policy set out herein, and failure to do so shall be construed to be a breach of this Agreement. The City also reserves its unqualified right to require at any time and for any reason, proof of coverage in the form of a duplicate of the insurance policy with all endorsements as evidence of coverage. In the event that the Consultant employs other consultants or Consultants (sub-consultants or sub-Consultants) as part of the work covered by this Agreement, it shall be the Consultant's responsibility to require and confirm that each sub-consultant or sub-Consultant meets the minimum insurance requirements specified above. The Consultant shall,upon demand of the City, deliver to the City copies of such policy or policies of insurance and the receipts for payment of premiums thereon. VII. General Conditions: A. Reports and Information: When requested by the City, Consultant shall furnish periodic reports and documents on matters covered by this Agreement. The reports and documents shall be furnished in the time and form requested. Consultant shall maintain accounting records in accordance with Generally Accepted Accounting Principles ("GAAP")to substantiate all billed amounts. B. Ownership and Use of Records and Documents: Original documents, drawings, designs and reports, including those in electronic format, developed under this Agreement are the property of the City. All written information submitted by the City to the Consultant in connection with the services performed by the Consultant under this Agreement will be safeguarded by the Consultant to at least the same extent as the Consultant safeguards like information relating to its own business. If such information is publicly available or is already in Consultant's possession or known to it, or is rightfully obtained by the Consultant from third parties, Consultant shall bear no responsibility for its disclosure, inadvertent or otherwise. All data, documents and files created by Consultant under this Agreement may be stored at Consultant's office in Tahuya, Washington. Consultant shall make such data, documents, and files available to the City upon its request at all reasonable times for the purpose of editing, modifying and updating as necessary until such time as the City is capable of storing such information in the City's offices. Duplicate copies of this information shall be provided to the City upon its request, and at reasonable cost. All documents, including all reports, drawings, specifications, computer software or other items prepared or furnished by Consultant pursuant to this Agreement, are instruments of service with respect to the project and are the property of the City. Any reuse by the City for other than the specific purpose intended will be at City's sole risk. C. Use of Photographs and Images. Consultant shall not use or distribute photographs or images depicting City officials, personnel, property, or equipment whether prepared by Page 4 of 8 Bremerton/Sound Urban Forestry,LLC Street Tree List Update Rev. 04/2023 Docusign Envelope ID:2A92783B-2687-4A47-A109-9408A29C124A Consultant or provided by City without prior written consent of the City. The City will not unreasonably withhold its consent. D. Work Performed at Consultant's Risk: Consultant shall take all precautions necessary and shall be responsible for the safety of its employees, agents, and sub-consultants in the performance of the work hereunder and shall utilize all protection necessary for that purpose. All work shall be done at Consultant's own risk, and Consultant 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. E. Place of Work: The Consultant shall perform the work authorized under this Agreement at its offices in Tahuya, Washington. Meetings with the City staff as described in Exhibit A, Scope of Work, shall take place at the City's offices, or at locations mutually agreed upon by the