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HomeMy WebLinkAbout072213_ca02Department of Public Works O Consent Agenda Page 1 of 1 Jefferson County Board of Commissioners Agenda Request To: Board of Commissioners Philip Morley, County Administrator From: Frank Gifford, Public Works Director ~.~ Agenda Date: July 22, 2013 Subject: Execution of Contract, Run-Off-Road and Intersection Safety Project, County Project No. CR1886, Federal Aid Project No. HSIP- 000S(259), Statement of Issue: Execution of Contract with Petersen Brothers of Sumner Washington for the Run-off-Road and Intersection Safety Project, County Project No. CR1886. Analysis/Strategic Goals/Pro's & Con's: This contract is for repair of existing guardrail and installation of new guardrail; traffic sign upgrades; installation and replacement of traffic lane markings; installation of rumble strips. Fiscal Impact/Cost Benefit Analysis: The bid amount is $473,573.71. This will be funded at 100% by the Federal Highway Administration. Recommendation: Public Works recommends that the Board execute all three (3) originals of the Contract with Petersen Brothers and return (2) originals to Public Works. Department Contact: Matt Klontz, P.E., Project Manager, 385-9160. Reviewed By: >~ ~> _! ~/~~~ p Morley; C unty ministrator Date ~ CONTRACT JEFFERSON COUNTY, WASHINGTON THIS AGREEMENT, made and entered into this day of , 201 ,between the COUNTY OF JEFFERSON, acting through the Jefferson County Commissioners and the Director of Public Works under and by virtue of Title 36, RCW, as amended and Petersen Brothers Inc of Sumner, Washin on hereinafter called the Contractor. WITNESSETH: That in consideration of the terms and conditions contained herein and attached and made a part of this agreement, the parties hereto covenant and agree as follows: 1. The Contractor agrees to furnish all labor and equipment and do certain work, to-wit: That The Contractor herein will undertake and complete the following described work: Run-off-Road & Intersection Safety Project -County Project No. CR1886, Federal Aid No. HSII'-OOOS(259); This contract provides for the improvements of various rural and urban collector roads throughout the Jefferson County Road System and includes replacement and/upgrading traffic signs, adding /replacing guardrails and end treatments, adding recessed pavement markers, and installing transverse rumble strips, for the total sum of Four hundred seventy three thousand five hundred seventy three dollars and seventy one cents ($473,573.71) in accordance with and as described in the attached plans and specifications and the Standard Specifications of the Washington Department of Transportation which are by this reference incorporated herein and made a part hereof. The Contractor shall perform any alteration in or addition to the work provided in this contract and every part thereof. The Contractor shall complete the described work as follows: Contract time shall begin on the first working daX following the Notice to Proceed Date. Be inning; with the first working day, the project shall be nhvsically complete with 75 working daXs. The Contractor shall provide and bear the expense of all equipment, work and labor of any sort whatsoever that may be required for the transfer of materials and for constructing and completing the work provided for in this contract and every part thereof. 2. The County of Jefferson hereby promises and agrees with the Contractor to employ, and does employ the Contractor to furnish the goods and equipment described and to furnish the same according to the attached specifications and the terms and conditions herein contained, and hereby contracts to pay for the same according to the attached specifications and the schedule of unit or itemized prices hereto attached, at the time and in the manner and upon the condition provided for in this contract. The County further agrees to employ the Contractor to perform any alterations in or additions to the work provided for in this contract that may be ordered and to pay for the same under the terms of this contract and the attached specifications at the time and in the manner and upon the conditions provided for in this contract. 3. The Contractor for himself, and for his heirs, executor, administrators, successors, and assigns, does hereby agree to the full performance of all the covenants herein contained upon the part of the Contractor. 4. Prior to commencing work, the Contractor shall obtain at its own cost and expense the following insurance from companies licensed in the State with a Best's rating of no less than A: VII. The Contractor shall provide to the County Risk Manager certificates of insurance with original endorsements affecting insurance required by this clause prior to the commencement of work to be performed. The insurance policies required shall provide that thirty (30} days prior to cancellation, suspension, reduction or material change in the policy, notice of same shall be given to the County Risk Manager by registered mail, return receipt requested, for all of the following stated insurance policies. Page 1 of 6 Revised 10/30/12 ` ~ If any of the insurance requirements are not complied with at the renewal date of the insurance policy, payments to the Contractor shall be withheld until all such requirements have been met, or at the option of the County, the County may pay the renewal premium and withhold such payments from the moneys due The Contractor. All notices shall name the Contractor and identify the agreement by contract number or some other form of identification necessary to inform the County of the particular contract affected. A. Workers Compensation and Employers Liability Insurance. The Contractor shall procure and maintain for the life of the contract, Workers Compensation Insurance, including Employers Liability Coverage, in accordance with the laws of the State of Washington. B. General Liability(1) - with a minimum limit per occurrence of one million dollars ($1,000,000) and an aggregate of not less than two million dollars ($2,000,000) for bodily injury, death and property damage unless otherwise specified in the contract specifications. This insurance coverage shall contain no limitations on the scope of the protection provided and indicate on the certificate of insurance the following coverage: 1. Broad Form Property Damage with no employee exclusion; 2. Personal Injury Liability, including extended bodily injury; 3. Broad Form Contractual/Commercial Liability including completed operations (contractors only); 4. Premises -Operations Liability (M&C); 5. Independent Contractors and Subcontractors; and 6. Blanket Contractual Liability. (1)Note: The County shall be named as an additional insured party under this policy. C. Automobile (2} - with a minimum limit per occurrence of $1,000,000 for bodily injury, death and property damage unless otherwise specified in the contract specifications. This insurance "shall indicate on the certificate of insurance the following coverage: 1. Owned automobiles; 2. Hired automobiles; and, 3. Non-owned