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Habitat for Humanity Critical Home Repairs - 012125
Grant Agreement by and Between Jefferson County and Habitat for Humanity—Critical Home Repairs For Affordable Housing/Homelessness Services Grant Funding WHEREAS, RCW 36.22.250 authorizes the use of SSB 5386 a recording fee surcharge to provide funding for affordable housing services, homeless housing and assistance, and local homeless housing and assistance; and WHEREAS, RCW 82.14.530 authorizes the use of SHB 1590 sales tax revenues tosupport affordable housing; and WHEREAS, RCW 82.14.540 authorizes the use of SHB 1406 sales tax revenues to support affordable housing; and WHEREAS, on September 3, 2024 the Board of County Commissioners approved funding levels and authorized the release of a Request for Proposals for the funds collected pursuant to the above cited RCW's; and WHEREAS, on November 18, 2024 the Board of County Commissioners approved the Housing Fund Board's recommendation for 2025 funding; NOW, THEREFORE, Jefferson County, a political subdivision of the State of Washington ("County"), and Habitat for Humanity, a non-profit corporation in Washington State ("Recipient"), in consideration of the mutual benefits, terms, and conditions hereinafter specified, do hereby agree as follows: 1. Grant Commitment. A grant of funds is hereby made to recipient for use of the Project described in Section 2. The approved maximum amount of the grant shall be$45,000, all coming from Fund 148. Payment of grant funds shall be made upon the submission of appropriate invoices pursuant to Section 3. 2. Project Description, Schedule and Budget. a. The scope of work for the Project is described in Exhibit A, attached. b. The Project begins on January 1,2025 and shall be completed by December 31, 2025. c. The budget for the Project is described in Exhibit B, attached. 3. Payment. Expenses incurred on the Project, as described in Section 2, by the Project's consultants, contractors, suppliers, or recipient's staff shall be submitted to the County Administrator's Office by recipient using a detailed invoice that includes all of the following: HOUSING FUND BOARD 2025 GRANT FUNDING HABITAT FOR HUMANITY-CRITICAL HOME REPAIRS Page 1 of 24 a. Each detailed invoice shall show individual items followed by the total amount incurred and the amount eligible for reimbursement under this Grant Agreement. Recipient may submit such invoices to the County once per month during the course of the Project for work completed. All invoices shall be submitted no later than 30 days after project completion; and, b. The county shall review and approve invoice payments. Payments will be limited to the monies that are available under this Grant Agreement as described in Section 1. • Such invoices, once approved, will be paid using the County's normal bill paying process and cycle. 4. Compliance with Laws. Recipient shall, in completing its project under this Grant Agreement, faithfully observe and comply with all federal, state,and local laws, ordinances, and regulation, applicable to the work to be completed under this Grant Agreement. 5. Indemnity The recipient shall defend, indemnify and hold the County, its officers, officials, employees, agents and volunteers (and their marital communities) harmless from any claims, injuries, damages, losses or suits, including attorney's fees, arising out of or resulting from the acts, errors or omissions of the recipient in performance of this Agreement, except for injuries and damages caused by the sole negligence of the County. Should a court of competent jurisdiction determine this Agreement is subject to RCW 4.24.115 if liability for damages occurs arising out of bodily injury to persons or damages to property caused by or resulting from the concurrent negligence of the recipient and the County, its officers, officials, employees, agents and volunteers (and their marital communities)the recipient's liability, including the duty and cost to defend, shall be only for the recipient's negligence. It is further specifically understood that the indemnification provided constitutes the recipient's waiver of immunity under Industrial Insurance, Title 51 RCW, solely for the purposes of this indemnification. This waiver has been mutually negotiated by the parties. This section shall survive the expiration or termination of this Agreement. 6. Required Insurance Coverages. a. Commercial General Liability. 1) Recipient shall maintain commercial general liability coverage on a form acceptable to Jefferson County Risk Management for bodily injury, personal injury, and property damage, in an amount not less than two million dollars per occurrence($2,000,000) and an aggregate of not less than four million dollars ($4,000,000), for bodily injury, including death, and property damage. 2) The commercial general liability insurance coverage shall contain no limitations on the scope of the protection provided and include the following minimum HOUSING FUND BOARD 2025 GRANT FUNDING HABITAT FOR HUMANITY-CRITICAL HOME REPAIRS Page 2 of 24 coverage: i. Broad form property damage, with no employee exclusion; ii. Person injury liability, including extended bodily injury; iii.. Broad form contractual/commercial liability,including completed operations and product liability coverage; iv. Premises-operations liability (M&C); v. Independent contractors and subcontractors;and, vi. Blanket contractual liability. 3) Recipient's commercial general liability policy shall include employer's liability coverage. 4) The County and its elected officials, officers and employees shall be named as an additional insured party under this insurance policy. b. Automobile Liability. Recipient shall maintain business automobile Liability insurance on a form acceptable to Jefferson County Risk Management with a limit of not less than a combined single limit of$1,000,000 each occurrence. Coverage shall include owned, hired, and non-owned automobiles. c. Workers' Compensation (Industrial Insurance). Recipient shall maintain workers' compensation insurance at its own expense, as required by Title 51 RCW, for the term of this Agreement and shall provide evidence of coverage to Jefferson County Risk Management, upon request. If the County incurs any cost to enforce the provisions of this subsection, all costs and fees shall be recoverable form recipient. 1) Recipient shall provide Workers' Compensation and Employer's Liability on a state approved policy form providing benefits as required by law with employer's liability limits no less than $1,000,000 per accident or disease. 2) This coverage shall extend to any contractor or subcontractor that does not have their own workers' compensation and employer's liability insurance. 7. Recipient expressly waives by mutual negotiation all immunity and limitations on liability, with respect to the County, under any industrial insurance act, disability benefit act, or other employee benefit act of any jurisdiction, which would otherwise be applicable in case of such claim. 8. General Insurance Requirements. a. Insurance coverage shall be evidenced by one of the following methods: 1) Certificate of insurance; or, 2) Self-insurance through an irrevocable Letter of Credit from a qualified financial institution. HOUSING FUND BOARD 2025 GRANT FUNDING HABITAT FOR HUMANITY-CRITICAL HOME REPAIRS Page 3 of 24 b. Any deductibles or self-insured shall be declared to and approved by the County prior to the approval of this Agreement by the County. At the option of the County, the insurer shall reduce or eliminate deductibles or self-insured retention, or recipient shall procure a bond guaranteeing payment of losses and related investigations, claim administration and defense expenses. c. Failure of recipient to take out or maintain any required insurance shall not relieve recipient from any liability under this agreement, nor shall the insurance requirements be construed to conflict with or otherwise limit the obligations concerning indemnification of the County. d. Recipient's 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 all the parties and shall be primary coverage for all losses covered by the above described insurance. e. Insurance companies issuing recipient's insurance 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 insurance policy. f. All deductibles in recipient's insurance policies shall be assumed by and be at the sole risk of recipient. g. Any judgments for which the County may be liable, in excess of insured amounts required by this agreement, or any portion thereof, may be withheld from payment due, or to become due, to recipient until recipient shall furnish additional security covering such judgment as may be determined by the County. h. Any 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 insurance policy recipient shall provide to comply with this Agreement. i. The County may, upon recipient's failure to comply with all provisions of this Agreement relating to insurance, withhold payment or compensation that would otherwise be due to recipient. j. recipient shall provide a copy of all insurance policies specified in this Agreement. k. Written notice of cancellation or change in recipient's insurance required by this Agreement shall reference the project name and agreement number and shall be mailed to the County at the following address: Jefferson County Risk Management, P.O. Box 1220, Port Townsend, WA 98368. HOUSING FUND BOARD 2025 GRANT FUNDING HABITAT FOR HUMANITY-CRITICAL HOME REPAIRS Page 4 of 24 1. Recipient's liability insurance provisions shall be primary and noncontributory with respect to any insurance or self-insurance or self-insurance programs covering the County, its elected and appointed officers, officials, employees and agents. m. Any failure to comply with reporting provisions of the insurance policies shall not affect coverage provided to the County, its officers, officials, employees or agents. n. Recipient's insurance shall apply separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the insurer's liability. o. Recipient shall include all subcontractors as insured under its insurance policies or shall furnish separate certificates and endorsements for each subcontractor. All insurance coverage for subcontractors shall be subject to all the requirements stated in this Agreement. The insurance limits mandated for any insurance coverage required by this Agreement are not intended to be an indication of exposure nor are they limitations on indemnification. p. Recipient shall maintain all required insurance policies in force from the time services commence until services are completed. Certificates, insurance policies,and endorsements expiring before completion of services will be promptly replaced. q. Recipient shall place insurance with insurers listed to business in the State of Washington and having A.M.Best Company ratings of no less than A-,with the exception that excess and umbrella coverage used to meet the requirements for limits of liability or gaps in coverage need not be place with insurers or re-insurers licensed in the State of Washington. r. Certificates of insurance as required by this Agreement shall be delivered to the County within fifteen(15)days of execution of the Agreement. To the extent a certificate lists or refers to any endorsements solely by name. description or number it shall be the responsibility of recipient to obtain and provide to Jefferson County Risk Management a full and complete copy of the texts of such endorsements. s. The County shall be named as an"additional insured" on all insurance policies required by this Agreement. t. Recipient shall furnish the County with properly executed certificates of insurance that,at a minimum, shall include: 1) The limits of coverage; 2) The project name and agreement number to which it applies; HOUSING FUND BOARD 2025 GRANT FUNDING HABITAT FOR HUMANITY-CRITICAL HOME REPAIRS Page 5 of 24 3) The certificate holder as Jefferson County,Washington and its elected officials, officers, employees and agents with the address of Jefferson County Risk Management, P.O. Box 1220, Port Townsend, WA 98368;and, 4) A statement that the insurance policy shall not be cancelled or allowed to expire except on thirty (30) days prior written notice to the County. 9. Independent Contractor. Recipient and the County agree that recipient is an independent contractor with respect to the project to be completed pursuant to this Grant Agreement. Nothing in this Grant Agreement shall be considered to create the relationship of employer and employee between the parties hereto.Neither recipient nor any employee of recipient, nor any subcontractor of recipient shall be entitled to any benefits accorded to County employees by virtue of their services on the project to be completed under this Grant Agreement. The County shall not be responsible for withholding or otherwise deducting federal income tax or social security or for contributing to the State industrial insurance program, or otherwise assuming the duties of an employer with respect to recipient, or any employee, representative of agent of recipient, or any contractor of recipient. 10. Subcontracting Requirements. a. Recipient Owns Contract Performance. Recipient is responsible for meeting all terms and conditions of this Agreement including standards of service, quality of materials and workmanship, costs and schedules. Failure of a subcontractor to perform is no defense to a breach of this Agreement. Recipient assumes responsibility for all liability for the actions and quality of services performed by any subcontractor. b. Subcontractor Disputes. Any dispute arising between recipient and any subcontractors or between subcontractors must be resolved with involvement of any kind on the part of the County and without detrimental impact on the delivery of contracted goods and services. 11.Legal and Regulatory Compliance. While performing under this Agreement, recipient, subcontractors,and their employees are required to comply with all applicable local,state and federal laws, codes, ordinances and regulations, including but not limited to: a. Applicable regulations of the Washington State Department of Labor and Industries, including WA-DOSH Safety Regulation; and b. State and Federal Anti-Discrimination Laws. 12.Termination. a. Termination by the County. HOUSING FUND BOARD 2025 GRANT FUNDING HABITAT FOR HUMANITY-CRITICAL HOME REPAIRS Page 6 of 24 1) Should recipient default in providing services under this Agreement or materially breach any of its provisions, the County may terminate this Agreement upon ten (10) days written notice to recipient. 2) Recipient shall have the right and opportunity to cure any such material breach within the ten (10) day period. 3) The County may terminate this Agreement upon immediate notice to recipient. Recipient will be reimbursed for services expended up to the date of termination. 4) This Agreement may be terminated or amended, in whole or in part,by the County upon thirty(30)days written notice in the event expected or actual revenue in Funds 148 and/or 149 is reduced or limited in any way. b. Termination by recipient. 1) Should the County, its staff, employees, agents and/or representatives default in the performance of this Agreement or materially breach any of its provisions, recipient, at its option, may terminate this Agreement by giving ten(10) days written notice to the County representative. 2) The County shall have the right and opportunity to cure any such material breach within the ten (10) day period. c. Termination Without Cause. This Agreement may be terminated without cause at any time by either party subject to a sixty (60) day advance written notice of such termination to the other party. 13.No Harassment or Discrimination. Recipient and any contractors/subcontractors will not discriminate against any person in the performance of work under this agreement or in the selection and retention of employees or procurement of materials or supplies on the basis of age, sex, marital status, sexual orientation, religion, creed, color, national origin, honorably discharged veteran or military status, or the presence of any sensory, mental, or physical disability or the use of a trained guide dog or service animal by a person with a disability, unless based on a bonafide occupational qualification. 14.Contract Expiration. This contract will run until the project is complete and until the County has made all payments required under this Grant Agreement, except that the project must be completed no later than the date listed in Paragraph 2.b. above, unless extended by mutual agreement. HOUSING FUND BOARD 2025 GRANT FUNDING HABITAT FOR HUMANITY-CRITICAL HOME REPAIRS Page 7 of 24 15.Failure to Appropriate. Recipient acknowledges that the County may only appropriate monies in the current year and in a manner consistent with Paragraph 1 above. The County agrees to appropriate monies to fund this Grant Agreement unless emergency circumstances prevent the County from doing so. Any monies to be paid by the County to recipient for this Grant Agreement are subject to appropriation by the County Commission. 16.Integrated Agreement. This Grant Agreement represents the entire and integrated agreement between the County and recipient and supersedes all prior negotiations, representation, or agreements written or oral. 17.Modification of this Agreement. This Agreement may be amended or supplemented only by a writing that is signed by duly authorized representatives of all parties. 18.No Assignment. Recipient shall not sell,assign, or transfer any rights obtained by this Agreement without the express written consent of the County. 19. Severability. Provided it does not result in a material change in the terms of this Agreement, if any provision of this Agreement or the application of this Agreement to any person or circumstance shall be invalid, illegal, or unenforceable to any extent, the remainder of this Agreement and the application of this Agreement shall not be affected and shall be enforceable to the fullest extent permitted by law. 20.No Third-party Beneficiaries. The parties do not intend, and nothing in this Agreement shall be construed to mean,that any provision in this Agreement is for the benefit of any person or entity who is not a Party. 21.Controlling Law. It is understood and agreed that this Agreement is entered into in the State of Washington. This Agreement shall be governed by and construed in accordance with the laws of the United State, the State of Washington and the County of Jefferson, as if applied to transactions entered into and to be performed wholly within Jefferson County,Washington between Jefferson County residents. No party shall argue or assert that any state law other than Washington law applies to the governance or construction of this Agreement. 