parties. F. Entire Agreement: This Agreement and its Exhibits constitutes the entire agreement between the Parties, and the Parties acknowledge that there are no other agreements, written or oral, that have not been set forth in the text of this Agreement. G. Severability: Should any part of this Agreement be found void, the balance of the Agreement shall remain in full force and effect. H. Modification: This Agreement may only be modified by written instrument signed by both Parties. L Written Notices: All communications regarding this Agreement shall be sent to the parties at the addresses listed below by registered or 1st class mail, or by personal service, and shall be deemed sufficiently given if sent to the addressee at the address stated in this Agreement or such other address as may be hereafter specified in writing. Notices to be sent to: Notices to be sent to: CITY: CONSULTANT: Attn: Ron Moore Attn: Kevin McFarland City of Bremerton Sound Urban Forestry, LLC 345 6th Street, Suite 100 P.O. Box 489 Bremerton, WA98337-1891 Tahuya, WA 98588 J. Waiver: Failure to enforce any provision of this Agreement shall not be deemed a waiver of that provision. Waiver of any right or power arising out of this Agreement shall not be deemed waiver of any other right or power. K. Non-Waiver of Breach: The failure of the City to insist upon strict performance of any of the covenants and agreements contained herein, or to exercise any option herein conferred in one or more instances shall not be construed to be a waiver or relinquishment of said covenants, agreements or options, and the same shall be and remain in full force and effect. Page 5 of 8 Bremerton/Sound Urban Forestry,LLC Street Tree List Update Rev. 04/2023 Docusign Envelope ID:2A92783B-2687-4A47-A109-9408A29C124A L. Compliance with Laws: Consultant shall comply with all applicable Federal, State, and local laws in performing its obligations under this Agreement. M. Choice of Law and Venue: This Agreement shall be interpreted according to the laws of the State of Washington. Any judicial action to resolve disputes arising out of this Agreement shall be brought in Kitsap County Superior Court. N. Attorneys' Fees: In the event of litigation to enforce any of the terms or provisions herein, each party shall pay all its own costs and attorney's fees. O. Assignment: Any assignment of this agreement by the Consultant without the written consent of the City shall be void. VIII. Equal Employment Opportunity Statement: In the hiring of employees for the performance of work under this Agreement, the Consultant, its subConsultants, or any person acting on behalf of Consultant 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. IX. 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. X. Termination: This Agreement shall remain in force until completion and acceptance of the services, terminated by written instrument upon mutual consent, or by the City of Bremerton for convenience. This Agreement may be immediately terminated for cause by a Party if the other Party substantially fails to perform through no fault of the terminating Party, and the non- performing Party does not commence correction of the failure of performance within thirty (30) days of the terminating Party's sending notice to the non-performing Party. Any Notice by Consultant shall include a report showing the status of all items listed in the Scope of Work current through the termination date. If the City receives reimbursement by any federal, state, or other source for work described in Section I herein, and that funding is withdrawn, reduced or limited in any way, or the project is cancelled or substantially reduced after the execution date of this Agreement and prior to the completion of the work,the City may summarily terminate this Agreement. A. Excusable Delays: The right of Consultant to proceed shall not be terminated nor