automobiles. (2) Note: The County shall be named as an additional insured party under this policy. Any deductibles or self-insured retention shall be declared to and approved by the County prior to the approval of the contract by the County. At the option of the County,. the insurer shall reduce or eliminate deductibles or self-insured retention or The Contractor shall procure a bond guaranteeing payment of losses and related investigations, claim administration and defense expenses. The Contractor shall include all subcontractors as insured under its insurance policies or shall furnish separate certificates and endorsements for each subcontractor. All insurance provisions for subcontractors shall be subject to all of the requirements stated herein. Failure of The Contractor to take out and/or maintain any required insurance shall not relieve The Contractor from any liability under the Agreement, nor shall the insurance requirements be construed to conflict with or otherwise limit the obligations concerning indemnification. It is agreed by the parties that insurers shall have no right of recovery or subrogation against the County (including its employees and other agents and agencies), it being the intention of the parties that the insurance policies so affected shall protect both parties and be primary coverage for any and all losses covered by the above described insurance. It is further agreed by the parties that insurance companies issuing the policy or policies shall have no recourse against the County (including its employees and- other agents and agencies) for payment of any premiums or for Page 2 of 6 Revised 10/30/12 ,- assessments under any form of policy. It is further agreed by the parties that any and all deductibles in the above ~ described insurance policies shall be assumed by and be at the sole risk of The Contractor. It is agreed by the parties that judgments for which the County may be liable, in excess of insured amounts provided herein, or any portion thereof, may be withheld .from payment due, or to become due, to The Contractor until such time as The Contractor shall furnish additional security covering such judgment as may be determined by the County. The County reserves the right to request additional insurance on an individual basis for extra hazardous contracts and specific service agreements. 5. The Contractor shall comply with all Federal, State, and local laws and ordinances .applicable to the work to be done under this Agreement. This Agreement shall be interpreted and construed in accord with the laws of the State of Washington and venue shall be in Jefferson County, WA. The Contractor shall indemnify and hold the County, and, its officers, employees, and agents harmless from and shall process and defend at its own expense, including all costs, attorney fees and expenses relating thereto, all claims, demands, or suits at law or equity arising in whole or in part, directly or indirectly, from the Contractor's negligence or breach of any of its obligations under this Agreement; provided that nothing herein shall require a Contractor to indemnify the County against and hold harmless the County from claims, demands or suits based solely upon the conduct of the County, its officers, employees and agents, and; provided further that if the claims or suits are caused by or result from the concurrent negligence of: (a) the Contractor's agents or employees; and, (b) the County, its officers, employees and agents, this indemnity provision with respect to claims or suits based upon such negligence, and/or the costs to the County of defending such claims and suits, etc., shall be valid and enforceable only to the extent of the Contractor's negligence, or the negligence of the Contractor's agents or employees. Claims against the County shall include, but not be limited to assertions that the use and transfer of any software, book, document, report, film, tape, or sound reproduction of material of any kind, delivered hereunder, constitutes an infringement of any copyright, patent, trademark, trade name, or otherwise results in an unfair trade practice or an unlawful restraint of competition. The Contractor specifically assumes potential liability for actions brought against the County by Contractor's employees, including all other persons engaged in the performance of any work or service required of the Contractor under this Agreement and, solely for the purpose of this indemnification and defense, the Contractor specifically waives any immunity under the state industrial insurance law, Title 51 R.C.W. The Contractor recognizes that this waiver was specifically entered into pursuant to provisions of R.C.W. 4,24.115 and was subject of mutual negotiation. 6. The Contractor's relation to the County shall be at al>1 times. as an independent Contractor, and nothing herein contained shall be construed to create a relationship of employer-employee or master-servant, and any and all employees of the Contractor or other persons engaged in the. performance of any work or service required of the Contractor under this Agreement shall be considered employees of the Contractor only and any claims that may arise on behalf of or against said employees shall be-the sole obligation and responsibility of the Contractor. 7. The Contractor shall not sublet or assign any of the services covered by this contract without the express written consent of the. County or its authorized representative. Assignment does not include printing or other customary reimbursable expenses that may be provided in an agreement. 8. Nothing in the foregoing clause shall prevent the County, at its option, from additionally requesting that the Contractor deliver to the County an executed bond as security for the faithful performance of this contract and for payment of all obligations of The Contractor. Page 3 of 6 Revised 10/3/12 IN WITNESS WHEREOF, the Contractor has executed this instrument on the day and year first below written, and the Board of County Commissioners has caused this instrument to be executed by and in the name of said County of Jefferson the day and year first above written. Executed by the Contractor ~~ 11 , 2013 Contractor: Petersen Brothers, Inc. (Please print) By: Ronald G. Petersen, President (Plea prin (Signature) CC-01 PETERBI187NZ State of Washington, Contractor Registration Number COUNTY OF JEFFERSON BOARD OF COMMISSIONERS John Austin, Chair Phil Johnson, Member David W. Sullivan, Member A roved as to fo my ~ ~~ 13 David Alvarez Date Deputy Prosecuting Attorney ,~ S / Frank Giffo Date Public Works Director Page 4 of 6 Revised 1Q/3Q/12 CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY, AND VOLUNTARY EXCLUSION The Contractor certifies to the best of its knowledge and belief, that it and its principals: (1) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; (2) Have not within a 3-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (3) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (2) of this certification; and (4) Have not within a 3-year period preceding this contract had one or more public transactions (Federal, State, or local) terminated for cause or default. Where the Contractor is unable to certify to any of the statements in this certification, such Contractor shall attach an explanation. Petersen Brothers, Inc. Name of Contractor (Please print) Ronald G. Petersen, President Name and Title of Authorized Representative (Please print} ,~/~~- Signature of Authorize Representative [~ I am unable to certify to the above statement. An explanation is attached. Page 5 of 6 Revised 10/30/12 ~~~~~~! '~~~~~~~ '~~~~ Bond No.: 105950518 That:, .Petersen. Brothers,: Inc. ;~f ..Sumner, WA , a Princi~aa, Vin{ Travelers Casua an ure ' Company of America. ,.. a:s:~~~'ety; are~~~ti~ aid s~v~r:~1~~ he~d.tt~ b~u~d: u~tc~ the ±~~~1NT~r' ~C?F our hundred seventy three thousand five hundred J)J~l~1R~£~N, the:: ei~al: sum of seventy.. r D P ~_~11~171J~1 i?4 ...::...