22.Reports: An annual report form will be due no later than January 31, 2026. The report form will be distributed before the end of the year. Non-compliance may result in no funds awarded in the future. HOUSING FUND BOARD 2025 GRANT FUNDING HABITAT FOR HUMANITY-CRITICAL HOME REPAIRS Page 8 of 24 (SIGNATURES APPEAR ON THE FOLLOWING PAGE) HOUSING FUND BOARD 2025 GRANT FUNDING HABITAT FOR HUMANITY-CRITICAL HOME REPAIRS Page 9 of 24 IN WITNESS WHEREOF, tile parties have caused this Grant Agreement to be executed this I/%day of V.6)144.6, 2025. Jefferson County Habitat for Humanity Board of Commissioners 12.- fitS/zo ZS Sigryiture ate MQu +ews , (KaAiive A' r �7 Printed Name/Title By: Cam` y l.{IL� Hei i Eisenhour, Chair Date -• *•,, ,1,,,,p,,,,,,, r• ON cOG!�v 'MISS/6 ySEAL: I .o° ti�;.. ,�..= ESN• N a • '••OF WASH��GS ATTEST: ,,,,,,,,,,,,,,,,,,, �, C iGt.& Gz X.//ZS Carolyn Gglaway, CMC Date Clerk of the Board Approved as to form only: for 01/17/2025 hilip C. unsucker Date Chief Civil Deputy Prosecuting Attorney HOUSING FUND BOARD 2025 GRANT FUNDING HABITAT FOR HUMANITY-CRITICAL HOME REPAIRS Page 10 of 24 EXHIBIT A - SCOPE OF WORK Recipient has been awarded$45,000, after recommendation by the Housing Fund Board. Recipient shall use the Award consistently with its response to the request for proposal submitted to the Housing Fund Board during the 2025 cycle. A true and correct copy of the Recipient's response to the request for proposal is attached as Exhibit C. HOUSING FUND BOARD 2025 GRANT FUNDING HABITAT FOR HUMANITY-CRITICAL HOME REPAIRS Page 11 of 24 EXHIBIT B—BUDGET Recipient only shall use the Award for the purposes identified in its request for proposal submitted to the Housing Fund Board during the 2025 cycle. Recipient shall invoice the County consistent with Section 3 of this agreement. Applicant: Habitat for Humanity Contact: Jamie Maciejewski Address: P.O. Box 658, Port Townsend, WA 98368 Phone: 360-379-2827 Email: director@habitatejc.org HOUSING FUND BOARD 2025 GRANT FUNDING HABITAT FOR HUMANITY-CRITICAL HOME REPAIRS Page 12 of 24 EXHIBIT C - RFP Application AFFORDABLE AND SUPPORTIVE HOUSING & HOMELESS HOUSING AND ASSISTANCE FUNDS For use from January 1, 2025 to December 31, 2025 GENERAL INFORMATION —It is understood that if awarded funding for this period, there is no guarantee of future funding beyond this award. We estimate the available funding for this period to be approximately $165,000 for 5386 Homeless Housing and Assistance (operating) funds; $840,000 for 1590 Affordable and Supportive Housing development funds; and first year operating funds; and $560,000 for 1590 Affordable and Supportive Housing operating funds. Note that 1590 operating funds may be used for all housing-related services. HOUSING FUND BOARD 2025 GRANT FUNDING HABITAT FOR HUMANITY-CRITICAL HOME REPAIRS Page 13 of 24 Name of Project or Program Critical Home Repairs Requested total amount for this $90,000 Area of the County to be served: All East Jefferson County with special focus on Brinnon and Quilcene(South County) Name of Applicant/Agency: Habitat for Humanity of Federal Tax ID#: 91-1885667 East Jefferson County Contact Person: Jamie Maciejewski Title: Executive Director Address: PO Box 658 City: Port Townsend State: WA Zip: 98368 Phone Number: 360.379.2827 Fax Number: E-mail: director@habitatejc.org CERTIFICATION by Authorized Agency Representative(Board President, CEO, or another person authorized to bind the agency in a contract). Name of Authorized Agency Representative (print): Jamie Maciejewski Title: Executive Director • Applicant certifies that these funds will be used as described in this application unless a change has been mutually agreed upon between Contractor and Jefferson County Board of County Commissioners. Substantive amendment requests will also require the approval of the Housing Fund Board("HFB"). • Applicant certifies that the information in this application is true and correct. • Applicant certifies that it has no outstanding obligations to the County with respect to housing funds. it, a 10/18/2024 Signature f Authorized A.1 ncy Representative Date HOUSING FUND BOARD 2025 GRANT FUNDING HABITAT FOR HUMANITY-CRITICAL HOME REPAIRS Page 14 of 24 SPECIFIC INFORMATION Please separately tab each section of the application submission as to Project or Program Description, Capacity, Alignment, Approach, Impact of Funds, Budget. PROJECT DESCRIPTION • Name of Project or Program: Critical Home Repair • Amount requested: $90,000 • Provide a brief description of the Project or Program: (LIMIT 200 WORDS) Between January 1 and December 31, 2025 Habitat EJC plans to perform a minimum of nine Critical Home Repairs for homeowners in East Jefferson County, focusing especially on those living in Quilcene and Brinnon and other rural areas of East Jefferson County. We request the County provide $90,000 to fund those critical repairs. These funds will be used to complete projects on homes owned by persons at or below 60% of area median income, and these repairs make it possible for the homeowners to remain in their homes, which otherwise might not be habitable. Examples of such repairs include updating of electrical wiring that may be hazardous and/or not to code; repair or replacement of failed septic systems; and roof repair or replacement. A no-interest note, forgivable after 20 years, will be attached to the home, ensuring the subsidy allows the current owner to remain in the home,rather than profit by fixing up the house to sell it. Habitat EJC shall provide all project and construction management: we will select projects, screen for income qualification and repair scope of work;manage subcontractors; and coordinate any volunteer involvement that may be appropriate • Specify the Project or Program goals and expected outcomes. Specify the measures of success by which the Project or Program will be assessed. (LIMIT 300 WORDS) Goals 1. At least nine homes will be repaired. Measures: Scope of Work is developed on each selected project to address critical repairs; permits are secured as necessary; homeowner signs off on completed project. 2. The qualified owners of each repaired home will be able to remain safely in their home at the completion of the repairs. A lien in the amount of the cost of repairs is attached to the mortgage and repayable to Habitat EJC upon sale of the home, or fully forgiven after 20 years. Measures: Homebuyer is certified at or below 60%AMI; a no-interest lien is placed against the home upon completion; no payments are collected for 20 years, or until the home is sold; HOUSING FUND BOARD 2025 GRANT FUNDING HABITAT FOR HUMANITY-CRITICAL HOME REPAIRS Page 15 of 24 after 20 years, the note is forgiven in full if the original owner continues to occupy the home; homebuyer completes required sweat equity, modified as necessary for age and disability. Outcomes will be measured using the following: • Scope of Work on each selected project addresses critical repairs • Signed MOU with Homeowner • Permits secured as necessary • Final punch list and MOU signed by Homeowner • Homeowner certified at or below 60%AMI • Executed, forgivable(after 20 years),no-interest note secured by a Deed of Trust • Documentation of required sweat equity, modified as necessary for age and disability • Specify the number of units of housing to be created or number of individuals who will be served by the Project or Program. Nine or more households will be served by the program, depending on the cost of each repair. Threshold Requirements: • Identify the specific eligible use(s) under 5386 and/or 1590 for which the Project or Program qualifies,as listed on pages two through four of the RFP. If you are submitting for both operating and development funds,please submit separate budgets for each. 5386 Operating Funds: 1590 Development Funds: XX (Alternative) 1590 Operating Funds: XX Eligible uses carried out by Habitat EJC's Critical Repair Program include"housing- related services for eligible households at or below sixty percent AMI" including the following population groups: • Persons with mental illness • Veterans • Senior citizens • Homeless(or at-risk of being homeless)families with children • Persons with disabilities • Domestic violence survivors HOUSING FUND BOARD 2025 GRANT FUNDING HABITAT FOR HUMANITY-CRITICAL HOME REPAIRS Page 16 of 24 NOTE: we are submitting under 1590 Operating Funds, with the option for the committee to move the application to 1590 Development Funds if it is believed to be a better fit. • Provide a brief description of recent, relevant and successful experiences in delivering similar programs and/or projects. In 2011, our affiliate joined Habitat International's Neighborhood Revitalization initiative, a holistic program that focused on partnership with volunteers, homeowners, neighbors and local organizations to help serve people in remote areas. The program emphasizes that, for families to succeed, sometimes the dynamics of their neighborhoods have to change. Through research and feedback from our community, we decided to focus our efforts on South County, where we saw an enormous need for home repairs. Thirteen years later, our repair program is flourishing. We have repaired over 50 homes with more than 30 of those in South County. Today, we are simultaneously working on around 7 repair projects scattered throughout East Jefferson County. We're helping families whose homes have affected their health and safety. With the completion of each repair, we empower them to safely stay in their homes for at least another 5 years. • Briefly describe how the project aligns with the priorities and objectives of the Five- Year Homeless Housing Plan and the community outreach conducted for the project or program. (LIMIT 400 WORDS) Habitat EJC's Critical Home Repair Program supports the priorities of the Jefferson County 5-Year Plan by rehabilitating homes of residents earning below 60%of the AMI —and often significantly lower that 50% AMI—thereby reducing the potential for home loss and homelessness and preserving the stock of lower-cost housing. Many homeowners in rural East Jefferson County, especially but not exclusively south of the Tri-Area, are vulnerable to homelessness and displacement, due to several key factors. These include: • Fewer resources. The median income in Brinnon is just over$52,000, less than the state median of$77,000. Quilcene and Brinnon have poverty rates of 10-11%.1 • Older residents. The median age in Brinnon is 64.4.2 • Aging housing stock. The median age of Quilcene's housing stock is 69 years old and Brinnon's is 41 years.3 HOUSING FUND BOARD 2025 GRANT FUNDING HABITAT FOR HUMANITY-CRITICAL HOME REPAIRS Page 17 of 24 • High rate of homeownership. In Brinnon, more than 85%of residents own their homes and over 65%in Quilcene.4 The picture is one of aging residents caring for aging homes with extremely limited resources. The typical homeowner who contacts us for home repair assistance is over age 80; they no longer have the capacity in terms of health and funds to care for their own home repair and maintenance needs. For many, their spouse once performed the primary repair and maintenance function, but is no longer living. The surviving spouse may never have been exposed to the work necessary to repair the home and has no idea how to go about securing a contractor. Thus, even those with some fmancial resources can be wholly unable to manage the process. • By repairing critical systems, we have been able to keep residents safely at home and extend the life of the structure by at least five years. This work prevents homelessness and displacement, without constructing additional housing. Investment in the current stock of housing makes sense. • This project addresses maintaining affordable housing throughout rural East Jefferson County. A. APPROACH-Completeness of Proposal and Readiness (5 Points) (LIMIT 400 WORDS) Habitat EJC's Critical Repair Program has become significantly more robust over the past year. Construction Manager Scott Lemm collaborates with Homeowner Services Manager Leanne Smith to identify and evaluate repair projects, define scope of work and create project timelines. • Is the Project or Program ready to use the funding now or are there actions to be taken before the Project or Program can begin? If so,what are those actions? Yes. No additional actions are needed. • Will the requested funds fully fund the Project or Program? If not, him does the organization intend to fill the gap? For fiscal year 2025,which began on July 1, 2024, $170,000 has been budgeted for critical repairs. Per-unit cost depends on the scope of the critical repairs to be performed and averages $10,000. The requested funding will fund up to nine critical repairs in 2025 and will significantly help Habitat EJC's efforts to keep East Jefferson County residents safe, dry, and warm in their homes. The gap will be funded through directed donations and unrestricted funds. • Could the Project or Program be scaled (include the per unit cost of the Project or HOUSING FUND BOARD 2025 GRANT FUNDING HABITAT FOR HUMANITY-CRITICAL HOME REPAIRS Page 18 of 24 Program)? Funding directly impacts the number of repairs we can perform. If we do not receive adequate funds, we will repair fewer homes, which means fewer households in need will be served. •Have additional funds been requested or will be requested. Identify the sources for those requests and the status of the requests. Several generous donors have directed donations to Habitat's Critical Repair program to support Habitat's work outside of Port Townsend. This has allowed us to expand our efforts, provide critical repairs on homes owned by low-income families with incomes below 80% AMI but above the income guidelines for County funds. B. IMPACT OF FUNDS -Leverage of Other Funds and Number of Persons Assisted (10 Points) (LIMIT 400 WORDS) • How would the project contribute to positive movement in Commerce's Homeless System Performance Measure: total project entries, length of time homeless,exits to permanent housing, returns to homelessness, and system prioritization. Go to www.jeffcountychamber.org. By repairing critical systems, we have been able to keep residents safely at home and extend the life of the structure by at least five years. This work prevents homelessness and displacement,without constructing additional housing. Investment in the current stock of housing makes sense. • Are you using any matching funds?If yes,what is the source? No matching funds are being used. Private contributions will supplement the grant funding from Jefferson County, and repair work will inspire additional individual giving to raise additional funds in 2025. • Are the requested funds to be used as a match for this Project or Program? If yes, provide a description of the Project or Program to be matched and how it relates to the goals and priorities of the Five-year Plan. Also, provide a budget for the entire Project or Program including funding from all sources and identify what portion of the Project or Program these funds will support. We do not currently have plans to use these funds as a match. Project budget is included below using the Capital Budget form • Specify the number of housing units that will be created or the number of individuals HOUSING FUND BOARD 2025 GRANT FUNDING HABITAT FOR HUMANITY-CRITICAL HOME REPAIRS Page 19 of 24 who will be assisted with this Project or Program in the first year. The funds would be used for critical repairs on existing homes. Critical repairs are defined as needed to extend the life of the home by at least five years. We would anticipate extending the life and livability of up to nine homes through this funding. •Specify the number of individuals who will be assisted with this Program. Households vary in size, but approximately nine households would be served by this funding. • Discuss how this Project or Program will be sustained after these funds are exhausted. Projects will be fully completed following sign-off on punch list. The Critical Repair Program is funded on an annual basis through the budgeting process, with funds raised through grant applications and individual donations. C. PROJECT OR PROGRAM BUDGET—A Feasible Financial Plan (5 Points) BUDGET FORMS Funding period begins January 1,2025,and ends December 31,2025. Please use the attached budget templates. If you need additional space,you may insert rows. "Proposal" refers to the funds requested from these funds that will be applied to this specific Project or Program. Blank spaces are provided for additional categories. Justification for budget items must be specific, and that same specificity should be reflected in subsequent billings. A maximum 10%Administration fee is allowed for projects if needed, however, Administration fees are not allowed for Capital Projects. CAPITAL BUDGET FOR REAL ESTATE DEVELOPMENT USES Financing Categories Estimate Basis of Estimate Total Acquisition Costs $ Construction $170,000 Repair costs for at least 12 projects Construction Fees $ Financing Fees and $ Charges Guarantees and Reserves $ Developers Fee $ Subtotal $ TOTAL $170,000 HOUSING FUND BOARD 2025 GRANT FUNDING HABITAT FOR HUMANITY-CRITICAL HOME REPAIRS Page 20 of 24 SOURCES Financing Categories Estimator . Indicate if Committed or Application has been made.If not made indicate date application is to be submitted Private Loan $ Jefferson County Funds $90,000 Grant application Public Sources(State or $ Federal Funds) Foundations $30,000 Donations $50,000 We have received donations exceeding this amount from donors who specifically wanted to support critical repairs,and anticipate renewed support next year. Low Income Housing $ Tax Credits(indicate 9% or 4%) Historic Tax Credits $ New Market Tax Credits $ Gap(if any) $ TOTAL S170,000 Please include any budget narrative that is descriptive or helpful to explain any part of your proposed expenditures in your capital budget(s). (LIMIT 300 WORDS) Uses Construction$170,000: Based on a minimum of 12 projects(homes)at an average of $14,200/project,which includes direct contractor costs and time from the construction manager in scoping, contracting, and managing projects. Sources Private contributions $50,000: We have received donations exceeding this amount from donors who specifically wanted to support critical repairs and anticipate renewed support next year. Foundations: We have several pending grant applications to private foundations. Gap: This is the amount of$90,000 we request from Jefferson County Affordable Housing Funds. HOUSING FUND BOARD 2025 GRANT FUNDING HABITAT FOR HUMANITY-CRITICAL HOME REPAIRS Page 21 of 24 Habitat for Humanity FYE 6/30/25 East Jefferson County Budget Income 4000 • Grants 1,556,000 4100 • Contributions 2,007,000 