shall Consultant be charged with liquidated damages for any delays in the completion of the work due to: 1)any acts of the federal government in controlling,restricting, or requisitioning materials, equipment,tools, or labor by reason of war, national defense, or other national emergency; 2) any acts of the City, its consultants, or other public agencies causing such delay; and 3) causes not Page 6 of 8 Bremerton/Sound Urban Forestry,LLC Street Tree List Update Rev. 04/2023 Docusign Envelope ID:2A92783B-2687-4A47-A109-9408A29C124A reasonably foreseeable by the parties at the time of the execution of the Agreement that are beyond the control and without the fault or negligence of the Consultant, including, but not restricted to, acts of God, fires, floods, strikes, or weather of unusual severity. PROVIDED, HOWEVER, that the Consultant must promptly notify the City within ten (10) calendar days in writing of the cause of the delay. If, on the basis of the facts and the terms of this Agreement, the delay is properly excusable, the City shall, in writing, extend the time for completing the work for a period of time commensurate with the period of excusable delay. B. Rights Upon Termination: In the event of termination, the City shall pay for all services performed by the Consultant to the effective date of termination, as described on a final invoice submitted to the City. After termination, the City may take possession of all records and data within the Consultant's possession pertaining to this project which may be used by the City without restriction. Any such use not related to the project which Consultant was contracted to perform shall be without liability or legal exposure to the Consultant. XI. Suspension & Debarment. For contracts involving Washington State and Federal funding, Consultant 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 State or Federal department or agency. Consultant shall provide immediate written notice to the City if at any time it learns that it is or has become ineligible for certification. Should Consultant enter into a covered transaction with another firm, Consultant 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. IN WITNESS WHEREOF, the parties below have executed this Agreement. CITY: CONSULTANT: CITY OF BREMERTON Sound Urban Forestry, LLC DocuSigned by: Doc�uSiiig/n�e�d by: ItOVIAM 6UALLUI By: D... By: kV/FM/0V Print Name: T omas nuc ey Print arf OCC 9B3037l (7.JN MCFARLAND Its: Public Works Director Its: Member Date: 7/17/2024 Date: 7/17/2024 APPROVED AS TO FORM: ATTEST: DocuSigned by: DocuSigned by: By: 6 � 661 r By: Qi ,� ' bbt�t,V' YCBE83ellia B074�i2... y 24ED5ED4F45C41 E, Kylie J. inn , remerton City Attorney Angela Hoover, City Clerk Page 7 of 8 Bremerton/Sound Urban Forestry,LLC Street Tree List Update Rev. 04/2023 Docusign Envelope ID:2A92783B-2687-4A47-A109-9408A29C124A R:\Legal\Legal\Fonns\FORMS ON COBWEB\Professional Services Agreement Rev.04 2023.docx Page 8 of 8 Bremerton/Sound Urban Forestry,LLC Street Tree List Update Rev. 04/2023 Docusign Envelope ID:2A92783B-2687-4A47-A109-9408A29C124A Exhibit A SUF Sound Urban Forestry, LLC P.O.Box 489,Tahuya,WA 98588 360-870-2511/suf1234@comcast.net 5/7/2024 City of Bremerton C/o: Colette Berna, Parks Preservation and Development Manager 680 Lebo Blvd Bremerton, WA 98310 RE: Approved Street Tree List Update Proposal Ms. Berna: Upon your request, I have developed the attached proposal to provide an update to the current City of Bremerton's Approved Street Tree list. The following table presents each task, associated costs and a total estimated cost. If you should have any questions, please feel free to contact me. Professionally Submitted, /1P1/4 .141' 14/15:fiLl Kevin M. McFarland, Principal Consulting Urban Forester ISA Certified Arborist PN-0373 & ISA Tree Risk Assessment Qualified Docusign Envelope ID:2A92783B-2687-4A47-A109-9408A29C124A Project Name: Bremerton Approved Street Tree List Elements and Tasks Time Rate/Hour Cost Estimate Estimate I. Communications with Tree Committee • Initial meeting to discuss project guidelines and collect input from Committee. 