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HomeMy WebLinkAbout042715_ca04Department 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: Monte Reinders, P.E., Public Works Director /County Engineer Agenda Date: April 27, 2015 Subject: Execution of Contract with Rognlin's, Inc. for Upper Hoh Road MP 3.338 Culvert Replacement, Project No. CR18960, Federal Aid Project No. PLH- A160(001) Statement of Issue: Execution of Contract with Rognlin's, Inc. for the Upper Hoh Road, MP 3.338 Culvert Replacement project, County Project No. CR18960. Analysis /Strategic Goals /Pro's ft Con's: This contract is for replacement of the substandard, failing culvert at Upper Hoh Road MP 3.338 with a new 42 -inch diameter steel culvert. The new pipe is to be installed by pipe ramming through the roadway fill adjacent to the existing culvert. Fiscal Impact /Cost Benefit Analysis: The bid amount is $515,000.00. Construction 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 Rognlin's, Inc. and return two (2) originals to Public Works for further processing. Department Contact: Mark Thurston, P. E., Project Manager, 385 -9160. Reviewed By: V my Administrator Date CONTRACT JEFFERSON COUNTY, WASHINGTON THIS AGREEMENT, made and entered into this day of , 20 , 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 Rognlin's Inc. of Aberdeen, Washington hereinafter called the Contractor. LVA11101�( 391gems 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: This contract provides for the improvement of Upper Hoh Road by replacing the culvert at Upper Hoh Road MP 3.338 in West Jefferson County near Forks, Washington. Work includes replacement of the culvert by the pipe ramming method, lining the pipe, and other work for the total sum of Five hundred fifteen thousand_ dollars ($515,000.00) 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 day following the Notice to Proceed Date. Beginning with the first working day, the project shall be physically complete within 45 working days. 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 7 Revised 1/2015 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 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. Page 2 of 7 Revised 1/2015 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. Any insurance coverage for third party liability claims provided to the County by a "Risk Pool" created pursuant to Ch. 48.62 RCW shall be non - contributory with respect to any policy of insurance the Contractor must provide in order to comply with this Agreement. If the proof of insurance or certificate of coverage indicating the County is an "additional insured" to a policy obtained by the Contractor refers to an endorsement (by number or name) but does not provide the full text of that endorsement, then it shall be the obligation of the Contractor to obtain the full text of that endorsement and forward that full text to the County within 30 days of the execution of this Agreement. The County may, upon the Contractor's failure to comply with all provisions of this contract relating to insurance, withhold payment or compensation that would otherwise be due to the Contractor. 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 all 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. Page 3 of 7 Revised 1/2015 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 4 of 7 Revised 1/2015 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 A 2 r 11 I ") t" , 20 1 C5 Con actor: C)e n1 105 1)(' (Please print) By: N � kn lease p�rint) / (Signature) 1�1)42 Lr State of Washington, Contractor Registration Number COUNTY OF JEFFERSON BOARD OF COMMISSIONERS David W. Sullivan, Chair Phil Johnson, Member Kathleen Kler, Member prove as to foArn only: ti z� is David Alvarez D to Deputy Pros ng tto ey l� Mon emders, P.E. Date Public Works Director /County Engineer Page 5 of 7 Revised 1/2015 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. IV1c Name of Contractor (Please print) N�(' Y-N n��n , V , �' t is Mn Name and Title f Authorized Representative lease print) Signature of Authorize Representative F] I am unable to certify to the above statement. An explanation is attached. Page 6 of 7 Revised 1/2015 CONTRACT BOND Bond No. 023031509 JEFFERSON COUNTY, WASHINGTON KNOW ALL MEN BY THESE PRESENTS: That Rognlin's, Inc. , of Aberdeen, WA , as Principal, and Liberty Mutual Insurance Company, as Surety, are jointly and severally held and bound unto the COUNTY OF JEFFERSON, the penal sum of Five Hundred Fifteen Thousand and No /100 Dollars ($-.5 15,000.00 'l, for the payment of which we jointly and severally bind ourselves, or heirs, executors, administrators, and assigns, and successors and assigns, firmly by these presents. The condition of this bond is such that WHEREAS, on the 10 day of April > A.D., 2015 •the said R29nlin's, Inc. , Principal herein, executed a certain contract with the County of Jefferson, by the terms, conditions and provisions of which contract the said Rogn,lin's Inc_ Principal herewith, agrees to furnish all materials and do certain work, to -wit: That the said Principal herein will undertake and complete the following described work: Upper Hoh Road MP 3.338 Culvert Replacement , in Jefferson County, Washington, as per maps, plans and specifications made a part of said contract, which contract as so executed, is hereunto attached, and is now referred to and by this reference is incorporated herein and made a part hereof as full for all purposes as if here set forth at length. NOW THEREFORE, if the Principal herein shall faithfully and truly observe and comply with the terns, conditions and provisions of said contract, in all respects and shall well and truly and fully do and perform all matters and things by the said Principal undertaken to be performed under said contract, upon the terms proposed therein, and within the time prescribed therein, and until the same is accepted, and shall pay all laborers, mechanics, subcontractors and materiaknen, and all persons who shall supply such contractor or subcontractor with provisions and supplies for the carrying on of such work, and shall in all respects faithfully perform said contract according to law, then this obligation to be void, otherwise to remain in full force and effect. WITNESS our hands this 10 day of April 2015. Rognlin's, Inc. Liberty Mutual Insurance Company PRINCIPAL SURETY COMPANY By :Karen Swanson, Attorney -in -Fact Attorney -in fact Address of local office and agent of surety company: Propel Insurance P. O. Box 2940 Tarnma WA 96401 (253)759 -2200 Page 7 of 7 Revised 1/2015 s THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Certificate No. 6877109 American Fire and Casualty Company Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That American Fire & Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the "Companies "), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Barbara A Johnson• Brent E Heilesen• Carley Espiritu; Christopher Kinyon; Cynthia