4600 Mason St 955,000 4600 Mason St - Prefunding 3,000,000 4300 • Habitat Store 500,000 4400 • In-Kind Contributions 72,000 4400 • In-Kind Cont. - Store 500,000 4500 • Home Sales 1,993,000 4800 • Mortgage Loan Disct Amort 30,000 4900 • Other Income 20,400 Total Income 10,633,400 Cost of Goods Sold 5000 • Direct Construction Costs 2,697,660 5050 • Repair Costs 153,000 5300 • Store Cost of Goods Sold 500,075 Total COGS 3,350,735 Expenses 6000 • Salary & Wage Expenses 1,275,277 6100 • Payroll Taxes & Benefits 374,193 6200 • Professional Fees 269,260 6300 • Supplies and Equipment 22,000 HOUSING FUND BOARD 2025 GRANT FUNDING HABITAT FOR HUMANITY-CRITICAL HOME REPAIRS Page 22 of 24 Habitat for Humanity FYE 6/30/25 East Jefferson County Budget 6400 • Telephone 19,000 6450 • Information Technology 83,100 6500 • Postage & Shipping 5,000 6600 • Facilities 79,200 6700 • Equipment Rental & Maint 2,220 6800 • Communications 54,190 6900 • Vehicle Expense & Travel 27,520 7000 • Conf, Cony, Mtgs, Seminars 19,400 7100 • Volunteers 38,500 7200 • Dues, Fees, Lic, Permits 81,650 7300 • Taxes 12,400 7350 • Interest 68,418 7400 • Homeowner Services 28,500 7500 • Tithes 80,000 7600 • Insurance 34,250 7700 • Community & Public Rel 11,900 7900 NMTC Expenses 23,556 8000 • Depreciation 39,300 Total Expense 2,648,834 Net Income 4,633,831 Other Cash In (Out) Land Held for Development _ (2,270,000) HOUSING FUND BOARD 2025 GRANT FUNDING HABITAT FOR HUMANITY-CRITICAL HOME REPAIRS Page 23 of 24 Habitat for Humanity FYE 6/30/25 East Jefferson County Budget House Construction (2,207,952) Cash impact, COGS on sale 2,697,660 Pledges/Grants Received - (deferred) 984,296 Debt & Financing Activity (45,264) Operating Activities 45,210 Changes to other Assets (3,000) Adjust. for non-cash activities 9,300 Total Other Cash In (Out) (789,750) Total change in Cash 3,844,081 Cash Reserves Released (Restr'd) (2,985,740) Change in Unrestricted Cash 858,341 Total Cash, end of period 5,474,463 Restricted cash, end of period 4,605,720 Unrestricted Cash, end of period 868,743 Basic Assumptions Home starts 10 Recycles Acquired - Number of New Houses Completed 8 Number of Recycled Homes Sold 1 Total Houses Sold (new + recycled) 9 HOUSING FUND BOARD 2025 GRANT FUNDING HABITAT FOR HUMANITY-CRITICAL HOME REPAIRS Page 24 of 24 ACCPREP CERTIFICATE OF LIABILITY INSURANCE D2DATEW 25mw)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 NAME: Lockton Affinity, LLC FAX Lockton Affinity, LLC IA/CC No.Extt088-553-9002 (A/C,No):913-652-3967 E-MAIL P. O. Box 873401 ADDRESS: Kansas City, MO 64187-3401 INSURER(S)AFFORDING COVERAGE NAICit INSURER A:Ace American Insurance Company 22667 INSURED INSURER B: Habitat for Humanity of East Jefferson INSURERC: CountyCg 2001CW.6S55 ims Way INSURERD Port Townsend, WA 98368-0658 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWTHSTANDING 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 POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. lLTERR TYPE OF INSURANCE ADDL SUER'y POLICY NUMBER POLICY EFF EXPPMIDD( LIMITS (MOLICY I POLICY 11 A X COMMERCIAL GENERAL LIABILITY X GL1065870-24 04/01/2024 04/01/2025 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $1,000,000 MED EXP(My one person) $0 PERSONALSADV INJURY $1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY JPRO- EC`T LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ —,ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS _ AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) $' UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED, ITN/A (Mandatory in NH) EL DICPACF-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISFASF-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Jefferson County, It's Elected Officials, Officers and Employees are listed as Additional Insured. CERTIFICATE HOLDER CANCELLATION 1065870 Jefferson County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN It's Elected Officials, Officers and Employees ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1220 / 1820 Jefferson St • Port Townsend, NA 98368 AUTH07;VES TATIVFIL'' 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 52240989 1065870 (7441 Department of labor a Industries Certificate of Workers' Compensation Coverage February 1 I,2025 WA UBI No. 501 850 143 LBI Amount ID 981,00E-00 Legal Business Name HABITAT FOR HUMANITY OF EAST JEFFERSON COUNTY Doing Business As HABITAT FOR HUMANITY OF EAST J Workers Comp premium Status: Aapnl Is Corms.* Estimated Workers Reported Quarter a of Year 2024'21 to 30 Workers' (See Oesmpdon Below) Account Representative Employer Sconces Help Line(360)902-481? Licensee Conea0M Yes License No. HABITFH9t205 License Esiratan 081062025 What does'Estimated Workers Reported'mean? Estimated workers reported represents the number of full time position requiring at least 080 hours of work per calendar quarter.A single 080 hour position may be filled by one person,or several part rime workers. Industrial Insurance Information Employers report and pay premiums each quarter based on hours of employee work already performed,and are liable for premiums found later to be due.Industrial Insurance accounts have no policy periods.cancellation dates,limitations of coverage or waiver of subrogation(See l:1W 51.12 OSQ and 51 16 190). cF_Iuee- Chubb BUSINESS AUTO DECLARATIONS ACE Property and Casualty Insurance Company P.O. Box 1000 436 Walnut Street Philadelphia, PA 19106 POLICY NUMBER: CAL H08787384 PRIOR POLICY: H08787384 012 RENEWAL : - Named Insured: HABITAT FOR HUMANITY OF EAST JEFFERSON COUNTY Address: PO Box 658 2001 W. Sims Way Port Townsend WA 98368-0658 PRODUCER Producer Number: Z01484 Producer Name: LOCKTON AFFINITY LLC Producer Address: EXECUTIVE CENTRE II 10895 LOWELL AVE SUITE 300 OVERLAND PARK KS 66210 PRODUCER BILLED -;• 1•••! ; • :' Form of Business: Other Named Insured's Business: Policy Period: Policy covers from 04/01/2025 to 04/01/2026 12:01 am standard time at the named insured's address stated above. Audit Period: NON-AUDITABLE Estimated Total Premium: $3,842.00 Deposit/Minimum Premium (Including taxes and surcharges) In return for the payment of premium and subject to all the terms of this policy we agree with you to provide the insurance as stated in this policy. DA-3K41b 02/2003 Copyright, Insurance Services Office, Inc.2000 Page 1 of 10 010 02/07/2025 CHUB B Chubb BUSINESS AUTO DECLARATIONS ACE Property and Casualty Insurance Company P.O. Box 1000 436 Walnut Street Philadelphia, PA 19106 POLICY NUMBER: CAL H08787384 PRIOR POLICY: H08787384 012 RENEWAL SCHEDULE OF PAYMENTS The estimated Total Payment is payable as follows: INSTALLMENTS DUE DATE AMOUNT DUE 1 04/01/2025 $960.50 2 07/01/2025 $960.50 3 10/01/2025 $960.50 4 01/01/2026 $960.50 DA-3K41b 02/2003 Copyright, Insurance Services Office, Inc.2000 Page 2 of 10 011 02/07/2025 C H U B B Chubb BUSINESS AUTO DECLARATIONS ACE Property and Casualty Insurance Company P.O. Box 1000 436 Walnut Street Philadelphia, PA 19106 POLICY NUMBER: CAL H08787384 PRIOR POLICY: H08787384 012 RENEWAL ITEM TWO - SCHEDULE OF COVERAGES AND COVERED AUTOS This policy provides only those coverages where a charge is shown in the premium column below. Each of these coverages will apply only to those "autos" shown as covered "autos." "Autos" are shown as covered "autos" for a particular coverage by the entry of one or more of the symbols from the COVERED AUTO Section of the Business Auto Coverage Form next to the name of the coverage. COVERED AUTOS (Entry of one or LIMIT more of the COVERAGES symbols from the THE MOST WE WILL PAY FOR ANY ONE PREMIUM COVERED AUTO Section of the ACCIDENT OR LOSS Business Auto Coverage Form shows which autos are covered autos) LIABILITY 7 $1,000,000 $2,568 MEDICAL PAYMENTS 2 $5,000 $70 UNDERINSURED MOTORISTS(When not included in Uninsured 6 SEE THE ATTACHED ENDORSEMENT(S)AND SCHEDULE $366 Motorists) OF COVERED AUTOS. (Not Applicable in New York) ACTUAL CASH VALUE OR COST OF REPAIR,WHICHEVER PHYSICAL DAMAGE IS LESS,MINUS$DED.FOR EACH COVERED AUTO. COMPREHENSIVE 7,8 BUT NO DEDUCTIBLE APPLIES TO LOSS CAUSED BY FIRE $358 COVERAGE OR LIGHTNING.(N/A private passenger types in NY) SEE THE SCHEDULE OF COVERED AUTOS FOR THE DEDUCTIBLE APPLICABLE FOR EACH AUTO. ACTUAL CASH VALUE OR COST OF REPAIR,WHICHEVER PHYSICAL DAMAGE IS LESS,MINUS$DED.FOR EACH COVERED AUTO. COLLISION COVERAGE 7,8 $480 SEE THE SCHEDULE OF COVERED AUTOS FOR THE DEDUCTIBLE APPLICABLE FOR EACH AUTO. PREMIUM FOR ENDORSEMENTS $0 TOTAL PREMIUM $3,842 DA-3K41b 02/2003 Copyright, Insurance Services Office, Inc.2000 Page 3 of 10 012 02/07/2025 C H U B B0 Chubb BUSINESS AUTO DECLARATIONS ACE Property and Casualty Insurance Company P.O. Box 1000 436 Walnut Street Philadelphia, PA 19106 POLICY NUMBER: CAL H08787384 PRIOR POLICY H08787384 012 RENEWAL ITEM THREE - SCHEDULE OF COVERED AUTOS YOU OWN DESCRIPTION Covered Year, Model,Trade Name, Original Terr Auto No Serial Number or Vehicle Identification Number(VIN) Cost New Code 00001 1997 ISUZU 4X8 68 BBC JALC4B1 K4V7004135 $10,000 131 00002 1999 Ford/Ranger 1FTZR15V5XPA69873 $3,000 131 00003 2018 Forest River Blazer 5NHUBL422JB468887 $5,340 131 00004 2006 Wells/Utility 1W4200D1864062932 $3,000 131 00005 2000 1-IM/Utility CA642666 $3,000 131 00006 2002 Mobil/Utility 73102000395 $3,000 131 TERRITORY CLASSIFICATION Size GVW Covered Town&State Where the Covered Radius Business GCW or Age Rating Factor Class Auto No Auto will be principally garaged of Use Use Vehicle Sceayting Group Liab Phy Dam Code 00001 Port Townsend WA L S 10001-20000 12 1.00 0.70 21189 00002 Port Townsend WA L S 0-10000 12 0.95 0.00 01189 00003 Port Townsend WA L 08 0.10 0.45 68189 00004 Port Townsend WA L 12 0.10 0.00 68189 00005 Port Townsend WA L 12 0.10 0.00 68189 00006 Port Townsend WA L 12 0.10 0.00 68189 Business Use Code: s= service; r= retail; c=commercial COVERAGES-PREMIUMS,LIMITS AND DEDUCTIBLES(Absence of a deductible or limit entry In any column below means that the limit or deductible entry In the corresponding ITEM TWO column applies Instead.) LIABILITY PERSONAL INJURY PROTECTION Limit stated in each Covered PIP END minus ded Auto No Limit Premium shown below Premium 00001 $1,000,000 $776 00002 $1,000,000 $738 00003 $1,000,000 $79 00004 $1,000,000 $79 00005 $1,000,000 $79 00006 $1,000,000 $79 ADDED PIP OBEL(N.Y.only) PROP PROT(Mich only) (Limit stated in each (Limit stated in Limit stated in PPI Covered Added PIP End) OBEL End.) END minus ded Premium Auto No Premium Premium shown below _ 00001 00002 00003 00004 00005 00006 AUTO MED PAY MEDICAL EXPENSE AND INCOME LOSS BENEFITS(Virginia Only) Limit Stated In Each Covered Medical Expense And Income Loss Endorsement Auto No Limit Premium For Each Person Premium 00001 $5,000 $10 00002 $5,000 $10 00003 $5,000 $10 00004 $5,000 $10 00005 $5,000 $10 00006 $5,000 $10 DA-3K41 b 02/2003 Copyright,Insurance Services Office,Inc.2000 Page 4 of 10 013 02/07/2025 C H U B B A Chubb BUSINESS AUTO DECLARATIONS ACE Property and Casualty Insurance Company P.O. Box 1000 436 Walnut Street Philadelphia, PA 19106 POLICY NUMBER: CAL H08787384 PRIOR POLICY: H08787384 012 RENEWAL UNINSURED MOTORISTS UNDERINSURED MOTORISTS(Not applicable in N.Y.) Covered Auto No Limit Premium Limit Premium 00001 See Endorsement. $122 00002 See Endorsement. $122 00003 00004 00005 00006 SUPPLEMENTARY UNINSURED/UNDERINSURED COMPREHENSIVE MOTORISTS (New York Only) Covered Limit stated in ITEM TWO Auto No Limit Premium minus ded. shown below Premium 00001 $500 $80 00002 00003 $500 $60 00004 00005 00006 SPECIFIED CAUSES OF LOSS COLLISION Covered Limit stated in ITEM TWO Limit stated in ITEM TWO Auto No minus ded. shown below Premium minus ded. shown below Premium 00001 $500 $98 00002 00003 $500 $59 00004 00005 00006 TOWING & LABOR TOTAL Covered Limit per PREMIUM Auto No Disablement Premium PER VEHICLE 00001 $1,086 00002 $870 00003 $208 00004 $89 00005 $89 00006 $89 Covered Except for towing, all physical damage loss is payable to you and the loss payee Auto No named below as interests may appear at the time of the loss. 00001 00002 00003 00004 00005 00006 Comprehensive Code: Collision Code: Specified Causes of Loss Codes: G =Full Glass Coverage G =Full Glass Coverage F= Fire Coverage PIP and PIPM Code: B =Broadened T= Fire&Theft Coverage 1. PIP only L =Limited W= Fire, Theft&Windstorm Coverage 2. PIP and PIPM L = Limited Specified Causes of Loss Coverage 3. PIPM only S= Full Specified Causes of Loss Coverage DA-3K41b 02/2003 Copyright, Insurance Services Office, Inc.2000 Page 5 of 10 014 02/07/2025 E I-I U B B Chubb BUSINESS AUTO DECLARATIONS ACE Property and Casualty Insurance Company P.O. Box 1000 436 Walnut Street Philadelphia, PA 19106 POLICY NUMBER: CAL H08787384 PRIOR POLICY: H08787384 012 r RENEWAL ITEM THREE - SCHEDULE OF COVERED AUTOS YOU OWN DESCRIPTION Covered Year, Model,Trade Name, Original Terr Auto No Serial Number or Vehicle Identification Number(VIN) Cost New Code 00007 2015 Ford/F-150 1FTFXIEFOFKE32366 $34,500 131 TERRITORY CLASSIFICATION Size GVW Covered Town 8 State Where the Covered Radius Business GCW or Age Rating Factor Class Auto No Auto will be principally garaged of Use Use Vehicle Se ying Group Liab Phy Dam Code Capaci00007 Port Townsend WA L S 0-10000 11 0.95 0.95 01189 Business Use Code: s= service; r= retail; c=commercial COVERAGES-PREMIUMS,LIMITS AND DEDUCTIBLES(Absence of a deductible or limit entry in any column below means that the limit or deductible entry in the corresponding ITEM TWO column applies instead.) LIABILITY PERSONAL INJURY PROTECTION Limit stated in each Covered PIP END minus ded Auto No Limit Premium shown below Premium 00007 $1,000,000 $738 ADDED PIP OBEL(N.Y.only) PROP PROT(Mich only) (Limit stated in each (Limit stated in Limit stated in PPI Covered Added PIP End) OBEL End.) END minus ded Premium Auto No Premium Premium shown below 00007 AUTO MED PAY MEDICAL EXPENSE AND INCOME LOSS BENEFITS(Virginia Only) Limit Stated In Each Covered Medical Expense And Income Loss Endorsement Auto No Limit Premium For Each Person Premium 00007 $5,000 $10 DA-3K41b 02/2003 Copyright,Insurance Services Office,Inc.2000 Page 6 of 10 015 02/07/2025 C H U B B` Chubb BUSINESS AUTO DECLARATIONS ACE Property and Casualty Insurance Company P.O. Box 1000 436 Walnut Street Philadelphia, PA 19106 POLICY NUMBER: CAL H08787384 PRIOR POLICY: H08787384 012 RENEWAL UNINSURED MOTORISTS UNDERINSURED MOTORISTS(Not applicable in N.Y.) Covered Auto No Limit Premium Limit Premium 00007 See Endorsement. $122 SUPPLEMENTARY UNINSURED/UNDERINSURED COMPREHENSIVE MOTORISTS (New York Only) Covered Limit stated in ITEM TWO Auto No Limit Premium minus ded. shown below Premium 00007 $1,000 $198 SPECIFIED CAUSES OF LOSS COLLISION Covered Limit stated in ITEM TWO Limit stated in ITEM TWO Auto No minus ded. shown below Premium minus ded. shown below Premium 00007 $1,000 $293 TOWING & LABOR TOTAL Covered Limit per PREMIUM Auto No Disablement Premium PER VEHICLE 00007 $1,361 Covered Except for towing, all physical damage loss is payable to you and the loss payee Auto No named below as interests may appear at the time of the loss. 00007 Comprehensive Code: Collision Code: Specified Causes of Loss Codes: G =Full Glass Coverage G =Full Glass Coverage F = Fire Coverage PIP and PIPM Code: B =Broadened T= Fire&Theft Coverage 1. PIP only L=Limited W= Fire, Theft&Windstorm Coverage 2. PIP and PIPM L = Limited Specified Causes of Loss Coverage 3. PIPM only S = Full Specified Causes of Loss Coverage DA-3K41b 02/2003 Copyright, Insurance Services Office, Inc.2000 Page 7 of 10 016 02/07/2025 CHUBS" Chubb BUSINESS AUTO DECLARATIONS ACE Property and Casualty Insurance Company P.O. Box 1000 436 Walnut Street Philadelphia, PA 19106 POLICY NUMBER: CAL H08787384 PRIOR POLICY: H08787384 012 RENEWAL ITEM FOUR - SCHEDULE OF HIRED OR BORROWED AUTO COVERAGE AND PREMIUMS LIABILITY COVERAGE -RATING BASIS, COST OF HIRE STATE ESTIMATED COST OF HIRE RATE PER EACH FACTOR(if liab. PREMIUM FOR EACH STATE $100 COST OF HIRE coy. is primary) TOTAL PREMIUM Cost of hire means the total amount you incur for the hire of"autos" you don't own (not including "autos" you borrow or rent from your partners or employees or their family members). Cost of hire does not include charges for services performed by motor carriers of property or passengers. PHYSICAL DAMAGE COVERAGE LIMIT OF INSURANCE ESTIMATED RATE PER EACH COVERAGES THE MOST WE WILL PAY STATE ANNUAL $100 ANNUAL PREMIUM DEDUCTIBLE COST OF HIRE COST OF HIRE ACTUAL CASH VALUE OR COST OF WA $2,500 0.65 $20 REPAIR,WHICHEVER IS LESS, COMPREHENSIVE MINUS$100 DED.FOR EACH COVERED AUTO,BUT NO DEDUCTIBLE APPLIES TO LOSS CAUSED BY FIRE OR LIGHTNING. ACTUAL CASH VALUE OR COST OF WA $2,500 0.96 $30 COLLISION REPAIR,WHICHEVER IS LESS, MINUS$500 DED.FOR EACH COVERED AUTO. TOTAL PREMIUM $50 e . NAMED INSURED'S BUSINESS RATING BASIS NUMBER PREMIUM Other Than A Social Service Agency Number of Employees Number of Partners Social Service Agency Number of Employees Number of Volunteers Garage Service Operations Number of Employees Number of Partners TOTAL PREMIUM DA-3K41b 02/2003 Copyright,Insurance Services Office,Inc.2000 Page 8 of 10 017 02/07/2025 C H U B B' Chubb BUSINESS AUTO DECLARATIONS ACE Property and Casualty Insurance Company P.O. Box 1000 436 Walnut Street Philadelphia, PA 19106 POLICY NUMBER: CAL H08787384 PRIOR POLICY: H08787384 012 RENEWAL ITEM SIX-SCHEDULE FOR GROSS RECEIPTS OR MILEAGE BASIS—LIABILITY COVERAGE—PUBLIC AUTO OR LEASING RENTAL CONCERNS RATES ESTIMATED Per$100 Of Gross Receipts PREMIUMS YEARLY ❑ Per 100 Miles Gross Receipts Per 100 Gallons El Mileage LIABILITY AUTO MEDICAL LIABILITY AUTO MEDICAL Gallons COVERAGE PAYMENTS COVERAGE PAYMENTS TOTAL PREMIUMS MINIMUM PREMIUMS When used as a premium basis: FOR PUBLIC AUTOS Gross Receipts means the total amount to which you are entitled for transporting passengers, mail or merchandise during the policy period regardless of whether you or any other carrier originate the transportation. Gross Receipts does not include: A. Amounts you pay to railroads, steamship lines, airlines and other motor carriers operating under their own ICC or PUC permits. B. Advertising revenue. C. Taxes which you collect as a separate item and remit directly to a governmental division. D. C.O.D. collections for cost of mail or merchandise including collection fees. Mileage means the total live and dead mileage of all revenue producing units operated during the policy period. FOR RENTAL OR LEASING CONCERNS Gross receipts means the total amount to which you are entitled for the leasing or rental of"autos" during the policy period and includes taxes except those taxes which you collect as a separate item and remit directly to a governmental division. Mileage means the total of all live and dead mileage developed by all the "autos" you leased or rented to others during the policy period. DA-3K41b 02/2003 Copyright, Insurance Services