~__._.__...___. t}llar~ (~ 473,573.71 ), fir ~~~ ~~yrrnent of ih:ich we Jv~intly and ~~~e~~atl~ bird ourselves; or heirs; ex~~u~vrs, adinisfirator~; and assigns, and s€~~Ges~ors anal ass~gn~,'fi~t~l~r b~+ tl~~s.~:p~esexrt~:. The:~indy~io~ v~'~~i~ l~ar~~ is ~u~ti ~l~at'~~~.; ~n ~iie,~ day o~~,11:i~,, ~0~ 13 a tih~ said Petersen Brothers, Inc. , i~`irncipal,~er~i~, exuted a certain ~on~racl ~?vilh,the ~ouz~ty of Jefferson, by the t~t~s, n~:itions sttd p~~ri~i~tis v~' which ct~n.t~'a+~t tl~e said Petersen Brothers, Inc. , 1'rinei'~al herevy~ith agrees tv furni~ all nate~~ls mid dt~: ~~rta~~ y~ts1„~C} t~-~vi~ "hat ~l~e:saicl P~~i~a1 l~ereirl v~tll undertake arid. ~corrip~ete the f~ila~ving c~es~~r~b~d work; Run-off-Road & Intersection Safety Project -County Project No. CR1886 Federal Aid No. HSIP-OOOS(259) iii J~f~ersa~i County, Washin~t~ri; per. lna~s, ~ls d speoil7~ttions rrlad~ a:pal~ o~ scii!~ Cbrl~ra.Cx; ~uv#~eh c~~~tract: as so e~ccuted, is hereunto attaie~, aid. ~~ ~o~w r+~~err~~ ~ a~d..by ~~.~s ref~ren: is:ii~e~r~arated .herein and made,a part h~r~pf a~ ~.tll fox all ~urpo~es as ~h~r~ sit ;f~rt~ ~.t::lerrgtl? NC?W TH~I~~J~,.:i~`~he ~r.1~~1p~1 ix~i~: sh~il fa~th~'uli~ aril °tt~:l~r +~l~~r~~ and carn~ily ri tine t+~rms, ~nditions arac~ ~trgvii.~i vf.. ~i~ ~o~~~~ ire. X11 re~cls. ~rtd sl~~ll vv~11 end tr~t~y .~r~t~ ~~.~~' dc~ ar~d p~~far~i X11 ~att~rs an~J: ~hiri~s by the 4 said. P~1~int~p~al und~rt;~r~ do tie ~i~i~tor~ed undex said contact; upon the t~~n.s ~~-ppc~sed therein,: arnd within the tirr~e pi~~sc~ib~d ~~r~in.~.a1~d unliil 'the same is a~ceep~ted; and shall pay aft l~bor~rs, m~ci~ancs, sul~cc~ntraciiors anti rn:alerialmen, and a.l~ persons v~rh~ shah sl~~.pl~ such +contctor ter subcor~t~~~or v+~th pro~isians rind. s~.~plics fflr the carrying on ~f such work, ,arid sha~1 in x,11 res~ects:faith.l.l~ p~Ffonn said con.tr~ct ,warding to lath; t~ieri this abii~,a.~ion.to bie v~flid, t~ther'wiSe to remain. in fill fe-r anci ~l~~ect.. ... ........................ ... . V~ITNI/~ our hands:.this 11th day of July , :~;1}l 3 Petersen Brothers, Inc. P~.R~I~IP~:Za. ~3~ Travelers Casualty & .Surety of Company of America S~[~RFT'~ CC~~AY B~: -, Karen Ingram .._~._._ A~~ey ire=~a~ct Ad~.r~ss cif 1c~c~.1 c3#fice and agent of sur~lry c~pv: 621 Pacific Ave. #400 Tacoma, WA 98402 Pale E~ of 6 R~visctl I U30/12 ' ~ WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER r ~A- POWER OF ATTORNEY TRAVELERS ~ Farmington Casualty Company St. Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters, Inc. Travelers Casualty and Surety Company of America St. Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St. Paul Guardian Insurance Company Attorney-In Fact No. 218993 Certificate No. 0 0 5 3 31118 KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut, that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa, and that Fidelity and Guaranty Insurance Underwriters, Inc., is a corporation duly organized under the laws of the State of Wisconsin (herein collectively called the "Companies"), and that the Companies do hereby make, constitute and appoint Karen Ingram, Karen J. Smith, Julie Craker, Thomas P. Hentschell, Leslie A. Parks, Brad Roberts, and Joanne Reinkensmeyer of the City of Tacoma ,State of Washington ,their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF, the Companies have caused this instillament to be signed and their corporate seals to be hereto affixed, this day of January 2013 Farmington Casualty Company Fidelity and Guaranty insurance Calnpany Fidelity and Guaranty Insurance Underwriters, Inc. St. Paul Fire and Marine Insurance Company St. Paul Guardian Insurance Company 14th St. Paul Mercury Insurance Company Travelers Casualty and Surety Company Travelers Casualty and Surety Company of America United States Fidelity and Guaranty Company ~\W1\INlgp, „yr.rw.y. GASG,~~~ ~ J4FlRE S \*N IksG ~,~ SNSUq +~, JP~tY gryQ ~Slgq~~ - ~~.~~{Y~ ~ OPP~RfT /. r ,says ~0..-....... _9> 4J 9y '• g `~G [~ ~4" 0 .U f ~ ~ ~ ~O ~ 4 'P~ ~'~pfiPORA>~i ,•;: •........,• ~•. 4P 9 1 9 S 2 ~ ~PORi4TED ~ z ~E ,,, •h = W ecpRPORAT ~ $ m ~ u`3 z ~ 19~ ~ "'= m . :'^ ~ F - _ : n = a MARTFOR~, < HAfi'1'N6R0, ~i a • a 1951 ~ ~ ~ :,SEAL o s '" • ° ~ ~ CONN. n ~,~ COrlN. ~ N 1896 ~+ ~~ ~ ~ o ~ SBA.L;'3 ,~ o tp.'\t ~,~p~ bey . ti~ >`~ ~"~s~s cE Go d'• ... ~.a'~r~ v'`........••~ aD ' a~ •I'11!'1 ba" )mnnlnplrol .l.~a.wNa- '~S ~ • ~'d 661 n ~Ny ~~ ~~ 'Mlu State of Connecticut City of Hartford ss. By: Robert L. Raney, enior Vice President On this the 14th day of January 2013 before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, 5t. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. G•T~ In Witness Whereof, I hereunto set my hand and official seal. ~ My Commission expires the 30th day of June, 2016. ~ pueu~3` 58440-8-12 Printed in U.S.A. ~ A. W w" l: . Marie C. Tetreault, Notary Public WARNING: THIS POWER OF ATTORNEY IS INVALID WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, which resolutions are now in full force and effect, reading as follows: RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her; and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary; and it is FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kevin E. Hughes, the undersigned, Assistant Secretary, of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United°States Fidelity and Guaranty Company do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Com}~~l,~ies, which is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 4.~P may of , 20 1(i~'' " Kevin E. Hughes, Assistant Sec tary ~~wnmuuuu GASUq~ 1.HRE ,~ \*µ INS •~ 1' N3~~ P~tY AHO ~ Y r y.. ~ G r` ~ b^ ~ ~ NIf~QRATED _ x af~O~POR~TF rGpRPORAT` o+s ~ 9A U' 1 9 S 2 Ct ~ ~ 9~ ~ - m€ to : "• ; m f ~ ~ F •.•.• ~ ' n i ¢ HARTFORD ~ ~ HRR~FdRDI ~ 4 1951 ' ~b~*~+~ ~ ~ ~~~y ~ 7:~SEl~T.jpn3 s7~:-STIi~L;~•3 j CONN. n OONN. ~, ~s< GO L ., ~ ~ ' Vy • 1'~ .'~ ,rg9hGf.ANC d • ••......... a'~1r d:'•.. dD ~b D~ . rNU~rrmnoo ~S•.......