6 Hours $175.00 $1050.00 • Meeting to discuss submitted draft list. • Concluding meeting to review final submittal IL Development of Updated List • Research of new varieties. 10 Hours $175.00 $1750.00 • Updates to list. III. Management Reserve 2 Hours $175.00 $350.00 Total 18 Hours $3150.00 SOUNURB-01 SYLVIABAI aCORnw CERTIFICATE OF LIABILITY INSURANCE DATE 8/8/2 DIYYYY) /8/2024 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: NFP Property&Casualty Services,Inc. PHONE FAX 1371 Hecla Drive (A/c,No,Ext):(303)951-5050 (A/C,No):(303)961-6060 Suite E E-MAIL Louisville,CO 80027 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Tokio Marine Specialty Insurance Company 23850 INSURED INSURER B: Sound Urban Forestry,LLC INSURERC: PO Box 489 INSURER D: Tahuya,WA 98588 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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 NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X X PPK2572541-009 7/1/2024 7/1/2025 PREMISESO(Ea occur ence) $ 300,000 X E&O$1 M/$1 M MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PECOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILECOMBINED SINGLE LIMIT LIABILITY (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE PUB870829-003 7/1/2024 7/1/2025 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 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) Certificate holder is listed as additional insured with respect to the general liability limits for acts arising out of the operations of the named insured per form CG20260413 Waiver of subrogation applies,the insurance is primary&non-contributory CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Bremerton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 345 6th Street Ste 100 Bremerton,WA 98337 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: PPK2572541-009 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): City of Bremerton Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III —Limits Of Insurance: with respect to liability for "bodily injury", "property If coverage provided to the additional insured is damage" or "personal and advertising injury' required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. In the performance of your ongoing operations; 1. Required by the contract or agreement; or or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations; rented to you. whichever is less. However: This endorsement shall not increase the applicable Limits of Insurance shown in the 1. The insurance afforded to such additional Declarations. insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 5 POLICY NUMBER: PPK2572541-009 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: City of Bremerton Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 0 PI-GL-005 (07/12) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Effective Date: 07/01/2017 Name of Person or Organization (Additional Insured): CITY OF BREMERTON BREMERTON PARKS & RECREATION SECTION II—WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the endorsement Schedule, but only with respect to liability for"bodily injury," "property damage" or"personal and advertising injury" arising out of or relating to your negligence in the performance of"your work" for such person(s) or organization(s) that occurs on or after the effective date shown in the endorsement Schedule. This insurance is primary to and non-contributory with any other insurance maintained by the person or organization (Additional Insured), except for loss resulting from the sole negligence of that person or organization. This condition applies even if other valid and collectible insurance is available to the Additional Insured for a loss or"occurrence"we cover for this Additional Insured. The Additional Insured's limits of insurance do not increase our limits of insurance, as described in SECTION III—LIMITS OF INSURANCE. All other terms, conditions, and exclusions under the policy are applicable to this endorsement and remain unchanged. Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. atdrceroa I A I t I-AHM"'" c_� DATE OF NOTICE: SEP 11 2024 PO Box 2368 CODE: Bloomington IL 61702-2368 69A AT1 15 A ooloss ooss NOTE: PLEASE NOTIFY STATE FARM AT THE CITY OF BREMERTON PUBLIC WRKS ADDRESS LISTED AT THE TOP, LEFT CORNER & UTILITIESOF THIS PAGE REGARDING ANY CHANGE OF gl100 OYSTER BREMERTON WA 98312-3455 BAYAVE N ADDRESS INFORMATION. III Ii11111111111111111liii1I IIIII IIIII11111111111111111111'I I1111 0 0 0 AE?©ITIONAL:INSURE VS'NOTICE OF CtiVEFIAGE State Farm Mutual Automobile Insurance Company 6196-FC20-A NAMED INSURED: POLICY NO: 394 3399-F06-47U COVERAGE: MC FARLAND, KEVIN M YR/MAKE/MODEL: 2016 TOYOTA STA WAG BI AND PD LIABILITY PO BOX 489 VIN/CAMPER: JTDZN3EU5GJO44053 $1100 DED.COMP. TAHUYA WA 98588-0489 AGENT NAME: DEREK THOMAS $250 DED.COLL. 9 AGENT PHONE: (360)943-8740 ENDORSEMENT NO: 6028BL POLICY EFFECTIVE AUG 05 2024 UNTIL TERMINATED POLICY MESSAGES: The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance o provided and subject to all policy provisions.The additional insured will be given 10 days notice if the policy is terminated. Until such notice 0 is provided,it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of g any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. 0 N FRT atdrceroa I A I t I-AHM"'" c_� DATE OF NOTICE: SEP 11 2024 PO Box 2368 CODE: Bloomington IL 61702-2368 69A AT1 15 A ooloss ooss NOTE: PLEASE NOTIFY STATE FARM AT THE CITY OF BREMERTON PUBLIC WRKS ADDRESS LISTED AT THE TOP, LEFT CORNER & UTILITIESOF THIS PAGE REGARDING ANY CHANGE OF gl100 OYSTER BREMERTON WA 98312-3455 BAYAVE N ADDRESS INFORMATION. III Ii11111111111111111liii1I IIIII IIIII11111111111111111111'I I1111 0 0 0 AE?©ITIONAL:INSURE VS'NOTICE OF CtiVEFIAGE State Farm Mutual Automobile Insurance Company 6196-FC20-A NAMED INSURED: POLICY NO: 394 3399-F06-47U COVERAGE: MC FARLAND, KEVIN M YR/MAKE/MODEL: 2016 TOYOTA STA WAG BI AND PD LIABILITY PO BOX 489 VIN/CAMPER: JTDZN3EU5GJO44053 $1100 DED.COMP. TAHUYA WA 98588-0489 AGENT NAME: DEREK THOMAS $250 DED.COLL. 9 AGENT PHONE: (360)943-8740 ENDORSEMENT NO: 6028BL POLICY EFFECTIVE AUG 05 2024 UNTIL TERMINATED POLICY MESSAGES: The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance o provided and subject to all policy provisions.The additional insured will be given 10 days notice if the policy is terminated. Until such notice 0 is provided,it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of g any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. 0 N FRT Statelarm STATE FARM® n DATE OF NOTICE: SEP 19 2024 PO Box 2368 Bloomington IL 61702-2368 CODE: 75A AT1 15 A 001050 0093 CITY OF BREMERTON PUBLIC WRKS NOTE: PLEASE NOTIFY STATE FARM AT THE & UTILITIES ADDRESS LISTED AT THE TOP, LEFT CORNER 100 OYSTER BAY AVE N OF THIS PAGE REGARDING ANY CHANGE OF BREMERTON WA 98312-3455 ADDRESS INFORMATION. IIi11"1.11'IIII1111111111II11"1111111"111ui11111'Il�l���ll�ll' 0 0 0 A©DiTl NA. NSl;1REfY'S:PIoTICIE:::CIF o'vERACaE: State Farm Mutual Automobile Insurance Company 6196-FC20-A NAMED INSURED: POLICY NO: 394 3399-F06-47V COVERAGE: MC FARLAND,KEVIN M YR/MAKE/MODEL: 2016 TOYOTA STA WAG BI AND PD LIABILITY PO BOX 489 VIN/CAMPER: JTDZN3EU5GJO44053 $1 MIL $100 DED.COMP. TAHUYA WA 98588-0489 AGENT NAME: DEREK THOMAS $250 DED.COLL. 9 AGENT PHONE: (360)943-8740 ENDORSEMENT NO: 6028BL POLICY EFFECTIVE AUG 07 2024 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy#3943399-47U. • The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance o provided and subject to all policy provisions.The additional insured