Office, Inc.2000 Page 9 of 10 018 02/07/2025 CHUBS° Chubb BUSINESS AUTO DECLARATIONS ACE Property and Casualty Insurance Company P.O. Box 1000 436 Walnut Street Philadelphia, PA 19106 POLICY NUMBER: CAL H08787384 PRIOR POLICY: H08787384 012 RENEWAL FORMS AND ENDORSEMENTS ATTACHED TO POLICY AT INCEPTION SCHEDULE OF ENDORSEMENTS ALL20887 (10/06) PRODUCER COMPENSATION NOTICE ILP0010104 TREASURY DEPT. (OFAC) IL00080217 WASHINGTON UNDERINSURED MOTORISTS COVERAGE SELECTION/REJECTION ILU0521010 WA OFFER OF PIP COVERAGE CC1K11k0422 SIGNATURES CA00011120 BUSINESS AUTO COVERAGE FORM ALL21101 (11/06) TRADE OR ECONOMIC SANCTIONS ENDORSEMENT IL01980908 NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (BROAD FORM) CA01351013 WASHINGTON CHANGES IL01460810 WASHINGTON COMMON POLICY CONDITIONS CA21341013 WASHINGTON UNDERINSURED MOTORISTS COVERAGE IL01231113 WASHINGTON CHANGES—DEFENSE COSTS CA20541120 EMPLOYEE HIRED AUTOS CA99031013 AUTO MEDICAL PAYMENTS COVERAGE THIS DECLARATION AND THE BUSINESS AUTO POLICY AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY. COUNTERSIGNED BY AUTHORIZED AGENT DA-3K41b 02/2003 Copyright, Insurance Services Office, Inc.2000 Page 10 of 10 019 02/07/2025 CHUBB° SIGNATURES Named Insured HABITAT FOR HUMANITY OF Endorsement Number EAST JEFFERSON COUNTY Policy Symbol Policy Number Policy Period Effective Date of Endorsement CAL Ho8787384 04/01/2025 TO 04/01/2026 04/01/2025 Issued By(Name of Insurance Company) ACE Property and Casualty Insurance Company THE ONLY COMPANY APPLICABLE TO THIS POLICY IS THE COMPANY NAMED ON THE FIRST PAGE OF THE DECLARATIONS. By signing and delivering the policy to you,we state that it is a valid contract. INDEMNITY INSURANCE COMPANY OF NORTH AMERICA(A stock company) BANKERS STANDARD INSURANCE COMPANY(A stock company) ACE AMERICAN INSURANCE COMPANY(A stock company) ACE PROPERTY AND CASUALTY INSURANCE COMPANY(A stock company) INSURANCE COMPANY OF NORTH AMERICA(A stock company) PACIFIC EMPLOYERS INSURANCE COMPANY(A stock company) ACE FIRE UNDERWRITERS INSURANCE COMPANY(A stock company) WESTCHESTER FIRE INSURANCE COMPANY(A stock company) 436 Walnut Street,P.O.Box moo,Philadelphia,Pennsylvania 19106-3703 M 71? BRANDON PEENE,Secretary JOHN J.LUPICA,President Authorized Representative 020 CC-iKllk(04/22) Page 1 of 1 POLICY NUMBER: CAL H08787384 COMMERCIAL AUTO CA 00 01 11 20 BUSINESS AUTO COVERAGE FORM Various provisions in this Policy restrict coverage. SECTION I—COVERED AUTOS Read the entire policy carefully to determine rights, Item Two of the Declarations shows the "autos" that duties and what is and is not covered. are covered "autos" for each of your coverages. The Throughout this Policy, the words "you" and "your" following numerical symbols describe the "autos" that refer to the Named Insured shown in the Declarations. may be covered "autos". The symbols entered next to The words "we", "us" and "our" refer to the company a coverage on the Declarations designate the only providing this insurance. "autos"that are covered "autos". Other words and phrases that appear in quotation A. Description Of Covered Auto Designation marks have special meaning. Refer to Section V — Symbols Definitions. Symbol Description Of Covered Auto Designation Symbols 1 Any"Auto" 2 Owned "Autos" Only those "autos" you own (and for Covered Autos Liability Coverage any Only "trailers" you don't own while attached to power units you own). This includes those"autos" you acquire ownership of after the Policy begins. 3 Owned Private Only the private passenger "autos" you own. This includes those private Passenger passenger"autos"you acquire ownership of after the Policy begins. "Autos" Only 4 Owned Only those "autos" you own that are not of the private passenger type (and for "Autos" Other Covered Autos Liability Coverage any "trailers" you don't own while attached to Than Private power units you own). This includes those "autos" not of the private passenger Passenger type you acquire ownership of after the Policy begins. "Autos" Only 5 Owned "Autos" Only those "autos" you own that are required to have no-fault benefits in the state Subject To where they are licensed or principally garaged. This includes those "autos" you No-fault acquire ownership of after the Policy begins provided they are required to have no- fault benefits in the state where they are licensed or principally garaged. 6 Owned "Autos" Only those "autos" you own that because of the law in the state where they are Subject To A licensed or principally garaged are required to have and cannot reject Uninsured Compulsory Motorists Coverage. This includes those "autos"you acquire ownership of after the Uninsured Policy begins provided they are subject to the same state uninsured motorists Motorists Law requirement. 7 Specifically Only those "autos" described in Item Three of the Declarations for which a Described premium charge is shown (and for Covered Autos Liability Coverage any "trailers" "Autos" you don't own while attached to any power unit described in Item Three). 8 Hired"Autos" Only those"autos"you lease, hire, rent or borrow. This does not include any"auto" Only you lease, hire, rent or borrow from any of your"employees", partners (if you are a partnership), members (if you are a limited liability company) or members of their households. 9 Non-owned Only those "autos" you do not own, lease, hire, rent or borrow that are used in "Autos"Only connection with your business. This includes "autos" owned by your "employees", partners (if you are a partnership), members (if you are a limited liability company) or members of their households but only while used in your business or your personal affairs. 021 CA 00 01 11 20 ©Insurance Services Office, Inc., 2019 Page 1 of 13 19 Mobile Only those "autos"that are land vehicles and that would qualify under the definition Equipment of"mobile equipment" under this Policy if they were not subject to a compulsory or Subject To financial responsibility law or other motor vehicle insurance law where they are Compulsory Or licensed or principally garaged. Financial Responsibility Or Other Motor Vehicle Insurance Law Only B. Owned Autos b. Repair; 1. If Symbols 1, 2, 3, 4, 5, 6 or 19 are entered c. Servicing; next to a coverage in Item Two of the d. "Loss"; or Declarations, then you have coverage for "autos" that you acquire after the policy period e. Destruction. begins of the type described for the remainder SECTION II—COVERED AUTOS LIABILITY of the policy period. COVERAGE 2. But, if Symbol 7 is entered next to a coverage A. Coverage in Item Two of the Declarations, an "auto" you We will pay all sums an "insured" legally must pay acquire after the policy period begins will be a as damages because of"bodily injury" or"property covered "auto"for that coverage only if: damage" to which this insurance applies, caused a. We already cover all "autos" that you own by an "accident" and resulting from the ownership, for that coverage or it replaces an "auto" maintenance or use of a covered "auto". you previously owned that had that We will also pay all sums an "insured" legally must coverage; and pay as a "covered pollution cost or expense" to b. You tell us within 30 days after you acquire which this insurance applies, caused by an it that you want us to cover it for that "accident" and resulting from the ownership, coverage. maintenance or use of covered "autos". However, 3. An "auto" that is leased or rented to you we will only pay for the "covered pollution cost or without a driver, under a written agreement for expense" if there is either "bodily injury" or a continuous period of at least six months that "property damage" to which this insurance applies requires you to provide primary insurance that is caused by the same "accident". covering such "auto", will be considered a We have the right and duty to defend any covered"auto" you own. "insured" against a "suit" asking for such damages C. Certain Trailers, Mobile Equipment And or a"covered pollution cost or expense". However, Temporary Substitute Autos we have no duty to defend any "insured" against a If Covered Autos Liability Coverage is provided by "suit" seeking damages for "bodily injury" or If is Cove u Form, the followingeistypesvideof "property damage" or a "covered pollution cost or vehicles are also cvered "autos" for Covered expense" to which this insurance does not apply. We may investigate and settle any claim or "suit" Autos Liability Coverage: as we consider appropriate. Our duty to defend or 1. "Trailers" with a registered Gross Vehicle settle ends when the Covered Autos Liability Weight Rating of 3,000 pounds or less Coverage Limit of Insurance has been exhausted designed primarily for travel on public roads. by payment of judgments or settlements. 2. "Mobile equipment" while being carried or 1. Who Is An Insured towed by a covered "auto". The following are"insureds": 3. Any "auto" you do not own while used with the a. You for any covered"auto". permission of its owner as a temporary substitute for a covered "auto" you own that is b. Anyone else while using with your out of service because of its: permission a covered "auto" you own, hire a. Breakdown; or borrow except: (1) The owner or anyone else from whom you hire or borrow a covered"auto". 022 Page 2 of 13 ©Insurance Services Office, Inc., 2019 CA 00 01 11 20 This exception does not apply if the (6) All interest on the full amount of any covered "auto" is a "trailer" connected to judgment that accrues after entry of the a covered "auto" you own. judgment in any "suit" against the (2) Your "employee" if the covered "auto" is "insured" we defend, but our duty to pay owned by that "employee" or a member interest ends when we have paid, of his or her household. offered to pay or deposited in court the part of the judgment that is within our (3) Someone using a covered "auto" while Limit of Insurance. he or she is working in a business of selling, servicing, repairing, parking or These payments will not reduce the Limit of storing "autos" unless that business is Insurance. yours. b. Out-of-state Coverage Extensions (4) Anyone other than your "employees", While a covered "auto" is away from the partners (if you are a partnership), state where it is licensed, we will: members (if you are a limited liability (1) Increase the Limit of Insurance for company) or a lessee or borrower or any Covered Autos Liability Coverage to of their "employees", while moving meet the limits specified by a property to or from a covered "auto". compulsory or financial responsibility (5) A partner (if you are a partnership) or a law of the jurisdiction where the covered member (if you are a limited liability "auto" is being used. This extension company) for a covered "auto"owned by does not apply to the limit or limits him or her or a member of his or her specified by any law governing motor household. carriers of passengers or property. c. Anyone liable for the conduct of an (2) Provide the minimum amounts and "insured" described above but only to the types of other coverages, such as no- extent of that liability. fault, required of out-of-state vehicles by 2. Coverage Extensions the jurisdiction where the covered "auto" a. Supplementary Payments is being used. We will not pay anyone more than once for We will pay for the"insured": the same elements of loss because of (1) All expenses we incur. these extensions. (2) Up to $2,000 for cost of bail bonds B. Exclusions (including bonds for related traffic law This insurance does not apply to any of the violations) required because of an following: "accident" we cover. We do not have to furnish these bonds. 1. Expected Or Intended Injury (3) The cost of bonds to release "Bodily injury" or "property damage" expected attachments in any "suit" against the or intended from the standpoint of the "insured" we defend, but only for bond "insured". amounts within our Limit of Insurance. 2. Contractual (4) All reasonable expenses incurred by the Liability assumed under any contract or "insured" at our request, including actual agreement. loss of earnings up to $250 a day But this exclusion does not apply to liability for because of time off from work. damages: (5) All court costs taxed against the a. Assumed in a contract or agreement that is "insured" in any "suit" against the an "insured contract", provided the "bodily "insured" we defend. However, these payments do not include attorneys' fees injury"u or "propertyr damage" occurs or attorneys' expenses taxed against the or agreement;euent to the execution of the contract "insured". or or 023 CA 00 01 11 20 ©Insurance Services Office, Inc., 2019 Page 3 of 13 b. That the "insured" would have in the 7. Handling Of Property absence of the contract or agreement. "Bodily injury' or "property damage" resulting 3. Workers'Compensation from the handling of property: Any obligation for which the "insured" or the a. Before it is moved from the place where it is "insured's" insurer may be held liable under accepted by the "insured" for movement any workers' compensation, disability benefits into or onto the covered"auto"; or or unemployment compensation law or any b. After it is moved from the covered "auto" to similar law. the place where it is finally delivered by the 4. Employee Indemnification And Employer's "insured". Liability 8. Movement Of Property By Mechanical "Bodily injury"to: Device a. An "employee" of the "insured" arising out "Bodily injury" or "property damage" resulting of and in the course of: from the movement of property by a mechanical device (other than a hand truck) Employment by the "insured" or (2) Performing the duties related to the unless the device is attached to the covered "auto". conduct of the"insured's" business; or b. The spouse, child, parent, brother or sister 9 Operations of that "employee" as a consequence of Bodily injury" or "property damage" arising out Paragraph a. above. of the operation of: This exclusion applies: a. Any equipment listed in Paragraphs 6.b. and 6.c. of the definition of "mobile (1) Whether the "insured" may be liable as equipment"; or an employer or in any other capacity; and b. Machinery or equipment that is on, attached to or part of a land vehicle that would (2) To any obligation to share damages with qualify under the definition of "mobile or repay someone else who must pay equipment" if it were not subject to a damages because of the injury. compulsory or financial responsibility law or But this exclusion does not apply to "bodily other motor vehicle insurance law where it injury" to domestic "employees" not entitled to is licensed or principally garaged. workers' compensation benefits or to liability 10. Completed Operations assumed by the "insured" under an "insured contract". For the purposes of the Coverage "Bodily injury" or "property damage" arising out Form, a domestic "employee" is a person of your work after that work has been engaged in household or domestic work completed or abandoned. performed principally in connection with a In this exclusion, your work means: residence premises. a. Work or operations performed by you or on 5. Fellow Employee your behalf; and "Bodily injury"to: b. Materials, parts or equipment furnished in a. Any fellow "employee" of the "insured" connection with such work or operations. arising out of and in the course of the fellow Your work includes warranties or "employee's" employment or while representations made at any time with respect performing duties related to the conduct of to the fitness, quality, durability or performance your business; or of any of the items included in Paragraph a. or b. The spouse, child, parent, brother or sister b. above. of that fellow"employee" as a consequence Your work will be deemed completed at the of Paragraph a. above. earliest of the following times: 6. Care, Custody Or Control (1) When all of the work called for in your "Property damage"to or"covered pollution cost contract has been completed; or expense" involving property owned or (2) When all of the work to be done at the transported by the "insured" or in the site has been completed if your contract "insured's" care, custody or control. But this calls for work at more than one site; or exclusion does not apply to liability assumed under a sidetrack agreement. 024 Page 4 of 13 ©Insurance Services Office, Inc., 2019 CA 00 01 11 20 (3) When that part of the work done at a job Paragraphs b. and c. above of this exclusion site has been put to its intended use by do not apply to "accidents" that occur away any person or organization other than from premises owned by or rented to an another contractor or subcontractor "insured" with respect to "pollutants" not in or working on the same project. upon a covered"auto"if: Work that may need service, maintenance, (a) The "pollutants" or any property in correction, repair or replacement, but which is which the "pollutants" are contained otherwise complete, will be treated as are upset, overturned or damaged as completed. a result of the maintenance or use of 11. Pollution a covered "auto"; and "Bodily injury" or"property damage" arising out (b) The discharge, dispersal, seepage, of the actual, alleged or threatened discharge, migration, release or escape of the dispersal, seepage, migration, release or "pollutants" is caused directly by escape of"pollutants": such upset, overturn or damage. a. That are, or that are contained in any 12. War property that is: "Bodily injury" or "property damage" arising (1) Being transported or towed by, handled directly or indirectly out of: or handled for movement into, onto or a. War, including undeclared or civil war; from the covered "auto" b. Warlike action by a military force, including (2) Otherwise in the course of transit by or action in hindering or defending against an on behalf of the"insured"; or actual or expected attack, by any (3) Being stored, disposed of, treated or government, sovereign or other authority processed in or upon the covered using military personnel or other agents; or "auto"; c. Insurrection, rebellion, revolution, usurped b. Before the "pollutants" or any property in power or action taken by governmental which the "pollutants" are contained are authority in hindering or defending against moved from the place where they are any of these. accepted by the "insured" for movement 13. Racing into or onto the covered "auto"; or Covered "autos" while used in any professional c. After the "pollutants" or any property in or organized racing or demolition contest or which the "pollutants" are contained are stunting activity, or while practicing for such moved from the covered "auto" to the place contest or activity. This insurance also does where they are finally delivered, disposed of not apply while that covered "auto" is being or abandoned by the"insured". prepared for such a contest or activity. Paragraph a. above does not apply to fuels, 14. Unmanned Aircraft lubricants, fluids, exhaust gases or other "Bodily injury" or "property damage" arising out similar"pollutants"that are needed for or result of the ownership, maintenance or use of from the normal electrical, hydraulic or "unmanned aircraft". mechanical functioning of the covered "auto" or its parts if: C. Limit Of Insurance (1) The "pollutants" escape, seep, migrate Regardless of the number of covered "autos", or are discharged, dispersed or released "insureds", premiums paid, claims made or directly from an "auto" part designed by vehicles involved in the "accident", the most we its manufacturer to hold, store, receive will pay for the total of all damages and "covered or dispose of such"pollutants"; and pollution cost or expense" combined resulting from any one "accident" is the Limit Of Insurance for (2) The"bodily injury", "property damage" or Covered Autos Liability Coverage shown in the "covered pollution cost or expense" Declarations. does not arise out of the operation of any equipment listed in Paragraphs 6.b. and 6.c. of the definition of "mobile equipment". 