•*~ y F •~S . A~1~ 61 N+ • '~ AtN ~~~~ M ..y„r„ To verify the authenticity of this Power of Attorney, call 1-800-421-3880 or contact us at www.travelersbond.com. Please refer to the Attorney-In-Fact number, the above-named individuals and the details of the bond to which the power is attached. NG: TH '~~ °® CERTIFICATE 4 F LIABILITY INSURANCE DATE (MM/°DIYYYY) 7/11/2013 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 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 Karen Smith NAME: HENTSCHELL & ASSOC INC PHONE (253) 272-1151 FA~ N : (253)272-1225 One Pacific Building E-MAIL .karens@hentschell.com 621 Pacif 1C AVe . , Suite 400 INSURERS AFFORDING COVERAGE NAIC # Tacoma WA 98402 INSURERA:The Travelers Indemnit Co. INSURED INSURER B :The Travelers Indemnit Co . Petersen Brothers, Inc . INSURER c :Travelers Pro Cas Co of Am 2008 East Valley Hwy INSURERD:Great American Insurance Co INSURER E ~a'ulrlner WA 98390 ~ INSURER F : I CC~VFRO[~FS f_FRTIGI('_ATG NIIIIARGQ•2A1~ [dT./n~~t•n/TTm4~/1.~sr nc~n~~~w~ ~u~~in~o. 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. ILTR TYPE OF INSURANCE ADDL B POLICY NUMBER MM DDY/YYYY MM DY/YYYY LIMITS GENERAL LIABILITY FJ\CH OCCURRENGE $ 1, 000, 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 300, 000 A CLAIMS-MADE a OCCUR X Y T-CO-526D9518-IND-12 11/1/2012 1/1/2013 MED EXP (Any one person) $ 10, 000 PERSONAL & ADV INJURY $ 1, 000, 000 GENERAL AGGREGATE $ 2, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2, 000, 000 POLICY X PRO- LOC $ AUTOMOBILE LIABILITY D SINGLE LIMIT Ea aBcide 1 000 000 A X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X T-810-526D9518-IND-12 11/1/2012 11/1/2013 BODILY INJURY (Per accident) $ X HIRED AUTOS X NON-OWNED AUTOS PROPERTY DAMAGE Per accident $ Medical a ments $ 5 000 C X UMBRELLA LIAR X OCCUR SM-CUP-526D9518-TIL-12 11/1/2012 11/1/2013 EACH OCCURRENCE $ 1, 000, 000 D X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1, 000, 000 DED X RETENTION 10,00 X 0196241-02 (Excess) 11/1/2012 11/1/2013 Each Occurrence/Aggregate $ 5, 000, 000 A ~II»: WC STATU- OTH- ~~ EMPLOYERS' LIABILITY Y f N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ^ N / A E.L. EACH ACCIDENT $ 1, 000, 000 (Mandatory in NH) If i -CO-526D9518-IND-12 11/1/2012 1/1/2013 E.L. DISEASE - EA EMPLOYE $ 1, 000, 000 yes, descr be under DESCRIPTION OF OPERATIONS below (WA-Stop Gap) E.L. DISEASE -POLICY LIMIT $ 2 000 000 DESCRIPTION OF OPERATIONS /LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, ff more space is required) RE: Run-Off-Road & Intersection Safety Project # CR1886; Fed Aid # HSIP-OOOs(259) Blanket primary additional insured as required by written contract or agreement per CGD246(8/05). & CAT353 (2-12); (#13-103) v~r~ ~ ~r~~.r~ ~ ~ nvw~r~ I.AIVCaLLA 1 IVIV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Jefferson County 623 Sheridan St. Port Townsend, WA 98368 AUTHORIZED REPRESENTATIVE Thomas Hentschell/KJS ~ ~--~,rc~~-~~I Acvrcu ~o (~u-l u-ue) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 (2o~oos).o1 The ACORD name and logo are registered marks of ACORD i ~ 1 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS). This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED - (Section II) is amended to include any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Cover- age Part, but: a} Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b) If, and only to the extent that, the 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 requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the in- surance provided to the additional insured shall be limited to the limits of liability re- quired by that "written contract requiring in- surance". This endorsement shall not in- crease the limits of insurance described in Section III -Limits Of Insurance. b) The insurance provided to the additional in- sured does not apply to "bodily injury", "prop- erty damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or sur- veying services, including: i. The preparing, approving, or failing to prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders or change orders, or the preparing, approving, or failing to prepare or ap- prove, drawings and specifications; and ii. Supervisory, inspection, architectural or engineering activities. CG D2 46 08 05 c) The insurance provided to the additional in- sured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products-completed op- erations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that oc- curs before the end of the period of time for which the "written contract requiring insur- ance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible "other insurance", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non-contributory basis, this insurance is primary to "other insurance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that "other insurance". But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible "other in- surance", whether primary., excess, contingent or on any other basis, that is available to the addi- tional insured when that person or organization is an additional insured under such "other insur- ance". 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include: ©2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY i. How, when and where the "occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the "occurrence" or offense. b) If a claim is made or "suit" is brought against the additional insured, the additional insured must: i. Immediately record the specifics of the claim or "suit" and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit" as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and otherwise comply with all policy conditions. d} The additional insured must tender the de- fense and indemnity of any claim or "suit" to any provider of "other insurance".which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional .insured by this endorsement is primary to "other insur- ance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. -DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 ©2005 The St. Paul Travelers Companies, Inc. CG D2 4fi 08 05 l ~' COMrvIERCIaL AuT~ THIS ENaORSE14~EI~IT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. [~1~~SS A~~` ~~~5;~~~ ~DOSMT This endorsement modifies insurance provided under the following: BUSIh1ESS AUTD COVERAGE FORM tll~th respect to coverage provided by this endorsement, the provisions of the Coverage Farrn apply unless modi- fied by the endorsement. GENERAL DESCRIPTION C3F 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 Gaverage 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 covereges. 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 1NSUREb B. BLANKET ADDITIONAL INSURED G. EMPLOYEE HIRED AUTO D. EMPLOYEES A5 INSURED E. SUPPLEMENTARY PAYMENTS -INCREASED !_1MlTS F. HIRED AUTD - LIMITED WORLDWIDE COVERAGE - INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE -GLASS PROVISIONS A, BROAD FORM NAMED INSURED The following is added to Paragraph A.'