L. Jay: Diane M. Harding; Eric A. Zimmerman; Jake Ola; James B. Binder; Jamie Diemer• Jeffrey L. Zimmerman; Jennifer L. Snyder; Julie R. Truitt; Karen Swanson; Kellie Hogan; Kristine A. Lawrence; Lisa M. Anderson; Mandy Keltner• Mitchell R. Smee; Peggy A. Firth; Peter J. Comfort; Sandra J. Kulseth; Wyntrene Mace all of the city of Tacoma state of WA each individually if there be more than one named, its true and lawful attorney -in -fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 19th day of February 2015 American Fire and Casualty Company The Ohio Casualty Insurance Company Liberty Mutual Insurance Company g ' West merican Insurance Company STATE OF PENNSYLVANIA ss David M. Care , Assistant Secretary COUNTY OF MONTGOMERY On this 19th day of February , 2015 , before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of American Fire and Casualty Company, Liberty Mutual Insurance Company, The Ohio Casualty Insurance Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting, Pennsylvania, on the day and year first above written. Teresa Pastella , Notary Public This Power of Attorney is made and executed pursuant to and by authority of the following By -laws and Authorizations of American Fire and Casualty Company, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, anclWestAinedcan Insurance Company which resolutions are now in full force and effect reading as follows: ARTICLE IV — OFFICERS — Section 12. Power of Attorney. Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the President may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney -in -fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. ARTICLE XIII — Execution of Contracts — SECTION 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation — The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys -in- fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same force and effect as though manually affixed. I, Gregory W. Davenport, the undersigned, Assistant Secretary, of American Fire and Casualty Company, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, 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 day of �/ �_✓ l.<— 20 . ? 9 BY' � Gregory W. Davenport, Assistant Secretary LMS_12873_122013 164 of 500 Client #: 14295 ROGNINCI ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DDIYYYY) 1 4/08/2015 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 Propel Insurance Tacoma Commercial Insurance NAME: Marc! Berger AX PHONE o 800 499 -0933 F 866.577.1326 A/C N Ext : A IC, No E -MAIL ADDRESS: mrb@propelinsurance.com p 1201 Pacific Ave, Suite 1000 Tacoma, WA 98402 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: National Fire Ins Co of Hartfor 20478 INSURED Rognlin's Inc. West State Street Aberdeen, WA 98520 INSURER 13: Navigators Insurance Company 42307 Illinois Union Insurance Com an INSURER C : Comp an 27960 INSURER D: Continental Insurance Company 35289 INSURER E GENERAL AGGREGATE INSURER F: GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X P M- LOC PRODUCTS - COMP /OP AGG 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 LTR rypE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM /DD POLICY EXP MM /DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 51 OCCUR X PDDed:2,000 X X 2077836807 12/3112014 12/31/2015 EACH OCCURRENCE $11,000,000 PREMISES (ERENTED nte $100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X P M- LOC PRODUCTS - COMP /OP AGG $2,000,000 $ D AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS X X 2077836810 12/31/2014 12/31/201 BIND (CEO a.,d.n SINGLE LIMIT 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ B UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE LA14EXC7710041V 12/31/2014 12/31/201 EACH OCCURRENCE s15,000,000 X AGGREGATE s15,000,000 DIED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 2077836807 WA Stop Gap 12/31/2014 12/31/201 WC WORTH IT OTH- E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 C D Pollution Liab. Installation CPYG23566205011 4027177418 12/31/2014 12/31/2014 12/31/2015 12/31/201 $1,000,0001$2,000,000 $500,000 / $2,500 Ded. DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Upper Hoh Road MP 3.338 Culvert Replacement - County Project No. CR18960. The certificate holder is included as additional insured per the attached endorsements. Jefferson County Department of Public Works 623 Sheridan St Port Townsend, WA 98368 ACORD 25 (2010/05) 1 of 1 #S1704391/M1614797 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE EX-, A'`6 ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD KTR00 Rognlin's Inc. �NA 2077836807 G- 140331 -D (Ed. 01/13) BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - WITH PRODUCTS - COMPLETED OPERATIONS COVERAGE It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART as follows: SCHEDULE (OPTIONAL) Name of Additional Insured Persons Or Organizations (As required by "written contract" per Paragraph A. below.) Locations of Covered Operations (As per the "written contract," provided the location is within the "coverage territory" of this Coverage Part.) A. Section II - Who Is An Insured is amended to include as an additional insured: 1. Any person or organization whom you are required by "written contract" to add as an additional insured on this Coverage Part; and 2. The particular person or organization, if any, scheduled above. B. The insurance provided to the additional insured is limited as follows: 1. The person or organization is an additional insured only with respect to liability for "bodily injury," "property damage," or "personal and advertising injury" caused in whole or in part by: a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your ongoing operations specified in the "written contract'; or b. "Your work" that is specified in the "written contract" but only for "bodily injury" or "property damage" included in the "products- completed operations hazard," and only if: (1) The "written contract" requires you to provide the additional insured such coverage; and (2) This Coverage Part provides such coverage. 2. If the "written contract" specifically requires you to provide additional insurance coverage via the 10/01 edition of CG2010 (aka CG 20 10 10 01), or via the 10/01 edition of CG2037 (aka CG 20 37 10 01), or via the 11/85 edition of CG2010 (aka CG 20 10 11 85), then in paragraph B.I. above, the words 'caused in whole or in part by' are replaced by the words 'arising out of. 3. We will not provide the additional insured any broader coverage or any higher limit of insurance than: a. The maximum permitted by law; b. That required by the "written contract'; c. That described in B.1. above; or d. That afforded to you under this policy, whichever is less. 4. Notwithstanding anything to the contrary in Condition 4. Other Insurance (Section IV), this insurance is excess of all other insurance available to the additional insured whether on a primary, excess, contingent or G- 140331 -D (Ed. 01/13) Page 1 of 2 Copyright, CNA All Rights Reserved. CNA G- 140331 -D (Ed. 01/13) any other basis. But if required by the "written contract" to be primary and non - contributory, this insurance will be primary and non - contributory relative to insurance on which the additional insured is a Named Insured. 