025 CA 00 01 11 20 ©Insurance Services Office, Inc., 2019 Page 5 of 13 All "bodily injury', "property damage" and "covered 3. Glass Breakage—Hitting A Bird Or Animal— pollution cost or expense" resulting from Falling Objects Or Missiles continuous or repeated exposure to substantially If you carry Comprehensive Coverage for the the same conditions will be considered as damaged covered "auto", we will pay for the resulting from one"accident". following under Comprehensive Coverage: No one will be entitled to receive duplicate payments for the same elements of "loss" under a. Glass breakage; this Coverage Form and any Medical Payments b. "Loss" caused by hitting a bird or animal; Coverage endorsement, Uninsured Motorists and Coverage endorsement or Underinsured Motorists c. "Loss"caused by falling objects or missiles. Coverage endorsement attached to this Coverage However, you have the option of having glass Part. breakage caused by a covered "auto's" SECTION III-PHYSICAL DAMAGE COVERAGE collision or overturn considered a "loss" under A. Coverage Collision Coverage. 1. We will pay for "loss" to a covered "auto" or its 4. Coverage Extensions equipment under: a. Transportation Expenses a. Comprehensive Coverage We will pay up to $30 per day, to a From any cause except: maximum of $900, for temporary transportation expense incurred by you (1) The covered "auto's" collision with because of the total theft of a covered another object; or "auto" of the private passenger type. We (2) The covered "auto's"overturn. will pay only for those covered "autos" for b. Specified Causes Of Loss Coverage which you carry either Comprehensive or Specified Causes Of Loss Coverage. We Caused by: will pay for temporary transportation (1) Fire, lightning or explosion; expenses incurred during the period (2) Theft; beginning 48 hours after the theft and ending, regardless of the Policy's (3) Windstorm, hail or earthquake; expiration, when the covered "auto" is (4) Flood; returned to use or we pay for its"loss". (5) Mischief or vandalism; or b. Loss Of Use Expenses (6) The sinking, burning, collision or For Hired Auto Physical Damage, we will derailment of any conveyance pay expenses for which an "insured" transporting the covered "auto". becomes legally responsible to pay for loss c. Collision Coverage of use of a vehicle rented or hired without a driver under a written rental contract or Caused by: agreement. We will pay for loss of use (1) The covered "auto's" collision with expenses if caused by: another object; or (1) Other than collision only if the (2) The covered"auto's"overturn. Declarations indicates that 2. Towing And Labor Comprehensive Coverage is provided for any covered"auto"; We will pay up to the limit shown in the (2) Specified Causes of Loss only if the Declarations for towing and labor costs Declarations indicates that Specified incurred each time a covered "auto" that is a Causes Of Loss Coverage is provided private passenger type, light truck or medium for any covered"auto"; or truck is disabled. However, the labor must be performed at the place of disablement. 026 Page 6 of 13 ©Insurance Services Office, Inc., 2019 CA 00 01 11 20 (3) Collision only if the Declarations 4. We will not pay for "loss" to any of the indicates that Collision Coverage is following: provided for any covered "auto". a. Tapes, records, discs or other similar audio, However, the most we will pay for any visual or data electronic devices designed expenses for loss of use is $30 per day, to for use with audio, visual or data electronic a maximum of$900. equipment. B. Exclusions b. Any device designed or used to detect 1. We will not pay for"loss"caused by or resulting speed-measuring equipment, such as radar from any of the following. Such "loss" is or laser detectors, and any jamming excluded regardless of any other cause or apparatus intended to elude or disrupt event that contributes concurrently or in any speed-measuring equipment. sequence to the"loss". c. Any electronic equipment, without regard to a. Nuclear Hazard whether this equipment is permanently installed, that reproduces, receives or (1) The explosion of any weapon employing transmits audio, visual or data signals. atomic fission or fusion; or d. Any accessories used with the electronic (2) Nuclear reaction or radiation, or equipment described in Paragraph c. radioactive contamination, however above. caused. 5. Exclusions 4.c. and 4.d. do not apply to b. War Or Military Action equipment designed to be operated solely by (1) War, including undeclared or civil war; use of the power from the "auto's" electrical (2) Warlike action by a military force, system that, at the time of"loss", is: including action in hindering or a. Permanently installed in or upon the defending against an actual or expected covered"auto"; attack, by any government, sovereign or b. Removable from a housing unit which is other authority using military personnel permanently installed in or upon the or other agents; or covered"auto"; (3) Insurrection, rebellion, revolution, c. An integral part of the same unit housing usurped power or action taken by any electronic equipment described in governmental authority in hindering or Paragraphs a. and b. above; or defending against any of these. d. Necessary for the normal operation of the 2. We will not pay for"loss" to any covered "auto" covered "auto" or the monitoring of the while used in any professional or organized covered"auto's"operating system. racing or demolition contest or stunting activity, or while practicing for such contest or activity. 6. We will not pay for "loss" to a covered "auto" We will also not pay for "loss" to any covered due to"diminution in value". "auto" while that covered "auto" is being C. Limits Of Insurance prepared for such a contest or activity. 1. The most we will pay for: 3. We will not pay for"loss" due and confined to: a. "Loss" to any one covered "auto" is the a. Wear and tear, freezing, mechanical or lesser of: electrical breakdown. (1) The actual cash value of the damaged b. Blowouts, punctures or other road damage or stolen property as of the time of the to tires. "loss"; or This exclusion does not apply to such "loss" (2) The cost of repairing or replacing the resulting from the total theft of a covered damaged or stolen property with other "auto". property of like kind and quality. 027 CA 00 01 11 20 ©Insurance Services Office, Inc., 2019 Page 7 of 13 b. All electronic equipment that reproduces, SECTION IV—BUSINESS AUTO CONDITIONS receives or transmits audio, visual or data The following conditions apply in addition to the signals in any one "loss" is $1,000, if, at the Common Policy Conditions: time of"loss", such electronic equipment is: (1) Permanently installed in or upon the A. Loss Conditions covered "auto" in a housing, opening or 1. Appraisal For Physical Damage Loss other location that is not normally used If you and we disagree on the amount of"loss", by the "auto" manufacturer for the either may demand an appraisal of the "loss". installation of such equipment; In this event, each party will select a competent (2) Removable from a permanently installed appraiser. The two appraisers will select a housing unit as described in Paragraph competent and impartial umpire. The b.(1) above; or appraisers will state separately the actual cash (3) An integral part of such as value and amount of"loss". If they fail to agree, described in Paragraphs equipment.(1) and b as2) they will submit their differences to the umpire. above. A decision agreed to by any two will be binding. Each party will: 2. An adjustment for depreciation and physical a. Pay its chosen appraiser; and condition will be made in determining actual cash value in the event of a total "loss". b. Bear the other expenses of the appraisal 3. If a repair or replacement results in better than and umpire equally. like kind or quality, we will not pay for the If we submit to an appraisal, we will still retain amount of the betterment. our right to deny the claim. D. Deductible 2. Duties In The Event Of Accident, Claim, Suit For each covered "auto", our obligation to pay for, Or Loss repair, return or replace damaged or stolen We have no duty to provide coverage under property will be reduced by the applicable this Policy unless there has been full deductible shown in the Declarations prior to the compliance with the following duties: application of the Limit Of Insurance, provided a. In the event of "accident", claim, "suit" or that: "loss", you must give us or our authorized 1. The Comprehensive or Specified Causes Of representative prompt notice of the Loss Coverage deductible applies only to "loss" "accident" or"loss". Include: caused by: (1) How, when and where the "accident" or a. Theft or mischief or vandalism; or "loss"occurred; b. All perils. (2) The"insured's" name and address; and 2. Regardless of the number of covered "autos" (3) To the extent possible, the names and damaged or stolen, the maximum deductible addresses of any injured persons and applicable for all "loss" in any one event witnesses. caused by: b. Additionally, you and any other involved a. Theft or mischief or vandalism; or "insured" must: b. All perils, (1) Assume no obligation, make no will be equal to five times the highest payment or incur no expense without deductible applicable to any one covered our consent, except at the "insured's" own cost. "auto" on the Policy for Comprehensive or Specified Causes Of Loss Coverage. The (2) Immediately send us copies of any application of the highest deductible used to request, demand, order, notice, calculate the maximum deductible will be made summons or legal paper received regardless of which covered "autos" were concerning the claim or"suit". damaged or stolen in the"loss". 028 Page 8 of 13 ©Insurance Services Office, Inc., 2019 CA 00 01 11 20 (3) Cooperate with us in the investigation or 5. Transfer Of Rights Of Recovery Against settlement of the claim or defense Others To Us against the"suit". If any person or organization to or for whom we (4) Authorize us to obtain medical records make payment under this Coverage Form has or other pertinent information. rights to recover damages from another, those (5) Submit to examination, at our expense, rights are transferred to us. That person or by physicians of our choice, as often as organization must do everything necessary to we reasonably require. secure our rights and must do nothing after "accident"or"loss"to impair them. c. If there is "loss" to a covered "auto" or its B. General Conditions equipment, you must also do the following: (1) Promptly notify the police if the covered 1. Bankruptcy "auto" or any of its equipment is stolen. Bankruptcy or insolvency of the"insured" or the (2) Take all reasonable steps to protect the "insured's" estate will not relieve us of any covered "auto" from further damage. obligations under this Coverage Form. Also keep a record of your expenses for 2. Concealment, Misrepresentation Or Fraud consideration in the settlement of the This Coverage Form is void in any case of claim. fraud by you at any time as it relates to this (3) Permit us to inspect the covered "auto" Coverage Form. It is also void if you or any and records proving the "loss" before its other "insured", at any time, intentionally repair or disposition. conceals or misrepresents a material fact (4) Agree to examinations under oath at our concerning: request and give us a signed statement a. This Coverage Form; of your answers. b. The covered "auto"; 3. Legal Action Against Us c. Your interest in the covered"auto"; or No one may bring a legal action against us d. A claim under this Coverage Form. under this Coverage Form until: a. There has been full compliance with all the 3. Liberalization terms of this Coverage Form; and If we revise this Coverage Form to provide b. Under Covered Autos Liability Coverage, more coverage without additional premium we agree in writing that the Liability ed"Co haera e,n charge, your policy will automatically provide theadditional obligation to pay or until the amount of that coverage as of the day the obligation has finally been determined by revision ist effective in your state. judgment after trial. No one has the right 4. No Benefit To Bailee—Physical Damage under this Policy to bring us into an action Coverages to determine the"insured's" liability. We will not recognize any assignment or grant 4. Loss Payment—Physical Damage any coverage for the benefit of any person or Coverages organization holding, storing or transporting At our option, we may: property for a fee regardless of any other provision of this Coverage Form. a. Pay for, repair or replace damaged or 5. Other Insurance stolen property; a. For any covered "auto" you own, this b. Return the stolen property, at our expense. Coverage Form provides primary insurance.s We will pay for any damage that results to For any covered "auto" you don't own, the the"auto"from the theft; or insurance provided by this Coverage Form c. Take all or any part of the damaged or is excess over any other collectible stolen property at an agreed or appraised insurance. However, while a covered "auto" value. which is a "trailer" is connected to another If we pay for the "loss", our payment will vehicle, the Covered Autos Liability include the applicable sales tax for the Coverage this Coverage Form provides for damaged or stolen property. the "trailer" is: (1) Excess while it is connected to a motor vehicle you do not own; or 029 CA 00 01 11 20 ©Insurance Services Office, Inc., 2019 Page 9 of 13 (2) Primary while it is connected to a (5) Anywhere else in the world if a covered covered "auto"you own. "auto" of the private passenger type is b. For Hired Auto Physical Damage Coverage, leased, hired, rented or borrowed any covered "auto" you lease, hire, rent or without a driver for a period of 30 days borrow is deemed to be a covered "auto" or less, you own. However, any "auto" that is provided that the "insured's" responsibility to leased, hired, rented or borrowed with a pay damages is determined in a "suit" on the driver is not a covered"auto". merits, in the United States of America, the c. Regardless of the provisions of Paragraph territories and possessions of the United States a. above, this Coverage Form's Covered of America, Puerto Rico or Canada, or in a Autos Liability Coverage is primary for any settlement we agree to. liability assumed under an "insured We also cover "loss" to, or "accidents" contract". involving, a covered "auto" while being d. When this Coverage Form and any other transported between any of these places. Coverage Form or policy covers on the 8. Two Or More Coverage Forms Or Policies same basis, either excess or primary, we Issued By Us will pay only our share. Our share is the If this Coverage Form and any other Coverage proportion that the Limit of Insurance of our Form or policy issued to you by us or any Coverage Form bears to the total of the company affiliated with us applies to the same limits of all the Coverage Forms and "accident", the aggregate maximum Limit of policies covering on the same basis. Insurance under all the Coverage Forms or 6. Premium Audit policies shall not exceed the highest applicable a. The estimated premium for this Coverage Limit of Insurance under any one Coverage Form is based on the exposures you told us Form or policy. This condition does not apply to you would have when this Policy began. any Coverage Form or policy issued by us or We will compute the final premium due an affiliated company specifically to apply as when we determine your actual exposures. excess insurance over this Coverage Form. The estimated total premium will be SECTION V—DEFINITIONS credited against the final premium due and A. "Accident" includes continuous or repeated the first Named Insured will be billed for the exposure to the same conditions resulting in balance, if any. The due date for the final "bodily injury" or"property damage". premium or retrospective premium is the date shown as the due date on the bill. If B. "Auto" means: the estimated total premium exceeds the 1. A land motor vehicle, "trailer" or semitrailer final premium due, the first Named Insured designed for travel on public roads; or will get a refund. 2. Any other land vehicle that is subject to a b. If this Policy is issued for more than one compulsory or financial responsibility law or year, the premium for this Coverage Form other motor vehicle insurance law where it is will be computed annually based on our licensed or principally garaged. rates or premiums in effect at the beginning However, "auto" does not include "mobile of each year of the Policy. equipment". 7. Policy Period, Coverage Territory C. "Bodily injury" means bodily injury, sickness or Under this Coverage Form, we cover disease sustained by a person, including death "accidents" and "losses"occurring: resulting from any of these. a. During the policy period shown in the D. "Covered pollution cost or expense" means any Declarations; and cost or expense arising out of: b. Within the coverage territory. 