!., Who Is An Insured, of SECTION I! -LIABILITY COV- ERAGE; Any organiza~on you newly acquire or form dur- ing the policy period over which you maintain 50°~ or more ownership infierest and that is not separately insured for Business Auta Coverage. Coverage under this provision is afFvrded only un- til the 180th day after you acquire ar form the or- ganization or the end of the policy period, which: ever is earlier. B. BLANKET ADDITIONAL INSURED The following is added to Paragraph c. In A.'I., Who !s An Insured, of SECTION li _ LIABILITY COVERAGE: Any person or organizatlon who is .required under a written contract ar agreement between you and that person yr arganiaation, that is signed and H, HIRED AUTO PHYSICAL DAMAGE -LOSS OF USE -INCREASED LIMIT 1. PHYSICAL DAMAGE -TRANSPORTATION EXPENSES -INCREASED LIMIT J. PERSONAL EFFEGT5 1C. AIRBAGS L. NOTICE AND KN0INLEDGE OF ACCIDENT C?R LQ~S M. BLANKET WAIVER OF SUBROGATION N. UNINTENTIONAL ERRORS OR QMISSIONS executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "Insured" for Llat,ifity Cover- ege, but only for damages to which #his insurance applies and only to the extent that person yr or- ganization qualifies as an "insured" under the 11Uho Is An Insured provision contained in Sec#ivn I1. C. EMPLOYEE HIRED AUTO '1. The fallowing is added to Paragraph A.I., Who Is An Insured, of SECTION II - L- ABILITY COVERAGE: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee`s" name, with your permission, white performing duties related to the conduct of your busi- ness, CA T3 S3 0212 ®20'10 Tl~ Travelers Indemnity Company Page'~l of 4 Includes cnpyrtghted material of Ir~uran~ Services Office, inc. with its permission. C©MMERCIAL AUTt~ 2. The following replaces Paragraph b. in 8.5., Ctther Insurance, of SECTION iV - BUSI- NESS At1TtJ CON©ITIUNS; 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 barrow; and (~~ Any covered "auto" hired or rented by - your "employee'" under a contract in that individual "employee's" name, with your permission, white perform- ing duties related to the conduct of your business. - However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". [?. EMPLOYEES AS INSURED The following is added tv Paragraph A.'1., Who (~ An insured, of SECTION H -LIABILITY CDV- ERAGE: Any "employee" of yours is an "insured" while us- ing acovered "au#o" you don`t own, hire yr borrow fn your business or your personal affairs. E, SUPPLEMENTARY PAYMENTS - INCi4EASED LIMITS 1. The fallowing replaces Paragraph A.2.a.(Zy, of SECTIt?N II -LIABILITY COVERAGE: (2j Up to $3,OUa far cost of bail bonds {in- cluding bands for related traffic lava viala- tions) required because of an "accident" we cover. We do not have to furnish tl1B5e bonds, 2. The' following replaces Paragraph A.Z.a.{4), of SECTION Il -LIABILITY C©VERAGE: (4y Ail reasonable expenses incurred by the 'tinsured" at our request, including actual lass of earnings up to $50~ a day be- cause of bme off from work. F. HIRED AUTO -LIMITED W©RLDWIDE CQV- ERAGE -INDEMNITY BASIS The following replaces Subparagraph {5) in Para- graph 8.7., Pollcy Perlod; Coverage Territory, of SECTION IV -BUSINESS AUTO CONDI- TIONS; {5) Anywhere In the world, except any Gauntry or jurisdiction while any trade sanction, em- bargo, or similar regulation imposed by the United States of America applies to and pro hibits the transaction of business with or within such country or jurisdiction, fvr Liability Coverage for any covered "auto" that you lease, hire, rent or borrow without a driver fvr a period of 31~ days yr less and that is not an "auto" you lease, hire, rent or borrow from any of your "employees", partners {if you are a partnership), members (if you are a limited liability campany~ or members of their house- holds. {a~ 1N'ith respect to any claim made or "suit" brought outside the Unfted States of America, the territories and pvssessicins of the United States of America, Puerto Rico and Canada. {i} You must arrange to defend the "in- sured" against, and investigate or sst- tie any such claim or "suit" and keep us advised of ail proceedings and ac- tions. {ii) Neiti~er you nor any other involved "insured°' will make. any settlement without our consent. (lily INe may; at our discretion, participate in defending the "insured" against, or in the settlement of, any claim or "Slab". {lvy We wiii reimburse the "insured" for sums that the 'tinsured" legally must pay as damages because of "bodily injury" or "property damage" to which this insurance applies, that the "in- sured" pays with our consent, but only up to the limit described in Para- graph C., Limit Of Insuranr~, of SEC- TION Ii -LIABILITY COVERAGE, (vy We wiii reimburse the "insured" for the reasonable expenses incurred with our consent for your .investiga- tion of such claims and your defense of the "insured" against any such "suit", but only up to and included within the limit described in Para- . graph C., Limifi Of Insurance, of SECTION Ii -LIABILITY COVER- AGE, and not in addition to such limit, Our duty to make such payments ends when we have used up the ~p- plicable limit of insurance in pay- ments for damages, settlements or defense expenses, (by This insurance is. excess over any valid and collectible other insurance available Page 2 of '4 ~} 2410 The Travelers Indemnity Company GA T3 53 4~ 1 Z includes cQpyrlg€~ted material of ln~urance Services QfilGe, Inc, with its permission. .t , GOMMERCIRL AUTO to the "insured" whether primary, excess contingent or on any other basis. • {c} This insurance is not a substitute for re- quired or compulsory insurance in any country outside the United States, Its ter- ritories and possessions, Puerto Rico and Canada. 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- surance requirements. (dy It is understood that we are not an admit- ted or authorized insurer outside the United States of America, 'rts territories and possessions, Puerto Rico and Can- ada tNe assume no responsibility for the furnishing of certificates of insurance, or for compliance in any way with the laws of other cx7untries relating to insurance. G. WAIVER OF DEDUCTIBLE --GLASS The following is added to Paragraph D., De- ductible, of SECTION il! -PHYSICAL DAMAGE GOVERAGE: No deductible far a covered "auto'' will apply to glass damage if the glass is repaired rather than replaced. H, H1RED AUTO PHYSICAL DAMAt3E - LCJSS C?F USE _ INCREASED LIMIT The following replaces the last sentence of Para- graph A.4,b,, Lass Of Use Expenses, of SEC TION III -- PHYSICAL DAMAGE COVEtZA+GE: However, the most we will pay for any expenses for loss of use is $85 per day, to a maximum of $750 for any one "accident", i. PHYSICAL DAMAGE _ TRANSPORTATION EXPENSES -INCREASED LIMIT The following replaces the first sentence in Para- graph A,4,a., Transportation Expenses, of SECTION III -- PHYSICAL DAMAGE CC7VERA- GE: 1Ne will pay up to $50 per day to a maximum of $7,500 for temporary transportation expense in- curred by you because of the total theft of a cov-. Bred'"auto°' of the private passenger type. ,!. PERSONAL EFFECTS The following is added to Paragraph A.4., Cover- age Extensions, of SECTION 111 - PHYSICAL DAMAGE COVERAGE; Personal Effects We wilt pay up to $400 for "lass" to vrearing ap- parel and other personal effects which are: ('t j Owned by an "insured"; and (2y In or an your covered "auto". This coverage applies only in the event of a total theft of your covered "auto". No deductibles apply to this Personat Effects coverage. K. AIRBAGS The following is added to Paragraph B.3., Exclu- slans, of SECTION III - PHYSIGAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "ions" to one or more airbags In a covered "auto" you own that in- flate due to a cause other than a cause of '"}oss" set forth in Paragraphs A,'I.b, and A.1,c., but only; a. if that "auto" is a covered "auto° for Gompre- hensivs Coverage under this policy; b. The airbags are no# covered under any war- ranty; and c. The airbags were not intentionally inflated. We wiii pay up to a maximum of $'l,~(}0 for any one "foss". L. NOTICE AND KNQiNLEDGE OI~ ACCIDENT OR LOSS The following is added to Paragraph A.