5. The insurance provided to the additional insured does not apply to "bodily injury," "property damage," or "personal and advertising injury" arising out of: a. The rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: (1) The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and (2) Supervisory, inspection, architectural or engineering activities; or b. Any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this Coverage Part. C. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: 1. The Duties In The Event of Occurrence, Offense, Claim or Suit condition is amended to add the following additional conditions applicable to the additional insured: An additional insured under this endorsement will as soon as practicable: (1) Give us written notice of an "occurrence" or an offense which may result in a claim or "suit" under this insurance, and of any claim or "suit" that does result; (2) Except as provided in Paragraph 13.4. of this endorsement, agree to make available any other insurance the additional insured has for a loss we cover under this Coverage Part; (3) Send us copies of all legal papers received, and otherwise cooperate with us in the investigation, defense, or settlement of the claim or "suit "; and (4) Tender the defense and indemnity of any claim or "suit" to any other insurer or self insurer whose policy or program applies to a loss we cover under this Coverage Part. But if the "written contract" requires this insurance to be primary and non - contributory, this provision (4) does not apply to insurance on which the additional insured is a Named Insured. We have no duty to defend or indemnify an additional insured under this endorsement until we receive from the additional insured written notice of a claim or "suit." D. Only for the purpose of the insurance provided by this endorsement, SECTION V — DEFINITIONS is amended to add the following definition: "Written contract" means a written contract or written agreement that requires you to make a person or organization an additional insured on this Coverage Part, provided the contract or agreement: 1. Is currently in effect or becomes effective during the term of this policy; and 2. Was executed prior to: a. The "bodily injury' or "property damage'; or b. The offense that caused the "personal and advertising injury," for which the additional insured seeks coverage under this Coverage Part. All other terms and conditions of the Policy remain unchanged. G- 140331 -D (Ed. 01/13) Page 2 of 2 Material used with permission of ISO Properties, Inc. Copyright, CNA All Rights Reserved. CNA Gd. 07-12) 2onassao7 (Ed. 07 -12) CONTRACTORS' GENERAL LIABILITY EXTENSION ENDORSEMENT It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART as follows. The changes this endorsement makes do not apply with respect to any coverage that has been excluded or amended by another endorsement attached to this policy. SCHEDULE Coverage is summarized below. For particulars and limitations affecting each coverage, please refer to the corresponding policy provisions in the body of this endorsement 1. Additional Insureds Seven additional insured extensions. 2. Bodily Injury — Expanded Definition 3. Broad Knowledge of Occurrence/ Notice of Occurrence 4. Broad Named Insured 5. Broadened Liability Coverage For Damage To "Your Product" And "Your Work" Limit: $100,000. 6. Contractual Liability — Railroads Expanded definition of "insured contract." 7. Contractual Liability For Personal And Advertising Injury 8. Electronic Data Liability Loss of Electronic Data Limit: $100,000. 9. Expanded Personal And Advertising Injury - Discrimination Or Humiliation 10. Expected Or Intended Injury Reasonable force — "bodily injury" or "property damage." 11. General Aggregate Limits Of Insurance - Per Project 12. In Rem Actions 13. Incidental Health Care Malpractice Coverage 14. Joint Ventures /Partnership /Limited Liability Companies Coverage for your interest in such terminated or ended organizations. 15. Legal Liability/Alienated Premises /Borrowed Equipment Coverage Extended perils. Default limit increased to $500,000 for Damage to Premises Rented To You. $25,000 limit for "property damage" to borrowed tools or equipment at a jobsite. 16. Liberalization Clause 17. Liquor Liability Coverage Extension 18. Medical Payments Limits increased to $15,000. Reporting increased to three years from the date of accident 19. Non -owned Aircraft Coverage 20. Non -owned Watercraft Increased to 75 feet 21. Primary And Non - Contributory To Other Insurance 22. Property Damage - Elevators 23. Supplementary Payments Cost of ball bonds increased to $5,000. Daily loss of earnings increased to $1,000. 24. Unintentional Failure To Disclose Hazards 25. Waiver of Subrogation - Blanket Waiver of subrogation where required by written contract or written agreement 26. Wrap -Up Extension G-1 8652-J (Ed., 07 -12) Page 1 of 12 Copyright, CNA All Rights Reserved. Ad A 2077836807 1. ADDITIONAL INSURED SECTION II — WHO IS AN INSURED is amended to include as an insured any person or organization (called additional insured) described in paragraphs A. through G. below whom you are required to add as an additional insured on this policy under a written contract or written agreement, provided the written contract or written agreement: L is currently in effect or becomes effective during the term of this policy; and ii. Was executed prior to the "bodily injury," "property damage" or "personal injury and advertising injury" for which the additional insured seeks coverage. However, we will not provide the additional insured any broader coverage or any higher limit of insurance than the least that is: a. The maximum permitted by law; b. Required in the written contract or written agreement; c. Afforded to you under this policy; or d. Described in the applicable paragraphs A. through G. below. A. Controlling Interest Any persons or organizations with a controlling interest in you but only with respect to their liability arising out of 1. Their financial control of you; or 2. Premises they own, maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for such additional insured. B. Co -owner of Insured Premises A co-owner of a premises co -owned by you and covered under this insurance but only with respect to the co- owner's liability as co -owner of such premises. C. Lessor - Equipment 1. Any person or organization from whom you lease equipment, but only with respect to liability for "bodily injury, "'property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person or organization. G- 18652 -J (Ed. 07 -12) Page 2 of 12 G-1 8652-J (Ed. 07 -12) 2. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any 'occurrence" which takes place after the equipment lease expires. D. Lessor - Land An owner or other interest from whom land has been leased by you but only with respect to liability arising out of the ownership, maintenance or use of that specific part of the land leased to you and subject to the following additional exclusions: This insurance does not apply to: 1. Any 'occurrence" which takes place after you cease to lease that land; or 2. Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. E. Lessor - Premises A manager or lessor of premises but only with respect to liability arising out of the ownership, maintenance or use of that specific part of the premises leased to you and subject to the following additional exclusions: This insurance does not apply to: 1. Any 'occurrence" which takes place 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 additional insured. F. Mortgagee, Assignee or Receiver A mortgagee, assignee or receiver but only with respect to their liability as mortgagee, assignee, or receiver and arising out of the ownership, maintenance, or use of a premises by you. This insurance does not apply to structural alterations, new construction or demolition operations performed by or for such additional insured. G. State or Governmental Agency or Subdivision or Political Subdivisions A state or governmental agency or subdivision or political subdivision subject to the following provisions: 1. This insurance applies only with respect to the following hazards for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization in connection with premises Copyright, CNA All Rights Reserved. C VA Gd.07 -1 ) 2077836807 {Ed. 07 -12) you own, rent, or control and to which this insurance applies: a. The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk vaults, street banners, or decorations and similar exposures; or b. The construction, erection, or removal of elevators; or c. The ownership, maintenance or use of any elevators covered by this insurance. 2. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. 3. This insurance does not apply to: a. "Bodily injury," "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or "property damage" included within the "products- completed operations hazard." A governmental permit which requires you to add the governmental entity as an additional insured will trigger this Provision 1. as if the permit were a written contract 2. BODILY INJURY — EXPANDED DEFINITION SECTION V — DEFINITIONS, the definition of "bodily injury" is changed to read: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including death, humiliation, shock, mental anguish or mental injury by that person at any time which results as a consequence of the bodily injury, sickness or disease. 3. BROAD KNOWLEDGE OF OCCURRENCE/ NOTICE OF OCCURRENCE Condition 2. Duties in The Event of Occurrence, Offense, Claim or Suit of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is amended to add the following provisions: A. BROAD KNOWLEDGE OF OCCURRENCE G- 18652 -J (Ed. 07 -12) Page 3 of 12 You must give us or our authorized representative notice of an "occurrence," offense, claim, or "suit" only when the "occurrence," offense, claim or "suit" is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) An executive officer or the employee designated by you to give such notice, if you are a corporation; or (4) A manager, if you are a limited liability company. B. NOTICE OF OCCURRENCE Your rights under this Coverage Part will not be prejudiced if you fail to give us notice of an "occurrence," offense, claim or "suit" and that failure is solely due to your reasonable belief that the "bodily injury" or "property damage" is not covered under this Coverage Part However, you shall give written notice of this "occurrence," offense, claim or "suit" to us as soon as you are aware that this insurance may apply to such "occurrence," offense claim or "suit" 4. BROAD NAMED INSURED A. Any subsidiary or affiliate organization, other than a partnership, joint venture or limited liability company, in which a Named Insured specifically shown in the Declarations has management control, directly or through one or more subsidiary organizations, at the time of loss will qualify as a Named Insured but only if there is no other similar insurance available to such organization, nor similar insurance which would be available but for exhaustion of its limits. For the purpose of this provision, similar insurance means general liability or equivalent insurance, no matter whether its coverage is broader or narrower than that provided by this insurance. But if the only other similar insurance is for a "consolidated (wrap -up) program," then a subsidiary that qualifies as a Named Insured on such project - specific insurance can still qualify as a Named Insured on this insurance, but not for projects covered by the "consolidated (wrap -up) program." [Please see Item 26.C. of this endorsement for the definition of "consolidated (wrap -up) program."] B. This endorsement does not apply to any organization for which coverage is excluded by another endorsement attached to this policy. C. Only for the purpose of this endorsement: Copyright, CNA All Rights Reserved. G-1 8652-J CNA2077836807 (Ed. 07 -12) 1. Management control means: a. Ownership interest representing more than 50 of the voting, appointment, or designation power for the subsidiary organization's governing body; or b. Having the right, pursuant to a written contract, or pursuant to the by -laws, charter, operating agreement, or similar document of a specifically shown Named Insured or controlled subsidiary organization to select, appoint, or designate a majority of the subsidiary organization's governing body. Such contract or document must have been created prior to the time of loss; or c. Having the right, pursuant to a written trust agreement, to protect, control the use of, encumber or transfer and sell property held by a trust. 2. Governing body means the Board of Directors of a corporation. 3. Loss means: a. The occurring of the "bodily injury" or "property damage"; or b. The committing of the offense that caused the "personal and advertising injury." D. The insurance provided by this policy applies to Named Insureds when trading under their own names, or under such trading names or doing - business-as (DBA) names as any should choose to employ. 