1. Any request, demand, order or statutory or The coverage territory is: regulatory requirement that any "insured" or (1) The United States of America; others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any (2) The territories and possessions of the way respond to, or assess the effects of, United States of America; "pollutants"; or (3) Puerto Rico; (4) Canada; and 030 Page 10 of 13 ©Insurance Services Office, Inc., 2019 CA 00 01 11 20 2. Any claim or "suit" by or on behalf of a Paragraphs b. and c. above do not apply to governmental authority for damages because "accidents" that occur away from premises of testing for, monitoring, cleaning up, owned by or rented to an "insured"with respect removing, containing, treating, detoxifying or to "pollutants" not in or upon a covered "auto" neutralizing, or in any way responding to, or if: assessing the effects of, "pollutants". (a) The "pollutants" or any property in "Covered pollution cost or expense" does not which the "pollutants" are contained include any cost or expense arising out of the are upset, overturned or damaged as actual, alleged or threatened discharge, dispersal, a result of the maintenance or use of seepage, migration, release or escape of a covered "auto"; and "pollutants": (b) The discharge, dispersal, seepage, a. That are, or that are contained in any migration, release or escape of the property that is: "pollutants" is caused directly by (1) Being transported or towed by, handled such upset, overturn or damage. or handled for movement into, onto or E. "Diminution in value" means the actual or from the covered "auto"; perceived loss in market value or resale value (2) Otherwise in the course of transit by or which results from a direct and accidental "loss". on behalf of the"insured"; or F. "Employee" includes a "leased worker". (3) Being stored, disposed of, treated or "Employee" does not include a "temporary processed in or upon the covered worker". "auto"; G. "Insured" means any person or organization b. Before the "pollutants" or any property in qualifying as an insured in the Who Is An Insured which the "pollutants" are contained are provision of the applicable coverage. Except with moved from the place where they are respect to the Limit of Insurance, the coverage accepted by the "insured" for movement afforded applies separately to each insured who is into or onto the covered"auto"; or seeking coverage or against whom a claim or c. After the "pollutants" or any property in "suit" is brought. which the "pollutants" are contained are H. "Insured contract" means: moved from the covered "auto" to the place 1. A lease of premises; where they are finally delivered, disposed of 2. A sidetrack agreement; or abandoned by the"insured". Paragraph a. above does apply to 3. Any easement or license agreement, except in Paragraph apnts, fluids, exhaust notgaapp or fuels,other connection with construction or demolition lusimilar"pollutants" that are needed for or result operations on or within 50 feet of a railroad; from the normal electrical, hydraulic or 4. An obligation, as required by ordinance, to mechanical functioning of the covered "auto" or indemnify a municipality, except in connection its parts, if: with work for a municipality; (1) The "pollutants" escape, seep, migrate 5. That part of any other contract or agreement or are discharged, dispersed or released pertaining to your business (including an directly from an "auto" part designed by indemnification of a municipality in connection its manufacturer to hold, store, receive with work performed for a municipality) under or dispose of such "pollutants"; and which you assume the tort liability of another to The"bodily injury", pay for"bodily injury" or"property damage"to a (2) y ry", "property damage" or third party or organization. Tort liability means "covered pollution cost or expense" a liability that would be imposed by law in the does not arise out of the operation of absence of any contract or agreement; or any equipment listed in Paragraph 6.b. or 6.c. of the definition of "mobile equipment". 031 CA 00 01 11 20 ©Insurance Services Office, Inc., 2019 Page 11 of 13 6. That part of any contract or agreement entered 5. Vehicles not described in Paragraph 1., 2., 3. into, as part of your business, pertaining to the or 4. above that are not self-propelled and are rental or lease, by you or any of your maintained primarily to provide mobility to "employees", of any "auto". However, such permanently attached equipment of the contract or agreement shall not be considered following types: an "insured contract" to the extent that it obligates you or any of your "employees" to a. Air compressors, pumps and generators, pay for "property damage" to any "auto" rented cleaning,g spraying,i welding, building or leased by you or any of your"employees". and well-servicingeg, geophysical exploration, lighting and equipment; or An "insured contract" does not include that part of b. Cherry pickers and similar devices used to any contract or agreement: raise or lower workers; or a. That indemnifies a railroad for"bodily injury" 6. Vehicles not described in Paragraph 1., 2., 3. or "property damage" arising out of or 4. above maintained primarily for purposes construction or demolition operations, within other than the transportation of persons or 50 feet of any railroad property and cargo. However, self-propelled vehicles with affecting any railroad bridge or trestle, the following types of permanently attached tracks, roadbeds, tunnel, underpass or equipment are not "mobile equipment" but will crossing; be considered "autos": b. That pertains to the loan, lease or rental of a. Equipment designed primarily for: an "auto" to you or any of your "employees", if the "auto" is loaned, leased (1) Snow removal; or rented with a driver; or (2) Road maintenance, but not construction c. That holds a person or organization or resurfacing; or engaged in the business of transporting (3) Street cleaning; property by"auto" for hire harmless for your b. Cherry pickers and similar devices mounted use of a covered "auto" over a route or on automobile or truck chassis and used to territory that person or organization is authorized to serve by public authority. raise or lower workers; and I. "Leased worker" means a person leased to you by c. Air compressors, pumps and generators, a labor leasing firm under an agreement between cleaning,eg spraying,i welding, building you and the labor leasing firm to perform duties rl icing equipal exploration, lighting related to the conduct of your business. "Leased or well-servicing equipment. worker" does not include a "temporary worker". However, "mobile equipment" does not include J. "Loss" means direct and accidental loss or land vehicles that are subject to a compulsory or damage. financial responsibility law or other motor vehicle insurance law where it is licensed or principally K. "Mobile equipment" means any of the following garaged. Land vehicles subject to a compulsory or types of land vehicles, including any attached financial responsibility law or other motor vehicle machinery or equipment: insurance law are considered "autos". 1. Bulldozers, farm machinery, forklifts and other L. "Pollutants" means any solid, liquid, gaseous or vehicles designed for use principally off public thermal irritant or contaminant, including smoke, roads; vapor, soot, fumes, acids, alkalis, chemicals and 2. Vehicles maintained for use solely on or next to waste. Waste includes materials to be recycled, premises you own or rent; reconditioned or reclaimed. 3. Vehicles that travel on crawler treads; M. "Property damage" means damage to or loss of 4. Vehicles, whether self-propelled or not, use of tangible property. maintained primarily to provide mobility to N. "Suit" means a civil proceeding in which: permanently mounted: 1. Damages because of "bodily injury" or a. Power cranes, shovels, loaders, diggers or "property damage"; or drills; or 2. A"covered pollution cost or expense" b. Road construction or resurfacing equipment to which this insurance applies, are alleged. such as graders, scrapers or rollers; 032 Page 12 of 13 ©Insurance Services Office, Inc., 2019 CA 00 01 11 20 "Suit" includes: O. "Temporary worker" means a person who is a. An arbitration proceeding in which such furnished to you to substitute for a permanent damages or "covered pollution costs or "employee" on leave or to meet seasonal or short- expenses" are claimed and to which the term workload conditions. "insured" must submit or does submit with P. "Trailer" includes semitrailer. our consent; or Q. "Unmanned aircraft" means an aircraft that is not: b. Any other alternative dispute resolution 1. Designed; proceeding in which such damages or "covered pollution costs or expenses" are 2. Manufactured; or claimed and to which the insured submits 3. Modified after manufacture; with our consent. to be controlled directly by a person from within or on the aircraft. 033 CA 00 01 11 20 ©Insurance Services Office, Inc., 2019 Page 13 of 13 TRADE OR ECONOMIC SANCTIONS ENDORSEMENT Named Insured HABITAT FOR HUMANITY OF Endorsement Number EAST JEFFERSON COUNTY Policy Symbol Policy Number Policy Period Effective Date of Endorsement CAL H08787384 04/01/2025 TO 04/01/2026 04/01/2025 Issued By(Name of Insurance Company) ACE Property and Casualty Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This insurance does not apply to the extent that trade or economic sanctions or other laws or regulations prohibit us from providing insurance, including, but not limited to, the payment of claims. All other terms and conditions of policy remain unchanged. Authorized Agent ALL-21101 (11/06)Ptd. in U.S.A. Page 1 of 1 034 POLICY NUMBER: CAL H08787384 IL 01 98 09 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (Broad Form) This endorsement modifies insurance provided under the following: COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL LIABILITY UMBRELLA COVERAGE PART FARM COVERAGE PART FARM UMBRELLA LIABILITY POLICY LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY 1. The insurance does not apply: B. Under any Medical Payments Coverage, to A. Under any Liability Coverage, to "bodily injury" expenses incurred with respect to "bodily in- or"property damage": jury' resulting from the "hazardous properties" of "nuclear material" and arising out of the op- (1) With respect to which an "insured" under eration of a "nuclear facility" the policy is also an insured under a nu- organization. Y by any person or clear energy liability policy issued by Nu- clear Energy Liability Insurance Associa- C. Under any Liability Coverage, to "bodily injury" tion, Mutual Atomic Energy Liability Under- or "property damage" resulting from "hazard- writers, Nuclear Insurance Association of ous properties" of"nuclear material", if: Canada or any of their successors, or (1) The "nuclear material" (a) is at any "nuclear would be an insured under any such policy facility" owned by, or operated by or on be- but for its termination upon exhaustion of its half of, an "insured" or (b) has been dis- limit of liability; or charged or dispersed therefrom; (2) Resulting from the "hazardous properties" (2) The "nuclear material" is contained in of "nuclear material" and with respect to "spent fuel" or "waste" at any time pos- which (a) any person or organization is re- sessed, handled, used, processed, stored, quired to maintain financial protection pur- transported or disposed of, by or on behalf suant to the Atomic Energy Act of 1954, or of an "insured"; or any law amendatory thereof, or (b) the "in- (3) The "bodily injury" or "property damage" sured" is, or had this policy not been issued arises out of the furnishing by an "insured" would be, entitled to indemnity from the of services, materials, parts or equipment in United States of America, or any agency connection with the planning, construction, thereof, under any agreement entered into maintenance, operation or use of any "nu- by the United States of America, or any clear facility", but if such facility is located agency thereof, with any person or organi- within the United States of America, its terri- zation. tories or possessions or Canada, this Ex- clusion (3) applies only to "property dam- age" to such "nuclear facility" and any prop- erty thereat. 035 IL 01 98 09 08 ©ISO Properties, Inc., 2007 Page 1 of 2 0 2. As used in this endorsement: (c) Any equipment or device used for the process- "Hazardous properties" includes radioactive, toxic ing, fabricating or alloying of "special nuclear or explosive properties; material" if at any time the total amount of such material in the custody of the "insured" at the "Nuclear material" means "source material", "Spe- premises where such equipment or device is cial nuclear material"or"by-product material"; located consists of or contains more than 25 "Source material", "special nuclear material", and grams of plutonium or uranium 233 or any "by-product material" have the meanings given combination thereof, or more than 250 grams them in the Atomic Energy Act of 1954 or in any of uranium 235; law amendatory thereof; (d) Any structure, basin, excavation, premises or "Spent fuel" means any fuel element or fuel corn- place prepared or used for the storage or dis- ponent, solid or liquid, which has been used or ex- posal of"waste" posed to radiation in a"nuclear reactor"; and includes the site on which any of the foregoing is "Waste" means any waste material (a) containing "by- located, all operations conducted on such site and all product material" other than the tailings or wastes premises used for such operations; produced by the extraction or concentration of ura- "Nuclear reactor" means any apparatus designed or nium or thorium from any ore processed primarily for used to sustain nuclear fission in a self-supporting its "source material" content, and (b) resulting from chain reaction or to contain a critical mass of fission- the operation by any person or organization of any able material; "nuclear facility" included under the first two para- graphs of the definition of"nuclear facility". "Property damage" includes all forms of radioactive contamination of property. "Nuclear facility" means: (a) Any"nuclear reactor"; (b) Any equipment or device designed or used for (1) separating the isotopes of uranium or plu- tonium, (2) processing or utilizing "spent fuel", or (3) handling, processing or packaging "waste"; 036 Page 2 of 2 ©ISO Properties, Inc., 2007 IL 01 98 09 08 0 POLICY NUMBER: CAL H08787384 COMMERCIAL AUTO CA01351013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WASHINGTON CHANGES For a covered "auto" licensed or principally garaged in, or for "auto dealer operations" conducted in, Washington, 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. A. Changes In Covered Autos Liability Coverage B. Changes In Physical Damage Coverage The Employee Indemnification And Employer's 1. The lead-in to Paragraph B.1. in the Business Liability Exclusion applies only to "bodily injury" to Auto and Motor Carrier Coverage Forms and any "employee" of the "insured" whose employment Paragraph F.3.a. in the Auto Dealers Coverage is not subject to the Industrial Insurance Act of Form is replaced by the following: Washington (Washington Revised Code Title 51). We will not pay for "loss" caused directly or With respect to "bodily injury" to "employees" of the indirectly by any of the following: "insured" whose employment is subject to the 2. The Limit Of Insurance provision with respect to Industrial Insurance Act of Washington, the repair or replacement resulting in better than like Employee Indemnification And Employer's kind or quality is replaced by the following and Liability Exclusion is replaced by the following: supersedes any provision to the contrary: Employee Indemnification And Employer's We may deduct for betterment for parts normally Liability subject to repair and replacement during the This insurance does not apply to"bodily injury"to: useful life of the "auto". In this event, deductions a. An "employee" of the "insured" arising out of shall be limited to the lesser of: and in the course of: a. An amount equal to the proportion that the (1) Employment by the"insured"; or expired life of the part to be repaired or (2) replaced bears to the normal useful life of that Performing duties related to the conduct of part; or the"insured's" business; or b. The amount by which the resale value of the b. Any obligation to share damages with or repay "auto" is increased from the repair or someone else who must pay damages replacement. because of the injury. 3. The following is added to the Limit Of Insurance This exclusion does not apply to "bodily injury" to provision: domestic "employees" not entitled to workers' compensation benefits or to liability assumed by the We will not pay for a "loss" which is paid under "insured" under an "insured contract". A domestic Underinsured Motorists Coverage. "employee" is a person engaged in household or domestic work performed principally in connection with a residence premises. CA 01 35 10 13 ©Insurance Services Office, Inc., 2012 Page 1 of 3 037 C. Changes In Garagekeepers Coverage This exclusion does not apply to liability If Garagekeepers Coverage in the Auto Dealers assumed by the "insured" under an "insured Coverage Form is selected or if the Garagekeepers contract'. Coverage endorsement or the Garagekeepers 3. Paragraphs 5.a.(1), (2) and (3) of the Who Is An Coverage— Customers' Sound Receiving Equipment Insured provision apply only to "employees" of endorsement is attached, then the exclusion which the "insured" whose employment is not subject to refers to declared or undeclared war or insurrection is the Industrial Insurance Act of Washington replaced by the following: (Washington Revised Code Title 51). We will not pay for "loss" arising directly or indirectly 4. With respect to "employees" of the "insured" out of the following: whose employment is subject to the Industrial a. War, including undeclared or civil war; Insurance Act of Washington, Paragraph 5.a. of the Who Is An Insured provision is replaced by b. Warlike action by a military force, including the following: action in hindering or defending against an actual or expected attack, by any government, a. "Bodily injury" or "personal and advertising sovereign or other authority using military injury': personnel or other agents; or (1) To you (if you are an individual), your c. Insurrection, rebellion, revolution, usurped partners (if you are a partnership), your power, or action taken by governmental members (if you are a limited liability authority in hindering or defending against any company) or a fellow "employee" of the of these. "insured" while in the course of his or her employment or while performing duties D. Changes In General Liability Coverages related to the conduct of your "auto dealer With respect to the Auto Dealers Coverage Form: operations"; 1. Exclusion 2.d. Employee Indemnification And (2) For which there is any obligation to share Employer's Liability under Paragraph A. Bodily damages with or repay someone else who Injury And Property Damage Liability applies must pay damages because of the injury only to "bodily injury" to any "employee" of the described in Paragraph (1) above; or "insured" whose employment is not subject to the (3) Arising out of his or her providing or failing Industrial Insurance Act of Washington to provide professional health care (Washington Revised Code Title 51). services. 