~.a,, of SECTION tV--BUSINESS AUTt7 CUNDITIC?N5: Your duty to give us or our authorized represents- tine prompt notice of the "accident' or "loss" ap- plies only when the "accident" or "loss" is known to: (a} You (if you are an individual); fib) A partner (if you ere a partnership}; {c} A member (if you are a limited liability com- PanY}. {d} An executive officer, director or insurance manager (if you are a cor~ara#ion or other or- ganization); or (e} Any "employee" authorized by you to give na tics of the °accident" or "loss", CA T3 53 02 'I 2 ~ 24'10 The Travelers indemnity Cornparty Page 3 of 4 Includes copyrighted material of Insurance Services t~ffica, inc. with its permission. ,~ can~l~ERCIAL Aura IVl. BLANKET WAIVER OF SUBRiQGATIt~N The fallowing replaces Paragraph A.S., Transfer C)fi' Rights Of Recovery Agains# Others To Us, of SECTitJN !1T -- BUSINESS AUTO CQNQ!- TlC~NS: 5. Transfer Df Rights Of Recovery Against . Qthers To Us We waive any right of recovery uve may have against any person or organization to the ex- tent required of you by a written contract signed and executed pricar to any "accident" ar °IOSS"~ provided that the "i~CC:idBnt" ~r "loss" arises out of nperaticans contemplated by such contract. The waiver applies only to the person or organization designated in such contract. N. UNIAl7ENTlONAL ERRORS OR OMlSSlONS The fallowing is added to Paragraph B.Z., Con- cealment, Misrepresentation, t7r i=raud, of SECTIQN iv -- BU;SiNES5 AUTCt CQNdITtQivS: The unintentional omission of, or unintentional error in, any information given by you shalt not prejudice your rights under this insurance. How- ever this provision does not affect our right to col- lect add~ional premium or exercise our right of cancellation or non-renewal. P~9~ 4 of ~ ~ 2a1C1 The Travelers Indemnity Comparry CA T3 53 QZ 't 2 includes copyrighted material of Insurance Services ai~ce, inc. with I#s permission. COMMERCIAL GENERAL LIABILITY THIS ENDC}RSEMENT CHANGES THE POLICY. PLEASE .READ IT CAREFULLY. CONTRACTORS KTEND ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESGRIPTIQN OF GOVERAGE -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 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. Aircraft Chartered With Pilot B. Damage To Premises Rented To You G. Increased Supplementary Payments D. Jncidental Medical Malpractice E. Who Is An Insured -Newly Acquired Or Formed Organizations F. Who Is An Insured - Broadendd Named Insured - Unnamed Subsidiaries G. Blanket Additional Insured -Owners, Managers Or Lessors flf Premises H. Blanket Additional Insured -Lessors Of Leased Equipment I. Blanket Additional Insured -States Or Political Subdivisions -Permits J. Knowledge And Notice Of Occurrence Or Offense K. Unintentional omission L. Blanket Waiver Of Subrogation M. Amended Bodily Injury Definition N. Gontractual Liability -Railroads PROVISIONS A. AIRCRAFT CHARTERED WITH PILOT The following is added to Exclusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION I -COVERAGES -- COVERAGE A BODILY IN- JURYAND PROPERTY DAMAGE LIABILITY: This exclusion does not apply to an aircraft that is: (a) ,Chartered with a pilo# to any insured; (b) Not owned by any insured; and (c) Not being used to carry any person or prop- erty for a charge. B. DAMAGE TO PREMISES RENTED TO YOU 1. The first paragraph of the exceptions in Ex- clusion j., Damage To Property, in Para- graph 2. of SECTION I -COVERAGES - COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY is deleted. INJURY AND PROPERTY DAMAGE LI- ABILITY: Exclusions c. and g. through n. do not apply to "premises damage". Exclusion f.(9)(a) does not apply to "premises damage" caused by: a. Fire; b. Explosion; c. Lightning; d. Smoke resulting from such fire, explosion, or lightning; or e. Water; unless Exclusion f. of Section I -Coverage A - Bodily Injury And Proper#y Damage Liability is replaced by another endorsement to this Coverage Part that has Exclusion -All Pollu- tion Injury (7r Damage or Total Pollution Ex- clusion in its title. 2. The following replaces the last paragraph of A separate limit of insurance applies to Paragraph 2., Exclusions, of SECTION I - "premises damage" as described in Para- GOVERAGE$ -COVERAGE A. BODILY graph 6. of SECTION fll -LIMITS OF IN- SURANCE. CG D3 9 fi 1'I 9 7 ~ 2011 The Travelers Indemnity Company. All rights reserved. Page 1 of fi COMMERCIAL GENERAL LIABILITY 3. The following replaces Paragraph 6. of SEC- TION III -- LIMITS pF INSURANCE: Subject to 5. above, the Damage To Prem- ises Rented To 'You Limit is the most we will pay under Coverage A for damages because of "premises damage" to any one premises. The Damage To Premises Rented To You Limit will apply to all "property damage" proximately caused by the same "occur- rence", whether such damage results from: fire; explosion; lightning; smoke resulting from such fire, explosion, or lightning; or water; or any combination of any of these causes. The damage To Premises Rented To You Limit will be: a. The amount shown for the Damage To Premises Rented To You Limit an the Declarations of this Coverage Part; or b. $304,400 if no amount is shown for the Damage To Premises Rented To You Limit on the Declarations of this Coverage Part. 4. The' following replaces Paragraph a. of the definition of "insured contract" in the DEFINI- TIQNS Section: a. A contract for a lease of premises. How- ever, that portion of the contract for a lease of premises that indemnifies any person or organisation for "premises damage" is not an "insured contract"; 5. The following is added to the DEFINITIONS Section: "Premises damage" means "property dam- age" to: a. Any premises while rented to you or tem- porarily occupied by you with permission of the owner; or b. The contents of any premises while such premises is rented to you, if you rent such premises for a period of seven or fewer consecutive days. 6. The following replaces Paragraph 4.b.(1j(bj of SECTION IV -COMMERCIAL GENERAL LIABILITY C#3NDITiQNS: (bj That is insurance for "premises damage"; or 7. Paragraph 4.b.(1 jtGj of SECTION IV - CC}MMERGIAL GENERAL LIABILITY Ct'JN- DITIpNS is deleted. C. INCREASE©SUPPLEMENTARY PAYMENTS 1. The following replaces Paragraph 1.b. of SUPPLEMENTARY PAYMENTS - COVER- AGES AANC? B of SECTION 1 - CpVER- AGE: b. Up to $2,5QQ far the cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to fur- nishthese bonds. 