5. BROADENED LIABILITY COVERAGE FOR DAMAGE TO "YOUR PRODUCT" AND "YOUR WORK" A. Under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Paragraph 2. Exclusions is amended to delete exclusions k. and 1. and replace them with the following: [This insurance does not apply to:] k. Damage to Your Product "Property damage" to "your product" arising out of it, or any part of it except when caused by or resulting from: (1) Fire; (2) Smoke; (3) Collapse; or (4) Explosion. G- 18652 -J (Ed. 07 -12) Page 4 of 12 1. Damage to Your Work "Property damage" to "your work" arising out of it or any part of it and included in the "products - completed operations hazard." This exclusion does not apply: (1) If the damaged work or the work out of which the damage arises was performed on your behalf by a subcontractor, or (2) If the cause of loss to the damaged work arises as a result of (a) Fire; (b) Smoke; (c) Collapse; or (d) Explosion. B. The following paragraph is added to SECTION III — LIMITS OF INSURANCE: Subject to 5. above, $100,000 is the most we will pay under Coverage A for the sum of damages arising out of any one "occurrence" because of "property damage" to "your product" and "your work" that is caused by fire, smoke, collapse or explosion and is included within the "product- completed operations hazard." This sublimit does not apply to "property damage" to "your work" if the damaged work or the work out of which the damage arises was performed on your behalf by a subcontractor. C. This Provision 5. Broadened Liability Coverage For Damage To "Your Product" And "Your Work" does not apply if an endorsement of the same name is attached to this policy. 6. CONTRACTUAL LIABILITY — RAILROADS With respect to operations performed within 50 feet of railroad property, the definition of "insured contract" in SECTION V — DEFINITIONS is replaced by the following: "Insured Contract" means: A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract'; b. A sidetrack agreement; c. Any easement or license agreement; Copyright, CNA Ali Rights Reserved. G-1 8652-J 52VA2077836807 (Ed. 07 -12) d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; (2) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in (1) above and supervisory, inspection, architectural or engineering activities. 7. CONTRACTUAL LIABILITY FOR PERSONAL AND ADVERTISING INJURY Under SECTION I — COVERAGE B — PERSONAL AND ADVERTISING INJURY LIABILITY, Paragraph 2. Exclusions is amended to delete exclusion e. Contractual Liability. This provision 7. does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part. 8. ELECTRONIC DATA LIABILITY A. Under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions is amended to delete exclusion p. Electronic Data and replace it with the following: [This insurance does not apply to:] p. Electronic Data G- 18652 -J (Ed. 07 -12) Page 5 of 12 Damages arising out of the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate "electronic data" that does not result from physical injury to tangible property. However, this exclusion does not apply to liability for damages because of "bodily injury." B. The following paragraph is added to SECTION III — LIMITS OF INSURANCE: Subject to 5. above, $100,000 is the most we will pay under Coverage A for all damages arising out of any one "occurrence" because of "property damage" that results from physical injury to tangible property and arises out of "electronic data." C. The following definition is added to the SECTION V— DEFINITIONS: "Electronic data" means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software (including systems and applications software), hard or floppy disks, CD -ROMS, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. D. For the purposes of the coverage provided by this endorsement, the definition of "property damage" in SECTION V — DEFINITIONS is replaced by the following: 17. "Property damage" means: a. Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; b. Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of the "occurrence" that caused it or c. Loss of, loss of use of, damage to, corruption of, inability to access, or inability to properly manipulate "electronic data," resulting from physical injury to tangible property. All such loss of "electronic data" shall be deemed to occur at the time of the "occurrence" that caused it. For the purposes of this insurance, "electronic data" is not tangible property. E. if Electronic Data Liability is provided at a higher limit by another endorsement attached to this Copyright, CNA All Rights Reserved. G-1 8652-J �XA 2077836807 (Ed. 07 -12) policy, then the $100,000 limit provided by this Provision 8. Electronic Data Liability is part of, and not in addition to, that higher limit. 9. EXPANDED PERSONAL AND ADVERTISING INJURY - DISCRIMINATION OR HUMILIATION A. SECTION V — DEFINITIONS is amended to add the following to the definition of "Personal and advertising injury": h. Discrimination or humiliation that results in injury to the feelings or reputation of a natural person, but only if such discrimination or humiliation is: (1) Not done intentionally by or at the direction of. (a) The insured; or (b) Any "executive officer," director, stockholder, partner, member or manager (if you are a limited liability company) of the insured; and (2) Not directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person or persons by any insured. B. Under SECTION 1 — COVERAGE B — PERSONAL AND ADVERTISING INJURY LIABILITY, Paragraph 2. Exclusions is amended to add the following additional exclusions: [This insurance does not apply to:] Discrimination Relating To Room, Dwe[ling or Premises "Personal or advertising injury" caused by discrimination directly or indirectly related to the sale, rental, lease or sub -lease or prospective sale, rental, lease or sub -lease of any room, dwelling or premises by or at the direction of any insured. Fines Or Penalties Fines or penalties levied or imposed by a governmental entity because of discrimination. This provision 9. does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part. 10. EXPECTED OR INTENDED INJURY Intended Injury and replace it with the following: [This insurance does not apply to:] a. Expected or Intended Injury "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. 11. GENERAL AGGREGATE LIMITS OF INSURANCE - PER PROJECT A. For each construction project away from premises you own or rent, a separate Construction Project General Aggregate Limit, equal to the amount of the General Aggregate Limit, is the most we will pay for the sum of: 1. All damages under Coverage A, except damages because of "bodily injury' or "property damage" included in the "products- completed operations hazard "; and 2. All medical expenses under Coverage C, that arise from "occurrences" or accidents which can be attributed solely to ongoing operations at that construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations, nor the Construction Project Aggregate Limit of any other construction project B. All: 1. Damages under Coverage B, regardless of the number of locations or construction projects involved; 2. Damages under Coverage A, caused by "occurrences" which cannot be attributed solely to ongoing operations at a single construction project, except damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard'; and 3. Medical expenses under Coverage C caused by accidents which cannot be attributed solely to ongoing operations at a single construction project, Under SECTION I — COVERAGE A — BODILY will reduce the General Aggregate