2. With respect to "bodily injury" to "employees" of E. Changes In Conditions the "insured" whose employment is subject to the Industrial Insurance Act of Washington, Exclusion 1. The Appraisal For Physical Damage Loss 2.d. Employee Indemnification And Condition is replaced by the following: Employer's Liability under Paragraph A. Bodily Appraisal For Physical Damage Loss Injury And Property Damage Liability is If you and we disagree on the amount of "loss", replaced with the following: either may demand an appraisal of the "loss". In d. Employee Indemnification And Employer's this event, each party will select a competent Liability Exclusion appraiser. The two appraisers will select a This insurance does not apply to "bodily competent and impartial umpire. The appraisers injury"to: will state separately the actual cash value and amount of "loss". If they fail to agree, they will (1) An "employee" of the "insured" arising out submit their differences to the umpire. A decision of and in the course of: agreed to by any two will be binding. Each party (a) Employment by the "insured"; or will: (b) Performing duties related to the a. Pay its chosen appraiser; and conduct of the"insured's" business; or b. Bear the other expenses of the appraisal and (2) Any obligation to share damages with or umpire equally. repay someone else who must pay Neither we nor you shall be held to have waived damages because of the injury. any rights by any act relating to appraisal. Page 2 of 3 ©Insurance Services Office, Inc., 2012 CA 01 35 10 13 038 2. The Transfer Of Rights Of Recovery Against 3. The following is added to the Legal Action Others To Us Condition is replaced by the Against Us Condition: following: If this action is brought pursuant to Sec. 3 of RCW Transfer Of Rights Of Recovery Against 48.30, then 20 days prior to filing such an action, Others To Us you are required to provide written notice of the a. If any person or organization to or for whom basis for the cause of action to us and the Office we make payment under this Coverage Form of the Insurance Commissioner. Such notice may has rights to recover damages from another, be sent by regular mail, registered mail, or those rights are transferred to us for that certified mail with return receipt requested. payment. That person or organization must do everything necessary to secure our rights and must do nothing after "accident" or "loss" to impair them. b. We are entitled to a recovery only after the person or organization has been fully compensated for damages by another party. CA 01 35 10 13 ©Insurance Services Office, Inc., 2012 Page 3 of 3 039 POLICY NUMBER: CAL H08787384 IL 01 46 08 10 WASHINGTON COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. The conditions in this endorsement replace any 3. We may cancel the Commercial Property similar conditions in the policy that are less favorable Coverage Part and the Capital Assets Program to the insured. (Output Policy) Coverage Part, if made a part A. Cancellation of this policy, by mailing or delivering to the first Named Insured and the first Named Insured's 1. The first Named Insured shown in the agent or broker written notice of cancellation at Declarations may cancel this policy by notifying least five days before the effective date of us or the insurance producer in one of the cancellation for any structure where two or following ways: more of the following conditions exist: a. Written notice by mail, fax or e-mail; a. Without reasonable explanation, the b. Surrender of the policy or binder; or structure is unoccupied for more than 60 c. Verbal notice. consecutive days, or at least 65% of the rental units are unoccupied for more than Upon receipt of such notice, we will cancel this 120 consecutive days, unless the structure policy or any binder issued as evidence of is maintained for seasonal occupancy or is coverage, effective on the later of the following: under construction or repair; a. The date on which notice is received or the b. Without reasonable explanation, progress policy or binder is surrendered; or toward completion of permanent repairs to b. The date of cancellation requested by the the structure has not occurred within 60 first Named Insured. days after receipt of funds following 2. We may cancel this policy by mailing or satisfactory adjustment or adjudication of delivering to the first Named Insured and the loss resulting from a fire; first Named Insured's agent or broker written c. Because of its physical condition, the notice of cancellation, including the actual structure is in danger of collapse; reason for the cancellation, to the last mailing d. Because of its physical condition, a address known to us, at least: vacation or demolition order has been a. 10 days before the effective date of issued for the structure, or it has been cancellation if we cancel for nonpayment of declared unsafe in accordance with premium; or applicable law; b. 45 days before the effective date of e. Fixed and salvageable items have been cancellation if we cancel for any other removed from the structure, indicating an reason; intent to vacate the structure; except as provided in Paragraphs 3. and 4. f. Without reasonable explanation, heat, below. water, sewer and electricity are not furnished for the structure for 60 consecutive days; or g. The structure is not maintained in substantial compliance with fire, safety and building codes. 040 IL 01 46 08 10 ©Insurance Services Office, Inc., 2010 Page 1 of 4 0 4. If: 7. If this policy is cancelled, we will send the first a. You are an individual; Named Insured any premium refund due. If we cancel, the refund will be pro rata. If the first b. A covered auto you own is of the "private Named Insured cancels, the refund will be at passenger type"; and least 90% of the pro rata refund unless the c. The policy does not cover garage, following applies: automobile sales agency, repair shop, a. For Division Two — Equipment Breakdown, service station or public parking place if the first Named Insured cancels, the operations hazards; refund will be at least 75% of the pro rata we may cancel the Commercial Automobile refund. Coverage Part by mailing or delivering to the b. If: first Named Insured and the first Named Insured's agent or broker written notice of (1) You are an individual; cancellation, including the actual reason for (2) A covered auto you own is of the cancellation, to the last mailing address known "private passenger type" to us: (3) The policy does not cover garage, a. At least 10 days before the effective date of automobile sales agency, repair shop, cancellation if we cancel for nonpayment of service station or public parking place premium; or operations hazards; and b. At least 10 days before the effective date of (4) The first Named Insured cancels; cancellation for any other reason if the the refund will be not less than 90% of any policy is in effect less than 30 days; or unearned portion not exceeding $100, plus c. At least 20 days before the effective date of 95% of any unearned portion over$100 but cancellation for other than nonpayment if not exceeding $500, and not less than 97% the policy is in effect 30 days or more; or of any unearned portion in excess of$500. d. At least 20 days before the effective date of The cancellation will be effective even if we cancellation if the policy is in effect for 60 have not made or offered a refund. days or more or is a renewal or continuation 8. If notice is mailed, proof of mailing will be policy, and the reason for cancellation is sufficient proof of notice. that your driver's license or that of any driver who customarily uses a covered B. Changes "auto" has been suspended or revoked The policy contains all the agreements between during policy period. you and us concerning the insurance afforded. 5. We will also mail or deliver to any mortgage The first Named Insured shown in the Declarations holder, pledgee or other person shown in this is authorized to make changes in the terms of this policy to have an interest in any loss which policy with our consent. This policy's terms can be may occur under this policy, at their last amended or waived only by endorsement issued mailing address known to us, written notice of by us and made a part of this policy. cancellation, prior to the effective date of C. Examination Of Your Books And Records cancellation. If cancellation is for reasons other We may examine and audit your books and than those contained in Paragraph A.3. above, records as they relate to this policy at any time this notice will be the same as that mailed or during the policy period and up to three years delivered to the first Named Insured. If afterward. cancellation is for a reason contained in Paragraph A.3. above, we will mail or deliver D. Inspection And Surveys this notice at least 20 days prior to the effective 1. We have the right to: date of cancellation. a. Make inspections and surveys at any time; 6. Notice of cancellation will state the effective date of cancellation. The policy period will end b. Give you reports on the conditions we find; on that date. and c. Recommend changes. 041 Page 2 of 4 ©Insurance Services Office, Inc., 2010 IL 01 46 08 10 0 2. We are not obligated to make any inspections, G. Nonrenewal surveys, reports or recommendations, and any such actions we do undertake relate only to 1. Wea may elect not to renew this by mailing or delivering written notice of insurability and the premiums to be charged. nonrenewal, stating the reasons for We do not make safety inspections. We do not nonrenewal, to the first Named Insured and the undertake to perform the duty of any person or first Named Insured's agent or broker, at their organization to provide for the health or safety last mailing addresses known to us. We will of workers or the public. And we do not warrant also mail to any mortgage holder, pledgee or that conditions: other person shown in this policy to have an a. Are safe or healthful; or interest in any loss which may occur under this b. Comply with laws, regulations, codes or policy, at their last mailing address known to standards. us, written notice of nonrenewal. We will mail or deliver these notices at least 45 days before 3. Paragraphs 1. and 2. of this condition apply not the: only to us, but also to any rating, advisory, rate service or similar organization which makes a. Expiration of the policy; or insurance inspections, surveys, reports or b. Anniversary date of this policy if this policy recommendations. has been written for a term of more than 4. Paragraph 2. of this condition does not apply to one year. any inspections, surveys, reports or Otherwise, we will renew this policy unless: recommendations we may make relative to a. The first Named Insured fails to pay the certification, under state or municipal statutes, renewal premium after we have expressed ordinances or regulations, of boilers, pressure our willingness to renew, including a vessels or elevators. statement of the renewal premium, to the E. Premiums first Named Insured and the first Named The first Named Insured shown in the Insured's insurance agent or broker, at least Declarations: 20 days before the expiration date; 1. Is responsible for the payment of all premiums; b. Other coverage acceptable to the insured and has been procured prior to the expiration 2. Will be the payee for any return premiums we date of the policy; or pay. c. The policy clearly states that it is not renewable and is for a specific line, F. Transfer Of Your Rights And Duties Under This subclassification, or type of coverage that is Policy not offered on a renewable basis. Your rights and duties under this policy may not be 2. If: transferred without our written consent except in the case of death of an individual Named Insured. a. You are an individual; If you die, your rights and duties will be transferred b. A covered auto you own is of the "private to your legal representative but only while acting passenger type"; and within the scope of duties as your legal c. The policy does not cover garage, representative. Until your legal representative is automobile sales agency, repair shop, appointed, anyone having proper temporary service station or public parking place custody of your property will have your rights and operations hazards; duties but only with respect to that property. 042 IL 01 46 08 10 ©Insurance Services Office, Inc., 2010 Page 3 of 4 0 the following applies to nonrenewal of the b. We will not refuse to renew Liability Commercial Automobile Coverage Part in Coverage or Collision Coverage solely place of G.1.: because an "insured" has submitted claims a. We may elect not to renew or continue this under Comprehensive Coverage or Towing policy by mailing or delivering to you and And Labor Coverage. your agent or broker written notice at least c. If we fail to mail or deliver proper notice of 20 days before the end of the policy period, nonrenewal and you obtain other insurance, including the actual reason for nonrenewal. this policy will end on the effective date of If the policy period is more than one year, that insurance. we will have the right not to renew or continue it only at an anniversary of its original effective date. If we offer to renew or continue and you do not accept, this policy will terminate at the end of the current policy period. Failure to pay the required renewal or continuation premium when due shall mean that you have not accepted our offer. 043 Page 4 of 4 ©Insurance Services Office, Inc., 2010 IL 01 46 08 10 0 POLICY NUMBER: CAL H08787384 COMMERCIAL AUTO CA21341013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WASHINGTON UNDERINSURED MOTORISTS COVERAGE For a covered "auto" licensed or principally garaged in, or for "auto dealer operations" conducted in, Washington, 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. Named Insured: HABITAT FOR HUMANITY OF EAST JEFFERSON COUNTY Endorsement Effective Date: 04/01/2025 SCHEDULE "Bodily Injury" And "Property Damage": $1,000,000 Each "Accident" Or "Bodily Injury": Each "Accident" This endorsement provides"bodily injury" and "property damage" Underinsured Motorists Coverage unless an"X" is entered below: If an"X" is entered in this box, this endorsement provides"bodily injury" Underinsured Motorists Coverage only for the following "autos": Description Of"Autos": Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Coverage B. Who Is An Insured 1. We will pay all sums the "insured" is legally If the Named Insured is designated in the entitled to recover as compensatory damages Declarations as: from the owner or driver of an "underinsured 1. An individual, then the following are"insureds": motor vehicle". The damages must result from "bodily injury" or "property damage" sustained by a. The Named Insured and any "family the "insured" caused by an "accident". The members". owner's or driver's liability for these damages b. Anyone else"occupying" a covered "auto"or a must result from the ownership, maintenance or temporary substitute for a covered "auto". The use of the "underinsured motor vehicle". covered "auto" must be out of service because of its breakdown, repair, servicing, "loss" or destruction. CA 21 34 10 13 ©Insurance Services Office, Inc., 2012 Page 1 of 5 044 c. Anyone for damages he or she is entitled to 5. The first$300 of the amount of"property damage" recover because of "bodily injury" sustained to the property of each "insured" as the result of by another"insured". any one "accident" caused by a hit-and-run 2. A partnership, limited liability company, vehicle as described in Paragraph 5.d. of the corporation or any other form of organization, definition of "underinsured motor vehicle". In all then the following are"insureds": other cases, this insurance does not apply to the first $100 of the amount of "property damage" to a. Anyone "occupying" a covered "auto" or a the property of each "insured" as the result of any temporary substitute for a covered "auto". The one"accident". covered "auto" must be out of service because of its breakdown, repair, servicing, "loss" or 6. Anyone using a vehicle without a reasonable destruction. belief that the person is entitled to do so. b. Anyone for damages he or she is entitled to 7. "Bodily injury" or "property damage" to an recover because of"bodily injury" sustained by "insured" while operating or "occupying" a another"insured". motorcycle or motor driven cycle which is not a covered "auto" for Covered Autos Liability c. The Named Insured for "property damage" Coverage under this Coverage Form. only. 8. Punitive or exemplary damages. C. Exclusions 9. "Bodily injury" or "property damage" arising This insurance does not apply to: directly or indirectly out of: 1. The benefit of any insurer or self-insurer under a. War, including undeclared or civil war; any workers' compensation law or any similar disability benefits law. b. Warlike action by a military force, including action in hindering or defending against an 2. The benefit of any insurer of property. actual or expected attack, by any government, 3. "Bodily injury" sustained by: sovereign or other authority using military a. An individual Named Insured while personnel or other agents; or "occupying" any vehicle owned by that Named c. Insurrection, rebellion, revolution, usurped Insured or made available for that Named power, or action taken by governmental Insured's regular use that is not a covered authority in hindering or defending against any "auto" for Covered Autos Liability Coverage of these. under this Coverage Form; D. Limit Of Insurance b. Any "family member" while "occupying" any 1. Regardless of the number of covered "autos", vehicle owned by that "family member" or "insureds", premiums paid, claims made or available for that "family member's" regular vehicles involved in the "accident", the most we use that is not a covered "auto" for Covered will pay for all damages resulting from any one Autos Liability Coverage under this Coverage "accident" is the limit shown in the Schedule or in Form; or the Declarations. c. Any "family member" while "occupying" any 2. No one will be entitled to receive duplicate vehicle owned by the Named Insured or made payments for the same elements of "loss" under available for the Named Insured's regular use this Coverage Form and any Liability Coverage that is insured for Liability Coverage on a form, Medical Payments Coverage endorsement primary basis under any other Coverage Form or Personal Injury Protection Coverage or policy. endorsement attached to this Coverage Part. 4. Property contained in or struck by any vehicle We will not make a duplicate payment under this owned by or available for the regular use of the coverage for any element of "loss" for