will be given 10 days notice if the policy is terminated. Until such notice m is provided,it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of gany change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. N FRT 2rarefanrn STATE FARM OC:® DATE OF NOTICE: SEP 20 2024 PO Box 2368 CODE Bloomington IL 61702-2368 97A AT1 15 A ooloze ooss NOTE: PLEASE NOTIFY STATE FARM AT THE CITY OF BREMERTON PUBLIC WRKS ADDRESS LISTED AT THE TOP, LEFT CORNER zl & UTILITIESOF THIS PAGE REGARDING ANY CHANGE OF r100 OYSTER BAY AVE N BREMERTON WA 98312-3455 ADDRESS INFORMATION. •IIIIIIIuIIIIIIII ildl1IhInII1IIIIlhIIIhlIIIIIIIIIIlIIIIhIhhli 8 0 0 0 . • ADDITIONAL INSURE S NOTIC DE:OF COVERAGE . State Farm Mutual Automobile Insurance Company 6196-FC20-A NAMED INSURED: POLICY NO: 394 3399-F06-47V COVERAGE: MC FARLAND, KEVIN M YR/MAKE/MODEL: 2016 TOYOTA STA WAG BI AND PD LIABILITY PO BOX 489 VIN/CAMPER: $1 MIL JTDZN3EU5GJ044053 $100 DED.COMP. TAHUYA WA 98588-0489 AGENT NAME: DEREK THOMAS $250 DED.COLL. AGENT PHONE: (360)943-8740 ENDORSEMENT NO: 6028BL POLICY EFFECTIVE AUG 07 2024 UNTIL TERMINATED POLICY MESSAGES: co • The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance • provided and subject to all policy provisions.The additional insured will be given 10 days notice if the policy is terminated. Until such notice a, is provided,it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of o any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. 0 AODITI.ONAL i.NSURED'S NOTICE;OF Ci'7VERA+ E: State Farm Mutual Automobile Insurance Company 6196-FC20-A NAMED INSURED: POLICY NO: 394 3399-F06-47W COVERAGE: MC FARLAND, KEVIN M YR/MAKE/MODEL: 2016 TOYOTA STA WAG BI AND PD LIABILITY PO BOX 489 VIN/CAMPER: JTDZN3EU5GJO44053 $1 MIL TAHUYA WA 98588-0489 AGENT NAME: DEREK THOMAS $10o DED.COMP. AGENT PHONE: (360)943-8740 $250 DED.COLL. ENDORSEMENT NO: 6028BL POLICY EFFECTIVE AUG 21 2024 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy#3943399-47V. The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance provided and subject to all policy provisions.The additional insured will be given 10 days notice if the policy is terminated. Until such notice is provided,it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of Fi any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. i3 FRT matelot'', STATE FARM® CD a:: DATE OF NOTICE: SEP 26 2024 PO Box 2368 Bloomington IL 61702-2368 CODE: 63A AT1 15 A ooioss 0093 NOTE: PLEASE NOTIFY STATE FARM AT THE CITY OF BREMERTON PUBLIC WRKS& UTILITIES ADDRESS LISTED AT THE TOP, LEFT CORNER OF THIS PAGE REGARDING ANY CHANGE OF BREMERTON WA 98312-3455 R0 OYSTER BAY N ADDRESS INFORMATION. 31 { 111111IIIIIIItiuII1111"1'IIIIIII'IIIII'IIpu1IIIIiIiIIIii111111iI 0 0 0 s ADDITIONAL I ISURED'S.NOTICE OF COVERAGE' . State Farm Mutual Automobile Insurance Company 6196-FC20-A NAMED INSURED: POLICY NO: 394 3399-F06-47X COVERAGE: MC FARLAND. KEVIN M YR/MAKE/MODEL: 2016 TOYOTA STA WAG BI AND PD LIABILITY g PO BOX 489 VIN/CAMPER: JTDZN3EU5GJO44053 $1 MIL $100 DED.COMP. TAHUYA WA 98588-0489 AGENT NAME: DEREK THOMAS $250 DED.COLL. AGENT PHONE: (360)943-8740 ENDORSEMENT NO: 6028BL POLICY EFFECTIVE SEP 04 2024 UNTIL TERMINATED Fi co POLICY MESSAGES: This policy shown above supersedes policy#3943399-47W. A The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance o provided and subject to all policy provisions.The additional insured will be given 10 days notice if the policy is terminated. Until such notice is provided,it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of 8 any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. FRT Oldgwrewila � 1 A I t I-AHM- PO Box 2368 Bloomington IL 61702-2368 DATE OF NOTICE: SEP 11 2024 CODE: 69A AT1 15 001098 0093 CITY OF BREMERTON PUBLIC WRKS & UTILITIES 100 OYSTER BAY AVE N U1, BREMERTON WA 98312-3455 cv ro 2 111111 [111 11 [11111111111111111111111111111111111111111 1 1111111111 NOTE: PLEASE