Limit shown INJURY AND PROPERTY DAMAGE in the Declarations. LIABILITY, Paragraph 2. Exclusions is amended to delete exclusion a. Expected or G-1 8652-J (Ed. 07 -12) Page 6of12 Copyright, CNA All Rights Reserved. G-1 8652-J 2077836807 (Ed. 07 -12) C. The limits shown in the Declarations for Each Occurrence, for Damage To Premises Rented To You and for Medical Expense continue to apply, but will be subject to either the Construction Project Aggregate Limit or the General Aggregate Limit, depending on whether the "occurrence" can be attributed solely to ongoing operations at a particular construction project. D. When coverage for liability arising out of the "products- completed operations hazard" is provided, any payments for damages because of "bodily injury' or "property damage" included in the "products- completed operations hazard," regardless of the number of locations involved will reduce the Products- Completed Operations Aggregate Limit shown in the Declarations. E. If a single construction project away from premises owned by or rented to the insured has been abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. F. The provisions of SECTION III — LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue to apply as stipulated. 12. IN REM ACTIONS Any action in rem against any vessel owned or operated by or for you, or chartered by or for you will be treated in the same manner as though the action were in personam against you. In rem is a term used to designate actions instituted against the thing, as distinct from actions against the person, which are said to be in personam. 13. INCIDENTAL HEALTH CARE MALPRACTICE COVERAGE A. With respect only to "bodily injury" that arises out of a "health care incident," COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY OF SECTION I — COVERAGES is amended to replace Insuring Agreement Paragraphs 1.b.(1) and 1.b.(2) with the following: b. This insurance applies to "bodily injury" only if you are not in the business of providing professional health care services, and only if: (a) "Bodily injury" caused by a "health care incident" will be considered caused by an "occurrence'; and (b) All acts, errors or omissions that are logically connected by any common fact, circumstance, situation, transaction, event, advice or decision will be considered to constitute a single "occurrence "; (2) The "bodily injury" occurs during the policy period. All "bodily injury" arising from an "occurrence" will be deemed to have occurred at the time of the first act, error, or omission that is part of the "occurrence"; and B. With respect only to the insurance provided by this Provision 13., Exclusion 2.e. Employer's Liability of SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE, is amended to append the following: Only for "bodily injury" not covered by other liability insurance (including state - sanctioned self insurance) available to the insured (or which would be available but for exhaustion of its limits), this exclusion does not apply to "bodily injury" that arises out of a "health care incident." C. SECTION V — DEFINITIONS is amended to add the following new definition: "Health care incident' means a negligent act, error or omission by your "employees" or "volunteer workers" working on your behalf in the rendering of or failure to render professional health care services in any of the following capacities, or the related furnishing of food, beverages, medical supplies or appliances: a. Physician; b. Nurse; c. Emergency medical technician; d. Paramedic; e. Chiropractor, f. Dentist; g. Athletic trainer; h. Audiologist; i. Physical therapist; j. Psychologist; (1) The "bodily injury" is caused by an k. Speech therapist; "occurrence" that takes place in the I. Other allied health professional; or coverage territory. For the purpose of this insurance: G- 18652 -J (Ed. 07 -12) Page 7 of 12 Copyright, CNA All Rights Reserved. G-1 8652-J CAd 2077836807 (Ed. 07 -12) m. Provider of first aid or Good Samaritan services rendered in an emergency and for which no payment is demanded or received. D. SECTION 1— COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions is amended to add the following additional exclusions. These new exclusions apply only to this Incidental Health Care Malpractice Coverage: [This insurance does not apply to:] Dishonesty or Crime Any dishonest, criminal or malicious act, error or omission. Clinical Trials 1 Product Testing Acts, errors or omissions that occur in the course of human clinical trials or product testing. Medicare /Medicaid Fraud Medicare or Medicaid fraud or abuse. Services Excluded by Endorsement Any "health care incident" for which coverage is excluded by endorsement. E. SECTION V — DEFINITIONS is amended to add the following subparagraph to Paragraph f. of the definition of "insured contract": Paragraph L does not include that part of any contract or agreement (4) Under which you assume another's tort liability for "bodily injury" arising out of the rendering of or failure to render professional health care services. F. SECTION II — WHO IS AN INSURED is amended to add the following provisions: 1. Your "employees" are insureds with respect to: a. "bodily injury" to a co "employee" while in the course of the co-"employee's" employment by you or while performing duties related to the conduct of your business; and b. "bodily injury" to a "volunteer worker" while performing duties related to the conduct of your business; when such "bodily injury" arises out of a "health care incident." 2. Your "volunteer workers" are insureds with respect to: G- 18652 -J (Ed. 07 -12) Page 8 of 12 a. "bodily injury" to a co "volunteer worker" while performing duties related to the conduct of your business; and b. "bodily injury" to an "employee" while in the course of the "employee's" employment by you or while performing duties related to the conduct of your business; when such "bodily injury" arises out of a "health care incident." 3. Paragraphs 2.a. (1)(a), (b) and (c) of SECTION II — WHO IS AN INSURED do not apply to "bodily injury" for which insurance is provided this Provision 13. 4. Paragraph 2.a.(1)(d) of SECTION 11— WHO IS AN INSURED is deleted. G. With respect to the Provision 13., the Paragraph 4.b.(1) COMMERCIAL CONDITIONS: insurance provided by this following is added to of SECTION IV — GENERAL LIABILITY To the extent this insurance applies, it is excess over any of the other insurance (including qualified self insurance), whether primary, excess, contingent or on any other basis, except for insurance purchased specifically by you to be excess of this policy. 