which Named Insured or any "family member", if the payment has been made by or for anyone who is Named Insured is an individual, which is not a legally responsible. covered "auto" for Covered Autos Liability Coverage under this Coverage Form. Page 2 of 5 ©Insurance Services Office, Inc., 2012 CA 21 34 10 13 045 E. Changes In Conditions 2. Duties In The Event Of Accident, Claim, Suit The Conditions are changed for Washington Or Loss in the Business Auto and Motor Carrier Underinsured Motorists Coverage as follows: Coverage Forms and Duties In The Event Of Accident, Claim, Offense, Suit, Loss Or Acts, 1. Other Insurance in the Auto Dealers and Errors Or Omissions in the Auto Dealers Business Auto Coverage Forms and Other Coverage Form are changed by adding the Insurance — Primary And Excess Insurance following: Provisions in the Motor Carrier Coverage Form are replaced by the following: a. A person seeking Underinsured Motorists Coverage must also promptly notify us in If there is other applicable insurance available writing of a tentative settlement between the under one or more policies or provisions of "insured" and the insurer of an "underinsured coverage: motor vehicle" and allow us 30 days to a. The maximum recovery under all Coverage advance payment to that "insured" in an Forms or policies combined may equal but not amount equal to the tentative settlement to exceed the highest applicable limit for any one preserve our rights against the insurer, owner vehicle under any Coverage Form or policy or operator of such "underinsured motor providing coverage on either a primary or vehicle". However, this provision does not excess basis. apply if failure to notify us does not prejudice b. Any insurance we provide with respect to a our right to recover payment from the person vehicle the Named Insured does not own shall legally responsible for the"accident". be excess over any other collectible 3. Legal Action Against Us is replaced by the underinsured motorists insurance providing following: coverage on a primary basis. Legal Action Against Us c. If the coverage under this Coverage Form is a. No one may bring a legal action against us provided: under this Coverage Form until there has been (1) On a primary basis, we will pay only our full compliance with all the terms of this share of the loss that must be paid under Coverage Form. insurance providing coverage on a primary b. Any legal action against us under this basis. Our share is the proportion that our Coverage Form must be brought within one limit of liability bears to the total of all year after the date on which the cause of applicable limits of liability for coverage on action accrues. a primary basis. If this action is brought pursuant to Sec. 3 of RCW (2) On an excess basis, we will pay only our 48.30, then 20 days prior to filing such an action, share of the loss that must be paid under you are required to provide written notice of the insurance providing coverage on an basis for the cause of action to us and the Office excess basis. Our share is the proportion of the Insurance Commissioner. Such notice may that our limit of liability bears to the total of be sent by regular mail, registered mail or certified all applicable limits of liability for coverage mail with return receipt requested. on an excess basis. CA 21 3410 13 ©Insurance Services Office, Inc., 2012 Page 3 of 5 046 4. Transfer Of Rights Of Recovery Against b. Unless both parties agree otherwise, Others To Us is changed by adding the following: arbitration will take place in the county in If we make any payment and the "insured" which the "insured" lives. Local rules of law as recovers from another party, the "insured" shall to arbitration procedure and evidence will hold the proceeds in trust for us and pay us back apply. A decision agreed to by two of the the amount we have paid. We shall be entitled to arbitrators will be binding. recovery only after the "insured" has been fully F. Additional Definitions compensated for damages. As used in this endorsement: Our rights do not apply under this provision with 1. "Property damage" means injury to or destruction respect to damages caused by an "accident" with of the property of an"insured". an "underinsured motor vehicle" if we: 2. "Family member" means a person related to an a. Have been given prompt notice of a tentative individual Named Insured by blood, marriage or settlement between an "insured" and the adoption, who is a resident of such Named insurer of an "underinsured motor vehicle"; Insured's household, including a ward or foster and child. b. Fail to advance payment to the "insured" in an 3. "Occupying" means in, upon, getting in, on, out or amount equal to the tentative settlement within off. 30 days after receipt of notification. If we advance payment to the "insured" in an 4. "Suit" means a civil proceeding in which: amount equal to the tentative settlement within 30 a. Damages because of "bodily injury" or days after receipt of notification: "property damage"; or (1) That payment will be separate from any b. A"covered pollution cost or expense" to which amount the "insured" is entitled to recover this insurance applies, are alleged. under the provisions of Underinsured "Suit" includes: Motorists Coverage; and (1) An arbitration proceeding in which such (2) We also have a right to recover the damages or "covered pollution costs or advanced payment. expenses"are claimed; or 5. The following condition is added: (2) Any other alternative dispute resolution Arbitration proceeding in which such damages or a. If we and an "insured" disagree whether the "covered pollution costs or expenses" are claimed. "insured" is legally entitled to recover damages from the owner or driver of an 5. "Underinsured motor vehicle" means a land motor "underinsured motor vehicle" or do not agree vehicle or"trailer": as to the amount of damages that are a. For which no liability bond or policy applies at recoverable by that "insured", then the matter the time of an "accident"; or may be arbitrated. However, disputes b. For which liability bonds or policies apply at concerning coverage under this endorsement the time of the "accident", but the amount paid may not be arbitrated. Both parties must agree under all of the bonds or policies to an to arbitration. If so agreed, each party will "insured" is not enough to pay the full amount select an arbitrator. The two arbitrators will an "insured" is legally entitled to recover as select a third. If they cannot agree within 30 days, either may request that selection be damages caused by the"accident"; or made by a judge of a court having jurisdiction. c. For which all insuring or bonding companies We will pay all arbitration expenses. deny coverage or are or become insolvent; or Arbitration expenses will not include the d. That is a hit-and-run vehicle and neither the "insured's" attorney's fees or any expenses driver nor owner can be identified. The vehicle incurred in producing evidence or witnesses. must either: (1) Hit an "insured", a covered "auto" or a vehicle an "insured" is"occupying"; or Page 4 of 5 ©Insurance Services Office, Inc., 2012 CA 21 34 10 13 047 (2) Cause "bodily injury" or "property damage" (2) Owned by a governmental unit or agency. with no physical contact with the "insured" This provision does not apply if the or the vehicle the "insured" was governmental unit or agency is unable to "occupying" at the time of the "accident', pay damages because of financial inability provided: or insolvency. (a) The facts of the "accident" can be 6. Whenever the terms "uninsured motorists corroborated by competent evidence coverage" or "uninsured motor vehicle" appear in other than the testimony of any person the Coverage Form or any endorsements having an underinsured motorists attached to the Coverage Form, they are replaced coverage claim as a result of such by the terms "underinsured motorists coverage" "accident" and and "underinsured motor vehicle" for covered (b) Someone reports the "accident" to the "autos" licensed in, or "auto dealer operations" police within 72 hours of the"accident". conducted in, Washington. However, "underinsured motor vehicle" does not include any vehicle: (1) For which the Covered Autos Liability Coverage of this Coverage Form applies. However, if the Named Insured is an individual and that Named Insured or any "family member" sustains damages while "occupying", or when struck by, an "auto" which is a covered "auto" for Covered Autos Liability Coverage under this Coverage Form, this exception to this definition of an "underinsured motor vehicle" does not apply to that Named Insured or any such "family member". CA 21 34 10 13 ©Insurance Services Office, Inc., 2012 Page 5 of 5 048 IL 01 23 11 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WASHINGTON CHANGES - DEFENSE COSTS This endorsement modifies insurance provided under the following: COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL LIABILITY UMBRELLA COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART—LEGAL LIABILITY COVERAGE FORM COMMERCIAL PROPERTY COVERAGE PART—MORTGAGEHOLDER'S ERRORS AND OMISSIONS COVERAGE FORM ELECTRONIC DATA LIABILITY COVERAGE PART FARM COVERAGE PART FARM UMBRELLA LIABILITY POLICY LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCT WITHDRAWAL COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK COVERAGE PART A. The provisions of Paragraph B. are added to all 5. Coverage C — Mortgageholder's Liability under Insuring Agreements that set forth a duty to the Mortgageholder's Errors And Omissions defend under: Coverage Form. 1. Section I of the Commercial General Liability, Paragraph B. also applies to any other provision in Commercial Liability Umbrella, Electronic Data the policy that sets forth a duty to defend. Liability, Farm, Liquor Liability, Owners And B. If we initially defend an insured ("insured") or pay Contractors Protective Liability, Pollution for an insured's ("insured's") defense but later Liability, Products/Completed Operations determine that none of the claims ("claims"), for Liability, Product Withdrawal, Medical which we provided a defense or defense costs, Professional Liability, Railroad Protective are covered under this insurance, we have the Liability and Underground Storage Tank right to reimbursement for the defense costs we Coverage Parts, Auto Dealers Coverage Form have incurred. and the Farm Umbrella Liability Policy; The right to reimbursement under this provision 2. Section II under the Auto Dealers, Business will only apply to the costs we have incurred after Auto and Motor Carrier Coverage Forms; we notify you in writing that there may not be 3. Section III under the Auto Dealers and Motor coverage and that we are reserving our rights to Carrier Coverage Forms; terminate the defense or the payment of defense 4. Section A. Coverage under the Legal Liability costs and to seek reimbursement for defense Coverage Form; and costs. 049 IL 01 23 11 13 ©Insurance Services Office, Inc., 2013 Page 1 of 1 POLICY NUMBER: CAL H08787384 COMMERCIAL AUTO CA20541120 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EMPLOYEE HIRED AUTOS 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. A. Changes In Covered Autos Liability Coverage For Hired Auto Physical Damage Coverage, any The following is added to the Who Is An Insured covered "auto" hired or rented by your "employee" provision: under a contract in an "employee's" name, with your permission, while performing duties related to An "employee" of yours is an "insured" while the conduct of your business is deemed to be a operating an "auto" hired or rented under a covered "auto"you own. contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your business. B. Changes In General Conditions Paragraph 5.b. of the Other Insurance Condition in the Business Auto and Auto Dealers Coverage Forms and Paragraph 5.f. of the Other Insurance — Primary And Excess Insurance Provisions Condition in the Motor Carrier Coverage Form are amended by the addition of the following: 050 CA 20 54 11 20 ©Insurance Services Office, Inc., 2019 Page 1 of 1 POLICY NUMBER: CAL H08787384 COMMERCIAL AUTO CA99031013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO MEDICAL PAYMENTS COVERAGE 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. A. Coverage 3. "Bodily injury" sustained by any "family member" We will pay reasonable expenses incurred for while "occupying" or struck by any vehicle (other necessary medical and funeral services to or for an than a covered "auto") owned by or furnished or "insured" who sustains "bodily injury" caused by available for the regular use of any "family "accident". We will pay only those expenses incurred, member". for services rendered within three years from the date 4. "Bodily injury"to your"employee" arising out of and of the"accident". in the course of employment by you. However, we B. Who Is An Insured will cover "bodily injury" to your domestic "employees" if not entitled to workers' 1. You while "occupying" or, while a pedestrian, when compensation benefits. For the purposes of this struck by any"auto". endorsement, a domestic "employee" is a person 2. If you are an individual, any "family member" while engaged in household or domestic work performed "occupying" or, while a pedestrian, when struck by principally in connection with a residence premises. any"auto". 5. "Bodily injury" to an "insured" while working in a 3. Anyone else "occupying" a covered "auto" or a business of selling, servicing, repairing or parking temporary substitute for a covered "auto". The "autos" unless that business is yours. covered "auto" must be out of service because of 6. "Bodily injury" arising directly or indirectly out of: its breakdown, repair, servicing, loss or destruction. C. Exclusions a. War, including undeclared or civil war; b. Warlike action by a military force, including This insurance does not apply to any of the following: action in hindering or defending against an 1. "Bodily injury" sustained by an "insured" while actual or expected attack, by any government, "occupying" a vehicle located for use as a sovereign or other authority using military premises. personnel or other agents; or 2. "Bodily injury" sustained by you or any "family c. Insurrection, rebellion, revolution, usurped member"while "occupying"or struck by any vehicle power, or action taken by governmental (other than a covered "auto") owned by you or authority in hindering or defending against any furnished or available for your regular use. of these. CA 99 03 10 13 ©Insurance Services Office, Inc., 2011 Page 1 of 2 051 7. "Bodily injury" to anyone using a vehicle without a E. Changes In Conditions reasonable belief that the person is entitled to do The Conditions are changed for Auto Medical so. Payments Coverage as follows: 8. "Bodily Injury' sustained by an "insured" while 1. The Transfer Of Rights Of Recovery Against "occupying" any covered "auto" while used in any Others To Us Condition does not apply. professional racing or demolition contest or stunting activity, or while practicing for such contest 2. The reference in Other Insurance in the Auto or activity. This insurance also does not apply to Dealers and Business Auto Coverage Forms and any "bodily injury" sustained by an "insured" while Other Insurance — Primary And Excess the "auto" is being prepared for such a contest or Insurance Provisions in the Motor Carrier activity. Coverage Form to "other collectible insurance" D. Limit Of Insurance applies only to other collectible auto medical payments insurance. Regardless of the number of covered "autos", F. Additional Definitions "insureds", premiums paid, claims made or vehicles involved in the "accident", the most we will pay for As used in this endorsement: "bodily injury" for each "insured" injured in any one 1. "Family member" means a person related to you by "accident" is the Limit Of Insurance for Auto Medical blood, marriage or adoption who is a resident of Payments Coverage shown in the Declarations. your household, including a ward or foster child. No one will be entitled to receive duplicate payments 2. "Occupying" means in, upon, getting in, on, out or for the same elements of "loss" under this coverage off. and any Liability Coverage Form, Uninsured Motorists Coverage Endorsement or Underinsured Motorists Coverage Endorsement attached to this Coverage Part. Page 2 of 2 ©Insurance Services Office, Inc., 2011 CA 99 03 10 13 052 JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS CONSENT AGENDA REQUEST TO: Jefferson County Board of Commissioners FROM: Carolyn Gallaway, Clerk of the Board DATE: January 21,2025 SUBJECT: AGREEMENT re: 2025 Affordable Housing/Homelessness Grant Funding; Habitat for Humanity—Critical Home Repairs STATEMENT OF ISSUE: On November 8, 2024 the Housing Fund Board met and reviewed the RFPs received. On November 18,2024,the Board of County Commissioners approved the Housing Fund Board's 2024 funding recommendations for Affordable Housing Fund 148, Homeless Housing Fund 149, 1590 and 5386 Funds. One of the recommendations was to fund; Habitat for Humanity—Critical Home Repairs; in the amount of$45,000 ANALYSIS: The attached Grant Agreement will provide $45,000 in funds approved by the Board of County Commissioners on November 18, 2024. FISCAL IMPACT: $45,000 from Fund 148. RECOMMENDATION: Approve the attached Grant Agreement. REVIEWED BY: ,&./6. /V1 OF--As- Mark McCauleyunty, Administrator Date CONTRACT REVIEW FORM Clear Form (INSTRUCTIONS ARE ON THE NEXT PAGE) CONTRACT WITH: Habitat for Humanity Contract No: HABITAT-CRITICAL Contract For: Critical Home Repairs term: 01/01/25 - 12/31/25 COUNTY DEPARTMENT: County Administrator Contact Person: Carolyn Gallaway Contact Phone: x122 Contact email: carolyn@co.ieferson.wa.us AMOUNT: $45,000 PROCESS: Exempt from Bid Process Revenue: Cooperative Purchase Expenditure: $45,000 Competitive Sealed Bid Matching Funds Required: Small Works Roster Sources(s)of Matching Funds Vendor List Bid Fund# 148 ✓ RFP or RFQ Munis Org/Obj Other: APPROVAL STEPS: STEP 1: DEPARTMENT CERTIFIES C LI C WIT J C .55.080 AND CHAPTER 42.23 RCW. CERTIFIED: ❑■ NIA:0 nature Date STEP 2: DEPARTMENT CERTIFIES THE PERSON PRO OSED FOR CONTRACTING WITH THE. COUNTY (CONTRACTOR) HAS NOT EEN BARRE ANY FEDERAL, STATE, OR LOCAL AGENCY. CERTIFIED: ❑i1 N/A: Ei /IL /J71 5 Signs a Date STEP 3: RISK MANAGEMENT REVIEW(will be added electronically through Laserfiche): Electronically approved by Risk Management on 1/17/2025. STEP 4: PROSECUTING ATTORNEY REVIEW(will be added electronically through Laserfiche): Electronically approved as to form by PAO on 1/17/2025. Thank you for making the changes! STEP 5: DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT AND PROSECUTING ATTORNEY(IF REQUIRED). STEP 6:CONTRACTOR SIGNS STEP 7: SUBMIT TO BOCC FOR APPROVAL 1