NOTIFY STATE FARM AT THE ADDRESS LISTED AT THE TOP, LEFT CORNER OF THIS PAGE REGARDING ANY CHANGE OF ADDRESS INFORMATION. ADDIT' lOt4AL. INSURED'S NOTICE OF p. VE,: AGE . ....:.... State Farm Mutual Automobile Insurance Company 6196-FC20-A NAMED INSURED: POLICY NO: 394 3399-F06-47U COVERAGE: MC FARLAND, KEVIN M YR/MAKE/MODEL: 2016 TOYOTA STA WAG BI AND PD LIABILITY $ 1 MIL PO BOX 489 VIN/CAMPER: JTDZN3EU5GJ044053 $100 DED. COMP. TAHUYA WA 98588-0489 AGENT NAME: DEREK THOMAS $250 DED. COLL. AGENT PHONE: (360)943-8740 ENDORSEMENT NO: 6028BL POLICY EFFECTIVE AUG 05 2024 UNTIL TERMINATED POLICY MESSAGES: The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance provided and subject to all policy provisions. The additional insured will be given 10 days notice if the policy is terminated. Until such notice is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. FRT StateFarm STATE FARM® PO Box 2368 Bloomington IL 61702-2368 168A AT1 15 001236 0093 CITY OF BREMERTON 345 6TH ST STE 100 BREMERTON WA 98337-1891 IIIIII'llllll'III'III'll'I'llllllll'I'll'lllll'lll'll'll'llllllll 0 0 g 0 b A DATE OF NOTICE: OCT 02 2024 CODE: NOTE: PLEASE NOTIFY STATE FARM AT THE ADDRESS LISTED AT THE TOP, LEFT CORNER OF THIS PAGE REGARDING ANY CHANGE OF ADDRESS INFORMATION. RECEIVED OCT 15 2024 City of Bremerton ity Attorney's Office DDI > 0 A A TI NAL:INSURED S NOTICE OF COVER GE::::::... >: .. .....:........... State Farm Mutual Automobile Insurance Company 6196-FC20-A NAMED INSURED: POLICY NO: 394 3399-F06-47X COVERAGE: MC FARLAND, KEVIN M YR/MAKE/MODEL: 2016 TOYOTA STA WAG BI AND PD LIABILITY PO BOX 489 VIN/CAMPER: JTDZN3EU5GJ044053 $ 1 MIL o $100 DED. COMP. TAHUYA WA 98588-0489 AGENT NAME: DEREK THOMAS $250 DED. COLL. C AGENT PHONE: (360)943-8740 o ENDORSEMENT NO: 6028BL POLICY EFFECTIVE SEP 04 2024 UNTIL TERMINATED POLICY MESSAGES: am The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance o provided and subject to all policy provisions. The additional insured will be given 10 days notice if the policy is terminated. Until such notice co is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of gany change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. N r- FRT Statee&rm STATE FARM® C� • a PO Box 2368 Bloomington IL 61702-2368 98A AT1 15 001029 0093 CITY OF BREMERTON 345 6TH ST STE 100 1 BREMERTON WA 98337-1891 'r+ �l�l�lil�l�lll�l�llllll'lIII, l-IIIIIIIJill, III 111lllll'lllll'1111 DATE OF NOTICE: SEP 20 2024 CODE: NOTE: PLEASE NOTIFY STATE FARM AT THE ADDRESS LISTED AT THE TOP, LEFT CORNER OF THIS PAGE REGARDING ANY CHANGE OF ADDRESS INFORMATION. RECEIVED ucf U 1 X?4 City of Bremerton City Attorney's Office ADDITIONAL INSURED'S NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 6196-FC20-A NAMED INSURED: MC FARLAND, KEVIN M PO BOX 489 TAHUYA WA 98588-0489 POLICY NO: YR/MAKE/MODEL: VIN/CAMPER: AGENT NAME: AGENT PHONE; ENDORSEMENT NO: 394 3399-F06-47V 2016 TOYOTA STA WAG JTDZN3EU5GJ044053 DEREK THOMAS (360)943-8740 6028BL COVERAGE: BI AND PD LIABILITY $ 1 MIL $100 DED. COMP. $250 DED. COLL. POLICY EFFECTIVE AUG 07 2024 UNTIL TERMINATED POLICY MESSAGES: The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance provided and subject to all policy provisions. The additional insured will be given 10 days notice if the policy is terminated. Until such notice is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. ADDITIONAL INSUREDS NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 6196-FC20-A NAMED INSURED: POLICY NO: 394 3399-F06-47W COVERAGE: MC FARLAND, KEVIN M YR/MAKE/MODEL: 2016 TOYOTA STA WAG BI AND PD LIABILITY PO BOX 489 VIN/CAMPER: JTDZN3EU5GJ044053 $ 1 MIL TAHUYA WA 98588-0489 AGENT NAME: DEREK THOMAS $100 DED. COMP. AGENT PHONE: (360)943-8740 $250 DED. LOLL. ENDORSEMENT NO: 6028BL POLICY EFFECTIVE AUG 21 2024 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy# 3943399-47V. The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance provided and subject to all policy provisions. The additional insured will be given 10 days notice if the policy is terminated. Until such notice is provided, it shall be presumed that the required renewal premiums have been paid, The additional insured must notify us within 10 days of any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. FRT StateFarm STATE FARM`v PO Box 2368 Bloomington IL 61702-2368 64A AT1 15 001067 0093 CITY OF BREMERTON 345 6TH ST STE 100 BREMERTON WA 98337-1891 1111111111Jill III 1' 1111111111111111111111' 11' 11' Jill 1111111111111 A DATE OF NOTICE: SEP 26 2024 CODE: NOTE: PLEASE NOTIFY STATE FARM AT THE ADDRESS LISTED AT THE TOP, LEFT CORNER OF THIS PAGE REGARDING ANY CHANGE OF ADDRESS INFORMATION. 0 C T 0 7 City oi Bremerton Risk Management ADDITIONAL INSUREVS NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 6196-FC20•A NAMED INSURED: POLICY NO: 394 3399-F06-47X COVERAGE: MC FARLAND, KEVIN M YR/MAKE/MODEL: 2016 TOYOTA STA WAG BI AND PD LIABILITY PO BOX 489 VIN/CAMPER: JTDZN3EU5GJ044053 $ 1 MIL $100 DED. COMP. TAHUYA WA 98588-0489 AGENT NAME: DEREK THOMAS $250 DED. COLL. AGENT PHONE: (360)943-8740 ENDORSEMENT NO: 6028BL POLICY EFFECTIVE SEP 04 2024 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy# 3943399-47W. The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance provided and subject to all policy provisions. The additional insured will be given 10 days notice if the policy is terminated. Until such notice is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. FRT StateFarm STATE FARM® PO Box 2368 Bloomington IL 61702-2368 97A AT1 15 001222 0093 CITY OF BREMERTON 345 6TH ST STE 100 BREMERTON WA 98337-1891 1 It N 0 00 N b 0 co 0 0 0 s III III 1111111111111111111111111111111111111' I l l 11 Jill l l l l l 111 l l l l A DATE OF NOTICE: OCT 22 2024 CODE: NOTE: PLEASE NOTIFY STATE FARM AT THE ADDRESS LISTED AT THE TOP, LEFT CORNER OF THIS PAGE REGARDING ANY CHANGE OF ADDRESS INFORMATION. OCT 2 8 211','4 City of elremerion Risk Managemont ADDITIONAL;INSUR.ED'S NOTICE>OF COVERA.GE State Farm Mutual Automobile Insurance Company 6196-FC20-A NAMED INSURED: POLICY NO: 394 3399-F06-47Y COVERAGE: MC FARLAND, KEVIN M YR/MAKE/MODEL: 2016 TOYOTA STA WAG BI AND PD LIABILITY PO BOX 489 VIN/CAMPER: JTDZN3EU5GJ044053 $ 1 MIL $100 DIED. COMP. TAHUYA WA 98588-0489 AGENT NAME: DEREK THOMAS $250 DED. COLL. AGENT PHONE: (360)943-8740 ENDORSEMENT NO: 6028BL POLICY EFFECTIVE OCT 11 2024 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy# 3943399-47X. The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance provided and subject to all policy provisions. The additional insured will be given 10 days notice if the policy is terminated. Until such notice is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. FRT azacerarm STATE FARM' 44® PO Box 2368 Bloomington IL 61702-2368 71A AT1 15 001207 0093 CITY OF BREMERTON 345 6TH ST STE 100 E.-A BREMERTON WA 98337-1891 DATE OF NOTICE: OCT 30 2024 CODE: NOTE: PLEASE NOTIFY STATE FARM AT THE ADDRESS LISTED AT THE TOP, LEFT CORNER OF THIS PAGE REGARDING ANY CHANGE OF ADDRESS INFORMATION. RED �, ��� - �V NOV 0 6 2024 City of Bremerton RISK Mar.ayement A4DITIONAL INSUREVS NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 6196-FC20-A NAMED INSURED: POLICY NO: 394 3399-F06-47Z COVERAGE: MC EARLAND, KEVIN M YR/MAKE/MODEL: 2016 TOYOTA STA WAG BI AND PD LIABILITY PO 130X 489 VIN/CAMPER: JTDZN3EU5GJ044053 $ 1 MIL $ DIED. COMP. TAHUYA WA 98588-0489 AGENT NAME: DEREK THOMAS $250 o DIED. COLL. AGENT PHONE: (360)943-8740 ENDORSEMENT NO: 6028BL POLICY EFFECTIVE OCT 11 2024 UNTIL TERMINATED POLICY MESSAGES: The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance provided and subject to all policy provisions. The additional insured will be given 10 days notice if the policy is terminated. Until such notice is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. PRT