14. JOINT VENTURES / PARTNERSHIP 1 LIMITED LIABILITY COMPANIES A. The following is added to SECTION 11 — WHO IS AN INSURED: 4. You are an insured when you had an interest in a joint venture, partnership or limited liability company which terminated or ended prior to or during this policy period, but only to the extent of your interest in such joint venture, partnership or limited liability company. This coverage does not apply: a. Prior to the termination date of any joint venture, partnership or limited liability company; b. If there is other valid and collectible insurance purchased specifically to insure the partnership, joint venture or limited liability company; or c. To a joint venture, partnership or limited liability company which is or was insured under a "consolidated (wrap -up) insurance program." Copyright, CNA All Rights Reserved. w�A 2077836807 [Please see Item 26.C. of this endorsement for the definition of "consolidated (wrap -up) program. "] B. The last paragraph of SECTION II — WHO IS AN INSURED is deleted and replaced by the following: Except as provided under the Contractors' General liability Extension Endorsement or by the attachment of another endorsement (if any), no person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. 15. LEGAL LIABILITY /ALIENATED PREMISES/ BORROWED EQUIPMENT A. Under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions is amended to delete exclusion j. Damage to Property in its entirety and replace it with the following: [This insurance does not apply to:] j. Damage to Property "Property damage" to: (1) Property you own, rent, or occupy; (2) Premises you sell, give away or abandon, if the "property damage" arises out of any part of those premises; (3) Property loaned to you; (4) Personal property in the care, custody or control of the insured; (5) That particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations, if the "property damage" arises out of those operations; or (6) That particular part of any property that must be restored, repaired or replaced because "your work" was incorrectly performed on it. Paragraph (2) of this exclusion does not apply if the premises are "your work." Paragraphs (3) and (4) of this exclusion do not apply to "property damage" to tools or equipment loaned to you. A separate limit of insurance applies to such tools or equipment that are damaged while being used in your operations. G- 18652 -J (Ed. 07 -12) Page 9 of 12 G-1 8652-J (Ed. 07 -12) Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire) to premises rented to you or temporarily occupied by you with the permission of the owner, or to the contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to Damage To Premises Rented To You as described in SECTION III— LIMITS OF INSURANCE. Paragraphs (3), (4), (5) and (6) of this exclusion do not apply to liability assumed under a sidetrack agreement. Paragraph (6) of this exclusion does not apply to "property damage" included in the "products- completed operations hazard." B. Under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE the last paragraph of Paragraph 2. Exclusions is deleted and replaced by the following. Exclusions c. through n, do not apply to damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner nor to the contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described in SECTION III — LIMITS OF INSURANCE. C. The following paragraph is added to SECTION III — LIMITS OF INSURANCE: Subject to 5. above, $25,000 is the most we will pay under Coverage A for damages arising out of any one "occurrence" because of "property damage" to tools or equipment loaned to you by others that occurs while the equipment is being used to perform operations. D. Paragraph 6. Damage To Premises Rented To You Limit of SECTION III — LIMITS OF INSURANCE is replaced by the following: 6. Subject to Paragraph 5. above, (the Each Occurrence Limit), the Damage To Premises Rented To You Limit is the most we will pay under SECTION — I — COVERAGE A for damages because of "property damage" to any one premises while rented to you or temporarily occupied by you with the permission of the owner, including contents of such premises rented to you for a period of 7 or fewer consecutive days. The Damage To Premises Rented To You Limit is the greater of. a. $500,000; or Copyright, CNA All Rights Reserved. ��A Gd.07 -1 ) 2onsssso7 (Ed. 47 -12) b. The Damage To Premises Rented To You Limit shown in the Declarations. E. Paragraph 4.b.(1)(a)(ii) of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is deleted and replaced by the following: (iii) That is property insurance for premises rented to you, for premises temporarily occupied by you with the permission of the owner, or for personal property of others in your care, custody or control; F. This Provision 15. does not apply if Damage To Premises Rented To You Liability under SECTION — I — COVERAGE A is excluded by endorsement. 16. LIBERALIZATION CLAUSE If we adopt a change in our forms or rules which would broaden coverage for contractors under this endorsement without an additional premium charge, your policy will automatically provide the additional coverage as of the date the revision is effective in your state. 17. LIQUOR LIABILITY Under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions is amended to delete exclusion c. Liquor Liability. This provision 17. does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part. 18. MEDICAL PAYMENTS A. Paragraph 7. Medical Expense Limit, of SECTION 111 — LIMITS OF INSURANCE is deleted and replaced by the following: 7. Subject to Paragraph 5. above (the Each Occurrence Limit), the Medical Expense Limit is the most we will pay under SECTION — I — COVERAGE C for all medical expenses because of "bodily injury" sustained by any one person. The Medical Expense Limit is the greater of: (1) $15,000; or (2) The amount shown in the Declarations for Medical Expense Limit. This paragraph B. does not apply to medical expenses incurred in the state of Missouri. 19. NON -OWNED AIRCRAFT Under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY. Paragraph 2. Exclusions is amended such that exclusion g. Aircraft, Auto or Watercraft does not apply to an aircraft you do not own, provided that 1. The pilot in command holds a currently effective certificate issued by the duly constituted authority of the United States of America or Canada, designating that person as a commercial or airline transport pilot; 2. The aircraft is rented to you with a trained, paid crew; and 3. The aircraft does not transport persons or cargo for a charge. 20. NON -OWNED WATERCRAFT Under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Paragraph 2. Exclusions is amended to delete subparagraph (2) of exclusion g. Aircraft, Auto or Watercraft and replace it with the following. [This exclusion does not apply to:] (2) A watercraft you do not own that is: (a) Less than 75 feet long; and (b) Not being used to carry persons or property for a charge. 21. PRIMARY AND NON - CONTRIBUTORY TO OTHERINSURANCE With respect to any person or organization that is an additional insured under this Coverage Part, the following is added to Paragraph 4. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If you have agreed in writing in a contract or agreement that this insurance is primary and non- contributory relative to an additional insured's own insurance, then this insurance is primary and we will not seek contribution from that other insurance. For the purpose of this Provision 21., the additional insured's own insurance means insurance on which the additional insured is a Named insured. B. Paragraph 1.a.(3)(b) of SECTION I — This Provision 21. does not apply in situations COVERAGE C MEDICAL PAYMENTS, is where the endorsement on this policy affording replaced by the following: coverage to the additional insured specifies that this insurance is excess over any other insurance (b) The expenses are incurred and reported to available to that additional insured. us within three years of the date of the accident; and 22. PROPERTY DAMAGE — ELEVATORS G- 18652 -J (Ed. 07 -12) Page 10 of 12 Copyright, CNA All Rights Reserved. G-1 8652-J CNA2077836807 (Ed. 07 -12) A. Under SECTION 1 — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions is amended such that exclusion k. Damage to Your Product, and subparagraph (3), (4) and (6) of exclusion j. Damage to Property do not apply "property damage" that results from the use of elevators. B. With respect only to the coverage provided by this endorsement, Condition 4. Other 26. Insurance in SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is amended to add the following subparagraph b.(1)(a)(v): 4. Other Insurance b. Excess Insurance (1) This insurance is excess over (a) Any of the other insurance, whether primary, excess, contingent or on any other basis: (v) That is Property insurance covering property of others damaged from the use of elevators. 23. SUPPLEMENTARY PAYMENTS A. Under Section I — Supplementary Payments — Coverages A and B, Paragraph 1.11b., the limit of $250 shown for the cost of bail bonds is replaced by $5,000: B. In Paragraph 1.d., the limit of $250 shown for daily loss of earnings is replaced by $1,000. 24. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS If unintentionally you should fail to disclose all existing hazards at the inception date of your policy, we will not deny coverage under this Coverage Part because of such failure. 25. WAIVER OF SUBGROGATION - BLANKET Under SECTION IV —COMMERCIAL GENERAL LIABILITY CONDITIONS, The Transfer Of Rights Of Recovery Against Others To Us Condition is amended by the addition of the following: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of. However, this waiver applies only when you have agreed in writing to waive such rights of recovery in a contract or agreement, and only if the contract or agreement: 1. Is in effect or becomes effective during the term of this policy; and 2. Was executed prior to loss. WRAP -UP EXTENSION: OWNER CONTROLLED INSURANCE PROGRAM, CONTRACTOR CONTROLLED INSURANCE PROGRAM OR CONSOLIDATED (WRAP -UP) INSURANCE PROGRAMS Note: The following provision does not apply to any public construction project in the state of Oklahoma, nor to any construction project in the state of Alaska, that is not permitted to be insured under a "consolidated (wrap -up) insurance program" by applicable state statute or regulation: If the endorsement EXCLUSION — CONSTRUCTION WRAP -UP or another exclusionary endorsement pertaining to Owner Controlled Insurance Programs (O.C.I.P.) or Contractor Controlled Insurance Programs (C.C.I.P.) is attached to this policy, then the following changes apply: A. The following wording is added to the endorsement: With respect to a "consolidated (wrap -up) insurance program" project in which you are or were involved, this exclusion does not apply to those sums you become legally obligated to pay as damages because of 1. "Bodily injury," "property damage," or "personal or advertising injury" that occurs during your ongoing operations at the project, or during such operations of anyone acting on your behalf; nor 2. "Bodily injury" or "property damage" included within the "products- completed operations hazard" that arises out of those portions of the project that are not "residential structures." B. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is amended to add the following subparagraph 4.b.(1)(c) to Condition 4. Other Insurance: [This insurance is excess over] (c) Any of the other insurance whether primary, 1. Your ongoing operations; or excess, contingent or any other basis that is 2. "Your work" included in the "products completed insurance available to you as a result of operations hazard." your being a participant in a "consolidated (wrap -up) insurance program," but only as G- 18652 -J (Ed. 07 -12) Page 11 of 12 Copyright, CNA All Rights Reserved. 2077836807 respects your involvement in that "consolidated (wrap -up) insurance program." C. SECTION V — DEFINITIONS is amended to add the following definition: "Consolidated (wrap -up) insurance program" means a construction, erection or demolition project for which the prime contractor /project manager or owner of the construction project has secured general liability insurance covering some or all of the contractors or subcontractors involved in the project, such as an Owner Controlled Insurance Program (O.C.I.P.) or Contractor Controlled Insurance Program (C.C.1.P.). "Residential structure" means any structure where 30 or more of the square foot area is used or is intended to be used for human All other terms and conditions of the Policy remain unchanged. G-1 8652-J (Ed. 07 -12) residency including but not limited to single or multifamily housing, apartments, condominiums, townhouses, co- operatives or planned unit developments and also includes their common areas and/or appurtenant structures (including pools, hot tubs, detached garages, guest houses or any similar structures). When there is no individual ownership of units, residential structure does not include military housing, college /university housing or dormitories, long term care facilities, hotels, or motels. Residential structure also does not include hospitals or prisons. This provision 26, does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. G- 18652 -J (Ed. 07 -12) Page 12 of 12 Material used with permission of ISO Properties, Inc Copyright, CNA All Rights Reserved. POLICY NUMBER: 2077836810 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: Countersigned By: Named Insured: Rognlin's Inc. Authorized Representative] SCHEDULE Name of Person(s) or Organization(s): ANY PERSON OR ORGANIZATION WHICH IS REQUIRED TO BE NAMED AS A RESULT OF A WRITTEN CONTRACT. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 POLICY NUMBER: 2077836810 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Endorsement Effective Date: SCHEDULE Name(s) Of Person(s) Or Organization (s): Jefferson county Department of Public Works 623 Sheridan St Port Townsend, WA 98368 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident' or the 'loss" under a contract with that person or organization. CA 04 4410 13 Copyright, Insurance Services Office, Inc., 2011 Page 1 of 1