2. The following replaces Paragraph 1.d. of SUPPLEMENTARY PAYMENTS - CQVER- AGES AAND B of SECTION I -- COVER- AGES: d. All reasonable expenses incurred by the insured at our request to assist us in the investigation ar defense of the claim or "suit", including actual loss of earnings up to $500 a day because of time off from work. D, INCIDENTAL MEDICAL MALPRACTICE 1. The following is added to the definition of "oc- currence" in the i7EFINITIC3NS erection: 'Occurrence" also means an act or omission committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to a person. 2. The following is added to Paragraph 2.a.(1j of SECTION I! -1fVH0 IS AN INSURED: Paragraph (1j4d} above does not apply to "bodily injury" arising out of providing or fail- ing to provide: (ij "Incidental medical servlCes" by any of your "employees" who is a nurse practi- tioner, registered nurse, licensed practical nurse, nurse assistant, emergency medi- cal technician or paramedic; or (iij First aid or "Good Samaritan services" by any of your "employees" or "volunteer workers", other than an employed or vol- unteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide trst aid or "Good Samaritan ser- vices" during their work hours for you will be deemed to be acting within the scope of their ernpioyment by you or performing duties related to the conduct of your busi- ness. Page 2 of fi ~ 2011 The Travelers Indemnity Cornp~ny. Atl rfghts reserved. CG D316 11 11 . ~; s COIUIbIIERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 5. of SECTION Ill -LIMITS OF INSURANCE: For the purposes of determining the applica- ble Each occurrence Limit, alt related acts or omissions committed in providing or failing to provide "incidental medical services", first aid or "Goad Samaritan services" to any one per- sonwill be deemed to be one "occurrence". 4. The following exclusion is added to Para- graph 2., Exclusions, of SECTION I - COV- ERAGES - COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury" or "property damage" arising out of the willful violation of a penal statute or ordinance relating to the sale of pharmaceuti- cals committed by, or with the knowledge or consen# af, the insured. 5: The following is added to the DEFtNiTIt1NS :erection: "Incidental medical services" means: a. lNedical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; or b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. "Good Samaritan services" means any emer- gency medical services for which no compen- cation is demanded or received. 6. The following is added to Paragraph ~.b., Ex- cess Insurance, of SECTION !V ~ COM- MERCIAL GENERAL LIABILITY CONDI- TIONS: The insurance is excess aver any aalid and collectible other insurance available to the in- sured, whether primary, excess, contingent or on any other basis, that is available to any of your "employees" or "volunteer workers" for "bodily injury" that arises out of providing or failing to provide "incidental medical ser- vices", first aid or "Good Samaritan services" to any person to the extent not subject to Paragraph 2.a.(1 j of Section II - iA~to Is An Insured. E. WHt? IS AN INSURED -- NEWLY ACQUIRED OR FORMED ORGANIZATIONS The following replaces Paragraph 4. of SECTION tl - WHtJ IS AN INSURED: 4. Any organization you newly acquire or farm, other than a partnership, joint venture or lim- ited liability company, of which you are the sole owner or in which you maintain the ma- jority ownership interest, will qualify as a Named Insured if #here is no other insurance which provides similar coverage to that or- ganization. However: a. Coverage under this provision is afforded only: ~1j Until the ~SOth day after you acquire or farm the organization or the end of the policy period, whichever is earlier, if you do not report such organization in writing to us within.180 days after you acquire or form it; or t2) Until the end of the policy period, when that date is later than 180 days after you acquire or f©rm such organization, if you report such organization in writing to us within '180 days after you acquire or form it, and we agree in writing that it will con- tinue to be a Named Insured until the end of the policy period; b. Coverage A does not apply to "bodily injury°' or "property damage" that occurred before you acquired or formed the organization; and c. Coverage B does not apply to "personal in- jury" or "advertising injury" arising out of an offiense committed before you acquired or formed the organization. F. WHO IS AN INSURED -BROADENED NAMED INSURED - UIdNAAAED SUBSIDIARIES The following is added to SECTION II -WHO IS AN INSURED: Any of your subsidiaries, other than a partnership, joint venture or limited liability company, that is not shown as a Named insured in the Declara- tions is a Named Insured it you maintain an own- ership interest of more than 5d°fo in such subsidi- ary on the first day of the policy period. Na such subsidiary is an insured for "bodily injury" or "property damage" that occurred, or "personal injury" or "advertising injury" caused by an of fence committed after the date, if any, during the policy period, that you no longer maintain an ownership interest of more than 50% in such sub- sidiary. CG D316 11 'l 1 ~ 2fl~ 1 The Travelers Indemnity Cnanpany. Ali rights reserved. Page ~ of 6 ~ i ,~ ~ COMMERCIAL GENERAL LIABILITI( G. BLANKET ApDITIC?NAL INSURED -DINNERS, MANAGERS OR LESSORS OF PREMISES The following is added to SECTION II -WHO IS AN INSURED: Any person or organization that is a premises owner, manager or lessor and that you have agreed in a written contract or agreement to in- clude as an additional insured on this Coverage Part is an insured, but only with resp®ct to liability for "bodily injury", "property damage", "personal injury" or "advertising injury" that: a. Is "bodily injury" or "property damage" that occurs, or is "personal injury" ar "advertising injury" caused by an offense that is commit- ted, subsequent to the execution of That con- tract or agreement; and b. Arises out of the ownership, maintenance or use of that part of any premises leased to you. The insurance provided to such premises owner, manager or lessor is subject to the following pro- visions: a. The limits of insurance provided to such premises owner, manager or lessor wi11 be the minimum limits which you agreed to pro- vide in the written contract ar agreement, ar the limits shown on the Declarations, which- everare less. b. The insurance provided to such premises owner, manager or lessor does not apply to: (1) Any "bodily injury" or "property damage" that occurs, or "personal injury" or "adver- tising injury" caused by an offense that is committed, after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such premises owner, lessor or manager. c. The insurance provided to such premises owner, manager ar lessor is excess over any valid and collectible other insurance available to such premises owner, manager or lessor, whether primary, excess, contingent ar on any other basis, unless you have agreed in the written contrac# or agreement that this in- surance must be primary to, or non- contributory with, such other insurance, in which case this insurance will be primary to, and non-contributory with, such other insur- ance, Page 4 of fi H. BLANKET ADDITIQNAL INSURED - LESSORS !?F LEASED EQUIPMEAlT The following is added to SECTION II -WHO IS AN INSURED: Any person or organization that is an equipment lessor and that you have agreed in a written con- tract or agreement to include as an insured on this Coverage Part is an insured, but only with re- spect to liability for "bodily injury", "property dam- age", "personal injury" or "advertising injury" that: a. Is "bodily injury" or "property damage" that occurs, or is "personal injury" or "advertising injury" caused by an offense #hat is commit- ted, subsequent to the execution of that con- tract or agreement; and b. Is caused, in whole or in part, by your acts or omissions in the maintenance, operation or use of equipment leased to you by such equipmen# lessor. The insurance provided to such equipment lessor is subject to the folbwing provisions: a. The limits of insurance provided to such equipment lessor will be the minimum limits which you agreed to provide in the written contract or agreement, or the limits shown on the Declarations, whichever are less. b. The insurance provided to such equipment lessor does not apply to any "bodily injury"' or "property damage" that occurs, or "personal injury" or "advertising injury" caused by an of- fense that is committed, after the equipment lease expires. c. The insurance provided to such equipment lessor is excess over any valid and collectible other insurance available to such equipment lessor, whether primary, excess, contingent or on any other basis, unless you have agreed in the written contract or agreement that this insurance must be primary to, ar non-contributory with, such other insurance, in which case this insurance will be primary to, and non-contributory with, such other in- surance, i. BLANKET ADDITIONAL INSURED -STATES DR PDLITICAL SUBDIVISIONS -PERMITS The following is added to SECTION it -WHO IS AN INSURED: Any state or political subdivision that has issued a permit in connection with operations performed by you or on your behalf and that you are required ~ 2011 The Travelers Indemnity Company. AU rights reserved. CG D3 1611 1'l ,A t Y CQMM~RCIAL GENERAL LIABILITY by any ordinance, [aw or building code to include as an additional insured an this Coverage Part is an insured, but only with respect to liability for "bodily injury" "property damage", "personal in- jury" or "advertising injury" arising out of such op- erations. The insurance provided to such state or political subdivision does not apply to: a. Any "bodily injury," "property damage,,, "per- sonal injury" or "advertising injury" arising out of operations performed for that state or po- litical subdivision; yr b. Any "bodily injury" ar "property damage" in- cluded in the "products-completed operations hazard". J. 14NOWLEDGE AND NOTICE OF OCCUR- RENCE OR OFFENSE The following is added to Paragraph 2., Duties In The Event of Occurrence, Offense, Clalm or Suit, of SECTION IV - COMIVIERCIAL GEN- ERAL LIABILITY CONDITIONS: e. The following previsions apply to Paragraph a. above, but only for the purposes of the in- surance provided under this Coverage Part to you or any insured listed in Paragraph 1. or 2. of Section ll -- Who Is An Insured: ~'! } Notice to us of such "occurrence" or of- fense must be given as soon as practica- ble only after the "occurrence" or offense is known by you {if you are an individual), any of your partners or members who is an individua! of you are a partnership or joint venture), any of your managers who is an individual (if you are a limited (lability company), any of your "executive offi- cers" or directors cif you are an organiza- tion other than a partnership, joint venture or limited liability company3 or any "em- ployee" authorized by you to give notice of an "occurrence" or offense. (7) If you are a partnership, joint venture or limited liability company, and Wane of your partners, joint venture members or man- agers are individuals, notice to us of such "occurrence" or offense must be given as soon as practicable only after the "occur- rence" or offense is known by: (a) Any individual who is: {i) A partner or member of any part- nership or joint venture, (ii) A manager of any limited liability company; or (iii) An executive officer or director of any other organization; that is your partner, joint venture member or manager, or {b) Any "employee" authorized by such partnership, joint venture, limited li- ability company or other organization to give notice of an "occurrence" or offense. {~) Notice to us of such "occurrence" ar of an offense will be deemed to be given as soon as practicable if it is given in good faith as soon as practicable to your work- ers' compensation insurer. This applies only if you subsequently give notice to us of the `occurrence" or offense as soon as practicable after any of the persons de- scribed in Paragraphs e. (1} or i~)« above discovers that the "occurrence" or offense may result in sums to which the insurance provided under this Coverage Part may apply. However, if this Coverage Part includes sn en- dorsement that provides limited coverage for "bodily injury" or "property damage'° or pollution costs arising out of a discharge, release or es- cape of "pollutants" which contains a requirement that the discharge, release or escape of "pollut- ants" must be reported to us within a specific number of days after its abrupt commencement, this Paragraph e. does not affect that require- ment. IC. UNINTENTIONAL OMISSION The following is added to Paragraph 6., Repre- sentations, of SECTION IV - GOMAIIERCIAL GENERAL LIABILITY CONDITIONS: The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not preju- dice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance wi#h applicable insurance laws or regulations. L. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph 8., Transfer Of Rights Of Flecovery Against Others To Us, of SECTION IV -COMMERCIAL GENERAL LI- ABILITY CONDITIONS: CG D3 1 ~ 91 11 ~ 2011 Tt~ Travelers indemnity Company. Alf rights reserved. Page ~ of 6 ~.~~ . - ~ r CQMMERCIAL GENERAL LIABILITY' If the insured has agreed in a contract or agree- ment to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organiza- tion, but only for payments we make because of: a. "Bodily injury" or "property damage" that oc- curs; or b. "Personal injury" or "advertising injury„ caused by an offense that is committed; subsequent to the execution of that contract ar agreement. M. AMENDED BODILY INJURY DEFINITION The following replaces the definition of "bodily injury" in the DEFINITIONS Section: 3. "Bodily injury"' means bodily injury, mental anguish, mental injury, shock, fright, disability, humiliation, sickness or disease sustained by a person, including death resurting from any of these at any time. N. CC3NTRADTUAL LIABILITY -RAILROADS 1. The following replaces Paragraph c. of the definition of "insured contract" in the DEFINI- TIONS Section: c. Any easement or license agreement; 2. Paragraph f.(1 ~ of the definition of "insured contract" in the DEFINITIONS Section is de- feted. Page 6 of 6 ~ 2011 The Travelers Indemnity Company. All rights reserved. CG D3 16 71 11